Mental health pre-registration nursing students' experiences of group clinical supervision: A UK longitudinal qualitative study

Nurse Education in Practice 14 (2014) 123e129

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Mental health pre-registration nursing students’ experiences of group clinical supervision: A UK longitudinal qualitative study Neil Carver a,1, Nicola Clibbens a, 2, Russell Ashmore a, *, Julie Sheldon b, 3 a b

Sheffield Hallam University, United Kingdom Rotherham, Doncaster and South Humber NHS Foundation Trust, United Kingdom

a r t i c l e i n f o

a b s t r a c t

Article history: Accepted 29 August 2013

There is widespread international interest in the use of clinical supervision in nursing as well as recognition of the need to introduce nursing students to its concepts and value. This article reports on a three-year longitudinal qualitative focus group study which explored students’ views and experiences of a group clinical supervision initiative. Students attended supervision groups facilitated by teaching staff over their three year pre-registration mental health nursing course, with a main aim of developing skills, knowledge and attitudes as supervisees. The findings showed that students derived benefit from the experience, gained greater awareness of the nature of supervision and became active supervisees within their groups. These benefits took time to emerge and were not universal however. While the findings support the value of exposing students to the experience of group clinical supervision educators wishing to implement such a programme need to address a host of issues. These include; the preparation of students, structural and resource concerns, and issues relating to group dynamics. Ó 2013 Elsevier Ltd. All rights reserved.

Keywords: Clinical supervision Focus groups Group clinical supervision Mental health Pre-registration nursing Qualitative research

Introduction Within the United Kingdom (UK), there have been accounts highlighting the value of clinical supervision for registered nurses since 1989 (Butterworth et al., 2008) and more specifically continuing recognition that clinical supervision should be part of mental health nursing (Department of Health [DH], 2006). Within the UK and for the purposes of this article, clinical supervision is defined as: “.a formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice, and enhance consumer protection and safety of care in complex clinical situations” (DH, 1993). There is also recognition of the need to introduce preregistration nursing students to the theory and practice of clinical

* Corresponding author. RM 204 Mundella House, 34 Collegiate Crescent, Sheffield S10 2BP, United Kingdom. Tel.: þ44 (0)114 225 5489; fax: þ44 (0)114 225 5394. E-mail addresses: [email protected] (N. Carver), [email protected] (N. Clibbens), [email protected] (R. Ashmore). 1 Tel.: þ44 (0)114 225 5750. 2 Tel.: þ44 (0)114 225 5912. 3 Tel.: þ44 (0)1302 7960106. 1471-5953/$ e see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.nepr.2013.08.018

supervision (Cutcliffe and Proctor, 1998; Ashmore and Carver, 2000; Cleary and Freeman, 2005; Clibbens et al., 2007). The interest in clinical supervision is paralleled across Europe, North America and Australasia although discussion is hampered by the fact that the term clinical supervision is conceptualised and used in different ways (Cutcliffe and Lowe, 2005; Haggman-Laitila et al., 2007; Buus and Gonge, 2009; Severinsson and Sand, 2010). In the UK and within this article, clinical supervision refers to the support of a practitioner who attends pre-arranged supervision sessions without the expectation that the supervisor will directly observe practice. Despite the above, one recent review of the clinical supervision literature has highlighted its value but was largely focused on clinical supervision for registered nurses (Jones, 2006; Brunero and Stein-Parbury, 2008; Butterworth et al., 2008; Buus and Gonge, 2009). Buus and Gonge (2009, p. 262) note; “Clinical supervision in psychiatric nursing is commonly perceived as a good thing.” but “.the empirical evidence supporting this claim is limited”. Nevertheless, attempts have been made to establish an evidence base showing a causal relationship between clinical supervision, quality of care and patient outcomes (White and Winstanley, 2009, 2010). In practice the prevalence of clinical supervision varies greatly (Butterworth et al., 2008). Buus et al. (2009) described studies

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Table 1 Focus group data generation points. Year 1

