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

​

NARRATOR INTRO: 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: Hello, and today I'm joined by Ruth Wharton, who is an osteopath of course, but she has also been very involved in supervision for quite a while now. So thank you for joining me today, Ruth, and taking some time out.

RUTH: Thank you very much for having me. It's great to be here. I'm excited. Thanks, Gilly.

GILLY: Me too. My pleasure. We've known each other, we've spoken quite a few times in the past here and there for ages, and it's sort of interesting to see how your journey's been coming along. So tell us a bit more about how you got into osteopathy and what's led you to this point now.

RUTH: Okay. How I got into osteopathy originally?

GILLY: Yeah.

RUTH: Okay, yeah. So it was a career change for me. I was working previously in the voluntary sector, in social work, so I was supporting lots of people one to one. Very intense. I loved it, but I was being encouraged to go into senior management and funding applications, which wasn't my thing. And at the same time I was having osteopathy. I'd had a serious car accident in my twenties, serious spinal injuries, and I'd been seeing an osteopath. One day I was lying on her couch, had a bit of an epiphany, a lightbulb moment, and thought, actually, can I do this? I wanted very much to still work with people one to one in a supportive way, but I didn't want to do the very, very hardcore frontline stuff. I was working in prisons and stuff, so it was pretty intense. My osteopath was fantastic. I said, "Could I do this?" And she said, "Yes, you could, and this is what you need to do."

So I had a language degree. I didn't have any science, so I went off and did the appropriate access courses at the time to get my sciences up to the right level. I gave up my job, took out a loan, went to the BSO as it was at the time, and trained as an osteopath. It was always the cranial side of things that I was drawn to, in terms of my receiving osteopathy, because that's what I'd always had. I'd also been treated, actually, when I was three for ear infections, so that was my first introduction. I was confident of knowing, as we know, that this really works, osteopathy really works, and also wanting to carry on working one to one with people. So that was my route in.

GILLY: Wow. You make it sound as if you just kind of gently wandered in.

RUTH: Yeah, it was kind of, yes. I mean, I found the training phenomenally difficult. I felt grateful for my other training that I'd done before becoming an osteopath in terms of the counselling skills that I had, for example. I'm not a qualified counsellor, but I had done various courses, which was really helpful, especially being a mature student when I trained. When we were in clinic, I really enjoyed being with people. That was less daunting. The most daunting bit for me was all the science.

GILLY: Yeah. When you've got an English leaning.

RUTH: Yeah, exactly. So all my younger peers on my course, my lovely younger friends on the course, were generally thriving with the whole learning side of it academically. I might have found it a little bit easier being alongside people with pain, albeit I didn't up to that point know how to be with people in physical pain. So it was, yeah. Yeah, that's how that began.

GILLY: And then it's more recently - sorry, you were going to ask...

GILLY: I was just going to say, you know, so you were practising as an osteopath, and then it sounds as though you started to get drawn towards more of the cranial side of things.

RUTH: And it was always the cranial side that had inspired me from my own experience. When I went to see the osteopath having had the car accident, it was a cranial osteopath. And so for me, my knowledge of osteopathy, my felt knowledge of osteopathy, was all the kind of cranial approach. That's just what I thought osteopathy was. And my osteopath said, "You'll have to learn loads of other stuff, of course," and she was right, before you get to that bit.

But then, as soon as I qualified from the BSO in 2004, I moved to Yorkshire. My partner and I had planned to move there. And I then worked, for which I'm immensely grateful, at the OCC in Manchester, which closed down subsequently. But I worked there, and it was there that I was introduced to more of the biodynamic cranial approach to osteopathy. Too many words, in my opinion, we have so many terms, but basically osteopathy that I resonated with. And it was a tutor there who said to me, "Oh, you need to do the biodynamic pathway." I had no idea what that was, but that's then what I pursued, which was fantastic. I had the time to do it. I was in a new area in practice, I was setting up my own private practice in Yorkshire as well, and I had time. So I spent ages at the OCC, which was just wonderful for me.

GILLY: You must have learned tons there.

RUTH: Yeah, just amazing. I mean, anyone that has worked at the OCC knows the full-on busyness of it all. It was a very child-friendly nature, which meant that I had to learn very quickly how to get my hands on in the most loving, supportive way in a very full-on scenario. And that's kind of an extension of what I had been doing in my work before I trained as an osteopath. It's being with people where they're at, whether with physical treatment or just in communication, because that's how I see what we do as osteopaths. We're communicating. We're having a dialogue. We're having a dialogue with the person's body and with the person, because we can't separate the two.

