THE APPLICATION OF DIALECTICAL – SYSTEMIC EPISTEMOLOGY IN THE TRAINING OF SUPERVISORS AND INTERPROFESSIONAL CONSULTANTS

Abstract

 Supervision and interprofessional consultation are considered essential prerequisites for effective psychotherapeutic or counseling work with individuals, families, groups, or organizations. However, for their effective practice, both professional experience and specialized training of experts are required. In recent years, training programs have been implemented, internationally, aiming to equip professionals with theoretical knowledge, the ability to support supervisees, the skill to utilize group processes, the development of a functional collaboration with supervisees, and familiarity with legal, ethical, intercultural, and professional conduct issues.

              The corresponding training program of the Athenian Institute of Anthropos (AIA) is based on Dialectical-Systemic Epistemology and is adapted to the standards of the European Family Therapy Association. Trainees participate in experiential exercises, analyze recorded video or audio material, study the relevant literature, attend regular group supervision meetings, and complete 180 hours of individual and group supervision as supervisors under supervision. Finally, they prepare theoretical studies, which are presented at scientific conferences, thereby enhancing their theoretical and practical training.

Keywords: Supervision, Interprofessional Consultation, Training, Dialectic – Systemic Epistemology.

INTRODUCTION

              Psychotherapy and Consultation are well-established practices for addressing personal psychosocial challenges, fostering personal growth, and strengthening family functionality. At the same time, group consultation, whether for educators, athletes, or professionals in various fields (such as mental health), or companies and organizations, plays a crucial role in enhancing collaboration among members or staff, effectively managing crises, and ultimately improving the functionality and efficiency of teams and organizations. To effectively meet the demands of their roles, professional consultants and psychotherapists require high-quality education, specialized training, and ongoing supervisory support, particularly during the early years of their practice (American Association for Marriage and Family Therapy, 2014; American Psychological Association, 2014; U.S. National Association of Social Workers, 2013; EFTA-TIC, 2011).

                 The role of a supervisor is often undertaken by professionals with many years of experience in a relevant scientific field (Holloway, 1999; Βασσάρα, 2016). Since supervision is a highly responsible and demanding process that requires more than just professional experience -it also necessitates specialized training- supervisor and interprofessional consultant training programs have been implemented internationally in recent years. Their primary goal is to enhance the quality of services provided and safeguard the well-being of those receiving consultation (American Association for Marriage and Family Therapy, 2014; American Psychological Association, 2014; U.S. National Association of Social Workers, 2013; EFTA-TIC, 2011; World Health Organization, 2005).

              First, this paper will outline the fundamental principles that are considered essential for the training of supervisors and consultants on an international level. Then, we will present the training program for supervisors and interprofessional consultants as it was developed and is implemented by the Athenian Institute of Anthropos (Α.Ι.Α.).

INTRODUCTORY DEFINITIONS AND DISTINCTIONS

              The general term "supervision" refers to the consultative, guiding, or educational process aimed at developing the professional skills of those being supervised and, ultimately, improving the quality of services they provide to their clients (American Association for Marriage and Family Therapy, 2014, American Psychological Association, 2014, US National Association of Social Workers, 2013, Μαλικιώζη-Λοΐζου, 2011). Internationally, supervision is recognized as a fundamental method for developing and ensuring the quality of psychotherapy, consultative, education, and related fields. Many professional associations worldwide require supervision as a prerequisite for obtaining and maintaining professional certification for specialists. Τhis way, supervision becomes a key component of the lifelong education of mental health professionals. Supervision often takes the form of evaluating the supervisees and safeguarding the profession, according to the standards set by the relevant professional associations or the legislation of each country. Additionally, the supervisory process is governed by standards, often legislated, as it is considered a distinct professional activity that requires appropriate training, practice, corresponding supervision, and certification (Consalvez & Milne, 2010; EFTA-TIC, 2011; Holloway, 1999; World Health Organization, 2005; Milne et al., 2011; Schlippe and Schweitzer, 2008; Βασσάρα, 2016).

              However, we also use the term "interprofessional consultation". There is a distinction between these two terms, as follows (Caplan, 1964; Stainberg, 1994; Σακκάς, 1994):

              Supervision primarily refers to the supportive relationship provided by a more experienced professional to a less experienced one. It focuses on skill development, professional autonomy and quality assurance, through feedback, evaluation and professional empowerment. It is an intradisciplinary process aimed at the continuous improvement of the supervisee. Often, the supervisor has the final responsibility for the progress of the therapeutic or counseling work, and may also be entrusted with the authority to grant or deny professional certification to the supervisees. A subcategory of clinical supervision is the oversight of students' practical training.

