From Wounded Healer to Healing Healer: Facilitating Wellness Through Thoughtful

SupervisionBarbara Lehmann, PhD, LICSW

Melissa Hensley, PhD, LISWAugsburg College Department of Social Work

What it means to be “wounded”

• Mental health professionals, even those who are very skilled, are not immune to emotional difficulties.

• Many of us (believe it or not!) have mental health diagnoses of our very own!

• In addition, many of us are inspired/influence to become mental health providers because of healing interactions we have had with helping professionals.

How to use lived experience?• Having experienced mental illness or having received mental health

does not mean that an individual is necessarily better or worse as a provider.

• Lived experience can contribute to the capacity for empathy, or it can make professional practice more difficult.

• Thoughtful supervision can help social workers and other providers with lived experience to fulfill their role with greater skill and personal well-being.

Topics for this Workshop• How can we effectively supervise individuals in emotional distress?

• How can we effectively supervise peer specialists and other providers who are “out” about a mental health diagnosis?

• How can we support practitioners who are experiencing vicarious trauma?

• How can we support and model self-care for all supervisees?

Small group Reflection:• List three of the most helpful qualities of your best supervisory

experience when you were in emotional distress?

• List three of least helpful qualities of your worst supervisory

experience when you were in emotional distress?

What is stigma?• Stigma is a mark of disgrace that sets a person apart.

• Negative attitudes create prejudice which leads to negative actions

and discrimination.• Three out of four people with severe emotional impairments report

that they have experienced stigma. • When a person is labeled by their diagnosed illness they are seen

as part of a stereotyped group.

Stigma brings experiences and feelings of:

• Shame• Blame• Hopelessness• Distress• Isolation • Reluctance to seek and/or accept necessary help

Stigma and Severe Emotional Distress in the Profession

Internal From colleagues

• Embarrassment• Loss of status• Feelings of isolation• Belief they should be different• Shame • Fear of loss of job• Fear of rejection• Reluctance to get help

• Being labeled as impaired• Attributions of all difficulties

due to emotional problems• Fear of exposure• Concerns about confidentiality• Fears about professional

censure• Group norm of being free of

emotional problems

Some clinicians indicate

“their experiences enhanced their abilities as a therapist. Because of their own struggles, these women felt increased empathy with their depressed clients, more patience in the therapeutic process, increased appreciation for how challenging psychotherapy can be, and greater faith in the process of psychotherapy.”

• Gilroy, Carroll, and Murra (2001)

Social Workers as Supervisors of “Peers”

• Social workers are frequently called upon to supervise certified peer specialists or other workers with a “peer provider” role.

• These supervisory relationships can be wonderful and enriching for both parties.

• Peer providers are not “low-cost case managers,” however; they have a distinct role in the organization that is not identical to that of a social worker or other professional provider.

Social Workers as Supervisors of “Peers”

• Why is the role of peer support or peer recovery specialist important in our service systems?

• Peer-delivered services have been associated with improved outcomes in several areas:o Reduced inpatient service useo Improved relationship with non-peer providerso Better engagement with careo Higher levels of empowermento Higher levels of activationo Higher levels of hopefulness for recovery (Chinman et al., 2014)

Effective Supervision of Peer Providers

• Understanding of the peer role is importanto Peers have a different “power relationship” with clients than social workers do.o Part of the peer role is to integrate lived experience into collaborative helping relationships. Self-

disclosure and boundaries may look different in a peer provider context.o It is important to respect and honor the unique voice of peer providers.o Peers still need consultation and solution-focused supervision for many of the same reasons that

other professionals do.o The advocacy role performed by peer providers will hopefully not always be cast as “adversarial

toward the agency and its structures.”

o (NAOPS, 2014)

Working with Supported Employment Participants

• In Minnesota and other states, supported employment services for people with mental illness are growing.

• These services, such as Individual Placement and Support, emphasize rapid placement into competitive employment, as well as ongoing support.

• If you supervise someone receiving IPS services, it is important to establish with the worker the lines of communication with the worker’s IPS provider and others on the worker’s support team.

• If you work with someone receiving IPS services, friendly workplace interactions and on-the-job support can be beneficial.

What about professionals who are “out”?

• There are many effective professionals who have a diagnosis of serious mental illness.

• Some social workers with lived experience keep this aspect of their identity private, but others are more “out” in the work context.

