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Doing Supervision and Being Supervised

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There is always a lively interest in the supervisory process and its explication. Courses in supervision abound and the critical role of supervision in becoming a psychotherapist is widely acknowledged. It is for this reason that this book aims to present the essentials of supervision, establish validated principles of teaching and learning, define a series of optimal supervisory precepts, consider some of the basic issues in this sometimes difficult arena, explore the supervisee's concerns as the student, and address the future of supervisory work.Supervision should be principled and properly framed, sufficiently consistent and well defined to assure the supervisee the best possible supervisory experience and the supervisor a situation with as little possibility of crisis and untoward reactions, and as much reward as possible. This book is dedicated to both teachers and students: to their growth, maturation and ultimately to better psychotherapy for their patients.

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CHAPTER ONE. Issues in supervising psychotherapy

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An idealized picture of psychotherapy and its supervision will teach us little; a realistic and perhaps troublesome picture, as Freud argued, will teach us a great deal. Psychotherapy is an uncertain and emotionally charged field where mistakes, large and small, are inevitable and commonplace — though often unrecognized. It therefore is reassuring to know that one inevitable way of learning and growing as a psychotherapist, supervisor, or supervisee is through a deep understanding and rectification of the errors of our ways.

A TALE OF SUPERVISION

I will begin our journey into the world of supervision with an embellished true stoiy, based in part on a published report. Let us ask. as we follow it along, what is constructive and what seems bothersome about this picture of supervision? What are the signs of trouble and where did they come from? What can we learn from this at times grim tale?

The supervisee was a young man who was a trainee at a psychotherapy institute, who was being supervised by his boss, also a man, for whom he does research. There is no established time for the supervision because the supervisor’s schedule is full; they meet on a catch-as-catch-can basis. Most often they talk in the dining room of the institution where they work, less often in either person’s office. Whenever a batch of process notes, written during the sessions with the patient, have been transcribed by his secretary, the supervisee sends them via inter-office mail to the supervisor.

 

CHAPTER TWO. A clinical foundation for supervisory practices

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To fulfil the promises of this book, we must establish a sound theoretical and clinical basis for the definition of effective and validated supervisory interventions and the underlying principles that support their use. To do this, we must redefine the parameters of supervision in light of recent insights into the nature of conscious and especially unconscious communication and processes, and make use of our newly acquired understanding of the evolved architecture and adaptive resources of the emotion-processing mind (Langs, 1986, 1987a, 1987b, 1988, 1989, 1992a, 1992c, 1992e, 1993a, 1993b, in press b, in press c). Let us turn to these tasks at once.

SOME BACKGROUND ISSUES

As Goodheart (1992, 1993) has cogently argued, psychoanalysis is a folk psychology that operates via global observations and draws general conclusions in the form of broad, high-level theoretical constructs that lead to rather uncertain technical precepts for the conduct of a psychotherapy—and its supervision. We are not surprised, then, that writings on principles of supervision are scarce and that there is no consensus as to how supervision should be carried out — and no validated precepts of supervisory practice. Teach as you were taught and were analysed is the credo — a simple, down-to-earth approach that lacks guiding discipline or structure.

 

CHAPTER THREE. Models of supervision and unconscious validation

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To broaden our purview, it will help now to identify the prevailing models of supervision and their main attributes. With this done, we can then continue our pursuit of a sound listening process for the supervisory experience and develop a clear and incisive validating methodology.

There are, it would seem, three loosely defined basic models of supervision. To introduce them here, they are:

This terms refers to the many loosely related dynamic forms of supervision. While the model has many variations, its main distinguishing features are:

a. The presentation in some form by a supervisee of a description of therapy sessions with one or more patients.

b. The supervisor’s offer of loosely structured comments on the supervisee’s work and on issues of theory related to that work, as well as a variety of extraneous comments on a wide range of possible topics.

c. The use of some form of psychoanalytic theory as a foundation on which the teaching is based.

d. The concentration of the teaching on the reported material from supervised therapy.

