Topic: Worker Support

The importance of receiving clinical supervision to support your work with forensic AOD clients cannot be overstated. Clinical supervision differs from line supervision (which may focus on compliance with organisational procedures) by providing a safe, reflective space to explore your therapeutic work with clients. As described by Scott (1999) from a family therapy perspective:

“Supervision is a process of discovery. It is a time when two or more people reflect on their work together in order to liberate them to be as creative as possible in their work. It may be a time to decide where and how to increase skills or to change some work practices. It may also be a time when administrative issues can be discussed. It may be a time when the wisdom of one person is passed on to another person as a form of mentorship.”

Clinical supervision provides numerous benefits for staff well-being and professionalism by providing opportunities for workers to:

• Seek guidance, and practical information for client cases
• Maintain professional competence (e.g., staying up to date with workplace demands)
• Maintain professional identity and purpose (e.g., staying on track with workplace roles)
• Maintain professional integrity (e.g., ethical practice).

Whilst clinical supervision is beneficial for work with all clients, the complexities of forensic work make it particularly valuable. Forensic clients may present additional challenges for their AOD workers with particular issues relating to risk (to themselves, to others and to the broader community); complexities in relation to information sharing which differ from other clients; challenges for the clinicians in responding to antisocial or criminal attitudes and behaviours of their clients; and working with the dual systems of AOD treatment and Corrections.

To manage some of these challenges effectively it is important that agencies working with forensic clients place a priority on providing clinical supervision – separate to standard line supervision – to their staff.

Tips for Supervision:

• Establish and case-note the expectations, roles and commitments of the supervisory relationship at the commencement of the supervision – such as how the supervision sessions will work, what areas of practice the supervisee wants to develop, what client information will be recorded, and what is expected of the supervisee;
• Prioritise higher risk clients for discussion in supervision. This will ensure that you are optimising the time you have available, by focusing on the most challenging clients, targeting the greatest risk issues and gaining insights that can be applied to other lower risk clients.
• Use supervision to help develop case formulations. It can be highly beneficial to be able to explore and test your assessment/interpretation of a client’s presentation with another experienced clinician, as a way to focus your work with this client and to develop your clinical skills more broadly.
• Consider establishing regular group clinical supervision or peer reflective practice sessions. There are significant benefits to reflecting on your client work with your peers and sharing knowledge and insights. Clear ground rules should be established, however, to ensure that all participants feel safe to share their experiences without judgement or criticism from their peers.
• Be mindful of client confidentiality during supervision – either conceal the identity of the client and associated parties, or ensure that your client consent process clearly explains how and when their personal information may be disclosed with supervisors.
• Consider opportunities to engage external clinical supervisors. For some agencies, where there are limited clinical supervisors internally, it may be appropriate to engage external supervisors to provide group or individual clinical supervision to staff. External supervision can be beneficial in providing clear differentiation between the “line” supervision of the agency, and the clinical development of workers.

References:

Scott, L. (1999). The nature and structure of supervision in health visiting with victims of child sexual abuse. Journal of advanced nursing, 29(3), 754-763.

Carroll, M. (2007). One more time: what is supervision? Psychotherapy in Australia, 13(3), 34.

Day, A. (2012). The nature of supervision in forensic psychology: Some observations and recommendations. The British Journal of Forensic Practice, 14(2), 116-123.

Mullarkey, K., Keeley, P., & Playle, J. F. (2001). Multiprofessional clinical supervision: Challenges for mental health nurses. Journal of psychiatric and mental health nursing, 8(3), 205-211.

Self-Care

Stress is our body’s natural way of responding to the demands of life and is something we all experience. However, when stressors accumulate it can create chronic stress that becomes hard to manage. Working with forensic clients comes with its own unique set of challenges and stressors such as threats to self, challenging client behaviours, compassion fatigue, burnout and exposure to vicarious trauma, which can all have effects on mental health.

While different people experience and respond to stress differently, some of the consequences of chronic stress include sleep disturbance, poor concentration, confusion, anxiety and headaches.

