My Developing Approach to Supervision

by Patsy Brady

Introduction

Peat bogs are wondrous places. As a boy, reared in the heart of a city in a working class area I used to love the advent of the weekends and the summer holidays when free time was abundant. It was then that I and my buddies would go off out the country raising foxes and hares from the marsh with our dogs, and when in season, we would seek out tadpoles and the like to be brought triumphantly home in jam jars to be placed on window sills where the transformation of the frog embryos would be observed daily. I was only ever vaguely aware that there was a life or death, evident beneath the bog surface that was my play surface, and that peat once peeled away and dried could provide life-giving heat in fires through the winter.

I now live the rural life, up a mountain, over a lake. It is stunningly beautiful here though harsh in the winter. Now, like the frogspawn of my youth I have transmuted from working class city dweller to middle class country-man. I have fallen into the rural clock.  One element of this cycle involves preparing for winter, ensuring that there is enough fuel to carry one through the dark times. This year I have immersed myself further in the cycle and have bought a plot of bog.

It is through working on the bog alone, turning the turf sods to dry them that I began to realise the parallels between the bog, psychotherapy and supervision. All of these are multi-layered and organically finely balanced. The bog is not inanimate; it is a complex living system that supports other types and areas of life. Preparation is put in place to ensure that the bog remains drained and does not become flooded (supervision).  Machinery or manual labour is then employed to strip away the surface and expose the riches that lie underneath (therapy). It is through the attention given to be harvested turf, turning and stacking that a good harvest if brought home (tending the relationship).

Definition and Explanation of Supervision

Val Wosket describes supervision as “a formal arrangement whereby a practitioner discusses their work regularly with someone who is an experienced practitioner and supervisor. The task is to work together to ensure and develop the efficiency of the practitioner/client relationship.” (Page and Wosket, 2001). Supervision has many objectives, but the main concern is to provide a relationship, provided by the supervisor to the supervisee where the core aims of supporting the therapist, developing the therapist, and monitoring the therapist can all be fulfilled.

The means with which the above can best be met is within a safe though heavily challenging relationship between supervisor and supervisee. One of the important tasks of the supervisor is to be able to balance the development and progression of the supervisee while always being mindful of the centrality of the client’s process. It is the supervisor’s responsibility to provide a nurturing and restorative environment wherein the supervisee is allowed to replenish mental and emotional energy through this process and positive modelling within the supervisory relationship. The objective is ultimately to assist the supervisee to create a similar environment in the therapeutic relationship with their client where good therapy and positive outcomes for the client can occur.

The Three Key Functions of Supervision Support

In providing the service that we do as supervisors we claim a degree of knowledge and experience in the realm of counselling. Often supervisees who attend for supervision with me are looking for answers to their clients’ problems. Likewise, they may attend being emotionally disturbed or drained by the information or issues, which they carry from a session with a particular client. One of the primary ways that I can support a supervisee with such issues is to promise a sense of security and containment within which both the supervisee and client’s insecurities can be held. (Hawkins and Shohet, 2000) compare this relationship to that of an infant and its mother or father. In fulfilling this task it is not “I” the supervisor who is providing the support, rather paradoxically it is the supervisory relationship, which provides the container within which support can occur.

Monitoring

Bordin reminds us that “supervisors are part of a professional gatekeeping apparatus designed to protect the public and the profession” (1983). However monitoring is complex and multi-layered in the supervisory matrix. It is not just a policing or quality assurance task. There is also an intimate weave of transferences and projections, introjects and defences. These occur in a multitude of directions; client-therapist, therapist-client and supervisor-supervisee and so on. All of this requires monitoring and it is the supervisor’s task to tend to this function. The supervisor is dependent on the supervisee to bring the material. The amount of trust and goodwill, and the quality of the relationship between the supervisor and supervisee determine the effectiveness of the monitoring function.

Developing

Worthen and Mc Neill’s research of psychotherapy trainees clearly illustrates that “the most pivotal and crucial component of good supervision experiences that was clearly evident in every case studied was the quality of the supervisory relationship” (1996).  The quality of the supervisory relationship informs the manner and style in which I as a supervisor can intervene with a supervisee. This in turn has a proportionate effect on how I can help a therapist in developing their casework or themselves as a therapist. I myself have experienced “a ha!” moments in my own supervision and now love the odd moment when with a supervisee the same occurs for them.

The Cyclical Model

Page and Wosket describe the cyclical model of supervision as “the motion of a circle conveys the seamless pattern and recurring rhythm of the supervisor process as we see it” (2001).  It is the notion of rhythm and seamlessness, which really attracts me to the approach. Though the model has very precise and exact beginnings and endings for its five stages, at no time does it jar as a highly technical, or mechanical formula that is anathema to the human condition. Rather, like good psychotherapy it allows for the flow to develop while allowing the supervisor to ‘map’ the supervisory session while in progress, thereby allowing for navigation and location of important issues.

