Supervising the Counsellor and Psychotherapist

A cyclical model

Steve Page, Val Wosket

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317644774
• Edition: 3
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

Supervising the Counsellor and Psychotherapist considers how to meet the supervision needs of trainee and experienced counsellors, psychotherapists and other helping professionals using an integrative approach that will appeal to practitioners from a broad range of backgrounds and theoretical persuasions. The book charts the development of the supervisor as he or she moves through making the transition from therapist to supervising the work of others and includes consideration of the advanced competencies required to supervise experienced practitioners.

This third edition brings a number of contemporary perspectives to a well-known and widely respected core text for the training and development of supervisors. The Cyclical Model at the heart of the book has established its relevance in the UK as one of the best known frameworks for teaching and learning the steps and stages of supervision. All chapters in this new edition have been extensively revised and updated, and key elements include:

- Two brand new chapters on deepening supervision practice and moving beyond supervising counsellors and psychotherapists

- Updates on recent developments in supervision, including research outcomes, the use of technology and supervising short-term work

- Creativity, play and the use of metaphor and imagery in supervision

- Developing the use of self through relational supervision.

Supervising the Counsellor and Psychotherapist is a key text for trainee and experienced supervisors of counsellors and psychotherapists, those who train supervisors, and supervisees wishing to better understand the supervisory process.

Chapter 1 An historical overview

DOI: 10.4324/9781315761305-1

In this first chapter we will attempt to place supervision in its historical context in order to identify the source of some aspects of the role and to capture the sense of supervision being in a process of development. We will begin by identifying a number of the roots and various influences that have affected its evolution.

We find that supervision originated in 1902 as part of the informal meetings of ‘The Wednesday Night Psychological Society’ held at Sigmund Freud’s home. Freud’s authoritative approach, consistent with classic psychoanalytical therapy, comprised the conveying of knowledge and truth ‘downward to the supervisee, who, no matter how bright and creative, is to receive rather than co-construct what becomes known’ (Frawley-O’Dea and Sarnat 2001:16). Fleming and Benedek ([1966] 1983) describe the development of psychoanalytic supervision from the 1920s through to the mid-1960s. Apparently, within psychoanalysis, supervision was an integral part of the training process that complemented the theoretical teaching and the analysis of the fledgling analyst (Buckley et al. 1982).

These three elements (supervision, teaching and personal analysis) of the training process were made a formal requirement by the International Training Commission in the 1920s (Feltham 2000). Thus what had started out in 1902 as, to quote Freud, ‘a number of young doctors gathered around me with the express intention of learning, practising and spreading the knowledge of psychoanalysis’ (Freud [1914] 1986:82) moved through informal apprenticeship to a training structure that provides the basic components used in many current training programmes in psychoanalysis, psychotherapy, counselling and allied fields.

It is important to note that in this precise context we are referring to trainee supervision; that is, supervision that is part of the process of preparing the fledging practitioner. This should not be confused with supervision of someone who has completed their formal training, which we shall term practitioner supervision. This is an important distinction as there are many differences between, for example, supervising a second-year trainee and supervising a therapist with 20 years’ experience. A trainee therapist is likely to be concerned with issues of technique, forming effective therapeutic relationships, case conceptualization, boundary issues, understanding the material the client brings, and dealing with personal feelings of anxiety and perhaps inadequacy. The experienced practitioner is more likely to be concerned with: teasing out and working with relationship dynamics, including parallel processes (see below); containing and understanding complex processes such as attachment and dependency; choosing nuanced intervention options; dealing with strong feelings (in self and client); and, as we shall consider further in Chapter 12, exploring how their personal life issues and their professional issues overlap and intertwine.

This distinction is often not made in the literature and it is quite usual for the term ‘supervision’ to be used when what is being described is restricted to what we are calling ‘trainee supervision’. This is particularly the case in supervision literature from the United States although there is limited evidence of attention being given to supervision for more experienced practitioners. We find Rogers (1951) encouraging this as far back as the early 1950s. Although all the specific references he makes to supervision refer to trainee supervision, he does also propose the usefulness of a resource person, someone with whom an experienced counsellor can consult. More recently we have seen North American authors such as Gold (2006) and Veach (2001) advocating ongoing supervision as essential for psychotherapists to help with skills development, the management of ethical and boundary issues, and the complexities of dynamics in therapeutic relationships, including transference and counter-transference. Borders (2006) notes that, increasingly, a requirement for ongoing supervision is linked to professional licensure in the United States and that training requirements for clinical supervisors are becoming the norm.

