BAPPS
NEWSLETTER
MAY 2005
BAPPS
SPRING CONFERENCE
Shame and Guilt: Punishment or Revenge?
20 BAPPS members gathered at the LCP on Saturday March 5th 05 to explore this theme in relation to supervision. The wealth of ideas and experiences shared by this group, in 6 or 7s and as a plenary, left me feeling that it was a SHAME that more BAPPS members had not come to contribute and benefit. There seem to be more events on Saturdays than any other time and, unfortunately, it’s not possible to go to everything interesting – so GUILT does not come into it. I can only give a brief resume of what impressed me in this event, and this may not be at all representative of everyone who took part, but it will, hopefully serve as feedback to keep our outlying members interested in BAPPS:
The social aspect of the meeting struck me first – how important it is to keep a regular forum for members to meet, catch up with each other and recreate anew each time a feeling of belonging to a dynamic worthwhile organisation. This initial socialisation created a safe place in which to begin an exploration of the theme before more in-depth work in small groups, more informal dialogue over coffee and a final plenary.
The frame, even if not specified in words, is all-important in our work – but how does it differ between when we see patients and when we work with supervisees? Are we aware of the contract that we make with ourselves? Are frame breaks less important in supervision? And what do we do with them – or do we ignore them? Is reassuring supervisees permissible in supervision? Do we ignore negative transference in the triad that we would not ignore in the dyad? What happens to the supervisee’s rage at not getting what they wanted/expected and the supervisor’s rage at being attacked/exposed? What is ‘enough personal therapy’ to deal with all this without perverting the task in supervision? Some sort of mental/emotional anxiety thermometer might help.
As it was the day before Mothers Day, there was reflection on supervision as ‘pay-back time for Mother’ – the first all-powerful ‘other’ who shamed us and who we were guilty of giving a rough time. All sorts of primary process fears, ever-lurking below awareness, can emerge in the exposing situation of supervision to constellate archetypes like ‘the charlatan’. The effect of the premises can’t be avoided – they will evoke all sorts of feelings from envy of our imagined possessions to disgust at our messes. It is hard enough to bring them into words in therapy – what happens to them in supervision?
Shame is both harder to define and harder to bear than guilt: something about control – you can control guilt by getting yourself punished but shame is about losing control over what/how you are seen. Exposing and acknowledging ‘the bad bits’ is more acceptable in therapy than supervision. “Supervision is supposed to make us feel better”. If supervising is seen as a ‘reward’ or ‘perk’ for reaching higher levels of ‘the hierarchy’ then the supervisor’s anxiety about exposure may be heightened – more to lose! Collective shame may operate in our systems of training and practice so that we perpetuate it. Another view of supervision can be that it means ‘working in the depressive position’ with constant pulls in the direction of regression and paranoid phenomena.
I have outlined just a few of the thoughts and experiences that were shared and I hope I have created a flavour of the immense richness of the collective work of this conference.
Over the past six months, as I have become more and more familiar with the work of the BAPPS executive and the various developments that are happening in the ‘external world’ of our profession, I am repeatedly aware of the dedication and commitment of BAPPS members both to the internal development of BAPPS and BAPPS’ relationship with external bodies such as UKCP.
Evidence for this is apparent in the content of this Newsletter and the contributions reflect the range of activities that BAPPS members are involved in.
Following on from the last Autumn Conference two new members joined the conference committee and Ruth, Eddie, Janet and Deirdre have worked hard together to produce another stimulating Spring Conference and an interesting Autumn Conference with Brett Carr. They are also looking at advertising the Autumn Conference in one or two journals and hopefully this will bring in a wider audience and a wider awareness of BAPPS.
The Ethics committee are looking at developing a mediation process for our complaints procedures and have also responded to the challenge of a 64 page draft document from UKCP which we, along with other UKCP organisations, were asked to comment on. A mammoth task done with goodwill and considered reflection.
