An Integrative Approach to Therapy and Supervision

A Practical Guide for Counsellors and Psychotherapists

Mary Harris, Anne Brockbank

• Publisher: Jessica Kingsley Publishers
• Year: 2011
• ISBN:
  9780857004987
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

An Integrative Approach to Therapy and Supervision presents an innovative and flexible model for therapy and supervision practice.

The model draws on ideas from the psychological traditions of Transactional Analysis, Gestalt theory and Cognitive Behavioural Therapy to develop an integrated approach to working with clients and to developing a supervisor-supervisee relationship that can be adapted to suit the needs of individual personalities and situations. The authors lay out the theory underlying the model, how it relates to existing models of supervision, and demonstrate how the model works in practice using case material to illustrate the range of approaches that can be applied in a given scenario.

This book is essential reading for both new and experienced practitioners, as well as those responsible for training therapists, counsellors and supervisors.

PART 1

Introduction

CHAPTER 1

THE FIT MODEL

This chapter introduces the integrative model for enhancing psychotherapy and supervision, which we term the ‘FIT model’. The psychotherapist is referred to throughout as a therapist. The FIT model is founded upon the three domains of human functioning:

Feeling (F)

Initiating (or acting) (I)

Thinking (T)

The FIT model developed out of a perceived need for a model of therapy and supervision which, rather than being limited to a single psychological theory and approach, utilises an holistic approach which incorporates a range of theories and issues. The model can be used by beginning and experienced therapists as well as by beginning and experienced supervisors looking for a way to expand their practice to include more than one approach in a systematic and comprehensive manner.

Within our recommended person-centred approach, we propose the integrative use of ideas from three other theoretical orientations, namely transactional analysis (TA), Gestalt therapy and cognitive behavioural therapy (CBT). These approaches are summarised below. We go on to explore in more detail how each can be applied using the FIT model in both therapy and supervision in Chapters 4 to 13.

The person-centred approach which underpins the model, is described in Chapter 2, and in this chapter we present a summary of the other three approaches and also map out how they relate to the FIT model.

The Single FIT: understanding the individual

The domains addressed when using the FIT model are described as Feeling (F), Initiating (I) and Thinking (T). They are illustrated in Figure 1.1 below, the Single FIT, which depicts the three domains as they occur within an individual.

Figure 1.1: The Single FIT

EXPLANATION OF THE DIAGRAM

F denotes emotions, affect and feelings - material expressed in this domain of the model may be accessed using person-centred, Gestalt or TA techniques.

I denotes initiating, that is, behaviours and actions initiated by the individual - this domain of the model may be accessed through TA or CBT.

T denotes cognition, thoughts, beliefs and self-talk - this domain of the model may be accessed through TA, Gestalt and CBT.

The model provides a structure which encourages explicit choices by the individual in the context of therapy or supervision at every stage of the interactions. The use of transparency within the transactions reflects the person-centred belief in congruence and respect for an individual’s ability to find answers within him or herself.

The listening and attending skills used throughout the process reflect Rogers’ belief that each intervention aims to achieve a deep understanding of the world of the individual (Rogers 1951, 1957, 1961). Instead of encouraging avoidance of difficult issues, this process fosters an organic process, that is the deeper issues emerge as and when the individual is ready and able to engage with them.

The Single FIT diagram can be used by the therapist to understand how an individual client functions and views the world, which can have valuable therapeutic implications.

The Double FIT: understanding the client/therapist relationship

The diagram in Figure 1.2 expands the FIT model and depicts the relationship which exists between the individual client and their therapist, who is the supervisee in this example. The insight gained by viewing the two people in relation to each other in this diagram provides useful material to be explored in supervision and also has valuable therapeutic implications.

The diagram suggests that the client’s functioning in each of the three domains is seen individually as well as in relation to the therapist’s functioning. The Double FIT can give focus to the therapist’s understanding of the client’s issues and, additionally, the interplay between the issues occurring between the client and therapist.

This view provides an extra dimension to the therapeutic work. The client’s feelings, thoughts and behaviours towards the therapist are manifestations and reflections of the inner world of the client and expressions of previous learning and relationships.

While continuing to hold the information regarding the client’s functioning, the therapist is asked to consider his own functioning in each of the three domains, and to consider the arising interplay between the client and himself. The therapist can use the diagram to explore how his own feelings (F), behaviours (I) and beliefs (T) impact on and intersect with the client work. When this process occurs, the work in therapy becomes introspective as well as interactive.

By attending to his own feelings, behaviours and thoughts regarding his work with the client, the therapist is able to gain deeper insights into both the client’s as well as his own functioning, which then informs and expands the therapeutic work. The FIT model is used to foster this process; the therapist is able to provide insights and observations to enhance their understanding of the therapeutic work.

Figure l.2: The Double FIT

The Triple FIT: understanding the client/therapist/ supervisor relationship

In order for the supervisor to foster the effective use of the FIT model, they need to be aware of their own functioning in each of the three domains, in order to hold and understand the interactions which occur between the client and the supervisee and between the supervisee and themselves. Figure 1.3 illustrates this relationship.