Year 2

Year 3

Unit 1

Unit 2

Unit 3

Unit 4

Unit 5

Unit 6

Two focus groups e

e

e

e

e

Cohort 2

Four focus groups (see Carver et al. (2007) e

e

e

e

Two focus groups e

e

Cohort 3

Two focus groups e

Two focus groups

One focus group

Cohort 1

showing that between 33% and 81% of psychiatric nurses engaged in the activity. Clinical supervision may be delivered in both individual and group formats (Hawkins and Shohet, 2006) with individual supervision predominating in the UK (Edwards et al., 2005) and both formats being equally effective (Edwards et al., 2005). Few authors discuss the experiences of student nurses in either group supervision per se (for example Markham and Turner, 1998; Severinsson, 1998; Lindgren et al., 2005; Saarikoski et al., 2006; Arvidsson et al., 2008) or in arguably similar ‘reflective practice groups’ (Platzer et al., 2000a, 2000b). If clinical supervision is to succeed it is important to explore how pre-registration students may be introduced to this activity. This article presents the third stage of a wider project that aimed to evaluate a programme designed to orientate students to clinical supervision. The group clinical supervision programme itself was based on a successful evaluation of a similar short-term initiative (Ashmore and Carver, 2000). The group clinical supervision programme The programme had the following aims;  To support and develop students’ learning by critically exploring the links between theory and clinical practice,  To develop students’ skills, knowledge and attitudes as supervisees and supervisors,  To offer the opportunity to learn in a small group setting. At the time of the study the three-year mental health preregistration nursing course consisted of six units of learning, each with one clinical placement. Clinical supervision groups of 10e12 students met with the same supervisor on three occasions during each placement. Groups maintained the same membership over the three years other than in exceptional circumstances, for example a student returning from maternity leave to a different cohort. Groups lasted between one and one and a half hours. Attendance was a required part of the course. A two-hour didactic session introduced students to the principles of clinical supervision and the programme. Students had a choice of two supervisors. The programme’s protocols are described in greater detail elsewhere (Clibbens et al., 2007).

idea of supervision, although there were significant anxieties both about supervision in general and of group supervision in particular (see Carver et al., 2007). The aim of this third stage of the evaluation (as described below) was to explore mental health students’ views, opinions and experiences of the group clinical supervision initiative. Focus groups were chosen because they allow the collection of large amounts of ‘rich’ data as well as enabling the researcher to probe issues as they arise (Kitzinger, 1994). Methods A purposive sample of 44 students in total was recruited from three consecutive cohorts enabling data to be obtained from all parts of the course (see Table 1). Findings from the Unit 1 focus groups (examining students’ expectations of supervision) have previously been reported (Carver et al., 2007). A total of nine focus groups were conducted between Unit 2 and Unit 6. Each was comprised of between four and eight participants and lasted 45e 60 min. Discussions were guided by a semi-structured question schedule developed from a review of the clinical supervision literature and analysis of the findings from an earlier short-term initiative (Ashmore and Carver, 2000) and stage two of the evaluation (Carver et al., 2007). Groups were facilitated by a research assistant (JS), audio-taped and transcribed verbatim. Analysis Transcripts were analysed independently by two researchers (NC and NC) using a process of thematic analysis outlined by Burnard (1991). Open coding of the transcripts generated preliminary themes, which in turn were finalised following discussion between the researchers and a process of ‘member checking’ with the participants (Lincoln and Guba, 1985). This procedure did not result in any changes to the preliminary themes. In order to enhance the richness of the data care was also taken to ensure that where possible degrees of consensus and dissent were incorporated in the development of the themes. The quotes presented in the findings exemplify ‘typical’ statements, disagreements, and illustrate issues of consensus in the group. Rigour

Evaluation of the group clinical supervision programme The evaluation of the programme comprised three stages. Stage one consisted of semi-structured interviews with mental health nursing lecturers and aimed to explore their views and experiences of facilitating the supervision groups. The findings suggested that the idea of undertaking supervision for students is attractive to lecturers, although not without challenges (see Ashmore et al., 2012). Stage two consisted of four focus groups aimed at exploring students’ expectations of clinical supervision prior to taking part in the programme. The findings suggested that students valued the

The rigor or trustworthiness of this study was established using the four criteria of credibility, dependability, confirmability and transferability (Guba and Lincoln, 1994). Credibility was enhanced by data being derived from ‘real-life’ supervision groups facilitated by different lecturers over a three-year period and at different stages of the course. As mentioned above, independent analysis of data and member checks were also used. Dependability was established through the rigorous application of the methods used to generate and analyse data in the study. Confirmability or the attempt to minimise the influence of the researcher on the reported findings was addressed by the employment of a research assistant

