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Clinical supervision is a cornerstone of mental health practice and professional development, yet the relational dynamics underpinning supervision are often underexamined. This article explores the roles of transference and countertransference within the supervisor–supervisee relationship and their implications for learning, evaluation, professional development and patient care. Drawing on contemporary literature, it argues that these processes are not merely obstacles to effective supervision but valuable sources of insight into both clinical and supervisory relationships. The article examines how transference may influence supervisees’ perceptions of authority, feedback and evaluation, and how countertransference can shape supervisors’ judgements, emotional responses and decision-making. Particular attention is given to the effects of power differentials, cultural influences and organisational contexts. The risks associated with unrecognised relational dynamics, including non-disclosures by supervisees, bias, weakened supervisory alliances and compromised clinical decision-making, are critically discussed. Finally, evidence-informed approaches for managing these processes are outlined, including reflective practice, collaborative exploration of relational dynamics, role clarification and psychologically safe supervisory environments.
How assessments are best designed and implemented is a significant area of study and debate. Just as laws evolve with the times to remain relevant and fit for purpose, so do assessments. Recent developments include responses to the use of generative artificial intelligence and contract cheating which have seen greater use of invigilated assessments including traditional sit-down exams and the resurgence of viva voces. Contemporary emphases on authentic assessment and work-integrated learning have seen assessment regimes revamped to better enable students to demonstrate coherent integrated learning as part of becoming job-ready graduates. Research into the value of developing soft skills as part and parcel of legal education continues, advancing the important of cultivating interpersonal skills and traits like effective communication, empathy, active listening, teamwork and leadership.
This chapter starts by giving you some general tips for how to approach assessments, no matter the type, before launching into some of the common and emerging types of assessments you may be asked to complete as part of your degree.
The primary purpose of this review is to compare the implementation of Balint groups (mandatory versus voluntary participation) in medical training, particularly for medical students and psychiatry trainees, and the accreditation pathways for Balint leaders across the United Kingdom (UK), the United States (USA), Ireland, Canada, and Germany. The review aims to highlight the rationales and implications of each model. A comparative literature review was conducted to evaluate existing approaches in the specified countries, drawing on national guidelines, society requirements, and relevant studies. The methods focused on identifying specific requirements set by governing bodies such as the Royal College of Psychiatrists (UK), the American Balint Society (ABS), the College of Psychiatrists of Ireland, and the German Medical Association. Data were handled by summarizing the variations in implementation and accreditation. Implementation varies significantly; the UK, Ireland, Canada, and Germany typically mandate some form of reflective group work for psychiatry trainees, linking it to progression or certification. Ireland and Germany have explicit session requirements, while the USA largely maintains a voluntary model. Accreditation pathways share core philosophies but differ in specific hour requirements, with European pathways being more rigorous than the portfolio-based models in the USA and Canada. The global trend recognizes a clinician‘s emotional awareness as crucial for effective patient care, pushing toward mandatory exposure to reflective group work in psychiatry training. To ensure consistency across diverse national Balint societies, the International Balint Federation could develop global minimum standards for participation and co-leadership to eliminate ambiguity.
Mpox infection causes fever, rash, painful lesions, and flu-like symptoms and disproportionately impacts people living with HIV disease. The Mpox outbreak in 2022 afforded an opportunity to explore how learners adapted to emergent circumstances. We conducted a quality improvement project using a qualitative focus group exploring how medical residents demonstrated characteristics of a Master Adaptive Learner, including caring for a stigmatized LGBTQIA+ population and people living with HIV. Five medical residents agreed to participate and showed evidence of adaptive expertise on the continuum. Development of healthcare learners who continuously reflect and adapt within complex, ever-changing healthcare environments is critical.
Joshua Lowe, San Antonio Military Medical Center,Rachel Bridwell, Uniformed Services University of Health Sciences,John Patrick, San Antonio Military Medical Center,Alec Pawlukiewicz, Carl R. Darnall Army Medical Center,Gillian Schmitz, Uniformed Services University of Health Sciences,Michael Yoo, University of Texas Health San Antonio
This clinical vignette guides learners through the emotionally complex task of delivering bad news in the emergency department. After stabilizing a critically ill patient with a life-threatening variceal GI bleed, the physician must update the patient’s spouse with honesty, empathy, and professionalism. This case models how to initiate these conversations using the SPIKES framework and demonstrates the importance of setting, pacing, and word choice when conveying grave prognoses. Learners are introduced to the emotional “residue” left behind by such encounters and are encouraged to process it using Dr. Cline’s DR5 model for reflective practice. By observing and emulating this structured, compassionate approach, trainees develop the communication tools necessary to lead with clarity and kindness; skills that define maturity in emergency medicine and build trust in times of crisis.
