Podcast: What is supervision and how does it support you?

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NARRATOR: Hey, this is Gilly Woodhouse on the Osteo Business Podcast, talking all things osteo business. Here’s Gilly Woodhouse, an author, speaker, award-winning business coach and passionate advocate of osteopathy.

GILLY: So welcome back to Ruth Wharton. We had a chat before on the podcast about supervision and how that might be helpful for osteopaths in practice. And after we finished the episode, Ruth and I had a huge chat about loads of other things, and I said, oh, we’re going to have to get you back, because there’s so much more to talk about. So here we are. Thank you very much for taking some time out, Ruth, to come and talk to me.

RUTH: Thank you. Great to be here again, really.

GILLY: I think the first thing that I was thinking about that we didn’t explore very much last time was your osteopathic teaching experience. We were talking about your journey to becoming an osteopath, so tell me a bit more about that.

RUTH: So once I qualified from the BCNO, as it was then, now BCOM, I moved with my partner up to West Yorkshire, because that’s where we wanted to settle. And I thought that that would mean I’d miss out on working at the OCC, which was something, being osteopathic and passionate about children, I really cared about. But fortunately, I became aware there was a centre in Manchester, the OCC in Manchester, the little-known northern relative of the very well-known London charity set up by Stuart Korth.

So I was building my practice. I didn’t have many patients in my private practice, so I was very fortunate to be able to go to the OCC regularly. I volunteered there initially three times a week, which led me into basically doing the biodynamic pathway of cranial osteopathy. I was encouraged by the tutors there. They were saying, this is what this is. I didn’t know, I was very new. I thought, okay, I’m going to pursue that then. So that was my next course, my financial course of CPD that I did as a new graduate.

I’d been qualified about a year when I started the nine-year programme. Because I was also working at the OCC so regularly, I then had the very great benefit of working with other osteopaths who by then were doing the Master’s in Paediatric Osteopathy via the OCC. They were very embracing of me, very encouraging. Before I knew it, I found myself being part of this, basically starting the Master’s, which I’d never planned to do. Honestly, I was quite done in by my undergraduate training. I loved osteopathy, but I found the training full-on as a mature student. It was just tremendous, et cetera. And I had lots of hands-on experience.

And so when I completed that Master’s, there was a need for clinical tutors at the OCC in Manchester. So I very quickly applied for one of those. I mean, honestly, I met a lot of other people, so I sort of had to make myself ask a bit. It wasn’t a huge pool. I’m not putting myself down there. I feel grateful that I had the opportunity.

And so I literally segued quite fluently really into, once I’d got my Master’s in Paediatric Osteopathy, tutoring other osteopaths who then volunteered their time, as I originally had, at the OCC. And this was an amazing learning environment. For those that aren’t familiar, everyone probably will be, but it was a very busy, thriving community. A huge room, it was an old warehouse actually, in Manchester. Very lots of windows, lots of space, eight treatment couches. So potentially eight osteopaths treating eight babies or children or pregnant mums or postpartum mums, all in one room. Carers, grandparents, partners, other siblings, quite an environment usually.

So very quickly I learned to have my hands on, so to speak, I literally tried all the moving targets. And someone that’s not going to lie down, as an adult might. So I had that experience, because that’s where my paediatric osteopathy practically happened. The theory part happened at the London OCC.

So as a tutor, I was already used to that environment, for which I was grateful. So my passion, and this was my first time when I tutored, and I loved it. So by that I mean I would be alongside the osteopath, a qualified osteopath, working on a member of the public and their children. I would then supervise that and enable the osteopath to understand what they were feeling and to go over, clinically, what the situation was, and then chat outside of the room. So it was very, very hands-on. That’s what that was.

And that then led to my tutoring myself. I was there over a few years, right up to the close. But the funding was just not available for work in that charitable sector, and in particular in northern England. So it very sadly closed.

By that time I was several phases into the biodynamic pathway. It’s a nine-year pathway. And when you’ve got to phase seven, you’re able to tutor on Bio Basics, which is the introductory programme for any osteopath, including third or fourth-year undergraduates, who want to learn about the biodynamic approach, the traditional approach towards the whole thing. So knowing I’d love to do it, I leapt at the chance to be able to tutor on that, and your two-day events. I’ve done that for many years now. I’ve also lectured there, and I’m lecturing soon actually, for the first time at the next one in London. I enjoy the lecturing. I have to say though, the tutoring, and one-to-one or one-to-two, working hands-on with some people actively, people who want support, that’s definitely my greatest passion for teaching.

