Month: November 2020

  • Therapeutic Presence: The Critical Component in Providing Relationship-Based Services Via Telehealth

    Therapeutic Presence: The Critical Component in Providing Relationship-Based Services Via Telehealth

    COVID-19 has dramatically shifted how we provide clinical and supervisory services to families and mental health practitioners.  Home- and office-based in-person meetings have been replaced with video and telephone calls.  Never before has the idea of “how we are is as important as what we do” in our clinical work been so important to remember (Pawl & St. John, 1995).

    In this time of social distancing and subsequent provision of services via virtual formats, we are challenged to discover new ways of being present over a screen or the telephone.

    We have been tasked with figuring out how to hold onto our core ways of being with others while at the same time to let go of ideas of operating under the premise of “business as usual.”  We have had to pull all of our resources for creativity, compassion, flexibility, and adaptability to the forefront of our work over the past several months and the unknowable future for many of us.  Meeting virtually no longer seems like a temporary arrangement to help families, but has become part of the fabric of how most of us are working for the foreseeable future.  A central challenge before us remains: How do we embody relational principles of “how we are” over a screen when meeting with families and supervisees so that they can experience feeling truly met with by us?

    How We Are

    Of course we should always strive to consciously embody how we are with others in our clinical work; however, working virtually demands that we be especially mindful of fully and authentically embodying our “how we are” to share with others over a computer screen or the telephone.  Our “how we are” includes being fully present, emotionally regulated, safe, reflective, and focused on the centrality of relationships (Pawl & St. John, 1995).  We must strive to be open and responsive to each individual’s experience of sheltering in place; tolerate and organize their feelings as they ride an unpredictable emotional roller-coaster; create a sense of safety in being together in whatever way might be available at any given time; continue to seek understanding of how behaviors, feelings, and thoughts shift in response to how things are in the home and the outside world, and keep in mind the critical importance of having a safe and trusted relationship in which to feel held, no matter the format in which it is experienced.

    As we stretch to find new ways of maintaining a sense of connection during this time of extended social isolation, we must consider how to help others feel held in mind; to know that they are not alone as they navigate through this frightening time under such extreme stress, pressure, and vulnerability.  It is the felt experience of being held in another’s mind that is especially salient here.  An important aspect of being held in another’s mind includes being “spoken to over distance … tethered across space and out of mutual sight” (Pawl, 1995, p.5).  A sense of connection is created by being consistently held in another’s mind, which is by definition a way to sustain that sense of “not-alone” when physically apart from one another.  Current research suggests that irregular, brief, unscheduled contact with clients can strengthen the therapeutic relationship and lets them know that they are in your thoughts even when you are not meeting at a scheduled appointment time (Caldwell, 2020).  A quick text to check in with parents or supervisees may be important to consider during these unpredictable times.  Of course there are a host of valid clinical reasons to think this option through carefully in reflective supervision, and it may not be appropriate for every family, but from a relational perspective, it may be an important option to consider to help others feel held in mind during extended periods of quarantine and social isolation.

    Therapeutic Presence

    The concept of therapeutic presence is one that not only cuts across theoretical orientations as one of the most fundamental requirements for effective clinical work, but it can also cut across mediums in which therapeutic services are provided.  Therapeutic presence is defined “… as having one’s whole self in the encounter with a client by being completely in the moment on a multiplicity of levels — physically, emotionally, cognitively, spiritually, and relationally” (Geller & Greenberg, 2012, p.7).  Bringing our full presence to a virtual encounter with a family or supervisee is essential to creating and sustaining the sense of being together that we might otherwise take for granted when meeting in person.  By bringing our presence in an open and receptive state and then consciously focusing our sustained and sensitive attention on others, we are able to help them “feel felt with” by us (Furman, 1992; Siegel, 2010).

    How do we access our presence and capacity to attune to others when working virtually?  We need to actively protect our ability to attend from any outside distractions — phone silenced, email and text notifications on the computer turned off — and to have a designated workspace from where we can sit comfortably.  It can be helpful to find a few quiet moments before a session to anchor your feet firmly on the ground and take a few deep breaths to clear your mind so that you can be in that open and receptive state from which you can then consciously turn your attention and attune to the people you are meeting with on the screen or on the phone.

