Supervising personality assessment: the integration of intersubjective and psychodynamic elements in the supervisory process

The supervision of personality assessment can be likened to the process of teaching art. Much like artistic training, supervision of personality assessment is a complex process that calls for creative integration of different working processes, some more technical and formal and others broader and more complex. On the surface, compared to psychotherapy supervision, supervision of personality assessment is fairly structured and centered on specific tasks such as scoring, making a diagnosis, or determining personality organization. Nevertheless, principles of psychodynamic psychotherapy such as parallel processes are relevant as well. We discuss the process of integrating intersubjective and psychodynamic elements into personality assessment supervision and argue that this integration helps the supervisory work to proceed effectively. We present the role of knowledge, the institution, and parallel processes in the supervisory work.     

How honest do counsellors dare to be in the supervisory relationship?: An exploratory study

A study was conducted to investigate the extent to which psychodynamic counsellors feel able to disclose sensitive issues in supervision. Ninety-six counsellors in supervision responded to a questionnaire that asked about supervision arrangements, the supervisory working alliance, and the likelihood of disclosing issues such as erotic feelings towards clients and discomfort with the supervisor. Results showed that supervisees were likely to disclose more in individual rather than in collective supervision, when their supervisor was someone whom they themselves had chosen rather than had allocated to them, and when they were supervised independently of the setting in which they counselled rather than in-house. There was a positive correlation between the quality of the supervisory working alliance as experienced by the supervisee and the extent of his or her disclosure. Implications of counsellors feeling inhibited from disclosing particular issues in supervision, and the impact on the quality of their work with clients, are discussed.     

The peer supervisory group for psychoanalytic therapists

The recent interest in peer supervisory groups for psychoanalytic therapists raises important questions regarding both psychoanalytic training and group process. The present paper explores these issues and suggests that there exists a continuum from case-centered peer supervisory groups to process-centered peer supervisory groups. Transference and countertransference and the recognition of parallel processes in psychotherapy supervision are examined in their relation to the supervisory group experience. The authors suggest that the model a therapist employs regarding the role of countertransference will most likely influence the kind of peer supervisory group that s/he will choose. Further, there are specific techniques, as well as experiences, which may foster alteration of the group's psychic organization. Illustrative case examples are provided throughout.     

An approach to supervision in health care settings

This article describes a flexible approach to supervision which allows for the fact that integration may mean different things to different people under different circumstances. In the health contexts described the clinical mix which was found most helpful in the supervisory work combined psychodynamic, Jungian and humanistic perspectives. The application of this particular mix of clinical techniques is demonstrated with reference to the work with two supervisees. It is felt that the methods employed are consistent with the current notions of difference in counselling and psychotherapy.     

Supervisory reactions: an important aspect of supervision

Anne Alonso was passionate about the practice of supervision. An excellent supervisor herself, she sought to identify and teach the ingredients of effective supervision throughout her career. Her first book, The Quiet Profession (1985), was about the supervisory relationship and the various influences on it from within and without the relationship, and she insisted that the Center for Psychoanalytic Studies training program that she directed for many years include a required course on supervision. While the usual focus in supervision is on the supervisee and the clinical material presented, supervisors often experience powerful emotional reactions. Sometimes this is parallel process, in which the dynamics of the psychotherapy are replayed in the supervisory relationship. However, many other sources can contribute to supervisory affect, including the personality, background, and developmental stage of the supervisor, the impact of the clinical material, and the setting in which the supervision takes place. Supervisory reactions can be informative about the psychotherapy being supervised, about the supervisory relationship, or about the supervisor. Supervisors need self-awareness in order to identify their own contribution to their affective responses in supervision. The use of a supervisor decision tree of 1) awareness of reaction, 2) identification of its source, 3) relevance to current supervision, and 4) appropriate use of the reaction in the current supervision is recommended.     

Group supervision of groups: a modern analytic perspective

This article is introduced by historical references to Freud's Wednesday Evening Society and to relevant sources in the literature on group supervision. The aims of group supervision are defined: helping supervisees to understand the individuals who comprise their groups, helping the supervisee become a group-oriented therapist, alerting supervisees to the critical task of monitoring and regulating the amount of emotional excitation within their groups, helping supervisees deal with the range of feelings induced in them by their groups, and helping them become familiar with the principles and become proficient in the techniques of modern analysis. Major aspects of the group-supervisory process are delineated and illustrated through the use of relevant vignettes. Resistance in supervisory groups is discussed with examples of the resolution of some resistances. The author's method and style of leading supervisory groups is presented, as are observations on the boundaries of supervisory groups.     

Trainee therapists’ views on the alliance in psychotherapy and supervision: a longitudinal study

The shape of alliance in psychotherapy and supervision using growth curve modeling was examined for clinically inexperienced trainee therapists, who were engaged in long-term cognitive behavioral - or psychodynamic individual psychotherapy at a Psychology Clinic in Sweden. Trainee therapists rated their view of the alliance with their clients and their supervisors on the Working Alliance Inventory at five time points. The alliance to the client show a consistent, positive development throughout the therapy. The alliance to the supervisors show initially a decrease, followed by an increase, and then again, the rate of increase in the supervisory alliance ratings slowed down indicating a more complex view of the supervisory alliance compared to the view of the alliance in psychotherapy.     

Supervision and Analysis at a Crossroad: The Development of the Analytic Therapist: Discussion of Papers by Joan Sarnat and Emanuel Berman

This discussion of papers by Sarnat and Berman on psychoanalytic supervision explores the complex nature of the contemporary psychoanalytic supervisory relationship. It considers how developments in psychoanalytic theory and practice, reflecting relational, intersubjective, attachment, and field theory influences over the past 30 years, have changed the ways in which many analysts practice and theorize supervision. Contemporary supervisors attend not just to the patient being presented, or to the therapeutic dyad, but to the supervisory relationship itself as part of the clinical/supervisory frame of reference. Similarities and differences between therapy and supervision are considered.     