In contracting, attention is given to ground rules, boundaries, accountability, expectations and relationship. Carroll (1996)states that“the relationship is an area in supervision that requires clear contracting and negotiation”. To have the relationship one has to conduct what Van Ooijen (2003) refers to as the importance of doing some groundwork. This groundwork is the basis of the preparation of the contract and is in my view very important.  Van Ooijen (2003) cites 3 steps in this process

• The ‘what’ of a working agreement – i.e. what is your role? my role etc.?
• The ‘how’ of a working agreement – i.e. how are we going to work together?
• The ‘what’ of a working agreement – i.e. what can we agree on now regarding the  goals and the process of supervision?

I view contracting as a good way to ensure that supervision gets off to as smooth a beginning as possible in order that the client work can quickly become the primary focus of attention. Issues of time, payment and boundaries all have to be addressed in a very forthright and clear way. I have a group of psychotherapists in training who attend with me for supervision. I found the contracting stage especially useful with them around the issues of accountability and expectations, as I was also in the position of reporting to their training organisation on their performance as I experienced it. The perceived power differential that they as trainees experienced in their place of training was discussed and made relevant to their experience of me as someone who would be in a position of authority to be able to report back on them to their trainers. Expectations, accountability and trust all became real issues very early on. One method that I decided to utilise in my requirement to ‘appraise’ these trainees on behalf of their training establishment was to individually meet with them and to bring a collaborative element to the appraisal element.  I feel this approach brought about a high degree of trust and most importantly, transparency to the supervisory dynamic.  Importantly I felt it also demonstrated a way of working as a therapist with clients for the supervisee/trainee.

For me, Hunt says it well when he states

“it seems that whatever approach or method is used, in the end it is the quality of the relationship between supervisor and trainee therapist (or counsellor) that determines whether supervision is effective or not. There needs to be a degree of warmth and genuineness and respect between them in order to create a safe enough environment for supervision to take place” (1986).

Focus

This is the doorway through which the work of supervision is begun. For me this is the common meeting point between supervisor and supervisee, a place where issues facing the supervisee in their work with a client can become emergent and crystallise. A very good example of this comes to mind in my work with a supervisee whom I saw recently.  My supervisee had disclosed in earlier sessions some personal information where she describes having been sexually abused as a child. In her introduction of a client, with whom at this point she had only spoken once on the phone and had physically observed once from a distance, she stated that she was absolutely positive that this new client had been sexually abused as well. I replied that it sounded to me like she (the therapist) had begun the work ahead of and without the client. I was amazed at the impact that this intervention had and the focus of our session then centred on how the supervisee could work on the containment of her own personal material while allowing the client the space for hers.

The five components of focusing according to the cyclical model are issue, objective, presentation, approach and priority. In a way they help one to maintain a focus on the focus! I do not, I must admit refer to all of these five components in my work with supervisees around identifying focus.  Like Greenberg (1980) I feel that the complexity of the supervisory situation ensures that much will not be explicit. “Ideally, what happens in supervision would be mutually decided upon by both participants, the basis of what is most useful for the supervisee. However, even if an accurate and mutually agreeable appraisal of a trainee’s strengths and weaknesses were available, how to focus supervision would still not be clear” (Greenberg, 1980). This is because supervisee’s goals are complex and over lapping. What is available is also limited by the supervisor’s biases and skills as well as the problems presented by one’s clients. So instead of a mutual decision, both supervisor and supervisee make independent, covert or unconscious decisions as to the focus of supervision.

For me in my own use of this model I currently tend to concentrate very strongly on focus. It has been my experience in the past that poor attention in this area with supervision can have quite a detrimental effect later in a session when I may discover that I have not paid enough attention to mutually identifying the issue. Conversely there have been times in discovering this that I have then become aware of the parallel process at play where the loss of attention to focus between my supervisee and me is also being played out with my supervisee and their client.

Space

This is according to Page and Wosket “The heart of the supervision process” (2001).  Contracting is done, the issue or dilemma facing the supervisee has been identified. For me, this is where we both sit back in the chairs and take a breath and begin to examine the issues that the supervisee has brought. The best visual metaphor I can think of is that the supervisee-client material is a rubik-cube, multi dimensional and complex and that this is the time to play with it.

The five component elements to this part of the model are collaboration, affirmation, containment, challenge, and investigation. All five play a regular feature of my work with individuals in supervision. There are indirectly times though when one or two in particular take precedent. I find with relatively new therapists or those in training, that affirmation and containment may be very prevalent as it almost reflects their own need to be assured and help in their work. Similarly, I find the possibility to work with all five with supervisees who are more assured in their role as therapists, but not exclusively so.