We can trace the requirement that all practitioner members of the British Association for Counselling and Psychotherapy (BACP) be in supervision regardless of their length of experience back to at least 1992 (BAC 1992). This created quite a sizeable demand for counsellor supervision in the United Kingdom, which increased as the proportion of practitioners with significant experience grew. The role of supervisor is one of the developments to have emerged out of the professionalization of counselling and psychotherapy, which includes the recent (voluntary) registration of BACP therapists.

Interest in the development of supervision amongst experienced therapists in Europe, America and Australasia has continued to grow (Bond 2000; Rønnestad and Skovholt 2013; Watkins 2013). In Europe there seems to be an increasing openness to supervision across professions, whereby supervisors are less restricted to working principally within their ‘home’ profession (Bond 2010). In Australasia and North America, as reported by Bond (2010), developments in multicultural counselling appear to be creating opportunities for supervision to play an increasingly important role in supporting therapists in acquiring culturally informed and sensitive ways of working.

The evolution of supervision models and approaches

To begin with, approaches to supervision tended to take the theory and practice of a counselling or psychotherapy model and then apply the principles and processes of that approach to the practice of supervision (Friedlander et al. 1989; Hart 1982). Thus a psychodynamic supervisor would be inclined to interpret the material being presented and would use an awareness of the relationship dynamics between herself and the supervisee as a means of supervising (Bradley and Gould 2001; Driver and Martin 2002, 2005; O’Shaughnessy et al. 2010). A client-centred supervisor would be concerned to convey the core conditions of acceptance, respect and genuineness to his supervisee (Frankland 2001; Lambers 2000, 2006; Tudor and Worrall 2004). The cognitive behavioural supervisor would use methods such as goal clarification and action planning with the therapists she supervises (Ricketts and Donohoe 2000).

As the number of counselling and psychotherapy approaches increased, an increase in the use of these approaches as a basis for supervision developed, as expounded and updated in anthologies such as Bradley (1989), Hess (1980), Ladany and Bradley (2010) and Watkins (1997). Using an approach to counselling or psychotherapy as a model for supervision has the attraction of both being familiar to the supervisor and, usually, providing the therapist with a model that also fits her own practice. There is certainly a compelling argument for trainee counsellors and psychotherapists to be supervised by a practitioner who is thoroughly experienced in using the approach in which the therapist is being trained. This offers consistency and an opportunity to examine in detail the technique of the therapist and how she is applying the approach in practice. Goodyear and Bradley (1983) however provide a cautionary note for the supervisor who is all too ready to fall back on tried and trusted counselling theory in the practice of supervision: ‘As a mental road map, theory focuses supervisors’ attention and guides their action, but can also blind them to phenomena that are not charted on that map’ (p. 63).

A further drawback of therapy-related models of supervision, as Bernard (2006) has pointed out, is that (depending on the approach) attention may be focused on learning the microskills of an approach and diverted away from the supervisory relationship. There is also the danger of confusion where supervision is based upon a therapeutic model. Let us consider an example. During supervision of a counsellor’s work with a depressed client whose marriage is breaking up the supervisee mentions that he has invited the client ‘out for a pint to cheer him up’. The supervisor in this case has a responsibility to explore and challenge the counsellor’s actions as there is the danger here of an unhelpful blurring between a therapeutic and social relationship. This is quite different to an intervention a counsellor might make if his client mentions having asked a depressed friend out for drink.

Unless the differences between supervision and therapy are clear, for both supervisor and therapist in the above example, there are two possible dangers. If the supervisor is not clear about the differences then she may simply avoid confronting the counsellor, preferring to offer, for example, empathy or interpretation and as such fail to discharge her responsibility to monitor client safety. Let us assume that the supervisor does act and challenges the supervisee to change his behaviour, while giving a clear ethical rationale for this. If the supervisee is not clear about the differences between counselling and supervision he might take the supervisor’s behaviour as a model for how he should behave with clients and start to become excessively challenging or directive. It is important therefore that the supervisor ensures that her supervisees understand the distinctions between these roles so that inappropriate role modelling is discouraged. A number of key differences between therapy and supervision are outlined in Table 2.1 onpage 19.