And then finally, the other part of my osteopathic teaching I’ve been involved in, well, I’ve had a mentoring group as a result of the biodynamic work, for a local group of people that wanted to have a hands-on session. I did that for a few months. I haven’t done that now for a few years. But then I decided that I would support a cohort of students who were doing the biodynamic pathway.

So what I mean is that the teaching was done by my teacher, one of those who taught me, who is the main person in the UK that taught this programme. He was doing the lecture, the event, and was effectively talking people through the practical exercises. But I was there as what’s called a table tutor to enable the osteopaths. And I loved that.

So I’ve been with the same cohort from phase one, and just last week did phase eight with them in the south of France.

GILLY: Very nice.

RUTH: So it’s been a real joy following that essentially same cohort, with a few extras, but just really joyfully seeing their transformation and their felt, sensual experience expanding and growing, and their confidence. So that’s been my experience.

I think because of the nature of the one-to-one, this is a bit, rather than doing huge lectures to huge numbers of people, that was then a factor when I thought, as I spoke last time, that my own experience of supervision had been so profound, I wanted to try to do this myself. And it’s, you know, the one-to-one nature is not a million miles away from what I’d done teaching-wise. And there are aspects of supervision that involve what you might call teaching, depending on the need of the osteopath.

So it’s always been through various pathways, things you know. I’m open to receiving specialists, et cetera, but that’s my real... but actually if someone just wants to learn about one-to-two support, Bio Basics for example, coming up, I can. I’m on their organising team, for a number of years actually, as well. It’s a great course because there are seven osteopaths to a table, and then per two osteopaths is one tutor.

GILLY: Right.

RUTH: So we’re doing a lecture and then there’s a practical after each one, and the tutor is enabling the osteopaths to carry out the practical. So it’s very intensive support. That’s how the wider teaching faculty used to operate.

GILLY: I recall now you say that, and I know that the participants really liked it because they got so much benefit from that close connection and discussion about the thing, and learning as they went but with lots and lots of help and support. And we used to do the feedback forms at the end. They were always fantastic, because they really felt they came away with stuff, new skills they could use on the Monday morning, which is really the whole point of it, isn’t it?

RUTH: Absolutely. And of course when mostly osteopaths are working one-to-one in the room with the patient, they generally have the experience of not really trying things two days in a row or having someone there with you giving feedback. The last time that happened was probably under exam conditions in student clinic. And it’s completely, as everyone listening to this will know, very different. So yes, it’s a great learning environment.

GILLY: Well, yeah. Well, that’s amazing. I can sort of see how that would really bring people on to trust what they’re feeling or what they’re thinking about what’s going on, and to have that confirmed at the table there is really helpful, isn’t it? So it builds our confidence.

RUTH: Because I’m working with an osteopath, it’s also able to be a dialogue. In this scenario, I think that’s true, to get that feedback. There’s a different type of feedback than we get from our patients.

GILLY: Yeah.

RUTH: But we have to be more informed, as opposed to what we’ve all gone and enabled. It’s a great learning.

GILLY: Yeah. Amazing. So getting back to the supervision idea then that we were talking about before, is it really only suitable for those sort of fledgling osteopaths, or who does it really benefit?

RUTH: Literally it’s everyone. And lately I have lots of supervisees who are actually in practice for decades. Usually, yeah, often they’re osteopaths running busy practices, with many associates, reception team, et cetera, et cetera, and have been doing that on their own, apart from maybe talking to their friends and occasionally doing a CPD thing, but not that one-to-one support, and who are really done in, really approaching burnout. Someone saying, I can’t continue to do what I do, or we through supervision identify that they are and that some drastic changes need to be made.

Because in addition to their patient work, often these principal osteopaths, as I said, they manage everything else and all the dynamics. And it’s a lot. And it’s also all of that stuff. We’re not taught that when we’re training. I wasn’t taught about business management. That’s where people like you and different coaches come in. So if you’ve got an osteopath, because there are a lot of osteopaths, and then they’ve been so successful, they’ve grown this great clinic, I mean, it’s a lot. And some of them are thinking, I’m not a nugget, I just do it and get on with it.

So increasingly I’ve seen more osteopaths that have been in practice for many years and many decades. And I see newer people right now. And I see people in the middle.