Our UKCP reps have been working overtime to keep up with all the documents coming from the UKCP at this important time for the profession. As you may all be aware the Government is putting into place statutory regulation for the psychotherapy profession. They are negotiating with UKCP and BACP and UKCP is formulating new structures to meet these demands. It certainly is going to be an interesting few years as this comes into place and Penny and Geri are ensuring that BAPPS is in the frame as an essential part of this process.
In relation to the decision at the AGM Kristiane is progressing the process of BAPPS becoming a Company Limited by Guarantee and there will be further news on this later in the year. I’m also very grateful to Kristiane, and the other members of the executive, for their support and skills in keeping things moving. I’m also aware that it is impossible to name all the people involved in the running of BAPPS but I thank you all because without all the individual efforts BAPPS would not be developing in the way that it is.
The membership committee (Ted and Ruth) have been dealing with a steady influx of applications and the publications committee (Ann, Ted, Ruth and myself) have liaised on a regular basis in order to develop the newsletter and keep members up to date with current developments and BAPPS activities. One of the main ‘events’ in May is the collection of the annual subscriptions and you will have received the letter and subscription renewal form. We do hope that you will consider paying by standing order if possible as this eases the workload of the Treasurer and makes the administration of BAPPS finances more straightforward.
As we come round to another summer I am also aware that the AGM is coming up on the horizon and I do hope that members might think if they would like to join any committees and especially if anyone would like to take on the important role of Treasurer, which will be coming vacant this year.
The great thing about being part of BAPPS is the energy and enthusiasm of its members and of being part of a body of people who are committed to consideration and development of supervision work. The external developments make for interesting and exciting times. Developments in supervision training are happening in many places and the importance of supervision as part of CPD is becoming firmly established. Supervision is a developing and creative field of clinical work and BAPPS plays an important role in this.
I look forward to meeting with you all again at another exciting autumn conference.
Best wishes,
Chris Driver
Following our last report, the Supervision Consultation Document was circulated to all UKCP Member Organizations. The document is at present being amended & this will take account of suggestions from all modalities. We at BAPPS sent in quite a few criticisms & suggestions. At present the policy will be indicative not prescriptive but we believe it will have to form part of regulation once UKCP enters the Health Professions Council. BACP sees no difficulty with this & since they have 20,000 practicing members & UKCP has only 6,000 registrants, we think, as all counselling & psychotherapy becomes regulated, supervision also will have to be regulated. We shall be putting BAPPS name forward in this regard.
UKCP Restructuring
At the AGM in March, Rosie Winterton the Secretary for Health made a presentation making it clear that change is inevitable. The Department of Health intend to regulate all counselling and psychotherapy as soon as possible. The public, it is felt, is in need of a regulated profession. It became clear that the department of health have decided that the regulatory body will be the Health Professions Council. Having already agreed that UKCP would restructure so that disciplinary and regulatory functions will separate, we further agreed the formation of 4 new modality institutions, for the time being to be called Member Institutions. We shall be registered by these bodies annually. BAPPS is still hoping to be the body to accredit supervisors for the Psychoanalytic & Psychodynamic Member Institution. But until there is a policy on supervision, this is a moot point.
Disciplinary Function
It was agreed that the Complaints Procedures document will be amended taking account of criticisms. I made BAPPS criticisms:- that it failed to take account of the role of supervision (it actually only mentions supervision in relation to it being something a fully qualified psychotherapist would no longer need!) indicating that it had not been drafted with the Supervision Consultation Document in mind, or with knowledge of BACP policy on supervision, i.e. that it is something we would continue to have throughout our careers and as part of CPD. This was taken on board by the Chair of Ethics. However, the Chair has now changed and we shall write a letter to the new Chair – with whom both Geri and I are well acquainted – reminding him of this point.
Titles
The Chair of the Registration Board has taken account of the concerns of the Psychoanalytic & Psychodynamic Section & we believe it is still possible that there will be several titles registered. I asked what BPS had done & their representative said they have registered several titles none of which are psychotherapist. As this moves forward we shall discuss the possibility of a supervisory title. Since most of us seem to use the titles ‘Psychoanalytic & Psychodynamic Supervisor’ we shall push for this. It seems appropriate to us that if Supervision accreditation becomes a policy then appropriate titles will have to be registered.
