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An Important Aspect of Educational Orientation in Psychotherapy Supervision: Providing Supervisees With a Conceptual Framework for Understanding Their Own Therapist Development

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Watkins, E. (2015). An important aspect of educational orientation in psychotherapy supervision: Providing supervisees with a conceptual framework for understanding their own therapist development. Psychotherapy Bulletin, 50(1), 24-27.

Dr. C. Edward Watkins

Dr. C. Edward Watkins

In my supervision practice, I work with doctoral students at the beginning of their work as therapists. These students have either had no therapeutic experience or limited experience. As Chessick (1971) indicated, three critical issues often confront therapists in their shift from classroom to clinic: (a) learning to manage anxiety early on during the treatment process; (b) developing a sense of therapist identity; and (c) developing conviction in the power and possibility of psychotherapy as treatment. Because this beginning training period can be particularly trying, with student vulnerability being most pronounced and awareness of practice deficits being most acute, I believe it is crucial that I create a safe learning container within which beginning therapists can freely grapple with those issues with impunity. In creating such a container, the foundation for my thinking is richly informed by both therapist development theory and research and adult learning theory and its application (e.g., Knowles, Swanson, & Holton, 2011; Ronnestad & Skovholt, 2013). Building on that developmentally anchored body of work, the question uppermost in my mind in starting any new supervision experience is: How can I create a safe learning container that best meets the specific learning needs of this particular supervisee now?

In creating that learning container, I believe strongly that educationally orienting supervisees about all aspects of supervision (e.g., purposes of supervision, roles of supervisor and supervisee) is always the best place to start. Educationally orienting supervisees, recognized transnationally as an important supervision competency (e.g., Pilling & Roth, 2014), (a) provides clarity and enhances conceptual understanding about the supervision process and (b) enhances supervisor-supervisee collaboration. Supervisees are at their best when fully informed, and I want my supervisees to be as fully informed as possible from the outset (e.g., through use of supervision agreements, discussions, role induction)—the hope being that they will then be better able to effectively use supervision and take a more active role in its unfolding process.

In what follows, I would like to accentuate one aspect of educational orientation that I regard as particularly crucial for any supervision: Conceptualization. As defined here, conceptualization refers to supervisees having a framework for understanding their own therapist development experience. As a supervisor, I foremost want to provide supervisees with such a developmental, conceptually anchoring framework. I believe that this aspect of educational orientation can be all too easily overlooked and shortchanged in importance. It is a developmentally-informed first step that can get supervision started off most favorably and contribute to supervisees’ learning enhancement—the hope being that supervisees will be better able to understand and effectively respond to the vagaries and vicissitudes of their own developmental process in the moment.

Orlinsky and Ronnestad (2005), Ronnestad and Skovholt (2013), Skovholt (2012), and Stoltenberg and McNeill (2010), in my opinion, are the best sources for gaining understanding about the importance of (a) thinking developmentally, (b) incorporating a developmentally-informed perspective into supervision, and (c) providing a developmental rationale and framework within which to locate the therapist/supervisee growth process. Their work (a) captures nicely the unfolding trajectory through which therapists pass on their way to developing a practice self or therapist identity and (b) identifies or suggests supervisory actions that stimulate therapist growth along the developmental continuum. As Hess, Hess, and Hess (2008) stated, “If supervision is educative, then it makes sense to feature an educational process model” (p. 165). A crucial part of any such model would involve educating the participants about the very educational process in which they will be participating; a critical component of that participant education would be helping supervisees better understand their own therapist growth process that is now in motion.

From the perspective of adult learning theory (Knowles et al., 2011), educating for process preparedness provides answer to the “why” of the learning experience for supervisees and can contribute to their feeling more sense of process ownership. From the perspective of therapist development theory, educating for process preparedness can allay anxiety and equip supervisees for what lies ahead. The forewarned supervisee is a forearmed supervisee (Skovholt & Ronnestad, 2003). We educate to elucidate. We educate to collaborate.

