Resources

Clinical supervision has established a long pedigree in the helping professions as a tool to assist people hone their practice, sharpen their skills, and endure the traumas associated with working with people in distress. It has provided a means by which the otherwise private exchanges between health professionals and recipients of care can be reflected upon, examined and improved. The seeds for clinical supervision were planted and germinated in another age in which face to face therapy developed well beyond the gaze of the public, and the knowledge of health practitioners and therapists were inaccessible to all but a few initiates. In a little over a decade, as a consequence of the evolution in digital technology, the ground has shifted. In 1964 McLuhan coined the phrase 'The medium is the message' and urged us to consider how we are shaped by the tools that we create. This paper reflects on the changes being wrought through evolving media on our notions of personal identity, community, helping professions and practices such as clinical supervision. If clinical supervision is to continue to bear fruit in the coming years then it will need to be a cultivar of the original variety, firmly rooted in concern for the intimate person-professional relationship but adapted to evolving media and shaped by the global context of professional practice.

Dialectical Behavioural Therapy (DBT) is an evidence-based treatment for borderline personality disorder and other problems associated with emotional dysregulation. It has traditionally been deployed as a face-to-face programme comprised of attendance at group skills training, individual therapy and phone coaching. Social distancing measures arising from the COVID-19 pandemic led to a cessation of therapeutic programmes in many places. This survey of DBT clinicians in a regional State mental health service in Australia explored the impact of the cessation of DBT programmes in the region and obstacles to engaging with people via online platforms. Clinicians have been able to engage in DBT informed care, but it was perceived that many people have experienced a clinical deterioration or have increased their use of crisis services, which is entirely appropriate, as group skills programmes have ceased. Movement to online platforms of delivery poses problems, as some people do not have the access to internet or privacy in their home environments to engage in online therapy. Ideally, clinicians need to be supported through education, supervision and coaching in the use of telehealth interventions. Social distancing requirements has enabled an opportunity to carefully consider how programmes can be adapted to enable the extension of these programmes to those who have traditionally been unable to access them.

The capacity to be empathic and communicate empathically are foundational skills of counselling and psychotherapy, if not all interpersonal helping endeavours. Empathy requires the capability, inclination and capacity to take the perspective of others, appraise and understand their experience without being overwhelmed, and communicate this understanding in a helpful way to the other person. This paper reviews and highlights the importance of this interpersonal capability and describes a form of ‘advanced empathy’ characterised by the capacity to take the perspective of others experiencing extreme states, making sense of this experience and conveying an understanding of that experience in a way which is useful to the person. The capacity for ‘advanced empathy’ is a foundation for any kind of therapeutic work with people who may express delusional or disturbing ideas and will be helpful for anyone needing to develop or maintain a relationship with people in extreme states. These ideas have been tested in practice and with a wide variety of audiences. This synthesis and summary might therefore be useful for training, supervision or reflection by those who hope to build alliances with people who may be in crisis, experience psychosis or are ‘out of step’ with people around them. This paper argues that empathy is useful in most helping relationships but is essential to effective mental health care.

Clinical supervision (CS) has been found to be beneficial in the role development of nurses and can contribute to increased job satisfaction and reduced burnout. However, implementing CS can be resource intensive, and there are few accounts of it being implemented in developing countries. Ten psychiatric nurses in Trinidad engaged in an action research project over a 5-month period to develop, implement, and undertake an initial evaluation of a model of peer-group CS for use in routine practice. The participants were involved in undertaking peer-group CS and contributing to monthly focus groups to reflect on the practices and further refine the model. This inexpensive form of CS was perceived by participants to have positive effects on the way they viewed and practiced nursing. An outline of the model and initial evaluation is presented, but further research is necessary to establish the sustainability of the model in practice.

