Some Ideas Regarding Family Therapy Supervision & Training

By: Colm O’Connor

Introduction:

I am always uncomfortable with the enormity of the gap between the cohesive clarity of the various models of psychotherapy as documented in our literature and the ordered chaos of working with clients. In this article I’ll highlight some of the observations I have made in my work as a Family & Marital therapy supervisor with particular reference to other modes of supervision.

We all engage in conversations with our clients and supervisees. These conversations help our clients adopt different behavioural, experiential and attitudinal positions regarding their difficulties in living. Supervision in practice can cover a wide terrain: The relationship between supervisor and therapist; the therapist’s ‘issues’; the skills of the therapist; the therapist/client relationship; the client’s dynamics; the context of therapy, etc. The canvas is broad but can be divided into discreet regions that help determine how to respond. If supervision is the canvas then the approaches we adopt are like the brushes and techniques we use to create the picture. I hope to outline a few ideas that distinguish some of the ‘brush strokes’ of systemic supervision from other approaches.

Theory of Change

I believe the most important theory that needs to be articulated and under­stood when working with people is the personal ‘Theory of Change’ of the therapist. All of us emerge from our past with a theory of change carved from the granite of our families. Re-sculpting this granite takes many years of sanding and polishing. Tasks of integration are not so much about differ­ent models as joining one’s inherited theory of change with newly acquired ones. In addition, I believe that the seasoned therapist is one who is able to draw from a range of conflicting theories without having to re-invent him/herself. However, I believe that family systems therapy models offer us a more holistic and potentially useful theory than many traditional ones.

There are various models of family therapy reflecting different origins. Early in the history and development of family therapy, training was a fairly homogeneous concept, modest in scope and influence and characterised by the clinical wizardry of the ‘Great Originals’, as Hoffman referred to them. This is no longer the case. In the last decade, we have witnessed exponential growth in family therapy training and supervision. There is now a vast body of knowledge reflecting this growth.

The contemporary context of training and supervision around the world has changed. For example, training is designed in different ways depending on the working context and experience of the trainees. The context within which supervision occurs also influences its structure, process and objectives.

When considering the profession of family and marital therapy one has to consider both training and supervision in the same breath. The literature on supervision is inextricably linked to training schools and models. Trainers in family therapy by necessity need to be supervisors. It is a concern that many workshops offered around the country are defined as training courses, when, in fact, they merely serve as introductions to new ideas.

Training and supervision are important because they transmit the field’s values, body of knowledge, professional roles and skills to new clinicians. It should be of serious concern that some practising psychotherapists do not go through any serious process of theoretical formation. The emphasis on ‘personal development experiences’ to the exclusion of intellectual formation and the development of ideas is disturbing.

The Screen

Lynn Hoffman in her book: ‘Foundations of Family Therapy’ points out that one of the pivotal developments in the family therapy field was the use of the ‘one-way’ mirror in live supervision. She writes: “The screen became a stake-out place from which to view the faunas of the realm that had always been before us yet never truly seen. With this format it became possible to abandon what was becoming for many an outmoded concept: the concept of the therapist as a free-standing agent acting upon a free-standing subject, the client or family”.

View from the Outside

What this tool brought to the development of family therapy was the unique and necessary ‘view from the outside’ – what Gregory Bateson called the bicameral format. This heightened our awareness of how our assessment of reality was really dependent on the position from which we viewed it, or more accurately, the position from which we participated in this reality.

When I supervise post-graduates I will assist them in beginning to get a feeling for how they, when working with a couple or family, form a new family. The therapist tends to get induced, often hypnotically, into the family like a new relative. This is inevitable to a greater or lesser degree. The therapist can begin to be regulated by unspoken family rules. Families have a range of induction rituals that gradually regulate the therapist’s behaviour and influence. If the therapist is wholly induced into the system s/he can no longer see the system from the outside position. As a result ‘live’ supervision becomes an essential component.

No matter how skilled the clinician, it becomes impossible to enter the family without handing over some objectivity at the door. We all feel we are objective, we all think we have a good understanding of our clients, but as soon as we enter the world of the family, we become psychologically unable to observe ourselves and the system in which we are set. Therefore, the supervisee who comes to talk with me about her case, is to some degree, coming as a member of a new family. The more intense the block or diffi­culty experienced by the supervisee, the more likely she has been drawn into the emotional mass of this new ‘family’.