GILLY: Yeah, I like that. It is interesting. It's like a dialogue, yeah, just from the patient's perspective. It's really interesting that you say that.

RUTH: Yeah. It's like being able to meet the patient where they are, because we come to osteopathy as whole people. So when I'm a patient in that context, I really appreciate being met by my osteopath, and when I'm treating, I hope that I meet the patient. There's obviously clinical reasoning and the assessments and all of those things, but part of that is really being able to actually get alongside the person and be what they need.

GILLY: Yeah, it's just part of treatment. And something that I do as well as a business coach, I meet a client where they are currently and then bring them forward gently to where they need to be in order to really flourish.

RUTH: It's interesting you use that phrase because that's exactly what we say too, is I meet them where they are and give them what they need, and then gradually give them what they really, really need, if at that point hopefully they will know that that's also what they really need, because that journey, you would have been on that journey together. It's like walking alongside rather than shoving someone over there or telling them that that's what you need. It's about working collaboratively. And I guess that's what I hope I do. What I believe I do with my patients, and also what I hope I do with my supervisees as well. That's kind of the next sort of bit of the journey for me, I guess.

But I think it's all about communication and dialogue, having a conversation. We were talking before about this, and obviously this is a conversation, and I think it's important to have all kinds of conversations with the people that we meet, be they our patients, they might be colleagues that we're working with, might be a principal, might be associates, so many things. But these conversations are how we heal, actually, I think.

GILLY: Yes, I think that's a really good point, actually. I like that.

RUTH: We don't really heal - well, maybe there are some people, I don't know - but I don't think generally speaking, as human beings, we heal in isolation. We need to. In terms of the osteopath and the patient, it's obviously a mutually beneficial transaction, or therapeutic relationship. It hopefully is. But when we're working well as osteopaths, it also serves us, not in some self-seeking way, but it's enabling, you know, we're enjoying our work.

GILLY: Yeah, exactly.

RUTH: And we need to work for multiple obvious reasons. If we can also enjoy what we're doing, that is brilliant. It's a win-win situation for us as practitioners and also for anyone that comes to see us.

GILLY: Yeah, I like that very much. And so what led you towards supervision then, Ruth?

RUTH: Yeah, so, well, I guess because of the nature of whatever we do as osteopaths, but especially I've worked over the years with lots of people experiencing trauma of different types. So I've done quite a bit of work with refugees as an osteopath, run a community project in a housing complex for young people, under-25-year-olds with complex needs, doing osteopathy, going in and giving osteopathy there. And even before that, I was mindful that I got to see all kinds of people in pain - physical pain, emotional pain. And one day, I don't know particularly why at this point, but one day it just occurred to me: wow, actually if I was a psychotherapist or a counsellor, which I'm not, or even if I was a craniosacral therapist, a homeopath, multiple other disciplines sort of within the helping professions, I would have to have supervision. It would just be an integral part of what I would need to do.

I thought, I would really benefit from talking. I kind of thought, could I do this? No one, no one's ever mentioned to me in however many years I've been an osteopath the idea of supervision. It's not something I'd come across. I spoke to a colleague and a friend of mine who is a psychotherapist and said, "You know, you have supervision?" She said, "Yeah, absolutely." I said, "Well, I'm just thinking about this. I get to hear lots of stuff, which is sometimes really difficult to hold, and personally it might, as it has been in the past, potentially be triggering about stuff from my own life. And even if it's not, it's intense stuff."

Then I make my notes. Informally, at this point, I would talk to osteopathic friends, without obviously breaching any confidence, and with different colleagues. And when I've worked in practices with other osteopaths, there would be that mutual kind of support. But I just really felt I could do with a space in which to talk about things more in depth, that there was a held space that was not with a friend. I've got great friends. I've got great osteopathic friends. I'm very grateful for that. And there came a time where I just felt like it was a responsibility, really. Yeah, really.

So this colleague recommended her supervisor. I spoke to her supervisor, who was a psychotherapist, not an osteopath, and said, "Look, I'm an osteopath. This isn't a thing in my profession, but I believe that it will be a good thing and I would like to try it." She was happy to take me on as a supervisee despite me not being a psychotherapist. So I was seeing her for a good five years at least. So I've been in supervision for at least ten years now. Sorry, it's quite a long time.

