Editors: Chris Driver, Lynda Norton, Annie Power

www.supervision.org.uk

 

Articles                                                                            

 

Hewison, David. Dr : Supervising Couple Psychoanalytic Psychotherapy:

A view from the Tavistock Centre for Couple Relationships

 

Morley, Elspeth :  The Supervision of Couple Therapy                  

 

Riddell, Jenny : Supervising with the Couple in Mind

 

Quail, Margaret : Countertransference in Supervision

 

Driver, Christine : Owning Countertransference – some reflections

 

Martin, Ted : Death of a Supervisee

 

Barnett, Ruth :  Dual Roles in Therapy Organisations

Book Reviews

 

Copland, Sue (2005) Counselling Supervision in Organisations:

Professional and Ethical Dilemmas Explored.  Routledge

Reviewed by Ruth Barnett

 

Carroll, Michael and Gilbert, Maria C.  (2005) On Being a supervisee: 

Creating Learning Partnerships. Vukani Publishing.

Reviewed by Annie Power

 

Bryant-Jefferies, Richard (2005)  Counselling Victims of Warfare: 

person-centred dialogues.  Radcliffe Publishing.

Reviewed by Ruth Barnett

 

Pritchard, Jackie (Ed) (1994) Good Practice in Supervision:  

Statutory and Voluntary Organisations. Jessica Kingsley.

Reviewed by Ruth Barnett

 

Supervising Couple Psychoanalytic Psychotherapy:

A View from the Tavistock Centre for Couple Relationships

                                                    

Dr. David Hewison

 

The Tavistock Centre for Couple Relationships (TCCR) has a distinctive tradition of training and thinking in staff supervision (Hughes & Pengelly 1997) and it utilises some of this thinking in the supervision of psychoanalytic psychotherapy with couples.  There is particular attention paid to the ‘organisational setting’ of the work, whether this be institutional practice or private work – TCCR would consider both to be particular examples of ‘organisations’.  In our experience, the organisational nature of private work is often underplayed, on the assumption that this is a private arena and not one that shares commonalities with work in settings such as the Heath and Social Services, or the Voluntary Sector.  Nonetheless, TCCR has an opinion that the dynamics that are familiar in the former setting also play out in the latter.  The way of clarifying this is to outline the supervisory dynamics that exist in each forum.

 

There is an attention paid to the interlocking of two triangular dynamics (Mattinson 1997): those between participants and those between the needs of the participants, as indicated in the following two triangles.

 

               

        Diagram 1: Participants                                          Diagram 2: Needs

The various corners are not identical with each other.  Although, for example, the needs of the organisation may well be held in mind by the Supervisor, they may equally be held in mind by the Supervisee – though if there is a managerial relationship between the two, responsibility for the needs of the organisation rests with the Supervisor.  If they are in a collegial relationship, or one that ‘splits-off’ the needs of the organisation like some ‘clinical supervision’ arrangements, then the responsibility is more diffuse.  Similarly, the needs of the Clients/Patients should be foremost in the minds of both the Supervisor and Supervisee.  The Clients/Patients should be enabled to remain free of concerns about the organisation or the practitioner – though where there is a low fee scheme such as the CG Jung Clinic at the Society of Analytical Psychology where intensive analysis is offered at a substantially reduced rate the Clients/Patients may be made aware of an expected minimum period for their analysis/therapy/counselling (see www.cgjungclinic.org.uk).  In such cases the needs of all three functions are met.

 

 One of the things to note is that the needs of the Supervisee are for “Professional development”, not “Personal development”.  There is no place for personal therapy in the supervision of another practitioner’s or trainee’s work.  One senior analytic supervisor takes this as far as indicating that comments that a supervisee “to take such and such a feeling to their analyst” should not occur: as he points out “We are analysts so lets us proceed analytically, not as traffic policemen” (Astor 2000  p 372).

 

This is particularly appropriate for a number of modalities of work, not just couple psychoanalytic psychotherapy.  In couple psychoanalytic psychotherapy there has been a history of working with the ‘Reflection Process’ (Mattinson 1975).  This developed from a tradition of parallel single sessions with members of a couple in which it was noticed that the dynamic within the couple was found to be influencing the dynamic between the two therapists involved.  Moving over time to a co-therapy foursome with couples has allowed this phenomena to be better held therapeutically – at TCCR co-therapists schedule times to meet together to discuss their case after each session.  In addition, the practice of regular conferencing between clinicians in a regular clinical workshop allowed split-off dynamics to be identified within that format also.  It requires a willingness to see intra-group phenomena as having their origins in the processes of defence and communication (primarily those of projective identification) going on between the couple.  

 

Diagram 3: Dynamics in Foursome Couple Psychotherapy

 

That these dynamics are necessarily highly complex in foursome work is vividly illustrated in Diagram 3, which is based on Jung’s ‘Marriage Quaternity’ (Jung 1946 para 422), the well-known illustration of the transference-countertransference dynamics going on between individual patient and analyst.  It should be no surprise that this would require ‘registering’ via a group setting outside the unconscious dynamics between the couple and their therapists, between the couple, and between the therapist pair.

 

 

What about Practice?

 

Supervision of Couple Psychoanalytic Psychotherapy is more complex that that of individual work because, as will now be apparent, there is a highly complex matrix of transference-countertransference dynamics at play.  TCCR does not legislate for only one style of supervision, though it does require weekly supervision sessions as part of its Clinical Training.  Core Clinical Staff at TCCR have a weekly peer supervision meeting.  In addition, trainees attend a weekly clinical workshop that has the dual function of attending to the detail of the session, presented by process recording, and of making explicit for investigation and examination the dynamics within the workshop group and the light they can shed on the couple relationship and the process of the therapy itself.

