Doing Supervision and Being Supervised

Robert Langs

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367324155
• eBook ISBN: 9780429912870
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

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.

Chapter One
Issues in supervising psychotherapy

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 story, 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.

The supervisor reads the material in advance of meeting with the supervisee, and when they get together he offers his general impressions of the supervisee's work and a discussion will ensue. At times when notes are unavailable, the supervisee will simply present some issue or problem with which he needs help — little or no specific case material is used. Supervisory discussions are typically intermixed with talk about work, social relationship, gossip about other members of the department, and whatever else one or the other person happens to bring up. Finally, although the supervisee is unaware of this, the supervisor is presenting the work of this supervision to the institute's study group on supervisory practices.

Truth is stranger than fiction — especially in psychoanalysis and psychotherapy.* Without making a formal analysis of this supervisory situation, we may attempt to empathize with both the supervisor and the supervisee. The former is likely to have conscious feelings of guilt for secretly appropriating the supervisee's material for presentation to other therapists — and the guilt will affect not only the supervision, but his own work as a therapist and even his daily life outside his profession. Furthermore, his awareness that his efforts are under scrutiny is certain to influence and bias his supervisory interventions.

The supervisor also is likely to be concerned about his mixed relationship with the supervisee: its three components — work, social, and supervision — are bound to be sources of confusion and conflict. The supervision will be affected by the two other realms of contact, and. in making his supervisory interventions, the supervisor undoubtedly will modulate his comments depending on what has happened between himself and the supervisee elsewhere — sometimes making his remarks more critical than otherwise, sometimes less so. In all. the supervisor undoubtedly will lose some of his necessary concerned detachment and neutrality because of these contaminating factors.

The irregularity of the supervision might well give the supervisor pause for concern should anything go awry with the supervised case. As the recipient of notes in advance of the supervisory discussions, he might well over-intellectualize the supervision because the preview will deprive the supervisory process of its spontaneity and excitement, and of the constructive uncertainty that accrues when a supervisee presents fresh process note material in the sequence in which the session had unfolded. Doing supervision in the dining room also could spoil this supervisor's appetite and create many guilt-promoting distractions.

Without further speculation, it seems probable that this is a treacherous and by no means entirely gratifying situation for the supervisor. We can suspect, too. that many of the effects of the erratic and poorly defined structure of the supervisory situation will go unnoticed and exert their influence outside his awareness — a setting ripe for neurosogenesis. A framework of this kind, filled with contradictory inputs and sources of anxiety and guilt, is quite poor in its holding qualities and could well drive the supervisor crazy (Searles, 1959).

What then of the supervisee — the much-neglected partner to these arrangements? It is easy to imagine his anxiety in presenting his work to his boss and the many dreaded consequences he would conjure up should his work be judged inadequate or. worse still, as harmful to the patient. And what if the supervised patient did poorly or experienced a symptomatic exacerbation or severe regression, for example? The sense of vulnerability, so common among supervisees, is likely to be compounded to levels that might well be beyond endurance and containment. The basic worry over being viewed as a competent psychotherapist is also exaggerated under these circumstances. And what if the supervisor developed grave doubts about the supervisee's ability to be a psychotherapist — what then?

Think too how this supervisee must have felt not knowing when he would have his next supervisory session and yet knowing that, in all probability, it would take place in the dining room where others could hear what was being said and recognize what was going on. The authoritarian position of the supervisor, reinforced by the fact that he also is the supervisee's boss at work, is certain to make questioning and doubting his supervisory interventions a very difficult position to adopt — and unusually risky as well.

These difficulties are compounded by the absence of a clear and fair, unconscious means of validating the supervisor's efforts. In particular, making supervisory pronouncements from notes read in advance of the supervisory session precludes prediction and the use of encoded validation in the material from the patient that follows a supervisory proposal regarding technique and the like. We must raise serious questions as to how effective teaching and learning can be under these strikingly arbitrary and frame-deviant conditions.

