“THE FLY ON THE WALL” REFLECTING TEAM SUPERVISION*1

The reflecting team concept, a practical application of constructivist ideas, is adapted for use in group supervision. The evolving model includes a focus on the unique “fly on the wall” perspective of the reflecting team. In addition to case supervision, the benefits of the model include: (a) the supervisee's ability to be at the meta-level of his or her own process; (b) the presentation of feedback in a less threatening manner; and (c) dramatic insight regarding the process, which enhances work with clients. Not only are trainees introduced to a multiverse of new ideas and perspectives, it is done in a refreshing context which integrates some of the most challenging ideas in the field.     

The Reflecting Team Process In Training

The process of evolution of a reflecting team in live supervision sessions is discussed. Theoretical ramifications for systemic training of systemic family therapy are explored and feedback from trainer, trainees and client families about the use of the reflecting team is presented.     

Creating Dialogic Contexts for Multidisciplinary Clinical Reviews: The Reflecting Team Process

When multidisciplinary teams review their work, it is common for clinicians to hypothesise about their clients from the perspective of their role or theoretical model. The outcome of this review process may depend on the team's views. Here the epistemological position taken by team members about reality and objectivity can lead to starkly different pathways. There can either be a dialogue about different hypotheses, with the team jointly constructing new meanings; or, conversely, there can be a monologic exchange based on competition between different hypotheses. This paper explores why teams may struggle with coordinating different theoretical approaches and models. It suggests the dialogic nature of a reflecting team process offers one approach for helping teams to find ways of ‘putting their differences to work’. Ideas for implementing this process within multidisciplinary teams are illustrated with comments provided by teams who have begun to experiment with this approach.     

Family of Origin Supervision in the Workplace: Impacts on Therapist and Team Functioning

The Adolescent and Family Unit at Redbank House carried out a trial of Bowen's Family of Origin Coaching that has prompted us to comment on the usefulness of this approach as a component of clinical supervision. This article will describe how this trial came about, the process adaptations required to make it possible and how some of the ethical dilemmas raised by this approach were addressed. Personal reflections from the team members will be shared, and our observations in terms of impact of this form of supervision on clinical functioning, team cohesion and service provision will then be discussed. In essence, we aim to provide an anecdotal account of our experience and ask the question, ‘Is supervision that focuses on the therapist's individual functioning as a product of their intergenerational patterns a valid use of resources in a clinical setting?’     

A REFLECTING TEAM APPROACH TO FAMILY THERAPY: A DELPHI STUDY

Due to different conceptualizations and unclear theoretical guidelines, a reflecting team approach to family therapy has lacked conceptual and practical clarity. The purpose of this exploratory study was to outline the theory and practice of a reflecting team approach to family therapy. A Delphi technique was employed for panelists to consider the theoretical assumptions, techniques, how change occurs, major goals, when to use, and contraindications of a reflecting team approach. Analysis of data revealed where consensus was reached and a profile was formed to aid in further clarifying this approach.     

Planning and implementing group supervision: a case study from homeless social care practice

ABSTRACT

Effective clinical supervision is increasingly recognised as essential in supporting staff who are working in the field of social care. Using a case study approach, this paper illustrates the processes involved in planning and implementing a group supervision pilot with a team working in a homeless service. The supervision models used to inform and guide this initiative are described and the style and structure of the supervision sessions are discussed. The paper additionally provides a reflective analysis of group dynamics and group processes observed during this work. Subsequent conclusions identify the key features of this process and may provide guidance for other practice settings.     

Union Legitimacy and the Team Concept: A Case Study of Workers’ Attitudes*

Unions are facing a crisis of legitimacy resulting in part from employer‐initiated workplace participation programs that seek to undermine labor militancy and attachment to unions. The overall trend among union leaders, however, is support for the team concept when implemented in unionized settings. This study examines the effect of union involvement in the team concept on pragmatic and moral union legitimacy at the first unionized team concept assembly plant in the automobile industry—the General Motors’ truck plant in Shreveport, Louisiana. The unique contribution of the study is that it systematically examines how workers who began their careers in the industry under different production regimes view the team concept and union legitimacy. The analysis is based on a random sample survey of workers and employs an original approach of comparing work attitudes and union legitimacy among different “political cohorts.” The results indicate that the team concept threatens pragmatic union legitimacy for veteran workers because it undermines seniority rights. Significant time working under the team concept may also weaken moral union legitimacy, even among workers socialized initially in nonteam concept environments.     

Three Journeys Toward The Reflecting Team

The experience of familiestrainee and supervisory therapists involved in reflecting team work are explored through the metaphor of ‘journey’ and by asking a small number of our colleagues and clients about their experiences. Ideas gained from this approach are tentatively used to raise some questions about the reflecting team specifically and the current direction of family therapy. More rigorous research into this area is invited.     

