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Supervision and professional support in complex cases, severe illness, loss, work with children and families, professional and ethical dilemmas, secondary traumatisation and burnout.
Work in the helping professions involves a constant encounter with another person's suffering, conflict, loss, dependency, traumatic experiences, severe illness and situations in which there is no easy or unambiguous answer.
Professional competence is not exhausted by techniques and theoretical knowledge. It also includes the specialist's ability to reflect on their own involvement in the relationship, to recognise moments of helplessness, excessive engagement or distancing, and to use these reactions as part of understanding the case.
Supervision, Balint work and professional consultation create a space in which practice can be considered beyond the urgency of daily tasks. They are not a form of control over the specialist and do not imply that they are "not coping". On the contrary – the possibility of thinking about one's own work is an important part of quality professional practice.
The Institute offers individual and group forms of supervision for psychologists, psychotherapists, social workers and other specialists from the helping professions, as well as specialised work on professional burnout, secondary traumatisation and complex clinical or ethical situations.
Individual supervision
What is it?
Individual supervision is a protected professional space for in-depth reflection on practice. At its centre may be a specific client, patient or family, a difficulty in the relationship, a professional dilemma or the specialist's own reaction to a particular case.
Some professional difficulties do not arise from a lack of knowledge. Sometimes the specialist knows the methods and theoretical models, yet still feels blocked, excessively involved, irritated, helpless or uncertain how to proceed.
These reactions can contain important information about the relationship and the situation. Supervision allows them to be thought through, rather than automatically perceived as professional failure.
The supervisor does not provide a ready-made recipe for what the specialist should say at the next session. The task is to broaden the understanding of the case, of the relationship and of the possible professional positions.
Led by: Dr Margarita Tareyn, Prof. Orlin Todorov
Who is it suitable for?
For psychologists, psychotherapists, social workers and other professionals who work directly with people.
When may it be helpful?
- in a complex case;
- when the work appears blocked;
- with a strong sense of helplessness;
- with irritation or anger towards a client;
- with excessive emotional involvement;
- with difficulties around professional boundaries;
- with an ethical dilemma;
- when the specialist wonders whether they are working within their own competence;
- when there is a need for a space for regular professional development.
What does the supervisory work involve?
A detailed examination of cases, the relationship between specialist and client, the professional frame, ethical questions, one's own reactions and possible directions for further work.
How does the first session proceed?
The professional context, qualifications, area of work, reason for seeking supervision and expectations of the process are clarified.
In regular supervision, the frame, frequency and basic working principles are also agreed.
Format and frequency
Format
Individual, in person or online, when the format is suitable.
Duration and frequency
May be a one-off consultation on a specific case or regular supervision.
Who conducts the supervision?
Specialists with qualifications and professional experience in supervision and the relevant area of practice.
Important
Supervision does not replace the specialist's personal psychotherapy. When a personal issue begins to take centre stage and goes beyond the professional context, separate psychotherapeutic work may be recommended.
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Group supervision
What is it?
Group supervision allows a single professional case to be considered through the experience and thinking of several specialists.
Different perspectives can help notice aspects that have remained invisible to the person presenting the case. At the same time, participants learn not only from their own cases but also from their colleagues' work.
The group is not a place for competing over who has more knowledge, and it is not an examination of professional competence. For it to be useful, participants need to be able to talk about uncertainty, mistakes, difficult feelings and moments when they do not know how to proceed.
This is why the framework of confidentiality and professional respect is particularly important.
Led by: Dr Margarita Tareyn, Prof. Orlin Todorov
Who is it suitable for?
For psychologists, psychotherapists, social workers and other specialists from the helping professions who wish to work regularly in a professional group.
When may it be helpful?
- when different perspectives on complex cases are needed;
- for specialists at the beginning of their professional path;
- for experienced professionals who want a regular space for reflection;
- when working with severe and emotionally demanding cases;
- with professional isolation;
- for building a more sustainable reflective practice.
What does the supervisory work involve?
Presentation and analysis of cases, discussion of the professional frame, relationships, interventions, ethical questions and the specialist's own reactions.
