How Does the Analytic Supervisor Teach Group Therapy?

This paper presents a detailed account of the role of the analytic supervisor of group therapy. In addition to overseeing the teaching of clinical skills, the analytically-oriented supervisor monitors the dynamics of the supervisee and the supervisory relationship itself. Unconscious processes may both interfere with, and shed light on what is occurring in the treatment. The author suggests that a collaborative relationship characterized by safety and mutual reflection promotes learning. The distinctions between analytic and nonanalytic supervision of groups are discussed.     

The Experience of Leader-Led Peer Supervision: Genetic Counselors' Perspectives

As we proceed through our professional lives, it is essential that we challengeourselves in order to continue to develop our genetic counseling skills. Conferences, workshops,post-graduate courses, journal clubs, and involvement in professional organizations havebecome the traditional methods of continuing education for post-graduate geneticcounselors. While these forums address the need to stay updated on scientific orinformation-based topics, there is little available to counselors to promote growth incounseling skills. A group of Boston-based genetic counselors describe how their leader-ledsupervision group has established a setting to meet the needs of its members both forsupport and continued counseling training. We outline here the evolution of this group andhow it has become a valued part of our professional lives. We feel that the model of leader-ledpeer supervision holds great value in helping genetic counselors continue to enhancetheir interpersonal skills in a supportive, safe, and challenging environment. It is our hopethat others will elect to form similar groups in their own communities, thereby creating newopportunities for growth within the genetic counseling profession.     

Photo-synthesis: Facilitating Goal Setting in Supervision Using Images and Creativity

ABSTRACT

One of the most important aspects of clinical supervision is goal-setting. In the early stages of supervision, supervisees may find it difficult to connect authentically with their supervisors due to the inherent power differential in supervision. Difficulty connecting may be exacerbated when students are attempting to set goals regarding their areas for growth. Based on literature reviewed on the counselor-client relationship, the authors posit that using images may increase vulnerability between supervisors and supervisees. Additionally, the authors introduce relational-cultural theory as a framework for connecting authentically through creative images. The authors present examples of using images in individual and group supervision, specifically employing The Coaching Game made by Points of You.     

A Qualitative Investigation of Student and Supervisor Perceptions of Live Supervision in Genetic Counseling

Live supervision of genetic counseling students is critical for ensuring quality client care and student clinical skill development. However, no research has investigated students' and supervisors' experience of this primary supervision method. In this study, separate focus groups of students and supervisors discussed their perceptions of the nature and impact of live supervision. A modified Consensual Qualitative Research method (Hill et al. (1997) Couns Psychol 25:517–572) was used to analyze the data. Results suggest that live supervision is an essential and effective method that promotes student skill development and professional development for both students and supervisors. There is a lack of formal training regarding supervision; most learning is trial and error. Students worry about being evaluated, and supervisors wonder if they are providing supervision effectively. Both samples emphasized that client care should not be compromised. Participant recommendations for improving live supervision are described, and suggestions are made for future research.     

Experiential Group Psychotherapy Supervision

Following a review of various traditional models of supervising group therapy, an experiential model of supervising group in a group setting is presented. The model stresses the group aspect of the supervisory process, encourages group interaction, here-and-now responses and associations, and employs concepts from both object relations and group-as-a-whole theory to understand what is taking place. The model's premise is that case material presented in a supervision group stimulates parallel material in supervisees, which is then used to elucidate what has taken place in the therapy group being presented. Excerpts from one supervisory group are used to illustrate major features of the model.     

The competent psychoanalytic supervisor: Some thoughts about supervision competences for accountable practice and training