Space provides the opportunity for the supervisor to assist the supervisee in examining dynamics that will be occurring outside of their awareness. Page and Wosket’s alternative version of the cyclical model as a ‘container’ emphasises the manner in which the four other stages of the wider model provide a ‘container’ for the potential of a secure supervisory ‘space’.

Within the ‘space’ creative approaches can be utilised in working with a supervisee to make visible the hidden. I now regularly for example, will ask supervisees “what it is that you really want to say to this client but don’t?” In giving the supervisee permission to utter the unspeakable I am now regularly amazed at the amount of hidden material that is brought into the open. In this way transferences, counter transferences, and projections can be brought to be worked on.

Metaphors can also be used here. In an interesting scenario I had a supervisee who in using this method described herself as feeling like a crutch or a stick for the client to lean on. On explanation of this further it became apparent that the supervisee as therapist was doing too much supporting of the client (like the client’s mother) and in fact had an unconscious well of anger toward the client (for exhausting her). So, now she wanted to punish the client with a stick!!

What is relevant here though, is that all creative methods can tap into unconscious material and can provide rich and almost always unexpected results for the supervisee.

One of my main problems as a supervisor occurs within ‘space’.  I am used as a former senior practitioner social worker to regularly come up with ‘the answer’.  This was my function as social worker. I am becoming very conscious of not trying to resolve my supervisee’s dilemmas.  In doing so, I know that this enables the supervisee to become more tolerant of their own client’s needs and in so doing they learn the value of not trying to fix their client.

Bridge

In olden times before baby foods were created and before we became sterilised as people, there was a method of passing solid food to young children who had been weaned from the breast. This involved the mother or carer of the child chewing whatever food was to be given to the child until it was a glutinous pulp within their mouth. When the consistency of the food was deemed appropriate for the child’s consumption it was passed on, usually by mouth. Almost like a kiss. This is how I see the bridge element of the model. Like the adult, chewing the food for the child this now is where the idea and possibilities discussed earlier are chewed on and refined. It is the point in supervision where if done properly ‘digestion’ or integration of the material will be easier and most beneficial.

This ‘chewing’ of the material can occur with some or all of the five related component aspects in evidence. Goal setting for the supervisee in their client work or learning goals for the supervisee, information giving from the supervisor through the sharing of ideas or their own experience, action planning and considering the clients perspective all come into operation here. One question that I use a lot with supervisees at this juncture is, “I wonder what you want to do with what we have been discussing?” I like this question as it directly links or bridges the gap between the accumulation of the work that has been done throughout the session with the supervisees requirement to consolidate the material and move forward with awareness and purpose in their work with their client.

In conclusion, on the bridge aspect I have become aware as supervisor of the need to bridge not just within sessions but also between one session of supervision on a particular client and another. Page and Wosket state that “unless attention is given to application it is quite possible that the client will experience a discontinuity as a consequence of the supervision, with the counsellor having significantly shifted his perspective or his behaviour between sessions” (2001). I am with my supervisees to tread a steady path within supervision. Through bridging it is the idea that they maintain a steady consistency of rhythm with clients.

Review

The final style of the model concerns the process of reviewing and evaluating. It is where one end of the circle finally meets the other. It is as Page and Wosket state “where the end (re-contracting), is also mirrored in the beginning (the contract)” (2001).  This is the time for mutual feedback and an opportunity to examine ways in which the supervisory experience can be maximised both for the supervisee and the client’s benefit. I find in my own work as supervisor that I have to actually remind myself to include the opportunity for review to occur. Perhaps this is at times a demonstration of my own unconscious desire to avoid any critique of my own performance as supervisor? I have found that when this part of the work is done, a much more collaborative dynamic is engendered between myself and supervisees. Out of this I am aware that review allows a type of mutual quality assurance to permeate the supervision relationship.

Non-attachment/Looseness in Supervision

One of the philosophies that over-arches and informs my own approach to supervision almost seems to fly in the face of some psychotherapy theory and principles. I am now aware and becoming more so, that as human beings we learn to defend ourselves against emotional pain. This type of ‘defensiveness’ can in turn lead to a type of ‘stuckness’ which almost always becomes quite complex. Acknowledging that therapists and supervisors are not god-like, it follows that we too become stuck, both in our own material and stuck in our clients’ material. It is my view that this ‘stuckness’ is the material which often becomes the meat of the supervision meal.