 

Some TCCR supervisors require copies of process recordings to be given to them, which they then read through as the supervisee presents.  Others require the supervisee’s process report to be delivered verbally, allowing the supervisor to be free to use their evenly suspended attention to notice particular elements of it.  These can then be addressed in a way that matches the supervisee’s learning stage – they may require more explanation and confirmation at the beginning of their training and more space to be imaginative and playful, learning from their own mistakes and successes, towards the end of their training.  Attention is also paid (usually in an informal way) to a supervisee’s preferred learning style – how they learn best.

 

 My general personal preference is to be more directive about the frame and setting of the work when a clinician is new to it as the clarity of the frame allows the individual dynamics of the case to become clearer, particularly when it involves pressure on the therapist to enact a conflict that the couple are not yet aware of fully themselves.  Once the frame has been sufficiently integrated into the supervisee’s way of working then attention can be redoubled to an area that will also have been seen to be important: the exercise of the supervisee’s capacity to be emotionally and imaginatively in touch with the couple and their conflicts (see eg Hewison 2005).  This requires developing a disciplined flexibility in technique and focus as the supervisee develops a therapeutic attitude that allows them to move to and from individual- and couple-interpretations and comments.  I think it is a sign of either faulty technique stemming from a misunderstanding of couple psychoanalytic psychotherapy or a sign of a kind of ‘projective gridlock’ (Morgan 1995) with the couple if a therapist continues to make only one kind of interpretation or focuses on only one kind of emotional state/couple dynamic.   This is a sign that the therapist is caught-up in a powerful countertransference experience that needs understanding.  The same is true of the supervisor and what they allow themselves to know about in the case and in their relationship with their supervisee.  The supervisor needs to be able to be themselves and to enable the supervisee to be themselves too.  Being oneself, however, does not mean abrogating the painful and rather abstinent place of a psychoanalytic psychotherapist.  It means ‘being oneself in context’: the context is the boundaried, somewhat artificial, dependency-inducing, emotionally risky practice of committing oneself to another person/people come what may.  Supervision helps with this and it gives a chance to link together the different elements involved in the work. 

 

 

References:

Astor, J. (2000). "Some Reflections on Empathy and Reciprocity in the Use of Countertransference between Supervisor and Supervisee." Journal of Analytical Psychology 45(3): 367-383.

Hewison, D. (2005). Sex and the Imagination in Supervision and Therapy. Psychoanalytic Perspectives on Couple Work 1: 72-87.

Hughes, L., and Pengelly, P. (1997). Staff Supervision in a Turbulent Environment. London: Jessica Kingsley.

Jung, C.G. (1946). Psychology of the Transference. The Practice of Psychotherapy. London: Routledge & Kegan Paul. CW 16.

Mattinson, J. (1975). The Reflection Process in Casework Supervision. London: Institute of Marital Studies.

Mattinson, J. (1997). The Deadly Equal Triangle. London: Tavistock Marital Studies Institute.

Morgan, M. (1995). The Projective Gridlock: A Form of Projective Identification in Couple Relationship. Intrusiveness and Intimacy in the Couple. (Eds, Ruszczynski, S. and Fisher, J.). London: Karnac.

 

 

Biography:

Dr David Hewison is a Senior Staff Member and Couple Psychoanalytic Psychotherapist at the Tavistock Centre for Couple Relations.  He is also a Jungian Analyst and Professional Member of the Society of Analytical Psychology.  He teaches supervision and supervises supervisors working in organisations and in private practice.  He is also in private practice in North London as an individual analyst, couple psychotherapist, and supervisor.

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The Supervision of Couple Therapy

Elspeth Morley

 

As a younger sibling in the psychoanalytic family, the profession of couple psychoanalytic psychotherapy has to struggle to establish a separate identity from that of the illustrious Founders of Psychoanalysis and their followers who, although their theoretical work and training has focused only on the individual patient, may nevertheless extend their practice to include work with couples. Supervisors may follow suit, regardless of the different dimension involved in supervising couple therapy.

 

So what is the difference in the work and supervision of psychoanalytic therapy with couples?  Those who seek to minimise it will argue that it is one only of making the couple-as-client the focus of the therapy, so that interpretations are made, not to the clients as individuals, but to the unconscious couple fit of their mutual projective identifications.  This is already indeed a skilled process, theoretically and clinically.  It involves a painstaking observation of the couple’s interaction to see how their unconscious choice of each other has usually mirrored a shared emotional task arising from their attachment to, and detachment from, their families of origin.  Stereotypically this has left them with opposite ways of tackling their shared emotional scenarios, and now often seeking unconsciously to identify with (or reject) the partner’s way. At its most basic, one partner may be seeking to attach indissolubly to the other without being engulfed, while the other has sought to detach without being abandoned.

 

 The couple therapist will be helped in supervision to study and compare the individual geneograms of the partners, their ‘vertical’ inter-generational and (most importantly because so often ignored in psychoanalytic practice) their ‘lateral’ sibling intra-generational patterns of relationship.(Mitchell, 2005). Previous relationships will also be studied to see particularly the repetition of family patterns, with the partners often alternating choices of, e.g. pressurising the partner into a repeat of a parent or sibling, or becoming themselves identified with that family figure while giving to the partner their own discarded role in the family of origin.  Again it is particularly important to look for such re-enactments, within the context of the relationship with the mother, on the lateral sibling level as often determined by position in the family. E.g. It can sometimes be observed that the oldest of the family has mutually chosen a partner who was the youngest, each seeking to repeat, or to grapple with, an important sibling configuration.  Perhaps each is a twin, or each has a dead sibling, for whom perhaps one has felt pressured into being a ‘replacement’ child, and the other has felt excluded from fulfilling that role. A huge variety of such mix-and-match factors can be discerned in couple choice, rendered all the more complex by the particular impact of gender, sexuality, age differentiation etc, uniquely for those individuals, and for the interlocking partnerships they have formed. The couple therapist should welcome the shared dialogue of supervision to explore the diagnosis of each unconscious couple ‘fit’.