GILLY: Yeah, I see exactly that from my point of view. And so I’m obviously all about getting the place to run more efficiently so they don’t have to spend so much time sorting out problems and looking through data and trying to find out what’s happened with Mrs Jones’s payment and all the rest of it that they often end up getting embroiled in, all the nitty-gritty. That’s just more stuff on their shoulders. And I’m often close to saying, yeah, you’re amazing, and you’re working 60 or more hours a week and then you’re working on the business at the weekend. But what happens when the wheels come off, sunshine?

RUTH: Yeah. Well, a lot of my work, I guess, is the emotional fallout of some of that stuff. Or it’s really positive if I’m working with someone before that happens and so we know there’s support in place. But in whatever way it’s needed in that person, sometimes I need to refer people to see psychotherapists, or to do specific work on some issue in their own life. Because of course when we’re working, working, working, working, working, any aspects or challenges, cracks in our own personal life will seep in and add to the festering overload. And that is not something that we as human beings can deal with on our own. Not effectively. It’s too much.

GILLY: I agree. There’s so much. We’re just such givers. There’s so much of you that you give to not only those patients, but the team and maybe receptionists as well, or whoever. And there’s only so much you can give to everybody else. And like you say, some sort of incident or tricky conversation at home or elsewhere could really make everything blow out of all proportion, because it’s like a powder keg really, isn’t it? It’s like waiting to go.

RUTH: Yeah. One thing as well about especially osteopaths managing busy practices is the amount of responsibility that they also feel over the patients, but also for the associates and the osteopaths that they are supporting, or they want to support. There’s limited capacity, but this is only one person, and the responsibility to support them and the ending is huge.

So one of the things that I also do in my work as a supervisor is I increasingly offer packages to clinics whereby not only can I support the principal, but also there are a few associates and the principal would like to offer that this is something that the associates could access. They fund the supervision for the associates, if that makes sense. I didn’t express that very well.

GILLY: Yeah, yeah, it makes sense.

RUTH: The principal knows that there is this person. It’s not always for everybody in the practice, but if, so I have, for example, worked with somebody who was having major challenges with one of their associates, a very difficult dynamic between her and the associate. And I worked with the principal around what that was, what that was about for her. And it transpired that it was actually really useful offering a couple of sessions to the associate. It’s important to know I was also working with the principal, and obviously my work is confidential, but the support that we wanted to give to the associate took the pressure off the associate and principal because I’m coming in from the outside with no agenda other than to support these people. And actually that led to a real change in the dynamic in the clinic. Not just because of what I did, but it is relevant.

So yeah, I might support the principal directly, and other times they get support by knowing that their associates have got one-to-one support. Because many principals would love to offer monthly one-to-one sessions with their associates, but the reality is tricky. And there’s another thing, if I can just say, in terms of the dynamic, the potential dynamic of that. Because of the nature of supervision being therapeutic, now obviously there are multiple power dynamics at play in the principal-associate relationship, which is not kind of in my knowledge and monitored anyway. So it can be, therefore there are plenty of places where associates and principals are really happy and get a lot out of it. I guess I see the other side of it more.

It’s difficult for an associate to be necessarily fully honest with the principal when they’re dependent on the principal to get the patients, to get the income. So if there’s something with their own confidence and scenario, they might not want to make themselves vulnerable to the principal, because there’s a fear that that might mean they have less in the way of referrals, et cetera. It’s an interesting dynamic.

And it’s an interesting one that actually I touched on very recently in a conversation with the new CEO, Alison, of the Institute of Osteopathy.

GILLY: Yes.

RUTH: We touched on that topic. It was a very helpful meeting. She’s very keen on supervision as a concept, which I was very encouraged to hear.

GILLY: And that’s interesting because it sounds very valuable to me, and something that, you know, it would be a more voluntary thing rather than having to do it as part of the CPD stuff, but to recognise that it’s an important part of de-stressing from all the stuff. I mean, I know the kinds of things I’ve done to my osteo, and then I go home feeling better while they’re left over with a big bucket full of vomit and stuff, the emotional vomit all over them. That’s because I’ve been in my therapeutic space and I feel much better and moving and feeling better and that’s that. And that’s the same for every patient, I suppose, that they’re in a safe place where they can just go, and then this happened, and then last week, and I was doing a really fantastic job, and they’re left with this stuff and nowhere really to put it. That kind of stuff is not small.