John Wellwood says

“the path of working with the polarities and contradictions of being human involves learning not to identify with anything – neither pleasure or depression, neither separateness nor togetherness, neither attachment nor detachment.  Hardening into a position, no matter how just if might seem, dulls our sensitivity to what is needed.  Non-attachment in the best sense means that we are not completely identified with our needs, our likes and dislikes.  We recognise our needs, yet we can also tap in to a larger awareness inside us where those needs do not have a hold over us” (1983).

Wellwood could quite easily be describing Buddhism – the way of non-attachment.  However the struggle in life is to fight the human condition to ‘attach’. In this sense through resisting the urge to ‘attach’ or ‘harden’ into a position we can remain loose and supple as supervisors and even as therapists. Kopp (1988) describes the struggle between unconscious resistances in therapy as ‘psychotherapeutic judo’. Clive Garland (2005) my former supervisor said it best when he stated:

“one can surmise therefore that to help in a therapeutic context, is a complex task and that there are a number of forces both in terms of what the individuals bring and the nature of the work itself, this makes the holding of an unattached position difficult.  Clients often find it extremely difficult to let go of cherished belief positions even if these positions are unhealthy for them. A belief system that involves non-attachment is thus even more essential if one it going to be able to stay within the resistant and defences which do not wish to be removed”.

It is in the hand-to-hand combat with clients or supervisees, in dealing with ‘stuckness’ through Kopp’s concept of ‘psychotherapeutic judo’, that non-attachment translates into the supervisor adopting a fluid and loose stance.  I am discovering that it is through this way of being that I can develop a capacity as a supervisor to counter complexity; painful emotions and intense feeling of not knowing and in doing so still have my feet on the ground. For me, this the fundamental use of self in the supervision space.

Ethical and Professional Issues

Stoltenberg, McNeill and Delworth (1998) draw attention to the need for supervisors to be aware of the necessity to behave as a role model for supervisees whatever their level of development. For me, at its most basic level this involves being professional in supervision. I make it my business to always prepare for my supervisees and the work that they bring. This involves, like my direct client work, doing some work before and after they come. Additional to this I have ensured that I am familiar with the code of ethics of both myself as a supervisor, and my supervisees, and their affiliated associations.

There has been an issue in my work, which threw up interesting ethical and professional questions recently. This involved a supervisee who brought a case whereby a client had divulged an involvement as perpetrator in child sexual abuse. Through the processing of the issue with the supervisee it became evident that the supervisee had not contracted clearly with their client around confidentiality. It was my task to enable the supervisee to work through, amongst other issues, the responsibility that they had both at a professional and ethical level, not just in maintaining confidentiality but also in knowing when to break it.

Conclusion

This has been a meandering, attempt to illustrate my approach to psychotherapeutic supervision. It is a huge area and one in which I am learning to paddle, which is why in my defence I have splashed out a bit! I have attempted to outline how I currently use the cyclical model with some tweaking and additions of my own. If I were to surmise these past few pages and clumsy meanderings it would go something like this; I believe that supervision is about ensuring safety and quality for the client primarily, and also the supervisee. It is about assisting the growth, enablement and transformation for all concerned. As a supervisee of mine said “It’s like  holding with no hands”!

Patsy Brady lives up a mountain, over a lake amongst the megalithic tombs of Carrowkeel Co. Sligo. Patsy works in private practise as a supervisor and therapist. He is also an assistant programme director of the Sligo GP training programme.

References

Bordin, E.S. (1983) ‘A Working Alliance Based Model of Supervision’ in The Counselling Psychologist 11,1. 35-42

Carroll, M. (1996) Counselling Supervision. Theory, Skills and Practice. London: Cassells

Garland, C.(2005) ‘The Sheer Necessity of Supervision’ in Eisteacht Spring 2005

Greenburg, L. (1980) ‘Supervision From The Perspective of the Supervisee’ in P. Hawkins and R. Sholet ‘Approaches to the Supervision of Counsellors’

Hunt P. (1986) ‘Supervision’  Marriage Guidance, Spring 15-22

Kopp S. (1988) If You See Buddha on the Road, Kill Him. New York: Bantam

Page, S. and Wosket, V. (2001) Supervising the Counsellor, A Cyclical Model. 2^nd ed.London: Brummer-Routledge

Stoltenberg, CD. McNeill, B. and Delworth, V. (1998) IDM Supervision: An integrated developmental model for supervising counsellors and therapists. San Francisco: Jossey-Bass

Van Ooijen, E. (2003) Clinical Supervision Made Easy. Churchill: Livingstone

Worthen, V. and McNeill, B.W. (1996) ‘A Phenomenological Investigation of “good” Supervision Events’ in Journal of Counselling Psychology 43: 25-34

Wellwood, J. (1983)  Awakening the Heart Boulder. Colorado: Shambala