Reflective practice and clinical supervision: meticulous rituals of the confessional.

BACKGROUND: Reflective practice and clinical supervision are progressively asserting hegemony upon nursing practice with claims of emancipation and empowerment. However, this is being achieved in an environment where there is little critical debate about the assumptions on which these practices are based. AIM: This paper sets out to challenge the basis upon which reflective practice and clinical supervision are promoted within nursing discourse by employing Michel Foucault's (1982) concept of governmentality. Theme. A broad Foucauldian perspective is used to demonstrate how the technologies of reflective practice and clinical supervision have been accommodated within modern forms of government. These technologies are consistent with the flattened hierarchies and increasing dispersal of practitioners in contemporary health care. In this context reflective practice and clinical supervision can be shown to function in two independent but interrelated ways. First as modes of surveillance disciplining the activity of professionals. Second, as "confessional" practices that work to produce particular identities--autonomous and self-regulating.