Basic Unit

Family therapists think of a family as the basic unit to be observed and understood. As I suggested above, there is also the assumption that the system cannot see itself – nor can any member of the system have an overall view of that system. It is the same in our own families, we can often detect ‘who is to blame’, we usually fail to get a firm hold of our own family myth­ology. Carl Whittaker describes us as walking ‘fragments of families’.

Sceptical

For these reasons I am somewhat sceptical about the degree to which one-to-one-observing supervision is helpful, in a systemic context, to the client. Live supervision illustrates very powerfully the huge discrepancy that often exists between what the therapist reports and what the observer sees. Frequently they are worlds apart.

One-to-one supervision is often a context where the therapist uses the client to work through his/her own family-of-origin material in a manner that may be helpful to the therapist but frequently unhelpful for the client.

Therefore, Point Number One: Live supervision always keeps the family and its presenting concern in view. It is used in family therapy, not because it is a useful tool, but because it is a necessary and logical extension of a systemic view of human behaviour.

Between Vs. Within

It is my belief that a supervisor can, by virtue of his/her influence and the position she adopts toward the supervisee, literally create any problem or any solution for the supervisee. Equally the dilemmas of the client, as articulated by the therapist, can be hugely influenced by the position from which the therapist approaches the client. In supervision, therefore, I will be more curious about the ‘position’ of the therapist vis-a-vis the client (and the position I am inclined to adopt vis-a-vis the supervisee.) How over or under-involved is she? How over or under-responsible is she? How does the therapist ‘activate’ the client and vice versa? What kind of language is she using to describe the family? What is her inherited theory of change?

Therefore, Point Number Two: The position of the supervisor/therapist in terms of levels of involvement, responsibility, closeness, anxiety, hope etc, will contribute significantly to the so called supervisee/client problem.

Triangles

Systems theory tends to think in terms of units of at least three people. To understand a phenomenon like depression, for example, the family therapist will begin by thinking about it as a three (or more) person event. This is a radically different perspective on human behaviour to what we are accus­tomed.

This is revealed in supervision when the supervisor considers the primary triangles in which the supervisee and clients are set. These triangles are very often what both create and define the problem as presented. For example, the GP-patient-therapist triangle; the agency-therapist-client triangle; the therapist-client’s family-client triangle. The list is-endless, but the assumption is that the invisible third party often scores the manuscript of therapy.

Therefore, Point Number Three: The supervisor assumes that experience is at least a three person event.

Context

A systems approach is always thinking of context, what gives meaning to communication, behaviour and experience. In family therapy supervision I will invite supervisees to consider how they may be interacting with their client and co-creating a particular dilemma. A therapist who works with a couple using a systemic approach will co-create a different reality with that couple than a therapist who adopts a Gestalt approach.

Traits Vs. Context

Having experienced intensive supervision in psycho-analytically and humanistically oriented psychotherapy I believe both of these models can miss a great deal because of their focus on interpersonal realities and dynamics. In these models the therapist tends to work on material that has been evoked in the session with clients. However, what is evoked emotion­ally for the therapist is often an indication of the manner in which the therapist has been induced into the system.

An important difference between supervisors within other disciplines and supervisors who work from a systemic/relational approach is the degree to which the former describes a supervisee on the basis of individual traits. For example, a supervisor who sees the supervisee as ‘difficult’, ‘constricted’, ‘cut off from emotions’, etc., is in sharp contrast with many systemic under­standings that assume that people act and react on the basis of their perception of information. The systemic view is that ‘mind’ does not reside within the individual, but in the interactive circuit between person and world. The problem of the supervisee is an interactive one and not an inter-psychic one. In this way the family therapist will not talk of the father of the family being angry but as ‘showing’ anger. Similarly, the supervisor may wonder how is it that the supervisee, with his client, ‘shows’ incompetence rather than competence?

Therefore, Point Number Four: Supervisees ‘show’ various levels of competence/incompetence to the supervisor.