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to undertake the focus group interviews with the students and the independent analysis of the data by two of the authors. Transferability ‘refers to the probability that the study findings have meaning to others in similar situations’ (Streubert and Carpenter, 1999, p. 29). While it is difficult to conclusively demonstrate this, the discussion section in this article attempts to places our findings in a wider context. Ethics Approval to undertake the evaluation was granted by the ethics committee of the School of Nursing and Midwifery. Findings Analysis of the findings produced seven major themes which are presented below. Preparation This theme outlines statements made by participants about being prepared to engage in clinical supervision. At every sampling point some participants felt that their preparation for clinical supervision had been only partially successful perhaps because, as acknowledged in year two, some students felt overwhelmed at the beginning of the course. This may explain why some continued to deny that there was any preparation even when their peers pointed out that they were mistaken. Although participants suggested preparation could involve experiential and didactic learning accompanied by filmed examples of supervision, one said; “.you’ve got to experience clinical supervision to understand it.” Understanding supervision This theme concerns the extent to which participants understood the meaning and purpose of supervision. In year one, participants were mainly able to distinguish supervision from appraisal and recognised that clinical supervision should focus on nursing practice. While no one felt that clinical supervision was a place to discuss any personal material, some believed that the supervision groups should include academic support, particularly in the early, ‘stressful part’ of the course. Participants recognised they often talked about difficult experiences in clinical supervision, but felt that positive experiences should also be discussed. Initially participants tended to discuss general issues in practice but by year three they were more focused on specific client case material. They also demonstrated greater understanding of the significance of group processes and dynamics for example, showing greater responsibility for managing behaviours such as monopolisation. However, a small number of participants never seemed to develop an appreciation of the value of supervision. The role of the supervisor This theme summarises participants’ views on the role of the supervisor. In year one, participants were concerned that supervisors may be obligated to pass on material that the student would wish to remain in the group. Some also questioned whether lecturers were sufficiently engaged with clinical practice to supervise. Neither of these concerns received any further mention. In addition, some questioned whether lecturers could remain impartial or avoid role conflict;

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“I don’t like him [the supervisor] because of what’s happened in a lesson.you want somebody who’s impartial and doesn’t know anything about anybody”. Another commented; “.it would have been better if they were from a different university.or someone from the wards.” By year three participants seemed less concerned; “.they’re detached from your placement but have some responsibility towards it as well”. By year two, participants were able to give informed opinions about key supervisory responsibilities including; keeping the group on task, maintaining ground rules, and managing individual behaviours in the group (for example the contribution of ‘silent’ supervisees). Participants appreciated supervisors who; used humour, were ‘laid back’, put students at their ease and shared their own nursing experiences. When participants were less happy it was because they; had a sense of not being able to “satisfy” the supervisor, found it difficult to understand what was wanted from them, and felt supervisors were too directive or not directive enough. Staying safe This theme presents participants views on the need to feel ‘safe’ from a psychological perspective, in supervision. There was also recognition that trust needed time to develop with groups being sometimes characterised by competitiveness rather than cooperation. Looking back, students felt that some of these issues resulted from not knowing other group members and were in agreement when one said: “I certainly wouldn’t have felt happy bringing up things when I first started, or confident to do it but now I’m able to do that”. One suggestion regarding this was that group membership could be based on any existing interpersonal relationships. Students also retrospectively criticised the perceived lack of choice of supervisor and peers; “I find it quite strange that you’re expected to bring.things to a group that you’ve not chosen to be in.” Nevertheless, by year two students were clearly describing the development of trust and cooperation; “.you get closer. We value each others’ opinions and respect each other.if we do have a problem we look forward to being able to discuss it in our group.” In another focus group, participants commented; S1: “I would say our group’s fairly good .not all of us agree but each of us respects the fact that the other has the right to their opinion.” S2: “Plus we’ve also got to know each other as well.” S3: “.I think that yeah.” S4: “Yeah it’s got better as it’s gone along hasn’t it?” S1: “Yeah, you’re more trusting of people as you get to know them.” S1: “.yeah it’s something that develops over time I agree with you.” Nevertheless, some never succeeded in fully establishing trust; “I brought up something that I wished I hadn’t. I felt that some group members were judging me.”