This paper reviews the history and capacity development challenges of Civil Society Organizations (CSOs) in Angola. Based on assessments and findings retrieved during the implementation of the United Nations Development Programme’s (UNDP) “Support to Civic Education Project,” a capacity development approach will be proposed that facilitates skills development, discovery learning, and self-appropriation of Angolan CSO staff to become effective contributors to economic, human, and social reconstruction.
Chronic pelvic pain (CPP) has exceptionally high co-morbidities with common mental health conditions and is often associated with gendered healthcare inequalities. This study aimed to investigate the ways in which cognitive behavioural therapists’ (CBT therapists) perceptions, understandings, and assumptions regarding women’s health and healthcare influence their therapeutic practice with women experiencing CPP. In-depth semi-structured interviews were conducted with 21 CBT therapists working in a variety of healthcare settings. Transcribed interviews were analysed using a mixed inductive and deductive thematic analysis (TA). Three themes were developed: the gendered nature of CPP, the role of CBT, and building relationships. Therapists treated CPP as a distinctly gendered condition, which may lead to male therapists being viewed as less able to empathise with those suffering from CPP, and CPP in trans clients being left undiscussed. Therapists displayed varied understandings of the role of CBT with CPP clients and discussed how standard CBT training under-recognises the importance of women’s health in therapy. They identified trust as a key barrier to mental health care in women with CPP, highlighting relationship-building as a priority with this client group. This study demonstrates the impact that therapists’ own perceptions regarding women’s health has on their treatment approach with CPP, underscoring the importance of reflective practice in this area. It also highlighted significant gaps in the literature relating to approaching gendered topics such as CPP with trans clients, and a need to integrate women’s health issues into core CBT training and long-term conditions (LTC) training.
Key learning aims
(1) To understand key difficulties facing women experiencing chronic pelvic pain.
(2) To identify how clinician perspectives regarding women’s health can affect clinical practice with this client group.
(3) To learn from other clinicians what has worked well and what has been difficult when working with this client group.
Human-centered design involves designing for users who may have social identities that are dissimilar from designers’ social identities. These differences could impact designers’ ability to understand users’ needs and integrate considerations of social identity into design decisions. Reflective interventions could encourage designers to actively consider social identity in design and our aim in this research is to explore this hypothesis through an experimental study. We tested the effects of completing a social identity-based reflection exercise on novice designers’ task clarification behavior. We also qualitatively examined the quality and content of the reflection responses. We find that participants who completed the intervention generated more social identity-focused design requirements, irrespective of the persona provided to them. Additionally, the content analysis revealed that designers who occupy minority identities (e.g., women and students of color) were more likely to provide deeper and higher-quality reflection responses. These findings suggest that reflective interventions could be an effective mechanism to promote inclusive design, leading to the design of products that users across social identities can use equitably. Furthermore, designers with different social identities may require different reflection cues (e.g., ones more focused on their personal experiences), to encourage deeper reflection on the effects of social identity in design.
Edited by
Richard Pinder, Imperial College of Science, Technology and Medicine, London,Christopher-James Harvey, Imperial College of Science, Technology and Medicine, London,Ellen Fallows, British Society of Lifestyle Medicine
A person-centred approach is central to effective lifestyle discussions, avoiding stigma and blame that can undermine patient motivation and self-efficacy. This involves shifting from a clinician-led model to collaborative consultations that respect patient values and goals, and fosters a partnership between the clinician and the patient. Compassionate care is essential for this approach. To prepare for consultations, health professionals must consider factors such as language, accessibility, and reception staff attitude that can influence the patient’s perception of person-centred care. Health professionals should use open-ended questions and active listening to gather a comprehensive lifestyle history that aligns with patient values and preferences. They should also understand patient concerns and expectations, and use them to build rapport and develop shared treatment goals. Moreover, health professionals must assess relationships and support systems that can significantly impact health outcomes, and explore positive mental states and life satisfaction to assess mental wellbeing comprehensively. By establishing a therapeutic relationship through compassionate history taking, health professionals can lay the foundations for effective behaviour change interventions.