What are the competences required to satisfactorily practice effective or “good enough” psychoanalytic supervision? In this paper, I would like to consider that question. Over the past approximate 15-year period, increasing attention has been directed toward more specifically identifying and defining the components of competent psychoanalytic practice. But any parallel attention toward identifying and defining the components of competent psychoanalytic supervision practice has, in comparison, been sorely limited if not virtually absent. If we are to best practice competent psychoanalytic supervision and best train future psychoanalytic supervisors for competent practice, effort needs to be made to concretely delineate the competences that are requisite for such practice. In what follows, I present and adapt six broad-based families of internationally relevant supervision competence areas for use in psychoanalytic supervision: (1) knowledge about/understanding of psychoanalytic supervision models, methods, and intervention; (2) knowledge about/skill in attending to matters of ethical, legal, and professional concern; (3) knowledge about/skill in managing psychoanalytic supervision relationship processes; (4) knowledge about/skill in conducting psychoanalytic supervisory assessment and evaluation; (5) knowledge about/skill in fostering attention to difference and diversity; and (6) openness to/utilization of a self-reflective, self-assessment stance in psychoanalytic supervision. Although by no means an exhaustive list, 30 supervision competences (five per family) are proposed as significant for guiding competent psychoanalytic supervision practice and supervisor training, and a brief explanatory comment is offered in support of each broad-based family of competences.     

The efficacy of teaching psychology students exposure and response prevention for obsessive-compulsive disorder

The aim of the study was to investigate whether inexperienced student therapists could successfully learn exposure and response prevention for obsessive-compulsive disorder. Twenty out of 21 outpatients completed treatment as delivered by ten psychology students. A total of 60 hours group supervision and approximately 30 hours with individual supervision was given to the students over the course of three semesters. Large effect sizes were observed for measures of symptoms and depression. Sixty-two percent ( N = 13) of the intent to treat group achieved clinical significant change and 81% no longer met the diagnosis criteria ( N = 17). The treatment effects observed at the 6 month follow-up period were promising. The results are encouraging for training students in evidence based treatment for specific disorders.     

A Survey of Clinical Supervision in Genetic Counseling

Three hundred and thirty-five full members of the National Society of Genetic Counselors completed a survey concerning the nature of clinical supervision for genetic counseling students. Slightly over half (54.3%, n = 182) had provided clinical supervision within the past 5 years. Of those who supervised, 66.7% had 5 years or less supervision experience, and 55% had supervised 10 or fewer students. The majority became supervisors because they enjoy teaching and contributing to the profession. Common reasons for not supervising include no local graduate program, and had never been asked to supervise. Live supervision is the most prevalent student evaluation method: every supervisor reported providing one-on-one oral feedback, and 47.3% indicated that they always provide feedback immediately following a counseling session. The most frequent challenges involve students who lack technical knowledge and who fail to incorporate feedback. Training, policy, and research implications are discussed.     

Facilitating Individuation Processes in Supervision Groups Comprised of Co-Therapists Conducting Group Therapy with Bereaved Parents

Helping Israeli bereaved parents work through losses and anger poses great emotional challenges for group therapists. Separation-individuation becomes an issue for both mourners and conductors alike. Supervision groups composed of such co-therapists often go through unique stages in the course of their development. The conflict between a defensive belonging to a dyadic subgroup with their co-therapist on the one hand, and involvement with the supervision group and its leader on the other, are the main reasons for this uniqueness. In these stages, special difficulties in the co-therapist's separation/individuation may be observed and furthered. An important emotional function we call reverse parallel process can be activated in supervision groups, and can eventually influence the therapy. It is achieved in the supervision through the containment and working through of difficult emotions disowned by the therapy group. What seemed to be an obstacle to the group's development, if processed by the co-therapists, can enable patients to work through their difficulties and improve their functioning. If, on the other hand, the co-therapists' separation/individuation development is faulty, containment dysfunction may burden the receptiveness and working through of dreadful projections, and result in massive acting-out. The rich Israeli experience in this field could contribute to cope with similar group situations.     

Cybervision: Virtual peer group counselling supervision — Hindrance or help?

This study explored the use of text‐based computer‐mediated communication in counsellor supervision. ‘Cybervision’ is an innovative collaboration between counsellors and computer technology. The study reports on the use of clinical case presentation by e‐mail and the discussion of cases in text‐based chat rooms. The inquiry, conducted from a qualitative research perspective, seeks to explore the potential effectiveness of Cybervision along with its advantages and disadvantages. Prior to each supervision session, the supervisee presented case concerns by e‐mail and later received 60 minutes supervision from the remaining three group members adopting the role of supervisor. As a form of co‐operative inquiry, the personal experience of research participants was investigated and reported, highlighting key themes and issues relating to the absence of face‐to‐face contact. In all cases, participants reported that Cybervision effectively influenced and informed the clinical practice of the counsellor. Participants quickly and successfully formed a meaningful group where support, challenge and feedback were expressed and valued. The ‘disinhibition’ effect of on‐line contact was found to support open and honest communication. Feelings were communicated in this environment with surprising ease. The consistent emergence of useful parallel processes was another significant finding.     