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Structure of supervision This theme describes comments on the structural elements and conduct of the supervision groups. There was a general consensus that ground rules needed to be adhered to by both supervisees and supervisor. Comments about group size suggested that some participants felt that some groups were too large. By year two, participants were expressing views about the frequency of the groups; “.sometimes waiting for supervision is like waiting for an eternity”. Some participants suggested that clinical supervision was not always effective as concerns were sometimes dealt with before the group for example by seeing their personal tutor. Participants suggested that groups were most effective when evenly spaced throughout their clinical placements and close enough to maintain continuity. Participants also felt that the groups should be longer in year one and two but shorter in year three due to their greater experience. There were also further comments relating to group membership. Some participants suggested students placed in a particular geographic location could attend a group held in that location. Others suggested groups could be composed of students undertaking the same kind of clinical experience at that time (for example acute care). In terms of the conduct of the sessions participants initially felt that each supervisee should take turns and have equal time to talk. However, by year two, participants had rejected this idea, preferring to prioritise important issues rather than obliging everyone to speak; “I’d rather listen to somebody who’s got something to say for twenty minutes than try and find something to say for five [minutes]”. Finally, some disliked the fact that attending clinical supervision was compulsory. Being a supervisee This theme describes participants’ views and experiences of being a supervisee. From year one participants suggested supervisees should; be assertive, be open, be aware of what they wanted from supervision, be confident to share in the group, adhere to ground rules, know when to listen and when to speak, respect others views, use time effectively, and make allowances for different personalities. In year one, some believed that the supervisor should have sole responsibility for dealing with difficult issues and provide definitive answers to clinical problems. By year two participants were; taking increasing collective responsibility for the supervisory process, being more actively engaged as supervisees, and recognising that they themselves were able to offer and accept suggestions of help. Impact of supervision This theme outlines participants’ views on the effects of supervision. In the first year, participants’ views were tentative; S1: “.sometimes you get something out of it but you can’t quite put your finger on it.” S2: “.you know it but you can’t just say you got this out of that group.”

By the second year participants were better able to articulate the contribution of supervisees and the value of supervision; “.if you have an open mind.and you’re listening to what’s going on.I can’t see where it can be detrimental to you, you can only benefit from it.” Or as another described; “.you get out what you put in.” Participants felt the groups provided alternative approaches to problem solving and a forum in which to challenge preconceived ideas: “You can work through the issues. systematically and logically and come up with. some answers. you could go in with your opinion and come out thinking totally differently”. Although some participants were unsure that clinical supervision had a direct impact on nursing care some were; “S1: .it makes you look at your own practice. S2: Yeah. S1: So you’re more self aware of what you’re doing. S3: You’re more thoughtful. S1: You’re getting other people’s ideas. S3: Yeah, you’re getting opinions and others’ experience. S1: It’s a chance to question practice. Collective: yeah. S1: It gives confidence as well when you go back to clinical practice. S2: Knowing that other people are dealing with it in a similar way. S3: .a similar way.yeah it does”. Participants agreed that groups provided support, were a place to ventilate feelings and validate experiences from practice; “.it’s taught me you’re not alone.because everything you do is new.and it’s nice to come back and share that”. Another commented; “I thought I shouldn’t be feeling like this.getting emotionally tired . Taking it to clinical supervision offered me reassurance that. anyone would be feeling like that.so I came out thinking well it was alright.”. Other gains included mentoring and assertiveness skills, knowledge of group dynamics and self awareness. Despite the above, a few participants did not believe that supervision was relevant to them and some simply disliked groups. One commented; “If you’ve support networks already, what is it we are supposed to be getting.from the supervisor?” Some also felt that the groups were stressful and could become “a moan box”; leaving them feeling exhausted. Others recognised they were part of a “difficult group” in which interpersonal conflict was never fully resolved and there was continuing disagreement with the supervisor.