Developmental models of supervision

A new strand in the evolution of supervision emerged when Hogan (1964) published his paper on the four stages of the development of the psychotherapist. This paper stimulated something of a plethora of developmental supervision models – according to Borders (1989) an estimated 25 models had been published by 1988. Subsequently this stream of developmental models slowed to a trickle and Stoltenberg and colleagues, in their comprehensive review of supervision research (1994), could find only one major developmental model of supervision proposed between 1987 and 1994. However, a recent third edition of the seminal text on the main developmental model provides some testimony to the enduring usefulness of this approach (Stoltenberg and McNeill 2010) and there is evidence (discussed below) that contemporary, creative adaptations of developmental models are giving them a new lease of life.

Initially, developmental models were based on the rationale that supervisors need to acquire a range of styles and approaches that are adapted to the individual needs of the trainee therapist as he or she moves through a sequence of, for the most part, clearly definable developmental stages. The different stages were seen as describing a more-or-less linear process of growth in competence and awareness through which the therapist moves on his or her journey from novice to ‘master’ practitioner. This development was understood to follow a natural and normally predictable pattern while allowing for occasional relapses to an earlier stage.

Exponents of the developmental approach argued that the supervisor could be trained (or at least alerted) to address the supervisee’s particular developmental needs through a specific set of competencies matched to: the supervisee’s level of therapeutic skills; their capacity to conceptualize the counselling task and process; their personal and professional development; and their awareness of the dynamics of the counselling relationship. So, for example, in Stoltenberg and Delworth’s (1987) model (later revised with McNeill in 1998 and reformulated by Stoltenberg and McNeill in 2010) ‘Level 1’ supervisees tended to be seen as highly motivated but anxious and largely dependent on the supervisor, who therefore needed to provide a clearly structured and supportive environment where positive feedback and encouragement could allow the supervisee to begin to lessen his or her anxiety about ‘getting it right’. We have summarized the four stages of this model of counsellor development together with recommended supervisor behaviours and styles of intervention in Table 1.1.

Table 1.1 Developmental stages of counsellor supervision, adapted from Stoltenberg and McNeill (2010)

Developmental stage of counsellor	Supervisor interventions and behaviours
Level 1	Level 1
Limited knowledge of theory and technique. Highly motivated, whilst also anxious, confused and dependent on the supervisor. Awareness of self and others may be limited, although focus on self (often negative) may be intense. Low professional self-concept. Evaluation and performance anxiety. Desire to emulate experienced therapists/ supervisors. Concern with micro skills and specific interventions and applying these prescriptively. Confidence and skills begin to increase with experience and facilitative supervision.	Provides clearly structured and supportive environment. Has an educative function and shares knowledge about techniques and when they should be applied. Encourages supervisee to gain experience and understanding of difference and diversity across cultures. Suggests suitable intervention strategies and helps supervisee structure clinical work. Encourages risk-taking, intentionality and integration of theory and practice. Acts as professional role model. Focuses on relationship skills. Gives guidance on the management of boundaries and professional ethics. Encourages problem solving. Supports growth of autonomy.
Level 2	Level 2
Motivation fluctuates. Moves between autonomy and dependence on the supervisor. Swings between over-confidence and overwhelm in response to increased awareness of the complexity of therapy. Increasingly self-assertive. Less focus on self and more on client. Growth in empathy apparent with more attention on understanding the client (verbally and nonverbally). Beginning to develop own identity and experiment with range of interventions and techniques. Dependenc...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Dedication
• Contents
• Figures
• Tables
• Preface
• Acknowledgements
• 1 An historical overview
• 2 From therapist to supervisor
• 3 Overview of the supervision model
• 4 Stage 1: Contract
• 5 Stage 2: Focus
• 6 Stage 3: Space
• 7 Stage 4: Bridge
• 8 Stage 5: Review
• 9 Supervising in groups
• 10 Ethical and professional issues
• 11 Difference and diversity in supervision
• 12 Supervising experienced practitioners
• 13 Deepening supervision practice
• 14 Training and development of the supervisor
• 15 Beyond supervising the counsellor and psychotherapist
• References
• Index