Full transcript below
Reflective practice groups are a subject that has come up a few times on the podcast as being an important way of supporting both staff wellbeing and patient care.
Paula wanted to explore this in more depth, so in this episode she is joined by Dr Arabella Kurtz, consultant clinical psychologist and psychoanalytic psychotherapist to talk about her Heads and Hearts model. They discuss how reflective practice is defined in this context, the different components of the Heads and Hearts model, and common challenges.
Arabella and her colleague Dr Joanna Levene have summarised the model in a chapter of the excellent ACP-UK book entitled ‘Psychological Staff Support in Healthcare’, which was edited by Dr Harriet Conniff.
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Transcript
Paula Redmond 00:04
Hi, I’m Dr Paula Redmond, a clinical psychologist, and you’re listening to the When Work Hurts podcast. On this show, I want to explore the stories behind the statistics of the mental health crisis faced by health professionals today and provide hope for way out through compassion, connection and creativity. This season is brought to you by the Association of Clinical Psychologists, the representative professional body for clinical psychologists in the UK. Join me as I talk to inspiring clinical psychologists about their work in this field and learn how we can support ourselves and each other when work hurts. Reflective practice groups are a subject that has come up a few times on the podcast as being an important way of supporting both staff wellbeing and patient care. I wanted to explore this in more depth and so I spoke with Dr Arabella Kurtz, consultant clinical psychologist and psychoanalytic psychotherapist about her Heads and Hearts model. She and her colleague Dr Joanna Levene have summarised this in a chapter of the excellent ACP-UK book entitled Psychological Staff Support in Healthcare, which was edited by Dr Harriet Conniff. I started by asking Arabella to define what reflective practice is.
Arabella Kurtz 01:34
Well, I mean, as you know, I’m so kind of immersed in reflective practice in groups, and that’s a very particular form. But if we step back a bit, and we think what does it mean as a more general term, from my point of view, it’s in a way, very straightforward and in another way, not at all straightforward. So the straightforward bit for me is that it really is about thinking about your practice. It’s about the development of practice. And the term was originally put forward by Donald Schön, who was a town planner. So actually, it applies across the range to different forms of professional practice, not just healthcare, not just psychology, but you know, architecture or law or whatever else. So it really is about thinking about practice. But it seems to me that it’s a particular form of thinking about practice. So if we go back to Schön’s original definition, what he was really trying to do was introduce a kind of outside the box, creative, non standard way of thinking about practice, to complement, standardised ways of thinking about practice. So standardised meaning a bit more automatic, bit more drawing on the established evidence base, scientific and technological to, if you like, apply knowledge, the current state of knowledge, to a range of human situations and problems. That’s the more standardised form, which Schön saw as being given great priority in our culture as being dominant, incredibly useful, but dominant to the exclusion of other forms of thinking about human problems. And what Schön was really saying is, we need ways of thinking about situations which are non standard, which, in our particular line of work may have enormous emotional impact and mean, it’s not just about thinking through them, but how we feel, and dealing with emotional impact. But also we might need to draw on creative and a whole range of kinds of resources to make sense of more complex, ambiguous, uncertain, emotionally impactful situations.
Paula Redmond 04:01
Yeah, great. So there’s yeah, there’s something about, it’s very interesting to hear that that came from outside healthcare, I didn’t know that. And just, I guess, thinking about working in healthcare and the complexity of all those kind of wicked problems that we face the need for to draw on different types of thinking.
Arabella Kurtz 04:23
Yeah. But we only have to kind of look around us just all sorts of forms of human endeavour and what’s going on in the world to see that wicked problems are everywhere. And sometimes people are going at them much too fast. And in much too reactive away, and Schön was, you know, trying to say, there are this, there’s this other form of thinking, that he called reflexive. In healthcare, and I suppose in the model, the heads and hearts model, it’s about bringing creative outside the box thinking to bear on situations, but also bringing together the thinking and feeling parts of ourselves.