 

As in all psychoanalytic work, the transference and countertransference between patients and their couple therapist(s) will often be reflected in the parallel process of the relationship with the supervisor.  But in the case of couple therapy the transference to be seen and interpreted should primarily be to the couple, rather than to the therapist. If the couple therapist works to create and maintain a transference to him/herself, with whom there is no unconsciously chosen couple ‘fit’, this is unlikely to be as strong or effective a medium for work as exploring the patients’ transference to their own couple relationship. The transference to the therapist will become apparent, but if sought after and prioritised, above that of the couple, as the primary agent of change, it may either be unhelpfully competitive or ineffectively outclassed.

 

The couple therapist’s countertransference, by contrast, is generally even more important, diagnostically and therapeutically than in individual therapy.(Siegel, 1997)  The couple therapist is outnumbered by the couple, who know each other better at every level than s/he knows either; and they have after all many more hours together than the single weekly hour with the therapist.  S/he has far less influence or control on the volatile dynamics acted out in couple sessions than is usual in individual work. S/he can be made to feel like the hapless parent, or older (or indeed younger) sibling in the face of the quarrelling siblings the couple represent.  It is here that the couple therapist can most be in need of the supervisor’s help not to enact the countertransference by imposing order unhelpfully, bludgeoning the couple with interpretations, or capitulating to their joint impact in a way that disables the therapist’s capacity to think. Or s/he may give way to the sometimes intolerable pressure to ‘divide and rule’, siding with one or the other partner, sometimes alternately, but losing the focus of the ‘couple-as-client’.

           

A supervision session may reflect the transference/countertransference issues in couple therapy, as it does with individual work.  The ‘couple’ of supervisor and therapist may usefully reflect the patient couple’s dynamics (as can be so readily seen in the therapist couple working with the patient couple in foursomes).  But it will be contained in the ‘thinking space’ of the supervision session, sometimes in contrast to the uncontained therapy session where the ‘acting out’ may not have been confined to the patient couple.

 

In summary, supervision may be a yet more invaluable tool for the couple therapist than for individual work, particularly if the therapist is working solo, rather than in a therapeutic pair.  But despite drawing heavily on psychoanalytic theory and practice, couple therapy has a professional genre of its own and its effective supervision needs to have the same additional dimension.

 

References

Mitchell, Juliet (2003)   Siblings: Sex and Violence. Cambridge: Polity.

Morley, Elspeth(2005)   The influence of sibling relationships on couple choice and      

development. In Sibling Relationships. Ed. Prophecy Coles. Karnac:

Seigel, Judith(1997).    Countertransference as the Focus of Consultation .                                                  Countertransference in Couples Therapy  Ed. Solomon and Siegel. Norton.

 

 

Elspeth Morley is a Senior Training Member of the British Association of Psychotherapists, and of the Society for Couple Psychoanalytic Psychotherapists. Her forty years of private practice with individuals and couples includes work with her husband, Dr Robert Morley, as co-therapist.  She trains couple counsellors on the Tavistock Centre for Couple Relationships Postgraduate Diploma in psychodynamic couple counselling.

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Supervising with the Couple in Mind

Jenny Riddell

 

It is a widely held view that in couple therapy it is the couple relationship that is the client. That is to say that the “couple fit” or mutual projective system which results from the interaction of the two individuals’ psyches, is the place for the therapist to observe, focus and place their interpretations. That it is this overlap that requires containment and understanding.

 

My experience of supervision of couple work broadly divides into two areas, supervision of the therapist who works with the couple, and supervision of the therapist who works with the individual in an intimate relationship, with a couple problem when the partner chooses not to attend. I would like to suggest a third area of supervision, which is working with the couple in mind. This would include what I believe is a rather under attended area of supervision which is the responsibility, curiosity and care of the psychotherapist to bear in mind the intimate adult relationship of their client, when engaging in an individual psychotherapy.

 

As a psychoanalytic supervisor of couple therapy I am predominantly interested in the reflection process in case presentation and the dynamic in the room during supervision. How are the couple presented? Does the therapist present two individuals, introducing separate histories, descriptions and pieces of therapy? Or does the therapist present a couple, with an interest in similarities or differences between the two and how and why they would choose each other? How is the transference worked with? Is it possible to have a “couple transference” and if so what does it look like and how is it worked with? What is their counter transference, how does a therapist manage a couple counter transference, which must relate to his or her own internalised couple? In addition there is the “here and now” of the supervision session. How do the two of us relate in the immediacy of this session and what does that tell us about the couple being presented?

 

Three in a room is charged with potential Oedipal issues and the therapist needs to hold on to their ability to take a ‘third position” (Mattinson) within themselves, to maintain empathy with each and with the couple and yet not be overwhelmed or withdraw. To be with a couple as they demonstrate, both consciously and unconsciously, their anxieties, distress, yearning, hostility or whatever else may be immediate in the room, raw and undigested, not recollected in tranquillity, can be very hard to bear. Supervision can and should be a space where the therapist can allow these powerful feelings to be safely explored.

 

Technically there are also other issues to contend with in comparison with one to one work. What happens if only one turns up, do you see them or don’t you? Do therapist and supervisor see this differently, and if so are they holding different parts of the dyad. Who pays for the sessions and how? How is the organisation of the therapy managed i.e. times days and holidays, whose needs predominate?

 

In spite of the complexity, supervision of couple therapy is every bit as challenging and rewarding as the couple therapy itself. It is a privilege to be allowed into the inner world of any other human being, but to be allowed into the inner world of an intimate adult couple is also an opportunity to create a “triangular space” (Britton) in which all are engaged but also watch and observe, are included and excluded, which can be painful as well as enlightening.

