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Risks and Safeguards in
Person-of-the-Therapist Supervision
Brent J. Atkinson, Ph.D. |
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Supervision that addresses person-of-the-therapist
exploration involves an added level of vulnerability on the part of
supervisees. With this greater vulnerability comes the possibility of
additional risk for exploitation or psychological distress. Careful
measures must be taken to protect the vulnerability of therapists in
person-of-the-therapist supervision. Several such measures are described
in this paper, which arise out of the experience of the author. Readers
are encouraged to reflect on their own practices and to contribute to a
dialogue regarding risks and safeguards in person-of-the-therapist
supervision.
I believe that supervision is most useful when the focus of supervision
moves back and forth between the professional and personal functioning
of the therapist. Professional aspects include learning how to apply
theory and technique to the practice of assessment, interviewing, case
planning, and so on. It involves knowing what do next, where and how to
direct therapy, what to give attention to, and what to ignore. The
personal functioning of the therapist is much more complex, involving
automatic internal and interpersonal processes that are not always under
the therapist's conscious control. Indeed, therapists' reactions to
clients are often so automatic that therapists may not even be aware of
them. I have come to believe that the effectiveness of each therapist is
determined largely by the extent to which they are successful in
becoming aware of these reactions, listening to them, learning from
them, and helping them change when change is needed.
As a supervisor, I observe therapists interacting with clients and help
them identify automatic interpersonal and internal reactions that occur
regularly. As therapists refine awareness of reactions set in motion
during therapy sessions, they also generally choose to explore them
during supervision. Often, this involves accessing and attending to
these reactions directly during the supervision hour. Thus, a portion of
supervision becomes a context for practicing the art of listening to,
accepting, receiving suggestions from, and eliciting cooperation from
aspects of oneself that sometimes operate at a tacit level. As
supervision progresses, therapists generally experience greater
sensitivity to the nuances of their reactions to clients, a greater
ability to use this information effectively in therapy, and a greater
sense of internal harmony as they become more skilled in exploring and
calming uncomfortable aspects of their experience with clients.
Sometimes therapists are interested in discussing aspects of their
personal histories or present circumstances in supervision, particularly
if it occurs to them that some of the reactions they are having with
clients parallel the ones they are having (or have had) in their own
lives. Therapists are never pressured to discuss such information, but
often choose to do so as they seek to give attention to automatic
processes that operate in their relationships with clients.1
Risks
It is common for therapists to feel some apprehension about exploring
the personal aspects of their professional functioning with a
supervisor. One of the reasons often has to do with the fact that part
of a supervisor's responsibility is to evaluate therapists at various
points during supervision. It is natural for therapists to be hesitant
to disclose their internal experience with someone who has
organizational authority over them.2 There is a possibility
that the supervisor could become biased and/or use personal information
against the therapist in an evaluation. Conversely, the therapist may
feel that their supervisor's evaluation was biased by personal
information, even if the supervisor made every effort to be honest and
objective. There is also a risk of psychological distress if therapists
disclose aspects of their internal experiences with their supervisor,
then feel judged, rejected, disapproved of, or betrayed by this person
whom they have come to trust and respect. Before beginning supervision,
I discuss these potential risks with therapists, and discuss several
safeguards that I believe work to prevent misunderstanding and the
potential for exploitation in the supervisory context.
Safeguards
First, I believe that supervisors who intend to facilitate
person-of-the-therapist exploration should have previously engaged in,
or be currently engaged in supervision or supervision-of-supervision
that focuses on their own reactions to others in the professional
context. Risks are most minimal when supervisors place a high priority
on maintaining awareness of their own reactions to therapists during
supervision, and able to ascertain when subtle emotional states are
influencing their actions as supervisors. Supervisors should model the
kind of internal awareness that they are attempting to facilitate with
therapists. This requires a certain amount of vulnerability on the part
of supervisors, but I believe this is essential for supervisors who
intend to help therapists with person-of-the-therapist exploration.
