The Argument for
Comprehensive
Supervision: Supporting
Great Staff and Good
Trauma Work
2011 Sexual Assault Care
Conference
Nancy N. Mayer, M.S.W., R.S.W
© Crisci & Mayer 2011
Disclaimer/Copywrite Information:
The information being presented in this workshop is
copywritten and is intended for instructional use by the
participants of this workshop only. Reproduction and
distribution of this material is strictly prohibited. This
information cannot be distributed electronically, or
duplicated in any fashion without written permission of
the authors.
Crisci & Mayer
Toronto, Ontario, Canada
Phone (416) 480-1611
Fax (416) 480-2922
nmayer@ckmconsultation.com
www.ckmconsultation.com
The Argument for Comprehensive Supervision
Workshop Objectives:
•Be able to identify the potential difficulties that workers
experience when working with sexual assault victims
•Understand how solid clinical supervision assists workers
in providing good services
•Understand a two-tiered supervision model that
accommodates staff needs for clinical supervision as well
as creating a safe space to explore personal reactions to
clients
•Recognize when to utilize external consultants to assist
staff
There are
significant
challenges in
working with people
who have been
sexually assaulted
Traumatic events result in
clients being subjected to
overwhelming, uncontrollable
experiences that
psychologically impact them
and create feelings of
helplessness, vulnerability,
loss of safety, and loss of
control
Challenges
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Being able to establish safety can be difficult
Developing a trusting therapeutic relationship is hard
Through the telling of the traumatic experience, the
therapist bears witness to the abuse
Empathic engagement with the client makes knowing
that story more difficult
Potential Involvement with justice system
- Potential Impact on therapeutic alliance
- Potential risks/liability to therapist
Transference and counter transference
Intersecting lines between therapists personal history
and life
Impact of workplace politics
Compassion Fatigue and Secondary Trauma
Compassion Fatigue
Compassion fatigue is a state experienced
by those helping people in distress; it is
an extreme state of tension and
preoccupation with the suffering of those
being helped to the degree that it is
traumatizing for the helper.
Dr. Charles Figley
Vicarious
Traumatization
© Crisci & Mayer
Vicarious Traumatization refers
to the transformation in the
trauma worker’s inner
experience resulting from
empathic engagement with
clients’ trauma material.
Pearlman and Saakvitne, 1995
© Crisci & Mayer
Vicarious Traumatization
Through exposure to clients’ graphic accounts
of sexual abuse experiences and to the
realities of people’s intentional cruelty to one
another, and through the inevitable
participation in traumatic reenactments in the
therapy relationship, the therapist is vulnerable
through her empathic openness to the
emotional and spiritual effects of vicarious
traumatization.
Pearlman and Saakvitne, 1995
© Crisci & Mayer
Vicarious
Traumatization
These effects are
cumulative and permanent,
and will be evident in both
the workers professional
and personal life.
© Crisci & Mayer
Vicarious
Traumatization
It is not the responsibility of our
clients, nor in any way an
indictment of them. It is an
occupational hazard that must be
acknowledged and addressed.
Pearlman and Saakvitne, 1995
© Crisci & Mayer
Secondary Trauma
is a process, not an
event
© Crisci & Mayer
IMPACT OF SECONDARY TRAUMA
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Causes Disruptions to one’s sense of:
Meaning
Connection
Identity
World View
Tolerance
Psychological needs
Beliefs about self and others
Interpersonal relationships
Sensory memory
Spirituality
© Crisci & Mayer
CONTRIBUTING FACTORS
TO VICARIOUS
TRAUMATIZATION
 Specific Characteristics of the
Therapy/Relationship and its Context
 Particular Characteristics and
Vulnerabilities of the Listener
© Crisci & Mayer
CONTRIBUTING
FACTORS TO
SECONDARY TRAUMA
SITUATION
Nature of the work
Nature of the clientele
Cumulative exposure
Organizational context
Social and cultural context
Pearlman & Saakvitne, 1998
© Crisci & Mayer
CONTRIBUTING
FACTORS TO
SECONDARY TRAUMA
THERAPIST/LISTENER
Personal History
Personality and defensive styles
Current life context
Training and professional history
Personal Therapy
Pearlman & Saakvitne, 1998
© Crisci & Mayer
Very few epidemiological
studies in the workplace – some
with firefighters, police, soldiers
Studies challenge previous
belief that PTSD was a normal
response to a traumatic event
and can occur to anyone
© Crisci & Mayer
Research suggests that those
who “get” PTSD are influenced
by:
• a specific predisposition to PTSD
• a predisposition to mental illness
that can be triggered by adversity
• the actual traumatic event and the
meaning of that event
© Crisci & Mayer
Why a Two
Tiered Model of
Supervision
Supports Great
Staff and Good
Trauma Work
Supervision
Is the cornerstone to sound clinical practice. It
provides oversight and accountability
Having others examine the work we do with
clients gives us the opportunity to become
knowledgeable about issues outside our
awareness
Getting feedback and another point of view can
improve effectiveness
It’s a Professional Thing to Do
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All mental health workers will be
affected by the work they do
It is professional behaviour to
acknowledge these feelings and
examine them to ensure no harm
comes to clients
Not to do so can result in
unprofessional behaviour and
potential professional misconduct
and error
Kadushin’s Definition of Supervision
A supervisor is an agency administrative staff
member to whom authority is delegated to direct,
coordinate, enhance, and evaluate on-the-job
performance of the supervisees for whose work
she/he is held accountable. In implementing this
responsibility the supervisor performs
administrative, educational, and supportive
functions in interaction with the supervisee in the
context of a positive relationship.
