Psychotherapy Bulletin

Psychotherapy Bulletin

It has long been assumed that asking a supervisee to explore her conscious and unconscious feelings toward a client will help her work with that client, understand herself better, and ultimately facilitate her professional development (e.g., Ekstein & Wallerstein, 1972; Kagan, 1984). Underlying this assumption is an appreciation for the therapist as the instrument of cure, an appreciation that was rooted in early psychoanalytic writings (Kramer, 1995) and subsequently developed into a focus on the therapeutic relationship by Carl Rogers and other humanistic and existential psychologists. Based on this reasoning, the concept of process-oriented supervision found its way into the field, with psychoanalytic and humanistic supervisors, in particular, focusing their efforts on helping trainees become more self-aware and more conscious of the unfolding process of change in their relations with clients.

In this article, we describe our view of effective interpersonal, or process-oriented, supervision, by discussing how supervisors can bring about meaningful change in their supervisees through the use of specific relational strategies. As our view evolved from earlier theoretical and empirical literature on the supervision process, we begin our comments with a brief mention of some of this literature and then move to a more focused discussion of my (Friedlander) perspective on supervisor responsiveness, which I believe is at the heart of effective supervision. The article concludes with my (Shaffer) reflections on becoming a clinical supervisor, having researched relationally-oriented supervision for my dissertation.

Need for Understanding Precisely How Process-Oriented Supervision “Works”

Beginning in the 1980s, scholars began pointing out that good psychotherapists do not always make good supervisors, that the evaluative, gatekeeping function of supervision distinguishes the supervision process from the therapeutic process (Holloway & Wampold, 1983), and that supervisees are likely to strategically manage their self-presentations in supervision so as to be perceived favorably by their supervisors (Ward, Friedlander, Schoen, & Klein, 1985). Accompanying this perspective came research evidence about what can go wrong in supervision—that is, how frequently supervisees withhold vital clinical information from their supervisors (Ladany & Hill, 1996); how often supervisees experience role conflict and role ambiguity in supervision (e.g., Olk & Friedlander, 1992); and how vulnerable supervisees feel, given the non-voluntary nature of clinical supervision, when working with supervisors they view as ineffective, harmful, even abusive (Ellis, Berger, Hanus, Ayala, Swords, & Siembor, 2014; Nelson & Friedlander, 2001). These findings, alongside a fair amount of evidence for the importance of a strong supervisory working alliance (e.g., Ladany & Friedlander, 1995; Patton & Kivlighan, 1997; Ramos-Sanchez et al., 2002; Tracey, Bludworth & Glidden-Tracey, 2012), suggest a need for identifying specific in-session strategies that characterize responsive supervision (Friedlander, 2014).

Working Through Critical Events in Supervision

About 10 years ago I (Friedlander), with co-authors Nicolas Ladany and Mary Lee Nelson (Ladany, Friedlander, & Nelson, 2005), published Critical Events in Psychotherapy Supervision: An Interpersonal Approach, a book that introduced a task analytic model for understanding and researching in-session supervision processes. Based on the extant literature and our own experience as clinical supervisors, we wanted to draw attention to the complex reciprocity of the supervisory and therapeutic relationships. For instance, in helping a supervisee understand her difficulty with a client based on a lack of cultural competence (i.e., what we called a multicultural critical event), the supervisor needs to pay close attention to the supervision relationship when exploring the supervisee’s awareness of her racist, sexist, or homophobic attitudes. When a strain arises within supervision itself, such as the supervisee becoming defensive when asked to explore his feelings toward a minority group client, the supervisor needs to attend not only to what is occurring in the supervision process but also to what may possibly reverberate into the supervisee’s work with clients.

This dual awareness, which requires strategic shifting between a focus on the supervisee’s relation with a client(s) and the evolving relationship within supervision, is at the heart of supervisor responsiveness (Friedlander, 2012; 2014). Indeed, responsiveness is the primary teaching function of clinical supervision. That is, as supervision is essential to help entry-level therapists become optimally responsive to clients, supervisors must be attuned to their supervisees’ developing needs, both in relation to their clients and in relation to their personal and professional growth. Supervisors teach responsiveness to trainees explicitly (e.g., “Next time she comes in, be sure to take a sexual history”) as well as implicitly, by modeling it in the supervision relationship (Friedlander, 2012).

