Supervising Complex Trauma
in Daily Life
MACMHP Supervision Series
December 7, 2015
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Presenters:
Krista Nelson LMFT
krista.nelson@wilder.org
Shawn Schuette
shawn.schuette@wilder.org
Wilder Foundation Attachment and Trauma Training Program
and Kofi Services
Goals of Workshop
 Speak to the complexities of supervising front line staff who work
with traumatized clients living in unsafe settings. Consider shifts
in supervision structure, emphasis and outcomes to reflect
trauma’s impact on all
 Lay out components of trauma informed supervision that is both
directive and collaborative as we assume roles of Administrator,
Teacher, Coach and Mentor
 Present and practice tools for this process: van de Kolk’s Complex
Trauma Treatment Map, Reflective Supervision, Mindfulness for
staff and self
 Apply concepts to your own challenges-What are the essentials of
a healing environment in community mental health?
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“I find that people are hungry for a type of supervision that invites
them to inquire into and harmonize the fundamental practices of
their professional work with the fundamental values of their personal
lives.
Look around you, better yet, search your own experience. We work
with all kinds of families and a full range of the human experience.
But we bring to this work the full history of our own lives as well.
… The catalog of human suffering, triumph and their interweaving
is endlessly variable yet it unties us all, for in some deep way, it is
always the same.”
Willaim Schaffer Models and Domains of Supervision and Their Relationship to Professional
Development Zero to Three Newsletter November 2007
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Supervision Challenges
 “Is this supervision or therapy?” How do we help contain what
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staff are witnessing and feeling alongside children and parents in
cycles of violence and poverty?
How do we help staff gain the skills they need to do the work?
How do we meet agency mandates to reduce symptoms &
demonstrate skills when clients are still living in unsafe settings?
How do we buffer stress? How do we create a safe place in
supervision itself , so reflection and learning can occur?
How do we coach a unifying professionalism as staff come from
different life experiences and cultures?
The Joys of Middle Management
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Our job in Challenging Times
(Toward a Common-Factors Approach to Supervision
Morgan and Sprenke 2007)
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Develop Clinical Skills: intervention strategies, client dynamics,
clinical theories….
Guide how supervisee functions as professional within
ethical standards and administrative duties….
Elicit personal growth, awareness and emotional
management toward autonomy and confidence….
Monitor and evaluate supervisee per agency and
licensing board standards….
Balance emphasis on clinical competence with professional
competence….
Impact of Trauma Work on Staff
Trauma and the Organization: Understanding and Addressing Secondary
Trauma in Trauma Informed Care Kulkarni and Bell 2012
 Difficulty leaving work behind at end of day
 Lack of resources to do the work i.e. expectations to do
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more with less, not enough time in the day
Caught in need for systems change
Exposure to secondary trauma, suicide, homicide
Feeling ineffective or powerless to help client and yet want to
find a fix!
Different philosophies between staff, departments
Shawn’s thoughts
 How have you shifted the
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way you do supervision to
fit Kofi’s multicultural,
community context?
 How do you buffer staff
from client stress or agency
mandates to create a spot
for reflection?
 How do you structure
supervision so it is both
collaborative and directive
when needed?
 How do you build trust
with staff who distrust
large systems or have
language or education
barriers to meeting agency
mandates?
“The lived experience of
discussion differences and
conflicts within the
supervisory relationship is
one of the most valued
sources of mutual growth
and development for
supervisor and supervisee”
A Practical Guide to Reflective Supervision Heller and
Gilderson c. 2009
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Supervision Roles We Take
Clinical Competence
 Coach
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Critical feedback on clinical
work
Help client achieve goals
 Mentor
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Personal development of supervisee
as growing professional
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Strengths and limitations- use of self
Professional Competence
 Teacher
 Skills, theories, resources
 Broader context of client’s lives-
culture, class
 Assessment/diagnosis
 Administrator
 Ethical, legal standards
 Documentation
 Evaluate performance
Small Groups
1. Pick two roles as a group. List examples of each role.
2. Can or do you move fluidly between roles?
3. What are the barriers to doing so at your setting?
4. Why might finding a balance between the roles be
essential for supervising work with trauma clients?
5. What does the term “developing a colleague through
supervision ” mean to you?
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Discussion
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How are we blending these roles and meeting these challenges?
Can we create protective structures so learning can occur?
Can agency mandates mesh with realities front line staff face?