Jenny Riddell is a CAPP registered psychoanalytic psychotherapist working with couples and individuals in private practice. She supervises and teaches on a variety of trainings and academic courses, including Relate, TCCR, CAPP and WPF.

References

Britton (1989) The Oedipus Complex, London: Karnac

Mattinson  (1981) The Deadly Equal Triangle, Mass., and London: Northampton

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Margaret Quail

 

Jacky was an experienced counsellor in my weekly supervision group of three at a community counselling organisation. where clients are seen for eighteen sessions by volunteer counsellors.

 

Two years before joining the group Jacky suffered serious ill health that required brain surgery. She lost some confidence as a counsellor and, as she contemplated returning to work, she felt that just one or two clients in the supportive context of the organisation would help her re-establish herself. It was soon clear that she was a highly competent practitioner.

 

Jacky’s third client, ZW, was a young woman of twenty-eight, a British born Jamaican who spoke extremely quietly, almost whispering. When she could be heard, Jacky found it very difficult to understand what she was trying to say. She was referred by her GP and there was no mention of any physical health problems yet the client wanted to be ‘tested’ and ‘cured’ and ‘made normal’. She said she did not feel understood. She spoke of wanting to appear ‘ethical’ yet it was impossible for Jacky to establish what she meant by this.

 

Whenever Jacky presented, the level of anxiety in the group rose. It was clear that Jacky, who was very able and articulate, felt frustrated at not being able to present coherently. Usually what ZW said could not be heard or did not seem to make sense and in turn, Jacky felt that the group did not really understand the problem of working with this client. The anxiety built up and we all found ourselves feeling frustrated and helpless as we floundered about trying to offer explanations to account for ZW’s behaviour or to interpret the meaning of it or make practical suggestions of how Jacky could deal with it.

 

Added to this, I was aware of being a fairly inexperienced supervisor, concerned myself about being ‘ethical’, supporting the group and discharging my duty of care to ZW who was a powerful presence in the group, provoking anxiety and a desperate need to find solutions. Yet at the same time she seemed remote – in another world. She slipped through our fingers continually; there was nothing to hang on to. She fragmented the group as we individually wrestled with attempts to understand. Even the basic tool of language seemed inadequate and communicating was a tremendous strain both in the counselling and in supervision.

 

At last, after several weeks we began looking at what was happening – in the counselling, in supervision and in ourselves. Jacky admitted that, perhaps because of her illness, ZW evoked in her anxieties surrounding madness and her ability to think. We all found ourselves clinging to rational explanations and practical ideas perhaps because the ‘presence’ of ZW had such a destabilising effect, reflecting her own instability and fears. Meanwhile, I struggled to contain the anxieties of the group and support both Jacky and also her client.

 

We recognised that the feelings of the group reflected those of both ZW and Jacky and that, at least for a while, we should be content with ‘being’ rather than ‘doing’: for Jacky to be prepared to enter the inaudible and incomprehensible world of her client and for the group to follow suit. Also, I had to subdue my need to demonstrate my effectiveness as a supervisor. I needed to be less active and (as with the counselling) to allow more space and time for reflection whereby, hopefully, insights would emerge. As soon as I began to understand and contain my own anxieties, there seemed to be a backward countertransferential flow through the group and the counsellor and finally to the client who began to feel more accepted and comfortable with her own individuality

 

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Christine Driver

Trying to remember countertransference is like trying to remember a dream.  It emerges in the moment in relation to a dynamic of the therapeutic or supervisory relationship only to fade as that dynamic changes or moves away.  Ogden (2005) speaks of supervision itself as a sort of ‘dream’ in terms of a form of active imagination or reverie in relation to the countertransference feelings and fantasies within the supervisor. The difficulty with conceptualising and thinking about countertransference is that it is often like the difficulty of owning and thinking about a dream.  It slips away or is hard to own as it feels too ordinary or disturbing.

 

Countertransference often feels intrusive and induces shame.  It brings thoughts that we don’t want to think about or own and feelings that are defended against.  This is the step into the unknown that we need to take if, as supervisors, we are to enhance the depth of our understanding with the supervisee.

 

Recently a supervisee was presenting her work and I found I could not hold on to what was being said, my mind was wandering and I felt utterly useless.  I felt I should give up and also felt ashamed of feeling like this and wanted to disown the feelings.  However, in allowing myself to own these emerging thoughts I began to wonder why I felt like this.  I thought of what the supervisee was presenting and realised that she was presenting a different type of work than usual.  The supervisee was operating outside of her normal role, the organisation she worked for was all ‘out of place and disorganised’ and the patient constantly displaced the session to outside of the frame.  Overall therefore, everything and everyone was displaced and outside their normal frame of reference and therefore unable to function as normal.  My state of mind seemed to parallel this.  I was unable to function as normal and in thinking about the patient’s material it was also an accurate reflection of the patient’s state of mind.

 

Owning countertransference therefore can take us down a fruitful path but we need to allow ourselves to dream the emerging feeling and think the emerging thought.  To question, reflect and own rather than resist and dismiss.

 

Reference

Ogden, T.H. (2005) On Psychoanalytic Supervision. In, International Journal of Psychoanalysis 2005; Vol. 86 Part 5 : 1265 -1280

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Ted Martin

 

This particular person had been in supervision for a long time. Possibly too long, but the relationship seemed to continue to be creative and not at all collusive. From time to time I ran a session in front of my supervision of supervision group to check this out – and this seemed to confirm my own impression.

 

About 10 years ago my supervisee developed a cancer; he dealt with this by writing to all his clients, informing them about his illness, promising to write to them again three months later but telling them that if they felt in need of another therapist he would arrange for someone to assist them in that process. In the event all except one returned.  This was not brought to supervision (partly due to the urgent nature of the treatment), my supervisee making his own arrangements, and whilst being “left out of the loop” I felt the arrangements to be satisfactory and very much part of his style of working.