School leaders work in increasingly complex systems. Alongside leading learning, they daily navigate the needs and expectations of educational departments, teachers, students, parents, society, and themselves. Leadership can therefore be a dynamic vocational calling, but studies show that principals' professional agency, career sustainability, and wellbeing are diminishing. This Element brings a fresh perspective to how educational leaders can be better served and supported by collaborative, co-agentic partnerships at this time. It makes the case for professional supervision, a practice commonplace in clinical and pastoral professions that offers facilitated, action-oriented attention to the interplay of role, 'soul', and context. As a practice-based primer, this Element reclaims supervision against outdated associations with performance management by drawing on interdisciplinary research and the authors' own experience as supervisor partners with principals. It proposes a new schema of professional supervision in education informed by curiosity, unlearning, resonance, and attunement in a rapidly changing world.
Based on a range of detailed case studies, this innovative book presents a model for early career language teacher development. It showcases the lived experiences of English language teachers in their training years, as well as the reflections of two more experienced English language teachers, and uses these case studies to provide practical guidelines on early career needs and development. It outlines four essential and highly connected conditions that will enable teachers to survive and thrive in the profession: reflection, support, resilience, and well-being. Using an innovative, evidence-based, data-informed approach to reflective practice, the book covers teachers' philosophy, principles, theory, practice, and critical reflection beyond practice. Each chapter contains practical reflection activities, to encourage reflection throughout from the reader on what the research reveals. It is essential reading for graduate students who are training to become language teachers, as well as language teacher trainers and lecturers.
Chapter 2 provides details of the teacher participants and how the stories of their lived experiences were shared and how they evolved. It includes details of the reflective practice framework that was used. This is followed by a discussion of the methodology that includes details about the context, the seven participant teachers, and how their story was obtained and analyzed.
At its most basic, the application of reflective practice in teaching involves scrutiny of the practical theories and values that shape teachers’ daily activities. This is a complex process in which teachers undertake various forms of reflection. The purpose of this is to increase teachers’ comprehension of the teaching–learning process, increase their personal and professional efficacy, and formally investigate various classroom problems. The complexity of reflective practice requires that teachers engage in the formation of routines, practices, and structures that facilitate individual or collective reflection on their experiences when teaching, support for which can be provided by a range of tools. To discuss these issues in greater detail, this chapter is organised as follows. First, it explains what reflective practice means and what it involves. This includes elucidation of concepts such as reflection, critical reflection, and reflexivity. This is followed by a summary and endorsement of the theoretical framework for reflective practice developed by Farrell. Then, several tools that teachers are advised to adopt to reflexively examine and enhance their teaching are outlined. The chapter ends with a brief discussion of the concept of teachers as researchers and exemplifies teacher-led research in terms of action research and classroom ethnography.
Finally, Chapter 17 refers to an important aspect of the role of any EC professional – ongoing professional learning. This chapter discusses reflective practice and critical reflection as a means of ensuring that EC professionals review and monitor their own practice and understand how this practice affects children’s learning outcomes. Tools such as reflective journals and professional portfolios are discussed. The theoretical aspects of EC professionals’ pedagogical content knowledge, content knowledge and pedagogical knowledge are explored.
Concerns regarding equity and diversity are ongoing. Effective school and district leaders need to become ever-evolving researched practioners to meet the needs of the students, staff, and communities they serve. The achieve gap is explored and reflective practice is emphasized as a crucial tool as leaders delve into the additional concerns associated around the opportunity, confidence, and honesty gaps. Leaders are given a “mirror” to examine their place along the continuum regarding the concepts of being an ally, advocate, and/or activists.