    In relationship-based work with families, we aim to bring our therapeutic presence and subsequent attunement to multiple relationships and the complex, interconnected experiences of the parent, child, and provider.  We strive to support parents in their relationships with their children and to help strengthen the attachment between them, and offering our presence is a necessary aspect of this process.  Siegel and Bryson (2020) emphasize the importance of presence in parenting, what they refer to as a parent’s capacity for “showing up,” and how parental presence is a foundation for developing a secure attachment relationship between parent and child.

    By keeping in mind the centrality of presence in fostering healthy relationships and secure attachments, we can strive to provide this relational presence with the clients and supervisees with whom we meet.

    Self-Care and Self-Reflection

    We can only embody our “how we are” and offer our full attuned presence when we also prioritize our self-care.  We need to actively seek out the support we need in order to be truly and fully present in our work with others.  Being present for and with others is an active, emotional labor, and being present with others over screens can be even more emotionally labor-intensive.  When we are with others in person, we are able to make use of subtle, non-verbal cues that we are not even consciously aware of.  We can see the whole person in their whole environment, which allows a more relaxed presence to unfold.

    Over a screen, we have to work harder to project our presence to be felt by others.  We may end up feeling depleted and exhausted by Telehealth sessions in ways that we didn’t anticipate.

    For these reasons, we need to pay close attention to how we schedule our appointments, give ourselves breaks from looking at screens as needed, and be mindful of how we refuel ourselves when not working. In other words,  how do we practice self-care?

    Self-care can look different for each of us — it can be about finding ways to connect with others or with nature, creating time to get lost in a book, moving our bodies, meditating, practicing yoga, talking with trusted colleagues, and/or meeting with our reflective supervisors and consultants.  “Self-care is any action you purposefully take to improve your physical, emotional or spiritual well-being.  By making time for self-care, you prepare yourself to be your best so you can share your gifts with the world” (Brownn, 2020).

    We need to be mindful of how the change in the contextual frame in which we operate impacts ourselves and our clients and supervisees: how virtual ways of being together can initially feel uncomfortable or awkward, how the felt experience of being together might shift in both tangible and intangible ways, and how our relationships with others might be influenced over time.  I would suggest that it is only after we wrestle with and accept our own experience can we then invite supervisees and parents to join us in being curious about how these same shifts impact themselves, their children, and the relationships between them.  We need to appreciate what is being asked of all of us — supervisors, direct service providers, and families — to gently and compassionately “name it to tame it” (Siegel & Bryson, 2011) in order to help internally organize the experience for each of us during this unpredictable time in the world, so that all of us have the opportunity to feel held in the mind of another.

    Summary

    Some of our “what we do” needs to be adjusted and altered when working with families over video or telephone, but our “how we are” is a constant, no matter the format we use to meet with others.  We truly can offer these ways of how we are in relationships — our therapeutic presence — whether we are meeting with clients, supervisees, and/or students, and whether we are meeting them in their homes, in offices, or over computer screens or the telephone.  These ways of how we are with others are as important, if not more, than what we do, and thankfully are not defined by our physical proximity to each other, but by our embodied ways of being fully and therapeutically present when we meet with one another.

    References

    Brownn, E.  Retrieved May 4, 2020, from http://www.eleanorbrownn.com

    Caldwell, B. (April 15, 2020). The Value of Between-Session Contact. Simple Practice. https://www.simplepractice.com/blog/contact-helps-therapeutic-relationship/?utm_medium=email&utm_source=sp-blog&utm_campaign=20200417-paid-trial-leads-blog-update-value-between-session-contact&utm_content=body-link-3-sp-blog-post

    Furman, E. (1992). On feeling and being felt with. The Psychoanalytic Study of the Child, 47, 67-84.

    Geller, S. M. & Greenberg, L. S. (2012). Therapeutic Presence. Washington, DC: American Psychological Association.

    Pawl, J.H. (1995). The Therapeutic Relationship as Human Connectedness: Being held in another’s mind.  ZERO TO THREE, 15 (4), 1, 3-5.

    Pawl, J. H. & St John, M. (1995). How You Are Is as Important as What You Do. Washington, DC: ZERO TO THREE.

    Siegel, D. J. (2010).  The Mindful Therapist. New York, NY: W. W. Norton & Company.

    Siegel, D.J. & Bryson, T. P. (2011). The Whole-Brain Child: 12 Revolutionary Strategies to Nurture Your Child’s Developing Mind.  New York, NY: Delacorte Press.

    Siegel, D.J. & Bryson, T. P. (2020). The Power of Showing Up: How Parental Presence Shapes Who Our Kids Become and How Their Brains Get Wired. New York, NY: Penguin Random House LLC.

