Let's talk creative clinical supervision during lockdown

In this article, I will be giving a brief overview on the common symptoms experienced by therapists (counsellors, psychotherapists, dramatherapists and play therapists. 

I will then give an overview of how I have adapted my approach to delivering clinical supervision online throughout the 2020 - 2021 COVID-19 pandemic.

This article is aimed at qualified therapists, trainees, supervisors and lecturers delivering psychotherapy programmes.

Common symptoms reported by practising therapists during the lockdown

1. Avoidance of looking directly at the screen due to being distracted by seeing themselves. 

2. Fatigue and an increased urge to yawn during sessions. 

3. Anxieties around home interruptions, such as the doorbell ringing, home improvement noises from neighbours, flushing of toilet and a constant fear that children will enter the session. 

4. Self-awareness and environmental space awareness being a constant invasion of thought. 

5. Note-taking throughout session and missing vital cues from clients. 

6. During group online sessions, missing bouts of emotion due to the intensity of observing all participants on the call. 

7. Annoyance and 'awkwardness' caused by Wi-Fi connection issues ranging from screen freezes, audio or connection issues to losing clients all together on a live call.

8. Having to be mindful of shared homes, confidentiality and safety of clients; especially those who are living with a perpetrator.

9. The Black Lives Matter movement causing therapists, clients, supervisors, supervisees, lecturers and students to either openly explore this emotive area of systemic racism and the emotional impact, or to make reference to it and resume the 'agenda' or to make no reference to it at all.

10. Therapists reporting that the pandemic has created more clinical work than ever before which has been both financially rewarding as well as emotionally taxing. 

11. Full exposure of the sanctuary of home space now becoming the workspace. 

12. Loss of earnings to those practitioners who hire out room and office spaces.

Due to lockdown restrictions; therapists who practice self-care within communal gyms, yoga and fitness programmes have had to seek alternative physical outlets to maintain a healthy balance and avoid burnout, weight gain and other health complications caused by being stationary for most of the working day.

Therapists have increasingly reported blurred vision, increased use in glasses, less use of contact lenses due to dry eyes, increased head and eye aches as well as new prescriptions with opticians due to an increased screen time.

Drama and creative techniques in supervision

As a practising dramatherapist, EMDR practitioner and clinical supervisor, I have always encouraged energetic and dynamic approaches to supervision in order to assist the supervisee to explore their body responses as well as to enable the facilitation of gaining an existential gateway into their clients' material, as well as identifying the responses to the cognitive processes.

The supervision space is a learning hub to explore the client material whilst developing practice and skills as part of the therapists' ongoing CPD.

Whilst using remote online GDPR - approved apps, such as Zoom and Talkspace - the therapist is limited in only having visible access to, predominantly, the client's head and shoulders. This removes access to observing body responses to therapeutic treatment, such as tapping of feet and hands, therefore, the therapist has to work harder and adapt to a deeper enquiring mindset to ascertain a truer picture of the client's conscious and unconscious material.

Supervisees can benefit from creative clinical supervision by learning new innovative 'grounding techniques' within the supervision space.

The therapist can interweave these tools, as an additional resource to their clinical practice, to help clients to self – regulate within the therapeutic alliance as an aid to drawing them away from their intrusive negative thoughts, flashbacks, memories and images.  

This can be easily orchestrated by tapping into the five senses, using breathing techniques and returning the client to their 'special place or image'. Once the client is aware that they have a companion on their journey of reflection and processing, they will feel more relaxed which deepens their trust in the holding capabilities of the therapist. Supervisees can also get the opportunity to try these techniques out themselves in clinical supervision.

The supervisee, whilst engaging in creative clinical supervision, quickly becomes aware that their very being is a rich resource towards providing a more comprehensive and heuristic approach towards clients' conscious, unconscious, verbal and non - verbal communication.

This experience of exercising different elements of creativity in clinical practice will encourage the supervisee to grow in confidence with this developing psychodynamic approach to working remotely with clients, which will enable them (supervisee) to demonstrate more effective use of their social intelligence (Goleman, 2006). These elements include becoming more attuned with client material, confidently identifying body sensations experienced psychodynamically through transference, achieving accurate empathy and becoming more open to exploring diversity, class, race and other 'isms and skisms' within the therapeutic space. 

Roleplay and embodiment is a fun, powerful and expressive method to 'invite' clients into the supervision space. This enables the clinical supervisor to get acquainted with capturing moments of practice and clinical nuances as well as identifying blindspots to explore with the therapist.