Leaders at both school and district levels need to understand the complexities of equity and its role in order to support their students and staff and to avoid the pitfalls that their colleagues have become victims to due to a lack of knowledge and perspective. Beginning with a foundational understanding surrounding the multifaceted aspects of equity in the school setting, this book supports the researched practitioner with resources and tools to explore policies, practices, and daily decisions that occur as a result. The hands-on approach of case study analysis, followed by the factual review of “what happened” in the actual scenarios, allows for a self-reflective examination of individual decision making and insight concerning what pitfalls to avoid and/or expect. The reflective practice that each leader must strive to perform during their ongoing leadership journey is supported with an introduction to additional theories and subsequent learning concepts.
A unique and accessible guide to contemporary psychodynamic therapy and its applications. Introduced with a foreword by Nancy McWilliams, an author line-up of experienced educators guide the reader through the breadth of psychodynamic concepts in a digestible and engaging way. The key applications of psychodynamic psychotherapy to a range of presentations are explored, including anxiety, depression, problematic narcissism as well as the dynamics of 'borderline' states. Specific chapters cover the dynamics of anger and aggression, and working with people experiencing homelessness. A valuable resource for novice and experienced therapists, presenting a clear, comprehensive review of contemporary psychodynamic theory and clinical practice. Highly relevant for general clinicians, third-sector staff and therapists alike, the authors also examine staff-client dynamics and the development of psychologically-informed services underpinned by reflective practice. Part of the Cambridge Guides to the Psychological Therapies series, offering all the latest scientifically rigorous, and practical information on a range of key, evidence-based psychological interventions for clinicians.
This chapter provides an introduction to psychodynamic theory as applied to settings outwith the specialist psychotherapy clinic, paving the way for the chapters that follow in Part 4. An individual’s internal world affects how they relate to others. Others may be unconsciously invited into playing old roles that are familiar to the individual (such as rejecting, not listening, criticising), even though these roles bring difficulty and distress to both sides. This chapter explores how these powerful but sometimes ‘invisible’ interpersonal dynamics may play out between service users and staff in settings where the human relationship is at the fore (such as schools, social service agencies, and hospitals). We also discuss splitting within a clinical team and other system dynamics. In circumstances where services and professionals can sustain a good-enough therapeutic environment in the face of unconscious invitations to repeat a problematic relationship, trust may develop between service user and service and many people are able to discover new ways of forming relationships. This depends partly on the capacities and current state of the person using a service, but also, crucially, on the capacity of the professionals and services to observe and be reflective about both sides of the relationship.
This chapter provides a brief introduction to the relational dynamics underlying ‘multiple exclusion homelessness’ and an approach to working in this area. Adults experiencing multiple exclusion homelessness have often, during their developmental years, experienced multiple homes, disrupted attachments, un-forecasted endings, multiple and short-lived figures of support – all experiences that can lead a person to develop an understandable anxiety about trusting anyone to remain stable in their life. These dynamics may inadvertently be recreated in the person’s adult life through the impermanency of different organisations they are involved with. Multiple exclusion homelessness can be understood as a late emerging symptom of underlying difficulties in someone’s relationships with care. A psychologically informed approach for staff working in the homeless sector is outlined. The staff-service user relationship, while often viewed as important within mainstream services, is commonly seen as a vehicle through which treatments can be completed rather than as the treatment itself. By contrast, a psychologically informed service for people experiencing multiple exclusion homelessness understands that the reverse is often more accurate: that the tasks and activities are really just the vehicle through which a relationship can develop that carries the possibility of developing a sense of safety, trust, and continuity.
This chapter starts by considering anger and the various routes to this feeling. We discuss how anger can be a desperate call to be attended to and a powerful invitation to neglect. We then discuss aggression and violence, including the potential role of shame and humiliation. At times, violence may accompany a process of an individual projecting unwanted, intolerable, or overwhelming feelings into another person. At other times, violence may be understood more in the context of fighting a perceived danger. We take inclusive approach to contemporary theory, noting that more than one approach may be useful when trying to understand a person’s actions. We touch on wider societal responses to violence, acknowledging that this is a potentially divisive area associated with strong feelings. The dynamics of anger, aggression, and violence are not necessarily straightforward to make sense of, and it is easy for any of us to inadvertently become drawn into responses that may make a situation worse. Conversely, with an awareness of key dynamics and time to reflect on these, professionals and teams can find an understanding of angry, aggressive, or violent encounters, which is a prerequisite for safe practice, working matters through, and resisting harms.