Creative Practice for Self – Supervision

Introduction

Having your own Creative Practice prior to introducing it to your clinical practice is foundational, so the first step is to develop your own Creative Practice and get used to how the creative process works. It is your experience of this that will form and inform your perception while using your Creative Practice as part of your self-supervision. A Creative Practice is a resource for self-care and continued self-discovery as well as an aid to resilience and defence against burn out and vicarious trauma. This module is about how to use that resource as part of the self-supervision process. 

The development of an internal supervisor is intrinsic to effective psychotherapy and applying your Creative Practice to your self-supervision process enables you to be both reflective and reflexive in practice. Let me stress here, this does not replace your supervision with a supervisor, it better described as a way of preparing for supervision that gives you deeper insights into what is happening in the room.

An image can connect you back to the feeling in the room quicker than pages of process notes, because Images act as containers for process. As you look at the image you can reconnect with that somatic experience as you felt it with your client. When you need it to, an image can hold a difficult experience until you can see your supervisor or personal therapist. Having a Creative Practice journal gives you a safe place to put an experience down, and close the book, rather that holding that energy in your body.

Another way your Creative Practice helps is you can look back over time and notice patterns emerge for both you and your clients. You might notice that you always make the same kind of image with particular clients, or for certain issues, or at different times in the day or in the month. You may notice you make the same kind of image for a client who present different material each week, but your images show a common thread. A Creative Practice allows you examine process IN time as well as OVER time.

Your supervisor may be open to you bringing along your images and exploring them with you, but even if they are not, you could think of your Creative Practice as a resource that assists your preparation for supervision. By deepening your self- supervision process, you will bring new layers of understanding to your client work. You will select with clarity which clients you would like to discuss with your supervisor and which sessions you struggled with.

As I mentioned earlier, having your own Creative Practice will give you confidence around listening to your images so that when you start applying it to your self-supervision it will flow more easily. Equally so, using your Creative Practice for self-supervision it will improve your personal practice, as the time restriction means you can’t spend too much time thinking about what to draw. They work hand in glove as you allow your Creative Practice to develop the more you use it.

Creative Practice as a resource for self-supervision.

There are significant differences between your personal practice and the one you will use specifically for your self-supervision. The step-by-step method used in developing your Creative Practice will not apply in the same order, although the components are all still the same, the timing element is changed. Below are some of the main differences.

•      Self-supervision images are made quickly and are often with a pen or pencil as there is not usually time for much else.

•      Self-supervision images need to be kept in a separate journal and treated as you would your client’s process notes and kept in a way that complies with GDPR regulations.

•      Self-Supervision images are never added to clinical notes

•      These quick sketches are usually made between clients; you will not have time to do the reflection piece until the end of the day, at the weekend or before you attend supervision. The possibility of leaving out the reflection step is the greatest challenge and biggest difference as the timing requires a gap. Please, remember it is the reflection that offers insights and without that step discovery is limited.

Benefits of applying Creative Practice to Self-supervision

A Creative Practice offers you a visual representation of your experience with a client. Trust what you have drawn even if you can’t make sense of it in the moment.

Your Creative practice develops, strengthens and refresh's the internal supervisor which is essential to effective psychotherapy.

Applying your Creative Practice to your self-supervision process enables you to be both critically reflective and reflexive in practice.

It addresses our ethical responsibility to be fully present with your clients as it provides a way to put down your experience with one client, before moving on to the next.

Therapy is all about process - we have process too, and a Creative Practice gives us an opportunity to attend to that process quickly during the workday, and then reflect upon it at the end of day.

We are all at risk of vicarious trauma as it is the nature of our business to listen to the dramas of our clients’ day in and day out. Having a record of these experiences in the form of images quickly show us if we need to change something in our clinical practice, be that the number of cases presenting certain issues or the age demographic of our clients, etc This acts as a safeguard that can be discussed and assessed with your supervisor.

When to use your Creative Practice for self-supervision

•      In the gaps between clients, there is an opportunity to put down an image after the session. This time is usually reserved for notes, so the image need only be a quick impression of the session.

