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Chapter 1
A relational approach to supervision
Helena Hargaden
This approach is founded on an understanding that most relatedness is unconscious, that the unconscious mind cannot be discovered through cognitive means, and is based on a humanistic interpretation of the bi-directionality of transference and counter-transference (Moiso, 1985; Moiso and Novellino, 2000; Hargaden and Sills, 2002). The relational approach has its roots in the humanistic philosophy of a dialogic relatedness (Buber, 1970/1923), in which the therapistâs use of self and willingness to be vulnerable and change in relationship, is considered paramount to effective therapy with suffering people. There is an emphasis upon containment, with an understanding that the container will need to crack (ruptures and enactments) to shine a light on dissociated material. Drawing on theories of intersubjectivity and the co-created âthirdâ, definitions of which will be found below and throughout the chapters in this book, this relational approach has been co-created between supervisor and many supervisees who have been willing to travel on an experiential relational journey of discovery about how and why relationship and relatedness matters. It is primarily for this reason that I refer to relational supervision as an art form.
Interest in relational psychotherapy has been developing over many years, both in the psychoanalytic field (Mitchell and Aron, 1999; Aron and Benjamin, 1999; Aron, 2006) and in the humanistic tradition (Yontef, 1988; Shmukler, 1991; Moiso, 1985; Hargaden and Sills, 2002). Research (Asay and Lambert 1999; Beutler and Harwood, 2002; Luborsky and Auerbach, 1985) indicates that the relationship is a central feature of effective outcomes in psychotherapy. Before I discuss some major influences on my relational approach I begin with a reflective analysis of my experience of supervision practice.
Pitfalls in supervision: power and ethics
In the following section I offer my critique of some supervisory practices, not from a position of superiority, but more from the perspective of how we may learn from our experience and our mistakes. The question I am interested in here is what really works and supports our clinical practice and what is either unhelpful or damaging. Perhaps it is as a supervisee that we are best positioned to critique the process of supervision since the supervisee is best positioned to know what has been clinically fruitful in the therapeutic relationship. It is therefore from my experience as a supervisee that I offer the following reflections.
I have had many enlightening experiences which have informed my work as a therapist and as a supervisor. I feel gratitude towards those supervisors I have had in the past thirty years who have been willing to sit with me and listen, play and tussle with the questions, concerns and anxieties I brought to supervision. Acknowledging this positive experience however, and with the benefit of hindsight, I have reflected on those aspects that were either not so helpful or quite damaging. Beginning in the mid-1980s I struggled initially to know what I was supposed to do in supervision. In Chapter 4 Birgitta Heiller highlights the experience of the trainee psychotherapist and how, as supervisor, she manages the need for certainty and direction often thought to be typical of the new trainee in therapy. I was reminded of starting out in the profession as a trainee psychotherapist and new supervisee when I felt alienated by the behavioural focus and insistence on âobjectivityâ. From this experience I learned how unhelpful it can be when a supervisor relies too heavily on formal structures that become so controlling that no illicit thought or feeling could possibly escape into the environment!
It was with some relief that I found a supervisor who also seemed interested in the feelings of the therapist, creating an environment it which it was more possible to deepen associations and relational connections between therapist and client. In hindsight I think though that within the humanistic tradition we have tended to elevate feelings. I have seen how this process can lead to gratuitous and unfocused dynamics that do not change anything. In this context I found reading Guggenbhul-Craigâs (1971) critique of empathy useful, in which he suggests there is a shadow side to empathy that bestows an exaggerated and false sense of worth on the person expressing the feelings whilst simultaneously making the empathic person powerful, enabling them to hide their realness. An example of this is when the emotionality of a member of a supervision group is allowed to eclipse the clinical concerns of the client or patient. This way of working can seem to be ârelationalâ but often leaves other participants feeling hidebound to be âempathicâ with the emotional needs of another member of the group, quietly wondering, âWhat about the client?â or more particularly, âWhat about my client?â. Such an emphasis on âempathyâ can create an environment of âfaux loveâ. Nonetheless feelings of course are important, for without them âthe edifice of reason cannot operate properlyâ (Damasio, 1999, p. 43). The learning from this critique is that feelings used in this way are indeed the superhighway to the unconscious enabling us to refocus on the meanings inherent in feelings, that we are more likely to access different levels of unconscious associations through the emergence of new language (Eigen, 2006b).
Conversely, within the very different tradition of classical psychoanalytic supervision, I found that intellectual analysis seemed to trump feelings, that in essence feelings became second-class citizens. Although I found psychoanalytic supervision to be rich with insightful perspectives, there seemed to be an implicit expectation that the supervisorâs intellect, knowledge and ability should be understood as superior to the therapistâs knowledge, and that the analystâs interpretation was non-negotiable, regardless of what feelings might be in the room. Of course this may have changed over the years, and I do not wish to minimise the indisputable contribution of psychoanalysis to the development of the relational approach; for example, my most recent experience in psychoanalytic supervision has been very different in kind. I do not know if this is because that tradition is also changing or I just happened to meet an egalitarian-minded person with whom I had a supervisory relationship based entirely on mutual respect and reciprocity, providing an atmosphere in which I significantly increased my emotional and intellectual development as a clinician. Yet two examples come to mind of a particularly damaging effect of a non-relational, non-negotiable approach to supervision, and although they occurred in the psychoanalytic tradition they are not limited to that modality alone. More recently, for example, I hear not entirely dissimilar stories from trainees who are on placements, sometimes in environments that seem to be driven by anxiety, and rigid attitudes towards clinical work not confined to psychoanalysis but across all modalities. Some may recognise elements of their experience of the misuse and even abuse of power by people in organisations in the following two examples.