Metaphor

Families can only communicate in metaphor, they have no other language. Unlike a human being a family does not have vocal cords, a mouth or a word-based language. The only medium through which a family can show itself is through the behaviour of its members. This behaviour is regulated by the family in order to meet its own needs. Problem behaviours emerge as repetitive, rigid sequences.

In supervision, the dilemma of the supervisee is to learn to listen in metaphor and avoid the inherent paradoxes of words. So, the child who steals may be giving expression to the experience of a father who has been robbed of his dreams.

Therefore, Point Number Five: The family/marital supervisor, by necess­ity must listen and see metaphor.

Problem Focus

Families and couples do not come seeking personal development and the like. Rather, they come with real-life problems that do not allow the same luxuries as personal therapy or counselling, (a ten year old who keeps soiling himself, a couple on the brink of separation etc.). These kinds of problems, by their nature call forth a particular response. Family therapy schools have responded to this need for change in the client’s life and to the responsibility of therapists to develop appropriate technologies to respond to this reality.

Haley points out there are three major areas of focus in the area of training and supervision. 1/The problem situation, 2/The therapist’s awareness and personal issues, and 3/ The competence and skills of the therapist. Family therapy supervision works in all three domains but uses the dilemma of the client as its axis and the behaviour of the therapist as the tool with which to approach this difficulty. Jay Haley’s thesis is that neither of the first two approaches teaches the trainees or supervisees how to effect change or to understand the process of change.

Supervision that focuses on the client

This includes the history of the problem, the dynamics of the client’s intra­psychic life, defensive patterns etc. In these approaches the emphasis is on understanding how people work – why they are the way they are. It emphasises an appreciation for the client’s world. But it does not help the therapist to help the client to change.

If your client is a single parent struggling with an out-of-control eight year old, she wants to know what to do! Because of the immediacy of live supervision in family therapy it is less likely that the observing team will slip into the luxury of forgetting what the client needs.

Supervision that helps the therapist focus on herself

The assumption in this approach is that therapy is more effective when the therapist is more aware of her own ‘process’, when she has worked through the blocks in her own personality. For example, if the therapist has difficulty working with a bereaved client the supervisor may encourage her to address her own issues around grief. Haley suggests, (somewhat provocatively) ‘the more personal therapy trainees have had the more difficulty they have in learning. They become so preoccupied with themselves that clients have trouble getting their attention’!! (my exclamation marks)

Supervision that helps the therapist learn new ways of working

This approach operates on the assumption that the skills of therapy, like other trades or crafts are best learned in a situation where the supervisee is being observed. A lot of this kind of supervision disappeared with the psychoanalytic and client-oriented thinking around confidentiality. Family therapist supervisors tend to work with one-way mirrors and videos because to be of help they must know what actually happens in therapy.

I will create a safe learning environment, encourage self-disclosure and self-awareness, facilitate working with feeling and emotion but the over­riding concern will always be the familial unit of therapist + family + what needs to be done. The focus is on how to facilitate change. The emphasis is systemic. It is not on the client’s dynamics nor the therapist’s own issues but rather on the supervisor-supervisee-family unit.

Summary:

As a family therapist, working with supervisees, I find myself emphasising family therapy as a Craft because of what appears to be an over-emphasis in the counselling culture on therapy as if it were just a spontaneous act of intuition and feeling. This latter emphasis becomes inevitable if one cannot and does not emphasise the client’s specific needs in the equation when live observation is not compulsory, and when problems are seen as a result of intra personal ‘blocks’ rather than difficulties in the person’s social system.

The blossoming and development of a therapist cannot occur in a setting that prevents development and change. Therapists who have learned new ways of working do not necessarily need heightened personal awareness or ‘advanced’ personal development to maintain and develop their new learning and skills. Counsellors and therapists need to work in places that are client focused (as distinct from client-centred) and work toward more effective therapy.

Supervisors and trainers have a responsibility to advocate competence in therapy and to develop rigour in training. Family therapy supervisors and trainers will always emphasise context and the importance of improving workplaces where therapists practise. At the end of the day the therapist needs to be a ‘questioner’ – a scientist and a practitioner – one who acts and always asks: ‘Did it make a difference?’

Colm O’Connor is a Family therapist and Supervisor working in the Cork & Ross Family Centre, 34 Paul Street, Cork.