PEERsonal growth

For most of us this is our first experience of being an Assistant Psychologist (AP). Joining a new team is a daunting experience for anyone, but to do so during a global pandemic, where meeting people face-to-face was prohibited, made it even harder. Working from home made us all feel quite disconnected and we didn't get a proper sense of the job role. We were all sometimes left wondering "am I doing this right?".

Luckily, senior management recognised our concerns, and encouraged us to create Peer Supervision Sessions. Throughout these sessions we identified themes of difference of power, competitiveness, wellbeing, continuing professional development (CPD) and relational safety. Now, 18 months into our peer supervision journey, we have been able to reflect on the positive and negative elements of our experiences so far.

Clinical Supervision vs Peer Supervision

Supervision is recognised as a key part of the psychological profession throughout all stages of career development (The British Psychological Society, 2007). According to British Psychological Society (BPS) guidelines, APs should receive a minimum of two hours per week of quality supervision (The British Psychological Society, 2011).

Whilst formal clinical supervision is deemed a requirement, peer supervision is not embedded within the guidance. Peer supervision is defined as "facilitated, planned, or ad hoc interactions with colleagues of similar experience levels for the purposes of clinical training, professional development, mutual aid and affinity" (Golia & McGovern, 2015). Several models of peer supervision are available, and evidence suggests that they are effective in reducing stress and increasing resilience and job satisfaction.

Despite mandates from the BPS (Golia & McGovern, 2015), finding time for clinical supervision can be difficult. A quarter of APs report receiving less than 50% of the minimum required supervision time each week (Snell & Ramsden, 2020). Reflecting upon our own experiences, this statistic was not surprising. Clinical responsibilities take priority, and practical difficulties such as annual leave and vacancies of qualified psychologists impact the availability of time for clinical supervision.

Working from home made us all feel quite disconnected and we didn't get a proper sense of the job role. We were all sometimes left wondering "am I doing this right?"

Peer supervision has provided something unique to our practice. We meet monthly as a face-to-face group for a minimum of two hours with a focus on CPD, wellbeing and the development of research skills within a clinical setting. The format is flexible and can be changed to meet the needs of the group. We focus our sessions on our Social GGRRAAACCEEESSS: gender, geography, race, religion, age, ability, appearance, culture, class, education, employment, ethnicity, spirituality, sexuality and sexual orientation (Burnham, 2012). These topics help us to discuss and navigate new clinical challenges.

Power

Clinical supervision is a space to draw upon the expertise and experience of qualified psychologists to aid professional development. However, power is acknowledged as a challenge within this format of supervision (BPS, 2011). There is a clear hierarchy within psychology, and while we acknowledge that this is essential for structure and leadership, we have all experienced power differential within our own individual supervision. On reflection, this may be because of an underlying awareness that supervisors have the power to influence our career progression, and we have acknowledged that this generates feelings of anxiety. As a result, there is a pressure to present ourselves in a positive light and this tends to influence what we feel comfortable discussing in clinical supervision. 

Peer supervision offers an alternative forum. There is less overt power to manage as the group consists of professionals in the same role (Benshoff & Paisley, 1996; Cousellman & Weber, 2004).  

We are mindful that power dynamics can shift depending on levels of experience within the group. We recognised that within our group everybody has different clinical backgrounds, has spent varying time working in the service, and has knowledge across different specialities.

We quickly created a culture where decisions are made collaboratively and there is no leader. This helps to minimise the power dynamic and brings a feeling of safety to our sessions. We believe this has allowed us to be more vulnerable about the questions we ask and minimises the anxiety created by power. Peer supervision has been particularly beneficial when seeking advice for undertaking neuropsychological assessments for the first time and has allowed us to develop our confidence and competence without the fear of judgement.

Wellbeing

One in 35 people are on an NHS waiting list for support from mental health services, meaning that pressure on these services is at an all-time high (NHS Confederation, 2022). This environment puts staff under pressure as services attempt to meet rising demands. There is a link between staff wellbeing and patient outcomes (Sizmur & Raleigh, 2018), therefore, the need to prioritise wellbeing has never been more important.

Peer supervision has played a vital role in increasing our wellbeing at work. Our sessions give us the chance to take a step away from our clinical responsibilities and focus on ourselves.

Peer supervision has played a vital role in increasing our wellbeing at work. Our sessions give us the chance to take a step away from our clinical responsibilities and focus on ourselves. Having the time to discuss the pressures of the job with people who have a mutual understanding of the role has helped us all to connect and feel as though we are not alone.

In our line of work, it is not uncommon to feel guilty for taking wellness breaks when clinical demands are so high. Being a part of this group and taking protected time out together has helped to minimise this. We have collectively found that after leaving a peer supervision session we feel more relaxed and more confident in our ability to manage the stressors of our day-to-day job.