  • The Intersection of Leadership and Vulnerability: Making the Case for Reflective Supervision/Consultation for Policy and Systems Leaders

    The Intersection of Leadership and Vulnerability: Making the Case for Reflective Supervision/Consultation for Policy and Systems Leaders

    Introduction

    Reflective Supervision/Consultation (RS/C) has been widely recognized as a key component in the provision of quality infant mental health (IMH) informed services.  RS/C can be described simply as a “relationship for learning” (Shahmoon-Shanok, 2006, p. 343).  Just as we know that babies can only learn and grow in the context of relationships, we believe that the same is true for professionals.

    RS/C is a time for supervisees to examine their own reactions to the work with vulnerable babies and families and to use their new understanding to inform the services they provide.  As supervisees experience (and are invited to reflect on) their own learning and growth in the context of the supervisory relationship, they are able to harness the power of relationships in their own work with families.  As supervisees begin to feel safe, known and understood by their supervisor, they may find they are better able to quiet their inner experience, allowing more openness and curiosity about the experience of the baby and of the parent(s).  As the parent (or caregiver) is able to feel seen and known with the service provider, the parent may find that more space is available to consider the perspective of the baby.  In infant mental health work, this relational occurrence is described as the parallel process.  Essentially, the parallel process describes the way in which relationships impact relationships.

    In this field, it has come to be expected that direct service professionals are aware of how their relationships are impacting their work with the baby and his/her relationships with primary caregivers.  This article will argue for an expansion of our thinking for a more comprehensive parallel process. This includes the assertion that it is best practice for leaders of programs, organizations and systems to have the opportunity to experience RS/C in order to advance this systematic awareness on behalf of babies and the adults who care for them.

    Reflective Supervision/Consultation has become a crucial support for professionals in many settings, including early care and education, home visiting, infant early childhood mental health consultation, early intervention, behavioral health, general mental health here and many more.  It seems that funders and organizations have begun to recognize its value for frontline workers and, though less often, for their direct supervisors.  However, the concept, for leaders in policy and program administration, has not yet been fully embraced.  There are likely many reasons for this gap in professional support.  First, building RS/C into systems and providing it to all employees does come at a financial cost.  If the organization is not yet convinced of the value for those not providing direct services, it may be even more difficult to rationalize the additional cost of paying for qualified providers and the staff time that is spent in RS/C. Second, typically the conversations, published articles and research about the value of RS/C has centered on service providers and the direct impact on babies and families. This could give the false impression that its value is limited to the very immediate relationships between provider and family, and provider and supervisor.  Lastly, for those leaders who did not enter into the workforce with a human services or clinical background, the idea of RS/C as a way to reflect on one’s own thoughts and feelings may feel foreign and uncomfortable.  It may, in fact, not align with their values and beliefs around a leader feeling the need or pressure to be strong, tough and already possessing the answers.

    If we remember the core IMH principle that all learning and growth happens in the context of (safe, healthy) relationships and we believe that relationships impact relationships, then it seems logical that the need for RS/C would not stop with direct service providers and supervisors.  In the absence of RS/C, how will a leader have the space to explore the work in more depth, to manage annoyance at a particularly stubborn employee, to practice slowing down and listening deeply to one’s own internal process as well as that of the team?  How will the leader be allowed to experience the vulnerability that inevitably arises when one is on the cusp of learning something new that might require them to change their practice?  What is lost if one does not have the support to venture into that new territory of learning? Taken one step further, if this leader does have RS/C, but the leader’s supervisor does not, then what happens to the parallel process?

    Ultimately, how are those we serve impacted by this lack of reflection at the highest levels of a system? We believe it is the babies and families who will inexorably bear the burden of this cost.

    These are important questions that lead us to assert that all professionals in the infant and early childhood system, including and arguably especially leaders, should be receiving consistent, relationship-based RS/C.

    What Makes A Good Leader in Infant and Early Childhood Mental Health (IECMH) Systems?

