How to Start and Run a Peer Supervision Group - Julian McNally

Starting and Running ACT Peer Supervision Groups

The Who

Who are you going to invite? Who do you see as the natural constituency for this group? This will depend on the purpose (see ‘The Why’). You may have a focus on a specific clinical population, or you may have a group comprised simply of people in the same geographical area who can get to the meeting each week.

The other important person-focused issue though is whether to have a ‘closed’ or ‘open’ group. Open groups let new members come in at any time and attend for as little as one session or as many as they like. Closed groups run a bit more like a club, where the same people commit to attending regularly with only occasional intakes of new people. The main advantage of open groups is that there is continual ‘fresh blood’ as new people join, so it is less likely that the discussion will feel ‘stale’. The main advantages of the closed group are that levels of trust and safety are higher and this may lead to a greater sense of continuity in participants’ learning.

The Why

Decide your group's purpose and focus:

• learning techniques
• 'troubleshooting' applications
• debriefing from clinical work
• learning to develop ACT interventions
• applying ACT to specific clinical populations (e.g. eating disorders)
• or in specific practice contexts (e.g. residential substance abuse)
• overall ACT practitioner development

The Where: Have Your Premises Serve Your Purposes

The ideal ACT PSG venue has the following qualities. Think of these as ways of 'lowering resistance' to attendance. Since many people will be attending in unpaid time, possibly at the end of a hard day's work, we want to make it as easy as possible for them to arrive and as enjoyable as possible to stay.

• Located near public transport, cheap or free parking and cafes, restaurants or bars for after-group discussions.
• Easy to find. In a well-marked or prominent building or if you don't have access to such a building, at least provide a map and directions. Note that if you're posting details of your group here (ACBS web site) you can easily provide links to GoogleMaps or Mapquest maps. Go to their websites and enter the address and they will provide you with a map you can paste into documents, but also with links you can paste into your PSG description.
• The room. Large enough that fifteen people can talk among themselves comfortably, but small enough that three people won’t ‘rattle around’. Minimal room equipment is a whiteboard or blackboard, but even this can be foregone if your group doesn’t ‘do’ diagrams (Hexaflex etc.) or if you do them on large sheets of paper that everyone can see. Other handy things to have can be overhead or slide projectors and other such teaching paraphernalia and of course, the usual ACT ‘props’: Fingercuffs, rope for Tug Of War With A Monster, etc.

The How

There are books written on how to run PSGs (a good one is Brigid Proctor’s Group Supervision: A Guide To Creative Practice) and it might be a good idea to consult one before starting your group. Caution: the following reflects my opinion on our experience in Melbourne. It’s not the official ACT PSG system, rather just a way to set up and run a group.

A little history about our group first. The Melbourne ACT peer supervision group has run since Russ Harris first contacted interested practitioners in October 2004. Initially it was set up as an ‘interest group’. The problem we encountered with this label and purpose was that once you’ve shown you're interested then what? People attending in these early days tended to have one of the following two responses. Either they learnt a little information about ACT at these meetings and because they put it in the ‘that’s interesting, I might explore that more one day’ category stopped attending the meetings. Or they were enthused to start learning skills and applications of the approach immediately but became frustrated that there was no progression in knowledge and skill.

At one of our meetings Russ repeated Kirk Strosahl’s observation that workshops produce zealots, supervised practice produces practitioners. This prompted Russ to suggest that the group ‘morph’ into a peer supervision group which he led through 2005 and part of 2006. At this time I was able to secure a venue at RMIT University which gave us a home and consequently I started convening the group in June 2006.

At the end of this document is the format for supervision that we have used at the group since at least late 2006. From the feedback our members have given, this format has worked well, although for a small group (five or fewer members) two supervisors is probably overkill. We instituted this though at a time when our numbers were around 8-10 people regularly.

Rotating the supervisor and presenter roles through the group on a published roster maintains an egalitarian spirit and ensures everyone accesses similar learning experiences.

If you plan to use this format, then for the first few meetings it may be advisable to formally chair the meeting. This helps ensure people stay focused and adhere to the functions of their roles.

Tips and Challenges

• How do I keep the number attending high?

This is the biggest challenge especially early on. Short answer: time in the game. The longer you run the group the more chance of word getting around. Don’t give up when numbers drop to two or three people. It helps if you have someone locally who is running ACT workshops as Russ did, but if you don’t have that, then ask visiting ACT trainers to publicize your group at their workshops. It goes without saying I hope that you would set up a page for your group here on the ACBS site.

• Too many people are attending! What do I do now?

First tell me how you did it! Seriously the simplest answer, apart from get a bigger room is to split the group and run two groups. You may need to train someone to take over your role as leader for the other group.

• People keep giving non-ACT suggestions. How do I keep this an ACT supervision group and not something else?

It’s natural for people to go to what they know when they don’t have an answer for the problem that the supervisee is presenting. Model and encourage a ‘non-expert’ stance frequently, for example by offering yourself as the first supervisee. Ask how the suggestion fits the ACT model. Suggest that we all sit with the not knowing for a while (this may actually be something the supervisee needs to do as anyway!)

• Keep the case presentation section to under 20 minutes. Allow 30-50 minutes for case discussion. It should be easier to stick to these limits if you keep the discussion focused on answering questions such as those in the format below.
• Choose a standardised case formulation protocol. Russ Harris provides a couple – brief and briefer – in his workshops and you can access these through his site, www.actmindfully.com.au. The ‘gold standard’ protocol, also the most comprehensive, is the one Jason Luoma developed, available here at www.contextualscience.org.

ACT Peer Supervision Group Guidelines – Melbourne ACT Supervision Group

• One supervisee presenting the case, two supervisors providing guidance/supervision. The remainder of the group is to observe the supervision process and provide feedback to the supervisors.
• Supervisee needs to have a specific question(s) to ask the supervisors. Examples of good questions might be:

“Is there an ACT process I’ve overlooked?”
“What would you do?”
“What does it sound to you that the client needs from me or from the treatment process?”
“What more do I need to find out from/about the client?”

• Supervisors should aim to focus on core ACT therapeutic competencies.
• Format is:

1. Supervisee presents the case.
2. Supervisee asks first supervisor for their guidance – relevant to the question the supervisee has about the case. Supervisor can ask questions about the client to clarify issues such as history, strengths, previous treatments, family background, etc. Supervision interventions can include demonstrations, role-plays, exercises for the whole group or the supervisee as well as questioning and explanation.
3. Repeat for second supervisor
4. Rest of group provide feedback to the supervisors on what they think the supervisors might have done differently, any ACT components missed or competencies not followed up on. NOT an opportunity to ‘re-interview’ the supervisee about the case. (This means supervisees need to get good at case presentation)
5. The group should start the following session by following up with the supervisee to find out what ideas were tried or what was different in the subsequent session(s) with that client.

Case Formulation Questions

1. What thoughts or feelings are fused and unworkable? (Fusion)
2. What values is the client removed from? (Remoteness from values)
3. What experiences such as emotions, thoughts, reminders, contexts and behaviours is the client avoiding or having difficulty accepting (Experiential avoidance or unwillingness)
4. What is the client’s story about self? (Self as Content)
5. What is the quality of the client’s presence? How do they absent themselves from life, engagement or connection? (Contact with the present moment)
6. What does the client fail to start or fail to finish? Where does the client fail to or lose focus, or fail to engage in committed action? (Committed Action)

Feel free to comment below, on the ACT Listserve or directly to me (act@julianmcnally.com) with questions, reports of success or challenges you encounter in running a group.