39 Chapters
Medium 9781855752900

2: Culture, self, and cross-ethnic therapy

Karnac Books ePub

Kwame Owusu-Bempah

Among ideas and practices that vary across cultural contexts are beliefs about health and responses to disease, and also perceptions of mental health and psychological well-being. This renders any attempt at a “universal” definition of health problematic, such as the World Health Organization’s: “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.“ This is an unrealistic state that any human adult or young person may be expected to maintain over time. Besides, spiritual well-being is missing from this definition despite its centrality and importance to conceptions of general well-being in most world cultures. Belief in mystical phenomena, in the influence of spirits or supernatural beings on a person’s health or even destiny, is the commonest explanation of psychological problems throughout the world (Richeport-Haley, 1998). Consequently, Richeport-Haley advises, clinicians practising in multi-ethnic settings must be mindful that beliefs in spirit possession will be involved in some of the presenting problems of ethnic-minority clients.

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Medium 9781855750180

2. The Systemic Handover

Barry Mason Karnac Books ePub

Although this new kind of handover requires different sorts of skills, in particular, interviewing skills, it is in many respects a very simple notion.

Basic Outline of the System

(1) Prior to the new staff coming on shift, the staff presently on duty get the files up to date and make a list, for the new staff, of any administrative/organisational issues. For example, one task for the new shift might be that a nurse should make sure that patient A takes the drugs given to her at 6 p.m. as there is evidence to suggest that she has not been swallowing them.

Another example might be that the young person’s social worker should be telephoned to inform him/her of some issues which emerged during an individual meeting with that young person.

(2) The staff coming on shift meet for 5-10 minutes, briefly to look at files and formulate any ideas to take up when they meet with the staff going off shift. Hypotheses are often formulated at this stage.

(3) The major structural change to the traditional handover is that in this new system the staff coming on take charge of the handover, not the staff going of £ One of the new shift formally interviews the staff going off, using ideas which have come up in the discussion in (2) and ideas, hunches, hypotheses which they already have as a result of being a part of an on-going process of handovers carried out in this way. Other new staff coming on become observers of this interview and will be able, from the different position of being slightly removed, to formulate suggestions that will further enrich the ideas that are brought forth in the interview.

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Medium 9781855752801

6. Some reflections on process, relationship, and personal development in supervision Comments

Campbell, David; Mason, Barry Karnac Books ePub

Jeff Faris

The term “supervision” is used to cover a broad range of activities, including quality assurance of practice, management of service delivery, and case supervision. The term “clinical supervision” is not that much more specific, as it may refer to case management where the supervisor has clinical responsibility. It could also refer to case consultation as part of a therapist’s ongoing professional development, or it could refer to live supervision of clinical practice as part of clinical training. These activities are not mutually exclusive, and there is a degree of overlap between them. It may be useful to distinguish between these activities, and in this chapter I refer mainly to “supervision” within the context of teaching systemic psychotherapy.

In this chapter, personal development as an aspect of supervision in a psychotherapy training context is the focus for some personal reflections. What follows includes a personal narrative or a version of my own experience of supervision. As much for the sheer narcissistic pleasure of indulging in my own reflections, I have also maintained a personal view in keeping with a typical exercise that may be required of a trainee therapist. Such an exercise would invite a trainee to recall past experience of supervision and reflect upon how this experience influences his or her current perspectives as a practitioner in supervision. If an exercise is considered useful for trainees’ experience, could not a similar exercise be of benefit to a supervisor? As I have a keen interest in getting to grips with process, which proves to be highly elusive, I thought it would be useful to write this chapter on process and supervision as a reflective narrative and find out what the experience would bring forth. I would also find out what I would be willing to record and what I would prefer to keep to myself. The relationship between the personal epistemology embodied in therapists’ practice and the discourses of espoused theory about therapy seems central to this process (Schon, 1983).

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Medium 9781855753655

3. “Alice and Alice not through the looking glass”: therapeutic transparency and the therapeutic and supervisory relationship

Karnac Books ePub

Maeve Malley and Alfred Hurst


This chapter addresses the issues raised by working in a particular context, a London-based voluntary sector counselling and therapy agency for lesbians and gay men, and in a particular way—”in-the-room” supervision with all discussion in front of the clients. The experience of working in this way, in this context, made us aware of the effect that it had on us as therapist and supervisor and of how it seemed to be received by the clients seen during the two-year period that we worked together in this way. Some of the issues that it raised, though initially context-specific, were in fact general issues about power, knowledge and disclosure within therapy and about the nature of the therapeutic and the supervisory relationship. We discuss these issues from the angle of vision of the therapist, the supervisor, and what we surmise and were told about the experience of clients.

In-the-room supervision

While “in-the-room” supervision is not a new phenomenon within systemic practice (Gorell Barnes & Campbell, 1982), it is not a common way of working and is distinct from behind the screen supervision and reflecting team practice. This experience was distinct from the latter in that reflecting teams generally focus on the experience of the family, rather than the experience of the therapist, or the therapist with the family, and do not conduct their entire team discussion in front of clients, or confine supervisory input to this context. When we first embarked on this particular way of working we were not sure how it would be for the therapist or the supervisor, or indeed the clients, to confine our discussions about the work to this context. So, initially, it may have been a kind of experiment to see if we could talk about the things that seemed important to talk about, such as the therapist’s approach, or the ways that the clients engaged with therapy and with the therapist, and the supervisory relationship—all in front of the clients.

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Medium 9781855752801

3. A reflective recording format for supervisors and trainees

Campbell, David; Mason, Barry Karnac Books ePub

Barry Mason

As systemic clinicians and supervisors we try to contribute to the creation of useful change. Our beliefs about change influence both our clinical and supervisory practice and the nature of clinical and supervisory relationships. One way that I see change is as follows:

For change to happen we need to become less certain of the positions we hold. When we become less certain of the positions we hold we are more likely to become receptive to other possibilities, other meanings we might put to events. If we can become more open to the possible influences of other perspectives we open up space to be stated and heard. [Mason, 1994, p. 112]

Consistent with this definition of change are the therapeutic and supervisory stances that I take in relation to both clients and supervisees. This can be best described as working towards positions of safe uncertainty (Mason, 1993), safe uncertainty being a framework for establishing a safe-enough context to take risks, “orientating one away from certainty to fit” (p. 194) and authoritative doubt (Mason, 1993,1999). The latter can be described as the ownership of expertise in the context of uncertainty, as opposed to either an absolutist position of knowing or a misplaced and disingenuous position of “not knowing” (Anderson & Goolishian, 1992b), particularly, if “not knowing” is misread as a disowning of expertise. In relation to my practice as a supervisor, it is important that all elements of supervisory practice are consistent with such principles.

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