Supervisor social skill and supervision outcome

Background: The practice of clinical supervision is considered an effective procedure to achieve a variety of professional outcomes for supervisees. Supervisory alliance mediates many of the learning outcomes thought important for effective supervision. Therefore, it is important to identity supervisor characteristics that relate to the capacity to develop a positive supervisory alliance and achieve supervision outcome. Aim: Supervisor interpersonal skill was investigated as a characteristic involved with both supervisee assessment of supervisory alliance and learning outcomes of supervision. Method: Forty supervisors completed assessments for interpersonal skill and provided 8 sessions of supervision to 50 supervisees. Supervisees completed assessments for supervisory alliance and supervision evaluation. Findings: Supervisor interpersonal skill predicted supervisee rated supervisory alliance and supervision outcome. Implications: Supervisor interpersonal skill is important for the capacity to develop a positive supervisory alliance and manage the learning environment of supervision.     

Reflections on the Experience of Counseling Supervision by a Team of Genetic Counselors from the UK

Despite it being generally acknowledged that counseling supervision is a vital part of the work for experienced genetic counselors and not just students, not all practising genetic counselors in the United Kingdom and Eire have access to this yet. This case study documents the supervision experience of our team of genetic counselors from Cambridge in the U.K. We document our retrospective thoughts on working practice before supervision was available in our department. We also give an overview of the individual and collective views of having one-to-one supervision only and then one year later, the impact of adding group supervision. Our ‘supervision journey’ is recorded using a practitioner-centred approach with a mixed method of data collection. Two focus group discussions and two written questionnaires were used, at different time points to gather attitudes. This paper captures experiences as our practice of supervision has evolved. This work is relevant to practising genetic counselors around the world who either do not yet have access to supervision, are planning its implementation or else are adding different types of supervision to their practice.     

Psychoanalytic Psychotherapy for Severely Disturbed Borderline Patients: Observations on the Supervision Group of Psychotherapists

The authors describe the role of a supervision group of psychotherapists within a wider therapeutic field for severely disturbed borderline patients. The group concentrates on the transference and countertransference, seen according to Racker’s distinction between concordant and complementary identifications. The implications of the prevalence of the complementary identifications over the concordant identifications of the therapists to their patients and the resulting regression to primitive defense mechanisms can be counterbalanced by the group’s integrative functioning as receiver (1) of a variety of information about the patient, (2) of the therapist’s attempt to understand and synthesize, and (3) of the therapist’s countertransference reactions to his patient. The major discrepancies between the various conceptions of the borderline patients’ psychic world and the appropriate therapeutic technique to be applied are also discussed, as well as the way the group filters the information and integrates the therapeutic thought. It might be said, therefore, that, in the “inpatient” phase of the individual psychotherapy, the group of psychotherapists functions, for the patient and the treatment, in a synthesizing context, as it provides the therapist with a space of integration for his split-off part of self and object representations, which the therapist makes use of for his patient.*Members of the Athens University Project for Borderline Patients’ research team consisting of psychoanalysts and psychotherapists, Eginition Hospital, 74 Vas Sophias Avenue, Athens 11528, Greece.Maria Chatziandreou, M.D., is a member of the Hellenic Psychoanalytical Society.Haris Tsani, M.D., is a candidate of the Hellenic Psychoanalytical Society.Nikos Lamnidis, M.D., is a candidate of the Hellenic Psychoanalytical Society.Claire Synodinou, Ph.D., is a member of the Paris Psychoanalytical Society and an associate professor at Panteion University, Athens.Grigoris Vaslamatzis, M.D., is a training analyst of the Hellenic Society of Psychoanalytic Psychotherapy and an associate professor of psychiatry at Athens University.Address correspondence to: Maria Chatziandreou, M.D., 1-3, Skippi Street, 11525 Athens, Greece.     