Paula Redmond 05:02
And I guess that the model is a group model. So I suppose we could find reflexive ways of thinking just within our own heads or within a supervisory space. But this is a group process, a group model. And what do you think that adds to it the group element?
Arabella Kurtz 05:23
The resources of a group of individuals, the diversity of different people with different backgrounds, perspectives, ways of thinking about things. So there’s a sort of resource element in terms of, you know, the what’s brought to bear to make sense of a problem, if you like, the meaning making. But the other thing, of course, is that doing it in a group, enhances connection with peers. So there are those two elements, the group, the group gives an awful lot in terms of the improving practice element, if you like. But also, I think it’s very important for the wellbeing of staff to do this kind of thinking and, and with people and feel solidarity and connection.
Paula Redmond 06:09
And I’m just thinking about what we’ve been through, I guess, in healthcare of the last few years with the pandemic, and how, how important that bit has been reconnection and maintaining and building on those opportunities to connect with each other. Is that something you have been seeing over these last few years?
Arabella Kurtz 06:33
Yeah. And I think it’s a very, very, very relevant problem just at the moment, because I think so many teams have not reestablished themselves, and are not meeting regularly. And I think a lot of staff are feeling really isolated and unsure of who they’re working with, and where their base is and what they’re doing in terms of working with a group of colleagues. So I think it’s continued with this, with the very mixed blessings of a hybrid model. One of my bugbears is that there’s a big focus at the moment on getting it right for client work. So, for example, you know, thinking which clients need to be seen face to face, and what kind of work can carry on online. And that seems to me very good as far as it goes. But there’s very little consideration about what matters for staff. So, you know, I would argue that giving a priority to teams and working groups being together is really important, not just a sort of secondary issue.
Paula Redmond 07:36
And you’ve mentioned a couple of sort of key benefits there about, you know, being able to bring a different way of thinking to tricky stuff. And connecting with colleagues and reducing isolation. Are there any other benefits, you see to reflective practice?
Arabella Kurtz 07:57
Well, the two, the two main aims, certainly of my model are learning, learning about the work and improving practice and what I think of as relational containment through the recognition of the whole person in the work of care, and opportunities for shared meaning making with colleagues. So the main aim should be improved practice and a stronger sense of connection with colleagues. But there are lots of kinds of other things that come along with that. So we can then say, sort of maybe what are the particular aspects of practice that reflective practice addresses. And I would say a main one is empathy in connection with clients. So I’ve quite often had the feedback that after reflective practice group, staff are feeling different about the people they’re offering a service to. And those different feelings can take all sorts of different forms, but there’s a shift in the feeling state. And that’s, that’s very important. I think. The other thing to mention is there was a systematic review that came out last year, that looked at the impact of reflective practice in medical training in Australia. And they identified across 18 studies, the finding of what they call improved professionalism. And what that meant when they drill down in the different studies, was the building of theory practice links in the, in the medics, so that meant a sort of closer sense of fit, and more adapting and flexibility between theories and standard ideas about what we should be doing in practice and the particular needs of patients or clients. So I think that’s something that goes on in reflective practice, really kind of adapting our thinking to unique situations and cases.
Paula Redmond 09:58
And are you aware of either, you know, in your own work or in the research about broader impacts, sort of culturally within an organisation, I guess those are things like, you know, benefits to the individuals who are attending. But I wonder if they are ripple effects that go wider than that?
