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On Supervision

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This book comprises papers on the theory and practice of supervision, all written by experienced psychoanalytic psychotherapists and Jungian analytic psychotherapists. Important aspects of the supervisory relationship are covered, including papers on the supervisor's countertransference, supervising work with suicidal patients and the dynamics of racial difference in supervision, and group supervision and dynamics related to the supervisor's role in the assessment of trainees.The contributions in this book mainly began life as presentations to the BAP course on 'Developing Supervision Skills', a space in which new thinking about supervision has been able to be developed by contributors and participants alike. The book also covers fundamentals to consider when beginning in supervisory practice, including ways of creating a secure frame for thinking to take place and some of the ethical attitudes needed within the supervisory relationship. Supervisory technique is considered in broad overview and in some very personal views, from two highly experienced supervisors and a supervisee who has keenly observed some different supervisory styles.

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CHAPTER ONE: On beginning a supervisory relationship

ePub

Lou Corner

While the subject of supervision and the role of the supervisor have been written about within psychoanalytic literature (Berman, 2000; Brown &Miller, 2002; Grin-berg, 1997; Sedlak, 1997, 2003; Wiener, Mizen, &Duckham, 2003), the issues addressed most frequently refer to the supervisory relationship between a training analyst and a trainee. In such cases, the supervisor is familiar with the training that the supervisee is undertaking and has some idea in regard to the expectations upon him, the supervisor, and upon the trainee. It may be argued that supervision should only take place when the supervisor is familiar with the training. However, as Sedlak (1997) states when writing about his experience of working with untrained therapists in a region of the country not well blessed with good trainings:

The unavailability of personal therapy or analysis and of a good training experience does not stop people in the caring professions working in what they consider to be an analytic or dynamic way. Senior practitioners can of course choose to have little to do with this possible diminution of standards; alternatively they can explore in what ways they can help, while maintaining their professional integrity. [p. 26]

 

CHAPTER TWO: Boundaries and confidentiality in supervision

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Heather Wood

Introduction

There are wide variations in supervisory practice in the establishment and maintenance of boundaries. At the beginning of the encounter, one supervisor will receive a supervisee in silence and will wait for the supervisee to begin the work of the meeting; another will commence by asking the supervisee how they are; a third will offer coffee and social pleasantries. Each of these supervisors may have a rationale, based in psychoanalytic theory, for behaving in the way that they do. Different aspects of psychoanalytic theory can be used to justify a range of actions. Supervisors, therefore, face choices about the boundaries that they establish to protect and frame the supervisory relationship.

The boundaries of the supervision relationship relate to the formal arrangements between supervisor and supervisee. There is considerable variation in the way that even the practical aspects of this arrangement are managed—the regularity of supervision, flexibility over fees, the setting of the supervision, and the response to cancellations. The subject of boundaries also encompasses more qualitative issues: the boundary between therapy and supervision, between a social relationship and supervision, and between a teaching relationship and supervision. The literature on supervision reveals markedly differing views about where these boundaries should be drawn.

 

CHAPTER THREE: The ethics of supervision: developmental and archetypal perspectives

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Hester McFarland Solomon

This chapter argues that the provision of ongoing supervision, peer supervision, or consultation helps to ensure, among T other important functions, reliable access to ethical thinking in analytic practice. This does not in any way preclude the importance of, or suggest the lack of, an ongoing, active internal capacity for ethical thinking or an internal supervisory function that comes through the processes of internalization of the analytic attitude during the course of training and post qualification professional development. I am, however, advocating the expectation that analytic practitioners be aware of the need for constant attention to the ethical dimensions of their clinical work, and that this may best be fostered by supervision as a present factor in clinical practice.

The struggle to keep ethical thinking integral to clinical work and the theory building that develops out of clinical experience requires sustained diligence and is particularly needed in those areas of our analytic and therapeutic practice where we are likely to be the most tested as clinicians. The function of the ethical attitude in clinical practice is not simply a matter of a set of rules that can be forgotten as long as they are not contravened in the clinical setting. I have argued in other contexts (Solomon, 2000b, 2002) that the ethical attitude is integral to all our activities and relationships as human beings as well as clinicians, and especially to that most intimate, intense, and demanding of relationships, the analytic relationship. Since the time of the Hippocratic Oath, professional Codes of Ethics and Codes of Practice state the practitioner's commitment to ethical practice and the principles that underpin it.

 

CHAPTER FOUR Models of supervision

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Susan Howard

In the course of my career as a psychoanalytic psychotherapist I have been supervised by a number of different people. All were senior members of the profession and thus very experienced; most were helpful and I learned interesting and valuable things from each of them. There were some that I felt did not supervise me well, and from whom I learned less than I might. However, none of them made explicit whether they structured their supervision within any particular framework or model of supervision and, if so, what that model was. I wonder whether they supervised me, as I myself supervised later, according to their own experiences of being supervised and on the basis of their later experience of supervising. In other words, they may not consciously have had a model that framed their thinking. Likewise, when I first began to supervise I did it the way I had learned from my own supervisors. It was, therefore, something of a surprise to me when I discovered that there is a burgeoning literature about the supervisory process and theories about supervision, which has been developing for the past fifty years. These theoretical models can help in thinking about our role as supervisors as well as how we structure supervision sessions.