A powerful explanation of this is coined beautifully by Dr Isha Mckenzie - Mavinga (2009) where she states that when the fear and mistrust of race and indifference is ignored or brushed over in the therapeutic space, it can ignite a repeated process of abandonment and isolation, which are key indicators associated with racism. This subtle avoidance can be re-triggering for, in this case of the clinical supervisory relationship; the therapist/supervisee.

These differences are encouraged to be processed within clinical supervision by use of stories, images and metaphors to deepen the sameness and differences playing out, whilst enabling a space that is safe to process feelings of awkwardness, guilt, shame, anger, annoyance, rage, sadness and so much more.

For therapists, now is the time to deepen the enquiring mind to disentangle the threads of 'unsaids' and dare to be open to confronting the biases, social and cultural conditioning we have all grown to suppress through our daily lives. 

In one of the chapters in his new book, Intersections of Privilege and Otherness in Counselling and Psychotherapy, Dr Dwight Turner talks about 'otherness' and how it can be played out within the therapy space. This phenomenon can also be worked through in creative clinical supervision whereby the intersectionality between the therapist, client and the clinical supervisor can be explored through roleplay, embodiment, metaphor and imagery, to get a sense of feeling and embodying what it is like to be in that 'otherness'; whether by race, gender, sexual orientation amongst many 'others'. 

Delivering remote psychotherapy sessions; as well as clinical supervision can present a number of potential caveats, which are new and ever-changing in this alternative mass wave of delivering online therapy, groups and supervision.

One benefit from this pandemic lockdown for therapists is that uncomfortable issues and themes, such as race differences and ancestral war-fare within the therapeutic space have been encouraged to welcome into the space for exploration and enquiry so that it is no longer an 'elephant in the room'.  

I have found that asking, “If our ancestors were in the room; what would they be saying and how would they be feeling towards each other?" a powerful and thought-provoking statement with undertones of risk, perhaps?

Possibly.  

But a risk worth taking as once there is a therapeutic alliance filled with unconditional positive regard and established trust, 2020 has assured us that these narratives are well overdue!

The relationship between the therapist and their clinical supervisor enables a safe and secure demonstration and reassurance that these taboo themes can be contained, explored, processed, healed and reinstalled with positive cognitions attached to them as a way of navigating through the pain, shame and discomfort, whilst holding a sense of power and acknowledgement of the hero within. 

We will survive this!

Self-care for therapists 

My top five self-care tips for therapists, students and lecturers who have increased screen time with clients due to the lockdown are:

1.  Have a scent/fragrance diffuser in your work area associated with clinical work and a ‘home’ scent/fragrance used when you finish work and cross the metaphorical threshold back into your familiar, homely mode of being once your clinical work has ended.

2. Introduce short bursts of movement away from your seating position, in order to get the blood flowing and to aid the release of dopamine, norepinephrine and serotonin; all hormones which play a role in regulating mood. My personal ‘thing’ is using my aerobics hula hoop with my favourite music playing in the background.  A little hula – dance is so much fun and a good excuse to dance like no one is watching in the afternoon!

3.  Go for walks in nature, if possible. There is something quite soothing in walking in nature and parklands – the many observations to wildlife and changing forestry can make all the difference to balancing the day whilst getting those steps in!

4. Invest in a shiatsu heated exercise cushion (very reasonable on Amazon). Works wonders on threading out those tight knots in the shoulders and adding some heated comfort with rotation, which is a form of bilateral stimulation to soothe, calm and provide comfort.

5. Tap into brief meditation practices which focuses on breathing and invites focus on positive affirmations. There are plenty available on YouTube.

In closing, the therapeutic community have had to respond to a new way of working remotely with clients, supervisors and supervisees. This adaptation has taken boldness, confidence, containment, adaptation and perseverance. With such a tall order during a time when increasing anxiety levels are mirroring each other as a parallel process between the screens, I think we can all say that we have safely transitioned more quickly than we ever thought we would. 

We have learned to smile and breathe through the audio issues, be patient with the freezing within live calls, excuse the two-year-old who has slipped out of daddy's care and runs into the session screaming for mum’s attention – we have learned! We have let go of what is out of our control, we have learned that inviting strangers remotely into our homes has not been detrimental – we have learned! 

We have written notes on the front door to notify the postman not to ring the doorbell but to leave the parcel on the mat and we have structured our days with loved ones so that we create a closed space for the day whilst keeping out of each other’s way and respecting the acceptance of the developing dual function of the home.

It takes a pretty creative therapist to achieve all this, I'd say! 

If you want to book clinical supervision with me for individual or group processing - get creative and get in touch!