Example of Responsiveness within Critical Events

To illustrate our critical events model of supervision practice, we described seven critical events that are common occurrences in the course of clinical supervision: remediating skill difficulties and deficits, heightening multicultural awareness, negotiating role conflicts, working through countertransference, managing sexual attraction, repairing gender-related misunderstandings, and addressing problematic attitudes and behavior (Ladany et al., 2005). To work productively toward a resolution of these critical events, we further identified 11 interactional sequences: normalizing experience, exploration of feelings, focus on evaluation in supervision, focus on self-efficacy, focus on skill, focus on the therapeutic process, attend to parallel processes, assessing knowledge, focus on countertransference, focus on the supervisory alliance, and focus on multicultural awareness.

According to our model, a critical event begins with a marker, defined as a “supervisee’s statement, series of statements, or behavior signaling the need for a specific kind of help” (Ladany et al., 2005, p. 14). Once a supervisor understands the supervisee’s need, the critical event shifts to the task environment, which is comprised of a set of interactional sequences (described above) to help the supervisee work through the event and come to a resolution, or the outcome of the supervisory task. Tasks may be accomplished and resolved successfully, such as when a rupture to the supervisory alliance is repaired. Alternatively, tasks may be partially resolved or unresolved. Those that remain unresolved can damage the supervisory relationship.

To illustrate, consider one kind of critical event, a culturally based misunderstanding with a client. The marker might be the supervisee’s comment, “My client, Ahmed, asked me pointblank how I felt working with a Muslim, and I didn’t know how to answer because, really, I don’t feel prepared to work with Muslims.” The task in this situation is to help the trainee explore his feelings about working with Muslims in general and with this client in particular and then to identify ways in which he may become more competent to work with this population. The critical event ends successfully if the task is accomplished—if, for example, the supervisee becomes more aware of the basis for his feelings about working with Muslim clients and proposes a course of action to become more culturally sensitive in this regard. On the other hand, the task would be considered unresolved if the conversation drifted into a discussion of the client’s presenting problem without returning to an exploration of the supervisee’s feelings about working with Muslim clients.

Relational Behavior

Recently, we (Shaffer, 2015; Shaffer & Friedlander, 2012) set out to closely examine Ladany et al.’s (2005) interactional sequences in the critical events model in order to determine which of the 11 sequences epitomize a relational focus in supervision (i.e., “process-oriented supervision”) and whether greater use of these sequences would predict a relatively stronger supervisory alliance. To do so, we used the feedback from expert supervision researchers to identify which interactional sequences are most clearly interpersonal; subsequently we created a measure, the Relational Behavior Scale (RBS; Shaffer & Friedlander, 2012), using Ladany et al.’s operational definitions of the 11 sequences.

For my (Shaffer) dissertation, I conducted a confirmatory factor analysis (CFA) with 262 trainees who rated on a 5-point scale the extent to which their primary supervisor used each interactional sequence in their most recent supervisory session. Results indicated that the 5 behaviors that the experts had identified as most clearly relational (Exploration of Feelings, Focus on the Therapeutic Process, Attend to Parallel Process, Focus on Countertransference, and Focus on the Supervisory Alliance) constituted a single factor. Moreover, as hypothesized, RBS scores were positively associated with trainees’ perceptions of the supervisory working alliance (Shaffer, 2015).

Relational Supervision from the Perspective of a Novice Supervisor

Being a responsive supervisor develops with time. Just as therapists learn how to conceptualize clients, respond with interventions, and attend to the relationship in therapy, supervisors learn to think about trainees’ needs, respond with attention toward trainees’ growth as therapists, and use the therapeutic and supervisory relationships as grist for the supervision mill.

For me (Shaffer), the process of becoming a clinical supervisor felt oddly familiar. In my first experience as a supervisor, I provided supplementary supervision to a practicum student, “Jamie,” who was receiving her primary supervision on site. There was fear, on my part, about setting up appropriate expectations and boundaries and about balancing my relative power in the relationship: How was I supposed to be a supervisor, a position imbued with evaluative authority, while still encouraging Jamie to feel safe and willing to share herself with me?