Arabella Kurtz 10:17
Anecdotally, certainly, teams will talk about the fact that, that things have changed in the team, and they feel more able to speak openly with their colleagues about their experience of work, what matters to them in the work, the real questions and concerns and doubts that they’ve got about what they’re doing. So I’ve heard a lot about that anecdotally. And I think it contributes to a kind of more honest culture. I mean, I would say in healthcare, we’ve got a real problem actually with, with, with openness, we’re a very risk averse culture, and people are very, very worried about admitting to what they see as mistakes and sometimes being punished for them. So I think reflective practice has a really, you know, really helps to address that problem. So anecdotally, I’ve heard a lot about it, I’ve got more and more interested in recent months, in the idea of building what I think of as communities of reflective practice. So rather than supporting one-off groups, which I’ve done a lot of, either through facilitating them, or supervising people, facilitating them, I’ve got very interested recently in, in trying to nudge, you know, if let’s say 20 or 30, people come to a training course in facilitating reflective practice, then really trying to give ongoing support after that. And particularly with a, within a single organisation, building a network of people all doing the work, who can carry on providing peer support, and sort of ensuring there’s a bit more of a cultural change, because I think it’s very difficult to keep a kind of reflective practice culture going in isolation.
Paula Redmond 12:12
And I guess it’s something that, you know, as a psychologist, it’s often a sort of expected thing that you just are supposed to know how to do, and you know, not necessarily given opportunity to have training and supervision around this specifically. I’ve certainly been in that situation myself, you know, just lots of assumptions about y’know, just being able to do it, and it’s really challenging work.
Arabella Kurtz 12:49
Yeah, I mean, that was a big reason for developing the model. I was doing training courses without a model. And people were coming to the training courses and talking about a very heightened sense of imposter syndrome. This idea that this was really something they should know how to do. And in actual fact, they’d never received any training, possibly never been experienced themselves being part of a reflective practice group, even to draw on. And the other problem I came up against, was that sometimes a bit too frequently, really, people had been part of a reflective practice group, but had not had a good experience. In fact, they sometimes had an actively aversive experience. And then they were expected to deliver the goods and an offer something helpful.
Paula Redmond 13:38
Yeah, I was thinking that when you were talking about, you know, the benefits of groups, and you know, how we can all learn from each other and support each other, but equally, they can be scary places.
Arabella Kurtz 13:48
They can be scary and they can be destructive. You talk about when work harms, well, groups can be so helpful and supportive, and we need groups, I think, in the work of healthcare to do our job properly. But often, you know, the experience can be different.
Paula Redmond 14:09
So tell us about the model. I know, I know that you’ve written a whole book about it, we don’t have time to go into in depth detail about it, but can you give us an outline and maybe draw out some of the key features of it?
Arabella Kurtz 14:23
Well, I suppose one of the first things to start with is just to have a sort of clarity about the purpose of a reflective practice group. We’ve already talked about that. But I think it’s worth mentioning it again, because people mean a lot of different things by facilitation of reflective practice group. And in my mind, it is very, very much about, in a very open and hopefully creative and emotionally sensitive way, helping healthcare staff think about their work, but distinguishing that from let’s say a staff support group, or what sometimes happens in these situations, which is a kind of therapy by staff, I think the boundaries of the group are very important and the fact that it is, whatever kind of forays it takes into different ways of thinking and exploring a concern or situation, that is brought back to the work, that gives it its rationale and purpose, and I think is a very important anchoring and sense of safety. So I’d want to start with that. And then I think the model is very much intended for people to use and integrate into their own practice. And I just want to say, before starting to talk about it, I’ve never intended for it to be prescriptive, or for people to kind of obey the model in, you know, in, I don’t really want it to sort of be overbearing in that way. The model for me summarises what I think of as the sort of key ingredients of reflective practice. And I’ll say something about them in a minute. And I kind of, I included them thinking to myself, well, if I was going to review a group over a period of time, I’d want to make sure that these elements were all there. But I don’t want people to think that I do everything every time. I just don’t think that that’s how it works in the real world. And different groups need an emphasis on different things at different points in time. So one of the first things to say is that the model includes two contracting stages. And this is quite an important thing, really. So it, there’s a group contracting stage and that’s the kind of contracting that I think you people who work with groups will be familiar with, when you’re sitting with a group and you’re thinking, you know, what are we here to do? And what do we need in order to support us with what we’re here to do? And that’s reasonably straightforward. But something I’d want to mention and draw out is the organisational contracting stage. And that’s in there, really, because I became very familiar with colleagues’ tales of being asked to set up a group, going along to do it, and then bumping right up against major kind of like, service level ambivalence really. So you know, you get asked to do a group, but actually no one’s there, or everybody has been rotated to do a shift rather than when you turn up, or no room has been provided. Or you, or there’s the kind of other app kind of ambivalence, which is a little bit more about what the group’s for. So you realise over time that actually, the task you’re being given is to ensure these staff stop taking sick leave. Everybody’s off sick, we’ll bring in reflective practice, and it gets used as a sort of panacea for all ills in the serving, rather than there being agreement about what it’s really useful for and best and what you are offering.