I just loved the process. I really love the process of having a safe space in which to reflect, be asked sometimes challenging, in a very compassionate way, questions about why I was doing that, how I was responding, what can I do differently, but in a very - there was no sort of managerial level to it. I had a completely independent relationship with my supervisor. It wasn't about my supervisor getting me patients or approving something. Literally she met me, I met her, as an equal, face to face initially, and then after lockdown that has all been online because she carried on working in that way. In fact, she actually retired, which was difficult, but I found another brilliant supervisor.

So I was enjoying it so much. I really felt like this really ought to be a thing that would be available. I'm not into the idea of - there are so many rules, there's such a lot of prescriptiveness in the world in which we live, and potentially within various aspects of this profession. I'm not into the idea of making it mandatory, but I just feel, and still feel, that it ought to be something that would be available.

So I started to do the... There was another osteopath who has subsequently been unwell and hasn't been able to practise, but I was on a course with her and I was talking to her. I just mentioned that I was having supervision. She said, "I've just, I'm just partway through training to be a supervisor. I really recommend this course, it's absolutely brilliant. You should do it." I hadn't been thinking I must train as a supervisor, but when she said it, it was one of those aligning things. It was like, okay. Sort of right place, right time.

So I looked it up and signed up for the course. It's the only course, and I believe this is still the case, that will take non-people - people that aren't psychotherapists or counsellors - to train to be a supervisor. So I did this course with the Centre for Supervision and Team Development, with Robin and Joan Shohet, who are known in the supervision world as basically the masters of it. They've been doing it for forty years. So in the world and with professions where this is kind of more known, people tend to know these people. So they're the only course that would take on someone like me, as I wasn't exactly the norm. And I loved it. I really, really, really loved it.

As part of that training, we had to start supervising. So I was then assessed on that. I had to have supervision on my supervision to make sure that that was all going well, and that's all assessed. Fifty hours of that, I think it was. It was just really fascinating. There weren't any other osteopaths on the course. There were a couple of craniosacral therapists - I say that because there are obviously similarities as well as differences between the way that we work. And there was an interfaith minister, there were lots of occupational therapists, some physiotherapists, but no other osteopaths, and many, many counsellors and psychotherapists. So yes, I think that it ought to be available. I think I want osteopaths, or anyone in the helping professions, really, to know that this is a thing that you can access. And it's about looking after ourselves, for me. I know I wouldn't not have my supervision session. I see my supervisor about every six weeks.

GILLY: Really good. Because I imagine it's so important to offload some of that bigger stuff that's maybe sitting on you, and I imagine it could be cumulative over time. That's just like, oh, more heavy stuff from - you know, not knowing who's going to walk in and what they're going to vomit all over you, do you?

RUTH: Yeah, so it's hard. And yeah, and even though, when I've done - I feel fortunate because of the work I did before osteopathy, I think I've always been quite clear with my boundaries, because if we're not clear about our boundaries, we're going to absorb more of the vomit. But even, you know, obviously, I remain human and we will take on stuff and it can be difficult. And there's absolutely a cumulative effect.

That said, sometimes I will see my diary, I've got my supervision, and I'll be like, okay, I haven't particularly got - I can't in that moment think of I need to talk about that. Generally, I really enjoy my work, but my enjoyment of my work, part of that is to do with the fact that I have supervision. Just knowing that. Sometimes I'll arrive at supervision thinking, don't know what we're going to talk about today. There's always something, and it doesn't have to be something catastrophic. It's such a joyful place in which I'm with my supervisor. It holds me and my patients and the things that I talk about in a very - it's a very equal thing. So there's not some - I just forgot what your question was there, Gilly. What was your question?

GILLY: That's a very good question. What was my question? We've got on a tangent. But what I was going to move on to is, can you sort of give us some ideas of what supervision is not? Because I imagine that's what somebody is wondering. You know, how controlling is this going to be? So let's explore what it isn't, first of all.

RUTH: That's great. Yeah. So what it isn't: it isn't psychotherapy. It's not what you would go and see a qualified counsellor or psychotherapist for. It encompasses aspects of that, and we'll come on to that with what it is, but it's not that. It's absolutely not a kind of line management, managerial, here-to-check-you-out-what-you're-doing-wrong type scenario. It is nothing about blame or fear, which I think supervision in many other, maybe in a corporate side of the world and various different industries, is like that. You would have supervision with someone that you're dependent on for your income and your review, et cetera. So this is not that. This is absolutely not that.