Figure l.3: The Triple FIT

The therapist (now the supervisee) uses supervision to examine the Single FIT, which represents the client’s functioning in the three domains, as well as the Double FIT, which represents his awareness of his own feelings, behaviours and thoughts towards the client and the interplay between the two. Both the Single FIT and Double FIT are then explored in supervision sessions. The supervision process may also include input from the supervisor’s perspective, which constitutes the third or Triple FIT.

Figure 1.3 suggests that supervision needs to include awareness of the supervisee’s functioning as well as the client’s functioning in order for the therapy to be effective. In order to facilitate this process in supervision, the supervisor must also be aware of her own feelings, behaviours and thoughts towards the client as presented in supervision, as well as towards the supervisee. In particular, if the supervisee’s feelings (F) have been triggered by material brought by the client, supervision using this model can provide a clear framework for identifying and resolving the overlap between the supervisee’s and the client’s issues.

When the supervisee has unacknowledged and unresolved feelings towards the client, he will react to the client’s feelings, behaviours and thoughts influenced by this bias. The challenge in using this model is that the supervisee is offered an opportunity to become aware of his own process and to exploring his unresolved issues, while at the same time considering the potential impact these issues can have on the client.

This awareness may be in the background throughout the session or may become more in the foreground when the interactions between the supervisor and supervisee reflect dynamics occurring between them, which may impact on the work being done with the client. Throughout this process, the emphasis remains on facilitating the work with the client. Even when personal material is explored by the supervisee or expressed by the supervisor, the focus remains on deepening the supervisee’s understanding of the client’s needs and process.

Supervision sessions using this model will sometimes consider the feelings, behaviours and thoughts expressed by the client towards others, as well as towards the therapist. It may also explore the supervisee’s feelings, behaviours and thoughts towards the client, and the relationship between the supervisor and supervisee as it impacts on the work being done with the client. Both the supervisor and the supervisee need to be able to process the multiple interactions at the same time, that is, to ‘parallel process’ the work occurring in the supervision and in the therapy sessions. A mental map of the various diagrams provides an awareness of the interplay taking place within each of the three individuals involved in the process and allows awareness of the supervisor’s and supervisee’s functioning, as well as the client’s functioning, as reported by the supervisee.

Working with the FIT model, both supervisor and supervisee become increasingly adept at moving back and forth among the various domains to work with the emerging dynamics and issues.

FIT and reflective practice

This section describes how the FIT model supports reflective practice in supervision. The overall approach in FIT supervision is primarily person-centred in order to offer supervisees potential learning in all three domains, but particularly the affective or emotional domain. It is our contention that this approach is the one most likely to facilitate an exploration of all three domains, as detailed earlier. Hence as part of the FIT model of supervision we recommend a dialogue which is person-centred.

The supervision relationship is not a therapeutic one, but rather a learning relationship to support reflective practice. When the process of FIT supervision surfaces therapeutic material for the supervisee, then referral for therapy (quite separately from supervision) is recommended. A competent supervisor is able to identify and discuss such a referral when necessary.

FIT SUPERVISION AND CONNECTED KNOWING

In FIT supervision, the supervisor adopts a stance of ‘connected knowing’ (see Chapter 3), in which the supervisor seeks to understand the supervisee’s subjective experience and enters into a reflective dialogue. In other words, as a supervisor I do not have to necessarily agree with the stance of my supervisee, but I suspend my judgement in order to understand their stance.

A supervisory relationship which nurtures connected learning is likely to stimulate the challenge of double loop learning and person- centred FIT supervision is likely to facilitate the emotional work needed for the process, as well as the actions and thoughts needed to carry out the supervisee’s learning intentions. Double loop learning is described in Chapter 3.

FIT supervision is intentional in the sense that the supervisor is conscious of what she is doing and why. The supervisor may also wish to declare explicitly her purpose and how she intends to achieve it, to colleagues and/or supervisees. Such explicit articulation (naming that which is usually unnamed) means the supervisor can be clear about what she is doing and whether it is appropriate.

The model also provides the opportunity for supervision sessions to stimulate and explore the interactions between supervisors and supervisees as well as those occurring between supervisees and their clients. In addition, it provides a framework for supervision occurring within a single session or over ongoing sessions. It is based on the process of person-centred reflective dialogue, which includes structured time, space, clear boundaries, tolerance of uncertainty and competence in dealing with emotional material. This process is known to promote a powerful learning relationship between supervisor and supervisee, with the potential for transformational learning (Brockbank and McGill 2007).

While the FIT model offers intention, stance, awareness and modelling, a supervision environment which nurtures connected learning, ...

Table of contents

• Cover
• Of Related Interest
• Title Page
• Copyright
• Contents
• Preface
• Part 1: Introduction
• PART 2: The FIT Model Applied in Therapy
• PART 3: The FIT Model in Supervision
• Conclusion
• Appendix A: An Example of Ground Rules
• Appendix B: Supervision Contract
• Appendix C: Setting Goals or Objectives
• References
• Subject Index
• Author Index