AN ETHNOGRAPHY OF COUPLE AND THERAPIST EXPERIENCES IN REFLECTING TEAM PRACTICE

Couple and therapist perspectives about the use and process of reflecting team practice were analyzed using ethnographic research. A domain analysis was performed on postession interviews from both couples and therapists, and on field notes from each therapist. Seven couples and five therapists were interviewed at least twice over a 4-month period concerning their reactions to and perceptions of reflecting team practice. Six domains concerning reflecting team practice emerged from the analysis: (a)benefits of its use, (b) effects of gender, (c)recommended use, (d) contraindicated use, (e) the importance of creating spatial separateness between couple and team members, and (f) sequences of communication between the couple and team members that elicit change. The latter two domains described the process of reflecting team practice (i.e., steps in how it is used and how it is implemented). The role of ethnog rahy in reflecting team practice and in family therapy research is discussed.     

Training with o (observing) and T (treatment) teams in live supervision: reflections in the looking glass*

Working with a treatment and observing team at the same time, behind the oneway mirror, offers a variety of ways to: (a) generate multiple realities; (b) work with two different models of family therapy simultaneously; and (c) provide feedback on the teams' own roles, rules and group process. The process that 6 trainees and two supervisors used with T and O teams to examine their own coevolution as a therapeutic system using the Milan model of family therapy and Ericksonian hypnotherapy is described. The article concludes with a discussion of the advantages and pitfalls of this type of dual supervision.     

Multi‐Family Therapy with a Reflecting Team: A Preliminary Study on Efficacy among Opiate Addicts in Methadone Maintenance Treatment

In this study, we evaluate the efficacy of multi‐family therapy at reducing the addiction severity and at improving the psychological and family dynamics of opiate addicts receiving methadone treatment at a public treatment center. The study compares multi‐family therapy with a reflecting team (MFT‐RT) and a standard treatment following a methadone maintenance treatment program. The results show that multi‐family therapy with a reflecting team effectively reduces the addiction severity in several of the areas evaluated and noted that this effect is superior to standard treatment. The psychotherapy patients showed improvement in the areas of employment and social support; their drug use diminished and their psychiatric condition improved. At the same time, they needed a lower daily dose of methadone. In addition, the group undergoing standard treatment showed a noteworthy deterioration in their medical condition. Both groups showed a significant increase in their alcohol use. When applied to family treatments, the systemic‐constructivist approach by the reflecting team offers combined techniques that can help improve care for the families of patients with addiction problems.     

Live supervision in the same room

Following a brief explanation of live supervision, its advantages as a practice teaching method are outlined. The main part of the article focusses on detailed and practical suggestions for the preparation and conduct of live supervision sessions. Discussion then centres around some of the pitfalls and ethical issues which need to be considered. The article concludes by advocating that live supervision can make an important contribution to the current drive to improve practice competence in social work.     

A "READER'S THEATER" INTERVENTION TO MANAGING GRIEF: POSTTHERAPY REFLECTIONS BY A FAMILY AND CLINICAL TEAM

The sudden and accidental death of a child can be one of the most devastating events in the life of a family. This paper describes one couple's reflections of their grief and mourning following the death of their adolescent son as well as the clinical team's reflections of therapy. The uniqueness of this paper is that it offers a "reader's theater" intervention that enabled further change to occur. The clinical team used a belief model, emphasizing that altering constraining beliefs is at the heart of healing from such tragedies as sudden death (Wright, Watson, & Bell, 1996). This approach is operationalized through therapeutic conversations between family members, clinician, and clinical team. Interventions such as reflecting teams, therapeutic letters, and "homework tasks" were used to modify or challenge constraining beliefs of both the family members and the clinical team members. However, the intent to co-author a paper with this couple provided the serendipity intervention of a "reader's theater" that further served to identify, affirm, and solidify facilitating beliefs.     

The Expansion of the Peer Adviser Workforce: Opportunities and Challenges for Social Work

ABSTRACT

Peer adviser roles are becoming an increasingly common—and celebrated—aspect of agencies where social workers are located. This article reports on a qualitative research study exploring the experiences of staff within a homelessness outreach service in which three peer advisers (people with a lived experience of homelessness) commenced employment. Drawing on action research principles, the study explored the experiences of the peer advisers and the broader team following the introduction of the peer adviser roles. Themes identified include, realising the skills of peer advisers, defining the role, taking a “whole of team” approach, and reflecting on power. This study demonstrates that the introduction of peer adviser roles into human service organisations is a promising strategy for creating services that are more likely to respond effectively to the needs of service users. However, social workers need to be aware of the pitfalls of tokenism and the devaluing of experiential knowledge.

IMPLICATIONS

• Peer advisers in health and welfare agencies add significant benefits to an agency’s capacity to respond to the needs of service users.

• The introduction of the peer workforce is aligned to social work values of service user empowerment and the valuing of experiential knowledge.

• In order to avoid tokenism, the introduction of peer adviser roles should be supported by both the attitudes and actions of other staff members, as well as organisational support structures.