So it also differentiates it from the conversations some people would have with their principal osteopath. Some people are having great relationships, obviously, with their principal osteopaths, with their associates, and some people really aren't. And the power dynamic, that is a difficult one. An associate doesn't want to piss off their principal by saying how they really feel about something because they're not going to get referrals. The power dynamic is huge, multi-layered.

This is very much about meeting the osteopath, or other healthcare provider, but most of the people I work with are osteopaths, walking alongside them so that they feel safe to say whatever it is they want to say. So it's not finger-pointing, "You're doing this wrong. You ought to do that. Why did you say that?"

One thing that I really loved about the training, which is relevant I think to your question, is an opening exercise whereby we were all asked, in a role-play situation, what would be the one thing that your supervisor would absolutely not want to know about you? What is that thing? Looking at the judgements that we hold on to, what we don't want to share generally because of fear, blame, shame. I don't mean in supervision with me I'm like, what are you not going to say? But it's basically absolutely about empowerment, and not about fear and blame and being found out. "I feel like a fraud." We often all feel like a fraud. I feel like a fraud on a regular basis as an osteopath and a supervisor. It's part of the human condition. There is nothing better about me than you or the next person. So that's what it isn't.

What else isn't it? It's not business coaching. I'm not a business expert like yourself. I've had experience of running my businesses. I haven't trained as a business coach. It can overlap with some of these things, depending on what somebody wants to get help with. Sometimes we will talk about business-related things. Someone wants to get more patients, look at what the current situation is, but if there was a really stuck issue with that, I would be referring that person to somebody - well, not somebody, it would be you, actually. And I have done that.

But although I'm saying it's not psychotherapy, there are psychotherapeutic aspects to it, like emotional support. The training takes in parts of psychology. I am not a psychologist. But it's very much a meeting place in which people are going to be becoming more confident because they're able to share what's really going on for them. When we're with our patients, there's lots that we're not saying because that's not ethical, it's not appropriate, it's not our job, and a lot of those things need saying somewhere else in a self-contained space.

I don't mean we're not writing things on our notes. We're writing what's clinically necessary. We're adhering to the practice standards, we're doing all of those things. But sometimes things linger in our mind. We need to say them somewhere. So when I say it's not psychotherapy, I have also relatively regularly encouraged, or referred, people either to stop supervision, or more often than that, it's been someone who's then started seeing a psychotherapist at the same time, to look in greater depth at stuff that's come up. Because that's not my role, to delve into that in any depth.

So where that might have triggered somebody with childhood stuff or relationship stuff or whatever, then it's like, okay, you've now voiced that, you see that it is a concern for yourself, and this could be causing you unhappiness, et cetera. Now's the time to go and get that more officially looked at and talk it out. If something is kind of continuing, because sometimes there are things in supervision that are very personal, but if there's a completion with that and that's all that's necessary, it's not like the osteopath is struggling with that ongoingly, then that's fine. So if they kind of go, "I see what I'm doing there," or whatever, then they can say, "Okay, I see, I've caught myself out there. I won't do that again," kind of thing, and then it's done. But they've had that realisation through talking, through the dialogue.

GILLY: Through the dialogue, through the conversation that's hopefully transformative. Conversations that enable you to think differently.

RUTH: Exactly. By endeavouring to ask the right question, that enables the person to then think differently. And then it's like, you know, I'm not going to say that's the right question every time, because we all know - the same happens for me in my supervision - that we get stuck in our mindsets. We are human and get stuck in the internal dialogue of whatever it is. "I'm useless at this, I can't work with these patients," whatever it is. Something might be that we choose not to work with those patients, and that's fine if that's a decision. But actually if you want to be, for example, working with a certain group of patients and you're feeling stuck, that's something that we might talk about in supervision.

If it becomes apparent to me that that's no longer that, there's a deeper thing held there, then that'll be a time to go to therapy.

GILLY: It's really good. So it's almost like an interface in a way between practice and actually where any of us might need a bit of extra help with managing some feelings or some stuff that's come up.

RUTH: Exactly. And because our work is such - the osteopathic work, or work for anybody generally speaking, especially in helping professions - our work is such a massive part of us. It's a huge part of our identity. The majority of people who become osteopaths are osteopaths because we're giving and compassionate, want to help people, and we're empathic. We want to have that. And I hold my hands up to this, that it may well be a struggle for us to use that compassion towards ourselves. We're very good at giving it out. And we all also know this, and this will be something we're probably talking to our patients about as well, making sure they've got the right support networks, and they're having therapy if they need it, and they're doing exercise, and they're making the changes in their life. But it's like we kind of turn a mirror on ourselves.