Discussion The findings provide a detailed account of participants’ experiences in supervision and reflect their earlier expectations reported in Carver et al. (2007). In the main, participants developed an awareness of the supervisory process and became experienced

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supervisees who were able to successfully contribute to and utilise clinical supervision. The findings resonate with those of similar projects (for example Markham and Turner, 1998; Platzer et al., 2000a; Platzer, 2000b; Gould, 2004; Arvidsson et al., 2008) and following Holmlund et al. (2010), support the value of using group clinical supervision in nurse education. The findings show students becoming increasingly more autonomous learners, and active supervisees who value input from their peers. While it is undoubtedly the case that groups of this nature take time to develop (Platzer et al., 2000b; Hyrkas et al., 2002; Saarikoski et al., 2006) most reached what may be described as a ‘performing’ level (Tuckman, 1965). Nevertheless, the fact that some participants believed the groups should provide support for a broader range of student issues is a reminder that defining the scope of supervision for students must highlight the role of other support mechanisms available to them. Many of the participants’ comments show the ways in which supervision is valued, particularly relating to what has been described as its ‘educative’ and ‘restorative’ functions (Procter, 1986). Demonstrative statements reflecting Procter’s (1986) ‘normative’ function, identified by Brunero and Stein-Parbury (2008) (for example improving nursing care and critiquing practice) are present but less prominent. Participants also described gains that are unique to group supervision and identified in studies of qualified nurses (Cleary and Freeman, 2005; Buus et al., 2011). These included: benefiting from peers (Winstanley and White, 2003); the normalisation of their experiences (Holm et al., 1998; Platzer et al., 2000a); and being taken seriously by other group members (Platzer et al., 2000a; Holmlund et al., 2010). Supervision however was not always valued or successful, a point recognised elsewhere (Walsh et al., 2003; Arvidsson et al., 2008; Butterworth et al., 2008; Holmlund et al., 2010). Participants suggested that disagreements with their supervisor and interpersonal conflict in the group undermined its value, a dynamic also reported by Berg and Hallberg (2000). Nevertheless, it is unclear why some students did not benefit. While some may never value supervision per se it is possible that some may have gained from individual supervision. On the other hand, some of the participants’ negative views appear to signify resistance to their obligatory participation in the supervision programme. Certainly, supervisors of qualified nurses prefer supervisees to attend voluntarily (Arvidsson and Fridlund, 2005). So it may be argued that it is unfair to obligate students to participate in activities which are not strictly mandatory as a registered nurse, although it is worth noting that Lindgren et al. (2005) has described a positive evaluation of a similar obligatory group supervision programme. Nevertheless, when attending supervision is optional, there can still be high dropout rates (for example Fabricius, 1991). In addition, as Butterworth et al. (2008, p. 268) commented; “It is possible that those who most need clinical supervision may be less likely to engage in it and find it useful”. Finally, Platzer et al. (2000b) has demonstrated supervisees can feel ‘coerced’ even in the context of a voluntary supervision programme. Some participants e as do some qualified staff (Cleary and Freeman, 2005) e argued that formal supervision is not needed as it is available informally. Following Butterworth et al. (2008) this argument may simply represent a fear of formal supervision. The stance taken in the programme in relation to this point mirrored that of Teasdale et al. (2001), who suggest that there is a need for both informal and formal support mechanisms and Buus et al. (2011) who advised that informal ad hoc support mechanisms are no substitute for formal clinical supervision.