 

CHAPTER FOUR. Frames and systems: contexts for supervision

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Throughout animate and inanimate nature, the frame or boundary conditions of an entity or system are a major determinant of the functioning and survival of that entity. The supervisor/supervisee (S/S) system is, of course, no exception to that rule. Indeed, each S/S system is established within a framework, however well or poorly defined, and that frame exerts a strong influence over the conscious and unconscious experience and the functioning of the two members of the system. The paradox is that even though conscious experience is deeply affected by the frame, it has little appreciation of those effects — they tend to be written off or overlooked. Indeed, the symptom complexes that are frame-driven tend to be accounted for in other, erroneous or secondary, ways. In structuring a supervisory situation, it is essential to afford the systemic aspects and ground rules of the experience their full due.

THE INFLUENCE OF THE FRAME

The effects of the frame of supervision are everywhere. The ground rules of supervision establish the role and responsibilities of each party, the scope and limits of acceptable behaviour, the means by which the supervisory process is to unfold, the quality of the inherent hold and support of the supervisor for the supervisee and the appropriate ways that the supervisee secondarily can hold and support the supervisor (e.g. by preparing proper process notes, attending supervision regularly, listening attentively, etc.), and a host of other contextual considerations.

 

CHAPTER FIVE. The fixed frame of supervision

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We are now ready to spell out in detail the ideal, secured frame of supervision. The goal is slowly to build a picture of the supervisory framework as unconsciously validated by supervisees, and, indirectly at times, by their patients, and to develop a full appreciation for the functions and power of that frame. This exposition will serve the needs of supervisors and supervisees alike — for the supervisors, it spells out their responsibilities; for the supervisees, their rightful expectations and what they should in principle accept as the best conditions for their education and growth.

I will begin by identifying what are potentially the most stable aspects of the supervisory frame — the fixed attributes that can stand as relatively unchanging aspects of the conditions of supervision. In doing so, it should be borne in mind that the supervisor has the primary mandate for managing the frame, but the supervisee also has a responsibility to accept and adhere to the secured frame and to monitor the supervisor’s interventions in this basic area — and to intervene if possible if a frame is altered because the situation usually is of crisis proportions.

 

CHAPTER SIX. Privacy and confidentiality

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There are hosts of additional ground rules and boundaries that need to be established and maintained for an ideal supervisory experience. Among the most salient of these tenets, those related to the privacy and confidentiality of the supervision and to the relative anonymity and neutrality of the supervisor — and to some extent, the supervisee — are most vital.

As we approach these issues, let us be reminded again that without a sharp focus on rules, frames, and boundaries, these necessities escape notice on both sides of the supervisory equation. But unnoticed frame modifications have countless unnoticed but real consequences that extend from the supervisee’s (and supervisor’s) professional life into his or her daily living — unconsciously driven needs and defences are not left behind in a supervisor’s office. Both supervisors and supervisees have a distinctive responsibility to safeguard the framework of their supervisory work together.

A look at today’s practices of psychotherapy show an endless flow of frame modifications as they relate to the pivotal areas of privacy, confidentiality, and relative neutrality and anonymity. Disregard for these four dimensions of the secured frame in psychotherapy and supervision is rampant and on the increase each day—witness clinic records, insurance reports, governmental intrusions, the offer by therapists of personal opinions and directives, the use of home-office settings, and so forth. Given that approaches to supervision tend universally to be even more undisciplined than those towards therapy, we are dealing with aspects of the supervisory experience that are in need of major reconsideration and change.

 

CHAPTER SEVEN. Relative neutrality and anonymity

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Probably no ground rule of supervision is more abused than the requirement for the relative anonymity of the supervisor—the rule of no deliberate self revelations, Given the collegial and relaxed attitudes that pervade most private supervisory situations and the urge to help a supervisee-in-training to identify with his or her mentors, there are any number of rationalizations for unneeded and inappropriate personal revelations by supervisors. All manner of self-revealing biases are communicated by today’s teachers of psychotherapy, and seldom are their frame-altering aspects recognized consciously—though they are, of course, worked over by the supervisee’s (arid supervisor’s) second unconscious system with great intensity and perspicacity,

Linked to the relative anonymity of the supervisor is the much-misunderstood ground rule of the supervisor’s relative neutrality. There is of course no such entity as a totally neutral supervisor, in that it is impossible to teach without a viewpoint and a background theory that serves to order and give meaning to the hugely complex data of a psychotherapy session. However, these inevitable orienting principles should not imply a rigid approach that is arbitrarily prejudiced or refractory to new ways of ordering the data — and to fresh ways of thinking and doing both supervision and therapy.