GILLY: We're like the cobbler's children, isn't it? It's the same thing always.

RUTH: What's the saying? The cobbler's children don't have good shoes. He's making fabulous shoes for everybody in the town, but his own children don't have any decent shoes. Right. Okay. Yes. Well, then it also reminds me of another thing. This was something that came up in the training, actually. There was a story of an axe person, of course someone who is chopping wood, who was working for a new boss, and this person was determined to cut down as many trees as possible. One day they cut down five, the next day they completed ten trees. This continued and they continued to chop down, but not very much more each time. And then the woodsman went to the boss and said, "I'm not being able to cut down any more." And the question was, "When did you sharpen your axe?" "I don't have time to sharpen my axe. I've been trying to chop down trees." It's like, we all - all of us as osteopaths are working very hard.

GILLY: Yeah, in a lot of different scenarios, either on our own or with somebody else.

RUTH: Exactly. And we're either on our own, or even if we're not on our own, it can be - you know, it's wonderful, I love osteopathy, and it can be isolating. And so if we're spent, we need to look after ourselves, sharpen the axe.

GILLY: Slightly. Yeah. I get that, though, because otherwise you can't do your work properly if your axe is blunt.

RUTH: Yeah, exactly. And you aren't also going to enjoy your work.

GILLY: No. It's going to take more effort, more time, way more. You can get worn out. Yeah. That's the thing, actually. Can I just go off on this tangent? Can I just say this thing?

RUTH: Yeah.

GILLY: You may.

RUTH: Thank you. The reason that I stopped, you know, when I was doing my work before, I was getting pushed, like I said, to go into more senior management. I also had seen various colleagues get burnt out. And I was like, I don't really want that to happen to me. I quit working for a few years. I was a little bit older. It wasn't really a good fit. I didn't feel like that was me. But I also, I guess, was looking at why would it happen to all these people and not happen to me? And I didn't want that to happen. So I didn't want to carry on in a very intense place. So I left, and then thankfully had this realisation that osteopathy - and you know, as you must come across a lot, and as I know from multiple friends and people that I work with in terms of supervision - burnout happens unless we take action.

GILLY: Yeah, I think it is very prevalent in the profession from my experience. And I think it is because of that gorgeous, giving heart, that sometimes it's just like there's nothing left in the bucket. It's all been given and it's not getting refilled anywhere. And I think perhaps that's what you're saying about supervision, it's just helping to refill that bucket, keep that person feeling, yes, I am doing a good job, and okay, not everybody gets better, I've done my level best. Not everybody wants to get better.

What else can you tell us about what supervision is or what it brings to the practitioner?

RUTH: Certainly, it really increases confidence. Confidence in capacity to do what they do, but also about who they really are. It really enables the practitioner to trust themselves more.

GILLY: That's good.

RUTH: Because we will talk through different scenarios and uncover them with different perspectives, a different way of seeing it. And there'll be, as long as I'm asking the right question - I obviously don't always ask the right questions, and when that happens that's also a learning that goes on in the session for me and for them, actually. It's not - it's really about growth. I like "professional growth", but also personal growth, because we can't separate the two.

More confidence, better able to communicate with patients definitely, colleagues, peers, people in dynamics, other professionals. So people that are wary of communicating with people that they're going to refer their patients to, we'll talk through that. So if I had to - one word would be confidence. Two words would be increased confidence. Understanding. Increased joy, therefore, because the more confident we are, the more joyful life is. I think it also provides an opportunity to let off steam, because we're also - when we're with our patients and when we're in our clinics, we are operating as frontline medical professionals. Regardless of what various people say, that's what we are. And that is a lot.

And we need a space to be able to also offload and to be able to say stuff that would be unethical and inappropriate to say in front of your patient. You do need to be able to say it to somebody. Now, some people have the benefit of working in a big group practice, and when I've done that, that was great because you can have a bit of that banter. But you're still held by the system. One of the parts of the training that I've done is looking at the wider system in which we exist.

I've been doing what's called the seven-eyed model, which is seven eyes, as in seven ways, seven lenses of seeing things. One thing is about looking at the wider context. So having supervision helps us to understand everything that's involved in the room, because when we're in a room with a patient, we haven't just got us and the patient. We've got the patient's family, their partner, their employer, anyone that's like a stakeholder - I'd call it a stakeholder in the process. We've got a whole load of stakeholders with us. We need to make sure we're adhering to the practice standards. We need to make sure we're staying on the register by doing all the things we have to do. Of course, we have to do that. That doesn't leave space for the other stuff where we just need to go, "But what about this? I don't know what to do. But I should know what to do."