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Another issue for participants was the limited number of supervisors they could choose from. Edwards et al. (2005) showed that offering a choice of supervisor improved the effectiveness of clinical supervision. However, it does not follow that it is automatically the case that having choice is significant in itself. For example, a supervisee need not feel comfortable with any of the available supervisors. In reality, choices of supervisors will always be limited. If resources had enabled the programme to offer individual supervision, choice may have been enhanced by agreeing a probationary period between supervisee and supervisor; a strategy that is not feasible in group supervision. Some participants here also felt that they should be able to exercise control over group membership but were unable to suggest how this might happen. Despite the recognition that peer input in group supervision is reported as both valuable (for example Winstanley and White, 2003) and potentially damaging (Platzer et al., 2000b), the issue of participants’ control over group membership is often neglected. For example, in the study by Edwards et al. (2005), the issue of relationships between group members was not studied but can undermine the value of group supervision (Jones, 2003). Certainly here, some participants felt that extra-group relationships could negatively impact on trust in the group. It is unlikely however that conflict in groups can be avoided and therefore the challenge to supervisors is to be able to manage any emerging conflict effectively. Preparing people to experience supervision requires careful consideration (Carver et al., 2007; Kilcullen, 2007). We concur with those participants that noted sessions could have been improved by the use of video illustration of group supervisory processes. Certainly, didactic sessions are no substitute for experience of clinical supervision and it is noteworthy that participants here commented that they could only fully internalise the idea of clinical supervision through experience. Participants’ statements here, regarding whether the lecturer should be supervisor, are equivocal. Nothing in the findings suggested lecturers have uniquely beneficial characteristics to carry out clinical supervision. Ashmore and Carver (2000) suggested that potential advantages were that the lecturer was a continuous presence and as a ‘historian’ could highlight the students’ development over time. Neither of these advantages were mentioned by participants here. It is possible however that the success of the groups partly resulted from this continuity. Elsewhere Lindgren et al. (2005) and Saarikoski et al. (2006) both reported students valuing their lecturers as supervisors. A minor concern was that some participants believed that lecturers would experience conflict in their teaching and supervisory roles. Certainly qualified staff perceive a conflict in role when a line manager takes an additional role of clinical supervisor (Scanlon and Weir, 1997). Bowles and Young (1999, p. 963) also reported only 28.4% of their sample of qualified nurses selected supervisors from “within their area”; presumably to avoid such conflict. The programme protocol here recognised the possibility of similar role conflict and offered mechanisms through which students could choose not to be supervised by their personal tutor. This may have accounted for the lack of reported examples of role conflict taking place. A final minor concern related to the clinical credibility of lecturers as supervisors. This concern has been recognised elsewhere (Cutcliffe and Lowe, 2005) but as above was not reported as an actual problem. However, this negative evidence does not constitute an endorsement of the idea that lecturers should be supervisors as participants may have felt unable to raise this in the focus groups. Unsurprisingly, in terms of supervisory processes, participants here valued lecturers who performed as supervisory ‘gatekeepers’ and as facilitators who avoided the perils of both laissez-faire and over directive approaches.

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Turning to the structural elements of clinical supervision; our findings show that having gained experience of clinical supervision participants preferred time to be allocated to supervisees on the basis of mutually agreed priorities. Buus et al. (2010, p. 658) described findings where practitioners preferred a similar structure in which there was “mutual conversation”. This has an advantage in that individuals may not feel singled out but may allow some to avoid making a contribution. Other studies describe more formal models in which students are invited to present case material (Lindgren et al., 2005; Arvidsson et al., 2008; Holmlund et al., 2010). Our findings show that a more flexible and developmental model may be of equal value, with lecturers sometimes using both of these approaches in response to the particular needs of their supervisees. Although some participants felt that the groups were too large, it is not clear what impact group size actually had. Students initially feared the possibility of sub-grouping, factionalism and having to compete for time (Carver et al., 2007). If these dynamics occurred there were not reported here. Nevertheless, we also feel that smaller groups may have been more beneficial had more supervisors been available. Elsewhere, others have noted that participants preferred a group size of around six (Platzer et al., 2000b; Lindgren et al., 2005). Clinical supervision sessions of one hour in length seem most beneficial for qualified nurses (Winstanley and White, 2003); the findings here suggest that (at least within educational settings) consideration could be given to varying the length of sessions in relation to the experience of the supervisee. Finally, although there is nothing equivocal in the findings here, the consensus, as elsewhere (Winstanley and White, 2003; Edwards et al., 2005), appears to support clinical supervision being delivered on a monthly basis. Limitations It is possible that the views of participants here do not represent those of the whole cohort of students and although there is no evidence in the data to suggest this, it is possible that some participants felt inhibited within the focus groups. On the other hand, evidence supporting the credibility of the findings may be found in their consistency with the findings generated by the earlier shortterm initiative (Ashmore and Carver, 2000) and in each stage of this evaluation (Carver et al., 2007; Ashmore et al., 2012) as well as the wider literature on clinical supervision. Conclusion The findings have demonstrated the value of such a programme in enabling students to become supervisees in group clinical supervision. Nevertheless, they should be treated with caution and it is clear that educators wishing to implement such a programme face many challenges. These include; how to best prepare students for taking part in supervision, structural and resource concerns as well as issues relating to group dynamics. It may be argued students also need exposure to alternative models, particularly of individual supervision but this would be considerably more resource intensive than the programme investigated here. Whichever experiential approach is taken however, it must be accepted that engaging in supervision may always be a “risky business” (Carver et al., 2007, p. 775).

Conflict of interest statement There are no conflicts of interest.

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