Not surprisingly, I felt awkward and unsure of myself in the role of supervisor. I’m sure that my early interventions were stiff; I tried to remain genuine with Jamie, even though every word I spoke was heavily weighed regarding its “appropriateness” in the context of supervision. Suffice it to say, I was genuine in my fear and uncertainty in this new role.

At the outset of our work together, Jamie also seemed uncertain in her role with me, speaking in vague terms about her work with clients. Although confident in her role as a therapist, she was obviously ambivalent about the need for our supplementary supervisory arrangement. I became frustrated and felt that Jamie’s hesitance to engage with me was perhaps well-founded. Was I doing anything useful here? As I couldn’t tell what Jamie needed,I felt stuck.

In reviewing the video of our second supervisory session, my “sup of sup” group pointed out that a power struggle seemed to be occurring. I felt deflated. In the video, I saw that at one point, rather than respond to my questions about her practicum site, Jamie aired her frustration with what her primary supervisor expected of her. Although during our session I had been vaguely aware of the struggle between us (I was trying to focus on what she was doing in practicum, whereas she wanted to vent her feelings about her experience at her site), I kept doing more of the same. Reviewing the video, I realized I had missed a marker! Jamie’s remarks were signaling a critical role conflict event—we each had expectations for our work together, but these expectations didn’t match. The “task” for our next meeting would be to re-align our alliance to be more responsive to Jamie’s needs.

In the next supervision session, Jamie returned to airing frustration over the policies and politics at her practicum site, which she saw as interfering with her work with her clients, as well as her clients’ ability to make meaningful change. This time I did recognize the marker! Her frustration signaled a need to talk about and figure out how best to handle the experience at her site. In order to be more responsive to Jamie, I initiated exploration of feelings. I said something like “I hear how upset you are and how you feel stymied in your work. From what I’ve seen so far, you have really excellent therapeutic and conceptualization skills and it seems as though you feel you’re getting no support or encouragement for the hard work you do, and that must be demoralizing.” Jamie welled up with tears as I spoke. She heaved a sigh of relief and cried for a long time.

The task for this supervision session was now clear—we were on the same page about our respective roles in this supplementary supervision. She wanted and needed my help to process what she was experiencing on site, and I was fine with that. For the rest of the session Jamie spoke about her nine months’ experience of feeling undermined in her work and unsupported by her site supervisor.

From a critical events perspective, I used various relational sequences: (exploration of emotions and normalizing experience) to help Jamie clarify her negative feelings about the site, while remaining open to her clients (focus on the therapeutic process). Having “resolved” the “task” of reducing our role conflict, I found it incredibly easy to empathize and convey genuineness in my work with Jamie. I shared with her my beliefs about the importance of trust and genuineness in supervision (focus on the supervisory alliance), which apparently had become obscured at her site in favor of institutional policy.

Reviewing recordings of Jamie’s work with clients, I noticed a shift in her responsiveness to clients. Whereas earlier she had colluded with her adolescent clients in protesting the “draconian rules” at the site, Jamie was now able to explore her clients’ feelings about these rules and use them as points of intervention to talk about responsibility, maturity, healthy confrontation, and self-acceptance. Jamie was eventually able to confront her site supervisor about feeling unsupported and about her discomfort with specific site policies that were negatively affecting her clients. It occurred to me that Jamie’s growing ability to be authentic with her clients and with her site supervisor may have been facilitated by a parallel process in our work together.

My experience with Jamie taught me a lot about relational supervision and responsiveness. I learned how to relax and use the listening skills of therapy to identify critical events for supervisory intervention. In addition, I came to understand how the foci of supervision shift constantly among the supervisee, the therapeutic relationship, the supervisory relationship, the institution, and the interaction among all of these.

Relational supervision cannot take place without the use of the same basic listening and reflection skills we learn as therapists. In my experience with Jamie, clinical intuition facilitated insight into the supervisory process, which encouraged me to be responsive as a supervisor toward a supervisee’s emotional needs in training. This responsiveness shifted my focus in supervision toward relational behavior, and ultimately toward a rich and rewarding experience for Jamie, for her clients, and for me.

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Cite This Article

Friedlander, M. L., & Shaffer, K. S. (2014). It’s (still) all about the relationship: Relational strategies in clinical supervision. Psychotherapy Bulletin, 49(4), 13-17.

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