 

He returned to work and to supervision work that continued until early this year when he told me, following soon after an “all clear” from the oncologist, that he was getting some uncomfortable symptoms that were being checked out by the hospital. He then suddenly cancelled one of his fortnightly appointments because of his feeling unwell. He cancelled a second one by letter telling me his writing showed how he was feeling. I sent a card wishing him well, but registered that this might signal him not returning to work and that our next meeting might be about him closing his practice.

 

A message from his wife on my answer phone came shortly after  – I responded the following day and she told me of his death in postoperative care following an emergency admission. I talked for a few minutes about my feelings about him and she told me of the date of his funeral, the day before I was due to go on holiday and I confirmed I would want to attend. Just as she was about to ring off I remembered to ask about his clients, hoping to confirm that a colleague would be in touch with them. I was told a member of the family had this in hand and would be sending out a formal notice. Alarm bells started to ring and, thinking on my feet, knowing that I was responding to someone very distressed but thinking too of his distressed clients, I suggested that my name be added to the notice as a source of therapeutic help if needed. I also said to add a date of my availability, which would be some ten days later, because of my own break.  Please don’t supervise me on this, colleagues; it was the best I could think of!

 

The funeral with a large congregation paid tribute to a man of great integrity and of many parts. There were three eulogies – but I noticed that his counselling work, work that had been a major part of his life, received little mention and that no professional knowledge was displayed about this work. It was very private to him and perhaps to me and some other counselling colleagues.

 

It therefore did not surprise me that the one contact I have had (with one of his own supervisees) since the funeral thought the notice to be inadequate. Hindsight of course tells me that at some point I could (should?) have checked that he had made suitable provision. I failed to because I knew he had been closely involved with BACP ethics and complaints and assumed, not least because of the manner in which he had managed his earlier cancer episode, he would have made provision for this. I was wrong.

 

Since the funeral I have talked with BACP about such provisions who I believe are sympathetic to the points I raised and that they will consider making the naming of a colleague to manage a case in the event of death or incapacity part of the accreditation/ re- accreditation process.

 

My purpose in writing this is a self-acknowledgement of how easy it is not to talk about death, (an inevitably anxiety-provoking subject) but also to encourage other colleagues not to let that over-ride their judgment. Many professional bodies make such a provision mandatory – I think BACP will because they are amongst the few who so far haven’t. Until that happens perhaps it is the task of supervisors to be aware of this to address the issue with their supervisees. 

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Ruth Barnett

 

All the world’s a stage,

And all the men and women merely players:

They have their exits and their entrances,

And one man in his time plays many parts…

Jaques in “As you Like It”, W. Shakespeare.

 

In everyday life, as Shakespeare so aptly puts it, we play many roles on the communal stage. We are born and grow up with multiple roles as somebody’s son or daughter, sister or brother, cousin, even uncle or aunt. So why should we not also expect to play many roles, even simultaneously, in a therapy organisation?

 

Voluntary counselling organisations usually operate ‘on a shoe-string’ and so it is convenient and can save time and money to have personnel doing more than one part-time job in the team. It may also feel reassuring and helpful to have one person, who is trusted and liked, covering several areas of the service. For example the Counselling Co-ordinator may also assess and refer clients. As Co-ordinator she may hire the counsellors, know them well and can do a good job matching clients to their competencies. She may also supervise some or all of her counsellors. She may even take on counselling some clients that she has difficulty matching with any of the counsellors. If the organisation requires all counsellors to have supervision she may be a supervisee alongside some of her counsellors in a supervision group in the organisation. As the Co-ordinator usually works with a management committee, she may also be a trustee.

 

It is quite possible for one person to be Trustee, Counselling Co-ordinator, Assessor, Supervisor and counsellor/supervisee in one organisation. As far as I know this would not be illegal. But is it desirable? Is it ethical?  The BACP Ethical Framework for Good Practice does not allow therapists to have any other relationship than the therapy relationship with their clients. Should it require a therapist to have only one relationship with an organisation? In fact it is more or less how many counselling organisations began. One keen therapist, with a few dedicated helpers, organised everything, took as many clients for counselling as he could himself and supervised the others to whom he referred the rest of the clients. That was two or three decades ago. It provided very valuable counselling for people who could not afford private practice fees. Such small ‘family groups’ seemed to work very well as dedicated small teams.

 

As counselling training courses became established there were more counsellors looking for work. When they joined the small counselling groups they wanted to practice in line with their training. They wanted more professional procedures and synchronised standards. As the size of these voluntary organisations increased so did the need to reorganise with a professional structure. In small groups of like-minded dedicated counsellors serious differences were unlikely to arise. As the clinical team grew larger, the unanimity of the original founders became harder to preserve and the creativity of the newer graduates from training courses began to throw up problems. In my experience many such problems were rooted in dual roles relationships breaking down. As a supervisor of both counselling and of supervising I got to know about some quite pernicious tangles with dual roles. Let us look at some of the dual role combinations that are quite common in counselling organisations and consider the possible dangers.

 

It is possible for the role of Counselling Co-ordinator to be purely administrative. She is a real gem if she has the counselling skills to field & respond with empathy to all the incoming phone calls, deal with clinical issues of counsellors & supervisors as well, handle internal & external complaints & keep all the files up to date. Usually a part-time administrative secretary acts as a resource to the Counselling Co-ordinator. If she is a trained therapist/counsellor, as she needs to be to understand the increasing clinical issues of her counsellors & supervisors, she may not be happy doing only clinical organisation. She will want to do some clinical work too, as Intake Assessor, counsellor or supervisor.

