When is it Time for Reflective Practice and How Should I Prepare? Use this Checklist!

It’s been such a delight to spend time writing about reflective practice, it’s an area of real passion for me and is also something I’ve been shoulder deep in for the last several months as I churn over some new learnings and ideas and take on new clients. 

Check out my first reflective practice post here, about a personal experience with reflection that changed not only how I responded to a crisis at work but also how I thought about my own need for reflective work, almost a decade into my career at that point. THEN, check out last week’s post, if you haven’t already, about the particulars of reflective practice and how to set yourself up best for it. 

When is it time for reflection?

The mental health field has direct guidelines on supervision and an expectation for support while in training. Typically, psychotherapists like psychologists, marriage and family therapists, and social workers complete two to three thousand hours of supervised work. While they are working with clients they receive one our of individual supervision per week and 2 hours of group supervision per week. Ultimately for the first 2-3 years of their careers they are receiving at least 3 hours of supervision from a licensed and experienced supervisor. Occupational therapists get a fraction of this, if they’re lucky! While we complete supervised field work placements before becoming licensed, once we receive a clinical license, there is no expectation for supervised work. We can leave graduate school and essentially work independently (though I would advise against this!)

I was very, very fortunate to begin my career and receive the psychotherapy model- I had a 2 hour group and 1 hour individual supervision weekly for the first 5 years I was in practice. This taught me that regardless of how confident I feel in my intervention choices or ability to think through a case, the relational elements of our work always require reflection and processing. 

Now, almost 12 years into my career, I still mostly get monthly consultation and mentoring depending on my clinical needs. As I learn new information through training and reading, I enjoy the support of a mentor to help with integration and translation- moving new ideas into clinical practice and then reflecting on how it went. At this point, I pay for it myself

So, I suppose my short answer is- we always need reflection, regardless of what career stage we are in, how many trainings and continuing education credits we have completed. We especially need reflection when we find ourselves experiencing signs of burnout or of fatigue in general or with a specific client.

Checklist: Is it Time for More Reflective Time

Are you…

• Feeling more tired than usual

• Feeling more easily frustrated by colleagues or clients than usual

• Dreading the thought of work in general or of some, specific sessions 

• Feeling unmotivated to help clients reach goals- like it doesn’t matter whether they grow or not

• Feeling like an imposter or that you aren’t “good enough” to do the work that needs to be done

• Feeling unmotivated to learn new skills or further your skills for your role

• Feeling frustrated or angry at a client or caregiver for things that brought them to therapy (for example, feeling angry a caregiver isn’t doing a home program even though they presented with multiple stressors and chronic dysregulation) 

• Trying to move on from a frightening or dangerous situation in the course of your work (an aggressive client or parent, an accident, etc.)

If you answer yes to any of these, it might be a good time to get some support! These are some common ways that burnout and compassion fatigue present themselves and both of these situations can have really negative impacts on your clients and on you.

Preparing for Reflective Time as a Supervisor or Practioner

Showing up prepared for reflective practice will support your practice so much. Reflection requires regulation and physical and emotional presence. For many of us, the hustle and bustle of our daily work lives can hinder our sense of presence. 

If you’re a supervisor, mentor or manager providing reflective facilitation to others, it’s even more important to be a co-regulating presence for your clinician. 

• Take care of your own bio-needs, grab a snack and drink if needed, avoid back to back meetings when possible. If you can, end meetings at 5 minutes before the hour to give time for a bio break or stretch

• Schedule 5-10 minutes of down time before reflective sessions to do your own self-regulation

• Review any notes you may have taken in previous sessions to refresh yourself. Even if though you aren’t driving the direction of the conversation, it’s helpful to remember the cases or issues that may come up

If you’re a supervisee or mentee and are going into your own reflective supervision, it’s also important to be prepared. 

• take care of your bio needs- snack, drink, scheduling as best you can

• Build a list of one to three topics to discuss that you want to reflect on

• a particular moment from a session 

• a case that’s particularly salient 

• maybe one you’re struggling with 

• maybe one that’s going quite well but you can’t tell why or want to make sure you’re integrating all of what’s working to continue to build on those skills

• a topic of interest that you’d like to think through- I’ve often brought an article I’ve just read or new piece of information I’ve learned that I want to explore in reflective practice. Usually it ends up being connected to a case or multiple cases but even just reflecting on a theory or concept can be so helpful in translating new knowledge into practice.

Being prepared as a supervisee might sound surprising- like the facilitator should do the work, but, I highly recommend it! When you’re receiving support from a mentor or supervisor, knowing the questions you want to ask before walking in can help you make the most of your time together. Of course a reflective encounter may take unexpected turns but having a place to start will ensure no time is lost and give the facilitator a stronger sense of what you hope to get out of the interaction. Here are some examples of recent topics I’ve brought to reflective consultation with my OT mentor and my mental health mentor:

• OT mentor: “I think a lot about trauma and sensory integration already in my work but I’ve found that there are some holes in how I describe things and I feel like I might be missing information. Can we talk through the relationship between trauma and sensory integration from a neurological perspective so that I feel more equipped to articulate how they’re connected when I’m working with families or other providers?” 

• OT mentor: I have a student who didn’t qualify for many OT services after his evaluation with another therapist but now that I’m working with him I’m seeing some postural things that I think are significant. Can we talk through what I’m seeing and I can let you know how I’ve made sense of it? I’d like your feedback and to know what connections you are making and what other questions you would ask or things you would look for in treating him”

• Mental Health mentor: “We had talked before about how you structure new cases in terms of what your work with parents and the child separately and together look like. I have a new case that I think would fit nicely into a similar model. I’d like to think through how to blend what I need/want to do as an OT with how I can have a strong early childhood-parent mental health model in this case”

I promise these are real! These are the topics I’ve brought to my last three mentoring sessions over the last couple of months and all three yielded super rich hour long conversations. With a little bit of reflective work on my own before the meetings (while driving between clients, while making my lunch the morning before these meetings and other times like that) I just thought about what was most pressing in my work. 

Sometimes there might be pressure to go through your whole case load during each reflective or consultation meeting, sometimes that’s warranted, especially if supervision is happening with a manager who needs to keep track of details. But, whenever possible, I try to focus on one to two clinical issues I can explore deeply. The progress may feel slower in the moment but often yields big changes over time as compared to only scratching the surface of several cases each week.

I’d love to know- are you getting reflective support in your work? How has it been for you?

Disclaimer

The information provided on this blog is for informational purposes only. It is not intended to assess, diagnose, treat, or prevent any medical or mental health conditions. The content shared on this site should not be considered a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, mental health professional, or other qualified healthcare provider with any questions you may have regarding a medical or psychological condition. Never disregard professional advice or delay seeking it because of something you have read on this blog.