The Integrative Family Therapy Supervisor: A Primer

Robert E. Lee, Craig A. Everett

• Publisher: Routledge
• Year: 2004
• ISBN:
  9781135942427
• Edition: 1
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Encouraging the development of a personal model of supervision built upon the integration of theory, research, and regard for the uniqueness of clinical settings, this new text will prepare readers for approved supervisor credential while advancing their ability to blend systemic theory with clinical practice in the context of personal and professional development.

Chapter 1
Basic Ingredients in the Supervisory Process: The Ground Rules of Supervision

Learning to be a supervisor, like learning to be a therapist, is a lifelong task. But you need to begin somewhere and the journey of a thousand miles begins with the first step. This chapter is meant to be that first step. We intend to build a foundation upon which everything that follows can be erected. We believe that it is important for a beginning supervisor to have a clear understanding of those principles that seem to be central to all effective family therapy supervision.

First, we will ask you to reflect upon positive and negative experiences you have had as a consumer of supervisory services during your own training and to consider what you have learned from them. Next, we will identify and review what others in the family therapy field generally consider to be foundational to family therapy supervision. In the course of our journey together we expect that you will give considerable thought to these and make aspects of them your own.

Appreciating What You Already Know

We want to begin a process of personal reflection on your own resources which then can be integrated into the clinical and theoretical issues we will discuss. We would like you to think about your best and worst supervisory experiences. We want to stir up those memories to make your reading of this work more relevant and remind you of how much you may already know about effective supervision.

As you cull your memories for things that will be helpful to your own practice of supervision, we would like you to be very systematic and behaviorally explicit. In each exercise that will follow, close your eyes and try to really picture an event or a relationship as it occurred. Try for detailed visualization, with an alert eye to tone of voice, facial expression, and other body language. It may help to picture the room, your clothing, and even the season. As you reconstruct the past, visualize actual behaviors that illustrate what you mean: “I am——ing. My supervisor is——ing.” For example, if you are saying “My supervisor is being supportive,” what does “being supportive” look like in that vision? If someone is being “critical,” what demonstrates that? Finally, we recommend that you put the content that you construct in these exercises down in a journal or notebook so that you can integrate you insights when you begin to formalize you own philosophy of supervision in Chapter 13.

Exercise 1: Your Positive and Negative Models

Take a few minutes to close your eyes, think back, and visualize.

• What have your previous supervisors done that has been really helpful? What were their resources that you appreciated, at the time or in retrospect. Picture a supervisory session with a supervisor you really found beneficial. What was she or he doing in that session? And what were you doing?

After you have thought about this for a while, make a list of these ingredients. Then, prioritize them.

• Now think about when you were being supervised, and identify what sorts of things you would not want to experience again. What were the experiences at that time, or in retrospect, that were not helpful? If you can picture a really ugly session, do that. What was the supervisor doing and what were you doing?

Again, make a list and then prioritize these items.

Exercise 2: Supervisory Relationships

• Think of individual supervisors now or in the recent past who you value or have liked a lot. Think of your overall time together with these supervisors. Identify the supervisors who you really have appreciated in their overall relationship with you.

List and rank these with regard to their importance to you.

• Think of individual supervision now or in the recent past where you have felt dissatisfied, ill-at-ease, irritated, confused, or negatively tense. Think of the overall ambience of these relationships.

Make a list of those issues you have experienced as off-putting or unhelpful. Rank these with regard to their importance to your supervision experience.

Exercise 3: Developmentally Appropriate and Inappropriate Models

• Think of supervisors who you experienced as very helpful when you were first starting out. List their resources that you have really appreciated in the overall relationship.

List and rank these with regard to their importance to you at that time (and presently, too, if that would change your perceptions).

• Think of supervisors whom you experienced as not particularly helpful, or even as detrimental, when you were first starting out. List their traits or behaviors that you considered negative in the overall relationship.

List and rank these with regard to their importance to you at that time (and now, if that would change things).

• Think of specific episodes in specific training sessions with your first supervisors. What did you want from them during an episode and what did they do that you felt was unhelpful or detrimental?

Again, list and rank these with regard to their importance, if that is possible.

Exercise 4: Compiling Your Personal Lessons About Effective Supervision

Take a few minutes to reflect on what you have written. Go though your lists and highlight those items that strike you as very important to supervision at any stage and in any setting. Also identify those items that were sensitive to your developmental level or practice setting at the time. How do (or will) such personal experiences shape what you do as a supervisor?

We suspect that as you look at your two lists—the resources and dynamics that have typified good supervisory experiences for you and those that were toxic—a basic recognition of the nature of good supervision will start to emerge. We also suspect that as you complete these exercises, as with our own supervisors-intraining over the years, the issues you have identified have more to do with the process of supervision than with concerns regarding specific theoretical issues or schools of thought.

