By John Rowan
My approach to supervision involves an emphasis on dealing with the whole person and with the integration of schools. Although counselling and psychotherapy are two different things, I find that supervision of both is very similar and in what follows I will use the word ‘therapy’ to cover both.
I believe a key function of the supervisor is to enable the therapist to become aware of blind spots, deaf spots and dumb spots, and to work on them in such a way that professional development takes place. Because these issues are emotive, having to do with the supervisee’s self-image, supervision is a delicate and difficult business. This is all the more so because of the other pressures that bear on the relationship between supervisor and therapist, often including the administration of the setting within which therapy takes place.
Blind spots are those places where the therapist’s own inner workings get in the way of appreciating what is going on in the client. Countertransference is very often the source of these blind spots (though some kinds of countertransference can be valuable at times). I think it is useful to emphasise seven types of countertransference:
(1) Defensive: The therapist has some warded-off areas in their own psyche, and will not allow the client to explore any such territory (this may be temporary, due perhaps, to recent bereavement, or permanent, if having to do with childhood abuse or something of that kind).
(2) Aim Attachment: The therapist may have conscious or unconscious needs for success, power, omnipotence, love, recognition, admiration or money, may need to be a saviour, may need to feel superior or may need to assuage guilt by helping others. One way to look at this is to ask if the therapist has a favourite client.
(3) Transferential: When the therapist responds as if the client were a parent or sibling; manipulating, withholding, controlling, competing, punishing, etc., but in any case acting without awareness of the inner sources of the problem.
(4) Reactive: The therapist responds to the client’s transferential distortions as if they were real, for example, apologising for a poor room instead of taking the opportunity to explore feelings about imperfection.
(5) Induced: The therapist takes up a role suggested by the client’s transference or dependency needs. For example, giving advice, information or reassurance.
(6) Identification: The therapist over-identifies with the client, entering into a covert alliance with the client’s neurotic aims and agreeing with the client for example, that others are to blame for their difficulties.
(7) Displaced: The therapist displaces feelings from their own personal life onto the client. This is often the source of the experience where all of the therapist’s clients seem to be having the same problems at the same time.
I must make it clear at this point that I do not believe that countertransference is just a problem to be overcome. It is also a positive advantage to be cultivated and used. The emotional state of the therapist is often a more accurate guide to the psyche of the client than the therapists’s intellect. It might well be the case that most important insights into another person are actually derived from self-inspection. Projective identification is something much deeper and harder to deal with. It is certainly something to watch out for in this area. Supervisees may need particular help in dealing with it.
Recently, I and others have been writing about a particular experience, that Samuels calls ’embodied countertransference’, where the therapist and the client seem to be inhabiting the same imaginal space.
Alvin Mahrer has pointed out that this is actually quite easy to achieve, and can be very helpful indeed in the process of therapy. Here we have moved far away from the idea of a blind spot, and have moved into the area of especially clear vision.
There is another form of blind spot, where a therapist cannot see what good work has been done with a client, and needs to be encouraged to see it. This happens particularly with new therapists who are so busy thinking of their next intervention that they lose touch with the effective work they have done up to now.
Deaf spots are those where the therapist not only cannot hear the client but cannot hear the supervisor either. These are likely to involve particularly defensive reactions based on guilt, anxiety or otherwise unpleasant and disruptive feelings. Hostility to authority figures may come into the picture here.
Dumb spots are those areas where the therapist lacks the required knowledge and skill in dealing with the client. This is most likely to happen with new therapists or when the therapist is faced with clients who are very different or very difficult. However, it is good to be ‘dumb’ sometimes, in the sense of not pretending to know what we really do not know. In this sense all therapy is intercultural therapy, where we need to ask questions rather than assume we already know the answers. This is true also in supervision.
The Focus Can Change
Supervision not only has to deal with the overt matters which are easy to see, but also with the covert matters that are going on between therapist and client and between supervisor and therapist.
With a new therapist the emphasis may be more on; (a) what is going on in the client, consciously and unconsciously; (b) interventions to be used, policies in relation to boundaries and so forth. [I find the issues concerning boundaries are extremely important – not only in terms of time and money, but also in terms of the actual premises used and the furniture there]; (c) the relationship with the client, including the therapeutic alliance, the transfer-ential relationship, the developmentally required relationship, the trans-personal relationship and the authentic relationship; (d) what is going on within the supervisee, including issues of countertransference.