    First and foremost, leaders in IECMH systems are charged with keeping babies and families in mind, even though they are in a distanced role from them.  As policies for service provision and staff development are created and implemented, strong leaders should be asking themselves for nearly every decision, “How will this impact the infants, young children and families we are serving?”   In order to allow for this space to consider the vulnerability of babies and families, leaders must be willing to look inward and make space for their own sense of vulnerability.  It can be difficult to reflect on our own early experiences of feeling powerless and voiceless.  And yet our ability to do so allows us to hold deep empathy for those we serve, a key trait of quality service provision.  Second, leaders at all levels must be attuned to the staff and teams they lead:  What are their strengths and areas for growth? How do they best learn and grow? This level of attunement requires careful observation, listening, the ability to stay open to new information and integrate it into one’s thinking and decision-making.

    The final skill, though we acknowledge there are many more, we believe is essential to strong leadership is awareness of one’s own biases; biases related to race, gender, sexual orientation, religious beliefs, political ideology, parenting, etc. Each one of us interacts with the world through our own unique lens, which is inevitably tinted by our life experiences.  As a result, explicitly and implicitly, we assign value, prioritize, and make decisions based on our own values and beliefs.  As a leader in a system, it is critical that one is aware of these values, beliefs, and biases and how they impact the creation and implementation of policy and program administration. RS/C offers the rare space to identify and examine these biases with a trusted other. Intentionally doing so creates the opportunity to not only recognize differences between self and others within and throughout the system, but also to identify ways to capitalize on these differences in order to enhance each layer of the system. This allows leaders to navigate the complex relationships within agencies, departments and organizations more effectively and efficiently to ultimately offer the highest quality supports and services for families.

    RS/C with a consistent and skilled consultant allows a supervisee/consultee to engage in careful and thoughtful exploration of the work. It invites supervisee/consultees to be curious about the experiences of others and about their own experiences. Carefully placed reflections and questions invite supervisee/consultees to consider blind spots, things they may have missed, and perspectives not yet considered.  It seems to us an obvious conclusion that RS/C is immensely beneficial for any leader, and especially for those involved with systems and programs serving infants, young children and families.

    Next, we will share our work together as an illustration of how RS/C benefits leaders and systems in powerful and pivotal ways.  We offer our story with the hope that it will inspire you to consider your own work and the ways in which RS/C already has been, or could be, beneficial.

    Our Reflective Process

    When we began our reflective consultation experience together, we both came firmly grounded in IMH principles.  We share a passion for and commitment to supporting babies, young children and families.  Because of this, we were able to start with a shared language and perspective. What felt unique was that Meghan was no longer working directly or even closely with children and families. Part of her new reflective work became bridging her felt experience with parent-child relationships and attachment frameworks to her systems work.  This intentional linking over time helped us consider the eventual impact of Meghan’s work on the vulnerable young children and families whom the system serves. What felt similar was being rooted in relationship, development and the power of the parallel process. For example, when Meghan tapped into feelings of being overwhelmed with new professional expectations of her and her own evolving professional needs, we were able to easily make connections and contemplate how the baby is impacted when a parent’s expectations and capacity to offer support may shift along with each developmental milestone, depending upon the extent of how the parent’s own needs are being met.

    At other times, we did not explicitly link our work to a baby or family and instead relied on our trust in the parallel process in different ways.

    There is another way of conceptualizing “the baby” in policy and systems work that is also useful.  The baby represents, among other things, vulnerable persons or populations who do not yet have a voice, but whose needs are clear.

    This can be found either through data or anecdotally. For example, looking at the data that infants, toddlers and preschoolers are expelled from child care and preschool at 13 times the rate of children K-12 combined, and further that Black boys are expelled three times more than their white peers, it is evident that young children, and specifically African Americans, have a deep and complex experience that calls for radical systems change. This can feel like an enormous and daunting task for systems leaders to undertake.  RS/C offers the space to support  leaders in recognizing and processing evocative emotions that can result from startling data such as this in order to re-energize their own sense of agency, to stay connected with those in the system who are muted and disempowered, and to keep this work moving forward.

    The following excerpt exemplifies how we used the reflective space to support Meghan in her role as a leader in a large system. This particular example is in relationship to Meghan and her team of colleagues; however, these concepts hold true to any variation of systems relationships.

    We began our first session in person but most of the subsequent sessions were done virtually. This conversation took place about two years into our relationship.  A foundational relationship had been built for exploration and growth together and we had settled into a comfortable rhythm during our monthly RS/C sessions.

