Philosophy and Fundamentals of my Approach to Supervision in Psychotherapy

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General Approach

“When you watch good therapy being done you know it and it has a lot of commonalities … [G]ood cognitive therapists and good behavior therapists, psychodynamic therapists act an awful lot alike.” (Lambert, 1994, as cited in Miller, Buncan, Hubble, 1997)

Both as a psychotherapist and supervisor in private practice, I identify as an integrative practitioner. My approach includes several models of therapy. My integrative philosophy is based in part on an expanded version of the Systemic Cognitive-Developmental Therapy – or Supervision – model (SCDT) . A second strong influence is the work of Rudolf Steiner (anthroposophy), especially his thoughts on conscious awareness and free will.

Based on this philosophy I work under the assumption that therapists as well as their clients and I as supervisors feel a need for change when we feel disconnected from the whole and out of equilibrium. Behaviours and patterns are changed by becoming consciously aware of the current behaviour and patterns through direct and honest observation; setting in motion new behaviours or patterns through free choice based on conscious awareness of the Self as part of the whole / system; and practicing these new behaviours and patterns consciously until they become subconscious habit. (“Striving For Freedom, Spontaneous Unconditioned Will”, 2015).

The expansion of the SCDT model of integration results from other aspects of anthroposophy. For example I also take into consideration the main temperament of the therapist and his/her main learning faculty (abstract / thought oriented or practical / will oriented).
I pay great attention to the observational skills of therapists: their ability to observe objectively and to draw objective conclusions. For example I may ask therapists to hypothesize about the current presenting issue of the client system in two or three different ways and to describe how each of those hypotheses is based on their observations of the clients, understanding of the client system and presented issues, perception of the client system in the larger systems of society, world, etc., and application of information gained in previous sessions.

Systems Approach

System: “a network of interdependent components that work together to try to accomplish the aim of the system.”  (Deming, 1993, as cited in Yingling, 2000)

Anthroposophy is at its heart a systemic philosophy. As such it guides my approach in psychotherapy and supervision in general towards a systems framework. Specifically, while I support the importance of the individual as a unique entity, I continuously explore and interact with the individual’s role in the systems of his/her life and how (s)he places himself/herself in these systems.

In supervision this is done mostly through the supervisory relationship: through observation, conversation and specific interventions I explore the therapist’s unique perspective and narrative and in this help him/her understand his/her part in the relationships with his/her clients, colleagues, etc. Isomorphically, the therapist then takes these skills into his/her work with clients.

To deepen the therapist’s awareness of systemic thought, I often ask therapists to consciously explore their own place in the many systems of which they are a part:  the client-therapist system, the client-therapist-supervisor system, their own family systems, and other, larger systems such as culture, society, world. In this exploration I ask therapists to pay attention to perspectives and viewpoints that go beyond their own personal experience. Again, these explorations are often taken into the therapist’s own practice in isomorphic transfer .

Diversity

“Do not allow yourself to be misled by the surfaces of things”, (Rilke)

Curiosity about questions of diversity is, in my opinion, intrinsic to any truly (w)holistic and integrative approach to psychotherapy. In order to understand who we are and how we belong into the whole of the human community in which we live and the systems of our daily life we need to recognize, acknowledge, and appreciate our differences and their unique place in the whole. Thus, exploration of questions of diversity, both as factors in the issues and difficulties clients may experience and as unique attributes and possible solutions to personal issues, is an essential part of my approach to therapy and supervision.

Through clear definition and discussion of issues and strengths resulting from diversity within the supervisory relationship therapists’ awareness of these is increased. Power relations are openly addressed and discussed and whenever possible consciously negotiated between therapist and supervisor, emphasizing the knowledge power of the therapist and how it results from the unique life experiences incl. gender, socio-political background, ethnicity and cultural history, Family of Origin experiences, etc. Therapists are encouraged to do their own assessment of their position in society and in the systems of their lives using tools such as genograms, observation, exploration of personal narrative and personal myths, Family of Origin explorations, and journalling. Their experience with this work then isomorphically informs their approach to client-relationships and other relationships in their lives.

Supervisory Relationship

“Face-to-face ongoing dialogues between a supervisor and therapist where good will, acknowledgement and respect prevail; the learning is mutual and intense; the power relations are transparent; and the emphasis is on ensuring the wellbeing of clients as well as meeting the standards of the profession.” (Todd, 2014)

I believe that clear communication and clearly defined boundaries and roles are the best basis for good working relationships. Therefore I encourage open communication and honesty in my supervisory relationships with therapists.
The supervisory contract constitutes the core agreement of the supervisory relationship and reflects the unique intent and circumstances of each such relationship. Contracts vary depending on circumstances and participating parties. However, all contracts have some provisions in common in order to maximize transparency and collaboration as well as to ensure compliance with existing regulations and applicable Codes of Ethics etc. In the list below only correlations to the Code of Ethics of the AAMFT and the Professional Practice Standards of the CRPO are noted where applicable. Other associations’ or regulators’ requirements would be explored as appropriate and necessary.

