On Supervision

Psychoanalytic and Jungian Analytic Perspectives

Ann Petts, Bernard Shapley, Ann Petts, Bernard Shapley

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429917059
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

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.

Part I
Fundamentals of Supervision Practice

Chapter One
On beginning a supervisory relationship

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; Grinberg, 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]

Drawing upon my experience as a supervisor, and as a trainer of supervisors, I am going to focus upon the beginning of the supervisory relationship that a psychoanalytic psychotherapist may provide to trained counsellors, therapists, or others in the caring professions, or to those who are training as such. Some of the questions I raise may not be as relevant to the psychoanalytic psychotherapist who acts in their capacity as a training supervisor, supervising a trainee within their own or another familiar training organization. However, I would suggest that some of the issues will apply equally to these situations. For ease of writing, when appropriate, I shall refer to the supervisor as he and the supervisee as she as a means of distinguishing between the two. I shall also use the term “patient”, as used by psychoanalytic psychotherapists, although I am aware that supervisees who are in related fields, for example, counsellors, more frequently use the term “client”.

I shall address some of the issues that should be considered by the supervisor before a supervision contract is entered into, and the questions the supervisor might have in mind when meeting a potential supervisee for the first time. Supervisors who are more experienced may nevertheless find some of the issues helpful when re-evaluating their role. I shall not necessarily be providing answers as these will differ from supervisor to supervisor, in the same way that each chooses the model of supervision they will use. I hold the opinion that it is as important to think about such issues at this early stage as it is to think about the related issues when undertaking an assessment interview with a patient, in order to consider the appropriateness of undertaking treatment with them. To enter into a supervisory contract with a supervisee that we later consider falls into that category of practitioner who leads to a “diminution of standards”, when it should have been clear from the outset that this might be a possibility, leads to the tendency to blame the supervisee for our own neglect of addressing some of the issues I shall raise.

Some considerations prior to beginning a supervisory contract

Before a practitioner makes himself available as a supervisor, he has to have in his mind some idea as to whom he will work with and whom he will not. If the purpose of supervision is to enable a learning process, facilitating the professional development of the supervisee, then the supervisor has the responsibility to create such a learning environment. This cannot be done if the supervisor continuously feels critical towards the supervisee because he considers the supervisee is not serious about the work, has not undertaken an appropriate training of good standard, has not had a suitable analysis and so on. Further, the supervisor will only serve to undermine the supervisee, thus ensuring no professional development can take place.

It may be very tempting, when first enthusiastically setting out to undertake a supervisory role, to begin with a supervisee without considering these questions. In my experience of supervising those who supervise, there often comes a point when, in retrospect, there emerges the wish that such thinking had taken place at the outset. Of course, nothing can preclude the situation when, in an initial session, the supervisor’s countertransference response to the person before them is so negative that, not withstanding his thoughts about this, he decides he could not form a working relationship. However, it is important to consider the following questions before meeting a supervisee for the first time:

1. Are we willing to supervise a supervisee who considers herself to be trained, but has actually undertaken a poor training? Is this willingness based upon the hope that during the course of supervision they will come to see the inadequacies of their training and will seek to undertake further training? What will we do if this insight is not gained?
2. If a potential supervisee has not made good use of what might be a reasonable or even good training, but they now work as a qualified practitioner, do we think it is better to supervise their work so that they have this opportunity to improve? Do we take the view that, as there are patients working with this practitioner, we must consider offering supervision as a means of monitoring this work for the patient’s sake?
3. Are we willing to supervise work that is not of our own orientation but with a supervisee that might make use of our insights to enhance their own understanding? This might be in terms of theoretical underpinning or in terms of working with, say, social workers or psychiatric nurses.
4. Are we willing to supervise work that might be different from our own in terms of, for example, short-term versus long-term work, or once weekly rather than intensive work? Are we willing to adapt our usual way of working to accommodate the supervisee, or do we leave it to the supervisee to adapt our ideas to facilitate their work?

All of these questions have an ethical dimension. If we are uncomfortable about supervising under any of the circumstances above but nevertheless make our own needs to supervise the priority, we begin without the respect for the person before us. As put by Jacobs, David, and Meyer (1995), it is important to create an atmosphere in which learning can take place.