And what about the secret reporting being done by the supervisor? While the supervisee is not likely to be consciously aware of this situation (unless he inadvertently finds out — imagine that), it is highly likely that he will unconsciously perceive the presence of these intruders — psychotherapy patients always do so. This unconscious experience will have extensive ramifications for his professional work and personal life without his knowing or being able to do anything about their source. Were the supervisee to become dramatically paranoid in his work or social life, he would be seen as regressing and as ill, and the unconscious and interactional sources of the syndrome would go unrecognized.

What can we learn from simply empathizing with the two parties to this supervisory situation? Given that this vignette involves a supervision that received official sanction, it seems fair to say that, by and large, there are no perceptible ground rules, frames, boundaries, or precepts that are in common use among today's psychotherapy supervisors. A review of your own experiences as a supervisee, and, where applicable, the work you have done as a supervisor, will reveal many departures from common sensibility, the absence of clearly defined frames, and little in the way of validated principles of supervisory practice.

It is disconcerting to acknowledge the arbitrariness of the conditions and means by which the vital experience of psychotherapy supervision is presently conducted. We can only, for the moment, try to imagine the career-long adverse effects that these uncertainties and their traumatic qualities have on today's supervisees — and their supervisors as well. There is a conscious-system tendency among psychotherapists to avoid the direct realization of the price they are paying in emotional dysfunction and self-harm, and in harm to their patients, for these ill-defined approaches to supervisory work.

There are so many complex factors in emotional life, and in the sources of emotional difficulties. that we are seldom aware of the critical triggers or roots of emotional regressions and grief—whether in supervisees or their patients, or in their supervisors. Nevertheless, unconscious influence is an ever-present and exceedingly powerful part of professional life in the emotional domain. The effects of unconscious experience in situations like psychotherapy supervision are quite real, whether they are recognized as such or not — and especially when they are not.

Returning to our vignette, through empathy we can sense too that the lack of a stable structure for the supervision must have been disquieting for all concerned. The anxieties and pressures of learning how to do dynamic psychotherapy are enormous. The situation challenges our cherished, much-needed, and evolved psychic defences which we are obliged to modify or surrender in the service of helping patients become aware of and benefit from accessing deeply unconscious experiences — the ultimate source of emotional dysfunctions. As if this were not daunting enough, many of the repressed, encoded images in a supervised patient's material are extremely unflattering to the student — and often to his or her supervisor as well: nevertheless, they need to be trigger-decoded and consciously realized by all concerned. Adding superfluous and unneeded sources of anxiety and disequilibrium to these basic apprehensions can only be harmful on all sides.

In a global but affecting way. this opening vignette hopefully has motivated us to re-examine the supervisory situation and the practice and process of supervision. The story raises many questions about supervision that are as yet without satisfactory answers. It seems reasonable to believe that it is possible to fashion more stable, secure, and constructive settings and ways of doing supervision and being supervised than we have seen here. Let us begin that pursuit forthwith.

Some Basic Supervisory Issues

We will, of course, examine more specific and detailed vignettes as we proceed. Still, this broad introduction can serve to alert us to the kinds of supervisory issues that we will need to address in the course of this book. Here then are the main questions we will try to answer:

1. How is supervision to be established and structured? Does it require a clear framework or can it be loosely defined? If a frame is needed, what are its proper and validated attributes? Indeed, if a frame is important, what role do the ground rules and boundaries of the supervisory situation play in the experience, enlightenment, and growth of a student—and of a supervisor?
2. How is supervision to be conducted? Is there a basic paradigm? When, if ever, should that paradigm be abandoned? Are written process notes needed for supervision, and. if they are, should they be written during or (soon) after a given therapy session? And should they ever be offered to the supervisor in advance of a supervisory hour, or should they simply be reported in sequence during the meetings between the supervisee and his or her supervisor? And finally, is there any place in supervision for recorded sessions — or are they essentially harmful and counterproductive?
3. What are the basic goals and fundamental precepts of sound supervision? What are the respective role requirements of both supervisors and supervisees? And what are the essential responsibilities, entitlements, and satisfactions of each?
4. While all parties to supervision must be respected and treated with utmost sensitivity and grace, to whom does the supervisor have the primary commitment — the supervised patient or the supervisee? What should be done when the needs of these two individuals are in conflict?
5. What should a supervisee expect from his or her supervisor? How can the supervisee assess the supervision that he or she is receiving? And what should a supervisee do when he or she is dissatisfied with the work of a particular supervisor? When is it appropriate to change supervisors or to terminate supervision when it is going badly?
6. What are the main issues that can arise between supervisors and supervisees, and what are the types of supervisory crises that also may occur? How are these conflicts and problem situations best resolved?
7. What are the potentials of supervision and what are its limitations?
8. How long should supervision last, and when and how should it be appropriately terminated? And after termination. what is the position with respect to future contacts between a supervisor and supervisee? How should the search for further supervision for the terminated supervisee be handled, and what about the task of engaging in self-supervision?
9. How does supervision interdigitate with the psychotherapy of the supervisee? Must the two situations be in different hands, or is there some means and advantage to their being done together?