Why practice self-care in the workplace?

Self-care is an important practice that facilitates competency and ethical practice, and assists in maintaining clarity of judgment – which are especially important when working with forensic populations. If you start to feel stressed or overwhelmed, it can be helpful to take time to understand the causes of your stress. Prioritising time to practice self-care and support yourself during stressful times can help to mitigate its negative effects and help you to be more in control of your reactions and emotions. It is important to be aware of the effects of our work on our mental health and wellbeing, and implement strategies to address these effects and ensure self-care.

Strategies to help manage stress in the workplace:

• Know when to remove yourself from a stressful situation. Take a walk or make a cup of tea to give yourself some time to reset.
• Maintain work-life balance; establish boundaries and rules.
• Take proper work breaks and take time off when you need it
• Monitor your caseload (aim for a variety of clients/presenting issues)
• Seek help from colleagues, supervisors or your EAP provider.
• Debrief
• Learn and practice techniques to reduce stress levels
• Focus on what you CAN do, rather than trying to change things that aren’t going to shift
• Share your feelings in an appropriate setting (e.g. supervision)

Simple self-care tips:

• Do physical activity that you enjoy – walking, running, yoga, gym, gardening
• Take time for relaxing activities – journaling, breathing exercises, listening to music
• Plenty of rest
• Take time for planned relaxation
• Make the pleasurable things you do a priority
• Share your feelings with others
• Spend time with others whose company you enjoy
• Take time to eat healthy and nourishing foods
• Make time for self-reflection

What self-care strategies work for you? If one isn’t working for you, try another for a change. Remember, not all approaches will work for everyone, so try different things until you find a strategy that suits you.

Strategies for Team Leaders

Team Leaders and managers can help to create a team culture that supports staff and helps to reduce workplace stress. Some strategies include:

• Providing opportunities/space to listen to concerns of their team members
• Finding ways to address these concerns
• Supporting staff to take breaks and to leave work at work
• Include relaxation activities as part of the day to day work (walk at lunch-time, yoga/meditation before work)
• Consider walking meetings to get staff away from the office/desk
• Provide regular supervision and peer support
• Keep staff members up to date with any changes in the organisation – communicate regularly
• Encourage team members to generate new ideas for the team to function
• Hold team building days or activities to encourage a supportive workplace for all staff

Six free mental health and wellbeing tools we recommend:

Smiling Mind

Smiling mind is a mindfulness meditation app designed by psychologists to provide children and adults with simple and practical mindfulness tools. The app can set daily meditation reminders and help you develop more advanced mindfulness practices as your skills develop.

Free Guided Meditations

UCLA Mindful Awareness Research Center provides a range of introductory mindfulness meditation practices, with sessions including “Breathing Meditation” and “Body Scan Meditation”.

ReachOut Breathe

ReachOut Breathe helps users to actively reduce the physical symptoms of stress and anxiety. The app helps you control your breathe and measures your heart rate using the camera in your phone, helping you control some of the symptoms of stress such as shortness of breath, increased heart rate and tightness of the chest.

Music eScape

Music eScape uses your music library to create a playlist based on your mood. The app lets you create a music playlist to match your mood or select a music journey to express, enhance or change your mood.

MyCompass

MyCompass is a personalised and interactive self-help tool aimed to help people improve their mental health and gain control of stress or anxiety.

Headsup 

The Headsup website provides a range of information and strategies to implement in personal and workplace contexts to help improve mental health and wellbeing.

 

References:

Darcy Brown, Artemis Igoumenou, Anna-marie Mortlock, Nitin Gupta, Mrigendra Das, (2017) “Work-related stress in forensic mental health professionals: a systematic review”, Journal of Forensic Practice, Vol. 19 Issue: 3, pp.227-238

Dreier, A. S., & Wright, S. (2011). Helping society’s outcasts: The impact of counseling sex offenders. Journal of Mental Health Counseling, 33(4), 359-376.