In the first example I was a trainee psychotherapist on a placement at a London psychiatric hospital. My psychoanalytic supervisor stopped my work with a young Irish woman, a victim of the troubles in Northern Ireland, because he considered that I worked too interpersonally: this was after I had made a strong feeling connection with her, as a result of which she experienced a breakthrough in her depression. Not only did he seem fearful of the interpersonal exchange that had developed between myself and the patient, he failed to understand the significance of the cultural complexity embedded in the therapeutic relationship I was engaged in with the patient (see below for a fuller discussion using the cultural âthirdâ as a symbol to examine what happened between the supervisor and me). The supervisor became anxious at the type of intimacy that developed between myself and the patient, a closeness that was connected to our shared cultural connection; a connection that was forged through a shared affective experience of the effects of the Irish diaspora (I say more about this in Chapter 8). I knew this to be vital to her mental health because I shared a conviction along with Geertz (1973) and Samuels (1993) (see my collaboration too with Tudor in Tudor and Hargaden, 2002), that there is no such thing as human nature without culture. Instead, the supervisor viewed cultural analysis as irrelevant to the work of psychology and interpersonal connection as flawed and dangerous. I have often wondered about that young woman, and how she fared. The psychoanalyst was able to behave in this way because he came from a place of guaranteed superiority, supported by the hospital structures, a theoretical perspective that was rooted in quite a rigid methodology and a sense of his own certainty that he was absolutely right.
In a different and more benign example, in part because there was no organisational ballast behind the supervisor and, as you will see, the clientâs natural instinct was to reject what he experienced as an unhelpful interruption into the therapy relationship, a different psychoanalytic supervisor told me that my interpretation of my clientâs dream was facile, superficial and completely missing the mark. I had not mentioned that it had been my clientâs interpretation. The scornful tone of the supervisor unfortunately made it too difficult for me to integrate his understanding into my subjectivity. Instead, I offered the âsuperiorâ interpretation to my client, who snorted and returned to his next session to tell me about a dream he had had in which a big fat farmer caused the plane in which my client and I were on a journey to crash into an empty field! I think this is a good example of how an interpretation, delivered in such a disembodied way, misses the relational point, and in doing so, not only loses the intended impact, but makes what might have been a useful clinical intervention redundant. Maybe the supervisor was accurate, maybe too I was so in awe of the supervisor I could not integrate his interpretation into my subjective experience, which brings me to several questions about ethics and supervisory authority. How do we own our authority in the relational field? Where does the balance lie between authority and relationality? The supervisor, by definition, has seniority and responsibility, so how can we maintain those boundaries as well as being truly co-productive? I say more about this in Chapter 9 when I give examples of how ethical questions can appear to conflict with the relational ethos when mutuality has been confused with equality.
As a supervisor of more than twenty-five years of course I have fallen into some of the above traps. Supervision is a complex and challenging job! Many questions arise about how to find a balance between empathy, cognition and the provision of a space in which some aspects of the unconscious of both the client and the therapist, as well as that of the supervisor, can reveal themselves.
Early influences on the development of my relational approach to supervision
Since the advent of the now obligatory supervision course there is quite an emphasis upon theories of supervision which, although very useful, may also suggest that there is a uniform way to do supervision. The question discussed here is how the self of the supervisor is formed and influenced, how she draws on her life experience, including her unique way of integrating theory into her practice, and why this matters in the clinical situation of supervision. In the following examples I share some of the influences upon my clinical development to demonstrate how our personal experiences and subjective integration of theories shape who we are as supervisors. I show how this will both consciously and unconsciously impact upon the type of supervisory environment we co-create with our supervisees.
Improvisation and intuition
In my younger years, working as an English and Drama teacher, I learned the art of improvisation. Improvisation is defined as being able to âmake or contrive without preparation in an emergencyâ (Chambers, p. 766). The ability to improvise, and become good at it, seemed, at the time, to be an imperative if one was to survive each dayâs experience of working in an unpredictable environment with groups of lively children in a large comprehensive school on Merseyside. Retrospectively I can appreciate the influence of this early training on my work as a therapist and supervisor and on my development as a relational psychotherapist and supervisor. In her fascinating book about philosophical influences upon clinicians, Donna Orange (2010) discusses the influence of Martin Buber on humanistic thinking. The concept of âconfirmationâ, which formed a part of Buberâs dialogic philosophy, is clarified in the following way: âconfirming [a]â person as he is is only the first stepâ. For Buber confirmation of the client or patient involves the therapist taking in the patientâs âdynamic existence, in his specific potentialityâ, a process which has to involve the therapist feeling this potential (Buber, 1999, pp. 242â3, as cited by Orange, 2010, p. 27). I now understand my use of improvisation as an intuitive way to develop the potential inherent in the children, enabling them to find so much more within themselves than they thought might be possible, using play and the imagination to pretend and discover.