Research suggests that having dedicated time for supervision leads to benefits including reduction in stress, anxiety, and improvements in job satisfaction (Rothwell et al., 2019). Our peer supervised safe space has allowed us to offload the struggles that come with being an AP and being able to connect through mutual demands of the role has been beneficial for our wellbeing and has significantly increased morale.

Continuing professional development

The position of an AP is typically the first step in the path towards becoming a qualified psychologist, thus dedicating time to improve our knowledge and skills is a necessity. CPD exists to maintain and enhance professional skills (BPS, 2010) and BPS guidelines recommend 3.75 hours of CPD a week for APs (BPS, 2011). However, we found that in our roles sometimes clinical responsibilities must be prioritised over CPD.

For us, the benefit of peer supervision is that it offers us an opportunity to focus on our professional development outside of our regular duties. In these sessions we are in control of the structure of supervision and decided to focus our CPD in two areas. First, increasing leadership and presentation skills and secondly, staying up to date with current literature relevant to our roles and embedding this in our clinical practice.  

For a few sessions, each assistant has been asked to prepare a presentation on a chosen topic and to circulate a relevant piece of literature for the group to analyse. These presentations have become valuable spaces that allow us to share resources and signpost each other to relevant literature across different topics applicable to working in learning disability services. Delivering these presentations has helped us to take on new challenges and has instilled confidence in our own abilities and knowledge.

Competitiveness

Everyone in the group is aspiring for a place on a doctorate training course. The course represents a limited resource due to restricted funding for places and a disproportionate number of applicants who wish to pursue the course each year (Golding 2018), which has created a highly competitive environment for aspiring students. Within our peer supervision sessions, we have been fortunate that competitive attitudes have not been a driving force. This may stem from an initial negative experience we had when discussing the doctorate application process early in the development of our peer supervision group.

We reflected upon how this situation evoked uncomfortable feelings of competitiveness and was not effective for our agreed ethos of supervision. This led to the space feeling unsafe and fed into our anxieties and insecurities about our own abilities. As a result, we collaboratively established boundaries and do not seek support with doctorate applications in these sessions, choosing to take this to clinical supervision instead.

By purposefully separating peer supervision from the doctorate, we have created a culture where we do not see each other as a threat, but rather a supportive network that we can draw knowledge from. We believe that this culture was created through taking the time to get to know each other on a personal level before we shifted the focus onto professional development. The unity that we feel as a group has increased our emotional resilience and will help us to mitigate the negative consequences of competition in the future. 

Group dynamics

A lack of permanent contracts, coupled with a desire to seek a varied portfolio of experience, means that there is a high turnover of staff within AP posts. Our experiences have taught us that group dynamics can be fragile, and when people leave or join the group this presents a significant challenge. Reflecting upon Tuckman's Stages of Group Development (Tuckman, 1965), we have recently moved from the Performing Stage to the Storming Stage, now that a new AP has joined the team.

In our experience, despite working in busy clinical services, dedicating two hours a month to peer supervision has provided many benefits.

We were naturally apprehensive that a new arrival would potentially disrupt the safe environment we had created, but we quickly welcomed the opportunity to add to the diversity of the group. We recognised the importance of supporting the individual to integrate into an already established group in order to maintain the balance. We used the principles of our early supervision sessions to focus on building relationships and exploring what the group will look like going forward, in order to allow the new AP to become an equal stakeholder and to feel confident in influencing how we spend this protected time.

Membership of the group has been stable and so the group has not entered the Adjourning Stage (Tuckman, 1965). We are aware that this is inevitable and may change the function and dynamic of the group. Our awareness of these stages has helped us to plan and prepare for changes to ensure the integrity of the group is maintained.

A unique and fluid space

In our experience, despite working in busy clinical services, dedicating two hours a month to peer supervision has provided many benefits. It has given us a unique and fluid space to focus on professional development and wellbeing. And, while there can be challenges such as competitiveness and shifting group dynamics, we have found that these can be managed by prioritising positive relationship building in a safe and equal environment. For us, having a smaller group is more impactful as we are able to connect more easily, and all our voices are heard. We step away with an increased morale and feel valued, respected and listened to.

Although peer supervision is not mandated, our experience has demonstrated to us that it is an invaluable space that we hope to embed at all stages of our career. Establishing the group was relatively easy given that the responsibilities are shared, and we would encourage other APs to set aside time for peer supervision. We have shared what has been beneficial to us, but this is by no means a strict guideline on how peer supervision should run. The beauty of peer supervision is that it is a fluid space, that can be moulded to fit your needs at the time.  Reach out to others in your service and set up that first meeting. If we all promote and implement peer supervision within our services, it has the potential to change the landscape of staff support in the future.

About the authors

Amy Yuill, Charlotte Ellis, Hannah Tait and Jess Bradley are Assistant Psychologists working within Adult Learning Disability Services across Durham and Darlington.

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