This can only be done if the supervisee feels that his teacher is sympathetic to and in tune with the obstacles to learning he is encountering. The trainee must feel that the supervisor will help him identify and overcome those obstacles without judging him. [p. 54]

So, while it is appropriate to help a supervisee think about areas that are lacking in their training or understanding, if in this initial stage we cannot tolerate the gap between what we consider to be an appropriate standard and the stage our supervisee has reached, it would be better not to enter into the contract. Furthermore, if we think we are able to tolerate this difference, we may also have to reconcile ourselves to the fact that the supervisee may never reach the standard we would hope for.

Having drawn his own conclusions in regard to the above, a supervisor will then need to reflect upon other aspects which may affect the way he works that are important in regard to the possible expectations upon him from a supervisee.

A supervisor has to consider whether he is interested in working only with the confined clinical space, that is, with the case material presented by the supervisee, or whether he is willing and interested in thinking about the context in which the work takes place and how this might impinge upon it. The potential supervisee might work, for example, in a GP’s surgery, a hospital, a university counselling service, or a voluntary agency. Any impingement might be upon both the supervisee and upon their patient.

For instance, a therapist working in a GP’s practice may be regularly faced with patients who come with the expectation of an immediate cure. This is, of course, something many patients do, but it may be emphasized in this setting, particularly if it is the GP who has made the suggestion of counselling. A further complication might be that the therapist finds the room in which the consultation takes place is changed without warning, or that a receptionist handles their appointment diary and makes changes with the patient without liaising with the therapist. A supervisor might need to question whether the supervisee has been able to set their own parameters, enabling them to work in a dynamic way. Is the supervisee able to take up what might be going on for the patient or do they take it all at face value? If they have not fully understood the necessity for boundaries, have not yet grasped the nature of the transference relationship, will they need additional help to make sense of these occurrences? However, it may also require the supervisor to help the supervisee find ways in which they can facilitate their work, which includes negotiating with other staff in regard to a suitable, consistent room, perhaps making changes to the room to make it more conducive to a facilitating environment. It may be important for the supervisor to find out how their supervisee’s appointments diary is kept and whether they can negotiate more control over it. Will the supervisee need to “educate” a receptionist, so that she can understand why it is not helpful to say certain things to a patient that she might ordinarily do. In other words, the supervisor may have to provide a training input with regard to some of the basic requirements that enable psychodynamic work to take place. The supervisor may also need to recognize that there may be limits to the level of analytic work that can be carried out in such a setting.

A supervisee working in an educational context might face different impingements. Students seeking counselling may assume that the counsellor will be assessing them in the way that the entire university is doing, perhaps talking about them with their tutors. They may express hope that the counsellor will get them off their essay deadline or will make excuses for the failure of their examination. How does the counsellor respond to such expectations? Issues of confidentiality in such a setting are complex, and the counsellor also has to consider that the likelihood of meeting the student in the university corridor is much greater than working in other settings. If a supervisor is not interested in these things, and wishes to concentrate solely on the therapeutic encounter within the transference–countertransference relationship, they need to have this clear in their mind because it affects the kind of supervision they offer. The potential supervisee also needs to be made aware of this to avoid frustration on their part, which occurs when they feel the context in which their work takes place is misunderstood.

The supervisor also needs to consider whether they are interested in institutional dynamics. Do they wish to supervise on issues of management or the undertaking of tasks beyond the consulting room? For example, the supervisee who has to liaise with those in authority or who wants help with the management or even supervision of their own staff team.

Of course, such considerations also arise in private practice. A supervisor has to be alert to hearing when a supervisee’s family impinge upon the consulting room, or the way that a supervisee handles possible interruptions of the doorbell or, indeed, the telephone.

The initial interview: individual supervision

Beginning with a new supervisee has many parallels with starting with a new patient. Even those who are well trained and have experienced supervision before may have received this supervision from a supervisor who works differently. The relationship begins from the moment of initial contact on the telephone. It may seem trite to say that we should state that we would like to see the potential supervisee for an initial session so that we can learn a something about them, their experience, and way of working. They can use the opportunity to find out how we work and how we might work together. Yet, all too often, there is an assumption made that making the appointment is synonymous with forming a contract. Of course, sometimes we already know of the person and therefore have already formed opinions about them and they about us. It is still important to have this initial session and clarify the contractual aspects to ensure there are no misunderstandings that might cause later difficulties.