How does the first session proceed?
The way of working, the rules of confidentiality, the time allotted for presenting cases and the expectations regarding participation are presented.
Format and frequency
Format
A small professional group, in person or online.
Duration and frequency
Usually regular meetings for a pre-agreed period.
Who conducts the supervision?
A qualified supervisor with experience in group professional work.
Important
Information about clients and patients must be presented in a way that protects their identity and professional confidentiality.
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Supervision of clinical cases
What is it?
Some cases remain complex regardless of the specialist's experience. Symptoms may be contradictory, the client may pass through multiple systems, relationships may change rapidly, or various professionals may hold differing understandings of the problem.
Supervision of a clinical case allows the information to be organised and allows exploration not only of "what the person has" but also of how they function, their relationships, resources, risks and context.
Particular attention is paid to how the specialist is involved in the situation and how their own experience may influence professional decisions.
The aim is not for the supervisor to take over the case, but for the specialist to gain a clearer and broader clinical understanding.
Led by: Dr Margarita Tareyn, Prof. Orlin Todorov
Who is it suitable for?
For professionals working with complex clinical, psychological or psychosocial cases.
When may it be helpful?
- with a contradictory clinical picture;
- with multiple co-existing problems;
- when the case involves various institutions and specialists;
- with recurring crises;
- with difficulty formulating a clear focus for the work;
- when the specialist feels they have lost perspective;
- when there is a need to discuss the professional plan.
What does the supervisory work involve?
Structuring the information, clinical formulation, analysis of relationships, resources, risks and the professional position.
How does the first session proceed?
The specialist presents the case and the question they need to work on. It is not necessary to present the entire history if it is not related to the specific supervisory question.
Format and frequency
Format
Individual or group.
Duration and frequency
A one-off consultation or part of regular supervision.
Who conducts the supervision?
A specialist with appropriate clinical and supervisory experience.
Important
Supervisory discussion does not remove the specialist's responsibility for their own professional decisions and for compliance with regulatory and ethical requirements.
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Supervision in psycho-oncology
What is it?
Working with people with cancer places the specialist in a particular clinical context, in which psychological suffering is closely linked to real medical uncertainty.
The patient may speak of fear of death, progression, disfigurement, loss of function, sexuality, guilt towards loved ones or the sense that the future has been interrupted. These themes cannot be reduced to anxious or depressive symptoms.
Strong reactions may also arise for the specialist – a desire to reassure at any cost, helplessness, fear, sadness, identification with the patient, or avoidance of topics related to death.
Supervision in psycho-oncology allows these processes to be considered simultaneously in a psychological, medical and social context.
Led by: Dr Margarita Tareyn
Who is it suitable for?
For psychologists, psychotherapists, social workers and other professionals working with people with cancer and their relatives.
When may it be helpful?
- after receiving a diagnosis;
- with fear of relapse and progression;
- with advanced disease;
- in palliative care;
- with difficult conversations about prognosis;
- with severely affected relatives;
- upon the death of a patient;
- when the specialist experiences a strong personal reaction to the case.
What does the supervisory work involve?
Examination of the clinical case, the stage of the illness, psychological functioning, family and social context, the relationship with the specialist and their own reactions.
How does the first session proceed?
The specific clinical and supervisory question is clarified, without requiring unnecessary medical detail beyond what is needed for psychological understanding.
Format and frequency
Format
Individual or group.
Duration and frequency
A single supervision on a case or regular professional work.
Who conducts the supervision?
Specialists with experience in psycho-oncology, clinical work and supervision.
Important
Psychological supervision does not replace medical consultation and does not include providing recommendations for oncological treatment.
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Supervision when working with severely and chronically ill people
What is it?
Prolonged physical illness often changes the way a person experiences themselves, their relationships and their own autonomy.
The psychologist or social worker may encounter real limitations for which there is no psychological solution – progressive illness, permanent disability, chronic pain or dependence on the care of others.
This can create a strong sense of helplessness in the professional. Sometimes pressure arises to find a "positive" meaning at any cost, or to help the patient "accept" before they are ready.