              Interprofessional consultation (or professional role consultation) typically involves providing support to experienced professionals, teams, or organizations (Vassiliou & Vassiliou, 1983; Σιγάλας et al., 2012). The focus is on solving specific problems, improving collaboration, supporting decision-making, or facilitating the development of strategies or actions. It often aims at the prevention or treatment of work-related stress. The final responsibility for the quality of the services provided by the consulted professionals or organizations lies with the consultees themselves, who also retain the right to evaluate the services provided by the professional consultant (Caplan, 1964; Stainberg, 1994). Interprofessional consultation, therefore, takes place within a relationship of equality between the consultant and the consultees.

PREREQUISITES FOR THE COMPETENCE OF SUPERVISORS OR INTERPROFESSIONAL CONSULTANTS

              Given the importance that supervision has acquired in the practice of mental health professions, many relevant scientific societies or even governments have established ethical guidelines or competence requirements for supervisors or professional consultants (American Association for Marriage and Family Therapy, 2014; American Psychological Association, 2014; U.S. National Association of Social Workers, 2013; Carroll, 1999; Falender et al., 2004; Milne et al., 2011; Russell & Petrie, 1994). Therefore, supervisors:

·       Develop a clear cooperation agreement with their supervisees, which clearly defines the expectations and obligations of both parties.

·       Establish a relationship of trust and cooperation with their supervisees.

·       Have sufficient knowledge and significant experience in the clinical field that their supervisees are involved in.

·       Focus on the therapeutic relationship that supervisees build with their clients in therapy, while also accepting the ethical and moral responsibility to protect the clients’ well-being. They intervene directly when corrective measures are required for their supervisees' shortcomings.

·       Request feedback from their supervisees and jointly assess progress in achieving the goals of supervision.

·       Help their supervisees to self-assess their progress in acquiring professional competence.

·       Use various methods and tools to achieve the goals of their work. They are familiar with the use of appropriate technology and remote working.

·       Are aware of issues related to diversity and interculturality and are knowledgeable about their own competence in these areas, which includes attitudes, knowledge, and skills.

·       Are able to contain the anxiety or distress of their supervisees, as well as their own.

·       Are flexible and open to new learning throughout their work.

·       Are aware of the broader context in which their supervisees work, and seek to collaborate with it.

·       Regularly assess the progress of their supervisees and the effectiveness of the supervisory relationship, while addressing any emerging issues in a timely manner.

·       Are knowledgeable about ethical issues in the practice of their supervisees' professions.

·       Are committed to the code of ethics of their professional association.

·       Accept their role in safeguarding the credibility of the profession.

·       Are required to record and document their work, while collaborating harmoniously with other agencies that may supervise the work of their supervisees.

·       Ensure the acquisition and maintenance of their professional competence by participating in accredited training and clinical education programs. At the same time, they seek supervision for their own work.

              The goal of every supervisor or interprofessional consultant training program is to develop exactly the skills listed above in its trainees.

EDUCATIONAL PROGRAMS FEATURES

              Educational programs for supervisors focus on the essential skills and knowledge that a supervisor or interprofessional consultant must possess (American Association for Marriage and Family Therapy, 2014; American Psychological Association, 2014; Carroll, 1999; EFTA-TIC, 2011; Green & Dye, 2002; Hess et al., 2008; Lonneman Doroff, 2012; Milne et al., 2011):

• Theoretical training in psychotherapy, consultation and supervision models.

• Ability to guide, consult, and support supervisees.

• Learning monitoring and evaluation techniques to assess the performance of supervisees.

• Familiarization with group dynamics and the ability to leverage group processes.

• Ability to develop functional collaboration with supervisees.

• Adherence to ethical codes and understanding the legal and ethical frameworks governing supervision. Familiarity with legal, ethical, intercultural, and moral issues.

• Acceptance of cultural, racial, gender, and other differences.

• Appreciation of the effects of the broader system/organization to which the supervisees may belong. Supervisors need to consider the factors of the organization or community where they work. Understanding systemic features and flexibility in approach are critical elements.

• Development of meta-skills. Self-observation, self-assessment of supervisors. This process includes critical thinking and reflection.

• Empathy, flexibility, and open communication are considered vital for supporting and guiding supervisees. Supervisors must be willing to provide feedback and facilitate collaboration.

              Based on the above, trainers who participate in the training of supervisors and professional consultants need a set of specialized skills:

• Pedagogical competence: Trainers must be experts in theoretical and practical aspects related to supervision. They should be able to convey knowledge in an understandable and applicable way.

