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.     

The patient's material as an aid to the disciplined working through of the countertransference and supervision

The author argues that the patient's largely unconscious observations of the analyst's functioning are, at times, communicated in the patient's material and that this can impart a sense of clinical relevance to the countertransference. The concept of 'understanding work' is used to provide a psychoanalytical model of this phenomenon. This is illustrated in a clinical case and it is argued that a selective consideration of the patient's material can provide a proper discipline which steers the analyst between the twin dangers of megalomania, on the one hand, and involvement in a symmetrical, self-disclosing relationship, on the other. The author then applies these ideas to supervision and uses them to distinguish psychoanalytic supervision from a practice that also derives from an intersubjective paradigm but which, to the author's mind, is not distinct enough from personal analysis.     

Supervision, transference and countertransference

The author discusses supervision, transference and countertransference as seen in the context of the clinical case of a patient who had been first seen as a training analysis case and who later, in a fortuitous way, was treated by the supervisor of the training analysis. The supervisor, who in the first instance did not recognize the patient, discusses the reasons for this unusual experience in terms of the presence and absence of transference during the analysis of this patient as a training case and the problems inherent in the task of supervising. The patient's feelings towards the first and the second analyst and the vicissitudes of transference and countertransference during the supervision of the training analysis and its influence on the presentation of the analytical sessions by the student are also detailed and discussed. The question of recorded supervision presentations and their possible influence on the dynamics of supervision is raised.     

The analyst's theory: A third source of countertransference

The author asserts that the analyst's theory, personal and/or academic, is an important source of countertransference which complicates our traditional understanding of the analyst's emotional responses as being constructed from a mix of his transferences and the patient's effects on him. From this perspective, theory - because it has no intrinsic relevance to the essential phenomena of individual analytic processes - may be a confounding, as well as a necessary, factor in clinical work. Although the analyst's theory might be conceptualized as a component of his personality that shapes his emotional reactions to a patient, the author believes that there is a valuable increment of conceptual clarity and additional clinical utility to thinking about a more direct role of theory in the process of countertransference formation. He uses aspects of the clinical analysis of narcissistic resistances to illustrate how some theories might predispose an analyst to confounding unconscious enactments by generating either positive or negative countertransferences which can be used defensively by the patient and/or analyst. He also illustrates how, in some contexts, an analyst's theory might attenuate potentially informative countertransference reactions and interfere in this way with the analyst's apprehension of the patient's psychic functioning. Finally the author addresses the importance of 'fit' between an analyst's working theory and a patient's psychopathology, and considers implications of his ideas for psychoanalytic training and practice.     

Dialogical mindfulness in supervision role-play

Aims: This exploratory pilot study investigated Mindfulness-based Role-play (MBRP) supervision to find out how therapists would experience the approach, and to what extent they would find it useful, particularly in relation to empathy toward clients. Method: Thirteen therapists participated in a workshop, introducing mindfulness and MBRP supervision, and subsequently had one individual MBRP supervision session. Data collection and analysis: Qualitative data were collected by means of semi-structured interviews and analysed with regard to participants' supervision experiences by means of a modified version of the Consensual Qualitative Research method. Findings: Participants predominantly had positive emotional and cognitive responses to their supervision experiences. The main supervision outcomes were empathy with the client's emotional experience, enhanced awareness of functioning as a therapist, and thoughts about how to proceed in therapy. A subset of participants also reported observed effects in therapy with clients. Conclusions: Even taking into account the methodological limitations of the study, these findings are promising and suggest that further research into the MBRP supervision approach is warranted.     

The effects of meeting a family therapy supervision team on client satisfaction in an initial session

Despite the wide use of live supervision in marriage and family therapy training, there have been no randomized trials comparing different variations of the practice. This randomized trial of 86 clients was designed to measure client satisfaction after an initial therapy session under two conditions: meeting the supervision team behind the observation mirror or not meeting the team. A mixed linear model analysis of covariance was used to examine the relationship between ‘meeting the team’ versus ‘not meeting the team’ and client satisfaction. There were no statistically significant differences in client satisfaction based on whether clients met the team or not. There was a trend toward greater satisfaction with the therapy session among clients who did not meet the supervision team.     