Supervision allows one to consider how support can remain psychologically meaningful without denying the medical reality.
Led by: Dr Margarita Tareyn
Who is it suitable for?
For specialists working with chronically ill people, people with disabilities or patients with severe somatic conditions.
When may it be helpful?
- during prolonged work with a severely ill person;
- in cases of strong exhaustion;
- when there is no clear medical improvement;
- in cases of changes in autonomy;
- in cases of chronic pain;
- in cases of dependence on care;
- in cases of tension between patient and relatives;
- when the professional begins to take on excessive responsibility.
What does the supervisory work involve?
Analysis of psychological and social functioning, relationships, the limits of the professional role, and the specialist's own reactions.
Format and frequency
Format
Individual or group.
Duration and frequency
According to needs.
Who conducts the supervision?
A specialist with competence in medical psychology, psychosomatics, clinical social work or another relevant field.
Important
Supervision does not seek a psychological cause for the somatic illness and does not call into question the reality of the physical suffering.
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Supervision for work with loss and grief
What is it?
Working with loss places the specialist in proximity to experiences for which there is no quick solution and which should not be "fixed".
The professional may feel pressure to console, to give meaning to the loss, or to hasten the grieving process. In other cases, the client's suffering activates the professional's own loss or fear of death.
Supervision helps distinguish natural grief from states requiring additional clinical assessment, and helps consider how the specialist can be present without prematurely trying to remove the pain.
Particularly important may be cases of sudden, traumatic or child death, loss following prolonged illness, and situations involving strong guilt or conflicted relationships with the deceased.
Led by: Dr Margarita Tareyn
Who is it suitable for?
For professionals working with grieving people and families.
When may it be helpful?
- in cases of severe or prolonged grief;
- after a sudden death;
- in cases of the loss of a child;
- in cases of suicide of a relative;
- in cases of feelings of guilt;
- when the specialist finds it difficult to bear the client's suffering;
- when the case activates personal experiences;
- when there is uncertainty whether the reaction remains within the bounds of grief or requires additional assessment.
What does the supervisory work involve?
Examination of the specific loss, the relationships, the manner of grieving, the risk factors, and the specialist's emotional position.
Format and frequency
Format
Individual or group.
Duration and frequency
A one-off or regular supervision.
Who conducts the supervision?
A specialist experienced in working with loss, grief and clinical supervision.
Important
Grief has no universal duration, and supervision does not aim to determine when a person "should have" overcome the loss.
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Supervision for work with children and families
What is it?
Professional work with children almost always involves relationships with the adults around them – parents, guardians, foster parents, teachers, social workers or other professionals.
This creates a particular complexity. The child may have one need, the parent another, and the institution may expect a third outcome.
The psychologist or social worker may sometimes be imperceptibly drawn into the family conflict, may over-identify with the child or with one of the parents, or may be pressured to take sides.
Supervision helps keep the focus on the child's needs and development, while at the same time considering the family relationships and the professional framework.
Led by: Prof. Monika Bogdanova
Who is it suitable for?
For psychologists, psychotherapists, social workers and other professionals working with children, parents and families.
When may it be helpful?
- in cases of complex relationships between parents and child;
- in cases of separation or divorce;
- in cases of highly conflicted parents;
- in cases of adoption and foster care;
- in cases of violence or neglect;
- in cases of severe illness in the family;
- when it is difficult to determine the parent's involvement in the therapeutic process;
- in cases of tension between different institutions involved with the child.
What does the supervisory work involve?
Analysis of the child's development, family dynamics, the relationship with the specialist, the boundaries of confidentiality and professional responsibilities.
How does the first meeting proceed?
The specialist's professional role, the family and institutional situation, and the specific supervisory question are clarified.
Format and frequency
Format
Individual or group.
Duration and frequency
Depending on the case, or as regular supervision.
Who conducts the supervision?
A specialist with competence in work with children and families and in clinical supervision.
Important
When working with minors, confidentiality must be balanced with the legal and professional responsibility for the child's safety and best interests.
