Doing Better

Improving Clinical Skills and Professional Competence

Jeffrey Kottler, W. Paul Jones, Jeffrey Kottler, W. Paul Jones

• Publisher: Routledge
• Year: 2004
• Print ISBN: 9781138415119
• eBook ISBN: 9781135451165
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Doing Better is intended to help therapists and counselors to explore more fully and systematically the processes of self-improvement in their work and lives.

Chapter 1
When Therapists Supervise Themselves

Jeffrey A.Kottler

On the surface of things, the whole idea sounds pretty ludicrous: a therapist supervising him- or herself is sort of like trying to see the back of your own head—without a mirror. Even if a reflective object was available, the whole enterprise is so awkward, the angles so limited, the view so restricted, that it hardly seems worth the effort…unless, of course, there is nobody else available who can tell you that there is some unflattering indentation.

Therapists attempt to supervise themselves sometimes out of choice, but more often out of necessity. When there is nobody else around, when there isn’t the option of waiting until the next scheduled supervision session, we may have no other choice except to try and work things out on our own.

Needless to say, there are limits to what one can do on one’s own. For instance, it is difficult, if not impossible, to recognize and work through characterological problems on one’s own; believing you can do so might be evidence of its’ own form of personality disorder (Shub, 1995).

The Role of Supervising Oneself

There have been times in my career when I have worked with a supervisor I trusted fully, a mentor with whom it felt safe to share aloud my fears and insecurities, but that has been the exception rather than the rule. In most of the clinical settings in which I’ve worked, my supervisors were evaluators as well as consultants. They were the ones who decided if I got licensed or promoted. They wrote reference letters testifying to my competence. They decided if I was good enough, and their judgment might very well affect my whole future career. There was no way in such situations that I was ever going to talk about how little I really understood about what I was doing.

In case conferences, my fellow therapists and I would only bring up those clients with whom we already had a pretty good idea about what was going on. Although we were encouraged to present those clients and families with whom we were struggling the most, the actual consequence of doing so was that we would have most likely been skewered alive, ridiculed for our ignorance, and held out as examples of poor training and judgment. Group supervision was absolutely the last place in the world where we would have thought about being frank and honest about where we needed help most.

Even in individual supervision, I was reluctant to bring up my deepest fears of inadequacy, although I might very well do so during the times I consulted my own therapist to work on these issues. It was one thing to tell a therapist I trusted that I felt like a fraud, that most of the time I was faking it, pretending I knew so much more than I really did. But alas, the supervisors who controlled my workload would never have been those to whom I could reveal my greatest vulnerabilities.

I hope I am among the slimmest minority in this regard because I would hate to think that my own supervisees feel the same toward me, or that the majority of practitioners out there in the world are merely going through the motions in their own supervision. Unfortunately, based on my own research on the subject, I know that I am hardly alone in my caution. There are many of us just going through the motions with our supervisors, just doing what is expected in order to meet the minimal requirements.

Over the years, I have heard so many therapists relate similar stories of “performing” for their supervisors, saying what was expected, presenting “safe” cases in which they could demonstrate their expertise, flexibility, and responsiveness to suggestions. “The last place I’d ever talk about a troubling case,” one therapist admits, “is with my supervisor. Even if the guy could help me (which I often doubt), there would be repercussions at a later time.”

“What sort of consequences?” I asked her, feeling both intrigued and disturbed by how casually she was validating my own experience.

“Oh, you know. The usual. Black marks in my record for being less than perfect. Paternal condescension in which I was expected to act like a needy child. Basically feeling vulnerable because I admitted I don’t know what I’m doing all the time.”

“So?” I asked again. “Where do you get help with your difficult cases?”

This therapist revealed that she talks to colleagues about her struggles, but sometimes that isn’t all that helpful (or safe) either. So most of the time, she pretty much keeps things to herself, tries her best to look good in front of her peers, and then tries to figure things out on her own.

Such a strategy, of course, is not only misguided but also dangerous. Therapists are not only mandated to work continually on improving competence through various supervisory/educational experiences by qualified experts, but we need to do so in order to survive the uncertainty, ambiguity, and complexity of our jobs. If hierarchical supervision (with a designated supervisor) or peer supervision are preferred, the reality is that much of the time rather than consulting with others we try to work things out on our own. This may involve a variety of self-supervision activities, from solitary reflection, meditation, and journal writing to reading books, constructing narratives, reviewing audio- or videotapes, or journal articles (Lowe, 2000; Todd, 1997). At its best, self-supervision activities are highly rigorous and critical for continued improvement in clinical skills (Morrissette, 1999, 2002).

There are so many blind spots and dangers associated with trying to monitor our own progress; it flies in the face of the most sacred standards of our profession. Self-supervision is not intended to replace the formal instruction or structured supervision that is so critical for reality testing, accountability, and receiving constructive feedback. Rather, it is designed as a supplement for these traditional forms of professional improvement that involves training in specific skills (Donnelly & Glaser, 1992). Because therapists and counselors are in the rather unique role of facilitating positive changes in other people’s lives, we are also perfectly positioned to make ourselves better as well.