 

A supervisees to his supervisor his supervision group, which was one of three parallel supervision groups in a small counselling organisation. When she had taken on a client herself, the Counselling Co-ordinator joined his group for supervision. The supervisee had not been told about this in his original interview with her. When he questioned the arrangement she assured him it would be helpful, as she needed to experience how each group was getting on. He did not want to risk losing his group by complaining as he was on a training course and might have difficulty finding another group to supervise. He described how the Co-ordinator’s presence unsettled the group and disturbed the group dynamics. Moreover, it was very difficult for him to be the supervisor when the Counselling Co-ordinator was much more experienced and virtually took over the supervising role. His supervisees were baffled and their client material began to contain seemingly impossible boundary issues. In supervision he realised that he would be unable to help his supervisees to address their clients’ with boundary issues unless he tackled the boundary issue with his line-manager/supervisee the Counselling Co-ordinator.

 

Another supervisee who had been with her supervisor for three years was building up her private practice while counselling in a voluntary organisation. She brought a client to supervision because he was behaving out of character. He had become nervy and suspicious and accused her of ‘doing strange things’ but couldn’t explain what. The supervisee wondered if he had become paranoid and needed a psychiatric assessment. When her supervisor asked for the client’s history, it transpired that the supervisee had been recently accepted for supervision training and needed to find a group to supervise. Her voluntary organisation agreed to give her a group of counsellors to supervise. When she went to her usual supervision group in the organisation, the other supervisees gave her a hard time and the supervisor suggested it was going to be very difficult now that she was a supervisor in the organisation herself. The supervisee had taken this to the Counselling Organiser who suggested the supervisee take her client into her private practice and find supervision elsewhere. The supervisee saw all her clients in her own consulting room and it had not dawned on her to tell the client he had been transferred. She then told the client and they were able to work this through.

 

Another problem occurred with a supervisee who needed to clock up hours for accreditation as a supervisor. He had a friend who was a Counselling Organiser in an agency and who was able to get him appointed to supervise a group there as a voluntary supervisor. Things did not go well. His group did not settle. He had particular trouble with one supervisee who had five clients when the other three had only four between them and this made up the maximum client load of nine to keep within BACP requirements. She challenged him in every possible way and then, when she found the supervisee held his role as supervisor, she got herself transferred to another supervision group. Another counsellor was transferred against her will into the supervisee’s group. This counsellor was substantially lacking in counselling skills and the supervisee did all he could to help her, but to no avail. This ‘replacement’ counsellor was too resentful at having been bullied by the former supervisee to swap, and did not respond well. This spread resentment in the whole group. Through supervision the supervisee decided to tackle the Organiser, who was very abrupt and told him he would have to sort it out himself. Then the supervisee had a very unpleasant phone call from the supervisee who had left his group. She accused him of not being a proper supervisor because he wasn’t paid like the others, of harassing her friend who had swapped and trying to get between herself and the Organiser. With further exploration the supervisee decided to tackle the Organiser again. Inadvertently, he discovered that the Organiser and his former supervisee had trained together and were close friends as well as colleagues. The Organiser was in some way indebted to this counsellor for getting her out of a problem during training. Hence the Organiser, who did all the assessments and referrals herself, gave more clients to this counsellor than anyone else. The lid had been lifted off a ‘can of worms’ and the disturbance spread right through the organisation. It took a long time and a lot of persistence from the supervisee to get things back on a workable footing in his own supervision group.

 

Nothing illegal happened in these three cases, nor was there anything specifically prohibited by the BACP Ethical Framework. But in each case the situation of dual roles set the scene for relationships to become fraught between clinical colleagues. The balance of power and communication in the organisational rhombus was skewed in each case. The optimum setting would probably be one in which no person could wear more than one hat in the organisation. Effective working relationships would then still depend on clear lines of communication. Well thought-out contracts including clear role definitions are essential, in my opinion, to achieve this. Had there been such written contracts for counsellors, supervisors and Counselling Co-ordinator in each of the above cases, the power imbalances would probably have become visible sooner and been addressed. What so often happens is that counselling teams operate with verbal contracts, which work well until a situation arises to expose the fact that parties to the same contract hold very different versions of it in their minds.

 

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Copland, Sue (2005) Counselling Supervision in Organisations: Professional and Ethical Dilemmas Explored.  Routledge 222 pages.

 

Key Words:- Supervision, ending,  contract, payment, training, organizations.

 

It is a gratifying advance to find a book taking supervision in organisations seriously. It is also pleasing to see evidence of the growth of counselling departments employed by and operating within commercial organisations rather than EAPs acting as middle-merchants, making profits and calling the tune. The book is easy to read. It has just enough diagrams and bullet point lists to appeal to readers who visualise without putting off those who don’t.

 

Sue Copeland focuses on supervision of counselling in commercial firms and public services, such as the P.O. and NHS with much less material relevant to counselling agencies. This is appropriate as growth in counselling is in this direction. She also goes with the trend towards short term focal counselling using cognitive behavioural methods. Much is made of tripartite meetings between supervisor, supervisee and the line-manager that is usually not a counsellor but has organisational responsibility for the counselling department. She recommends that supervisees and the line-manager interview and appoint the supervisor. Unconscious processes set up by this and the multifaceted role of the supervisor are acknowledged, but not explored, and are seen mainly in terms of issues in the firm’s culture entering the supervision as parallel process.

 

The book is rich in vignettes of issues that illustrate the problems encountered in adapting counselling to fit into a wide variety of commercial and public service contexts that are themselves rapidly changing. The 11 tasks of the supervisor, explored in pages 126 to 142 may seem strange to supervisors working in voluntary agencies or with clients in private practice. Supervisors employed in large firms are expected to hold the tension between counselling and non-counselling line-management, and act as tutor, mentor, coach, and consultant to the firm as well as supervising clinical work and influencing the culture. Copeland discusses the boundary problems arising from these multiple roles but unconscious dynamics seem to be ignored. Nor does she distinguish between supervision which addresses case material and case discussions which should rightly belong in training. Personally, I find it hard to believe that counselling departments would not be better served by appointing a supervisor to supervise casework and a clinical organiser to take on or organise the rest of the roles.

