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THE SUPERIOR VISION IN SUPERVISION

Just today, November 26th, 2002, walking home through the slushy streets of the wintry Helsinki I was once again happy and grateful for the lessons I have learned in Montague Ullman's experiential dream groups during the last twenty years. I was returning from one of those many personnel group sessions, which I am supervising, in a communal psychiatric hospital, both inpatient and outpatient units.

This personnel group has advanced during this last year more and more away from clinging compulsively to traditional matter-of-facts, directing their steps more towards the processes of understanding. They have gained more confidence to walk into the unknown, to let the session itself give birth to the discussions. They have learnt to read more between the lines. The have begun to search the reference point more and more from their own individual psyche instead of the regulations, ideologies, therapy trends, roles, conventions, which they are impregnated with during so many years stressing them with all the innumerous normative factors aimed to convert the group into a homogenous army of workers operating in an official, generally accepted way, in line of the organization's official policy.

There is nothing remarkable in this kind of communal mental health "factory", patients flowing in and out of the assembly line. The mechanization of the health care systems cannot be removed. The organization itself cannot help individuals in the grip of itself because the organization contains all the same blind spots as the surrounding society, being a part of that society, funded by that society, unable to bite the societal hand which feeds it.

But there is something that can be done at the individual level.

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Supervision is one of the ventilation apertures that can be drilled into the tight walls of the typical communal mental health care. The Finnish Law of Mental Health included year 1990 a paragraph which ordered, that all the units providing mental health services, must have a working supervision structure.

Here come the dream groups in. I have described above one development of one group towards the living processes found only in themselves, not in any "evidence based research". The real understanding is always beyond any scientific measurements. I have led dream groups hundreds of times at both somatic and psychiatric units, the biggest difficulty in them being the pressure the participants have experienced from their non-participating fellow workers. Comments to dream group participants like "there you chat comfortably on dreams while we here on the ward must carry out your tasks, too" is a frightening psychological power, which the group has difficulties to cope with, if it does not have an acknowledged official status granted by the management of its organization.

I have seen how it is perfectly possible to have the fellow workers from the same unit participate in the dream groups without any adverse effects, and seen how often they have been able to help each other to understand their dreams, because dreams so often contain material from their workplace. Fellow workers, having experienced the same pressures as the dreamer, have often recognized the setting which has catalyzed the dream.

My purpose is not to go now in this article deeper into the dream group supervision but to pinpoint one professional situation outside of dream groups where the superior visions which dreams are pregnant of, can be utilized in non-dream supervision setting. The seeds sown in dream groups can thus produce much bigger crops outside of them.

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Now back to the initial group supervision example. The credit for much of what has happened in this 'non-dream' group has to be given to the dream groups. The dream group process is applicable - albeit with modifications because of the different setup - to any groups, which in a way or another are trying to understand the psychological innards of the human being.

The first stage in Monte's process; the presentation of the dream, corresponds to the patient history presentation in the beginning of the non-dream group session. The same holds to general discussion topics, let it be difficulties caused by some specific patient groups, or administrative questions, the ethical problems, the roles of health care professionals, the world view and philosophical questions, whatever. In any case the group is listening as attentively as a dream is listened to in dream groups.  The clarifying questions are asked until everybody feels the topic is clear enough.

The next step is a consolidation of Monte's next stages; projecting feelings and metaphors, dreamer's response, amplifying recent context and dream playback. The whole group, including those who have not personally participated in the situations which have originated the discussion, continues to discuss about the feelings the subject awakens in them. The group is encouraged to use metaphors and figurative language as much as possible, using their own dialect, their own typical expressions, their associations, in general as free flowing and nonjudgmental communication as possible. The task of the supervisor is here the same as in dream groups; to take care of the safety factor by protecting everybody's right to express himself without critique from the others, and to protect the rights to remain silent for those who want to do so. The other main task is to take care of the discovery factor by not letting the discussion flow completely out of topic and enhancing the process with open-ended, non-insisting questions.

If the discussion is about more general, non-acute problems, like philosophical and world view questions, the last stage, the orchestration, does not have to be so sharply defined as it is in dream groups. If the nature of the problem demands some immediate actions, like some difficult and acute patient case, it is better to keep the last stage; the orchestration, as a sharply defined, separate phase from the previous ones. The rationale for this is the difficulty and waste of time taking back the earlier, premature conclusions done at a time when the problem had not yet revealed all contributing factors. The problem must be first understood from every possible angle, before the orchestration and the decisions about actions are taken. That's why it is wise to stop immature decisions the group members may try to produce in earlier phases, just like in dream groups, too. By not jumping into conclusions too early it is possible to note how the problem produces many times by itself the answers, which are richer and more fruitful deep visions than no one could imagine in the beginning of the process. Just like in the dream group process!

In summary, the non-dream supervising process is divided into three main phases; the gathering of objective data, followed by the immersion into the problem with feelings and metaphors, and lastly the decision phase - if it is still needed.

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For me personally, the dream group process has taught me two main things: the technical side of the process and the confidence in the incorruptible core of human beings.  It has given me the certainty about what is needed to help every participant to search their own souls. Even when the group meets difficult times and obstacles, it does not dim my consciousness about the right direction, independent of the fact if some given supervision session happens to be more or less chaotic. Every group has its own limits in its ability to let go their safe routines and roles. I do not personally know any other process as effective as dream group experience, which could bestow upon the supervisor the enduring, tranquil vision and confidence in interconnectedness of all things, even when at times this vision seems temporarily have been lost from the sight of the group.

The dream group experience is of course similarly applicable in all human communication, be it professional or not. It will never hurt to be able to listen to the fellow man more and even more accurately until he feels that he is at last really heard. This is the sense of interconnectedness which has a healing effect on both parties; the one who is listening, the other who is being heard.

Markku Siivola