Opinions of Australian Psychological Society College Chairs about process and content in supervision training: Preliminary investigation in Queensland

Few psychologists in Australia have been trained to provide supervision to probationary psychologists. The current preliminary study investigated whether a supervision training workshop could, in the view of representative psychologists, provide effective training across a range of psychological specialties, or whether separate training was needed for different specialties. The nine Queensland Chairs of the Australian Psychological Society specialisation colleges were given a semi‐structured interview to investigate the goals, content and processes of supervision within their specialty, and perceived relationships with other specialties. Results indicated considerable agreement regarding the content and process of supervision across specialties, suggesting that supervision has much in common regardless of specialty.     

Theoretically informed qualitative psychotherapy research: A primer

This paper presents an introduction to theoretically informed qualitative psychotherapy research (QPR). Although QPR researchers have traditionally remained silent on theory, we suggest this has resulted in an implicit and unacknowledged use of theory. We argue instead for a clear articulation of qualitative researchers' theory and outline how theory can be incorporated to inform the entire qualitative research process. This approach assumes the research problem is embedded in a clearly defined and articulated theoretical framework, which also informs data collection and data analysis. We outline how researchers can use explicit theoretical frameworks to inform research question formulation, data collection and data analysis and illustrate this with specific applications of the method in practice. We believe that starting from a declared theoretical framework sets up a dialogue between the research problem, the type of data required and their meaningful analysis and interpretation. This aims not only to achieve greater depth in the final product of research, but also to enhance its utility in terms of practice; it contributes to building, altering and differentiating theory; and it allows for greater transparency by openly articulating the theoretical framework that scaffolds the entirety of the research process.     

Projective identification and working through of the countertransference: A multiphase model

Referring to Melanie Klein's unpublished views on projective identification, Bion's theory of container/contained and Money‐Kyrle's understanding of countertransference as a process of transformation, the author develops a multiphase model of projective identification. He differentiates five subphases of (1) adhesion, (2) penetration, (3) linking of the projection with an internal object of the analyst, (4) transformation and (5) re‐projection. In the author's view the differentiation of overlapping subphases may be helpful to better localize problems of working through the countertransference. Some technical implications are illustrated by brief clinical vignettes. To conclude, the paper discusses typical impasses and options for interpretation.     

Some reflections on empathy and reciprocity in the use of countertransference between supervisor and supervisee

Reciprocity refers in its general meaning to a mutual give and take. It is a background feature of all productive supervisory relationships. In this essay I want to bring it into the foreground. I will describe it by contrasting supervision and analysis. For, in my view, that is exactly what reciprocity is in the supervisory relationship: it is an attitude of mind in which the supervisor performs the task of differentiating internally the supervisory from the analytic vertex, in the context of the asymmetry of the supervisory relationship.     

Beyond transference,countertransference, the silences and the opinion1

The author examines several works of an intersubjectivist trend, as well as writings by Hanly, Cavell and Bion, defending many of the named psychoanalysts' viewpoints. These viewpoints are expressed in the search and the struggle for truth, recognizing, like Popper, that truth exists but that we cannot know with certainty whether and when we touch upon it, only that this endless effort merits a lifetime's work because it is the attempt at an encounter with ourselves‐the true encounter. The author explains the criticisms by Green of Jacobs, and defends the maintenance of ‘a certain possible neutrality’ (Eizirik). He poses some questions with regard to Ogden's ‘third subject’, considering it, among other aspects, from the supervisory point of view, which may demonstrate the existence of ‘a certain possible objectivity’ of the emotional confl ict. He develops some criticisms concerning silence as an interpretative action by Ogden, and summarizes two case histories. Both were unconsciously attempting to manipulate the analyst intensely‐one of them to get the analyst to intervene in his love life, and the other to interrupt acting out.     

Psychoanalytic supervision in the new millennium: On pressing needs and impressing possibilities

Having now completed its first century, psychoanalytic supervision has been and continues to be regarded as the cornerstone of psychoanalytic education; it is the primary means by which (1) psychoanalytic ideology becomes translated into practical product, and (2) budding analytic practitioners develop and grow in their therapeutic skills and professional identity. The supreme significance of supervision in contributing to the “making” of the competent psychoanalytic practitioner now seems a widely accepted given, even axiomatic. But as its second century gets underway, what have we learned from psychoanalytic supervision's first 100 years? What are its most pressing needs and, in turn, impressing possibilities at this time? And what needs to most change if psychoanalytic supervision is to most profitably advance in the years and decades ahead? In this paper, I would like to consider those questions, giving focus to five needs that seem to most require attention now: (1) making the practice of psychoanalytic treatment an increasingly competency-based, concretized learning affair; (2) enhancing the efficacy of supervisors through competency-based practice and training in psychoanalytic supervision; (3) more effectively incorporating existing technology and emerging technological advances into supervision and using them to enhance the psychoanalytic learning process; (4) better attending to matters of difference and diversity, and striving to seamlessly integrate them into the conceptualization and conduct of the psychoanalytic supervision experience; and (5) vigorously researching the psychoanalytic supervision process and working to establish an evidence base for supervisory practice.     