With a more experienced therapist the emphasis would shift more towards (c) and (d) with an added (e); the relationship with me – including questions of parallel process. With a very experienced therapist the emphasis may be more on collegial discussion, including; (f) my own personal reactions and feelings. In all cases there needs to be a high degree of honesty.
I encourage supervisees to bring tape recordings of their sessions and to play seven or eight minutes of the session during their visit with me. Many things that never appear in a set of notes do show up in a tape recording. I find that most clients are happy to have their words recorded so long as confidentiality is respected.
Supervision is, of course, quite personal and I think it is important to help the supervisee to see that they have their own existence and their own rights over against the client. It is not up to them either to take on everyone who comes along or to doggedly persevere with a client who is clearly not benefiting from the experience and who is making them feel miserable and exploited.
The whole question of when to refer someone on to another therapist is of real importance. I discourage therapists from using blaming words like ‘manipulative’.
Supervision Versus Therapy
One thing I am very clear about is the difference between supervision and therapy. Supervision is about professional development and therapy is about personal development. If personal issues seem to be coming in very much and clouding the relationship between therapist and client, I will ask the therapist to take the matter up in their personal therapy. If they are not in therapy at the moment, I will suggest that they set up a specific series of sessions to deal with the matter. In practice, virtually everyone I am seeing at the moment for supervision does have a therapist of some kind.
This enables me to aim for a balance between simply empathising with the client, letting them come to their own answers and intervening more actively. This means, in practice, that I try, where possible to enter with the supervisee into the process of joint problem solving. We are both wrestling with the material the supervisee brings to the meeting. So it becomes an existential meeting, where all of me and all of the supervisee are fully engaged. The meeting is quite intense and focused. It is as if we are both endeavouring to arrive at an agreement as to what we have before us and what its nature and limits are. It is only later that we may reflect on the process we have been through, and perhaps make discoveries about that too.
One of the key things about my approach is that I pay attention to the three legs on which I believe therapy stands – Regression – the biological details of the person, the early traumas, the personal unconscious, primitive phantasy and the like; – Existential – the current life situation of the person, pressures and limitations present (including questions around racism and sexism), resources available, false definitions of the self, hiding behind roles, the precise ways the person keeps problems alive, and so on; and finally, – Transpersonal – the divinity of the person, the life purposes of the person, the myths and phantasies that can be connected with the divine, the surrendered creativity of the person, their spiritual aspirations and problems and the imaginal world, insofar as it questions the boundaries of language. This is so, both in relation to the supervisee and to the client being presented. To leave any of these things out of the picture seems to me to be wrong, but to keep them in does seem to necessitate crossing the boundaries between different schools of therapy.
As far as regression is concerned, I think it is very important that therapists do not attempt to take clients into regions they have not explored themselves. I always check that the therapist has had the appropriate training before going into areas such as Kleinian phantasy, or the Grof/Lake trauma of birth or foetal life, conception trauma or past lives.
Similarly with the question of bodywork – I try to ensure that the therapist is not doing any bodywork (which can be powerfully regressive), for which they had not had the proper training.
As far as the existential area is concerned, it often seems very important for people to have adequate maps and not to be misled by maps that have large chunks missing. I will often do little bits of tuition, where I think it is appropriate, just to make sure the therapist has an adequate map and can if necessary pass that information on to the client. This never takes more than five minutes, often much less, however, it makes for much shared understanding. The map is not the territory but bad maps can be misleading and time-wasting as well as damaging and self-limiting.
As far as the transpersonal is concerned, I make a great deal of use of imagery. For example, if a therapist is having trouble with a client and is having a hard job understanding why, I will often say; ‘What image comes to mind for that client?’ I may explain that what I mean is like in a fairy story one person can turn into another person or animal or object. ‘What would this client turn into?’ The answer is then explored for associations and so forth, as with an image or symbol for a dream or a vision. This often helps a great deal to clarify things. I may also help the therapist to distinguish between psychotic breakdown and spiritual breakthroughs. People often have a fear of death and it may be that the transpersonal area has a part to play in dealing with this.
These are some of the main thoughts I have in mind when carrying out supervision. They are never far from my mind. I pass them on for what they are worth to others struggling in the same field.