    Meghan’s Perspective

    “Our ability to be daring leaders will never be greater than our capacity for vulnerability.” (Brown, 2018, p 11)

    My first experience of professional reflection was during my work as an Infant Mental Health home-based therapist. It was emotionally intense, intimate and clinical. This was also my introduction to the felt experience of RS/C. Often in the midst of overwhelmingly evocative emotions such as grief and despair, secondary trauma and hopeless incompetence, RS/C offered me the space to learn how to lean into the vulnerability of really feeling these emotions instead of running from them. I learned that only then could I regain a sense of organization, piece together a coherent narrative and most important, guide my work with the babies and families I was there to support. The magic of the parallel process came to life, and with it came the realization that RS/C is the unique vehicle to explore it. This experience was foundational to discovering and tapping into my best professional self. Therefore, when I found an opportunity to move into systems work, my biggest fear was to lose touch with the families, with “the baby” and with this reflective side of me. I knew I would need to find a new way to meet this professional need in this leadership role. For me, this meant finding a RS/C provider who could support me in this new systems world.

    It may seem obvious, but one of the first lessons I learned is that systems are simply made up of people, and thus innumerous relationships. Therefore, the same IMH relationship-based principles apply — parallel process, rupture and repair, and the need for authentic connection to inspire high-quality work. This realization gave me comfort. I appreciated the familiarity of those IMH frameworks and recognized that working at a systems level required innovative ways of executing them in this new environment. As I began my new leadership role, I also embarked on a new reflective relationship with Faith, quite literally.

    “In the absence of authentic connection -we suffer.” (Brown, 2018, p. 25)

    As I began this new season of my career, I believed that I had a plan for how I could maintain my own professional need for connection. I knew this was a crucial element I needed in order to meet expectations set for me and  guide my work with others. However, as the work progressed, I noticed that I continued to miss the deeper emotional side of the process; the powerful experience of holding and “being with” others in a more profound way and of myself being seen in a more authentic way. Because of my deep appreciation of the parallel process, I quickly recognized that this void had begun to negatively impact my work, one of my greatest fears. This prompted me to reevaluate what I needed in order to be able to  be more authentic and effective.

    My fear of failure was realized and exposed during a particular meeting when I felt that I wasn’t communicating effectively with my team. I felt reflectively rusty and that was a big red flag. Working with my team, familiar thoughts and feelings flared up in my chest like a wave of heartburn. “What if I’m not a good enough leader? What if I can’t give my team what each of them needs to do this work well? What if I fail at finding a way to keep this work going?” I began to internalize the notion that if I was not a good enough leader in this state systems position, if I couldn’t meet the needs of my team, the consequences would be exponentially deeper. If I was not able to find a way to sustain this work, the consequences would be exponentially greater. The weight of responsibility washed over me, and I felt overwhelmed not only by the needs of the metaphorical baby, but by the thousands of babies all over the state who would suffer if I was not enough. That narrative was paralyzing. I felt stuck, unable to even prioritize what task to begin next.

    I brought all of these complex feelings and thoughts to Faith during our next session. I didn’t yet know how to organize them, but I trusted that by leaning into my vulnerability and sharing this in our reflective space, Faith would contain and validate these overwhelming emotions in a way that allowed me to process each of them, safe from judgment. And by doing so, albeit uncomfortably at times, only then could I join in her wonderings to move me from rigidity to action.

    Faith’s Perspective

    In working with Meghan, I found myself wondering: How do those who lead embrace vulnerability? What do they need from us?  How do we encourage their willingness to dip into the reflective space, into their emotional experience, on behalf of the babies, families and staff they serve? How do I use the familiar frame of RS/C to support Meghan in her leadership role? Over time, Meghan and I created a shared language that allowed us to explore all of these dimensions of the work together.

    Meghan’s particular experience  felt so familiar. Who among us has not felt like the world, the systems we work within and their problems, are so big and we are so small?  I am aware that when we are working within complex systems, it can be hard to slow down, to focus on one thing and organize our many layered thoughts and feelings.  Working in large systems requires us to always be holding many perspectives and needs in mind, to be thinking on our toes, and to be willing to take risks.  It can feel overwhelming and heavy.  As she talked, I noticed a feeling rising within me that paralleled Meghan’s.  If these feelings had words, they would say to me, “Oh gosh, this is too big.  I’m not sure how to help.  Maybe another consultant would know what to do.”  I had been here before, many times, and I knew I could use my own experience to inform me as I supported Meghan.