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Supervision for social workers
What is it?
Social work is often carried out in situations where individual, family, medical, economic and institutional problems cannot be separated from one another.
The social worker may bear responsibility for cases involving violence, poverty, severe illness, disability, family conflict, loss of parental care or serious risk, while simultaneously working under the pressure of regulatory procedures and institutional deadlines.
In such conditions, it is easy for a sense to arise that the specialist must solve problems that in reality exceed the capacity of a single professional.
Supervision helps distinguish responsibilities, allows the case to be considered as a whole, and reduces the risk of the professional being overwhelmed by its urgency.
Who is it suitable for?
For social workers in healthcare, social services, child protection, non-governmental organisations and other systems.
When may it be helpful?
- in complex cases;
- in cases of high risk;
- in cases of tension between institutions;
- in cases of a sense of powerlessness;
- in cases of strong conflict with a client;
- in cases of unclear professional boundaries;
- in cases of an ethical dilemma;
- in cases of prolonged professional strain.
What does the supervisory work involve?
Analysis of the case, the risks, the resources, the social environment, the institutional context, the professional responsibilities and the social worker's own reaction.
Format and frequency
Format
Individual, group or with a team.
Duration and frequency
A one-off or regular supervision.
Who conducts the supervision?
Supervisors with professional experience in social, clinical and psychosocial work.
Important
Supervision does not replace the social worker's legal and institutional responsibilities, but may support the way in which they are applied within the complex context of the specific case.
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Balint groups for helping professionals
What are they?
The Balint group places at its centre not the diagnosis or the specific technique, but the relationship between the professional and the person they are working with.
The participant presents a case or an encounter that has troubled, irritated, burdened them, or remained inexplicably significant to them. The group then reflects on the relationship and the possible experiences of both parties.
This format allows the professional to see their own work from a different angle and to recognise processes that are difficult to notice when one is directly involved in the case.
Unlike classical supervision, Balint work has a particularly strong focus on the relationship itself and on the professional's emotional experience.
Led by: Dr Margarita Tareyn
Who is it suitable for?
For psychologists, psychotherapists, social workers, medical specialists and other helping professionals.
When may it be helpful?
- in cases of difficult relationships with a client or patient;
- in cases of an unusually strong reaction to a particular person;
- in cases of a sense of powerlessness;
- in cases of excessive involvement;
- in cases of irritation;
- in cases of difficulty maintaining professional distance;
- for developing the capacity for reflection on relationships.
What does the work involve?
Regular group meetings with a qualified Balint leader and the presentation of cases from professional practice.
How does the first meeting proceed?
The framework, confidentiality and method of work are presented. Each participant is not required to present a case at every meeting.
Format and frequency
Format
A small group, in person or, under suitable conditions, online.
Duration and frequency
A regular group process.
Who conducts the groups?
Qualified Balint leaders.
Important
The Balint group is not personal group psychotherapy and is not a place for assessing professional competence.
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Consultation for professional or ethical dilemmas
What is it?
Helping professions often involve situations in which there is no obviously correct solution.
There may be tension between confidentiality and safety, between the client's wishes and the child's interests, between the professional role and the institution's expectations, or between different principles of professional ethics.
In other cases, the specialist formally knows the rules, but the specific situation remains complex due to the relationships involved and the possible consequences of each decision.
Professional consultation provides an opportunity for the dilemma to be structured and examined from different perspectives.
Who is it suitable for?
For psychologists, psychotherapists, social workers and other professionals facing a specific professional or ethical difficulty.
When may it be helpful?
- in cases of conflict between confidentiality and safety;
- in cases of risk to a child or vulnerable adult;
- in cases of dual relationships;
- in cases of unclear professional boundaries;
- in cases of conflict with institutional requirements;
- in cases of tension between the interests of different family members;
- when the specialist wonders whether they can continue the work;
- when referral to another professional is needed.
What does the psychological work involve?
Clarification of the facts, the professional role, the ethical principles, the possible courses of action and their consequences.
Format and frequency
Format
Individual professional consultation.