The supervisor’s ultimate objective is to deliver to
agency clients the best possible service, both
quantitative and qualitative, in accordance with
agency policies and procedures.
© Crisci & Mayer, 2003
It is management’s job to manage and ensure
implementation of the goals, missions, policies
and procedures of an organization.
Staff are accountable to their managers, the
managers to the executive director and the
executive director to the Board.
The board is accountable to the funders and
the wider community
Community
Board
E.D.
CL
W
Human Service Organizations
Focus of this Model
Administrative - the promotion and maintenance
of good standards of work, co-ordination of
practice with policies of administration, the lines
of accountability are clear
Educational - the educational development of
each individual worker on the staff in keeping
with the organizations mission, policies and
procedures
Supportive - the maintenance of a positive
working relationship focused on providing the
best possible service to the client’s
Limitations of Internal Supervision
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Client’s needs are paramount – which may limit
Organizational accountability issues and the
supervisors role in performance appraisal and
discipline issues can negatively effect – trust
with personal information
Need to maintain boundaries – supervisors
should not become “therapists” to their staff
Potential issues when supervisee’s therapists do
supervision
Case for Ongoing Supervision
 Allows ongoing evaluation and feedback
 Mechanism for contact and accountability
 Tool to contain anxiety and problem-solve
 Educational opportunity
 Promotes fair work evaluation
 Supports good casework
 Vehicle for Support
Case for Two Tiered Model
of Supervision
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Internal supervision allows for ongoing evaluation of
staff and accountability to the organization and its
mission
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Since organization assumes liability, it should be
responsible for setting case direction and making major
case decisions
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The addition of a second form of supervision conducted
by an external supervisor with groups of staff allows
the staff to deal with the intersecting issues between
casework and their personal life in private and without
potential repercussions by organization (when the
issues are not potentially libelous)
Case for Group Supervision
External Supervisor
Group supervision allows staff to normalize
that personal issues can effect the
professional work if not monitored
 Allows staff to learn from each other
 Is cost effective. Conducting these
sessions in groups makes the cost
possible for most organizations
 Will promote staff cohesion
Issues with Use of External
Consultants for
Organizations
External consultant has a responsibility to the client and the
organization to report issues that come up that could lead to
liability for the organization and/or harm to the client
There should be a written contract between the external
supervisor with the organization and the staff that states the
above
The staff when ever possible will be encouraged to “report”
themselves to their organization with the consultants support
if necessary
Examples: sexual exploitation of clients, staff impairment
that would harm client
In Summary
Our experience has shown that the commonly
used model of supervision with an internal
supervisor has limitations, especially for trauma
work
The addition of group supervision with an
external supervisor with clinical knowledge of
trauma better addresses the issues raised in the
literature about secondary trauma and
compassion fatigue
Together, both approaches provide the
necessary resources to ensure good clinical
work and support of good staff
Crisci & Mayer
In 1997, we started Crisci & Mayer, Consultation Counselling and Training, to provide services
to professionals in the human services field. With our combined expertise and knowledge this
partnership has been successfully offering counselling services to people seeking help for
themselves or their family members and offering training to the professional community.
We also provide consultation to professionals, both on an individual and an organizational basis.
We are committed to improving the lives of people who have experienced trauma or who are
struggling with individual, couple or family problems and to bringing innovative perspectives to
our training and practice, based on the latest research and knowledge.
55 Eglinton Avenue East, Suite 506
Toronto Ontario Canada M4P 1G8
www.ckmconsultation.com
(416) 480-1611
Geraldine Crisci, M.S.W.
Nancy N Mayer, M.S.W., R.S.W.
© Crisci & Mayer 2006
Disclaimer/Copyright Information:
The information being presented in this workshop is copy written and is intended for instructional use by the participants of this workshop only.
Reproduction and distribution of this material is strictly prohibited. This information cannot be distributed electronically, or duplicated in any
fashion without written permission of the authors.
Visit our website to learn more about
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www.ckmconsultation.com