    When Meghan quieted and gave me the cue that she was ready for me to respond, I first took a deep breath.  I allowed a few moments of stillness and quiet.  Once we both had a chance to quietly breathe and re-center, I reflected to Meghan the emotional experience I heard her name — a sense of feeling overwhelmed and how that was leading her to feel  an intense sense of urgency. She agreed that this was how it was feeling to her, and that she was having a hard time regulating and organizing her thoughts.  This felt uncomfortable for her, as she was confused and could not figure out next steps when she was in this place.  As Meghan continued to describe the pressure she was feeling and the sense of being lost in all of the responsibilities, I was reminded of times in the past when she had come to our sessions with similar feelings. I had walked with her before through this process and knew she possessed the capacity to see herself through.  Since this emotional journey felt familiar, I decided to share that observation with her and wondered what she thought about that.  She immediately seemed to calm; her shoulders relaxed and she took a deep breath.  I asked her what she was thinking and feeling as she  remembered past conversations we had.  Meghan said she remembered that this is a familiar place of initial anxiety that she goes to, and she always finds a way through when she has the time and space to process.  I wondered with her if perhaps she comes to this place often because of how deeply she cares about the work, about her colleagues, and about the babies and caregivers she knows her staff are impacting.  Yes, she said, of course.  As we talked, she realized this place of feeling overwhelmed was not something she needed to fight her way out of.  It gave her important information. It reminded her that she was feeling strongly about something, and it offered her the opportunity to ground herself in her passion for the work. Our deeply felt desire to be helpful and make a difference for babies and families can be overwhelming, and it can also be energizing.  Once she felt like she had made sense and found some meaning in her strong reactions to this particular situation, her next steps became clear to her.  As her RS/C provider, I had the honor of holding the space while she made her way to a new place that allowed her to make a plan and feel empowered.

    Shifting Outcomes/Resolution

    RS/C is “A relationship in which strengths are emphasized and vulnerabilities are partnered.” (Shahmoon-Shanok, 2006, p. 343)

    Meghan’s reflective experience was very much rooted in the attachment-informed developmental need for a secure base — she needed to touch the wall of being in the reflective space in order to hold the emotional sense of urgency and discomfort of those doing the work directly with young children and the adults who care for them. She needed to find the balance of keeping the flame of urgency present, and yet not allow it to get to a point of overwhelming paralysis. This sense of urgency driven by the immediate needs of all of those babies, of their rapidly developing brains and attachment relationships, can often dampen with the distance and slow-moving evolution of systems work. Meghan was also searching for a way to continue to have hope and agency in order to effectively support the professionals within her system who  are responsible for nurturing our babies and young children and their families.

    Once she was able to “touch in,” to settle into that familiar and safe reflective space, she could then mentally prepare differently for the next team meeting. Here, she could foreshadow the possible triggering of the familiar internal narratives of self-doubt and incompetence. With the element of surprise inhibited, she could prepare a subtle regulation exercise that could re-ground her in that moment. During the next meeting, when the familiar feelings began to percolate, Meghan was able to respond rather than react.  She was able to recognize the physical sensations, name the parallel emotions, and lean into and contain them in a more controlled way. This allowed her to have the emotional energy to attune to the needs of the team, rather than expending that energy managing her own emotional response. As a result of this mental shifting, she was able to hear, validate and meet the needs of the team more effectively. This galvanized her belief that the responsibility of the growth and development of the team begins with her own willingness and capacity to embrace vulnerability.

    In our further reflections, we wondered together what the consequences may have been if Meghan had not had the opportunity to process her emotional reactions through RS/C.  What would her actions have looked like had she gotten stuck in the emotional mud of negativity? Certainly, it would have taken much longer, if ever, for her to effectively identify her own needs in order to be able to see more clearly the needs of the team. Undoubtedly, it would have led to creating patterns of miscommunication, rigidity, perhaps even feelings of rejection on both or all sides of the parallel process. Regardless of the specific path, we are certain that without the space to intentionally reflect, the negative reverberations would have been felt by many, including the babies and families we work so tirelessly to serve.

    Conclusion

    The familiar phrase, “You can’t give what you don’t get,” still holds true in systems work. How can those who lead learn the value of leaning into vulnerability in the absence of having that repeated felt experience? Direct service providers and their supervisors are regularly asked to venture into the reflective space with a trusted mentor in service of their work with vulnerable babies and families.  But what about those who supervise them?

    It is imperative for those creating policies and practices to keep “the baby” and all of the corresponding relationships in mind. Having access to RS/C space allows leaders to tolerate discomfort, mistakes, rupture, and vulnerability, all of which are necessary to access creativity, attunement, growth and mitigate bias.