• Experience: Experience in real supervision and consulting cases is essential. Trainers should be able to provide examples and share personal experiences that enrich the learning process.

• Ability to manage diversity in the personalities of trainees: Each trainee has different needs, learning styles, and levels of experience. Trainers must adjust their methods to support all participants.

• Communication skills: Effective communication is key to creating a learning environment. This includes active listening, clear formulation of goals, and enhancing collaboration.

• Reflective practice and self-awareness: Trainers must have the ability to assess their own practices and adjust their approaches. Reflective practice promotes self-improvement and continuous professional development.

• Technological literacy: With the development of distance learning and digital tools, trainers need to be familiar with technologies that facilitate supervision and training.

• Team management: In educational programs for supervisors, trainers must enhance collaboration within the group. Understanding group dynamics and the ability to intervene in crisis situations are essential (Vassiliou & Vassiliou, 1983; Βασιλείου, 1988; Μαλικιώζη-Λοΐζου, 2011; Σιγάλας et al., 2016).

• Ethics and professionalism: Trainers must emphasize the importance of ethical practice and ensure that trainees understand the ethical guidelines governing their profession.

EDUCATIONAL METHODS

              The suggested training methods for supervisors are based on contemporary practices that enhance professional development and ensure the quality of the supervisory process. These methods include theoretical, practical, and reflective approaches, applied both on an individual and group level (American Psychological Association, 2014; Carroll, 1999; EFTA-TIC, 2011; Lammers, 1999; Calimlim, 2021; Scott et al., 2000).

              Theoretical Training:

1. Lectures and Presentations: Lectures by experts represent a classic yet effective way of transferring theoretical knowledge. Supervisees become familiar with key concepts, theories, and supervision models. Multimedia presentations can make the content more engaging and understandable.

2. Literature Review and Overviews: Reading relevant scientific papers, manuals, and studies allows trainees to deepen their understanding of the theoretical foundation of supervision. Special assignments, such as case analyses, help connect theory with practice.

              Theoretical training includes topics such as various theoretical approaches and models of supervision and counseling, legal, ethical, and moral guidelines for supervision, etc.

              Experiential – Practical Training:

1. Workshops and Seminars: Seminars provide opportunities for dialogue and analysis, allowing trainees to actively participate in discussions, and exchange ideas with their colleagues. Workshops focus on practical skills, such as conducting supervisory sessions and problem-solving.

2. Simulations and Role-Playing: Simulating real supervisory situations enables trainees to apply their knowledge in a safe environment. Participants can take on different roles (supervisor, supervisee, observer) to understand the various perspectives within the supervisory relationship.

3. Recorded Sessions: Trainees record supervisory sessions and analyze them with the guidance of their trainers. This process allows for self-assessment and targeted improvement.

4. Supervision of Supervision: Trainees present their own sessions (where they act as supervisors) and receive guidance and feedback from the trainers, as well as from their peer group.

5. Additional Feedback Opportunities: Trainers may observe trainees during supervisory sessions and provide feedback to help improve their skills. This method combines practical application with immediate feedback, boosting trainees' confidence.

Reflective Training:

1. Individual Reflective Practice: Trainees are encouraged to document and reflect on their personal experiences and emotions during supervisory sessions. This process fosters self-awareness and helps them understand how their personal traits influence the professional relationship (Elkaim, 2008; Βασιλείου, 1988).

2. Group Reflective Sessions: Groups of trainees discuss their experiences and analyze the challenges they have encountered. The exchange of perspectives strengthens critical thinking and collaboration (Lammers, 1999).

3. Guided Feedback: Trainers provide structured feedback based on specific criteria, reinforcing areas that need improvement. This approach helps trainees recognize the impact of their actions.

              Utilization of Technology: Use of online tools and platforms for distance learning and feedback.

              The proposed models for the training of supervisors and interprofessional consultants involve a combination of all or most of the methods mentioned above. They integrate both in-person and online educational sessions. Trainees typically work in groups, where they have the opportunity to solve problems and develop common approaches. This promotes collaborative learning, enhancing creativity and cooperation among participants.