RUTH: Yeah, it’s not small. I want to just pick up on something that you said, which is really important to me, which is the voluntary nature of supervision. Because of the therapeutic nature of it, but it is not therapy and it’s not line-management supervision and it’s not mentoring, it needs to be a voluntary thing. Because we will all know whenever there’s a tick-box exercise, valid though these things are, they serve a purpose, but they don’t serve a therapeutic purpose in my experience.

So if, you know, we have to complete our own CPD. Of course we do, and we fulfil and are bound by a code of standards, all of those. If supervision, for example, was one of those things, you’ve got to have this number of hours, it would not work. It would completely undermine actually the sort of heart of supervision. It needs to be a voluntarily taken-up therapeutic relationship and ongoing dialogue with the supervisor.

I can’t say, right, I want to do my supervision now, I want to do this tick box. Because that’s never going to work.

GILLY: No. They’re not going to go in the right mindset in the first place, are they? They’re just going to be a bit cross and say, well I’m here to do my half hour of all this stuff and then I’m off.

RUTH: Well, and it’s not that. It’s obviously not that. The end goal is actually self-care, which ultimately means that practitioners are going to be invested in that whole thing. There’s another thing about that, which is when we pay for something we are already invested in that process. If we’re going to do supervision, we need to voluntarily embark on a relationship where we of course pay the supervisor, but that’s based on the fact that it’s therapeutic and that it’s a confidential and ongoing, through agreed parameters, relationship. And if you put into that this has to happen, like it’s a requirement, like a CPD requirement, it won’t work.

And this was something I was really encouraged by when I spoke with Alison, the chair of the IO, recently. It’s actually an agreement about that, that the voluntary nature of it is crucial because of its collaborative nature. Supervision is about collaborating with someone to become even happier and thrive in your practice and deal with often incredibly difficult scenarios, which I can give some examples of in a moment.

And also you celebrate things. Because we’re not around with all the patients. So I really want to come back into patient contact, whatever we did last time, doing it again. We might say, well, okay, my nose isn’t really... I don’t want to say what I said... but something magical happened. And also then what do I... like it’s great, the patient’s happy, I’m happy, but then it’s really important for us as human beings to get that reflected back, someone to share that, to celebrate it.

As a term in the supervision training that I completed, which was rigorous, it was rigorous, it was over a year, a very intense period of four-day courses, and then I had to do 50 hours of supervision that I was supervised on. It was very intense. There’s a thing called the sparkling moment.

So one thing I sometimes talk about is a sparkling moment. So tell me, tell me, tell me exactly about a sparkling moment that you’ve experienced with a client.

GILLY: Well, where she said she’d been with another coach and had only really lost a lot of money and hadn’t gained anything at all. And she’d been really unsure about coming to me, but we had a chat and then she joined up with us and we’ve been working with her for about a month. And she’s just reporting back this week, I can’t believe it, I feel so much better. I have some support from you, and you know the patients are coming now, and I’m making some money finally. And she’s just over the moon. And it’s like, yeah, that’s what we do. That’s why I do this. And I’ve got such a great little team, and I’m patting them on the back going, well done, you know, you really brought her up, and they each worked with her in their little niche. And she’s due to come back to me next week, so I’m going to have another sparkling moment over that.

RUTH: Well, fantastically illustrated. That’s exactly it, that we need support to share those moments. They tend to be fleeting because they happen to us all the time. We have to learn to recognise them. They’re not just things to go, well okay, I’m all done, okay. We need to celebrate them, because too much of our time can be spent worrying about the difficult stuff. And there is difficult stuff. There’s very difficult stuff, and as osteopaths we can face really, really grim scenarios.

GILLY: Yeah. I don’t know if you can talk about any of those at this point, but I’m not sure how to ask the question for you.

Well yes, I think so. I mean perhaps if we just touch back to Alison and the IO, did she have any other thoughts around the supervision idea that are interesting to me?

RUTH: Yeah. So you’ll be aware of the IO’s mentoring programme.

GILLY: Yeah.

RUTH: And my initial contact with Alison had been about talking about the overlap between aspects of mentoring and supervision. But also my concern is, who is supervising the mentors in the IO programme? I mean, they take on mentoring. Now these people, they need some professional support around that because of what they are going to be putting up with.