The Register
I spoke to the Chair of the Registration Board and said that I was amazed of the failure yet again of UKCP to provide the register on the web. I pointed out that the public need this as a matter of equal opportunity. I also questioned why BAPPS members are neither listed under our name at the back of the register, nor is mention made of our membership under our personal entry. The Chair was surprised at this and said he would look into it since he believed our members were entitled to have mention made of any listing organizations (BAPPS is one). We believe it is a matter or urgency that these matters are dealt with. I have repeated the request in an email and will follow this up at the next extraordinary PP Section meeting in a few weeks time.
Saturday 15 October 2005
BAP
British Association of Psychotherapists
37
Mapesbury Road
London
NW2 4HJ
020
8 452 9823
FREE CONFERENCE
PLACES
There is no such thing as a
free lunch but the next best thing is .. a potential free place at the Autumn
Conference. That is …. ‘Free’ to
someone will to contribute 500-750 words giving an appreciation of the
conference including their personal reactions.
Please contact Ruth Barnett ruthLbarnett@aol.com
Books left at Spring Conference. Someone brought some books to sell at the Spring Conference and they were left over at the end. Please contact Chris Driver if you think you left them.
The BAPPS’ newsletter is happy to publish details of
psychodynamic/psychoanalytic & supervisory events that promote clinical
& supervisory understanding unless the dates clash with a BAPPS’
event. There would be a nominal charge
to assist the postage costs.
The advertisement to be no more than half a page.
Supervision and the Analytic Attitude,
Edited by Christine Driver and Edward
Martin. Whurr 2005
With chapters by:-
Claire Allphin, Ruth Barnett, Stephen Crawford, Christine Driver, Edward Martin, Rose Stockwell, Mary Thomas, Sandra Thomas, Michael Whan and Vernon Yorke.
This new book on supervision brings together the theories, insights and understandings of the psychoanalytic and psychodynamic disciplines in relation to the supervisory process and the supervisory relationship. The chapters cover such areas as: the unconscious in relation to supervision, language and interpretation in supervision; Bion’s ‘vertex’ as a supervisory object; free association in supervision; attachment and the supervisory alliance; ego and superego in supervision; supervision as an alchemical process; creativity in supervision; supervision and training; supervision and the law; shame in supervision; and supervision as self-questioning.
The genesis of this book evolved from ideas for research into supervision and the development of an MA in Supervision. The aim is to consider the intertwining dynamics of supervision at depth both at an intellectual and clinical level and this book examines the way in which an analytic attitude and the use of analytic theory enables this.
The aim of this book therefore, is to consider how key theories and concepts inform an analytic attitude and generate awareness, understanding and meaning between supervisor and supervisee about the client.
The authors are psychoanalytic psychotherapists and/or analytical psychologists and some are members of BAPPS. All have worked extensively as supervisors and have experience in training supervisors. The chapters of this book have emerged from their work and have been written from the perspective that a return to, and a re-thinking of, basic psychoanalytic principles and an underlying analytic attitude are helpful in developing the skills needed for effective supervision work.
We hope therefore that this book will prove a valuable resource for those of you who are working as, or about to work as, supervisors.
‘Why would anyone want one?’ I hear you ask. Well, for me that’s like asking a mountaineer why he wants to climb a mountain – answer, ‘because it’s there.’
In late 2001 when a flyer from WPF promoting an MA in supervision plopped onto my doormat I knew I wanted to do it. I knew at that moment I did want the degree that had eluded me in my earlier life (a different story). I had already gained my certificate in psychodynamic supervision in 1989 and had been supervising groups and individuals for thirteen years. I loved being a supervisor and this opportunity seemed just right for me. I found that those interim years of supervising had given me invaluable experience when it came to studying for and writing my dissertation. I had lots of inner material to call upon and a confidence in myself, which cannot be learned in a classroom.