This includes, importantly, the transferential aspect of the supervisory relationship. Grinberg (1997) states: “There is also the possibility of some interference in the task of supervision due to transference and countertransference problems on behalf of the supervisee and supervisor” (p. 2). Brown and Miller (2002), however, have drawn attention to the fact that, while we may think about the supervisor’s countertransference response to their supervisee’s patient, the actual transference–countertransference between the supervisory couple can often be ignored, but, they argue, as a result useful material that might help to understand the patient is lost. At this early stage, these two positions can only be reconciled if the supervisor is able to recognize the transference, and his own countertransference, using it not to make interpretations, as with a patient, but to assist clarification in his mind as to the type of professional relationship that might evolve with the person before him. As Berman (2000) has pointed out: “The supervisor–supervisee relationship is always a rich and complex transference–countertransference combination, even if the supervision is utterly impersonal; teachers are always a major focus of transference feelings” (p. 276).

The fact that the supervisory relationship is more “relaxed” than that of the therapist/patient—we are, after all, working with a (potential) colleague—also means that it can be harder to handle our own countertransference feelings, which nevertheless we have to do.

From the initial telephone call, we may already gain some indication of the difference between the reluctant supervisee and those that see supervision as an important aspect of their work. In regard to the former, discovering what this reluctance is about when we first meet with a potential supervisee is an important factor when considering whether we want to form an ongoing contract. There can be a number reasons for this reluctance. For example, with the advent of Continuing Professional Development (CPD), many such schemes require some form of supervision or clinical presentation. Is the supervisee seeking supervision simply to fulfil such a requirement rather than seeking it as a way of developing their practice for themselves? A training requirement may be seen as essential by the course but as a hurdle to be got through by the trainee. Perhaps the supervisee has not yet developed, indeed may never develop, a serious attitude towards the work. We may experience this as a devaluing of our work, and our feelings in this regard may get in the way of our being open to alternative reasons for the reluctance. For example, is their reluctance a defence due to an unresolved transference to an authority figure? There may be anxiety about feeling judged by a supervisor, in particular one who is to write a report of their work at some stage. We have to be mindful of the fact that the supervisee may be nervous and may express this by appearing diffident.

In contrast to the reluctant supervisee is one who comes across as very enthusiastic about the work and keen to begin supervision, but may be engaged in an idealized transference. This, too, can be problematic, in that they then may be so anxious to please the supervisor that they are easily knocked back by what they perceive to be negative criticism, or that they exclude aspects of work that they consider might be judged badly. They may lose their own ability to question or evaluate, locating all the good aspects within the supervisor. Ultimately, this can serve to undermine their confidence in their own abilities.

Assessing the potential of the supervisee to use what we have to offer can be difficult, but there are questions we can have in mind that can help us ascertain the willingness or otherwise of a possible supervisee, even though this cannot be foolproof.

If we know the person professionally, perhaps we are familiar with their training, we may already have some knowledge of how they work, how they think, etc. If they trained some time ago, we may be more interested in their work experience than their training. The following checklist is offered as a guideline and will need to be adapted. As in an assessment with a potential new patient, questions are in our minds but are not necessarily asked directly. If we begin by asking them to say something about what brings the supervisee to us, what they might hope to gain, we are inviting them to tell us a great deal. By the end of this first session we will want to know the following:

1. Is the supervisee trained? If it was recent, how did they experience this training, what particularly excited them? Are they able to talk about it creatively or do they merely provide us with a list of subjects covered?
2. How do they describe their theoretical orientation? This is important because some potential supervisees will say they are psychodynamic but it quickly becomes clear that their conception of what it means to work psychodynamically and our own may be very different. We then have to assess whether this is a fai...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• ACKNOWLEDGEMENTS
• ABOUT THE EDITORS AND CONTRIBUTORS
• PREFACE
• INTRODUCTION
• PART I: FUNDAMENTALS OF SUPERVISION PRACTICE
• PART II: ON SUPERVISORY TECHNIQUES
• PART III: ON ASPECTS OF THE SUPERVISORY RELATIONSHIP
• INDEX