Applying Roles in Context of Front
Lines Complex Trauma
 Without maps of the Teacher, we lose our way- Without reflection of the Coach, we forfeit the
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best supervision and therapy tool we have,
ourselves---- Without an “eye on the prize” of the
Administrator as to what makes a difference,
we become hopeless and give up--- Without clear ways for rejuvenation of spirit and
purpose of the Mentor,, we lose capacity to
empower families in trauma---
Teacher Role: Providing MapsComponents of Trauma Informed
Explores impact of
trauma on client
functioning in the world
2. Offers supervisees
concepts and tools to
work with trauma’s
impact
3. Defines do able tasks and
outcomes and reenergizes mission
1.
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Training staff for front lines
 Provide foundational understanding of impact of trauma on
domains of developmental and neurological delays and on
family functioning
 Provide “ maps” for trauma therapy, despite technique, that
reinforces connection and coping for families in face of
persistent stress. Assess skill development in delivery
 Show examples of “seeable goals” for children and adults that
jumpstart development in five domains of loss
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 Address agency mandate for seeing change through outcomes
Stress- Too much damages body and spirit
Manageable amount builds resilience
Positive- brief increases in heart rate, mild elevations in
stress hormones
Tolerable- serious temporary responses buffered by
supportive relationships
Toxic- Prolonged activation of stress response systems in
the absence of protective relationships
Lifetime Consequences
5 Pathways of DifficultyFocus of treatment
 Executive Skills- difficulty with planning, organization, logical
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consequences
Language Processing Skills- misunderstands language, literal
thinking, limited feeling awareness
Emotional Regulation Skills- difficulty organizing self when
feeling strongly, irritable, reactive
Cognitive Flexibility Skills- difficulty with accepting
alternative plans, good/bad concrete thinking
Social Skills- misreads cues, unaware of how affect others
van de Kolk’s Components of Complex Trauma
Treatment- A Teaching “Map”
 Creating Safety
 Regulating Overwhelming Stress
 Promoting Reflective Thinking
 Trauma witnessing- telling of the story in treatment goals,
plans and documenting outcome
 Setting up supportive structures and relationships
 Practicing competence in a stress filled world
Complex Trauma Example:
Walla Walla’s Lincoln High
 “Nothing short of a conversion” ACE
studies flipped way principal thought
about child misbehavior- reframed as
stress responses
 Teach emotional regulation by
practicing emotional regulation
 Take one day at a time: each day is a
new start
 Rat studies- licked and groomed pups
handled stress better
 Are you in the Red Zone? No
problem solving till in green.
 “What is with you lately?” Hear the
back stories
To Activate Vitality in the Face of TraumaMake Room for the Coach Role
 Prepare for inevitable
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Secondary Traumatic Stress
on staff
 Create enough relational
trust to explore impact of
staff’s own traumatic
history or impact of
historical trauma on
decision making
 Make this explicit in
supervision contract
 Tend to vital skill of self
care
Administrator Role- Ethical
Dilemmas on Front Lines
 Culture/class similarities and or differences in supervisee
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that impact ethical judgments with clients?
Front line staff can see documentation requirements as
unnecessarily controlling?
Performance evaluation- an ongoing discussion
Clarifying professional boundaries
Safeguard therapy as place where traumatized clients are
protected enough to risk shifting patterns of survival?
“ As a therapist, you are something like an athlete, who must stay in
shape to be ready for whatever comes at you during the game. You
must have a team on your side who supports you, challenges you and
tells you when you are in danger of screwing up”
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Mary Jo Barrett- Ethics in Therapy: Defining Professional Boundaries 2014
Crafting Realistic Case Plans
Administrator Role
 Shows small steps of hope that can be experienced
 Repeats important examples of client’s resilience
 Gives a picture of what it looks like when it is better
 Prioritizes client’s choice for what she/he wants to see grow
 Organizes hard stuff into a story- beginning, middle, end
 Shows client is not alone- mobilizes resources
 Showcases client’s competence and coping
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Reflective Supervision in
community mental health
 Do not just stay in Administrative and Teacher Roles, despite
lack of time and resources- “Process Problem Solving”
 Make room in sup hour for guiding staff to take a “10
thousand feet view” of self interacting with client
 Is not therapy- focus is on what is happening between self and
client - Is safe place to explore, “what is snagging me?”