THE TRAINING PROGRAM OF THE AIA (ATHENIAN INSTITUTE OF ANTHROPOS)

              The training program for supervisors and interprofessional consultants developed and implemented by the AIA will now be described. As an example, we will focus on the first comprehensive program, which lasted a total of 300 hours and took place between 2019 and 2022. The main instructor was Dionysis Sakkas, with Ioannis Sigalas as his co-instructor. Other experienced members of the AIA also participated in the educational process. The trainees were eight experienced systemic therapists. The program focused on the practice of supervision (individual or group) or interprofessional consultation for family and group therapists, as well as consultants, based on the Dialectical-Systemic Epistemological Approach, which underpins all the therapeutic and educational activities of the AIA (Polemi–Todoulou, 2018; Polemi–Todoulou, 2018; Stainberg, 1994; Vassiliou & Vassiliou, 1983). It was adapted to the standards of the European Family Therapy Association (EFTA–EFTA-TIC, 2011). The main prerequisites for participants in the program were having completed their personal therapy and having extensive experience as therapists.

              The main educational tools utilized during the training process were the same as those always employed in all of the AIA's educational activities. These include familiarizing the trainees with Dialectical-Systemic Epistemology, fostering group dynamics among the trainees, and applying the principles of Experiential Education.

              The key principles of the Dialectical-Systemic approach are summarized as follows (Polemi–Todoulou, 2018; Vassiliou & Vassiliou, 1983; Βασιλείου, 1988; Σιγάλας et al., 2000):

·       The expressions of human functionality or dysfunction are examined not as static facts, detached from their environment, but dynamically, as processes. That is, as evolving sequences of events.

·       A set of processes, which evolve in comprehensive interaction, interconnection, and transaction with one another, form a System. The properties of a System cannot be reduced to the sum of the properties of its parts, due to the continuous transactional relationships that develop between the processes within the System. Moreover, since these transactional relationships are always bidirectional, it becomes impossible for the observer to distinguish linear cause-and-effect relationships between the processes that make up the System.

·       A person is defined as an open, autonomous bio-psycho-social system, which, in order to survive and develop, organizes and becomes a member of social groups with progressively increasing complexity (family, community, society, etc.). This is because the cognitive, emotional, and social differentiation and development of a person cannot occur in isolation. Therefore, we can understand the "Person" as a complex dynamic field, consisting of the entirety of their dynamic relationships, which enables them to fulfill their primary purposes, that is, to create, produce, and exchange outcomes.

·       In order for these functions to develop unhindered, there is a fundamental condition: The functioning of the social groups into which humans are integrated must be based on cooperative, collective relationships. When competitive and exploitative relationships prevail in social groups, psychosocial exploitation develops among their members, leading to severe dysfunctional consequences that gradually become generalized.

 The development of group processes among participants is considered a necessary condition for the positive evolution of any educational activity at AIA, as utilizing group processes during therapy, education, and supervision of specialists is the most important factor in applying the Dialectical-Systemic approach in these areas (Polemi–Todoulou, 2018; Polychroni et al., 2008).

              Based on this approach, each member of the group needs to develop a set of necessary skills, which are as follows:

·       To participate in creating an atmosphere of trust and responsibility.

·       To communicate openly and honestly, emotionally placing themselves in the other person's position. This way, the group develops cohesion, and members operate in an environment of familiarity and mutuality.

·       To be able to cooperate and engage in dialogue with other group members without seeking to control them. To be able to express their thoughts and feelings with courage and honesty.

·       To develop emotional awareness, as well as self-knowledge regarding their goals and capabilities. This allows them to take the initiative in action to achieve their goals by adopting behaviors that promote relationships with others.

              Through the development of these skills, reciprocal and comprehensive exchanges are cultivated among the group members (i.e. "systemic relationships" between them). As members become aware of their cognitive and emotional processes, they gain greater self-awareness, learn to act on their own initiative in behaviors that foster interpersonal relationships, develop empathy, and participate in "transactional learning", which contributes to the development of their personal differentiation.

              The development of meaningful communication among members, and the overall evolution of the group as a whole, occur through "creative dialogue". The concept of creative dialogue means that one member's viewpoint represents a thesis, another member's viewpoint potentially represents an anti-thesis, and through the interaction of the members, a synthesis will emerge. This final viewpoint becomes a new thesis, which leads to a new anti-thesis and synthesis, and so on. Through creative dialogue, the thesis and anti-thesis lead to synthesis and enrichment, rather than conflict and dissolution. The syntheses that emerge from creative dialogues within the framework of group dynamics are considered to be the most important source of transformative learning and personal differentiation for the members of the group (Βασιλείου, 1988).

              The role of the trainer in applying the Dialectical-Systemic approach includes the following parameters:

• The trainer ensures the necessary regulatory processes that bring life and movement to the group, and their leadership effectiveness is directly proportional to their ability to activate the self-leadership capacities of the group members.

• The trainer acts catalytically/regulatively. They facilitate the participation of all members in the creative dialogue so that the different viewpoints, considered as "internal voices" of the group, contribute equally to the production of learning.