Change process in systemic therapy: A qualitative investigation

This study addresses the process of therapeutic change in individuals who received systemic therapy. This study is an exploratory qualitative study based on the client's perceptions and therapeutic experiences. The sample included 10 clients who had completed their therapy with systemic therapists. The method used for the collection of the data was semi‐structured interviews (Change Interview; Elliott, Slatick, & Urman, 2001). The interviews were analysed using grounded theory analysis. The results showed that both specific and common factors in therapy function in a co‐occurring mode, hence suggesting a synergy effect between common factors and specific techniques or therapist factors in psychotherapy. The core category ‘experience of therapeutic change, within the secure frame of therapy, is a process of deconstructing and reconstructing the house you live in: Yourself’ emerged based on self‐exploration and self‐discovery and is then discussed in a theoretical constructivist framework. Implications for research on the issue of the process of therapeutic change are discussed.     

Qualitative undergraduate project supervision in psychology: current practices and support needs of supervisors across North East England and Scotland

The dissertation is a core component of a psychology undergraduate degree, though very little research has been conducted into supervision processes at undergraduate level. This study examined the accounts of supervisors of qualitative dissertations in order to identify current practices of supervision and possible resources that might support supervision. Seventeen supervisors from psychology departments in North East England and Scotland were interviewed, and three main themes were identified using thematic analysis: the quantitative culture in psychology teaching, supervisors’ expertise, and the supervision process. Supervisors noted that students were typically constrained in their choice of methodology due to limited qualitative methods teaching, lack of training and guidance for supervisors, and concerns about the risks of demanding qualitative projects. Supervisors therefore often reported staying within their comfort zone, electing where possible to supervise only the methods that they themselves use. Recommendations for practical resources are provided to help support students and supervisors in the process of undertaking qualitative psychology dissertations.     

‘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.     

Psychoanalytic case presentations in a weaving thoughts group: On countertransference and group dynamics

This article summarizes experiences of psychoanalytic case presentations in weaving thoughts (WT) peer groups. The format is presented and illustrated using a session with a group of analysts. In this setting, the frame of the presentation is guaranteed by the moderator. One aim is to create a group setting with many parallels to the analytic situation. A second aim is to discourage members from becoming enmeshed in destructive group functioning, such as internal disputes that may block a deeper understanding of the material. Classical psychoanalysis permits the analyst to reflect behind the patient on the transference-countertransference interplay. However, such reflections may be marred by undetected countertransference problems. Different supervision formats have different ways of helping the analyst with them. The WT format 'copies' the analytic session to the group, hence each member associates to the material in peace. Meanwhile the presenter looks, metaphorically speaking, at the web of their associations at his or her own pace. This may help him or her to confront and reflect on unresolved countertransference issues. This article indicates the method's similarities and differences compared with other formats. Arguments are supported by a child psychotherapy session, but the method is equally suitable for adult case material.     

A change in frame and countertransference experiences: Transitioning from face-to-face to telepsychotherapy

Unprecedented changes in traditional psychotherapeutic practice arose from the lockdown restrictions associated with the COVID-19 pandemic. These changes to practice included the imposed change to the therapeutic frame when transitioning clients from face-to-face meetings to delivery of psychotherapy sessions via videoconferencing (defined here as telepsychotherapy). The current study conducted qualitative interviews with 16 Australian psychologists who transitioned their existing adult psychotherapy clients from face-to-face therapy to telepsychotherapy and explored their novel experiences associated with countertransference reactions during this period. Thematic analysis of the interviews revealed several unique findings. The type of countertransference reactions towards existing clients was consistent across both face-to-face and online meetings; however, the felt intensity of countertransference reactions was reduced. Psychologists reported an increased hesitance to work with intense emotions during telepsychotherapy sessions and felt increased pressure to work harder during online sessions when compared to face-to-face meetings. Exposure to their clients' personal and home environments during telepsychotherapy sessions elicited several novel reactions towards their clients. These findings on countertransference and telepsychotherapy are informative for future practice and training. Awareness of these unique countertransference experiences is recommended prior to engaging in telepsychotherapy or when transitioning clients to this modality.