Mirrors and Reflections

Processes of Systemic Supervision

Charlotte Burck, Gwyn Daniel, Charlotte Burck, Gwyn Daniel

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367106089
• eBook ISBN: 9780429916304
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

In this volume, as the title indicates, the focus is on understanding and elaborating what might be said to be "going on" in supervision as well as further exploring what is distinctive about systemic supervision. Looking at processes within systemic supervision involves engaging with the different contexts within which the supervision takes place and engaging with a range of theories - some developed or applied within therapeutic contexts and others drawn from theories of learning. Various theoretical frameworks have emerged and been described as underpinnings for systemic supervision. Social constructionist and narrative ideas have been vital in the creation of supervisory practices that promote open dialogues, multiple perspectives and the interrogation of traditional assumptions about expertise and hierarchy. This has inevitably led to a discussion of tensions and contradictions: unease about implicit practices of power, the problematics of assessment and evaluation and issues concerning the allocation of clinical responsibility. Positioning theory, dialogic theories and ideas from the field of adult education have also contributed helpful theoretical concepts for use by systemic supervisors.

SECTION I

EVOLVING THEORIES

CHAPTER One

Theories of change and the practice of systemic supervision

Paolo Bertrando¹ and Gabriella Gilli²

As psychotherapists, whether experienced practitioners or not, we have all been in supervision, and periodically we go back to it. Supervision is considered essential to good training and good practice, although its precise boundaries, and even its usefulness, have been questioned (see Storm et al. 2001). Now, what is the main characteristic of such a key aspect of therapeutic practice? Probably the fact that the supervisor, more than any other professional in therapy, is “presumed to know”. The general idea of supervision involves the prejudice that the supervisor is the one who can (must) correct the supervisee’s mistakes. Thus—especially in cases where the supervisory relationship is one-to-one—the supervisor tends to act so as to constantly frustrate her supervisee.³ As a colleague of ours once happened to say: “I feel my duty is to help some people to understand when it’s the case for them to change their job.” This at least justifies the anxiety—sometimes the terror—experienced by supervisees in some circles. It can, however, at times, make the practice of supervision controversial, as this statement from an experienced psychoanalytical psychotherapist testifies:

In my work in recent years, I have found supervision becoming more and more of a problem, a challenge, and a reason for dissatisfaction to me … when I asked others what they remembered about their own experience of being supervised, several of my senior colleagues ... said in effect: “I always saw to it that I went to a supervisor who would interfere with me as little as possible.”

(Grotjahn cited in Schuster, Sandt, and Thaler, 1972: 77–8)

All this, however, sharply contrasts with both the theory and practice of systemic therapy, where the emphasis lies on strengths rather than limitations, and on the development of personal competence rather than on teaching some pre-existing wisdom (Bertrando, 2007). Thus, although the field of systemic therapy is by no means free from the exercise of authority (sometimes to the point of being authoritarian), the development of supervisory modalities shows some peculiarities that we would like to deal with in the following pages.

Questions

What is the influence of theoretical models on the practice of supervision? Of course, in order to discuss such an influence, the preliminary question has to deal with the nature of supervision. About which, as it happens, opinions differ. Rather than reviewing the vast existing literature on the subject, we will begin with a short definition which suits our aim. The basic purpose of psychotherapy supervision is to help supervisees develop an experiential expertise, useful in treating their clients.

Supervision (like training) is also a way to embody a theory in practice for trainees, or to refresh the theoretical basis for experienced practitioners. The supervisory experience thus cannot be detached from theoretical models. This does not mean, however, that the supervisor should always make the use of any model(s) explicit to the supervisee, but rather that such models inevitably shape her work. There should be some coherence between general theory, clinical theory and practice, training theory and practice, and supervision. This is what is called an isomorphic perspective: in optimal supervisory practice, supervision is isomorphic to therapy, in the sense that they both obey (more or less) the same set of rules (Liddle, 1988).

The important issue here is that the supervisee will learn (or in Gregory Bateson’s [1973] terminology “deutero-learn”) not from the content of supervision, but from the form that it takes. His practice will be influenced by the practice experienced in supervision. This is why the particular form given to the supervision is crucial.

If a supervisor implies that a therapist’s personal problems are interfering with the progress of a case, the therapist will suggest, directly or indirectly, to the client that his or her deep emotional problems are interfering with the progress of the therapy.

(Haley, 1988: 362)

Haley, in the article quoted, criticizes all insight-oriented, non-directive models of supervision. In his view, if the supervisor does not accept being in charge of the supervisory situation, the therapist will learn to not take responsibility for her case. We could say, conversely, that a supervisor too keen to take responsibility for a case will create therapists who do not accept the views of their clients. The fact is, the position that the supervisor brings into the supervision is the position that the supervisee will tend to learn.

Using the isomorphic perspective, the supervisor can transform this replication into an intervention, redirecting a therapist’s behaviour and thereby influencing interactions at various levels of the system. Supervisors are not passive observers of pattern replication, but intervenors and intentional shapers of the misdirected sequences they perceive, participate in, and co-create.

(Liddle, 1988: 155)

Should supervision models, then, be consistent with the premises of each theoretical model and with the practice of therapy? Or is it better for us to consider some basic issues—namely, focus, goals, and modalities—that any supervisor, sooner or later, has to face?