With all of these things in mind, the next step is to review what the supervision literature considers foundational.

13 Basic Principles of Clinical Supervision

We have identified 13 principles (Table 1.1) that appear to represent a core of theory and research about family therapy supervision. These have been derivedboth from the theory and research regarding clinical supervision in general as well as from our own experiences as training supervisors. We have found these principles to be essential to our own work over the years as clinical educators and family therapy supervisors. Each of these principles will be discussed in the ensuing chapters. We are listing them here at the beginning because they can provide a foundation upon which your own model of family therapy supervision will be built and evolve. However, we do not expect that this list is exhaustive. Over time, we expect that you will add to these principles from your own experiences.

1. Supervision Must Be Respectful

We must learn to look for, identify, and appreciate the unique qualities, resources, and constructions of reality of the many therapists and their clients we will supervise over the course of our careers. To do this successfully we must examine our own cultural views and values and become acutely aware of how they can influence our perceptions of those with whom we work (Anderson, J., 2000). Supervisors need to be attuned to and model sensitive and respectful verbal and nonverbal language and interaction (Corey, Corey, & Callanan, 1988; Haber, 2000; Isaacs & Benjamin, 1991).

TABLE 1.1 Basic Principles of Supervision

2. Supervision, Like Therapy, Must Be a Safe Place

When trainees are unnecessarily anxious, or even fearful, learning will be inhibited. Personal security for all of us facilitates self-disclosure, openness to feedback, and the risk-taking behaviors necessary to learning and professional growth. Consider your own training experiences. When supervision did not feel like a safe place to you, what happened? Our guess would be that you felt defensive or cautious. We would also expect that, if you felt afraid of or intimidated by your supervisor, you also felt uneasy with some clients. When a supervisor pushes a therapist to perform in a certain manner to get results, the therapist often passes those expectations on to the clients. (This refers to the concepts of parallel process and isomorphism. These are revisited in Principle #6 and are discussed in Chapter 3.)

As supervisors, if we cannot create a safe place for growth in our supervisory roles, we can expect our trainees to present us with a variety of defensive behaviors, from resistant to deceptive. For example, they may “forget” to tape sessions with difficult families or they may only bring in “successes” for you to review. They may be overly anxious or stern with their clients.

Rest assured, we are not advocating for the maintenance of tranquility of trainees! Safety for personal learning and growth certainly does not preclude critique, challenge, and even confrontation. Just as the experienced family therapist knows how to carefully perturb a dysfunctional family system, we recognize that a certain amount of discomfort often can enhance growth. Perhaps it is shaped something like a bell curve: too little stress and individuals may remain complacent, too much stress and individuals may panic. Some amount of arousal is probably “just right.” (In subsequent chapters we discuss this balance of stress and learning in the actual supervisory process.)

Emerson (1999) has suggested five elements of supervision that can promote and enhance safety for the trainee.

1. Supervisory sessions should aspire to be settings in which the trainees feel truly listened to, actively and attentively, by the other participants.
2. Supervisors should pay close attention to the trainee’s words and the feelings behind those words, respecting and accepting the individual who is speaking.
3. There should be no hurtful remarks, humor in which someone is victimized, or acceptance of self-degradation.
4. Trainees should have “the right to pass” with regard to struggling with specific issues.
5. Both supervisor and trainee must honor and promote safe sharing through strict confidentiality. This recommendation goes beyond the AAMFT ethical standards (see Principle #12 and Chapter 12) that prohibit only supervisors from revealing confidential information about trainees. All participants in the training system must feel trust.

3. A Working Alliance Must Be Developed

From the earliest stages of interaction in the supervisory relationship there must be shared goals and enough of an alliance to support work on achieving those goals (e.g., Colapinto, 1988). Bordin (1979) observed that a working alliance includes mutual agreement about the goals, theory, technique, pairing, and bond. No matter what issues or dilemmas appear in the supervisory experience, maintenance of this working alliance with your trainee must continue to be your first concern.

An important aspect of developing this working alliance is the supervisor’s ability to be open and available to the therapist while maintaining appropriate boundaries. Self-disclosure by the supervisor to the therapist is an important part of this process. However, all self-disclosure should be offered by design. Just as in our clinical work with families, in which we need to gauge an appropriate degree of connectedness and separateness, we need to be aware of the same dynamics with our trainees.

