May

15

2017

How to Make Counselling Supervision More Effective

Supervision is an integral part of counselling

All counsellors and psychotherapists in the UK need to take their work regularly to supervision. They review their work with a supervisor so that they can keep working effectively and safely with their clients.

This is a summary of a Brighton Therapy Partnership conference featuring three experienced and different supervisors in the therapeutic fields. The topics were as follows:

  • Colin Feltham opened the day asking what is supervision for and what makes it effective? Further how can we monitor the supervision and the supervisors?
  • Helena Hargaden framed her work as an art and she focuses on the unconscious in supervision. She showed how supervisor and therapist can use free association and their imagination to reach further into the client’s mind.
  • Robin Shohet highlighted how frightened we, (therapists) can be in exposing our flaws in supervision. Yet, how important it is to do this if people are to improve work with clients.

What makes Supervision effective?

What is Effective Supervision Practice?

It can be daunting to start seeing clients for the first time. Beginning practitioners need the support of their supervisor to help them understand their clients better and also to know how to respond to what their clients are bringing. Supervision also helps them to apply the theory they have learnt during their training into practice. This is also important ethically, so that clients seeking help are not inadvertently harmed by their experience of therapy.

Effective supervision translates into effective counselling

People experience challenges in their life. There may be a struggle with depression, anxiety, painful losses that are hard to bear, difficulties in their personal relationships or in their relationship with food or substances.  The reasons for these are complex and deep. So, practitioners have to try to understand what is going on below the surface – what is implicit or unconscious in what their clients are sharing. Supervision can be an important place of learning for all therapists. It can help through light on processes that get missed, feelings that get misinterpreted and having another pair of eyes on the work can also increase the progress and safety for the client.

However, should people have supervision throughout their career? What if they are very experienced practitioners working with a small number of clients?

It’s key for counsellors to think about how regular supervision can be important to them – especially as there has not been many large scale research projects on whether or not supervision really works. This may raise further interesting questions for counsellors. For instance, how does a new practitioner actually choose a supervisor and how do they know if they have found someone who is right for them? Also, in the UK, practitioners tend to stay with their supervisor for many years – why is that? Might it be more helpful to a counsellor if they changed supervisors so that they learnt more from a wider source?

The job of the supervisor

Counsellors should continue to challenge themselves with the questions above. However, it can also be said that supervisors may have a near impossible job!

They are expected to be informed on a range of clinical presentations, theories and approaches in counselling and psychotherapy. They are also meant to be politically aware and socially responsible. This means the process of supervisions runs the risks of supervisors being seen by therapists as being greater than they really are. So how does the profession look out for abusive, authoritarian or charismatic supervisors?

It’s important for us to consider the role of the supervisor, and that whilst counsellors may look to them for support, they are fallible too. Expectations can be placed on the breadth and depth of their knowledge and wisdom which are unrealistic. Ultimately, the question as to whether the supervisor is supporting a counsellor’s clients is the main one to consider.

These are questions and issues that counsellors should think about regularly and be aware of in their own practice. However, the key takeaway for effective supervision is that it isn’t about the counsellor as such. Supervision is ultimately offered for protecting and enhancing the service for the clients, and we should judge supervision and how effective it is based on that metric.

From an industry standpoint, more rigour in evaluation may help decide whether supervision is necessary and if so, what sort of supervision is needed to really help clients get well.

Reaching deeper with relational supervision

Whilst most practitioners tend to think supervision is necessary, that does not mean supervision has to be rigid or that there is a necessary right or wrong way to work with a client.

Taking different approaches to supervision can help therapists draw on their imagination and reach beyond what they rationally know. In other words, supervision can be a creative venture where two or more people stretch their minds and create new ways of thinking and feeling about a client.

Using methods of free association can help supervisees connect spontaneously to thoughts, feelings, sensations and images. This evokes new ideas for both therapists and supervisors alike. By reflecting and thinking on these, links can be made to theory. This helps practitioners understand the psychodynamics of their relationship with their clients. These ideas are based on Gerson’s (2004) “third” space.  Using both right and left brain functions, the supervisor helps supervisees to make connections with childhood and/or cultural experiences in the client that are not yet fully conscious for them.

A supervisor must cultivate an atmosphere in which learning can happen and develop. Some methods may be too rigid or staid, and altering those methods can help develop the right environment for learning and growth.

Power dynamics in supervision

It’s also important to consider the share of power in a supervisory relationship. Whilst supervisors do have authority, it is important that they do not misuse their power. After all, no one understands or knows the client better than the therapist who actually meets with them regularly. So, reflecting properly is important especially if the client is bringing a great deal of complex material. For example, stuck emotional experiences and repeated relational patterns that are not quite understood.

Making some use of Balint’s approach to supervision with doctors, Helena Hargaden has adapted this to fit with her clinical supervision groups, and it forms a framework for supervisors to use:

  1. Initially, the therapist describes her encounter with the client
  2. The group respond with feelings and free association
  3. The group then reflect on their process to see what is and what is not being processed fully
  4. The group and/or supervisor offers some theoretical input
  5. The therapist responds to the group’s communications

This process can open doors to all sorts of revelations that are hard to get to by thinking alone.

Learning from mistakes in supervision

For effective supervision, it’s important it is to embody qualities of openness and honesty on both sides.  Supervision can be very exposing for counsellors and psychotherapists. After all, to really learn about their clients and to work safely, they need to bring the work that they think isn’t going very well. They need to bring their mistakes in order to be able to learn from them.

Exposing all this to someone who has authority and who the practitioner may admire can be frightening. It risks feeling ashamed, inept, inadequate, incompetent. So in supervision, the supervisee may have all sorts of fears about what is going to be discovered. However, it is important for practitioners to face these demons and share their doubts anyway. Otherwise, there is a terrible risk that “poor work” gets hidden away and that is of no use to either the practitioner nor the client.

In other words, if the practitioner can be bold with themselves, there is a great opportunity to also find a sense of freedom that can then be communicated with the client. After all, they too are bringing parts of their lives that aren’t going too well either.

Reflecting on emotions – break the cycle of projective identification

Counsellors should also be aware of how important projective identification is in supervision. This is the process whereby feelings that have not been managed get evoked in others. For instance, if I am working with a client who struggles with feeling angry, I may find myself inexplicably angry. I may feel ashamed for having these feelings. I may try to deny I feel this way towards my client. Then, when I go to supervision, I may evoke angry feelings in my supervisor.

So, someone will need to break the pattern here and start reflecting on their anger rather than trying to avoid it! The more we can share our feelings as normal human experiences and the more we can sort out our relationship with authority, the more we can help others become empowered and real.

Building more effective supervision

Supervision can be a place for robust academic thinking, artful illustrations and reflections and experiential challenge. There is still a great deal to learn about what makes supervision essential and effective. There are also many ways of being a good supervisor. Ultimately, both counsellors and supervisors should appreciate this diversity in developing effective supervision.

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