And I was aware that the mentors in this programme, which I realise is really successful and has quite a good take-up, I mean I was just getting briefed about this, of course she’s only three months in post, but there isn’t specific training for the mentors on that programme and there is not currently supervision. I mean, Alison’s going to look into this more as a result of our conversation, which was only actually yesterday. But I was talking about how we need to support mentors in order that the mentors can support the osteopaths.

But supervision, clinical supervision, involves a really rigorous training, as I’ve mentioned, and ongoing, you know. So I have my regular supervision one-to-one, I’m part of a peer supervision group, that’s still required. Well, it is actually a requirement. For me personally I see that as a responsibility for doing this job. There’s nobody actually saying that has to happen, but I feel that’s my ethical responsibility to do that. And I would not be... it’s also massive support for me, and I continue to be a full supervisor by doing that.

So as a result of our chat, she’s going to look more herself at the mentoring scheme and speak to a couple of people on the council that are involved in that. And I’m now in touch with one of those people. And so we’ll see. But she’s very, very positive. Her background is within education and reflective practice herself, and I think that’s why she’s already a fan of the concept of supervision. I didn’t have to really explain what it was so much, and how she worked in areas where it was kind of a given. And that’s the challenge that I’ve spoken about today and before, about how generally in this profession we don’t know what it is because it’s not a requirement. It’s not even, and I don’t want it to be a requirement, but we don’t know if it’s even an option.

GILLY: Yeah, that’s true.

RUTH: So I think osteopaths need to know that this is an option that they can take up themselves with the right person. And they don’t of course have to do that. But if we don’t know there’s something that can help us, we certainly can’t access it.

GILLY: No, no. And I said, you know, the more I talk to you the more I can see how important that is. And that even going up the ladder, if you like, the supervisors need supervisors because they’re likely to get bigger buckets of vomit on them from their supervisees, if you call them.

RUTH: Yeah, yeah. One of my supervisees is coming towards the end of her training to be a supervisor on the same programme I did. She’s doing that. I don’t know if she came into supervision with me so much for this reason. This is now another osteopath, to my knowledge only the second osteopath doing this work, which will be excellent. So that’s going to be... we do need more supervisors. I don’t just see the role as only for osteopaths. I think all the helping professions need it, but we as osteopaths are helping lots of people and generally don’t know about it, don’t know about the possibility. So I was encouraged and she was making notes and she’s going to keep me in the loop about opportunities where I can speak about it. So I’m really... that’s very encouraging.

GILLY: Because I know just from my aspect of what I see with clients and with the conversations that are in my Osteo Growth Circle, you can see that sometimes it’s really difficult scenarios or things that they’ve got to listen to. You can’t just go, no, I’d rather not hear about that, right? You’re a little bit embroiled in the whole thing, aren’t you?

RUTH: Yeah. And so potentially, no doubt, some of that stuff that they’re hearing can be very triggering in their own experience and their own lives, which they’ve got to sort of manage in that moment, which can’t be easy.

GILLY: No, absolutely not. And then a class on top of that, the stuff they’re hearing, other things that have gone on in clinic or even after a treatment, for example, can be really, really upsetting. And the amount of responsibility that we can hold is just... as osteopaths it’s also sometimes misplaced. Of course we’re responsible for our patients. We’re responsible for what we do in the time that we’re with them. We cannot control what then happens after they’re with us. And because we’re empaths mostly, we hold a lot of that stuff.

So for example, like when somebody might contact us or contact the principal because they’ve had a treatment reaction or response, that can be really a lot. I mean, nobody wants that to happen. No one wants to be in more pain a couple of days later. Or worst case scenario, which I’ve, you know, this does happen on occasion, for the patient that they’ve seen to subsequently leave the practice and soon after die, for example.

GILLY: Yeah.

RUTH: For me, massively traumatic experience clearly. And that osteopath might... my, as a supervisor, my greatest responsibility is to that osteopath. And then obviously the clinic and the clinical care of the patient who, in this scenario for example, has died. Obviously there are protocols and procedures that have to be adhered to legally and ethically. But my responsibility as a supervisor is to really emotionally hold the osteopath who has to manage all of his or her emotions in relation to what’s happened.

GILLY: That must be massive.