Williams and Dombeck (1999) discovered in their focus groups with supervisors and trainees that the use of self-disclosure by supervisors may be a good way to model openness and facilitate joining, provide reassurance, and educate about the therapeutic and supervisory processes. However, too much personal material or self-disclosure can make trainees uncomfortable by promoting intimacy or providing personal information that therapists do not wish to know. Therefore, self-disclosures by supervisors should be carefully considered interventions and include only material that has been thoroughly worked through by the supervisor. Supervisors should never use trainees as “sounding boards” for their own personal problems or conflicts with colleagues, and trainees should not be made the keepers of information that would be embarrassing for others to know.

4. A Supervisor Does Not Offer Therapy to the Clinical Family

It is the therapist’s role to provide direct clinical work with the clients (Nichols, 1988). It is important to remember that one’s proper level of focus as a supervisor is on the therapist-client subsystem, no matter how inexperienced or ineffective your trainee may appear (Liddle, 1988). Some beginning supervisors may succumb to the temptation to show off their own clinical skills or to rescue the therapist or the therapy situation. Many therapists themselves may look for an opportunity to shift the therapeutic responsibility to their supervisors or to be rescued! Remember: The therapist treats the client and the supervisor facilitates the therapist. Of course, issues of client welfare, family safety, and personal harm may arise in which a supervisor may need to intervene. We discuss these matters in Chapter 12.

5. A Supervisor Does Not Offer Therapy to the Therapist in Training

As clinicians we recognize psychological and psychiatric disturbances on the one hand, and personal emotional issues that inhibit education and therapy on the other. Unless a supervisor operates from a Bowenian point of view (see Chapter 6) supervision and therapy are typically viewed as two distinct roles and the AAMFT Code of Ethics, Principle 4.2 (American Association for Marriage and Family Therapy [AAMFT], 2001) prohibits combining them. Therefore, most of us will be concerned about recognizing and maintaining the boundary delineating one role from the other. We also need to appreciate when therapy, as an adjunct to supervision, will be useful and/or required. This issue regarding the potential referral of a trainee for therapy is discussed further in Chapters 11 and 12.

6. Supervision Operates Within a Clearly Defined Clinical Training System That Includes Intergenerational Subsystems and Dynamics

A clinical training system is a complex environment “with reciprocally influencing domains of conceptualization and action” (Liddle, 1988, p. 154). However, such a training system can be thought of in the same way that family therapists understand the intergenerational dynamics of family systems.

A training system includes at least three and often four generations:

1. The supervisory mentor/supervisor
2. The Approved Supervisor candidate
3. The therapist or trainee
4. The client-family

Of course, the relative hierarchy and various dynamics of this intergenerational system may be viewed differently through the lenses of different supervisory models (see Chapter 6). Nevertheless, the interaction between each of these respective generations (e.g., the supervisor and the therapist) represents a distinct clinical subsystem. Just like in a family system, there will be relational dynamics such as triangles and coalitions. This systemic perspective allows a supervisor to step back and more objectively view interactional dynamics, defensive behaviors, and stuck places in order to be able to understand one’s training role.

The systemic supervisor expects that interactional patterns within the overall training system will replicate themselves within each subsystem (Liddle, 1988). This is called isomorphism. Isomorphism has been defined in a variety of ways (White & Russell, 1997). Generally it is considered to be a parallel process wherein patterns that occur in the client’s relationships may also occur in both the therapeutic relationship and the supervisory relationship. This dynamic can provide valuable insights for supervisors in understanding underlying dynamics with their trainees, and between their therapists and their clients (Lee, 1999a; Liddle, 1988; White & Russell, 1997). For example, if you and your therapist experience turbulence in your relationship, it may be a clue as to what may be happening downstream in the therapeutic relationship.

Isomorphism also provides clues to potential interventions (Liddle, 1988). For example, the supervisor’s move to correct a dysfunctional relationship between herself or himself and a therapist may result in parallel changes between the therapist and the clinical family. By way of an embarrassing example from early in his career, one of us (REL) was flattered by a therapist under his supervision, lost his objectivity, and accepted her request to provide therapy to her son. Concurrent with this happening, the therapist allowed a mutual attraction to build between her and an amorous client who was separated from his wife. A supervisory mentor saw what was happening, laid down the law, and once the supervisor quit muddying the water with his own boundary problems, the therapist ceased her unprofessional relationship with her client. Isomorphism and intergenerational issues are discussed further in Chapter 4.

7. The Dynamics of Supervision Involve Hierarchy and Power

Concerns regarding safety often involve issues of power. For the beginning supervisor the various types of power in a training situation may not be easily recognized. To be sure, some issues of power are quite overt and in many settings institutionalized. As a supervisor you become recognized as an authority within your clinical setting, and you are also ultimately responsible, legally and ethically, f...