 

CHAPTER EIGHT. The process of supervision

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We have established the framework for a sound and secured supervisory situation. It is time now to look at what transpires within that frame and to develop some unconsciously validated principles for the presentation of the supervisee and the interventions of the supervisor. Here too the communicative approach has shown that there are definitive precepts that configure supervision in a relatively optimal manner.

We have already seen that there are two levels of communication going on between the supervisor and supervisee. One is conscious and related to the defined task of the supervision, which is the education of the supervisee with stress on the validated techniques of psychotherapy. The other is generally unconscious and is related to the interaction between the supervisor and the supervisee, and especially the former’s management of the framework of the supervision.

We have seen too that during interludes in which the supervisory frame is altered or secured, the communications of the supervisee are likely to shift from the single-message’, manifest-contents and implications mode of communication needed for the cognitive supervisory work to the double-message/encoded-contents mode of communication. The latter mode of expression is activated in the presence of frame impingements and is needed to work over the immediate supervisory interaction when its frame and the process of supervision are disturbed and the situation needs to be restored to a stable, optimal secured-frame state.

 

CHAPTER NINE. The supervisor: basic issues

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We have to this point considered a variety of principles that are available to guide the work of a supervisor of psychotherapy. In the present and following chapter I integrate these scattered ideas into a comprehensive statement of basic precepts that configure the supervisory work and experience into an optimal situation for the teaching and learning of the proper techniques of psychotherapy. I begin by touching on several background issues that have a bearing on offering effective, unmarred supervision. In the next chapter, I offer a set of definitive precepts that can be used to help a supervisor to navigate the treacherous seas of supervision — the conscious system stands ever-ready to sabotage this potentially fine process.

SOME INTRODUCTORY CONCEPTS

Let us recall that our fundamental approach has been to embrace the proposition that to be considered valid, a supervisory intervention must be confirmed through encoded material from the patient (in the standard models, encoded confirmation from the supervisee is secondary). This means that there are criteria of sound and unsound supervisory criticisms and proposals, and that, in general, each class of interventions will have distinctive effects on the supervisee and on the therapy that is being supervised. Both the management of the supervisory frame and a set of validated techniques of teaching are required for an ideal supervisory experience. We will now explore how this goal is best fulfilled — and the nature of the inevitable obstacles that stand in the way of its achievement.

 

CHAPTER TEN. The supervisor: basic precepts of supervision

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The communicative approach has generated a series of unconsciously validated principles for the methods, timing, and style of intervening by a supervisor. There is no doubt that adhering to these tenets promotes a strong supervisory experience, while departures from these guidelines will always cause some harm to each member of the S/S/P system and interfere with the education of the supervisee. I will list and discuss each of these basic precepts.

Supervision involves reactive teaching; it should not be developed around the unilateral and arbitrary, typically self-serving, comments of the supervisor. Just as the patient orchestrates the interventions of his or her psychotherapist, the supervisee and the supervised patient similarly dictate the interventions of the supervisor.

The supervisor must work from a well-established, basic model of the mind and of the therapeutic interaction and should base his or her comments on an assessment of the moment-to-moment transactions of a given session. The communicative approach has proven to be the most valid among the models available at present with which to ensure the success of these efforts.

 

CHAPTER ELEVEN. The supervisee: responsibilities and entitlements

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Virtually everything covered so far in this book can be recruited by a supervisee for his or her own edification and perspectives on sound supervision. The means through which a supervisee can monitor his or her own efforts to learn and do psychotherapy and assess the work of his or her supervisor have also been made available. In this chapter, however, I focus quite specifically on the supervisee in order to bring his or her essential issues before us for discussion and illumination. I will, in the main, develop two areas of importance to the supervisee: first, his or her responsibilities to the supervisor, the supervisory process and the supervisory frame, and the means by which he or she can specifically evaluate his or her own participation in the supervisory process [self-assessment); second, the means by which the supervisee can evaluate the supervisor with whom he or she is working [the assessment of the supervisor) — and the choices that are available to the student, depending on the nature of that appraisal.

