Supervision and the
Recovery Agenda:
bridging the gap
between theory and
practice
Jan Hernen
Clinical Psychologist
Tom Atton
Project Worker
Turning Point Somerset (Substance Misuse)
Overview of the session
 Key messages of the Recovery Agenda
which apply to the supervision process
 The theory-practice gap
 Group supervision – Somerset model
 Example: using TOP at review (non-MI
and MI-consistent)
 Reflections and plans for future
supervision practice
2010 Drug Strategy
 “..for too many people currently on a
substitute prescription, what should be
the first step on the journey to recovery
risks ending there”
 An expectation that “all those on a
substitute prescription engage in
recovery activities”
Recovery-orientated Drug Treatment
Task Group 2010-present
 Evidence from drug users and
colleagues around the country that
people with addiction problems could be
better supported in their recovery and
that there could be greater ambition for
and focus on their potential to make
further progress
Recovery-orientated Drug Treatment
Task Group 2010-present
 Staff working in treatment services may
need additional training and support to
gain the competences to improve the
quality of regular review and
restructuring of personalised care to
support recovery
 Treatment services need to re-orientate
to achieve the best balance between
reduction of negatives (harm reduction)
and accrual of positives (recovery)
How do we obtain the
positives?
 By attending to efforts to identify
‘recovery capital’ in clients and staff
 By encouraging a more proactive and
aspirational approach for clients and
staff
 By identifying strengths and increasing
ambition to make important behavioural
changes
Which treatment approach could
help us to make teams more
recovery-focussed?
Express
empathy
Avoid
Roll with
argumentation resistance
Deploy
discrepancy
Support selfefficacy
e.g.
e.g.
not ‘quality
client care’ vs.
‘meeting
targets’ but
looking at
common
elements of
both
e.g.
between
status quo
and where
worker
would like to
be
e.g.
Identifying
and
developing
existing skills
in the
interest of
client
recovery
acknowledging
anxiety,
ambivalence
about change,
ideas about
treatment
philosophy
e.g.
‘coming
alongside’
with tensions
between
staff
beliefs/habits
and
proposed
changes
In an organisational context..
We need to:
Monitor,
evaluate and
promote clinical
competence
Ensure fidelity to
evidence-based
practices
Increase
treatment
efficacy
Increase
treatment cost
effectiveness
BPS Toolkit guidelines on
supervision
 Supervision as an essential element of
effective delivery of all psycho-social
interventions
 It is common to all well conducted trials
of effective interventions
 It therefore cannot be seen as an
optional extra (Roth and Pilling, 2008)
What gets in the way of effective
clinical supervision?
 Tight agency budgets leading to staffing
problems
 High demand for supervisors to provide
more direct services
 More emphasis on managerial than on
clinical supervision
 Lack of training and awareness of
supervisory models and skills
Turning Point Somerset
supervision Model
 Group supervision
Example; Mindfulness Skills Program
 For facilitators of Mindfulness skills programme
(which has emphasis on relapse prevention and
preparation for referral-on to Community
Access Project or other community-based,
service user led groups/programs)
 Supervisor meets group facilitators (approx 12
maximum), in informal group setting for 1.5-2hr
monthly.
Content of Supervision Sessions:
 Set agenda:
 Process of group, attendance, facilitators
experiences (problems or solutions with ideas
for development).
 Ongoing review of program materials both
reference and those given to clients.
 Session specific activities reviewed and
developed based on client and facilitator
feedback.
 Specific client related issues, i.e., special needs
in terms of content, i.e. language barriers, or
logistics of enabling all clients to attend.
Style of supervision sessions
 Supervisees use the therapeutic approach from
the skills programme (mindfulness) to reflect on
experience in supervision
 Personal challenges in working with certain
clients are discussed within an MI-consistent
conversation.
 Space is made for wider-ranging discussions
triggered by clinical practice, e.g. 'squaring' old
beliefs and practices with new recovery agenda.
In this supervision model how is
treatment made more effective?
Facilitators fed back following:
 Facilitators are able to discuss 'journeys' of clients from
the various referral pathways – pathways become clearer
and more consistent
 Similarities and differences between team processes can
be recognised and best practice shared
 This helps to put recovery clearly in the minds of the
facilitators and allows understanding of how others are
adapting their work practices to suit newer recoverybased practices with acceptance of difficulties therein.
How does this model support
staff?
 Emotional support through shared experience
 Sharing difficulties and being able to offer
solutions and alternative perspectives to each
other is widely recognised as being of great
value.
 Lack of 'own-team' management present
encourages openness and a chance to test
consensus or accept that issue is not mutually
held, before making a ‘group contact’ to
management for guidance.
 Encourages protection/defence of facilitators
time allocated to the proper running of the
group programme
Planning for supervision in the
recovery model – example: use of
clinical tools at client review
 Identification of key clinical tools used at review (e.g.






TOP and care plan)
Identification of a clinical scenario that will trigger some
discussion over recovery and harm reduction
Role played example of non recovery-consistent use of
clinical tools
Supervisees generate ways of using clinical tools in a
more recovery-consistent way
Supervisees role play using tools in ways identified
Supervisees reflect on the process (identifying
therapeutic approach most effective) and plan ways in
which they can change practice
Discussion is generated on recovery context – what
might recovery mean for the individual concerned?
Clinical case scenario
 56 year old heroin user who has been in core




treatment services for 8 years (GP does not
prescribe methadone)
Prescribed 65mgs methadone daily dispensed
twice a week
Smokes heroin now and again
Does a bit of casual work, sees his daughter
now and then, has some friends who live locally
Invited to appointments every 6 weeks but
attends generally every 3 months and does a
TOP and care plan
Use of a therapeutic model at
different levels of the treatment
process
Treatment worker and client
• Empathy
• Avoiding
argumentation
• Roll with
resistance
• Deploy
discrepancy
• Increase
self-efficacy
Supervisor and supervisee
Workshop facilitators and
attenders
Implications for future
supervision in your workplace
Becoming more recovery focussed:
 Supervision type: individual and/or
group?
 Supervision function: managerial and/or
clinical?
 Supervision content: specific client
issues and/or treatment processes?
 Overlaps between training and
supervision?
References
 HM Government (2010) Drug Strategy 2010: ‘Reducing





Demand, Restricting Supply, Building Recovery, Supporting
People to Lead a Drug-free Life’. London. HM Government
Recovery-orientated Drug Treatment: An Interim Report, (2011)
Professor John Strang
‘Routes to Recovery: Psychosocial interventions for Drug
Misuse: A Framework and Toolkit for implementing NICErecommended Treatment Interventions’ (2010) Pilling, S.
Hesketh, K & Mitcheson, L. National Treatment Agency for
Substance Misuse & British Psychological Society.
‘Principles of drug addiction treatment: A research based guide’
(1999) National Institute on Drug Abuse
Bradley, E.H et. Al (2004) ‘Translating research into practice:
Speeding the adoption of innovative health care programs’,
Issue Brief (Commonwealth Fund) July (724), 1-12
Miller, W .R & Rollnick, S. (2002) ‘Motivational Interviewing:
Preparing People for Change’. Guilford Press