The time commitment was one afternoon per week at WPF for seminar and supervision of supervision and approximately 4/6 hours study at home per week over one academic year. It took me another year under the guidance of my academic supervisor to write my dissertation.
The most difficult part was deciding on and narrowing down my topic, honing the title and writing the 2000 word proposal. With the help of the proposal workshop leader I formed a title: ‘The Impact of the Medical Organisational Setting on The Supervision of Counsellors Working in GP Surgeries: A Psychodynamic View.’ This is a subject about which I am passionate. I have worked as a GP surgery counsellor and have supervised counsellors working in surgeries for many years.
I have reached the conclusion that counselling in the setting of a GP surgery is a very different animal from that carried out in other settings and that this has an impact upon the supervision of GP surgery counsellors.
Staying with analogy of animals it occurred to me that working in a surgery is a bit like being in a circus where the ring-master has let all the animals out from their cages – animals walking and stalking within the boundary of the circus ring (surgery), within the boundary of the big-top (NHS). Think of the animals as unconscious processes. Think of the mechanisms of defence operating at an individual and corporate level within the primary care team, as interpersonal and intra-psychic bars - cages in which to keep the ‘animals’ safe or, more correctly, to keep the ‘animals’ safely unconscious. I use the word ‘safe’ advisedly because as a supervisor with a larger view of the setting I ask the question, ‘who is actually safe?’
Well that is the question, the question at the centre of the supervisory arena – an arena which holds safety for all in high esteem, in which permeability can reign and where inner boundaries can be loosened. A place where the ‘animals’ can roam and snarl, defecate and copulate – show their faces and their aggression, their fears and insecurities, their way of protecting and relieving themselves; a place where the ring-master (supervisor) has earned his whip and chair, learned to trust intuition, learned to recognise the different animals and their unique and yet unpredictable behaviours and, most important of all, discovered a safe escape route and if necessary how and when to call upon the circus troopers for help.
· The efficacy of supervision, and consequently subsequent counselling sessions occurring in a GP surgery, may be affected by the extent to which the impact of that setting is recognized and worked with in supervision. However, I note that there will be other factors, outside the remit of this dissertation, which may influence the efficacy of the supervision and counselling carried out.
· Unconscious processes manifested in the thoughts, feelings and behaviours in the parallel process occurring in the supervision of GP surgery counsellors, often reflect the frame specific to that setting.
·
The
GP surgery setting provides elements, which both contain and defend against
anxiety that can stem from the urgency and immediacy of patient and surgery
staff need. The perceived, and often
accepted role of a GP surgery within the community and in particular that of the
doctors employed there, is to provide a safe place and a belief that within
that place there is a knowledge of and a capacity to cure and/or control
emotional problems and mental ill health.
This perception often has the effect of containing an individual
patient’s anxiety. In addition, it can
have the effect of containing the anxiety of surgery staff. These widely held
and often institutionally upheld perceptions can also be seen as a defence
system which can operate in such a way as to promote the unconscious defence
mechanisms of denial, projection, splitting, medicalisation and somatisation
amongst patients, members of surgery staff, counsellors and supervisors.
·
Writing
this dissertation has reinforced for me the need for a supervisor to
concentrate solely upon the clinical material brought to supervision. The supervisor must ensure that his/her
experiences as a counsellor or supervisor in another surgery, does not unduly
contaminate his/her supervisory work.
·
Reflecting
upon thoughts, feelings and bodily sensations during and after the supervision
session can facilitate important, and sometimes missed, counter-transference
responses, free from the immediacy of the counselling session content.
Val Garrett
BAPPS TREASURER
Our current Treasurer, Eddie Roworth, will be standing down as Treasurer at the next BAPPS AGM in October. Do think seriously as to whether you could take on this important task which plays such a vital role in the ongoing work of BAPPS.
Please contact the Treasurer Eddie Roworth or the Administrator Catherine Cooper.