     

Reflections on the intersection of power and competition in reflecting teams as applied to academic settings

This article explores the author's experiences with the concepts of power and competition as they intersect with aspects of reflecting team practices in academic settings. It draws upon Bishop's (2002) work, the elements of which are based on Starhawk's (1987) ideas of power with and power over. The article describes how competition and other power over practices of domination might unfold and intersect with reflecting-team practices. It is proposed that a power over practice, such as competition, which is prevalent in our society and universities, can be incompatible with the collaborative nature of reflecting teams. Suggestions for addressing the dissonance between the environment and reflecting team practice are offered.     

Creating a bridge to healing: a professional/paraprofessional team approach

This paper describes a therapeutic model in which an English-speaking licensed clinician and a bilingual paraprofessional provide psychotherapy using a team approach in working with Cambodian refugee survivors of the Khmer Rouge. The team approach model differs from professionals who use interpreters in psychotherapy. The strengths and challenges of this approach are discussed. Agencies that serve refugees may not have professionally trained mental health providers who are from the country of origin of their clients. This model holds promise to provide culturally sensitive treatment. However, it is a model that is in its infancy in terms of knowing what works and how to duplicate that to other agencies and populations. This paper shares some of the benefits as well as some of the drawbacks.     

The influence of the Milan approach—Part 2. The legacy of Boscolo and Cecchin and their Paduan connection: A conversation with Andrea Mosconi

The Milan approach, pioneered by Selvini-Palazzoli, Boscolo, Cecchin, and Prata, has significantly contributed to the field of psychotherapy, particularly in the realm of systemic and family psychotherapy. While rooted in systemic principles and concepts, over time the original Milan group demonstrated differences in their clinical orientations and practices which led to their regrouping into two teams. The paper explores the divergences in their views and directions on family dynamics and the role of symptoms within the system. It delves into the influence of Boscolo and Cecchin, two of the ‘Milan Four’ on the Centro Padovano di Terapia della Famiglia. Drawing from a conversation with Andrea Mosconi, a mentee and collaborator of Boscolo and Cecchin, the paper examines the reconfiguration of the original ‘Milan Four’ team and its impact on their clinical approach. Key Milan principles and concepts such as hypothesising, circularity, and neutrality are examined with particular emphasis on the work of Boscolo and Cecchin's systemic work. These principles, intertwined and interconnected, provide a fertile ground for the construction of multiple hypotheses and circular questioning. The paper also highlights the concept of reflexivity, which originates from Bateson's work and plays a crucial role in family relations and communication while explaining the birthplace of paradox taking place when two levels of meaning are ‘confused.’ The Milan approach continues to be highly regarded, as its early concepts and ideas have evolved and left a lasting impact on the field of family therapy. By reflecting on the distinct contributions of Boscolo and Cecchin, and using examples, Mosconi offers valuable insights into the rich legacy and ongoing relevance of the Milan approach to contemporary therapeutic practice.     

The reflecting team as a reflection of second order therapeutic ideals

The reflecting (R.T.) team is examined within its theoretical, therapeutic and training contexts. A distinction is made between the reflecting team technique (R.T.T.) and the reflecting team process (R.T.P.), in order to explore whether or not the practice of team reflection is consistent with the requirements of the second order family therapies, the theoretical development which supported the R.T.'s emergence and subsequent popularity. The critique of the R.T.P. suggests that although this therapeutic process does represent attempts towards increasing acceptance of complexity, reduced attempts to control, collaboration, interconnectedness and contextual respect, there is little room for complacency either theoretically or practically.     

Managing Care and Joined Up Thinking in the Curriculum

This paper discusses the curriculum development of a level three undergraduate course in managing care. It was produced and is presented by The Open University. The course is aimed at frontline managers in health and social care. The course team made consultation with service users, carers and managers a priority in developing the curriculum. The paper discusses this consultation process and the learning gained from it. A major contribution was to clarify debates about how far the course should have one core curriculum and how far it should offer specialist options for managers in different settings. Service users and carers had strong views on the need for better co‐ordination of services and recognition of individual needs rather than divisions into service‐led categories. Managers stressed the importance of reflecting the reality of frontline management. This helped the course team to develop a framework that stresses the commonality in the work and the importance of ‘practice‐led’ management. Service users and managers were involved as critical readers of course texts to ensure that the consultation process continued through the course development. A second strand is the need for the course to be accessible to those not yet in management positions, and extracts from an interactive CD‐ROM which presents case study material demonstrate the innovative joined up and accessible approach taken to student learning needs.     

A team approach to practice teaching

The ideas presented in this paper were originally generated in a workshop at an NSPCC conference on Practice Teaching in March 1996. In this article we wish to develop some of these ideas further and explore the idea of a team approach to practice teaching. This is not some radical new notion, but an acknowledgement of the reality of many placements. Although a student will be allocated a practice teacher (and possibly an off-site practice teacher) he or she will not function by themselves but will be part of an organisation. It is this wider structure and its effects on the student that we feel needs closer scrutiny. Firstly, we believe that not enough attention has been given to the power that organisations can have over an individual (particularly one whose stay is only short-term and possibly part-time). Secondly, we believe students can obtain benefits from the wealth of knowledge existing in any team, drawing on the skills and expertise of all team members. When team learning works well we feel that it provides benefits for all parties - the student, the practice teacher, the team and service users.