Paula Redmond 18:17
Yeah, that’s something I’ve certainly come across that kind of, well, it feels like sabotage on the receiving end of that, you know, there’s you say, you turn up and it’s been cancelled, and no one told you, or, yeah, there’s no room booked. And I sometimes wonder if there’s a fear from an organisational or managerial level about what’s going to be going on in the group and that raising anxieties within the organisation or for managers. And again, that sort of sense of the power or the danger of a group if it’s, you know, if people are brought together, what could that lead to? I think there can be managerial fantasies about what could go on in a group.
Arabella Kurtz 19:11
Yeah. And the group somehow being against managers or kind of subverting the kind of service teams or whatever. Yeah. So that’s why I think that organisation contracting is a very useful stage. So that’s really where, rather than skipping that stage or seeing started the group as the point at which you sit down with the actual group, there’s attention given to liaising with other people in the service and sharing ownership for the support of the work.
Paula Redmond 19:46
And I guess that, I can imagine that being really difficult because, as a practitioner, you know, that sense of imposter syndrome, that sense of you know, how do you articulate the benefits, what goes on, to someone who may be quite ambivalent about it, it would be easy to avoid, you know, if there’s, you know, on paper agreement and, you know, contracting, easy to avoid those more in depth conversations.
Arabella Kurtz 20:19
But I think you have to be realistic about this aspect of the model. And it’s not like you, you, you know, you have extensive conversations and work it all out, it’s more that I think that line of communication and that element, the sort of systemic element has to be attended to in some way. So it’s important, I think, to let people know that the group’s happening, to get a sense from service managers about, you know, would they like to meet to talk about it? What might they expect to see as a result of it? One of the main practical benefits of having this in the model is that support for the work is owned. So let’s say you hit a problem like, nursing shifts, you can, you can then go back to somebody and say, we can’t really go ahead, because actually, you know, we can’t have three, four, and it’s only a tiny number of people that can meet if the shifts are organised like this, and it’s not your, your problem to solve. That’s one of the main, the main reasons.
Paula Redmond 21:27
One of the challenges that I’ve become aware of is when people are… when there’s a high turnover of staff, and the membership of the group isn’t very stable, that there’s new people coming and people leaving very regularly. Which makes that bit very challenging, because if you’ve got a new group every time. Any thoughts on that? How you kind of…?
Arabella Kurtz 21:53
Well, various really, I think, I suppose the first thing is to sort of think about whether if there was a bit more discussion with people at the sort of earliest stage, whether such a problem could be avoided. Because it’s very difficult to get a reflective practice group going if there’s too much instability. The second thing to say is, I think we should think a little bit, be a bit more willing than we sometimes are not to go ahead with a group. So I don’t think that reflective practice should be undertaken at any cost, not at all, it does have to be a judgement about good enough. From a purely practical point of view, something I’ve found helpful is, is just the use of a group record that’s for, so that if if there is a group that goes ahead with it with shifting attendance, hopefully not too extreme, you want a kind of enough of a cord that a sort of group culture builds up, but if attendance is shifting, sometimes a record, where after each group, there’s a sort of little note about the themes, the discussion, and certainly, the sort of contracting rules and agreements are noted down, that can get shared then with the right wider group.
Paula Redmond 23:13
Okay, so what are the other…?