 

However there is a wealth of information and ideas from Copeland’s own and many other authors’ research. Particularly enlightening is her material about clashes between different cultures and the ways that supervisors need to operate to achieve a fit between them. Although based primarily on the needs and context of counselling in commercial organisations, Copeland’s explorations of the structure, function and role of contracts, notes and records, risk assessment, monitoring standards, reporting back and dealing with endings and new beginnings gave me much food for thought in relation to reviewing policy in my own counselling agency. Five appendices give interesting examples of a job advertisement, an application form, a supervisor’s contract, a report form and a process for co-ordinating the tripartite responsibilities of supervisor, supervisee and line-manager.

 

Monitoring fitness to practice is a theme that recurs in selection and appointment, monitoring efficiency and effectiveness and endings. The supervisor’s retirement is one factor in a list of reasons for supervision ending. Redundancy and retirement figure as problems that clients are likely to bring to counselling as part of restructuring, take-over bids and other reorganisations in the firm. An interesting scenario develops when the counselling department itself is similarly affected by redundancy. Fixed term contracts are taken as the norm. There seems no place for addressing the emotional tasks for the counsellor and supervisor regarding facing retirement.

 

Copeland quotes some disturbing figures that show disparity in the field and that some counselling organisations and agencies are behind in development. From her own research she quotes that 37% of supervisors in health, educational and commercial settings have no contract at all with their organisation. 57% of supervisors in counselling agencies have no contract (page 86). She also quotes a study by Burton in 1998 that found that 47% of counsellors in Primary Care were paying for their own supervision (page 62). This of course means no contact between the supervisor and the supervisee’s line-manager (the GP).

 

This book is a useful read for all counsellors in the field. It should be of added interest for therapists involved in counsellor and/or supervisor training. Many of the issues explored in this book will need to find a place in training courses if they are going to equip counsellors and supervisors for employment in large commercial firms and public services as well as counselling agencies.

 

Ruth Barnett

 

Carroll, Michael and Gilbert, Maria C.  (2005) On Being a supervisee: Creating Learning Partnerships.

Vukani Publishing;  ISBN: 0955113903;  120 pages.  Price: £15.00

 

Key Words:- Supervision, guidance, planning, supervision sessions .

 

This publication comes from outside of the analytic world- although it does not explicitly declare a theoretical stance.  I was attracted by the book’s aim of helping trainees to maximise their learning in supervision and was interested to see if there could be a common understanding of this across the modalities.  Whilst I appreciated the focus of the book, I was often out of sympathy with both the content and style.

 

The style, whilst always impeccably clear, was often laboured and relied heavily on the use of lists.  My irritation with exclamation marks in the text must I think reflect the fact that I was operating a different set of assumptions from the authors and was thus not attuned to their sense of humour.  Whilst almost all the points in the book were rather overly spelt-out, there was one area of confusion in the case examples given at the end of each chapter.  These vignettes described difficulties in supervision and challenged the reader as to how they would manage such a situation, but the problems set seemed to be randomly addressed either to supervisees or to supervisors.

 

I was surprised at the low level of emotional literacy which was assumed in readers as well as at the prosaic manner in which every issue was addressed through lists.  A chapter on “Learning how to reflect” offers first of all a list of five definitions of reflection, with six “areas covered by these definitions”; next comes a list of twelve “internal requirements that facilitate our reflections”, then ten “components of a thinking environment” and finally nineteen “other ways that individuals learn to reflect at ever deepening levels”.

 

I think this style, which I found unimaginative, reflects a difference in therapeutic stance.  The effort to dot all  ‘I’s and to cross all ‘T’s suggests a more literal understanding of relationships, and therefore of boundaries, than in the psychodynamic approach where there is  more willingness to embrace the dynamism and to make creative use of the snags and cracks which emerge, and which signal the working of unconscious processes.  This difference is perhaps evident in the early chapters of the book which address “Roles and Responsibilities” and a “Supervisory Contract”.  The authors encourage supervisees to be very clear and specific in their learning goals and in their expectations of their supervisor.  They warn that without this there is a risk of misunderstandings and disappointments which can lead to games or ruptures in the supervisory alliance.  Whilst in outline I find this suggestion commendable – there does need to be clarity about the frame – I would argue that containment is achieved in the ability of the dyad to continually negotiate and think about their relationship.  That ongoing alertness to the relationship has to be maintained if we are to successfully read the parallel process.  Perhaps my strongest reaction to the approach laid out in the book is that it would be no fun at all to me.  Rather than the creative reverie or play which I associate with supervision, there is a constant grind of preparation, review and evaluation all conducted according to lengthy checklists.

 

Some of the checklists were useful to me; I liked one which helps the supervisee to reflect on how they are selecting the material which they take to supervision (p 28).  I also liked the chapter on “Understanding developmental stages of learning in supervision” which made use of Casement’s internalised and internal supervisor as well as Robinson’s three stages: “unconscious incompetence to conscious incompetence”, “conscious incompetence to conscious competence” and “conscious competence to unconscious competence”. 

 

Another useful point about learning styles was made with the help of a diagram which  expanded the meaning of the familiar categories: “activist, reflector, theorist and pragmatist” (p 108).  The chapter on giving and receiving feedback had much that was useful including one of the longest lists, which I could bear because it presented the information in an astute and accessible way.  This is a selection from the nineteen items offered under the heading: “Do any of the following statements apply to you?”:

·   If I wait long enough the situation will resolve itself.

·   I don’t want to increase distance between myself and the other person.

·   These are good people – they will know if they are getting things wrong. 

·   I told him twice and it hasn’t made any difference so why bother?