But we can't. We aren't - we're humans. So it's about being fully who we are, if that makes sense.

GILLY: Yeah, it does.

RUTH: And I guess the numbers nowhere prove this, and so often with great things we can't prove it, it's one of those known things, I do believe that supervision is something that enables us to keep working for longer, kind of whatever we're doing. If we want to work, if we want to work, or it will identify that we don't want to do it any more and then we're going to do something else. But our work is such a massive part of who we are and what we do. It's so beneficial to have an opportunity to grow with that and to bounce that off, because as brilliant as we are with our amazing brains, I can speak for my brain, I can only come up with various options. But the thing about being in dialogue, like we've been saying, having a conversation, is that bouncing off. And if you're bouncing off someone that's got your best interests at heart, with no other agenda other than helping to support you in your work, that's really helpful. If it's not a fit, then you don't work with that person.

GILLY: No. Yeah. That's going to happen sometimes, isn't it? And I think something I learned as part of my career and everything is HQQs, asking high-quality questions. That's clearly what you're trained to do. And like you said, sometimes you'll go, "Oh, that wasn't a great question." But I always remember my coach saying, "Let me ask you a better question." And it was like, in the moment, she'd ask a question and think, that's not where I want to go with this, this is a better question to get where I really need to go, to get down to the nub of the thing. And I think that's the skill that you've learned. It seems to me that it's innate in you anyway, that you're a great communicator. You've also added in the skills where you can spot where there's something that needs to be poked a little bit, just to get a realisation or get down to the actual issue that's happening, that you can see that the other person can't quite grasp yet. And that's what I see as the beneficial thing.

RUTH: Thank you. Thank you. And yes, being with, because when we go on that journey together, those realisations come. And the other thing, just to go back to what your coach said, one of my trainers said that everything that goes on in the conversation, in the dialogue of supervision, is all information. It's all relevant. Everything that happens. So in a way there's no wrong. There's information to be gleaned by both the reaction maybe in me as supervisor, or as the person that I'm supervising, because it's a collaboration.

Sometimes I will feel something very physically in my body as the person I'm working with is talking, and I will give feedback about that, because often, not always - in which case we have a conversation about that - but often that's reflecting something that's gone on in the dynamic they're talking about. Which is enough to know that feeling is such an immense part of what we do, not just with our hands. We're communicating on so many levels with that person.

GILLY: Yeah, you're more highly attuned than most of us when these things do or don't work. I don't mean they only don't work if you're not that genuine. But you've got that extra layer of perception or you've got like a better radar than most people in picking up what's going on in a body or in a person or in a mindset or whatever it might be. And you can sort of get to that quickly.

RUTH: It's certainly what I aim to do, and it's what I really love, enabling other people to continue to thrive doing that in whatever way they do it. I work with the whole very broad range of osteopaths.

GILLY: Yeah, it's the same dynamic. It's still the same dynamic in the clinic, isn't it? It doesn't matter what their modality is or anything.

RUTH: Exactly.

GILLY: So how can people work with you, Ruth?

RUTH: They can work with me online or face to face. Mostly it's online because I work globally, so that's obviously how that works. So they can email me.

GILLY: Oh, tell me the email, Ruth, and we'll put it in the notes as well.

RUTH: Okay, thank you very much. It is hello@ruthwhartonosteopath.com.

GILLY: Perfect. Great. And then they can find out a bit more. I'm going to agree with you, it's a really valuable addition to clinic life, and for people to have somewhere to go just to clear this stuff out. Because I imagine you must have some weeks where you see a lot of tough stuff, or you talk about a lot of tough stuff, and it must be quite hard to then just go home and say, "Okay kids, it's chicken nuggets for tea." We're all juggling lots of different things. And I think if we know - certainly I know for me and my supervisor - I know that there's that space where that can kind of go, which means that I'm just enjoying the rest of my life more.

RUTH: So you can just park there because you know when you can prise that open and then poke it a bit, but it can stay there now. And then interestingly, when it comes to that appointment in six weeks, that may or may not any more be a thing that needs to be looked at, but it might be something, and that in itself is something that's then... I've often said to my supervisor, "I was going to talk about this, but actually no, this has happened, that's been sort of, I guess, processed, and now what I was talking about is this," which could be - really, it really could be anything.