    Over the past two decades, the IECMH field has evolved to embrace RS/C as best practice for many varied roles. We believe the same expectation and support should exist for systems leaders as well.  Relationships impact relationships, and systems leaders will always be a part of the relational orbit surrounding direct service providers, families and babies.  Therefore, “how they are,” and not just what they do, matters greatly.  RS/C for leaders is a crucial strategy that needs to be woven throughout all levels of the system if we are to continue improving quality and outcomes in IECMH-informed services for our little ones and those who care for them.

    References

    Alliance for the Advancement of Infant Mental Health. (2018). Best practice guidelines for reflective supervision/consultation. Retrieved from https://www.allianceaimh.org/reflective-supervisionconsultation

    Brown, B. (2012). Daring Greatly. New York, NY: Penguin Group (USA) Inc.

    Shahmoon-Shanok, R. (2006). Reflective supervision for an integrated model: What, why & how? In G. Foley & J. Hochman (Eds.), Mental health in early intervention: A unity of principles and practice (pp. 343-381). San Francisco: Jossey-Bass.

     

  • Seeing What We Can Capture Together: Setting Up the Frame For Reflective Supervision/Consultation

    Seeing What We Can Capture Together: Setting Up the Frame For Reflective Supervision/Consultation

    In my work providing reflective supervision and consultation (RS/C) to groups and individuals, I consistently find parallels to my role as a mother of young children. Most recently, I sought to take a family photo — you know, one that looks joyful and warm, showing the connectedness and synchronicity my family and I feel with one another during our best moments together. But after a few attempts, I simply gave up.

    This failure to get a perfect family portrait got me wondering about the parallels to setting up a reflective experience for groups and individuals. Perhaps the first step to getting that magical photo is hiring a great photographer who can bring her skills and gifts to the photo session, who knows when a young child has simply had enough or needs a change of scenery, and who can identify when the lighting is poor or knows when she has finally gathered enough images. Similarly, providers of RS/C can hone their craft through ongoing training, learning the skills and practices that support others in settling into a reflective space, feeling held and supported in sharing their feelings authentically, and approaching their work with curiosity and openness. Through ongoing experience receiving and providing RS/C, consultants can build a capacity to trust in themselves, others, and the reflective process as a whole.

    In taking a photo, the next step is to choose a good enough time, when children are typically rested, open to new experiences, fed and happy. By some miracle that might align with a time when lighting in the environment makes everyone look wonderful and parents do not have to wake up before the sun to make everyone look polished and presentable. Similarly, consultants and supervisors can be thoughtful about the times, places, and routines they establish for regularly scheduled RS/C sessions. Personally, back-to-back pandemic video conference meetings without pre-scheduled breaks  do not put me in a state to listen intently, attune, and reflect with others. Rather, setting expectations and inviting participants to think about times and places that they can come together  with no interruptions impacts what we can achieve together moment to moment inside the frame of the RS/C session. Important, too, is allowing time to slow down when schedules are busy and everyone is able to attend to the experiences of others in the group or their own reflective process.

    Here is where things become complicated because the creation of a certain set of ideal circumstances can be difficult.  Even with the most thoughtful of plans, unexpected weather, illness, a disrupted routine, or any myriad of factors that might impact a small child’s mood or attention can derail his capacity to engage in a novel experience where he is expected to fully and joyfully engage with others.

    Like a parent in a family photo, consultants must also keep in mind that life is always happening outside the frame.

    Unexpected interruptions, overwhelming feelings of stress, busy schedules, a global pandemic, personal illness, or any number of factors might challenge or disrupt a supervisor or supervisee’s capacity to share their full attention with others in any given moment or session. The expression of hope for uninterrupted time to reflect, as well as acknowledgement of the challenges to this, can be discussed within the sessions on an ongoing basis. Perhaps now, in the midst of a pandemic, this should happen more than ever before.

    So, picture day arrives. We are rested, fed, and dressed appropriately. We arrive at our location, but how can we get everyone to look at the camera and smile? Moment to moment shared attention and connection seems like the tiniest task, but perhaps they are the most challenging. My family simply could not do it this year! We were able to explain hopes and expectations to my 5-year-old. She followed suit, showing up as her bubbly, big, performative self in a new and novel experience.  Throughout the session we bounced, rocked, shook toys, and made every silly noise we could think of for my more slow to warm 1-year-old as the photographer snapped away. However, that perfect picture of the four of us never came to fruition — someone was blinking, looking away, distracted trying to get another person to smile, disinterested, or crying.  The subsequent photos did not give anyone a sense of synchronicity and connectedness. Rather, you saw four different people, four different capacities for attention, four different emotional experiences, and four different moment-to-moment responses to our interactions with each other and the experience frame after frame.