As you can see, there are many pertinent unresolved issues related to the structure and nature of the supervisory process. The wide scope of these questions, and the uncertain response that many of them evoke in most readers, tells us that supervision is a territory that is, as yet, poorly explored and only vaguely mapped. The overall goal of this book is to give supervision the clear definition it deserves, while allowing as much room as possible for the individuality and inventiveness of both supervisors and supervisees.

The firmer the principles of supervision, the greater the opportunity for effective teaching and learning. Teaching activities do not go well when they are conducted within unstable conditions or with inconsistent techniques. Ill-defined efforts of that kind tend to generate schisms and contradictions between conscious and unconscious experience that disrupt the learning and growth of the supervisee.

The goal, then, is to identify ways that supervision can be conducted within a constructive, stable holding environment, with consistent yet sensitive and individually applied techniques. and in a manner that is consonant with both conscious and unconscious needs and experience. To do this, we need a validated methodology and a set of confirmed teaching principles. While these can be developed from observations within supervision itself, it is helpful to begin by exploring what clinical experience in the psychotherapy domain can offer as a guide and background to these efforts. This, then, is the subject of the next chapter.

*This book is about the supervision of dynamic forms of psychotherapy. It is. however, illuminated by psychoanalytic understanding. Therefore, no effort will be made to distinguish psychotherapy from psychoanalysis proper because the principles developed in the book apply to the supervision of all modes of treatment, including formal psychoanalyses.

Chapter Two
A clinical foundation for supervisory practices

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.

But there is yet another problem that besets today's supervisory practices. There is considerable evidence that psychoanalysts have retreated from a strong and clear position on the definition of its most basic proposition — the existence of a powerful unconscious domain with respect to communication, perception, fantasizing and remembering, and processing and adapting to incoming information and meaning. Characteristically, existing ideas are global and nondescript, so that anything that lies beyond someone's awareness at the moment is defined as unconscious. These elements may be processes, unnoticed patterns of behaviour, trends and actions, needs and motives, and the like. There is, however, virtually no conception of an organized unconscious system of the mind, one that embodies strong processing capacities and a deep intelligence. Nor is there a systematic approach to unconscious communication and to the means of defining and accessing unconscious m...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• FOREWORD
• Introduction
• CHAPTER ONE Issues in supervising psychotherapy
• CHAPTER TWO A clinical foundation for supervisory practices
• CHAPTER THREE Models of supervision and unconscious validation
• CHAPTER FOUR Frames and systems: contexts for supervision
• CHAPTER FIVE The fixed frame of supervision
• CHAPTER SIX Privacy and confidentiality
• CHAPTER SEVEN Relative neutrality and anonymity
• CHAPTER EIGHT The process of supervision
• CHAPTER NINE The supervisor: basic issues
• CHAPTER TEN The supervisor: basic precepts of supervision
• CHAPTER ELEVEN The supervisee: responsibilities and entitlements
• CHAPTER TWELVE Supervisory crises
• CHAPTER THIRTEEN Taking issue with the standard models of supervision
• CHAPTER FOURTEEN Self-processing supervision
• REFERENCES
• INDEX