If it felt outside the remit, then my supervisor telling me that, I would say to my supervisee - you know, like I've said - I would point them in the direction of working more in depth with somebody else around that. But yeah, I think it's something that everybody should have access to. And for that reason I think having the training is really invaluable. The other thing I forgot to say as well is I'm part of a peer support group, a peer supervision group. So people that I trained with, we have a monthly support group, which is a certain thing that we all do internally. So yeah, I think supervision is really important.

GILLY: Yeah, I agree. It sounds like it's a valuable aspect or bolt-on to practice.

RUTH: Yeah, I think so. For me, if you've got a physical pain, for example, you might go and see an osteopath. That would be a good idea, or take whatever other action was needed depending on the situation. But I think having, as part of your support circle, someone who's trained and qualified in holding the space about whatever it is, is, in my experience, invaluable. So yeah.

GILLY: So what my supervisor is saying is it helps you get perspective on things as well.

RUTH: Yeah. Because sometimes we blow things up a bit, and some HQQs might bring a bit of a levelling of that and say, well, that's okay. The response to that is what any of us might have. You're not wildly off the mark here.

GILLY: Yes, it's helping to get that perspective, and a perspective from somebody that's not in the scenario or the situation.

RUTH: You know, I was working quite recently with a principal osteopath who was really struggling with one of their associates and a dynamic in the clinic. And actually, it transpired to be a different issue. The actual nub of the issue turned out to be something other than what the person had initially thought it was, which was very empowering. It was actually, "Oh no, actually, I could do that." I guess it's about enabling. It enables us to feel differently because we think differently. We get a different perspective and a kind of fresher outlook, because we get stuck. As human beings, we get stuck.

GILLY: Yeah. And we can get a bit like, this is the thing, for example, they're the problem. This person is the problem. Maybe they probably are problematic. We can all be problematic. That doesn't necessarily mean they've got to go. It doesn't necessarily mean this is this. There are many, many options. But I think we work better to discover what solutions are when we work with somebody.

RUTH: Yeah, I really like the idea of that because it is, again, collaborating, isn't it? Rather than us trying to just figure everything out in our heads. Because like you're saying, sometimes the feelings in your body, they can go, "Oh, I don't know, that doesn't feel good," or "that does feel good," rather than our brain going like an AI machine, churning out, "It's all your fault, you're no good, you need to do another course."

GILLY: Yes, do our course, and then you'll find yourself.

RUTH: But there's so much of that. And as we said, so much of that amongst those of us who are really striving to help people all of the time. It's a challenge that the majority of us will face.

GILLY: Yeah. And for those that don't face that, well, great. Enjoy that feeling of not feeling it, maybe. But I think it can be quite lonely in practice.

RUTH: I have not felt lonely in practice. I really love my work with my patients. But it can be intense. At the end of the day, most of the time it's one of us. It's not always the case in bigger group practices if the principal is actually hands-on with the associate. In my experience, that really doesn't happen very often. Sometimes it can. And obviously most of us are on our own in whatever our clinic room is with the patient, which might be multiple patients because it might be a child and their family. I work with lots of families. In the end, we're there endeavouring to do a great job. And endeavouring to do a great job to the best of our ability, the majority of the time, that's a lot.

GILLY: Yeah. I always have great admiration for you, in the way that you can sort of delve into a body of systems and whatnot and sort some stuff out, and then come out of it again, and then say goodbye, and then the next one comes and you delve into another one. And I think, gosh, that must be quite intense when you are back to back like that. And I think it's quite amazing how you do that. Because I know when my diary is a bit jam-packed and I'm doing back to back myself, by the end of the day I'm a bit like that. So, God, who did I even see this morning? It's been so intense. So one thing that I admire that you're able to do on a daily basis is to engage with that human, then disengage, then engage with the next one. It's amazing.

RUTH: Well, thank you. I think that's part of the - certainly for me when I was doing my training, that wasn't a skill that was taught, in terms of how to manage that. And I haven't come across that being the case since I graduated, with the school situation now. For me personally, I was grateful having had to learn boundaries in relation to that with my previous work. But I think it's something - you don't just learn it. It's an art. It's an art that we continually need to practise. Just like osteopathy is a science and an art, it's like that. We have to keep maintaining and nurturing those boundaries.

GILLY: It's exactly that, we have to nurture them.