Arabella Kurtz 23:15
So, the other elements are two transitional stages, which are called in the model turning in and turning out. And they’re, there in recognition of the fact that moving into a reflective space, moving away from a very busy pressured, often action focus mode, and certainly one in which maybe your thinking is a bit more on automatic, not automatic pilot that will be overstating it, but solutions to problems that you’re hoping to recognise fairly quickly, as opposed to ones where you really need to slow down and work things out and hopefully with other people, that that’s a significant shift. And I was influenced by quite a bit of research, and it’s summed up in Kahneman’s book, ‘Thinking Fast, Thinking Slow’, but the shift is actually hard work. So rather than having this idea that reflective practice is a breeze, you know, and it’s just about sitting down and relaxing, actually, it’s kind of understanding that engagement with those other parts of ourselves, thinking and feeling parts, is quite a significant shift and takes effort to make. So different facilitators have very different ways of recognising and enabling those shifts, but that’s a part of the model. And then I guess, to get to the core of the model, there is the generation free response and more effortful thinking stages. And that’s like the core of reflective practice. So the generation stage is when a member of the group, or members, brings something which is something from their experience at work, and it can be a whole variety of things, but just something from work, to the group to sort of to think about together. And although that sounds very simple, it’s not really so simple, because we’re used to talking about our work with colleagues, but we do it in certain kinds of ways I think, generally speaking in healthcare. So there’s lots of shorthand that we use. So diagnostic language is just an example of a shorthand. But I don’t think… I think health care workers use more jargon really than we’re aware of, and whenever you have somebody come in from outside, you’ll just every sentence almost has a sort of incomprehensible bit of jargon in it, and that’s all shorthand. And so there’s something about a kind of opening a concern or a situation or experience up in a different way, not maybe so much by using shorthand, which is often a way of wrapping something up, but, you know, over time, in a group, you know, finding ways of talking to each other a bit more about it at the level of kind of raw experience. So that’s something that takes a bit of time. And the other thing that I try to encourage when I’m doing a group is for individuals to bring an experience that sort of their own, as opposed to what groups will often automatically think they should be doing, which is bring a common experience or a theme, and I think there’s a kind of crucial difference. So I think often when you start with a group, common experiences or themes feel important and useful to discuss and also a bit safer. But I think if you’re really wanting to use the resources of a group of individuals, with their different ways of thinking about things and experiencing things and understanding things, it’s really good when you can move just more to just an experience that a member of the group had, that can be listened to by other people very much as their experience. And that they can then get the group’s kind of help in thinking on it.
Paula Redmond 27:44
And there’s something about how that sets that apart to from conversations that are happening in other spaces and other parts of work. And I think, as you say, that is hard work to do and people need to have a sense of safety around that. Because I think in my experience, there’s often a pull to really get stuck into problem solving and care planning and those kinds of conversations that you know, that we’re used to, in the course of the working day. And there is something quite different that we’re asking the group to hold and to do with this kind of thinking.
