JCPSLP Vol 19 No 2 2017

time (SPA, 2014a). Expert practitioners have high self- awareness and confidence, are open to new experiences, have realistic expectations of themselves and their clients, have broad and deep knowledge, are strategic, and are able to motivate and encourage their clients (King, 2009a). “Experts learn experientially, through engagement (deliberate practice), reflection and feedback” (King, 2009a, p. 186). Clinicians at different stages in their career will need different amounts and types of supervision as their needs change (Geller & Foley 2009; SPA, 2014a) and Kilminster and Jolly (2000) found across disciplines “the supervision relationship is probably the single most important factor for the effectiveness of supervision” (p. 827). This relationship needs to be warm and supportive to create a safe space for supervision (Lyth, 2000; Pack, 2009). There needs to be an acknowledgment of the inherent tensions and power difference in order that there will be no shaming of the supervisee (Pack, 2009). Mutual trust and respect in the relationship are imperative to support depth of reflection, facilitating curiosity, openness, experimentation, mutuality and the tolerance of complexity (Pack, 2009). Time needs to be given to build rapport and attend to the supervisee’s needs (Pack, 2009). The supervisor should be honest, open and show good listening skills (Lyth, 2000). The supervisor is a role model and needs to show their flaws, to “explode the myth of perfection” (Pack, 2009, p. 659). responsibility and input into the process (Kilminster & Jolly, 2000) rather than the supervisor being directive (Lyth, 2000; Milne et al., 2008; Pack, 2009) as collaboration promotes autonomy (Lyth, 2000). As Geller and Foley (2009), discuss this involves creating therapeutic or working alliances with supervisees which includes “earned confidence and trust, … empathy …, and mutually developed goals” (p. 26). Supervision as reflective practice “The interplay of reflective practice and clinical supervision is very strong and runs as a theme throughout much of the literature” (Fowler & Chevannes, 1998, p. 380) as reflection is central to supervision in order to examine and identify the essential features of any experience (Kilminster & Jolly, 2000). Clinical supervision is a way of harnessing reflective practice, a key skill for allied health practitioners in general (Mann, Gordon & MacLeod, 2009) and SLPs in particular (Lewis, 2013). Supervision should create a creative safe place for critical reflection (Milne et al., 2008; Pack, 2009; Wheeler & Richards, 2007), where practitioners can share their stories and focus on their emotional experiences (Lyth, 2000). Focusing on emotions enables supervisees to notice unexpected reactions to clients or situations, so increasing self-awareness and the ability to understand and contain responses to difficult clients and situations (Geller & Foley, 2009). Reflection in supervision focuses on relationships with the client–therapist relationship potentially “re-enacted within the supervisory relationship” (known as parallel process), thus “enabling practitioners to conceptualise relationships and develop their relationship skills” (Pack, 2009, p. 661). The Relational and Reflective Model (Geller & Foley, 2009) emphasises the importance of the focus on relationships and reflection in supervision. Practitioners may find the deeper levels of reflection difficult to attain (Mann et The supervisee works with the supervisor in a collaborative relationship, having some control, organisations will need to plan for this. The supervisory relationship

al., 2009), but reflective practice is a key tool in learning from one’s own practice and developing expertise (King, 2009a), with the growth of reflective skills best accomplished within the context of a supervisory relationship (Schafer, 2007). Supervisees value education as part of supervision (Pack, 2009) and for the development of expertise, instructional learning (sharing and reflecting on information), observational learning (learning from the models of others), and experiential learning (learning from own experience) are all helpful (King, 2009a). In the context of a trustworthy and respectful relationship which facilitates reflection, feedback needs to be clear and constructive (Kilminster & Jolly, 2000; Lyth, 2000; Pack, 2009), given in a non-judgemental, respectful way with empathy (Lyth, 2000; Milne et al., 2008; Pack, 2009). Feedback may develop performance; however, changes in thinking occur more slowly and require repeated opportunities for reflection (Kilminster & Jolly, 2000). Feedback is a critical component of supervision to ensure there is a two-way interaction between the supervisor and supervisee (SPA, 2016). Relevant models The content and style of supervision are impacted by the model chosen (Kilminster & Jolly, 2000), although there is little evidence in the literature of superior efficacy for any particular model (Kilminster & Jolly, 2000; Lyth, 2000; Wheeler & Richards, 2007). Proctor’s model, prominent in the literature (Fitzpatrick et al., 2012; Kilminster & Jolly, 2000; Wheeler & Richards, 2007), describes the formative, restorative, and normative functions of supervision. The normative function addresses the accountability of practice, where the supervisor ensures the supervisee is meeting job requirements, complying with organisational policies and procedures, and achieving interpersonal and documentation targets. The formative function is concerned with learning aspects, supporting the supervisee’s development of skills through reflection on experiences, discussion, teaching and feedback. The restorative function ensures the supervisee has the emotional support required for the demands of the position; a safe space to explore stress levels and emotional responses to work tasks and work relationship issues. This model is supported by research (e.g. Bowles & Young, 1999, Kilminster & Jolly, 2000); however, it can be used as a “tick the box” exercise to ensure patient satisfaction and reduce organisational risk (Wheeler & Richards, 2007) rather than as a forum for support and development of the supervisee in which the quality of the supervisory relationship and use of reflection are key. In 2002, Geller proposed a new model for SLP supervision “based on the underlying belief that all learning takes place in the context of relationships and is critically affected by the quality of those relationships” (p. 192). Geller and Foley (2009) describe a relational and reflective model of clinical supervision in SLP stating that, in addition to the necessary focus on discipline-specific knowledge, supervision needs to attend to relationship-based learning and the development of reflective skills in both clinical practice and supervision. In this model, reflective practices are both the “means” and the “end” of the process of supervision, with relationship a critical factor in considering both therapeutic and supervisory processes. Within this Relational and Reflective Model the formative, restorative, and normative functions of supervision can be addressed.

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JCPSLP Volume 19, Number 2 2017

Journal of Clinical Practice in Speech-Language Pathology