Peer Supervision/ Peer Support Groups

Peer Supervision defined by Webster is to oversee, direct or manage.  The term supervision makes me think of a supervisor in a business setting who just sits back and tells me what to do.

The type of supervision I am talking about comes from other medical professions such as  psychology, social work and nursing.  The goal of supervision is to increase awareness and on-going self awareness of the therapist.  Supervision is all about the therapist and whatever they need to become what they want to be!   The more support we can get as therapists, the more support we can give to clients.

Supervisors are usually senior massage therapists  who specialize in working with issues related to the therapeutic relationship that occurs in our practices.  This is done through listening to how the therapist feels about whatever is going on in their practice.  It does not mean that the supervisor is going to tell you what to do!!  The goal of supervision is to have the supervisor mirror what is going on in the therapist with the intent of having the therapist learn for themselves what it is they need to do in their practice.  This is done through the process of active listening.   During the process, the therapist may ask for the supervisors opinion knowing that is just that -their opinion.  

Individual supervision is a one-on-one relationship where the therapist hires a supervisor.  A commitment to meeting regularly is needed to build the relationship and work to find the core issues that the therapist is struggling with.  Some common issues to work on are boundaries, transference and counter-transference, projections and specific details of practice. Working on an individual basis, the therapist gets the exclusive attention of the supervisor.

Peer supervision (peer group) is a group of peers meeting to share their experiences.  This again is not to “fix” the problem, but to share the underlying feelings that arise in practice.  Active listening is practiced.  The group may also be used for networking and talking about business building ideas, but time on this should be limited.  Often groups will invite a supervisor in at times to provide direction, clarity and support.  Groups can be all massage therapists or include other disciplines.
Working in a group will give you the feedback of others.  Sometimes you may not have time to talk about your process if someone has a difficult issue.  We learn about ourselves from the processes of others.  Group dynamics may be difficult to manage and balance. 

Group supervision is a group of peers meeting with a supervisor to discuss their feelings about the therapeutic relationship.  

Supervision is the next step in building the massage profession.  I wish we had a better word to describe what it is and what it does.  Massage therapists are such individualists that the term may scare some off, thinking that the supervisor is going to tell them what to do! Massage therapists are also often isolated in their practices that it becomes difficult for them to view what is happening in their practice.

Some definitions of supervision:

‘A formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety of care in complex clinical situations. It is central to the process of learning and to the scope of the expansion of practice and should be seen as a means of encouraging self-assessment and analytical and reflective skills’ (Vision for the future 1993). ]

Butterworth & Faugier (1992) said supervision refers to a range of strategies, including: ‘preceptorship, mentorship, supervision of qualified practice, peer review and the maintenance of identified professional standards’ and was: ‘both a personal and professional experience’.

Swain (1995) differentiates supervision in contrast to more well-known procedures: ‘(supervision is)…not psychotherapy or counseling…nor is it directive management, individual performance review or staff appraisal. It is not a form of disciplinary procedure…it is not any of those things which some nurses seem to fear it might be or could be used for’.

The Need for Peer Supervision

When I first read an advertisement for a class on Supervision, I immediately thought that I didn’t need anyone telling me how to do a massage. 

I had been doing it for 15 years. My practice was flourishing, but I felt like I was working too hard.  I was finally making the money that I needed, but I thought that I just wouldn’t be able to keep it up for 20 more years.  After reading an article by Jack Blackburn,(see articles section specifically the series called Caretaking) a local Seattle Trager practitioner, I started understanding that there was a need for supervision in the massage community.

You may want to consider finding a supervisor if you experience some or any of these things:

  • Are you making the money that you need to pay the bills, save, pay your taxes and go on a nice vacation?  If you are making that amount, are you working too hard to get it?

  • Are you friends with some of your clients? Do you feel like you would miss them when they move on or you do? Do you see them socially or do they call you at home?  I often feel that our profession is different since we touch people and see them regularly.  What is wrong with being friends or caring about what happens to them?  How does being friends affect your treatments or how does the client feel?  It does effect client relationships in some way.

  • Do you feel obligated to come in on your day off for clients who are injured or call at the last minute?

  • Do you often work more than the scheduled time to try and get the client feeling better?  Do you expect a tip or other compensation? How does it make them feel?  It may make them feel uncomfortable because they now never know how long a session really is and they may feel confused as to how much to pay you.

  • Do you feel frustrated when you can’t “fix” a client?  Is your main treatment goal to “fix” a client?

  • If you don’t think you need a supervisor, you may be fooling yourself.

  • You can only take a client as far as you are willing to go yourself.  this means in every way- physically, mentally, emotionally, spiritually not just physically as many massage therapists may assume.  Do you do all the things you tell your clients to do? Stretch? Drink enough water? Exercise? Eat healthy food?

If you answered yes to any of these but don’t really think that it is a problem, you may be surprised when you start looking into these issues.  Most of these issues are a result of projection and the transference/countertransference process that occurs in any kind of relationship.  There is really no right or wrong answer for the above situations or any relationship issue.  What really matters is are your values consistent with your actions and how do you feel about what is happening.

This can be addressed when working with a competent, caring supervisor. 


Peer Group Structure

The Structure of you group is determined by you but there are some basic guidelines that you can use:

  1. Invite therapists in your neighborhood to join your peer group. It is recommended that the size of the group be 8 or less.

  2. Determine the structure of leadership. Will one person always lead or will the leader rotate?  The leader will have the role of allowing the person to speak without being judged or criticized.  The main purpose of discussion is to allow for how someone feels about whatever happened or whatever issue is being talked about.  (more on this later)

  3. Determine the level of commitment.  How often will you meet? 1x a month, 2x a month? How long will you meet for each time?  How long will you meet for – 6 months, 1 year or something in between.  You can also pick a time frame to re-evaluate the time frame

  4. Is there a place where you can meet regularly or does the meeting place have to rotate?

  5. What will you do if you are unable to solve a problem or issue? Is there someone else you can consult with? Hiring a peer supervisor to facilitate the sessions can be beneficial in helping the group to understand their “helping instincts” and help bring new insights.

  6. Have participants fill out a practice profile questionnaire to share with the group to help get to know each other.