Arabella Kurtz 28:28
Yeah, that’s its value really, that’s what offers something different as you say. And then, so there’s the generation bit, that’s that’s the bit where something is shared, and you wanted to encourage colleagues to bring things in terms of human experience, really. So a focus on their real questions and concerns and doubts in a situation and trying to help as much as possible people to not feel too anxious about performance in front of colleagues, that they’ve got to be seen to be competent, that they’ve got to be seen to always know what they’re doing. There’s little point in really bringing something to reflective practice group if you already know what you’re doing. And you’re not going to sort of really help a group with a learning edge if that’s what everybody brings. So over time helping with that. And that’s generation. Then we move to the kind of what the group then does with what’s brought. And I use the technique from systemic supervision that people will be very familiar with, I think, but I generally speaking think it’s helpful to get whoever’s brought something to sit out for what’s called the free response and the more effortful thinking stages. And that’s just very simply because if they don’t, generally speaking, people will go back to them again and again for more information. And also, I think when you’ve shared something you’ve done a lot. And I kind of think that then it’s the group’s turn to do a bit of the work and sort of do something for their colleague really, rather than getting them to carry on thinking and telling them what the answers might be. So then there’s the free response and the more effortful thinking stages. And the way I think of it is that reflective practice at its best combines those two elements. And what you’re aiming for, is to have something of both in a group. The free response stage is kind of like the close up bit, it’s the more reactions to something, immediate reactions. It’s also the feeling part, you know, what do we feel after we’ve heard a colleague share something with us that may have been quite complicated or quite painful to listen to? Confusing? It’s really encouraging a feeling response. That’s the sort of free response bit. And some groups are kind of really up for that and it comes very easily and straightforwardly, and with other groups, it takes quite a long time for a bit more of that to come in, because they go to something much more cognitive, really, as a default. So that’s the free response bit. And I think facilitators will often describe having to work at these two different stages, there’s free response, and then after that, there’s what I call more effortful thinking. And that’s, if you’ve been close up with the free response bit, the more effortful thinking is like the moment when you ask the group to step back and have a look at what they’ve heard and the range of responses and thoughts in the room, and do a little bit of perspective taking. It’s the sort of, what do we make of it bit. And my feeling is that that as long as you bring those two elements together, and it’s not about being even handed, and sometimes a group will, there’ll be lots of free response, y’know lots of feeling and lots of reaction, and the perspective taking bit, the more effortful thinking taking bit, might be really quite short. But it’s there nonetheless, and that’s what matters. And sometimes it’s kind of the other way around. But I think it’s those two elements that give the containment to the experience.
Paula Redmond 32:58
Yeah, I was just thinking that as you’re talking, it just feels very contained and safe. And I’m wondering, in your experience, particularly of supervising facilitators, where you think, or what are there particular challenges that facilitators find in doing this work? Where do you think the most tricky parts are?
Arabella Kurtz 33:26
Well, there are themes, I suppose to what comes up. I mean, I think the first and most important thing to say is, I do think that facilitating reflective practice groups is really interesting and rewarding, and also pretty hard. So I think the first thing is not to expect to know how to do it and for it to be easy. I think a common issue that comes up in practice is about the transitions, the turning in and turning out. So oftentimes people will describe having group, and all sorts of things may be going on in a service that are pretty high impact, something may have happened the day before that’s really awful. You know, closure of part of the service or bad news of that kind, or whatever it may be. They’re working in a healthcare system in crisis and this is now unfortunately commonplace. And an issue that a facilitator might have then is that, you know, how much to allow that to dominate the group? And how much to try to move things on and do things properly kind of thing. That’s a very common issue. And I do think, you know it’s obviously it’s just kind of a thing of art, there’s no rule here. But I think generally speaking, it is quite important to try to give a little bit of space to that with a kind of check in at the beginning, but to take seriously the group’s agreement to do this work together and to focus on the work that’s going on, despite whatever is happening in the service, because I think that’s good for morale. You know, what I’m often struck by is the way that healthcare staff will carry on doing incredibly difficult, valuable work in extraordinary and often very aversive conditions. And I think in reflective practice, we honour that often. So I think there’s, there’s that, there’s that bit how you kind of give a bit of space to, to things that are having a real impact and may be important to consider as part of this, whatever’s brought, but still to kind of, to stick with the agreement to look, look at the kind of detail experiences of work together, to not let the client work go unthought about, let’s say. So that’s a very common area from practice.