•      If you have confidentiality concerns around writing process notes, and clinical notes by their nature are reductive, an image will connect you with the session without revealing details that anyone else could recognise and with surprising clarity. Using the clients initials along with the date, will link the image with the client anonymous.

•      When you find yourself thinking excessively about a client, you might make an image for their last session with you. Having it held in the supervision journal, allows you to close the book and reflect on it before you see your supervisor so you can discuss what has stayed with you from the session. It may be that there was not anything particularly disturbing in their session, but it activated something in you that needs to be processed. The journal offers containment for your experience.

•      If you find you are somatically holding an experience you have had with your client i.e. a depressed client may leave you feeling flat, an anxious client might leave you feeling jitter etc.  Your Creative Practice will allow you release those feelings and cleanse the energy in the room for the next person coming in. Expressing it in your journal will release the body and restore calm.

•      Using your Creative Practice before seeing a client, can provide a pathway for intuition and assumptions you may unconsciously have around this client and their process.

•      One of the most effective uses for your Creative Practice for self-supervision is as psychological First Aid. If you have an intense or traumatic experience with your client, your Creative Practice journal will facilitate holding the experience for you until you get to your supervision or your personal therapist. The images made straight after this kind of session can be used to help you connect, express and explore the experience fully, thereby reducing the possibility of post-traumatic stress activation in your clinical practice moving forward.

Creating a safe boundary

Containment is necessary for all forms of Creative Practice and professional practice requires you to treat confidentiality and containment as an ethical requirement.

As I have mentioned, having a self-supervision journal, separate from process notes or clinical notes, will keep the process contained. I suggest you use every other page in your journal, so that when you go back to your image for the reflection stage, you will be able to have your reflections written next to the image.

Remember to use the client initials, date and time of the session and state if the image was made before or after session.

Respect the artwork even if it’s just a scribbled image. You may have enjoyed developing your personal Creative Practice, using lots of colours, and giving time to the image making process. If that is the case, your quick drawings made in biro may seem less important, but do not be fooled by the brevity of line, the meaning and message will be there.

Complete the process by making time for reflection. This is the biggest hurtle in developing your self-supervision practice, as we all want to stop work at the end of the day, but the process is not over till the reflections happens. Once the image is made it will hold the process, but you will need to go back to reflect upon your image to gain any new insights from making it.

Art Exercise

You will be making your drawings in real time after a session with your client, so this exercise is to outline the steps to take.

Consider a client session that was in some way problematic for you. Accept the first thing that pops into your mind, trusting your own guidance around why you have picked that client.

Imagine yourself in your own therapy space awaiting your client.

Look around the room and see it as you might if you were a client on your first visit. Notice the temperature and ambience of the room. What can you smell? Put yourself in the client’s chair and see if the seat feels comfortable? What is your impression of the space? Does it feel safe?

Now put yourself in your usual seat, and ask the same questions; is it comfortable? Do I feel safe?

Think about the person you are expecting and notice any changes in your body when you think about them coming in.

What thoughts are going through your mind?

What emotions are evoked when you think about this client?

In your mind’s eye, allow the client to enter the room and let the session to progress as you remember it.

Stay connected with your body as the story unfolds and make a mental note of how you are feeling.

Watch their facial expressions and the way they embody their story as they tell it.

Notice how you respond to your client.

What thoughts are going on in the background of your mind.

Imagine you could look down on the room from above, what would the impression of your interaction be.

Connect again with your body, and see if there are any sensations you notice and where they are located in your body. Notice your breathing and see if it has changed throughout the session.

When you feel ready and in your own time, make an image from the session.

(5 mins max)

In real time you will sit for a moment after your clients has left, connecting with your body sensations and emotions before making your image. Once the image is made close the journal and move on to making your notes.

Reflection

Questions to consider when reflecting on your image

•      What is your impression of the image?                                                              

•      Is the image telling you something obvious? If so ask yourself could there be more to it and which one of you is the message about.                                                        

•      Consider what interventions you used during the session might relate to this image?                                                                                                                                                                                                   

•      If your image has more than one component, can you let parts of the image speak to each other? E.g. A drawing of a person kicking a ball, would mean you could speak from the ball or the person.