  • Common Contractual Provisions:
    Power relations within the client-therapist-supervisor relationship are clearly stated
  • Knowledge power is emphasized
  • Position and evaluation power of the supervisor is clearly defined and explained
  • Evaluation processes and requirements are being clearly explained and stated.
  • Therapist goals are stated and clarified and when necessary balanced with and weighted against expectations of associations or legal entities.
  • Supervisor expectations in regards to the supervisory relationship are clearly defined and stated.
  • Processes and procedures that regulate the supervisory relationship are clearly stated:
  • Duration, frequency, location, and format of supervisory sessions.
  • Duration of the supervisory relationship
  • Review processes, feedback processes and processes and recourse in conflictual situations.
  • Supervisory modalities and preferred therapy models of both supervisor and therapist as they will be used in the supervisory relationship.
  • Renumeration process
  • Confidentiality, disclosure, and advertising rules with special attention on declaration of the supervisory relationship to clients are clearly stated
  • Relevant legal and ethical context, e.g. Code of Ethics, agency’s policies and regulations, relevant law, professional associations and regulators, etc. is explored and noted.
  • Emergency protocols are clearly noted.
  • Meaning of and practical implementations of collaborative practice in supervision is explored and noted.

Outside the contractual relationship, ongoing interpersonal communication between me and the therapist is an essential part of my work as a supervisor. Through ongoing conversation trust is built, self-reflection is encouraged, curiosity is supported, conscious awareness of strengths and limitations is build and deepened, and therapist’s engagement in the supervision process is strengthened. By practicing and disclosing, within appropriate limits, my own self-reflection in regards to the supervisory relationship and my own limitations in knowledge and willingness to research and learn, I encourage the therapist to do the same in his/her relationship with clients.

As supervisor I often find myself in varying roles reaching from supervisor, teacher, mentor and coach to consultant and colleague depending on the level of experience of the therapist and on her/his goal for supervision. In a parallel relationship to my practice in client-centred therapy I find that working with an affiliative, non-directive approach best allows the therapist to be responsible for her/his own learning while also encouraging self-reflection between supervision sessions in order to choose which issues to present. Furthermore, by allowing some flexibility in my own role I more easily can adapt to the specific needs of the therapist in any particular moment, e.g. being more directive with a young intern-therapist who needs and asks for clear direction while being more peer-oriented and emphasizing the awareness and knowing of a veteran therapist who is seeking supervision for personal benefits or overall professional growth.

In order to deepen conscious awareness of strengths and limitations of the therapist, supervision sessions are generally set up in regular and frequent intervals. Check-ins in between sessions can be arranged on short notice should the therapist find himself/herself in need for urgent practical support with a specific situation. Session structure is tailored to the needs and professional development stage of the therapist and largely determined by the therapist (see above). Therapists’ learning and growth is continuously evaluated in conversation and supervisory interventions are geared to the therapist’s learning style, professional development stage, supervision goals, preferred therapy model, and professional development needs. Conflictual situations between the therapist and myself are approached as learning opportunities whenever possible. Therapists are encouraged to use any experiences of confusion, stuckness, or countertransference as an opportunity for self-reflection and personal and professional growth. Continuous practice of these interactions in the supervisory relationship fosters their isomorphic transfer into the therapist’s practice.

Supervision Modalities

“I write because I have to learn.” (Lewin)

My preferred supervision modalities are audio tapes and case reports. As a supervisor who is not affiliated with a training institution or agency I am working with therapists in private settings for whom it is usually difficult to arrange for video recording equipment in their sessions. Equally it would be extremely impractical for me to do in-room supervision in the therapist’s office. Fortunately, I have found that audio tapes offer sufficient information about client-therapist interaction when carefully reviewed and discussed with the supervisee.

I have found the effort it takes therapists to create a good case report to be a valuable learning tool. It requires them to reflect on their session, clients, own actions and reactions to the session, etc. The necessity to find appropriate words to explain their inner process and their interaction with the client in a way that is sufficiently vivid for me, the supervisor, to understand makes it almost inevitable that they learn something about the session on which they are reporting.

 

(For a complete copy of this paper including references and isomorphic table please email me)