 “Slice it thinner” Use silence Let hour move from “reporting
events” to impact of client on staff and staff on client
 Note staff’s struggle, themes, hold their pain, help them see
next steps –
 Use beginning and ending ritual to preserve this time, space
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Phases of an RF Session
1.
Preparation: Clear your mind, create a protected
environment for you and your staff. Orient thoughts to this
staff’s needs and strengths.
2.
Greeting and Reconnecting: Evoke relationship briefly
3.
Opening the Dialogue and Finding the Agenda: Ritual
to begin, listen, see what staff wants to focus on.
Telling your Story and Focusing on the Details: What
exactly happened, What was said and not said? What was
observed? Don’t seek solutions yet. Help staff become aware of
own reactions as he tells his story.
4.
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5. Understanding Perspectives and Generating
Hypotheses: Both of you share hunches about what is
going on. Wonder about client’s perspective, staff’s
perspective. “ I wonder if…”
6. Considering Next Steps: After clarify uncertainties,
and issues, guide consideration of next steps. “Given all you
shared, how do you want to approach your next visit.”
7. Closing: - Appreciate staff’s engagement in work and
continuation of next supervision contract
8. Post Supervision Reflection: Record key themes,
affect expressed, level of engagement and comfort with
session
Mentor Role- “Safe Base” holding
of client trauma - staff trauma?
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Respect each supervisee’s pace and readiness to learn
Strengthen supervisee’s observation and listening skills
Suspend harsh or critical judgment
Invite sharing of details of client’s particular strengths, behaviors,
interactions, concerns,
Listen for emotional experiences that supervisee is describing in
response to work: anger, impatience, sorrow, confusion etc.
Invite supervisee to have and talk about feelings awakened in the
presence of the client
Wonder about, name and respond to those feelings with appropriate
empathy
Maintain a shared balance of attention on client and supervisee
Reflect on supervision in preparation for next meeting
Let’s Practice This
Partner up
Supervisor Thoughts
Supervisee Thoughts
 “Her documentation is
 “ I just have to get through
weeks behind now. What
is going on? She used to be
the first in the team with a
new idea. Now she is
dragging and defensive too.
Did something happen?
She isn’t talking to me…”.
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this meeting. I am so
stressed I could crack, but
can’t let her find that out.
I keep thinking about Javon
and what he saw that night.
This job can’t protect this
kid. What is the point…?”
Discussion
 How might this be useful for “holding” the stressful
experiences of front line staff?
 Do you do it already and how do you balance it with
Administrator responsibilities in limited time?
 How might RS aid to supervision role of doing performance
appraisals in a proactive way?
 How might RS help us keep our Eyes on the Prize” building
regulating relationships and regulating environments for our
children and families?
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Mindfulness Tools
 “Wise Mind”- We are doing the best we can and we can
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always learn something new
Move from automatic or habitual responses to being fully
present in moment
Vital skills of self reflection and continuity of attention
Placing self in other’s space
Dawning self recognition
Staff can feel enabled vs. undermined when questioned by
supervisor about hard stuff
Supervisors –We Are Vital
Tending to our own“Mindsight” Is Vital
 “Lack of clinical supervision is a potential drain on the best
leadership skills and commitment of our most capable managers
and supervisors. They need support as they support those who
bear witness to the chronic pain and need of others”
 Supervision must prioritize time for reflection and self care,
most vital in this line of therapy, despite administrative demands
 Supervisors too must find a way to be “held” professionally so that
they can continue to hold and nurture a program and staff ”
 “When I distance myself from the tragedies that happen at work, I
put myself at risk. If I do not protect myself, I risk the program”.
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Tying it All Together
Trauma Resilient Practice
 Do we take time to recognize impact of traumatic stress on
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client behavior and goals we set in treatment, with an eye to
resilience and building of supportive relationships?
Do we take the time to do this with staff and in our
organizations? Is supervision a “holding space”?
Can we move fluidly between roles of administrator, teacher,
coach and mentor?
Can we draw from therapy models of trauma resilience
whatever our specific treatment methods?
Can we use elements of Mindfulness and Reflective
Supervision to recognize trauma’s impact on self and keep
fresh in the relational work?
Compassion Satisfaction- the pleasure we
derive from being able to do our work well
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 How do we want to
address agency barriers to
supervision as place of both
accountability and
reflection?
 What are our own
“Resiliency Plans”?
 How can we look forward
to Monday’s next
supervision meeting?
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