Using Narrative Therapy and Externalisation in supervision conversations.

By externalising problems, we can help to separate the person from the problem and view it from a new perspective. Here’s an example of how this might look in a supervision session:

Session Transcript:

Supervisee : I've been feeling so overwhelmed lately. The workload is just too much, and I don’t know how to handle it.

Supervisor : It sounds like "Overwhelm" is making things difficult for you right now. Can we talk about it as if it’s an entity outside of yourself?

Supervisee: Okay, I think I can do that.

Supervisor: Great. Let’s start by giving it a name. You spoke about feeling overwhelmed, How does “ The Overwhelm" sound to you?

Supervisee: That works. The Overwhelm feels like a fitting name.

Supervisor: Can you describe The Overwhelm for me? What does it look like, feel like, or act like?

Supervisee: Overwhelm feels like a heavy fog. It clouds my mind and makes it hard to think clearly. It’s like this constant pressure on my chest, making it hard to breathe sometimes.

Supervisor: When did you first notice The Overwhelm showing up in your life?

Supervisee: It’s been around before, but recently I think it started a few weeks ago when I moved to a different work area where I don’t know many of the other staff. Since then, it hasn’t gone away.

Supervisor: How has The Overwhelm been affecting you?

Supervisee: It’s made it hard to focus at work. I’m constantly worried about missing something important with my patients. At home, I feel exhausted and irritable.

Supervisor: That sounds tough. It may seem like an odd question, however, what would you say if I asked you if these things were OK?

Supervisee: I would definitely say that they were not OK.

Supervisor: How come?

Supervisee: Because when The Overwhelm is around I don’t feel productive and feel like I am not spending time with my patients.

Supervisor: What does that say about the type of practitioner you want to be?

Supervisee: It is important for me to make sure my patients are at the centre of my work. I also value my time away from work and don’t want to bring my worries home.

Supervisor: Have there been any moments when you felt you had some influence over The Overwhelm or were able to push it back, even if just a little?

Supervisee: Yes.  Now I think about it, The Overwhelm often shows up in new situations when I am a little unsure and am feeling isolated. It is diminished when I am organised and when I work more collaboratively with others in my team.

Supervisor: That sounds interesting. What do you think it is about those activities that kept The Overwhelm at bay?

Supervisee: I think having a clear plan made things seem less chaotic. It was like I could see through the fog a little bit and find my way.  And working more closely with my colleagues helps to remember that I don’t have to handle everything by myself.

Supervisor: I’m curious about how you were able to do that?

Supervisee: An exercise routine outside of work helps.  And remembering that I have been able to get through difficult situations like this before.

Supervisor: Is there a metaphor or image that might help you to keep The Overwhelm diminished?

Supervisee: I’m not sure, but wonder if the image of the sun might help me somehow. When the sun shines the fog is blown away. Maybe the sun helps shine a light on the things that help me; including being organised, connecting with my colleagues, and getting back into exercise.

Reflection

This example highlights how narrative therapy can be a powerful and creative tool in nursing supervision sessions, supporting professionals to make sense of their experiences and to find effective solutions to their problems.