Realities of Practice

Most of the time I am doing therapy I feel lost, confused, or in over my head. Under such circumstances I would love to have someone (or several someones) whom I can consult with about these cases, and particularly to talk about my feelings of ineptitude, failure, and impending doom. I have been fortunate at various times in my career to have such opportunities, but often the timing isn’t right.

For example, right now I spend most of my professional life teaching therapy in the classroom. Even though I have been doing this for almost 30 years, there isn’t a class I live through that I can’t think of at least a dozen confusing incidents that I didn’t understand and twice that number of things I said and did that were less than effective. I leave each class flooded with thoughts about things I could have done differently, just as I do when I see clients. The amazing thing to me, however, is that faculty almost never watch each other teach and almost never seek or offer feedback to one another. Somehow, it is assumed that because we are supposed to be such experts, we no longer need such supervision. So we rely almost entirely on student evaluations that, although useful, offer us a limited view of our behavior.

During the last class I taught, I was working with a group of masters students in Hong Kong. Although the students are quite fluent in English, some of them feel some reluctant to express themselves outside of their native language, especially related to the kind of personal matters that often crop up in a group therapy class. More than I am used to, there is a tremendous fear of losing face.

The discussion about instances when leader intervention is required was going particularly well when, all of a sudden, one of the students became agitated and started speaking rapidly in Cantonese. I politely interrupted him and asked what was going on. He apologized and then did his best to explain what was happening, but it seemed the moment was lost. I wondered whether I should have just let him go, and desperately wanted to consult with a colleague about the matter, but there was nobody available at the time. As a matter of fact, I have no colleagues at all who work with me during these assignments abroad.

A few minutes later, there was another incident in which several students began speaking to one another in Cantonese; by the look of their agitation, they seemed to be in conflict over something. This time I decided to let things run their course; to my surprise, the whole class jumped in, speaking away in a language I couldn’t understand. I leaned over and asked the person next to me what was going on, and whether it was safe to let things go. He ignored me and joined the discussion.

This, of course, was only one of a hundred things that took place during the day that puzzled me. I wished there was someone watching from behind a one-way mirror, or better yet, someone in the room with me. As a second choice, I would have been most grateful if I could have run down to a colleague or supervisor’s office during the break to get some input. But the nature of these circumstances was such that it was a few weeks before I could debrief these incidents with my supervisor, who did indeed have several useful suggestions. By then, of course, I had been struggling on my own to make sense of what happened for dozens of hours. I thought to myself then, as I have many times before, I sure wish I was better trained in supervising myself.

There are many reasons why therapists don’t make maximum use of traditional supervision opportunities: (a) Help isn’t readily available when we need it. (b) Whatever resources are available are not offered at a time and place that are convenient. (c) It is not safe to be very open and honest with one’s assigned supervisor. (d) The supervision available is not all that helpful. For these and a variety of other reasons, we often work things out on our own, sometimes intentionally and other times quite spontaneously. That, after all, is what we do—teach people to do their own therapy when we aren’t around.

Joys of Self-Supervision

When therapists are left to their own devices, several common themes are frequently reported. First of all, just as with our clients, there is often a high degree of emotional activation present that gets our attention in a way that can’t be ignored. When therapists are disgusted with themselves—when they are afraid, frustrated, exasperated, and helpless—they are extremely motivated to find some sort of peace and resolution. If a supervisor is not readily available, then we do what we can on our own.

Because we work in such intensely interpersonal settings, sometimes the solution to our problems is not more discussion and interaction with others, but less. Solitude, and what it affords, gives us a chance to metabolize stress, debrief ourselves, lick our wounds, and then perhaps consult others at a later time. When self-supervision is integrated into all the other forms of the learning, feedback, growth, and critical evaluation that are part of any therapist’s life, then we have a balanced blend of influence from without and within.

This can take many forms, depending on interests, style, and personal resources. Some therapists use hobbies or creative pursuits as a means to debrief themselves from work and process the difficulties they are experiencing. Others find that it is less the structured activity than the internal process they follow, whether that is during idle moments between sessions, driving home, going for a walk, or drifting off to sleep. This internal process can be systematically described in a series of logical, progressive questions (Table 1.1).

Structured Ways to Do Better

Surely one of the most annoying, dreaded, and time-consuming assignments that any therapist could be asked to complete is the construction of a typescript that represents a verbatim record of the exact conversation that took place, including an annotated commentary of all the things that were done right, wrong, as well as any new awareness and insights that have subsequently taken place. Of course, because nobody of sound mind would willingly undertake such a tortuous task unless assigned by a supervisor, one could make the case that this isn’t really a form of self-supervision as much as an adjunct to regular supervision. I disagree.