Frank and Frank’s (1991) conceptual framework about helping and healing relationships can also be used by extrapolation to inform supervisory thinking. In their model, those individuals seeking therapeutic assistance—typically in a demoralized, confused state of struggle—benefit from: (a) entering into a confiding relationship with a sanctioned helper in a designated helping setting; (b) being provided with a conceptual scheme or adaptive explanation by which they can understand their struggle and see remedy; and (c) actively and collaboratively working with the helper to implement a program of action that is based on that conceptual scheme. Where those elements are in place, the patient’s embrace of meaningful help and the instigation of desired patient change become increasingly likely (Budge & Wampold, 2015; Wampold & Budge, 2012; Wampold & Imel, 2015). From the helpee’s vantage point, positive expectations and hope of favorable outcome emerge.

Becoming a therapist is a developmental journey that also involves professional struggle and identity formation (Ronnestad & Skovholt, 2013; Stoltenberg, Bailey, Cruzan, Hart, & Ukuku, 2014). It is a unique learning experience for which there is no preexisting personal blueprint; that blueprint actually develops as beginning therapists immerse themselves in therapeutic practice and the process of therapist becoming. The blueprint for a therapist self develops “in the process of the process.” Further compounding the problem, learning/personality characteristics (e.g., being highly organized and planful, being adaptively obsessive) that have been quite helpful before may not be helpful now. Developing a therapist identity is a different sort of learning problem that requires a different sort of learning resolution. Supervisees understandably experience varying degrees of confusion, anxiety, doubt, and demoralization as they struggle to develop a practice self. As new therapists begin their practice of therapy and begin receiving supervision, their own self-scrutiny and the scrutiny that they receive from others (supervisor and practicum team members) ratchet up as never before and make for a time of heightened vulnerability, exposure, and shame.

In parallel with Frank and Frank’s (1991) model, beginning supervisees seeking educational assistance can similarly benefit from: (a) entering into a confiding relationship with a sanctioned supervisor in a designated educational setting; (b) being provided with a conceptual scheme or adaptive explanation by which they can understand the therapist development process, the struggles involved, and educational measures of remedy; and (c) actively and collaboratively working with the supervisor to implement a program of action that is based on that conceptual scheme (Watkins, 2012). Where those elements are in place, the supervisee’s embrace of meaningful supervision help and the instigation of desired supervisee change become increasingly likely (Watkins, Wampold, & Budge, 2015). Supervisee positive expectations and hope of favorable outcome emerge.

Adaptive explanation ideally is provided in which: (a) the therapist growth process is developmentally framed and its typical trajectory mentioned; (b) unpleasant yet necessary aspects of that growth process are normalized and validated (i.e., “strength is in the struggle”); and (c) supervision is identified as the educational catalyst that most contributes to therapist development. Providing new supervisees with such a developmental rationale and framework gives accessible, understandable context to their learning experience, reframes their evolving process as a vital necessity for advancement, and fosters positive supervision expectancies. An adaptive explanation example follows:

“Becoming a psychotherapist is a process that occurs through such repeated experiences as seeing clients, being supervised, and ongoing self-reflection. Being a developmental process, what you’re experiencing occurs in stages; you’re at the beginning stage in that growth process—where confusion, anxiety, and doubt and wondering ‘Can I really do this?’ can be quite common. Though it has been a long time since I sat where you are sitting, I definitely remember having felt what you are feeling, too. I assure you that you are not alone in what you are feeling now. All you are doing now is what you need to be doing to establish a sense of therapist identity. Supervision is the crucial catalyst in making that happen. I will do all that I can to help you on your way to becoming a psychotherapist. I have worked with many supervisees who have had questions and doubts identical to yours, and I have seen the supervision process enormously benefit them in proceeding developmentally and putting in place a more solid sense of who they are as a therapist.” (Watkins, 2012, p. 200)

Far more detailed examples can be found in Watkins (2015).