•      Do you have any sense of the image being about your process or your clients?  

•      From a supervision point of view, could this image be about:  Projective Identification, Transference, Counter transference or other.

•      Has the client material activated an old pattern of defence in you.

•      Does the image convey any sense of the co-created dynamic in the room and what might that dynamic be telling you.

•      What is the feeling you are left with?

•      Do you want to bring this session to supervision and if so, why?

As so much of this experience is subjective, I have given some examples below from my own supervision journal to demonstrate how to process your images. It is helpful if your supervisor is open to this way of expressing and exploring your clinical practice, but it is possible to do so on your own with great effect as you are bringing your insights regardless of how you reached them.

Examples of Creative Practice for self-supervision

 Image 1

This is an example of countertransference.

The Image was made after seeing a client who I felt at the time was hanging on by a thread. I found I was thinking about them a lot outside of office hours and I believed my image was indicative of their state of mind. I thought the image was about them at the time as it seemed to have an obvious message.

After reflecting on the image however, I realised that I felt like I had to untangle their very complicated material and was feeling overwhelmed by the complexity of their case.

On reflection I could see the enmeshment with their material and could let go of the fear I had for them recognising the agitation I was feeling was not concern for their wellbeing, but my own frustration that I couldn’t figure it out. The image helped me to let go and separate from the client material.

Image 2

This was an example of projective identification.

After the session I was so angry at my client’s parents for the way they were treating her and felt that anger to be totally justified by their abusive behaviour.

Through discussion with my supervisor, I realised that my client didn’t appear to feel any anger at all, accepting their behaviour as normal. I was feeling the anger my client couldn’t feel for themselves and identified with it so much it felt like my own.

 This image brought my client’s disconnect to my attention and allowed me to include that the next time we met. Without the image I might have remained unconscious of the ‘felt sense’ I experienced in an embodied way when I was with my client making it difficult to process.

    Image 3    Parallel process

This image was made before seeing a client, whom I believed was walking a tight rope around returning to self-harming behaviour, so the image I made was not a surprise to me.

I held the image lightly at the back of my mind throughout the session. It was not until I was reflecting on it that I realised it was an instruction to myself; to keep myself very balanced while encouraging my client to do the same.

The questions I was asking myself throughout were, can I trust my client to keep herself safe and how can I support her to do that. It was this image that helped me stay aware of the need to hold a really safe space for my client but also to acknowledge how much I was holding and balancing when working with her. Sometimes an image from the intuitive aspect of us knows exactly where our attention needs to be focused.

  Image 4 Transference

I made this image after a first session with a client. (Which is not usually my habit) My experience of sitting with her was like there was a sheet of plate of glass between us. Outwardly, she presented as open and receptive and yet I was left with this feeling of nothing being allowed to pass between us.

Understanding what this image was about did not emerge until much further into her therapy, (session 9) that she spoke of needing to protect herself from an overly critical mother by imagining herself to be inside a glass bubble.

I immediately remembered my first experience of this client and realised the transference had worked its way through.

Recap

•      This module considered the differences between using your Creative Practice for personal use and for self-supervision.

It showed the benefits of applying your Creative Practice to self -supervision in a way that works for you, daily/weekly before supervision

•      Yu will have learned the need and structure for safe boundaries around your practice and the importance of confidentiality regarding your supervision journal

•      You will have done the art exercise herein, and from that had your own experience of applying Creative Practice to a client.

•      You will have learned how to reflect on your image to gain insights and saw that insight doesn’t always emerge straight away.

•      You will have seen the kind of questions to ask about the images and opened your mind to the possibilities of sharing these insights with your supervisor.

It is only by using your Creative Practice for self-supervision that the real value comes to light. This is a new way to explore the therapeutic relationship and to include yourself more in a profound way. In a business that, by its nature is solitary, having a Creative Practice is a safe way to have another voice in the room, another perspective around what is going on for both you and your client.