SUPERVISION ON THE TELEPHONE
In this age of technology why should there be any concern about using the telephone to supervise? I well recall when in 1997 Maxine Rosenfield was writing her book on Counseling by Telephone of how people began to react. It was also at this time that questions were beginning to be asked as to whether or not sessions on the telephone could be counted as part of the accreditation process for BACP (BAC). A working party had been set up in 1996 with Helpline Associations and others to attempt to clarify what the differences were between face to face counselling and helpline work. Having clarified this we then moved to accepting telephone counselling as part of the accreditation process. This is now an acceptable part of the accreditation process of BACP.
So when did this thing called telephone supervision come into being
from? I am unclear as to when as a method it started. I believe that as the area of telephone counselling opened up,
supervisors began to own that they too provided supervision at times on the
telephone. It was also at this time that the accreditation process for
supervisors was coming into being. For many years supervision on the telephone
had been happening with psychotherapists in the Transactional Analysis (TA)
field due to the international nature of their training programs. Often it was
impossible for trainees to have direct access to their TA supervisors.
I became aware that the guidelines set out in Rosenfield’s book that applied to counsellors fitted with those of the supervisors. One of the important areas has to do with the manner in which the contract is made and how the telephone as a medium is used. I will discuss how to make contracts, areas of responsibility that are different from the usual form of contract making and, also responsibility, transference and counter-transference, skills and attitudes and differences in supervision when working on the telephone.
CONTRACT
Like any therapeutic contract there is a requirement to set a time for the call,
to discuss money, cancellation fees, theoretical orientation and membership
requirements plus course requirements, if appropriate. One of the main
differences has to do with whether or not the supervisor is going to meet with
the supervisee face to face to initiate the contract. The same reasons being as
those in counseling to whether or not there can be a working alliance. I
believe that face to face information can inform if there is going to be any
transference issues. However if the supervisee is in another country then
photographs can be exchanged. This is where the Internet can be most helpful
and effective. The supervisee can also provide photographs of their working
environment.
The need to have a review period set into it as part of the initial contact, for all of the same reasons as in any contract, is perhaps more important in using this medium for effective practice. I recall having made a contract for telephone supervision with a supervise whom I did not ever meet as their present supervisor was ill. The supervisee sent me their C.V. training background and information on their therapeutic relationship. This gave me the information as to their commitment to the therapeutic process in which they were involved with their clients. Having arranged times and agreeing when the fee would be paid, usually after the session our contract began. All went well for a number of sessions until on one of our appointments the supervise did not call, (all calls are make by supervisees) I waited for my standard ten minutes and called their number, without any result. As we had arranged other times I made the assumption that they had forgotten this appointment. When our next appointment came and went I became concerned. I tried telephone contacting without any results. So I wrote, only to find that my supervisee had been taken into hospital as an emergency and I had been left off the list of people to be contacted. The lesson learned being that regardless of the medium of supervision each of us needs to be clear as to what will happen should an emergency arise. I had not made it clear in my contract just who the supervisee would have as their professional executor and how their contact list was worked. I had not asked which is all I had to do.
In regard to the area of fees and payment, I have come to the conclusion that fees when working via the telephone should be paid prior to the session. This can be done on a session by session basis or for several sessions at a time.
RESPONSIBILITY
In telephone supervision it is more the supervisor who has to hold
responsibility for clarification of the non- verbal aspects of the call. Not
only in regard to where the client is but also on the reaction of the
supervisee. Indeed Super Vision and Super Hearing are key to interactions.
Tapes can be played over the phone. The contract as to amount of time spent on
listening to a piece of tape is most important. Where, in the tape, the interventions are taking place. What the supervisee wants the
supervisor to listen out for. Once these are clear then listening can begin.
Voice tones, intonations, word choice, sounds and movements are all part of the
process. Feedback has to be clear and articulate in order for the supervisee to
gain insights and to make suggestions to their clients.