    In the same way, even when consultants set up what appears to be an ideal set of circumstances to come together for dyadic or group reflection, there are still barriers to connecting with others in the reflective process. As consultants, we can certainly set up some guidelines for the reflective frame, such as letting participants know there might be a greater emphasis on the exploration of feelings and relationships or that supervisors may be “sitting on their hands” instead of problem solving. Yet all we can do is offer a gentle invitation into this way of thinking about themselves and their work, with the hope that everyone will engage, to the degree they can, in any given moment throughout our time together.

    Akin to those first few awkward snapshots where everyone in my family was trying to figure out what we were supposed to be doing and how we were supposed to be with one another, perhaps in the early moments of the supervisor/supervisee relationship or when reflection is still a novel experience, participants may have difficulty showing up authentically, sharing feelings or exploring vulnerabilities. In certain snapshots of an RS/C session, you may find participants responding reflexively to what they are presented with instead of remaining open and curious. Perhaps in those moments, consultants can offer questions that promote reflection, much like we tried to shake a toy outside the frame of our pictures, hoping to spark a moment of interest and joy.  One moment my 1-year-old burst into laughter, but the next a little too much noise and novelty led to tears. We did our best to anticipate what his responses might be. Similarly, as consultants we can anticipate, but cannot control how supervisees respond to our inquiries. Instead, we can simply offer the opportunity to respond authentically, and wonder about their experiences and feelings, as well as the experiences and feelings of others (baby, parent, caregiver or worker), with the hope that they will feel supported in their attempts to explore experiences and interactions in this way.

    Consultants, too, encounter their own barriers to being with others and inviting them into the reflective process. In my own set of family photos, I remember the difficulty of knowing where to focus my attention moment to moment. Do I smile at the camera, respond to the cues of my children, listen to the advice of the photographer or, in ideal moments, try to do all those things simultaneously? As consultants, we are trying to do many things at once: listen deeply, attune to an emotional undercurrent of the reflective process, hold our own internal experiences, and find a way to reflectively respond to others in a way that uniquely resonates with them moment to moment.

    In one moment or session, we may have trouble attuning to the thoughts, feelings and needs of supervisees because the relationship is still new, or because the narrative they are presenting pulls on something inside us or our own history that may merit greater exploration in our own RS/C. In another frame, our own drive to teach or move others toward the reflective space actually moves us further from a sense of attunement and connectedness. In another frame, we may find our internal curiosity about certain aspects of the family story, the baby, the parallel process, or the provider’s responses so compelling that we shift the shared attention to those aspects of the narrative without allowing supervisees to fully explore other aspects of their work.  On a personal note, I often wonder how my attempts to do so much during RS/C sessions interrupt my ability to model authenticity and offer genuine connection to others, which is the aspect of my work that brings me the most joy.

    In my opinion, the best family photos are filled with shared attention, connection, warmth, and authenticity. Sometimes there is just too much happening, outside the frame or within it, to cultivate those qualities in any given moment. My favorite family photos have not been staged or faked. Perhaps the most disruptive efforts to get anyone, though especially children, to take a “good picture” are the demands that they do so. In the same way, the idea that we can somehow force or fake connection or a reflective moment seems impossible.

    Rather, the process of connection and reflection is just that, a process we come in and out of, one we can cultivate, one we can explore, one we can practice, one we can strive for, and over time one we might come to trust in.

    When we are in it together, it’s a felt experience that holds for an entire session or a few fleeting frames.  Like my failed family photo attempts, in some sessions it never seems to materialize. When that is so, we can explore the experience, speculate about barriers, and support one another in trying again in our next session. Over time in group or individual RS/C, we will have a collection of snapshots that tell the story of our relationships to one another. Taken together, the snapshots reveal patterns for the ways in which we show up with each other. There will be moments we will look back on and laugh about, moments we are all looking different directions, moments where someone is distracted, moments filled with deep emotion, moments where we look lost, chaotic or awkward, and, if we are lucky, a few moments we cherish so deeply they are worth framing,