Paula Redmond 36:05
And I know that when I, you know, when I’ve heard about people who’ve described negative experiences of reflective practice, I think one of the things I’ve heard is people feeling like, it’s sort of a, like a moaning shop, and I’m also curious about that, because I guess it’s, you know, I think there will be people who kind of want that space to, you know, say it out loud, things that are going on that maybe aren’t talked about anywhere else. But then there’s a danger of really getting stuck in that, as you were saying, and that it, I guess that just as you’re talking, it makes me think that’s the kind of maybe where we are with our standard thinking, you know, trying to problem solve problems that aren’t solvable in an hour that you have. But it’s really easy to get bogged down by that, especially when it’s you know, people are in, the services are in crisis, and people are, you know, carrying this heavy stuff. And I imagine, I know that for me is a challenge, holding kind of confidence in the model and the purpose of this work that you can steer people to another course, while respecting, and, you know, not invalidating all of that stuff, too.
Arabella Kurtz 37:38
Yeah, I think that’s right. And I think the risk if you get kind of stuck in a venting mode is the risk is that while it might suit some people, others feel very demoralised and frustrated, but also, you’re not, you’re not really using the kind of working resources of the group. So sometimes there is really something to be thought about in the situation, not just a simple matter, but you know, that the story of what’s going on in a service is often quite complicated. So actually, it’s sometimes even worth taking an experience that the group as a whole might all want to all agree is one thing and then really being able to kind of think a little bit about it, and maybe unpick the different ways people are feeling. It’s not only, I mean, the problem with what we’ve just described is not only that the group gets taken over by a venting session, but also that you fall into this trap, which I’ve mentioned earlier of sort of groupthink, if you like, where there’s almost an agreement that everybody feels the same way about something. And that, again, I think is a problem for groups, because everybody doesn’t feel the same way about a thing. And it just, it can mean that although some members are getting their voices heard, others aren’t, and the kind of the learning of the group is very limited as well as a result.
Paula Redmond 39:14
Yeah. And can I ask you about online groups, because we sort of touched on that a little bit at the start about how things have shifted a lot in recent years, and many people are doing hybrid ways of working and reflexive practice groups are the same, you know, online groups and hybrid groups. What are your thoughts on how best to manage that?
Arabella Kurtz 39:41
Well, I think the first thing is we shouldn’t be too sold on online work. I’ve got increasingly mixed feelings about it. So it kind of, I know it suits us in certain ways, but I do think we have to start having more honest conversations about the drawbacks because they’ve become increasingly apparent to me. So, for example, I sort of became aware over time of some of the problems with privacy in these groups where, you know, groups can be running for quite a while and then the group becomes aware that actually, two or three people are joining, and they may be joining from shared offices, or from home environments where they’re not completely private. And I think these issues have been a bit obscured because we’ve had to find a way of supporting each other on working. So I think some honest conversations about the pros and cons. I definitely do some online groups and I think there are, there are ways of doing it that work better than others. So I think, taking a little bit more care with some of the group contracting, and maybe thinking particularly, and specifically about how to make a reflective practice group work online, so you’re not just adapting the way that you would talk about it in a room and doing the same thing, but you’re, you’re thinking about the demands of the environment and what it brings. I think, I mean, I found with one group that we sort of identified that people could feel very isolated after the group and we brought in a kind of soft departure, which I think was a good thing to do. So I think, so what happened was that group, the facilitators, myself and another person would leave at the appointed time, but the group itself had, you know, 10-15 minutes longer, simulating a little bit, what would happen when you leave a building together, that you’re not immediately just at home. And it occurs to me, you could do the same thing with a kind of soft arrival. It is my observation that groups find it more difficult to have difficult conversations online, and I think that does constrain reflective practice groups that happen online. And that’s what I mean, really about the being honest about the limits. I don’t think it’s the same. Well, I would prefer to do reflective practice groups more in person than I’m currently doing.
Paula Redmond 42:32
And I also wanted to ask you about, you know, coming into this from a perspective of being clinical psychologists, what do you think we, as a profession, specifically bring to this work?