Duration and frequency
Often one or several meetings on the specific dilemma.
Who conducts the consultation?
An experienced specialist with competence in supervision, professional ethics and the relevant clinical or social context.
Important
Such consultation does not replace legal assistance, the official position of a professional organisation, or the decision of a competent authority when these are needed.
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Support for secondary traumatisation
What is it?
Specialists who repeatedly listen to and work with stories of violence, trauma, severe illness, loss or other extreme experiences may themselves gradually be affected by the content of their work.
This is sometimes described as secondary traumatisation. Intrusive images, heightened anxiety, avoidance, sleep disturbances, excessive vigilance or a change in the way the professional perceives people and the world may appear.
This process does not mean that the person is not sufficiently professional. It is a potential occupational risk when there is prolonged contact with traumatic material.
It is important, however, to distinguish between secondary traumatisation, professional burnout and the specialist's own traumatic reaction, because the approach may differ.
Who is it suitable for?
For professionals working regularly with trauma, violence, severe illness, death, disasters or other severe human experiences.
When can it be helpful?
- with intrusive thoughts or images after work;
- when certain cases are difficult to leave within the professional space;
- with sleep disturbances;
- with heightened anxiety;
- with excessive vigilance;
- with emotional numbing;
- when work significantly changes personal relationships or the sense of safety.
What does the psychological work involve?
Assessment of professional load, symptoms, the nature of the exposure and individual factors, and, as needed – counselling, supervision or psychotherapeutic support.
How does the first session proceed?
The current symptoms, professional context, duration of the load and its impact on personal functioning are discussed.
Format and frequency
Format
Individual.
Duration and frequency
According to needs.
Who conducts the consultations?
A psychologist or psychotherapist with competence in traumatic stress and professional load.
Important
In cases of severe functional impairment, depressive state, substance abuse or suicidal risk, additional clinical and, if necessary, psychiatric assessment is required.
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Support for professional burnout
What is it?
Helping professions require prolonged emotional presence and often combine high responsibility with limited resources.
Burnout may gradually manifest as exhaustion, irritability, loss of satisfaction, cynicism, a sense of professional ineffectiveness, or a wish to distance oneself as much as possible from the people one works with.
Sometimes the specialist interprets this as a personal failure and tries simply to become even more disciplined and productive. This may further increase the load.
It is important to also consider organisational conditions. Neither psychotherapy nor supervision can turn a chronically unbearable working environment into a healthy one solely through changing the individual.
Who is it suitable for?
For psychologists, psychotherapists, social workers and other professionals experiencing prolonged professional exhaustion.
When can it be helpful?
- with constant fatigue;
- with loss of professional motivation;
- with emotional distancing from clients;
- with growing cynicism;
- with a sense of meaninglessness;
- with difficulty recovering after work;
- with strong irritability;
- when professional life begins to consume almost all resources.
What does the psychological work involve?
Exploration of the individual and organisational load, professional boundaries, expectations of oneself and the possible resources for change.
How does the first session proceed?
The working environment, workload, team relationships, personal functioning and the changes that have occurred over time are discussed.
Format and frequency
Format
Individual, though in cases of an organisational problem, work at team level may also be recommended.
Duration and frequency
Determined individually.
Who conducts the consultations?
A psychologist or psychotherapist with competence in professional burnout and the helping professions.
Important
Burnout should not be used as a universal explanation for every form of psychological suffering. In the presence of depression, an anxiety disorder, a traumatic reaction or another condition, the corresponding clinical assessment is required.
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The Institute's professional position
Supervision does not offer ready-made recipes and does not turn a complex human case into a set of instructions.
Its task is to broaden the understanding of the case, the relationships and the professional position; to help the specialist distinguish what belongs to the client, what arises within the relationship, and what is connected with their own history and professional role.
Supervision must also not be used as a concealed administrative assessment, a disciplinary tool, or a means of control by an employer.
Seeking supervision does not mean that you do not know how to work. On the contrary – it means accepting that good professional practice requires a space in which your own work, too, can be thought about.