Second, I take the position that person-of-the-therapist portion of
supervision is entirely optional, and I will do only the extent of it
that therapists feel comfortable with. If a therapist is hesitant to
begin person-of-the-therapist supervision as described in the first
paragraphs of this paper, I suggest that we talk it over and see if we
can come to an agreement about what might work. For example, the
therapist might be comfortable using supervision as a context for
identifying internal and/or interpersonal reactions that take place
during therapy, but not comfortable exploring them in the context of
supervision. I express flexibility (within a certain range), and
optimism that we can work something out. If we simply cannot come to an
agreement, I suggest that we meet with the other clinical supervisors,
discuss the situation, and decide what to do from there.
Third, I encourage therapists to wait to explore their personal
experience in the therapy room until they are confident that (a) I have
a strong commitment to maintaining awareness of my own reactions during
supervision, and would be able to recognize and willing to acknowledge
any of my reactions to them that were more extreme than a situation
warranted, and (b) I really care about their well-being and have their
best interest at heart. How can therapists develop this kind of
confidence about a supervisor before beginning supervision? I know of
two methods that help. First, supervisors can provide names and
addresses of former supervisees who are willing to discuss what
supervision was like for them. Prospective supervisees can be genuinely
encouraged to contact former supervisees to inquire about their
experience with the supervisor. Both the act of offering names of former
supervisees and the discussions therapists may have with former
supervisees can help establish an initial level of confidence as
supervision begins. Second, supervisors can demonstrate their commitment
to self-awareness in the supervisory process by expressing a willingness
to talk about their own development as supervisors and to discuss what
they have learned about themselves through their own supervision (or
supervision of supervision). If they feel comfortable, supervisors might
even discuss cutting-edge aspects of their own process they are
presently exploring in their development as supervisors. In initiating
such discussion, supervisors demonstrate their commitment responsible
self-awareness and receptivity in the supervisory process.
Fourth, I never push therapists to explore aspects of their experience
that (a) they don't think are important to explore, or (b) they don't
feel ready to explore. I encourage therapists to operate according to
their own sense of what is right for them, not my sense.
Fifth, I have an open policy regarding inviting in a third party to
supervision meetings. If a therapist should ever feel too uncomfortable
to talk with me about an issue one-on-one, or feel unsuccessful in
attempting to do so, I would encourage the therapist to bring another
person with him/her -- someone with whom the therapist could feel safe.
This could be another supervisor, a colleague, or whoever the therapist
would like.
Finally, I put all of this in writing and discuss it with therapists
before supervision begins. Therapists sign an informed consent document
indicating they understand the risks of person-of-the-therapist
supervision, and are comfortable with the safeguards I have suggested.3
I do not begin the person-of-the-therapist aspect of supervision unless
therapists have explicitly indicated that, should they become confused
or uncomfortable with anything that happened during supervision, they
would be able to discuss it with me, and they are confident that I would
respond appropriately. Of course, this is a necessary precondition for
any good supervisory experience, but I believe it is absolutely
essential in supervision that involves person-or-the-therapist
exploration. Sometimes supervision touches on areas that are highly
personal, and there is potential for therapists and supervisors to
misread the actions or attitudes of the other. Unless therapists feel
free to check out their perceptions and express confusion or discomfort,
they may be at risk for feeling violated, even in situations in which
supervisors place a priority on being supportive and responsive to
expressed confusion or discomfort. A hypothetical example will help
clarify: During the third week of supervision, while reviewing a
videotape of a session, it became obvious to both therapist and
supervisor that the therapist had become frustrated with a client, then
distanced emotionally during the session. At an appropriate point, the
supervisor asked if the therapist would like to explore these reactions
further during the supervisory hour. Because of his stress level on this
particular day, the therapist felt too vulnerable to be comfortable
exploring his emotional reactions. But the therapist was hesitant to say
this to the supervisor, thinking the supervisor might be disappointed or
disapproving. (He didn't yet know from his experience with the
supervisor that it was safe to draw personal boundaries). Consequently,
the therapist tried to minimize the feeling of hesitation, and instead
said "yes" to the supervisor's offer. Had the therapist
expressed reluctance (verbally or nonverbally) to explore the reactions,
the supervisor would have been understanding and supportive, recognizing
that the therapist must feel free to control the timing and limits of
his vulnerability in supervision. Fortunately, the supervisor picked up
on the incongruence in the therapist's answer and questioned him more
closely about his level of comfort. The therapist finally did express
his hesitation, and they agreed to postpone the exploration for another
day.