Consideration of developmental rationale and framework, best when accompanied by supporting reading materials (e.g., Pica, 1998) and practicum team discussions, is in my view ongoing. This intervention provides an orienting reference point that is revisited as supervisees’ needs require. For instance, should supervisee discouragement be triggered by work with a particularly challenging client, supervisees can be reminded about the developmental framework and its continuing relevance for them. Where supervisees become impatient with the slowly unfolding therapist development process, an explanation that emphasizes that slow-build aspect can help. Supervisees need hope, too, and providing them with a conceptual framework for understanding their own therapist development process can build hope into the supervision experience from the outset.

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References

Budge, S. L., & Wampold, B. E. (2015). The relationship: How it works. In O. C. G. Gelo, A. Pritz, & B. Rieken (Eds.), Psychotherapy research: Foundations, process, and outcomes (pp. 213-228). Dordrecht: Springer. DOI: 10.1007/978-3-7091-1382-0_11

Chessick, R. D. (1971). How the resident and supervisor disappoint each other. American Journal of Psychotherapy, 25, 272–283.

Frank, J. D., & Frank, J. B. (1991). Persuasion and healing: A comparative study of psychotherapy (3rd ed.). Baltimore, MD: Johns Hopkins Press.

Hess, A. K., Hess, C. E., & Hess, J. H. (2008). Interpersonal approaches to psychotherapy supervision: A Vygotskiian perspective. In A. K. Hess, K. D. Hess, & T. H. Hess (Eds.), Psychotherapy supervision: Theory, research, and practice (2nd ed., pp. 157-176). Hoboken, NJ: Wiley.

Knowles, M. S., Swanson, R. A., & Holton, E. F. (2011). The adult learner: The definitive classic in adult education and human resource development (7th ed.). Saint Louis, MO: Routledge.

Orlinsky, D. E., & Ronnestad, M. H. (2005). How psychotherapists develop: A study of therapeutic work and professional growth. Washington, DC: American Psychological Association.

Pica, M. (1998). The ambiguous nature of clinical training on the development of student clinicians. Psychotherapy, 35, 361-365. DOI: 10.1037/h0087840

Pilling, S., & Roth, A. D. (2014). The competent clinical supervisor. In C. E. Watkins, Jr., & D. Milne (Eds.), Wiley International handbook of clinical supervision (pp. 3-19). Oxford, UK: Wiley.

Ronnestad, M. H., & Skovholt, T. M. (2013). The developing practitioner: Growth and stagnation of therapists and counselors. New York, NY: Routledge.

Skovholt, T. M. (2012). Becoming a therapist: On the path to mastery. Hoboken, NJ: Wiley & Sons, Inc.

Skovholt, T. M., & Ronnestad, M. H. (2003). Struggles of the novice counselor and therapist. Journal of Career Development, 30, 45–58. DOI: 10.1177/089484530303000103

Stoltenberg, C. D., Bailey, K. C., Cruzan, C. B., Hart, J. T., & Ukuku, U. (2014). The integrated developmental model of supervision. In C. E. Watkins, Jr., & D. Milne (Eds.), Wiley international handbook of clinical supervision (pp. 576-597). Oxford, UK: Wiley & Sons, Inc.

Stoltenberg, C. D., & McNeill, B. W. (2010). IDM supervision: An integrative developmental model for supervising counselors and therapists (3rd ed.). San Francisco, CA: Jossey-Bass.

Wampold, B. E., & Budge, S. L. (2012). The 2011 Leona Tyler Award address: The relationship – And its relationship to the common and specific factors of psychotherapy. The Counseling Psychologist, 40, 601-623. DOI: 10.1177/0011000011432709

Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.

Watkins, C. E., Jr. (2012). On demoralization, therapist identity development, and persuasion and healing in psychotherapy supervision. Journal of Psychotherapy Integration, 22, 187-205. DOI: 10.1037/a0028870

Watkins, C. E., Jr. (2015). Listening, learning, and development in psychoanalytic supervision: A self psychology perspective. Psychoanalytic Psychology, 1-35. DOI: 10.1037/a0038168

Watkins, C. E., Jr., Wampold, B. E., & Budge, S. L. (2015, August). Extrapolating the Wampold/Budge model of the psychotherapy relationship to psychotherapy supervision. Paper to be presented at the annual meeting of the American Psychological Association, Toronto.

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