Tony MacCulloch

Professional supervision: trusting the wisdom that ‘comes’

ABSTRACT The lived experience of professional supervision is complex and dynamic. Techne, the knowledge that informs the ‘know-how’ of practice, offers guidance. Phronesis, the dynamic wisdom that trusts the ‘play’ of relationship in the supervision encounter, recognises the spirit of the encounter. While it is hard to capture that which is uniquely in the moment, this paper argues for an opening of the space that allows the phronesis of practice to be revealed. The notion of ‘play’ is explored, recognising supervision arises from the interaction between both parties. To yield effective supervision, play must be rooted in integrity, played out in a safe supportive environment, and underpinned by humility and courage. How the supervisor listens determines what the speaker will say. Unless a listening space is opened there is only empty talk. To embrace the phronesis of practice is to gift the supervision encounter with a rich wisdom that is beyond the scope of mere techne. One must also acknowledge however that this safest-of-all mode of practice paradoxically exposes the supervisor to vulnerability from a public scrutiny that seeks pre-defined ways. Techne has the certainty of the nod of approval while phronesis trusts in its own instinctual wisdom that can seldom be adequately explained. Yet, it is phronesis that makes the difference.

Reflections of a “Wounded Healer”

It intrigues me how, with the passage of time, some things change and what was once rejected and judged can become accepted and even valued. I am talking of how those who have experienced mental illness are now identified as consumers and are increasingly welcomed as participants on governing boards, at mental health conferences, and in various mental health related advisory groups. It is heart-warming that in these contexts their direct personal experience is listened to and valued and their opinions taken seriously. Such trends have the potential to add something very worthwhile to the notion of evidence based practice if it means we actually listen to the evidence of individual experience and not only to that which can be validated by randomized control research. And, of course, in support groups that seek to respond to individual needs that characterise the experience of mental illness, the consumer voice is often the dominant voice. You may be wondering where this conversation is leading. I am reflecting on the notion of the “wounded healer” described by Conti-O’Hare (1998, 2001) and how such an idea relates to what motivates us psychiatric nurses to enter that field of endeavour. Perhaps, though, I should begin with a confession: I am a wounded healer who has been a consumer of mental health services. I have given time and energy over the years to both understand and heal my own wounded-ness. There was a time when such disclosure carried much risk of judgment and the stigma that accompanied mental illness. My sense is that this risk has lessened but still remains in some contexts. Perhaps I am braver now and less concerned with such reactions from others. I am also much more aware of the distressing personal mental health issues experienced by many of my colleages in health care. Clearly, I am not alone. Indeed Heron (2001) would claim that we are all, in some way, wounded, but that many of

Assault on Nursing Staff: Blaming the Victim, Then and Now

In their November/December 2010 issue, The American Nurse published an article “Not ‘part of the job’. Nurses seek an end to workplace violence” (Trossman, 2010). It described nursing staff who had been victims of assault in horrific terms and gave examples of such victims around the country being blamed for the suffered assault. In addition, the lack of management action was described. This sounds, unfortunately, very much like the early 1980s when I began researching and publishing in the area of assault on nursing staff by patients. I interviewed staff who had been assaulted and reported my findings but no publication in nursing literature would publish because there was a belief that assault did not represent a problem in the health care industry/sector. I finally persuaded Hospital and Community Psychology to publish the article in 1983. Incidentally, the institution in which I was employed made me sign a document stating that no action would be taken to establish any training courses should my findings warrant it. This was back in the eighties and even though you would think that things have changed, little has. Nursing staff are still assaulted and nursing staff are still being blamed for the assault. Today, there are far more opportunities for speaking out and writing about the issue but for some reason, the knowledge we have about assault today is not present in the nursing culture, at least not at the practice level. This is unfortunate, considering that nursing staff are more likely to suffer non-fatal injuries while at work than employees in any other profession (Archer-Gift, 2003; Winstanley & Whittington, 2004). For example, Gacki-Smith et al. (2009) reported that 70% of the 3,500 registered nurses participating in their annual survey had been

Clinical Supervision and the Well-Being of the Psychiatric Nurse

University of North Carolina at Greensboro, School of Nursing,Greensboro, North CarolinaClinical supervision for many mental health practitionersis an essential part of a regular process that facilitates guidedreflection on day to day practice and the validation of decisionsmadeincomplexandchallengingclinicalsituations.Attheheartof its intent is the safety and well-being of the client and theirfamily. My focus though, at this time, is not so much directly onthe quality of care delivered to consumers but rather on the vitalrole clinical supervision should play in supporting the clinician.My sense is that the need for such support is greater than everbefore. In my contacts with mental health clinicians based inacute residential units, community based crisis response teams,andthoseinprivatepractice,itisincreasinglythecasethatintheface of diminishing resources and increased acuity of the clientpopulation served, practitioners experience much greater levelsof stress associated with high levels of individual responsibilityand accountability. Particularly in the community setting thereis often a greater degree of isolation from the immediate supportand feedback that close-knit clinical teams can provide. In suchcontexts consumer representatives, their families, and the widercommunitycontinuestoexpectconsistent,unwaveringexcellentservice. From their perspective such expectations are utterlyreasonable and worthy of fulfillment.The concern here is what all this might mean for the men-tal health practitioner. By its very nature, mental health caredelivered by nurses and other practitioners needs to respondeffectively to complex, difficult, personal, medical, social, andethical issues faced by patients, their families, and the wider

Constructions of truth, gate-keeping and the power of diagnostic labels.