If therapists are unable to say, "I'm uncomfortable," or
"I'm not up for exploring my feelings today," in response to
such situations, they may feel pushed or invaded, even in situations in
which supervisors are careful about respecting therapists' boundaries.
This is why I feel it is to critical, before supervision begins, for the
supervisor and therapist to discuss the therapist's ability and
willingness to express to the supervisor any discomfort or confusion
that might arise during the supervisory process. Good supervisors can
often pick up nonverbal signs of discomfort on the part of therapists,
but ultimately the safety of the supervisory experience requires an
ability and willingness on the part of therapists and supervisors to
speak openly about their level of comfort in supervision, throughout the
course of supervision.
Discussion
The safeguards described above serve several positive functions. First,
discussing them with the supervisor before supervision begins helps
therapists think through potential risks involved in supervision, and
become more sensitive to their level of comfort with the kind of
supervision being proposed. Second, discussion of risks and safeguards
assures therapists that the supervisor is aware of the potential risks
involved in supervision, and is concerned about the safety of the
supervisory context. Third, by being invited into a discussion of risks
and safeguards, and by being asked to assess their initial level of
comfort and choose the extent or manner in which they wish to begin
exploring personal aspects of their professional fuctioning, therapists
generally feel empowered and assured that their level of comfort with
the process is absolutely critical, and will be respected and honored
during the supervisory process.
While candid discussion about risks and safeguards is necessary, it is
not sufficient to guarantee the safety of the supervisory context. In
the end, the safety of the supervisory context rests with the emotional
maturity of the supervisor. Is it safe for therapists to express
discomfort or confusion with the supervisory process? Will the
supervisor be direct about his/her thoughts and reactions during
supervision? Can the supervisor be supportive of differences of opinion
or style that arise between supervisor and therapist? Is the supervisor
aware his/her reactions to a therapist that are more extreme than the
situation warrants? These are probably some of the most important
questions.
Conclusion
Because of the added level of vulnerability involved when therapists use
a portion of supervision to explore their own experience in the therapy
room, additional safeguards and measures must be taken to ensure that
therapists feel safe. I have attempted to lay out some suggestions in
this paper. I welcome comments, suggestions and descriptions of other
practices that supervisors have found useful in establishing a safe
context for exploring the personal functioning of therapists in their
work with clients.
References
Aponte, H. (1994). How personal can training get? Journal of Marital and
Family Therapy, 20, 3-15.
Atkinson, B. (1997). What is the difference between personal therapy and
person of the therapist supervision? In C. Storm and T. Todd (Eds.), The
reasonably complete systemic supervisor resource guide. Boston: Allyn-bacon
Publisher.
Atkinson, B. (1997). Informed consent in supervision. In C. Storm and T.
Todd (Eds.), The reasonably complete systemic supervisor resource guide.
Boston: Allyn-bacon Publisher.
Atkinson, B. (1993). Hierarchy: The imbalance of risk. Family Process,
32, 167-170.
Kantor, D., & Mitchell, E. (1992). Letter to the editor. The
Commission on
Supervision Bulletin, V(2).
Storm, C. (1991). Changing the line: An interview with Edwin Friedman.
The Commission on Supervision Bulletin, IV(3).
Tomm, K. (1993). Defining supervision and therapy: A fuzzy boundary? The
Commission on Supervision Bulletin,, VI(1).
Endnotes
1See Atkinson (1997) for a discussion of the difference
between therapy and supervision; also Aponte (1994), Kantor &
Mitchell (1992), Storm (1993) and Tomm (1994) for discussion on the
relation between personal therapy and person-of-the-therapist
supervision.
2This is true of any relationship which can be described as
hierarchical (see: Atkinson, 1993)
3See Atkinson (1997) for a recent draft of my informed
consent document.
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