 

CHAPTER FIVE: Supervising trainees: teaching the values and techniques of psychoanalytic psychotherapy

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Jean Arundale

When I was asked to talk about supervision technique, for the BAP course on Developing supervision skills , my initial response was I m not sure what the technique is, but I can think about what I do and maybe find out. Thinking of supervision as having a technique with a set of skills to be learned seems a natural approach in our technical culture, so I accepted the invitation. However, I soon had second thoughts about the notion of technique. Is supervision a matter of laying out procedures of good practice to be followed, or something deeper? I have now come to believe that the concept of technique in supervision is somewhat artificial, a view of the surface, and that it is much more a matter of values internalized from the experience and study of psychoanalysis that counts.

So I begin with some questions that are perhaps heretical in view of current trends towards training in supervision. Is it possible to teach the job of supervision, as such? Is supervision a group of skills or a process that can be transmitted in a training course? Is it necessary to provide training for the position of supervisor? Is training a necessary requirement for the job?

 

CHAPTER SIX: Some dynamics of supervision

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Mary Twyman

It is only in recent years that the subject of supervision in psychoanalysis and in psychoanalytic psychotherapy has become the topic of study and of training. Before that it was assumed that any competent practitioner of sufficient seniority would possess the qualities necessary to carry out the supervision of students or junior colleagues. So the technique of supervision is a comparatively recent area of debate, and differing styles of supervision are beginning to be described. My own take on this in the current paper is a personal one, and I aim to explain my approach to supervision and the attitudes that inform it as I have developed over the years of supervising psychoanalytic psychotherapy practice in differing settings.

My primary aim is to help the therapist to become the practitioner s/he is capable of becoming. I do not think that my role is to impose my own style of work upon the supervisee. It is important to give due respect and recognition to what the therapist beings to the task, including life experience, previous work in related and unrelated fields. I view my task in supervising is to potentiate whatever ability, whatever talent, whatever sensibility the therapist brings to the encounter with the patient. This does not, however, preclude the aspect of the task that involves helping to correct aspects of the work that need to change.

 

CHAPTER SEVEN: Some personal experiences of supervision

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Sue Johnson

W“Then thinking about the subject of supervision inevitably found myself reflecting on my own experi-W ences as a supervisee over the course of my work. I have tried in this paper to capture the essence of them by giving a name to each of my supervisors. They are as follows:

Mr A—The Eye Opener
Mrs B—The Humiliator
Miss C—The Know-it-all
Mr V—The Facilitator
Mr W—The By-passer
Mr X—The Colleague
Dr Y—The Restorer

“The Eye-Opener” was the first person to open my eyes to the unconscious and its appearance in the consulting room. He was the Clinical Supervisor of the College Health Service where I worked, and clinical discussions with Mr A were the highlight of my working week for a number of years. I looked forward to them with eager anticipation and came out of each one with a sense of excitement at what I had learned. Mr A was gifted in his abilities to involve each member of the supervision group and to both name and contain the most pressing anxiety in the group in relation to the patient being presented. Although at the time I found his intellect awesome, I never felt inadequate or inferior in his presence. Instead, he seemed genuinely interested in each contribution to the discussion and demonstrated his respect for my colleagues and me by using our individual differences, reflected in our comments, to shed light on the material being presented.

 

CHAPTER EIGHT: The supervision triangle

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Denise Taylor

Seeing this title, one may well ask, is supervision a triangle? Two people, the supervisor and the therapist meet together to discuss a third person, the patient, who is never present yet is the central focus of the work. If we compare this to psychotherapy, there are again two people meeting in the context of significant but absent others with which the patient's world was peopled. The focus in both is to a large degree on the relationship between therapist and patient. So where do we place supervision? We can say that supervision adds a further dimension to psychotherapy, another layer of complexity, where the supervisor appears as the third other person in the therapist-patient dyad. It will not be surprising to find, with such basic common denominators, very similar patterns in both settings, and there is constant overlap. In fact, triangular situations abound in both and are indeed a universal phenomenon.

The antiquity of the triad concept and its symbolism pervades human thinking, from primitive societies to modern organizations, from different religions to folk tales and fairy stories. Bettelheim (1978), in his fascinating book, The Uses of Enchantment, has a lot to say about the symbolic, often mystical meanings given the triad, or the number three. He points out that in the unconscious the number three stands for the three visible sex characteristics in men and women, as well as the fundamental fact that male and female have to come together in order to create new life. In supervision this is translated into creating new insights that were not possible in the dyad.

 

CHAPTER NINE: The analyst's countertransference when supervising: friend or foe?