·   I don’t know if I have enough evidence to confront him. 

·   I am afraid I might get angry if I really say what I want to say.

The appendix contained more checklists and forms.  Amongst these I found useful the “Criteria for evaluating counsellors in supervision”; though there was nothing novel in it, it did lay out the basics very clearly.  Less commonplace was, “A model for ethical decision making”, which suggested the stages involved in dealing with an ethical dilemma including the final one of “living with the ambiguities of having made the decision”.

I would not have proceeded with the review if I had not found that the book contained many useful points.  A significant part of my discomfort with the text was to do with its style; by writing it as a manual, the authors appeared to reduce supervision to a mechanical task.  Though my understanding of supervision is at odds with that view, I felt that the authors had addressed an area of importance and one which it would be interesting to see explored from an analytic point of view.

Annie Power

 

 

 

                  

True to its title this book presents some of the person-centred dialogue of two counsellors, each working with a client who has experienced war and been severely traumatised by it, and some vignettes of person-centred supervision with these counsellors. The first is a female counsellor whose female client has suffered multiple rape in Bosnia. The second is a male counsellor whose male client is a former soldier who experienced tours of duty in Northern Ireland, Bosnia and the Gulf War. The vignettes of supervision are particularly interesting for any supervisor interested in the overlap area between what is psychodynamic and what is person centred.

 

Richard Bryant-Jefferies engages the reader by telling these two stories as they unfold in the counselling and supervision sessions. At times it reads like a novel and this holds the reader’s interest admirably. I found myself wishing it actually was a novel as the unpalatability of the two clients’ experiences comes across all too vividly. At the same time the importance of both offering counselling to such victims of war trauma and providing good quality supervision to the counsellors comes across as paramount.

 

For any counsellor or supervisor who has not yet been confronted with a severely traumatised client, or has just begun such work, this is an excellent introduction to the complex issues involved, the skills needed and the importance of adequate holding in supervision. It is also a valuable teaching manual for students learning the theory underpinning client-centred counselling. I would suggest that this book could also be used for students on counselling courses that claim to be integrative; it lends itself to a study of how the technique of both the counselling and the supervision differ from the those used in the teacher’s own modality if different.

 

I am frequently saddened by the lack of understanding I find in students and graduates of counselling courses in which the same teacher teaches modules of different modalities. Outrageous stereotypes persist, particularly between counsellors grounded in either a psychodynamic or person-centred approaches. For example, “psychodynamic therapists act like inhumane poker-faced blank screens, mostly silent and only focus on the past and interpreting”. Or, “person-centred therapists are woolly, let all their own feelings hang out, reflect back everything the client says and avoid any negative stuff”. This book certainly debunks the latter and a psychodynamic teacher or supervisor could use this book to pick up on where the two modalities differ and, hopefully avoid trainee counsellors perpetuating such stereotypes.

 

This book would certainly be of interest to psychodynamic supervisors, working with supervisees who work in a person centred mode.

 

Ruth Barnett

 

 

 

Jessica Kingsley. 224 pages.      £17.95

 

This book is one of a “Good Practice in Social Work” series. As is to be expected, it focuses on supervision of social workers and trainees on placements in various setting where social workers are employed. Its title is somewhat misleading as 13 of the 15 chapters deal with supervision in social work settings such as the probation service, family court welfare teams, bail hostels, service managers, home care staff, residential and day centres. Consideration of the Voluntary Sector is left to the last two chapters and there is more about social workers than voluntary counsellors in these two chapters.

 

Hence, supervisors of voluntary therapists may be disappointed with this book. However, it should still interest them to inform themselves about developments in the statutory sector involving social workers. Notably, the definition, role and function of supervisors is generally rather different to what has developed in voluntary counselling and the supervision of trainee counsellors and psychotherapists. Therefore, without both sides having some detailed knowledge of the concepts and practices of the other, there is likely to be serious failure in communication between members of the two professional areas. Attempts at comparison between statutory and voluntary sector supervision in this book are minimal and misleading. Perhaps this is because a lot has happened in the twelve years since its publication. More likely it is due to social work training and supervision being the main interest of all the contributors. There is even a hint of voluntary workers having a ‘Cinderella’ status in the unconscious if not conscious minds of the contributors.

 

Nevertheless, I would recommend this book for supervisors who have grown up in the voluntary sector and have or might consider seeking employment in the statutory sector. The details of good and bad supervision management and practice in a variety of important social work settings is thought provoking and also would be useful to broaden the understanding of supervisors may  have no intention to leave the voluntary sector. Supervisors in the Statutory Sector are expected to function as managers, educators and agents of age for the organisation as well as addressing their supervisees client material. In fact managers seem often to be given the task of supervising both junior workers and students on placements without formal training for this. Some apparently do well but others misunderstand and neglect their supervisory role. Supervision of trainees in social work settings is often called ‘practice teaching’, which emphasises ‘teaching’ rather than the ‘learning’ approach Voluntary Sector supervisors are used to. Pritchard emphasises the need for supervisors to have groupwork skills but does not even mention training to supervise.

 

The last two essays, “Supervision in the Voluntary Sector” by Christine Stanners and “Supervision or Practice Teaching for Students” by Jackie Pritchard also offer stimulating information about social work supervision. They are interesting, however, in the singular lack of information about developments in voluntary sector supervision. Both Stanners and Pritchard are firmly rooted in the Statutory Sector. Their chapters are certainly interesting but one cannot help wondering why Pritchard, as Editor, did not include at least one essay by a supervisor who had grown up in the voluntary sector or at least was a psychotherapist/counsellor.

 

Overall, this book illustrates the need for ways of creating dialogue and understanding between social workers dealing with emotional issues and therapists whose clients often have social work involvement. I see a need for social work input into the training of therapists and counselling input into social work training. However, this can only be of real benefit if the trainer