TRANSFERENCE AND COUNTER-TRANSFERENCE
On the telephone I believe that it is easier to pick up the transferential
issues. How you might well ask is that possible? Like any of our interventions,
be they with clients or supervises, listening to the invitation to disclose
more than is appropriate about ones self, going over time boundaries, not
paying at the appropriate and agreed time for sessions. These are but a few of
the transferential issues that can arise. Counter-Transference involves the supervisor
not holding boundaries allowing the supervisee to call at any time, not fixing
an end of the telephone session, not challenging when the supervisee is making
judgmental statements about clients. Mostly these issues can arise when the
supervisor gets caught up in the fantasy of the supervisee’s world. Wanting to
be the best for the supervisee from a place of pride and not professionalism.
Being aware of perceptions and not projecting inaccurate impressions or making
false assumptions on to the supervisee are all part of the potential
counter-transferential issues that can arise. Of course not all supervises came
from a place of where transference is used. So the model of training must be
known and worked with in an appropriate manner.
SKILLS AND ATTITUDES
There is still not sufficient training for qualified counsellors, supervisors
or supervisees in the area of the use of the telephone as a medium for therapy
work. This is an area where training of people like the Samaritans are way
ahead. There is much to be learned from them in this field. The handling of
silence is an example where we are not taught to manage on the telephone, where
as the training the Samaritans get is excellent in this area. For instance,
what to do when the telephone rings and how to respond to the caller. Rule of
thumb, let the telephone ring at least three times then answer with you name and a good morning or
afternoon, then wait for the supervisee to respond. Use open questions, reflections
and be aware of verbal words being used. Clarify if you do not understand
either speech or any other issues that do not make sense to you. Check out what
is happening from an intuitive place and clarify if this makes sense to your
supervise. Use empathy as is appropriate using words like “it sounds as if ” or
more emotional “It feels to me as if you
are struggling with”. The most important role for the supervisor is to
keep calm, be gentle and reassuring.
DIFFERENCES
In telephone supervision, the supervision alliance has to be worked on without
seeing body language, which is usually available in face to face settings. Therefore assumptions cannot be made and
will need to be inquired after. Confidentiality can be As a telephone call is
not guaranteed to be confidential it is an area of difference that can be
problematical. This can be overcome by an agreement not to mention the clients
name on the telephone, or by contracting to use a number to represent a
particular client. Crossed lines do occur so it is of real importance to keep the
clients identity as safe as is possible. In “Supervision in the Helping
Professions” by Hawkins and Shohet they discuss six different ways to focus in
supervision. I would suggest that there is a seventh, which is the very fact of
using the telephone as a medium to work with.
CONCLUSION
I would suggest that supervision via the telephone is an excellent way of being
able to make sure that each supervise can get their needs met. They have more
choices of supervisor who can meet their needs that will fit into their
training background. There will not be any restriction on how far away their
supervisor lives. Telephone supervision encourages the supervisee to be aware
of their behavior, attitudes and ways of speaking in order to extend awareness
while working within their theoretical framework. It will require further
training as it is not a method suitable for everyone. How-ever with the changes
in technology I do believe that unless as supervisors, therapists, and
counsellors we are prepared to move with the times our clients will find people
who will meet their needs. Whether it’s email, videophone or the like we have
to move with the times and begin to change our training methods.
Terri Spy: FBACP, Accredited Counsellor, Supervisor, and Trainer, has worked for many years offering all forms of counselling, training and supervision many through the medium of the telephone. She is a Counselling Psychologist and Psychotherapist.
REFERENCES
Rosenfield M. (1997) Counselling by
Telephone. London: Sage.
Hawkins P and Shohet R. (1989)
Supervision in the Helping Professions.
Open University Press
The Telephone Helplines Association (1993) Guidelines for Good Practice in
Telephone Work. London.
The publication sub-committee welcomes emails, letters, comments on any
articles in this newsletter and original contributions of up to 500 words, in
the form of a piece of short comment rather than a formal paper. The sub-committee reserves the right to edit
contributions as necessary. Deadline
for agreed BAPPS Conference write ups to be received by the committee within
three weeks after the Conference.
Deadline for next edition of newsletter
is 30 August 2005.
Contributions preferably by email to
E Martin: emartin@fsmail.net.