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Volume 19, Number 2 2017
Journal of Clinical Practice in Speech-Language Pathology
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.
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
organisations will need to plan for this.
The supervisory relationship
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).
The supervisee works with the supervisor in a
collaborative relationship, having some control,
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