One of the reassuring comforts that can follow a visit to a doctor is coming away with a diagnosis or name to describe or label one’s affliction. After experiencing pain, or other puzzling or distressing symptoms that we are unable to explain, a diagnostic label provides reassurance and security because it enables us to name, and make sense of, the malfunction in our body. And we can share this information with family, friends, or colleagues who similarly are enabled to take comfort with identifying or naming what ails us. The medical-model discourse that facilitates this process is one that has dominated Western medicine since the birth of anatomical and physiological understanding about how the machine of our body functions (Foucault, 1994). Within that construction we have, in many ways, been served well in our pursuit of physical health, repair, and well-being. I have unquestioned appreciation for the wonderful treatment and cure the medical model has given me through coronary bypass surgery and, on a different occasion, intravenous antibiotics for septicemia. These were literally lifesavers for me. At the same time, though, there are those of us who nurture a more holistic view of the person and are increasingly troubled by the continued undervaluing of the mental, emotional, social, sexual, spiritual, and cultural dimensions of our being. In the fields of mental health, mental illness, and psychiatric nursing we are, of course, similarly shaped by the powerful discourses of psychiatry, psychology, and psycho-neurology. And we possess much depth of understanding about the multiple factors that contribute to mental health or illness. My own now distant beginnings in psychiatric nursing were well grounded in terminology that tidily delineated neuroses from psychoses,

The Concept of “The Will to Thrive” in Mental Health

Mental health nursing is focused on patients moving along the continuum between failing and thriving in terms of emotional functioning. This differs dramatically from a medical model of disease/cure. A variety of nursing theorists have both directly and indirectly identified the importance of patients “will to thrive” although this term has never been used. Peplau spoke of self-efficacy and self-esteem. Barretts model focuses on the patients participation in their own recovery as a key component. This article explores the concept, akin to failure to thrive in infants, of the will to thrive in the chronically ill and its role in assessment and nursing intervention. A particular emphasis on the importance of patient responsibility is identified as vital to the process of true change.

Nurses, Mental Health, and Hard Economic Times

Lately, it seems that the American public has been bombarded with frightening messages about the state of our economy and the wars in Iraq and Afghanistan. What’s more troubling is that, individually, most of us have little control over what the future holds for our families or our country (CollinsMcNeil & Carbage-Martin, 2004). Men and women are returning from war with physical injuries and the emotional aftershocks of war. More importantly, these battle ridden soldiers are returning home with serious mental health problems and an alarming shortage of mental health providers. More often these days, we’ve found ourselves either personally affected by the wars in Iraq and Afghanistan or listening to and consoling loved ones or neighbors who have been affected by wars (Collins-McNeil & Martin, 2004). If you haven’t been affected by the wars then I chance to say that you have been impacted by our downward spiraling economy. The media provides us with daily reminders of these perilous economic times and their impact on our lives and our families. The stock market drops, companies and banks are downsizing, restructuring, or closing, and our savings and retirement plans have all but disappeared. Add to that the rising unemployment rates, loss of health insurance, and home foreclosures and Americans are feeling distressed. Rates of depression and anxiety, substance abuse, and suicide are expected to increase as a result of the current recession and the wars in Iraq and Afghanistan.

Is it Time

The article argues that the relationship to time is at the root of what makes us human and that culture arises with and from efforts to transcend death, change and the rhythmicity of the physical environment. Time can be tracked through systems of time measurement and later transformed from a process of nature into clock time, a time to human design that is abstracted from context and content. In this form time can be traded with all other times. With contemporary science and new information and communications technologies, which operate in a new all-encompassing temporal spectrum that extends from nanoseconds to millennia, clock time is no longer appropriate to the associated present-oriented transactions and futures are traversed in the dual sense of the word. By historically locating temporal relations, the article provides both a new understanding of socio-cultural relations and a perspective on social change.

Do the causes of psychotic symptoms matter

There needs to be a better understanding of how psychoses and other serious mental illnesses develop. They do not develop in isolation but are connected with subsequent events that impose themselves on the individual. Predispositions, via heredity, starts the process, but it is what happens subsequently in the environment that leads to interactions that are dynamic. Hence knowledge into what causes psychosis is not helpful when treating the condition. An analysis of the remitting symptoms leading to the treatment of the symptoms offers a better chance of remedying the condition. There is a need for as early an intervention as possible, ideally, if possible, avoiding the use of medication and concentrating on the use of CBT or CT.

We all have mountains to climb.

Today, on Tuesday, 22nd January 2008, New Zealand said farewell to our national hero, Sir Edmund Hillary. He is no doubt best known for his heroic conquest of Mt. Everest together with Sherpa Tenzing Norgay in 1953 (Uhlig, 2008). This was an amazing feat. It demonstrated how strong determination and unwavering conviction by a team of fellow adventurers, led by the highly skilled John Hunt, could result in the success of a seemingly impossible climb to the summit of the highest mountain in the world, Mt. Everest (King, 2008). Sir Ed has, over the years, demonstrated many qualities that can be deeply admired and that justify his iconic status. His venture to the South Pole in 1958 illustrated the best in Kiwi ingenuity and showed determination against many odds. Using converted farm tractors, his team managed to successfully haul all the team’s equipment across the 1,930 kilometers from Scott Base to the Pole (Harvey, 2008). Since his conquest of Everest, Sir Ed’s extensive charity work in support of the people of Nepal is testimony to the power of gratitude and love to motivate truly generous gifts of time, energy, money, and caring for the needs of others. His medical, educational, and building aid has made an incredible long-lasting difference in the lives of many in that country. At the same time, it needs to be acknowledged that for Sir Ed things were not always easy. He has, like so many others, experienced more than a fair share of personal tragedy in his life that more than once left him in deep despair and grief. Somehow his dogged spirit kept him going to fight another day and to make a real difference in the lives of others. Many of the people we encounter in our work also seek to conquer their personal mountains against all manner of hardships. Like Sir Ed