 

CHAPTER TWELVE. Supervis ory cris es

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Although many supervisory experiences go reasonably well from beginning to end, it is in the nature of the process that moments of dissatisfaction are called forth on both sides of the desk. In the extreme, a supervisory crisis materializes, one that may be instigated by the supervisor or supervisee — or both. These crises jeopardize the continuation of the supervision or seriously impair the teaching and learning atmosphere. They may also raise serious questions about the competency of the supervisor and the skills and learning abilities of the supervisee and, in a training situation, call into question his or her status as a student. In all, then, we are dealing with critical moments of disequilibrium and disturbance within the supervisory situation, and they require prompt and concentrated attention.

Supervisory crises may arise as the result of a single acute dysfunctional behaviour by either party to the supervision — one that almost always has its precursors in previous lesser difficulties. Or they may arise as the culmination of chronic and insidious, but mounting problems that reach a breaking point. In addition, a crisis may arise primarily because of the supervisee’s work with the supervised patient or be centred around issues that directly involve the supervisory couple — most crises will involve both of these arenas.

 

CHAPTER THIRTEEN. Taking issue with the standard models of supervision

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It behoves us now to consider what appear to be the main problems with the standard models of supervision. We were faced with a limitation of supervision when we discovered that supervisory crises can be dealt with only on a manifest-content/implications level and in the realm of the rather unreliable conscious system. We realized that this all but eliminated the use of deep unconscious intelligence and that it cut off all access to the deeply unconscious motives that empower the supervisory experience as well its crises. We saw’ too’ that it may be possible to modify the standard models of supervision at times of crisis to develop encoded images from a supervisee. But is this modification of those models sufficient to render them complete, or do these basic models of supervision require changing?

To pursue this question, in this chapter I define more incisively the problems with the standard models that we have been touching on and show clearly that they reflect significant flaws in these paradigms. As we will see, there are indications that these limitations do appear to call for major changes in the basic structure of the supervision of dynamic psychotherapies and psychoanalysis. Indeed, once the problem is defined, in chapter fourteen we turn to one possible solution.

 

CHAPTER FOURTEEN. Self-processing supervision

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I have argued that the architecture of the emotion-processing mind is such that the most powerful level of human experience is processed by the second unconscious system. I have indicated, too, that there are major problems with a supervisory situation that fails to recognize and address this critical realm of emotional interaction. We embark now on a search for a means of integrating the two levels of experience essential for complete, non-contradictory, and deeply effective supervision — the conscious level which involves the case material, the supervisee, and his or her patient, and the deeply unconscious level which involves the supervisee and the supervisor.

THE SELF-PROCESSING PARADIGM

The communicative approach has evolved a new form of psychotherapy— self-processing therapy — constituted as teaching patients (they also are called students, and the therapist is also called the teacher] how to do their own psychotherapy — their own self-processing, as it is termed (Langs, 1992d, 1992f, 1993a). Self-processing is the communicative version of what is generally termed “self-analysis”. It has been found that teaching students, in small groups or, preferably, individually, how to access the second unconscious system and its trigger-encoded insights has profound healing effects — self-processing therapy is a very compelling and effective form of treatment. The combination of supervision with self-processing — self-processing supewision — offers a means of resolving the dilemma posed in this and the previous chapter. This paradigm creates the framework within which a supervisee is able to communicate narratives and seeks contemporaneous triggers in order to work over the supervisory interaction — the level of experience in supervision that has primacy in the deep unconscious part of the psyche. But, in addition, the model calls for the presentation of supervisory patient material so that the cognitive teaching and learning also is assured. In operating in this way, the model offers the significant added advantage of being able to show with remarkable clarity the ways in which supervisory transactions unconsciously influence the work and life of a supervisee. In all, self-processing supervision is a way of capturing and dealing with the two worlds of emotional experience in a single, workable setting — consciously and deeply unconsciously — and of showing how the two domains interact.

 

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