RUTH: That’s massive. I mean, thankfully this doesn’t happen to many. It’s not a big example, but it certainly is going to be something that’s very difficult to talk about with peers or colleagues. When you feel very guilty, even though there is no guilt attached, that’s a real human emotion that makes you feel horrendous. And ashamed, consequently. About that, down on yourself, all those negative voices. Or should I have done this? Or if I did that, should I have done...? All of this stuff that we do because we are conscientious. We have so many things to navigate as osteopaths. We’re like, well, should I have? Was that a red flag? Was that that? And of course those processes are important, but once something has happened, once there’s been a post-treatment dream and maybe somebody has died soon after treatment, it’s fundamental that the osteopath has someone like myself or another trained, experienced, qualified supervisor to talk about that with.

Hopefully the osteopath will have other support there supporting the emotion as well, but there’s going to be linked trauma in relation to that. The potential is the clinic potentially is now, you know, out in the public domain. We don’t know. There are protocols we have to go through. So really in that scenario it’s invaluable to have someone who is completely objective, and therefore whose concern is the welfare of the osteopath absolutely. It doesn’t take the place of the other processes obviously. You have to have the legalities, et cetera. But that pathway is really valuable. And the osteopath is not going to continue that work unless they have a space to emotionally offload and talk about whatever else comes up.

GILLY: Yeah, because, yeah, anything like that brings huge doubt upon yourself as a human being, as a practitioner, and it’s going to be no doubt playing with your head massively. All the what ifs and everything else. Really difficult.

RUTH: Yeah, gosh. But sharing that, sharing that in a confidential, safe space where there’s full respect for that individual that’s had that nightmare to deal with, is crucial for the mental health, and therefore physical health, of the osteopath.

And for me there are very similar reactions and feelings even if it’s just a complaint, which, you know, is also upsetting, not quite as upsetting, but still unsettling. You don’t want to have a list of people who are not so happy. You don’t want to die. You certainly don’t want there to be initially, through the clinic’s complaint procedure or via the GOsC complaint procedure, any of those. Nobody wants those things. And clearly we as osteopaths need to account for our actions. In my experience, the majority of us are overly responsible. We do not take our job lightly, mostly.

GILLY: That’s my experience too, yeah. The huge responsibility for your actions. And you know I always admire how deeply you can reflect upon your own judgements and behaviours and treatments and everything, to sort of constantly double-check yourself, kind of thing. I think it’s admirable.

RUTH: Thank you. And it is an admirable skill to have. And there is the potential downside of it for the osteopath, this complete inability to let go when something is no longer your responsibility. Really, what really buys into compassion fatigue, burnout, whatever we want to call it, both those things obviously prevalent in our profession. And understanding what’s our stuff and what isn’t our stuff, that is something I talk about a lot.

GILLY: Yeah, that is critical, isn’t it, because being empaths as well, it’s very easy to just go, what did I do? When you may not necessarily have done anything.

RUTH: Yeah, I know. It’s easily done.

GILLY: And going on from there, Ruth, what would you say are the most typical issues that are brought to you?

RUTH: Definitely boundaries. We’ve just touched on that. Professional boundaries, professional emotional boundaries. So for example, how much to charge, as classic as that is, how deciding what fee you happen to charge, how we value our time. And then that kind of then flows on. If that’s an issue, it often is the case, as you will know, that boundaries more broadly are an issue. For example, that appointment running late, or I always put that person at the end of the day because they always take half an hour extra. So yeah, why is that? What is that about? Digging to what is the core of that, digging mindfully, kindly, and also challengingly, gently. I can be quite direct with it, but ideally so that the osteopath sees what is that about.

As you know, if we can identify these patterns of behaviour, the cause of that, and recognise it and make that decision to change that with some dialogue, with me for example, then that shifts that. So if there was one word to encompass pretty much everything I do, it would be boundaries.

And it can even be, increasingly I have, as well as that, a number lately of osteopaths who are wanting to diversify the work they do, not just within osteopathy, that happens, yes, but more. I see those who are also wanting to do other forms of work as well. They want to continue to be an osteopath, but they also want to pursue other passions, like for example someone who is running a hotel as well as being an osteopath. Or someone else, a young man who’s a musician and does that part-time and osteopathy part-time. So this is different from boundaries, but about how to navigate kind of different parts of our identity.

The musician is on tour in the summertime and then is in clinic. How do we navigate that now? And I’m not a musician, but it doesn’t matter with this, because when you’ve been trained and you’ve got the skills to supervise, you can really supervise somebody with anything. You don’t have to be that same profession. So my supervisor I mentioned previously when we spoke is a psychotherapist, would never have supervised an osteopath before. Or she had a bit of an idea about what I might do because she’d seen osteopaths. But she was well able and confident about taking me on because she knows how to supervise.