• With appropriate interventions, the trainer regulates the group's process, helping to shape its functional goals, and then ensures the group remains focused on them.

• At the beginning of the educational process, the trainer contributes to the development of initial "familiarity" with trust and comfort among the group members, effectively initiating the "creation of the system" (system forming) within the group. To achieve this, the trainer uses experiential education techniques, such as splitting the members into pairs or triads, conducting simple introductory exercises, and then sharing thoughts and feelings from each small group (not from each individual) in the plenary session. In the small groups, an initial level of trust can be created, the opinions and experiences of each member (even those who hesitate or struggle to express themselves personally in the plenary session) can be utilized, and the first syntheses can emerge, which will contribute to the development of a richer qualitative synthetic process in the plenary session.

• During the training, the trainer monitors the flow of thoughts and emotions of their trainees, while also maintaining awareness of their own personal reactions. Τhis way, the trainer stays aligned with the emotional atmosphere that develops within the group, and can contribute more effectively to its proper regulation (Elkaim, 2008).

              Finally, we will refer to the third main axis of every educational process at AIA, which is "experiential learning" or "experiential education" (Polychroni et al., 2008; Σιγάλας et al., 2012; Σιγάλας et al., 2016). By these terms, we mean that:

• The trainees do not function as passive recipients of information, but actively participate in educational activities: a) through participation in properly designed exercises (which, for example, include role simulations); b) by sharing feelings and personal experiences; and c) by processing topics in small groups and sharing and discussing positions and questions in the plenary session.

• Through participation in the experiential educational process, trainees: a) learn by doing; b) learn from the emotional reactions triggered by stimuli; c) learn from their interactions within the small group; and d) learn by putting themselves in the other person’s position, i.e. by taking on roles. Or, as has been stated elsewhere, trainees derive meaning from experience and action.

• A group process develops among the trainees. Special emphasis is placed on the gradual development of trust and intimacy among the members of the trainees' group during educational activities.

• In order for group cohesion to be possible among the trainees, it is also necessary for the trainers (as well as the organizers) who participate in each seminar to take care of developing group cohesion and cooperation among themselves. Thus, the functioning of the trainers' group becomes a model for the trainees, who have the opportunity to observe how the trainers communicate with each other during the educational program (and often outside of it) and how they develop their collaboration in an atmosphere of trust, resolving any differences that may arise between them.

• Feedback is utilized. During the design of an educational process, a program of topics for processing may have been prepared. However, this program is modified and enriched according to the needs of the trainees, as these emerge during the course of the training. To identify these needs, the positions and questions presented, either individually or mainly through the discussions in small groups, are utilized, as well as the daily analysis of the group's process, which comes from studying the emotional interactions, as well as the verbal and non-verbal communication developed among the members and with the trainers. Therefore, an effort is made to ensure that the flow and content of each program continuously meet the needs of the trainees.

              We shall now describe a brief example of a practical exercise, dedicating it to the memory of the late Petros Polychronis, the former director of AIA, who fell ill and passed away during the implementation of the Program. Petros Polychronis taught this exercise to a group of supervisors of AIA's therapists, which included the first author of this paper, many years ago. The co-trainer of the program described a meeting from one of his own supervisions in a mental health facility, where he encountered certain difficulties. He asked the group of trainees to “supervise him”, adhering to the following rules: After hearing the case, they could ask any clarifying questions they wished, express emotions while trying to put themselves in the supervisor's position, and finally share any relevant personal experiences. This way, without any form of criticism, a rich processing of experiences and emotions developed, and the group functioned complementarily and supportively.

              In conclusion, the participants in the AIA Supervisor and Interprofessional Consultation Training Program:

• Developed group processes among themselves.

• Participated in experiential exercises.

• Utilized visual or audio recorded material from supervisions they had conducted themselves.

• Made use of internet resources.

• Participated in regular group supervision meetings with Dr. Sakkas.

• Had the opportunity to discuss the international literature on theoretical, ethical, and legal issues, with relevant literature provided.

• Completed 180 hours of individual and group supervision as supervisors, under supervision.

• Each trainee prepared a theoretical study on a topic related to the supervisory process. These papers were presented at the 13th Pan-Hellenic Psychiatry Conference for Children and Adolescents, as well as at the Scientific Celebration for the AIA’s 60th Anniversary.

              It is also worth noting that the group of supervisors who completed the aforementioned AIA program now regularly conducts supervisions for public mental health organizations, under the supervision or with the participation of their (former) trainers. Thus, we continue to function as a professional advisory team at AIA, having developed excellent cohesion, cooperation, and mutual support among us.

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