Arabella Kurtz 42:49
Well, I think quite naturally, we’re often looked to for facilitating reflective practice. And I think that’s, that’s really good, because our training with its emphasis on formulation really does emphasise meaning making, doesn’t it in our work. So I think we’re natural reflective practice facilitators in many ways. Having said that, I think in our profession, there’s an emphasis on mastery, which I think often we have to unlearn a bit to facilitate reflective practice. Because, for me, it’s a sort of different form of meaning making and learning that isn’t all about sorting out a problem, one per time kind of thing, but is a bit more organic, in terms of bringing threads together over time. And also bringing the feeling thing in which I think we’re sometimes not as good at, just stereotyping for a minute and talking very generally, I would say, other professions find that sometimes easier.
Paula Redmond 42:51
Yeah, it’s interesting, because I noticed when you were talking about the model, you know, part of me is like, oh, I love a model, you know, let me see the diagram and the different stages. And then when you said, oh, but you know, this isn’t prescriptive, it’s, you know, you got to find your way and there’s a part of me that’s like, oh, that sounds harder! But I guess there’s something about, as you said that, having that containment, but still having at the core of it, you know, formulation processes and being in the room with people and, yeah, developing those skills that were sitting with that messiness, without being drawn ourselves into you know, the groupthink which, yeah, can happen too I guess.
Arabella Kurtz 44:53
The other thing I would say is that I think, too often when clinical psychologists facilitate reflective practice, they’re not able to make use of it themselves, and I think that’s a problem. So, so one, you know, I think too many clinical psychologists are being asked to facilitate it rather than being part of a group themselves. And one of the things I’d really like to do in developing this idea of communities of reflective practice, is organise communities so that clinical psychologists who have to do the work alongside, let’s say, nursing and psychiatry colleagues, and so on, can organise swaps so that they can facilitate for each other’s teams. Because I think being part of a group is a very, very important experience to have if you’re facilitating, as well as the fact that it’s really good to have it to support you in the work.
Paula Redmond 45:43
Yeah. And what else do you think anyone facilitating reflective practice needs to be thinking about in terms of having in place to support them to do this work well?
Arabella Kurtz 45:59
Well, I think it’s very important to have a supervisory space where you can talk about facilitation of reflective practice and get received supervision on it. I had been struck by the fact that often people will say that it’s a part of their work they don’t get supervision on. And I don’t know whether that’s because supervisors aren’t experienced in facilitating reflective practice, or whether there’s just this assumption that it’s something that you should know how to do and it’s almost secondary to your key clinical tasks, which I don’t think it should be because I think it’s clinically demanding. Or it draws on clinical skills in a way that is quite demanding. So I think supervision for it is really useful. I mean I think, I do think that some people really enjoy working with groups and a lot of other people don’t. And so I think a little bit of… it’s better if you enjoy working with groups and the kind of messiness and liveliness and impact that groups have. Not to feel sort of too thrown by that.
Paula Redmond 47:09
Yes, yes. And what about for you in doing this work? And I guess you’re doing it at multiple levels, you’re delivering, facilitating groups, supervising groups, writing about groups, talking about the groups. What does this kind of work bring for you professionally? And yeah, what do you if anything, you know, sort of need to support you in doing this work?
Arabella Kurtz 47:39
Well, it’s not been too difficult, Paula, because I’ve, you know, I’ve had an enormous amount of interest and passion in the area, so that keeps me going. I’ve had a lot of colleagues who’ve worked alongside me, showing great interest, and they’re very sustaining. I’ve been part of, part of two or three networks of colleagues interested in reflective practice, most notably the East Midlands Reflective Practice Research Network. We’ve been meeting now over time, for quite a few years, over 10 years, I think. So interested colleagues and people to talk to about the work is the main thing.
Paula Redmond 48:25
Yeah, and that word community that you used seems really important.
Arabella Kurtz 48:32
Yes.
Paula Redmond 48:39
Thank you for listening. If you’ve enjoyed this episode, please support the podcast by sharing it with others, posting about it on social media, or leaving a rating or review. I’d love to connect with you, so do come find me on LinkedIn or at my website, and do check out ACP-UK and everything it has to offer. All the links are in the show notes. Thanks again and until next time, take good care.