This paper provides some critical reflection on the development of the concept of 'advanced practice'. Whilst defining, credentialing and regulating advanced practice promises rich fruits for nursing, advancing nursing practice will be a consequence only if the right conditions are fostered for the development and provision of nursing expertise in practice. A conscious and collective effort must be made to ensure that nursing expertise of all nurses is recognised and developed. One process which has shown promise in psychiatric and mental health nursing is 'clinical supervision. Evolving nursing leadership roles and more education can only provide a partial solution to the problem of advancing practice.

This paper provides some critical reflection on the development of the concept of 'advanced practice'. Whilst defining, credentialing and regulating advanced practice promises rich fruits for nursing, advancing nursing practice will be a consequence only if the right conditions are fostered for the development and provision of nursing expertise in practice. A conscious and collective effort must be made to ensure that nursing expertise of all nurses is recognised and developed. One process which has shown promise in psychiatric and mental health nursing is 'clinical supervision. Evolving nursing leadership roles and more education can only provide a partial solution to the problem of advancing practice.

There is an accelerating need for a skilled mental health workforce in Australia given the growing recognition of mental illness. However, developing an informed, flexible and skilled nursing workforce in hospital, community mental health and non-traditional settings is a challenge. The critical ingredients appear to be a mix of supported practice, particularly in the transition from graduate nurse to specialist, relevant postgraduate education and clinical supervision.

Since the loss of state registration and endorsement by nursing boards and councils, the only way to achieve recognition for mental health nurses is through the Australian College of Mental Health Nurses Credentialing program. To be eligible, registered nurses must have completed at least a postgraduate diploma in the specialty and met further practice and supervision requirements. Increasingly, these credentials are required for advancement for nurses in the mental health field – and rightly so. The public deserve to receive mental health nursing services from appropriately skilled people.

Introduction This research project examines communication processes between clinical supervisors and supervisees who engage in an online supervisory relationship via the Internet. An international team of nine researchers, comprising professionals and academics from a wide range of disciplines, collaborated in developing a long term research study to: explore the experience of computer mediated clinical supervision; establish the extent to which online clinical supervision matches the expectations of supervisees and meet professional standards; describe differences between computer mediated clinical supervision and face-to-face clinical supervision; and evaluate how communication practices are adapted using different computer applications in the process of online clinical supervision.
Method This presentation will illustrate: the development of the diverse research team; development of an ethical research proposal via collaboration through listserv communication; development of the project website (www.online-supervision.net); promotion of the research website; participants registering and indicating their suitability for inclusion or exclusion through website submission form (and quality control/training of participants); development of disclaimers and informed consent content; and technological design for matching supervisees within peer groups or and/or matching supervisees with supervisors.
Results It is anticipated that from the 80+ mental health professionals who have registered an interest in participating as of January 2003, a significant number will go onto become research subjects, along with other recruits, to form small supervision groups and dyads. A five-phase design encompasses an initial phase of data collection to enable the team to match participants, followed by four follow-up phases at three-month intervals of web based questionnaire completion about their experience of online supervision for analysis. Results of phase one of the research project and subsequent matching of participants and their expectations about the online supervisory relationship are presented as the result of the methodological techniques demonstrated.

Clinical supervision has a long pedigree in the mental health professions as a face-to-face relationship purported to assist in the maintenance of standards and to enhance practice through educative and restorative functions. The growth of the Internet and computer mediated communication technologies challenges the traditional notion that the context of clinical supervision need be face-to-face or undertaken by a supervisor intimately acquainted with the local practice setting. Over the last decade some psychiatric nurses and other health professionals have claimed that they have developed sustaining professional and collegial relationships akin to supervision or have actually entered into formal supervisory relationships using Internet technologies.

In 2002 an international research team comprised of a diverse range of disciplines collaborated in developing a long term research study to: explore the experience of computer mediated clinical supervision; establish the extent to which online clinical supervision matches the expectations of supervisees and meets professional standards; describe differences between computer mediated clinical supervision and face-to-face clinical supervision; and evaluate how communication practices are adapted using different computer applications in the process of online clinical supervision. This paper presents snapshots of the journey of this research team, and something of the reality and possibilities of on-line supervision.