TABLE 1.1. QUESTIONS FOR SELF-SUPERVISION

Although there is some accountability in that, presumably, the instructor or supervisor will review the typescript and write his or her own com ments, the very act of doing this on one’s own promotes quite a bit of self-reflection and self-critical behavior that can be internalized afterward.

Let’s take a look, for example, at a 2-minute excerpt from just such an assignment in which a student-therapist in an assessment and diagnosis course looks at her own performance with a critical eye.

See Table

Some of what this therapist reports is insightful, and other things may be a bit off base, subject to consultation with others who have more experience. But it is this process of self-scrutiny that is so important. What this student learns to do while reviewing a typescript after the session, experienced practitioners do inside their heads throughout the interview, constantly making adjustments as things proceed. Under the best of conditions, this critical voice does not so much scold or shame us, but bring our attention to things in need of closer scrutiny and selfreflection. It is, after all, reflective activities that help us understand better what we are doing in our work, what works best, and what we can do to improve our effectiveness (Best, 1996; Johns, 1999; Moore, 2000).

Informal Growth Opportunities

Some professionals use travel as a transformative experience, not only to recover from work, to rejuvenate and replenish themselves, but also to stimulate new growth through their journeys in novel environments. Ironically, significant changes most often occur not when under the “supervision” of a tour guide but when you have ventured off on your own. Under such circumstances, the pilgrim is more likely to solve problems in new ways, overcome challenges, expand horizons, face fears—do all the things we know lead to change in other settings.

In my research on this subject (Kottler, 1997, 2001; Kottler & Montgomery, 2000), it was surprising to learn how often that travel becomes most transformative after people get lost or face obstacles they must overcome. It is when you force yourself to do what is most difficult, when you get outside your comfort zone, when you immerse yourself in novel environments that require you to invent new ways to meet your needs, that growth most often occurs. Of course, that is the same lesson we teach our clients. This leads to the most important point of all related to our subject of self-supervision. If what we wish most for those we help is that they become self-sufficient in continuing their own therapy (with a little help from some family and friends), what better way to do that than for us to model this process in our own lives? It is through such efforts that we are able to show the world, and ourselves, that we can practice what we preach.

Doing Better is a book designed for those practitioners, both beginners and veterans alike, who are interested in improving their own professional competence. It is not intended to replace the formal instruction or structured supervision that are so critical for reality testing, accountability, and receiving constructive feedback. Rather, it is designed as a supple ment to these traditional forms of professional improvement. Because therapists and counselors are in a rather unique role to facilitate positive changes in other people’s lives, they are perfectly positioned to make themselves better as well.

Of course, we can all use some help.

References

Best, D. (1996). On the experience of keeping a reflective journal while training. Therapeutic Communities, 17(4), 293–301.

Donnelly, C., & Glaser, A. (1992). Training in self-supervision. The Clinical Supervisor, 10(2), 85–96.

Johns, C. (1999). Reflection as empowerment. Nursing Inquiry, 6, 241–249.

Kottler, J.A. (1997). Travel that can change your life. San Francisco: Jossey-Bass.

Kottler, J.A. (2001). The therapeutic benefits of structured travel experiences. Journal of Clinical Activities, Assignments, and Handouts in Psychotherapy Practice, 1(1), 29–36.

Kottler, J.A., & Montgomery, M. (2000). Prescriptive travel and adventure-based activities as adjuncts to counseling. Guidance and Counselling, 15(2), 8–11.

Lowe, R. (2000). Supervising self-supervision: Constructive inquiry and embedded narratives in case consultation. Journal of Marital and Family Th...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Preface
• The Editors
• The Authors
• Chapter 1 When Therapists Supervise Themselves
• Chapter 2 The Natural and Unnatural Evolution of Therapist Development
• Chapter 3 Critical Self-Monitoring
• Chapter 4 A Syllabus for Self-Supervision
• Chapter 5 Confronting Adversity
• Chapter 6 Hasta La Vista, Baby—I’m Outta Here: Dealing with Boredom in Therapy
• Chapter 7 Recognizing Ethnic/Racial Biases and Discriminatory Practices Through Self-Supervision
• Chapter 8 Self-Supervision in Youth Counseling
• Chapter 9 Technoconsultation: Getting Help in Far- Flung Places
• Chapter 10 There’s No “I” in Self: A Discursive Approach to Self-Supervision
• Chapter 11 From Self-Regulation to Self-Supervision: Lessons from Sport Psychology to the Practice of Therapy
• Chapter 12 Self-Supervision in Medical Settings
• Chapter 13 Licensing Boards and Continuing Professional Growth: Friend or Foe?
• Chapter 14 Therapist: Heal Thyself!
• Chapter 15 Blind Spots and Ruts in the Road: The Limits of Self-Supervision
• Chapter 16 Final Thoughts