So I am increasingly finding that lots of osteopaths, for a range of reasons, sometimes because they might not be charging what they could in their practice, but other times because they actually want to, and this is again for osteopaths as well that have been in practice longer, they want to not just do osteopathy. And so they come by me. And so there’s quite a lot of work talking about how that can best fit them, what they’re wanting, what they need, emotionally, financially, practically, logistically. Those things are quite practical. And then looking at what those different parts of the identity are and how they want to progress that. That’s been something that’s been coming up a lot lately.

And then lots about, the other thing, lots about dynamics in practice, like in big group practices. Whether this is from the principal osteopath, or I’m now going to be supervising some reception staff in practice, who obviously face and see so much in waiting rooms, and on the phone, when someone’s annoyed because they’ve got their time wrong, and all kinds of things. But the dynamics, how that works and how the dynamics impact one person. Because mostly we’re team players. We’re osteopaths, we’re a lot of very different things, but generally speaking we’re very empathetic, like we said, and then we like teamwork, yet we have this very isolated job. There’s not really the space necessarily, in a relaxed, confidential way, to talk about just some kind of small things about what happens in treatment. About how life is with that person. When that patient comes, I feel really exhausted. When I go with someone else I feel enlivened. And even if it’s not necessarily to do with quite liking the personality or application, what is that about in terms of the therapeutic dynamic?

And so using the model that I’ve trained with, it’s called the seven-eyed model of supervision. Eyes meaning kind of like the lenses, different ways we look at things, that supervision is obviously super-enhanced vision of our work life. Different models or lenses through which we can look at a scenario. And I’m not going to go into them all now, but one very helpful thing when I’m looking at group practice dynamics within practices is looking at the wider field. Even when we’ve got a wider field for the profession and then a wider system in which our profession is operating, and how we’re seen and not seen, and what expectations come from the outside, and how that sort of negativity is not going to be a good thing.

And then we can see how the individual osteopath is feeling about those things. So we can make, for example, links to parents. We can practice and not forget our licence from the GOsC. We’re pretty much power-like when children... most children, their parents are in that position. So that’s a way in which osteopaths are often triggered by the dynamics that go on in practice. So we’re looking at this from, okay, seeing the GOsC or the threat, going back to the complaint, a complaint from a patient, that’s often very triggering for someone that’s experienced a very overtly controlling parenting style as a child. If they have not worked through that, they’re going to be more intimidated than someone who had a different parenting style.

I’m not a therapist. I am able to use these therapeutic lenses to look at different scenarios. That’s one that comes up, and one that’s useful when we consider now the society that we live in with all the challenges that it has, and how that sort of negativity that’s generally around, our patients come in with. It’s useful to use that when working with someone to manage how they’re feeling about situations, looking at the wider world and the dynamic that we exist in, because it’s never just me and the patient. We’ve got all of these other factors that make us feel the way we are. I think I find those can be really enlightening.

GILLY: Yeah. And I guess the great thing is helping them to be asking the right questions, or pointing some of the way in the direction that helps them to have self-realisation. Because in my bit of experience in the world, I feel that when someone’s telling you stuff it doesn’t always go in. You just think, oh this is rubbish. But when you kind of have those realisations yourself because you’ve had that bit of guidance and you go, oh goodness, that was staring me in the face and I couldn’t see it.

RUTH: Yeah. The thing about perspective is that... I have these nice cute lenses. I have them, obviously multicoloured cubes, I mean I like bright colours. But when you look through something, a different lens, quite literally, we’re going to get a different perspective. And depending on where you stand and where the light falls through this, things are different. And we can’t do that on our own. We can’t be with the patient and hopefully put it in there and say, well what if we look from this angle? What would it be like if we looked at the patient through here, looked at your relationship through this lens?

GILLY: Yeah. Absolutely.

RUTH: But all that enables is a dialogue that, like you say, is about self-realisation. Not about, it’s definitely not about me saying, right, this is what you need to do. There’s a collaborative way of getting different perspectives on our work, which is just such an enormous part of who we are in our lives.

