Supervision: Part II: Peer Supervision

(This is the second part of the article I wrote for NJAMT News on professional clinical supervision for music therapists. The first part is here.)

Supervision: Part II: Peer Supervision

Roia Rafieyan, MA, MT-BC

The previous article looked at professional clinical supervision, addressing common misunderstandings about the role of the supervisor and describing what one might expect when one seeks the services of a clinical supervisor.

Another avenue for growth as a professional music therapist is peer supervision. This article will discuss the benefits of this way of learning and offer the author's experiences with her peer supervision group as one example.

What is peer supervision? How is it similar to/different from supervision with a clinical supervisor?

In contrast to professional clinical supervision, where a therapist with more experience acts as a mentor to another music therapist or a group of music therapists generally for a fee, peer supervision refers to both formal as well as informal connections between therapists who draw on each other's strengths and abilities as a means of developing their competence and effectiveness as music therapists.

Peer consultation/supervision can be as simple as posting a request for information on a music therapy email list or having a conversation with a trusted fellow clinician about a particularly difficult case. Some music therapists choose a more formal option. This involves working with a consistent group of people setting aside a specific time and place, agreeing on areas of focus and having a mutual commitment to ongoing professional growth. This piece will focus on my experience as a participant in a formal peer supervision group.

Where does it happen?

Our group chose to alternate meeting at the work sites of two of our members. Having enough physical space and access to a variety of instruments was important to us because we all felt a strong desire to use music-making as a part of our process. Just as significant was the need to find a central location since the group was spread out over a large geographic area.

How often? How long?

While meeting once a week or twice a month would be ideal, peer supervision groups can meet as often as is practical. The best our group was able to accomplish was to meet once a month. Meeting for about an hour and a half seemed to be a reasonable timeframe for our group which ranged in size from three to five people. This allowed each person to present case material and look at issues and gave us an opportunity to use the music to explore various aspects of our selves which affected the way we work with our clients.

What happens in a peer supervision group?

The group will develop its own rhythm. Ours gathered, checked in with each member, trying to find a common theme and come to a group consensus regarding the issues we wanted to focus on for that particular meeting. If no theme emerged, we did some musical exploring and improvising, starting with where we were and how we were feeling about our work. The music helped to initiate discussions through the act of listening to each other, analyzing our own musical experiences and observing the group process. Sometimes this would lead to more music-making with a more specific focus.

Different groups, because they are made up of different music therapists, will choose different approaches. While it could be a simple as a sharing of ideas and resources for music therapy experiences, it can also be a deep as supporting members to cope with profound feelings of helplessness or secondary traumatic stress and burnout.

How does this process help us increase our effectiveness as music therapists?

Music therapists have a unique opportunity to develop the skill of self-observation and to experience first-hand the dynamics and processes involved in group work when they engage musically and verbally in a self-examining peer supervision group with other music therapists.

By exploring our own feelings about and reactions to the work we do with our clients and our work situation(s) using music, we learn how to better engage our clients in a similar process. This enables us to become more effective in our work.

Helpful tips (based on our group's experience):

§ Let one or two people take responsibility for initiating, organizing and maintaining the group.

§ Meet in music therapy rooms in group members' workplaces (with permission) because it gives access to a variety of instruments (melodic and non-melodic) as well as freedom from distractions. It also provides the space needed to work.

§ Establish a date for the next supervision group before the end of each meeting (or set out a long-term schedule). This helps to create a commitment to the group and to the process. It is also helpful to send out email reminders.

§ Do not allow the group time to become a gripe session about how awful workplaces can be. Use music to explore and identify areas in which your own resistance may make it difficult to understand and support your clients.

§ Look for common themes in the stories that you share, or begin by improvising music based on what is currently being experienced by group members.

§ Watch out for the tendency to avoid using the music and to steer clear of difficult topics.

In summary a peer supervision group is one in which a group of professional music therapists come together on a consistent basis, and they use the skills they have to help each other grow as music therapists. By engaging in this process they are able to learn to be self-examining and may then, by extension, be able to take their work with clients to a deeper level.

Resources

Music Therapy Supervision (2001, Barcelona Publishers; M. Forinash, Editor) has three chapters describing peer supervision as well as experiential music therapy groups.

Chapter 12: Peer Supervision in the Development of the New Music and Expressive Therapist (E. Baratta, M. Bertolami, A. Hubbard, M. MacDonald, and D. Spragg) Chapter 14: Experiential Music Therapy Group as a Method of Professional Supervision (G. Langdon)

Chapter 15: Peer Supervision in Music Therapy (D. Austin and J. Dvorkin).

Additionally, of course, there are the many remaining chapters which focus on supervision of students during practicum experiences and internships, professional supervision, and institute training/supervision.

The Dynamics of Music Psychotherapy (1998, Barcelona Publishers; K. Bruscia, Editor) is a helpful read. While the chapters don’t specifically address clinical or peer supervision, there is a clear focus on the dynamic processes of therapy, and there are a number of chapters which focus on uncovering unconscious countertransference reactions to clients and working with elements of resistance within the therapist.