Although improvisation is defined by Chambers as a creative process, more negatively it is described as âto do anything without proper materials or preparationâ (p. 766). Perhaps there is an argument then to suggest that improvisation is most successful when the source of creativity is based on a wealth of experience. Nevertheless, when training to be a psychotherapist, I was taught that spontaneity was a contaminated idea, leading, as it easily could, to flippancy, and worse, revealing hidden sadistic instincts that would be harmful to a client or patient. It was of course both appropriate and containing for trainee therapists to be wary of our intuitive impulses. We were taught to rely on the facts of the situation, test any intuitive hypothesis with those facts, and to make a clinical diagnostic case for any interventions made. This rigorous type of training set the scene for a containing, ethical and professional practice, providing a secure environment to work with suffering people. The training provided a model of ongoing personal research, in which the clinician learned how to measure her use of interventions so she could be as effective a psychotherapist as it was possible to be: an ethical and professional goal worthy of all psychotherapists ambitious for the well-being of their clients or patients. Yet a crucial understanding about the nature of how people change was missing from this training, a fact I discovered by accident a few years after I had begun my private practice in the mid-1980s, prior to qualifying.
A vignette
I recall my work with a man who was possibly on the autistic spectrum, a condition I was unfamiliar with at the time. He spoke through the medium of his fascination and love for the composer BartĂłk, speaking in detail about BartĂłkâs use of tonality, which apparently did not follow traditional lines of musicality. His detailed description of the numerical aspects of the music often sounded like arithmetic or algebra to my ears. With the benefit of hindsight and experience I can now see that he was trying to tell me something in code about his difficulty with emotional connecting. Impervious to this understanding at the time I tried to decipher what he was saying through the medium of my fascination with the theoretical perspectives of transactional analysis and person-centred psychotherapy. My response to my clientâs communication was to jump up quite frequently to a whiteboard (it was thought appropriate and helpful to have a whiteboard in oneâs TA consulting room) and draw circles and triangles on the board, referring to ego states (Berne, 1961) and the drama triangle (Karpman, 1968), trying, as I imagined, to respond empathically to what my client was telling me by converting it into circles and triangles. We must have looked a rather odd couple: him with his algebra and arithmetic and me with my geometry. To an onlooker it would have seemed as though we were speaking in âtonguesâ! Nonetheless something important was happening under the surface as he continued his therapy, but I had no consciousness then of what that might have been.
About three months into the treatment, on the night before his session, my small son was ill and I spent a sleepless and anxious night tending to him. I cannot recall what the illness was but I was very uneasy and all the more so because any childâs illness made me fearful and excessively anxious of pending loss, with its unconscious echo of my time spent in hospital as an infant, not that I thought about that at the time. Instead of cancelling the session, I stoically carried on. However I was not in my âfascinated with my theoryâ mode. Instead I was feeling vulnerable, and in the type of space between sleep and wakefulness that John Keats (1899) described as ânegative capabilityâ, when a poet is at his most creative. In this vulnerable state I was more reliant on my intuitive sense, and although I cannot recall what exactly I said, it seemed, from what he later told me, that it was the quality of my listening, infused by the uncertainty that sleeplessness can bring, and an attuned sensibility towards the sickness in myself and others, which most affected him. I was most conscious however of a feeling of discomfort that I was not doing my job properly and hoping my client did not notice. I was surprised therefore when, at the end of the session, my client stood up, picked up his briefcase, turned to face me and, after a pause, when it seemed that he might be deciding whether to comment or not, and in which I dreaded to hear him say he was leaving therapy, he thanked me for the session, telling me it was the best one so far. I could see the feeling in his eyes, and something about the vulnerability of his body was captured by the way his pinstriped suit seemed to wrap itself around him, reminding me of how an infant is protected in a shawl, leaving me feeling a deep sense of sadness as he left.
Feelings had finally got through to me â feelings he had been trying to convey in his obsession with BartĂłkâs unconventional use of tonality. As I sat with my reflections, I noticed another emotion that was at odds with my sense that I had not done a very good job, it was a sense of my worth and value in those moments of meeting between us: my value as a human being. Something had happened that I had no theory for then, something intriguing and encouraging, leading me to think that maybe it was possible to be a good clinician whilst I strayed outside the strait jacket of concrete facts. Linking this to my work with children as a drama teacher I began to see how psychotherapy was potentially as intimately connected with artistic expression as it was with science (particularly medical science). My vulnerability had seemed to have the effect of a healing quality on the therapeutic relationship, my willingness to let go of âfactsâ, go with the âflowâ and improvise the session encouraged a connection at a feeling level. In Buberâs words I was more open to the âI-thouâ of relatedness, no longer coming from the superior position of the one who knows, but from one who listens, is open to connection, is able to feel the potential for mutuality. He was no longer an âitâ to me, no longer an object I had to do something with. From these experiences I learned that there was a role f...