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Jan Wiener

Introduction

We would surely all agree that transference and countertransference dynamics operate in supervisory relationships. Supervisees have transferences on to their supervisors, supervisors to their supervisees. Both may have transference and countertransference responses to the organizations in which they are trainees or members, particularly if reviews and evaluations are involved. However, although we may be in agreement that transference dynamics are alive and well in supervision, more difficult to assess is whether they are fostering or hindering the task of supervision. This will be the main focus of my chapter. I begin with an excursion to visit the concepts and processes of transference and countertransference as they operate in the supervisory relationship. Using two case examples, where transference projections from the supervisee, and their complementary counter-transference affects in the analyst either fostered or hindered this process, I then offer what I hope will be a helpful concept of my own about the particular nature of the supervisor's counter-transference.

 

CHAPTER TEN: The role of supervision (internal and external) in working with the suicidal patient

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Joscelyn Richards

Introduction

In my experience as a therapist and supervisor the most frequent situation in psychoanalytic psychotherapy concerning I issues around suicide is not so much a patient committing suicide successfully or even attempting to do so (though, sadly both these events can occur), but rather patients conveying to the therapist, directly or indirectly, that they are experiencing compelling thoughts to kill themselves. It is this situation that I am addressing in this chapter. When patients announce their intention in a deadly voice I always find it chilling and heart stopping. It is usually very alarming for the therapist to hear this kind of news and, if not, should be. Because it is shocking it is often difficult to keep one's bearings and to think as well as feel.

Often therapists feel they have to do something. They can especially feel that they have to pass the anxiety on to someone else but, as they are the ones on the receiving end of the communication, they need to be able to receive and process the information rather than go into action mode. When therapists are working in a public health setting, or any organizational setting, the belief in taking immediate action, such as telling the patient's GP or some other relevant professional, is often supported by policies of the wider health care system, for example, policies concerning the prevention of suicide. Thus, there can be both internal and external pressures to act rather than think that may overwhelm the therapist, so that the need to work out the most appropriate response, including considerations about confidentiality, may lose out to the pressure to act without thinking.

 

CHAPTER ELEVEN: The effects of difference of “race” and colour in supervision

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Helen Morgan

When S, an Asian woman, began her training to become an analytic psychotherapist, she joined a supervision group. The two other members of her group, the teachers, and her supervisor were white. At their first group supervision session the supervisor asked what concerns they might have in starting work with their first clients, and S said she had been wondering about the possible reactions for a white client coming expecting to see a white therapist who then discovers that their new therapist was black. The supervisor responded by saying “You poor thing!”, and then moved on to the next member of the group and the matter was never raised again. For the next year S's experience was of being constantly criticized and undermined by the supervisor—an experience corroborated by the other members of the group. In her regular assessment reports the supervisor questioned S's ability to understand internal processes and criticized her work. S survived the experience by ensuring that she exposed very little of herself, she kept her head down and did not mention any questions or concerns she might have regarding difference in colour again. Fortunately, there was a change of supervision arrangements after a year and a new supervisor was able to help her think through how the matter of difference between herself and her client might be used to illuminate the transference. Regular assessments of her were positive and, having completed all the requirements, she qualified as a psychotherapist.

 

CHAPTER TWELVE: The many “ifs” of group supervision

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Margaret Hammond

“There was a little girl, and she had a little curl,
Right in the middle of her forehead.
And when she was good, she was very, very good,
And when she was bad, she was horrid”

(Longfellow, 1807-1882, Concise Oxford Dictionary of Quotations, 1981)

Group supervision might be like the little girl with the little curl. When it is good, it is very, very good, and when it is bad, it is horrid. I think every therapist will empathize with both of these experiences. Sometimes, an experience of group supervision can create an atmosphere of connection and illumination, in a supportive environment. Sometimes, on the other hand, the shadow, as described by Jung (1950[1948]), takes over and the experience is more one of attack or belittling. The therapist feels that their patient has been misunderstood and they themselves have been sidelined. Donald Kalsched (1995) wrote about both these possibilities in a paper entitled “The agonies and ecstasies of casework supervision”. In this chapter I try to discuss some of the factors that can turn a potentially unique area for learning and growth into a nightmare. I focus on three areas: the frame and structure of the group, the process of the task, and the outlook of the leader, and I look at what might help and hinder in each category.

 

CHAPTER THIRTEEN: Janus as a metaphor for the assessment process

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Maureen Chapman

The aim of this chapter is to consider the function of assessment and how best we can fulfil this purpose within the various settings we might find ourselves in as supervisors of both trained and trainee therapists. It seeks to illustrate the function of the assessment process and the qualities looked for when preparing an assessment. The Formative and Summative approach to assessment is discussed. Using myth and metaphor the chapter explores some issues, illustrating the power of the unconscious that might blur the judgement of the assessor.

The Romans associated Janus with beginnings. January takes its name from Janus, marking the beginning of a new year when we reflect and assess the last year and make new resolutions. Using the story of Janus as a metaphor draws attention to the complexity and the “confrontational” nature of the supervisory relationship during assessment. I see the assessment process as a marker, a moment when the future is barred until the confrontational process of the assessment is complete.

 

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