Online resources

“Models of Clinical Supervision” by George R. Leddick: http://www.ericdigests.org/1995-1/models.htm

“Peer Consultation as a Form of Supervision” by James N. Benshoff: http://www.cyc-net.org/cyc-online/cycol-0801-supervision.html

“Peer Group Supervision”- presents a model of peer supervision for those in the business world as well as in social services. It lists six phases of peer group supervision. Some of the ideas may be useful in getting your own peer supervision group started: http://www.peer-supervision.com/index.html

Specific to a particular approach to psychotherapy, but it could be very useful: http://www.contextualpsychology.org/running_a_peer_supervision_group

"Truly there is a healing force in meaning." (Viktor Frankl)

When I saw the title of the book in the library, I knew I had to borrow it:

"The Unheard Cry for Meaning: Psychotherapy and Humanism"

Not surprisingly, it's by Viktor E. Frankl, the man who famously wrote "Man's Search for Meaning".

I haven't gotten very far into it, and now I have to dash off to get to a gig in Massachusetts, but here are some quotes I wrote down so far:

"The patient had not been taken as a human being, that is to say, a being in steady search of meaning; and this search for meaning, which is so distinctive of man had not been taken seriously at its face value, but was seen as a mere rationalization of underlying unconscious psychodynamics. It had been overlooked or forgotten that if a person has found the meaning sought for, he is prepared to suffer, to offer sacrifice, even, if need be, to give his life for the sake of it. Contrariwise, if there is no meaning he is inclined to take his life, and he is prepared to do so even if all his needs, to all appearances, have been satisfied." (p. 20)

And...

"...I think that, rather than exhibiting mental illness, someone worrying about the meaning of life is proving his humanness. One need not be a neurotic to be concerned with the quest for a meaning to life, but one does need to be a truly human being." (pp. 28-29)

And...

"If we are to bring out the human potential at its best, we must first believe in its existence and presence." (p. 30)

One more...

"...while food is certainly a necessary condition for survival, it is not sufficient condition to endow one's life with meaning and thus relieve the sense of meaninglessness and emptiness." (p. 33)

I absolutely must dash out of here, but I wanted to send along these thought-provoking comments. I'm sure you can see how music therapy fits into this nicely. And, having worked in an institution for so many years, you can, I'm sure, see how I might recognize how directly Frankl's comments speak to the experiences of my clients.

I'd be interested to hear how other folks relate to these quotes as well. It certainly follows appropriately on the tails of my thoughts with regard to whether or not my clients feel they're getting something out of being in music therapy.

The trouble with "quality" when one starts to think about it for too long

In my quest to figure out whether or not I'm providing quality services to my clients (because at this point, let's face it, it's become something of a quest), a lot of questions and thoughts have emerged for me.

It all sounded so easy on paper...

Obviously, on one level, this is clear-cut, and there's no real need for a lot of thought. We ("we" being music therapists) have certain elements in place to make sure we are doing what we're supposed to be doing.

We start by doing an assessment, from that we develop goals and objectives, we provide music therapy, and we evaluate the outcomes. Then, presumably, we can articulate "yes, the client met this objective" or "no, the client did not meet this objective."

When the goals and objectives are met we, ideally, proceed toward termination. When they're not, we either have to re-think what we're doing in order to help the person to be more successful or we decide that the goals and objective we originally set may not have been appropriate and we adjust them accordingly.

You'd think that would be the end of the story, but if we're really talking quality, it's not.

For a lot of reasons.

Meaning what? Or what meaning?

First of all, If I used a straight behavioral approach or a skill development approach in my work, then, sure, when my client achieves an objective that hopefully implies the effectiveness of the music therapy intervention I used. But it doesn't necessarily mean my client is happy with the service I'm offering or feels that s/he made some change that was important to her/him. It just means that s/he performed a specific action based on a specific objective/goal which may or may not have meaning for him/her.

Here's why I say that:

I work with people who not only don't use speech, but they're not usually the ones who decide they'd like to receive music therapy ( at least not initially). Furthermore, they may or may not understand what music therapy is, how it can benefit them, what is the process, and what the point of it all is (again, at least not initially).

This is how my caseload evolved: I either inherited my clients from former music therapists who worked at the institution, or I ended up working with people because I was assigned to provide music to their whole group and at some point I realized this particular person could use some individual intervention, or the team (that would be the treatment team who writes the "person-centered plan") makes a referral and asks me to work with someone.

More often than not, my clients never "request" music therapy, at least not with a clear understanding of what music therapy is and what it isn't. (And, to be truthful, people are often referred to us for music therapy because they "like music".)

Who/what determines quality in this context?

So I'm left wondering how is "quality" defined when I am providing services to people with severe disabilities who live in an institution, and when I use a relationally-based music therapy approach, the focus of which is not necessarily on developing specific skills?

Whose definition of quality do I use? The institution's definition (which is usually based on the rules and regulations provided by funding sources as well as a series of "core indicators")? Or the clients' definition?

I'm inclined to use my clients' definition, but how do I go about determining, when my clients don't use speech and their ways of communication can be confusing, what their perceptions, understanding, and preference for quality is? How can I figure out whether they are satisfied with the music therapy they're getting? And, given their histories, are they settling for, or being satisfied by, less than they should be?

On the other hand, it's important to respect the standards set by the institution as well. I can't very well ignore the context within which I'm working. As such, it's necessary to take that aspect into account as I move forward in this process.

And let me not fail to mention that, as a Board-Certified music therapist, I am expected to provide services with an awareness of the standards set forth by the Certification Board for Music Therapists (CBMT for short) and the American Music Therapy Association (AMTA).

Obviously, there's still more to say about this subject. On to the next post, eh?