RUTH: Yeah, because depending on what also is happening in our own lives, all kinds of things will be different. Business can be very intense then, and that's where the overwhelm happens and the heading towards burnout. I know you've spoken about burnout on the podcast before, where there comes a point where the person's becoming indifferent. And I've even heard people saying, "I actually hate my patients." They've got to that point where it's so bad and they're still not taking any self-care. It's horrible to see that extreme happen, which I have seen a few times. Not many, thank God. But I think again, circling back round to this, this is where you catch that and just go, "Oh, wait a minute, I'm noticing this is quite intense feeling you're showing me here. What's going on?"

And all those whatever-you-do moments, I think it's catching that, isn't it? It's like when you get the amber warning light on the - I don't know why I'm using this because I'm really not a techie person - but on a car, the amber light, the warning. Taking action rather than waiting for the big red flashing light and everything's gone, and that's it. That's a bit over-literal, but it would be really great to avoid that. At least for people to know that supervision is an option, as opposed to letting it get so dire.

And also, you've put so much effort and expense and energy into training to be an osteopath. It's mammoth, as we all know. Anyone who is responsible knows. So we have to really nurture that, I think.

GILLY: Yeah, I agree. Or think it. I mean, you're a fabulous advocate. That's an incredible gift that you give to our profession. I just love you.

RUTH: Well, I guess I also love us. And it's like, well, we have to look after - or at least I'd like people to know that it's an option to do something to look after ourselves, which is a kind of unpopular thing. As people that look after other people, we're often bottom of the list, as we've said a few times. Yeah, like, why would I spend money on that? It's about looking after ourselves. It's like we spend money on all the other expenses that we have in our businesses. I mean, this is your area, but some of these are essential.

GILLY: Like, if you want to grow, then invest in someone who can get you to grow quickly, without you going, shall I try this, shall I chuck a bit of money at that and a bit of money at that and a bit of money at that? And the same with you. You can talk to a mate down the pub about something, but actually some proper supervision or support is going to be more beneficial because of the questions and the reflection and the guidance and all of that. It's actually properly helpful, not just a chat.

RUTH: Yeah, I mean, I guess the chat in the pub in the short term is great. It's just a start.

GILLY: Yeah, but it is just that. It is a start.

RUTH: Because that's not, by nature of our mates, they're not, and it wouldn't be appropriate for them to be our supervisor. They're not going to be coming at it - they already love you and they're seeing you for the bits that they love about you.

GILLY: Yeah.

RUTH: It comes back to a different lens, a different eye, different perspective on the person and then the scenario.

GILLY: It's sort of like being in a helicopter, isn't it, and being able to see a bigger global picture that's going on here, and maybe spotting patterns or something. You can say, "You've mentioned that, you've used those words before," or "You've mentioned that a couple of times," and just sort of trying to find where the glitches are.

RUTH: Yeah, exactly. You just reminded me, thank you, Gilly, that some people will have supervision just every now and then, or if there's a particular thing happening. There was someone who was wanting to set up a new practice somewhere and had enquiries and uncertainties about that, and I did a piece of work with him over a period of time, and then he's coming back once he's got to a different stage, kind of thing. The majority of people I see regularly, but it is variable.

GILLY: That's interesting, because I thought maybe you've got to sort of commit to doing every six weeks or something.

RUTH: I mean, that's kind of - some people see me every four weeks. The majority, I was going through before we spoke, most people see me every six weeks. But I've got some people who come and see me every now and then when something comes up. So yeah, it's whatever's needed and whatever the person is wanting for their practice, or their work life really.

GILLY: Yeah. I've had a couple of people who have just come for like two or three sessions around something very specific. But the majority, yeah. I just want people to know that is a thing. You don't have to necessarily be saying, right, I'm going to commit every six weeks, I'm going to do that.

RUTH: There's a different benefit from doing the six-week thing. I mean, there's nothing magical about the timing in a way, like how long we have between treatments. We obviously base that on our clinical assessment and reasoning and judgement. But there's a lot of flexibility to it. It is about what the person needs.

GILLY: Yeah. Well, I love that. Well, Ruth, thank you so much for spending time with me today. It's been very, very eye-opening, and I've really enjoyed learning more about supervision and what it isn't and what it is. And I think it's very, very valuable actually, and I hope a lot more people are going to use a little bit of their income to come and offload some of the stuff that they maybe end up carrying around because they're such good osteopaths and empaths.

RUTH: Yeah, exactly. Well, thank you very much. And yeah, it's my privilege to be doing this work. I do really love it, but thank you, Gilly, for giving me this opportunity.

GILLY: Very much. Thanks, Ruth.

NARRATOR OUTRO: 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. Gilly's back soon with more tips, ideas and strategies to build your thriving practice.