• Self-disclosure, in and of itself, is neither good nor bad. However, there are issues that can arise that require skillful handling.o In chemical health settings, self-disclosure by counselors and other professionals is more

encouraged.o In mental health settings, self-disclosure is often met with disapproval.

What about professionals who are “out”?

• Advantages of disclosure in mental health settings:o Staff can be potent role models for clientso Clients may feel a stronger sense of trust or connection with a staff member who is “out.”

• Disadvantages of disclosure in mental health settings:o “Out” staff may be treated disrespectfully by other staffo Clients may be fearful of upsetting or harming a staff member who is open about a mental health

diagnosiso “Out” staff may need guidelines about appropriate material to disclose or not

Supervising staff who are “out”

• Some work challenges may be related to the staff person’s lived experience of mental illness, while others may not.

• Guidance on “use of self” and integrating lived experience into one’s helping role is important with supervisees with mental health diagnoses, just as it is helpful to other clinical professionals.

• It is important to remember that even for “out” professionals, there is a power differential between client and worker that needs to be taken into consideration when choosing whether to self-disclose.

• As with other clinical professionals, identifying and processing personal triggers is important. The supervisor does not have to be the supervisee’s “therapist,” but being mindful of the impact of lived experiences is still helpful and respectful.

Supervising staff who are “out”

• If a professional staff member with lived experience is making mistakes or experiencing difficulties, honesty with that individual is of utmost importance.

• Shielding staff members from their own troubles or mistakes is helpful to no one.

• Honest, open, constructive feedback on behavior helps the staff member to learn and grow.

Supervising staff who are “out”

• Self-disclosure is a topic that needs to be discussed with supervisees who are “out” about having a mental illness.

• Self-disclosure can help the professional to establish a more trusting bond with the client.

• However, there need to be well-established boundaries around the use of self-disclosure, so that it is used for the best interest of the client.

• Unloading one’s personal troubles onto a client is inappropriate for any professional.

Supervising staff who are “out”

• Recent literature studying attachment theory in supervisory processes have emphasized the importance of a secure attachment in the relationship between supervisor and supervisee.

• The idea of a “secure base” from which workers can go out and practice new skills can be helpful in developing confidence.

• The “safe haven” to which workers can return is also important to professional growth—the ability to come back to the supervisor and discuss/process work experiences.

o Bennett, 2008

Reasonable Accommodations• The Americans with Disabilities Act of 1990 specifies that

individuals with disabilities are entitled to “reasonable accommodations” that will help them in the workplace.

• According to the Boston University Center for Psychiatric Rehabilitation, “Reasonable accommodations are those adjustments within a work or school site that allow an otherwise qualified employee or student with a disability to perform the tasks required.”

• Most individuals with mental health diagnoses need no accommodations, but there are some people who will ask for accommodations.

Reasonable Accommodations• What are some examples of reasonable accommodations for people

with psychiatric disabilities?o Changes in schedulingo Additional supervision or mentoringo Flexible scheduling to accommodate medical appointments

• The individual with the disability still needs to be able to perform the essential functions of the job.

Person-Centered Supervision•  Domains of well-being

PERSON:

Physical Health• Goal:

Relationship Health• Goal:

Work Health• Goal:

Emotional Health• Goal:

Spiritual Health• Goal:

Person-Centered Supervision• Person-centered care in mental health treatment involves balancing

professional guidance with client self-determination (Corrigan, 2015).

• This kind of shared decision-making approach works well in supervision as well as direct practice with clients.

• In supervision, we can facilitate a process for providers to set professional goals for themselves and address care of self inside and outside of the workplace.

Person-Centered Supervision• Person-centered supervision is good practice for all mental health

providers and supervisors.

• Because of its focus on shared decision-making and its holistic approach, it is particularly helpful for supervisees who are facing mental health challenges of their own.

• Person-centered supervision makes us all better.

Encouraging and Modeling Self-Care

• Encouraging and modeling self-care is important for our supervisees as well as our clients!

• How do we handle anxiety or triggering experiences on-the-job?

Encouraging and Modeling Self-Care

• How do we instruct our supervisees and clients regarding the importance of self-care?

• Think about it: How do you actually practice self-care?

Encouraging and Modeling Self-Care

• Worksheet self-care exercise