As to focus, supervision may be focused, roughly speaking, either on the therapist, on the client(s), or on the therapist–client(s) relationship. As to goal, it may (mainly) concern solving some of the supervisee’s personal issues which may interfere with existing abilities; helping the supervisee to learn abilities and techniques; enhancing the supervisee’s awareness of his own context and positioning; or supporting the supervisee in stressful therapeutic situations. This last goal is often overlooked in the professional literature, although it may be considered one of the most important in some cases, such as the supervision of therapists working with abuse, violence, and trauma: “It cannot be reiterated too often: no one can face trauma alone. If a therapist finds herself isolated in her professional practice, she should discontinue working with traumatised patients until she has secured an adequate support system” (Herman, 1992: 153). Regarding modalities, supervision can be held in an individual or group setting, and it can either use case reports, or various modalities of direct observation. Each supervision model tends to have its specific focus, goal, and modality. In Table 1 we have summarized the most usual combinations, although we have to emphasize that other combinations are possible (and indeed frequent occurrences).

Table 1. Characteristics of supervision and theoretical models

Focus	Goal	Modality	Models
On therapist/trainee	Therapist’s personal and professional development Therapist’s support	Case report	Psychoanalytic Intergenerational
On family/client	Problem-solving	Direct (live) supervision	Strategic Structural Early systemic
On client–therapist relationship	Awareness of context and positioning	Case report Direct supervision	Postmodern systemic Narrative Conversational

Focus of supervision

On the therapist

If the supervision is focused on the therapist, the supervisor is mainly interested in the supervisee’s development as a therapist and, except for serious contingencies, leaves to the supervisee the whole burden of therapy without excessive intrusion. The quality of a specific client’s therapy is supposed to improve as a side effect of the supervisee’s overall professional growth. Such a focus is usually consistent with the goal of dealing with the supervisee’s presumed personal problems, which may interfere with him effectively implementing what he (in some way) already knows.

Probably the most time-honoured supervisory tradition is one where the focus is mainly on the person of the supervisee, namely psychoanalytic supervision. From its very beginning, psychoanalytic supervision has tended to privilege the resolution of personal issues. Supervision thus became a way of working on the person of the analyst, a further step after personal and training analysis. Already in 1926, the Committee of the International Psychoanalytic Association stated that: “Instructional analysis is the most important part of the training but it does not constitute the whole. It is absolutely essential that we should demand and give opportunity for further training, including, above all, the conducting of analyses under supervision” (International Psychoanalytic Association, 1926: 130). Thirty years later, the American Psychoanalytic Association added further determinants to supervision, aiming it very directly to the person of the analyst:

The aims of the supervision are: 1. To instruct the student in the use of the psychoanalytic method. 2. To aid him [sic] in the acquisition of therapeutic skill based upon an understanding of the analytic material. 3. To observe his work and determine how fully his personal analysis has achieved its aims. 4. To determine his maturity and stability over an extended period of time.

(American Psychoanalytic Association, 1956: 718)

Such a position has remained more or less the same through the years, as Eckstein and Wallerstein testify:

[Supervision is] not simply … the transmission of knowledge and skills, but rather … a complex process that goes on between the supervisor and the student. This process is a helping process in which the student is being helped to discover his [sic] problems as a psychotherapist, to resolve them with the help of the supervisor, and to develop toward higher integrations as a learner and as a psychotherapist. This process includes affective problems, interpersonal conflicts, problems in being helped, as well as in helping, and is therefore truly itself a helping process.

(Eckstein and Wallerstein, 1972: 251)

From the point of view of method, psychoanalytic supervision is a typical example of the use of the case report. To each session the supervisee brings news of what happened between himself and his clients since last meeting with their supervisor. The supervisor listens and makes comments about specific points. This very method, however, can be considered one potential source of authoritarianism, and has triggered a growing body of criticism, especially from authors such as Levine (2003) and Kernberg (2004). McCormick comments:

Verbatim reporting is a fundamentally persecutory set-up in which the only possibility of safety is the beneficence of the supervisor. In this—best—case, the student iatrogenically develops a strong bond of dependency to the supervisor, which is at odds with psychodynamic therapy’s aim of fostering personal autonomy.

(McCormick, 1994: 15)

Of course, it would be unfair to the psychoanalytic method of case report supervision to consider this as its only potential effect. Other, more positive effects, are the absorption by the supervisee of the very method that he has to learn and improve. Already in 1935, Helene Deutsch suggested the use of free association during supervision in order to make it more consistent with the basic rule of analysis:

The candidate’s unconscious actually absorbs the material given him [sic] by the patient at a time when he is still completely free from understanding its importance. If the candidate is allowed to reproduce the material in free association, one can see how much more wisdom his unconscious shows in the reproduction than does his conscious knowledge.

(Deutsch, 1935: 62)

This means that psychoanalytic supervision is like a subset of analysis, and it varies little according to the clinical experience of the supervisee: the process is the same, whether one is an experienced therapist or a trainee.

Within the field of family therapy, intergenerational supervision shows processes strikingly similar to the ones we have just described. In Bowen theory, for example, the emphasis is on differentiation of the self:

Role play and live supervision fall into the category of techniques that are employed to help people learn what to do. … The thrust of Bowen theory has always moved toward helping people to think and to go as far with their cognitive abilities as possible toward differentiation of self in their own families.

(Papero, 1988: 72)

Therefore, no direct techniques are employed in Bowenian supervision. Videotapes too are seldom reviewed, as they typically focus on skills and lead supervisees to imitation. The supervisee, instead, is helped to understand his position in his own family, and, at the same time, his position in relation to the family with which he is working. Techniques and skills are secondary to such an understanding. The main difference to analytic supervision is the emphasis on a comprehensive understanding of intergenerational theory. Bowen therapists should focus on maintaining their differentiation during family work, and not ...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication Page
• Contents
• Foreword
• The Contributors
• Introduction
• Section I: Evolving Theories
• Section II: Group Processes
• Section III: Power and Diversity
• Section IV: Agency and Professional Contexts
• Index