GILLY: Yeah, developing yourself, isn’t it, I suppose. It’s helping you to become more able to manage yourself with the stuff you’re bombarded with by goodness knows how many patients a week, and then a month, and so on. So there’s a lot of stuff coming at you from a lot of different people.

RUTH: That’s the thing too, isn’t it? The number of people coming in the door with different energies, different problems, different attitudes and so on that you’ve got to enter about, and then there’s the next one.

GILLY: And it always amazes me actually how you sort of connect and then disconnect because in two minutes’ time you’re going to connect again to a whole different larger system and goodness knows what else.

RUTH: We’re very... thanks for mentioning that. And thanks for recognising it, Gilly, because that’s something. Because we maybe don’t always disconnect, and so we’re taking into the next session whatever it was that probably was unhelpful from the previous dynamic, because we haven’t got time between, or we’ve never been able to learn or be taught some skills which help that shift. That’s some of the more educational aspects of some of the things I talk to people about.

Because you’re right. It’s like moving on to our next appointment, but actually, you know, we are already one person, one sensory system. And it is a lot. And especially for those of us that are very sensitive in a sensory way. We could use the word divergent, neurodivergent. There are so many terms for it, but generally speaking, because the majority of us are very empathic, we have an increased sensual awareness. And that’s how come we’re doing a great job.

GILLY: Exactly. That’s what I love too.

RUTH: The challenge to that, for many, many osteopaths not necessarily even recognising that we might have it, is that we might just feel full up and I don’t know why they’re doing this because we haven’t been given the skills of how to manage that, because it is a sensory and perceptual overload. If you have not got the space in which to go and do the emotional emptying you mentioned before, it’s actually sharing the vomit of it. So yes. And I don’t know if anybody has done a study. I don’t know of one. I don’t know that it’s necessary, but certainly neurodivergence in terms of its beautiful spectrum, I would be astonished if it’s not a really high amount of osteopaths that are on that spectrum on account of our capacity to be so aware.

I haven’t seen any work, maybe someone’s doing something that I’m not aware of. But I recognise that, you know, it is a multiple set of superpowers.

GILLY: Absolutely. It’s my experience, Ruth, that in the last 12 years, it took me a while, but then I started thinking I keep sort of seeing and working with the same kind of people who have got superpowers. And the amount of times that an osteo has said to me, oh sorry, I’m dyslexic, and I just go, of course you are. Yeah. I would put a number of at least 80 per cent. They say to me, oh sorry, I can’t spell that because I’m dyslexic. But I think there’s a combination of the same type of conversation and I go, oh, another superpower. And I do notice a huge amount of neurodiversity, which I’m not qualified to, but I just get that sense from being an empath myself and a sensitive person myself. There is. But it translates as being able to connect with another human being and work out what’s going on with them. It is a superpower.

RUTH: I agree with that myself. I mean, I say that. I don’t know what the balance is actually gender-wise, but certainly I would say even probably higher than 80 per cent of females who are neurodivergent, I would say. And of course, neurodivergence in women and girls is way less recognised than it is in boys and men. So that’s a correlation. I’ve been interested in that. I think that’s beginning to be covered now. And because that’s the gender politics, it’s to do with all kinds of societal things. This is level seven again, seven of the seven-eyed model, as I say. So we don’t come across as what uninformed people might think of as neurodivergent. But it is an additional factor. It’s not the type of factor because I’m not... it’s just part of who we are. It does mean that we need somewhere to offload all of the sensory imperatives and things. There are people who have an interest in those things who want to do that, that’s fine. But I’m not diagnosing it anyway. But you know, I recognise it in myself. And we can’t really have these superpowers without the things and challenges.

GILLY: No. And just remind us, Ruth, how we can get in touch with you.

RUTH: Yeah. So my website is supervisionwithruth.com.

GILLY: Supervisionwithruth.com. Right.

RUTH: And yeah, that’s how you can contact me via that website, email me or message me. I hope I will be able to be in attendance on the Saturday at the IO convention, if people just want to have a very happy free chat.

GILLY: Fantastic. Well, thank you so much for spending time with me today, Ruth. It’s been fascinating digging a little deeper, and I’ll catch you at the IO convention.

RUTH: Thank you. Thanks very much. Pleasure.

NARRATOR: Thanks for listening to the Osteo Business Podcast. Remember to like, follow and subscribe on all Gilly’s channels, which can be found in the show notes. See you back soon with more tips, ideas and strategies to build your thriving practice.