Caring for the Care-Giver: The Benefit of a Peer Supervision Group

I presented the following case to my leader-led peer supervisiongroup twice as the case evolved over the course of one year. During my firstmeetings with Mr. and Mrs. M we discussed a prenatal diagnosis of a skeletaldysplasia at thirty-three weeks of pregnancy and the option of a third trimesterpregnancy termination. One year later I presented follow-up on the outcome ofthe affected pregnancy, a new pregnancy, and Mrs. M's suicide. Although bothsegments of the case were completed by the time I presented, my peersupervision group was invaluable. With the encouragement and support of groupmembers, I could openly express and process my sadness and grief for the M'ssituation and the loss of Mrs. M's life.     

‘A baptism of fire’: A qualitative investigation of a trainee counsellor's experience at the start of training

Background: Belief in the effectiveness of professional counselling and psychotherapy training is widespread and generally unquestioned. Few studies have attempted to understand the changes experienced by trainees, or identified which aspects of professional training programmes assist them in the process of becoming therapists. Aims: to investigate how a trainee counsellor changes at the start of training, and to identify which aspects of a professional counsellor training programme were helpful in instigating and supporting change. Method: the experience of one trainee counsellor, Margaret, was captured through three semi-structured interviews conducted at the beginning, middle and end of her first term. The data were subjected to systematic qualitative analysis. Findings: Margaret experienced significant change during her first term. Each interview revealed a different phase of her development. The core categories were: becoming something new (week 3); growth in therapeutic confidence (week 6); surviving ‘stressful involvement’ through supervision (week 11). Experiential learning, in particular group supervision, was helpful throughout. The presence of real clients was identified as the main driver for change. Conclusion: The findings were found to be consistent with a number of other studies, which suggest that training is potentially painful because of the emotional demands it places on trainees, particularly at the start of practice. Consequently trainees require opportunities for experiential learning, peer support and supportive supervision to assist them in their development, but most importantly, given that supportive supervision can only minimise the harm of stressful involvement (Orlinsky & Ronnestad, 2005), they need early positive experiences with clients.     

An Integrative Approach to Teaching Dreamwork in Group Supervision

Dreams can be an important part of the counseling process to increase clients’ awareness of potentially unfinished business. We present an approach to teaching dreamwork in group supervision that is designed to assist supervisees’ integration of dreamwork techniques into their client consultation and to contribute to further development of advanced counseling skills.     

Positive experiences of doctoral-level supervisors-in-training conducting group-format supervision: a qualitative investigation

Experiential learning opportunities are powerful in shaping positive supervisor behaviours. We were interested in examining the positive experiences of supervisors-in-training during their first practice experience as supervisors. Our study was guided by two research questions: (a) what are the experiences that supervisors-in-training viewed as positive during the course of providing clinical supervision to master's-level counselling trainees? and (b) how did these positive experiences contribute to their professional development? We employed a variation of the consensual qualitative research method developed by Hill, Thompson, and Nutt-Williams (1997) and interviewed 10 supervisors-in-training regarding their positive experiences in supervising master's-level counselling trainees. The results included five major categories of positive experiences: (a) the positive value of feedback; (b) enhanced confidence in using a wider variety of supervision tasks and procedures; (c) the impact of the experience on other aspects of professional practice; (d) increased familiarity with the multiple roles of the supervisor; and (e) for some, increased comfort navigating co-supervision dynamics. Each of these categories included subcategories. We discuss our findings within the context of supervision training in graduate education.     

Creating a safe place for growth in supervision

When people are afraid, learning is inhibited. In too many disturbed families, institutional settings, rigid organizations, and some supervision groups, a feeling of emotional safety is missing. The first step in teaching, supervising, or therapy is the necessity to provide a safe environment. The author suggests a model applicable to any supervision group, work group, organization, classroom, or family. A group model, specifically applied to the relationship between family therapy students or interns and supervisors, suggests ways to enhance growth by minimizing fear.     

The Interface Between Countertransference and Projective Identification in a Case Presented to Peer Supervision

This case report, presented to a supervision group, is a prenatal genetic counseling casethat caused me a great deal of emotional discomfort as the events unfolded. Thediscomfort originated during my first meeting with the couple for routine preamniocentesiscounseling and continued through later encounters. This case illustrates the process ofworking through countertransference and projective identification issues that may arise ingenetic counseling.