Focus and process in supervision

Key dimensions of the supervisory process are not fully articulated in the literature or in the practice of supervision. Three particular areas are identified: the purpose of supervision, the importance of the supervisory relationship, and the development of competence. In relation to purpose, it is suggested that a superordinate focus should be on the 'quality of service' to the client. The supervisory relationship is discussed in terms of a process which unfolds over time through a series of stages. The challenge of defining competence is reviewed within a framework of developing 'reflective practitioners'.     

Suicide in group therapy: trauma and possibility

Abstract This paper compares and contrasts the experiences of two different long term psychodynamic psychotherapy groups in which a patient suicided. The acute reactions and longer term process of each group is described in detail and discussed. The reactions of the two leaders, married to each other and in a shared supervisory group with the late Anne Alonso, and their own working through of the traumatic losses are explored. Their experiences highlight the importance of open discussion of the suicides in the groups, consultation with senior colleagues, and continual processing of their own reactions as a means of fostering posttraumatic growth. The authors discuss their experience in light of the literature on trauma in groups and the emerging literature on posttraumatic growth and they reflect on implications for the community of group therapists.     

Disruption and Working Through in the Supervisory Process: A Vignette From Supervision of a Psychoanalytic Candidate

This paper describes the author’s supervision of a psychoanalytic candidate, including the development and resolution of impasse in both the supervised analysis and the supervisory relationship. When the author became aware of the degree to which her own anxieties and defenses were implicated, she sought consultation, after which both supervision and analysis moved forward. As supervision continued, work on supervisee’s and supervisor’s interlocking anxieties and defenses, and understanding of their impact on the supervised analysis, deepened. The author concludes that exploring supervisory disruptions allows both members of the supervisory dyad to come to grips with conflicts that subtly distort their work and facilitates a deepening of the supervised analysis.     

Group supervision and the psychoanalytic process

This article attempts to elucidate the psychodynamics of group supervision of group psychotherapists. The significance of the supervisory setting is explored with a particular emphasis on the frame. The regressive interactions in group supervision are regarded as enactments, which are conceptualized as nonverbal communications that are covertly transmitted. Enactments offer a link between the present group (supervisory group) and the absent group (the therapy group that is being supervised). The relationships between the experiential and didactic components of group supervision are also addressed. Clinical vignettes illustrate the interplay between the present and the absent group focusing on the supervisor's interventions.     

Transitional Dynamics of Three Supervisory Styles Using Markov Chain Analysis

Counseling supervision is a critically important process that depends on the establishment of a supportive, collaborative, and developmentally enhancing working relationship. However, the actual verbal exchanges within the supervisory dyads are infrequently examined in the literature. In this study, we used Markov chain analysis to explore supervision dynamics of 34 supervisory dyads and how these dynamics varied within three supervisory styles (i.e., attractive, interpersonally sensitive, and task oriented). Among the three styles, the interpersonally sensitive supervisory style was the only discriminant variable based on which supervisory dyads exhibited statistically different state-transitional patterns (i.e., movement patterns across six supervision events). The results of this study provide implications for clinical supervisors, counselor educators, counselors-in-training, and researchers who are interested in studying process features at the microlevel.     

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.     

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.     

The supervisory field and projective identification1

Taking as their starting point the Baranger and Baranger model of the ‘psychoanalytic field’, the authors extend the notion of intersubjectivity in the analytic relationship to the supervision process. They use a practical example of a supervision to show the development of what they term the ‘supervisory field’, formed from the superimposition of the two fields of analyst‐patient and supervisor‐supervisee. They emphasize the interplay of projective identifications with objects emanating from the inner world of the patient that are relived in the analytic relationship and transposed to the supervisory field. They believe that the concept of the ‘supervisory field’ contributes to a deeper understanding of the unconscious processes occurring in the mind of analysand, supervisee and supervisor during supervision, particularly regarding the identification, comprehension and resolution of persistent disturbances in the supervisory process.     

Dialectical Tensions Supervisor Attitudes and Contextual Influences in Psychotherapy Supervision

Psychotherapy supervision is a complex process; supervisors must concurrently balance multiple roles, such as teacher, counselor and consultant. The current paper proposes four “dialectical tensions” inherent in supervision which, if attended to, can guide supervisor behavior during the supervision session. Specifically, supervision requires balancing the following polarities: (1) promote change/provide support, (2) provide feedback/maintain relationship, (3) supervisee-directed/supervisor-directed, and (4) client focus/supervisee development focus. We discuss these dialectical tensions in a contextual framework, and we propose that supervisor awareness, intention and willingness are necessary to incorporate contextual factors and balance the dialectical tensions during supervisory interactions. We present two examples of supervisory interactions and describe how attention to the dialectical tensions can guide supervisory decisions.     

Can anybody hear me? Reacting to pressures from psychotic states of mind

In this paper material is presented from supervision groups run for nurses and other mental health professionals. The patients presented to the group all came from different mental health settings and suffered from psychotic states of mind. In this paper I will argue that the psychodynamic model can help nurses and other front‐line mental health professionals in their understanding of psychotic process. Nursing staff, in particular, are with their patients over long periods of time and see them in different settings. The psychodynamic model can be helpful in giving mental health professionals a language for describing their experiences of, and interaction with, their patients. The psychodynamic model can also provide a dynamic picture of the patient's problems over time. This type of assessment and thinking, which includes an understanding of the dynamic process involved in psychosis, can then stand alongside the medical model.     

Suicide in Group Therapy: Trauma and Possibility

Abstract

This paper compares and contrasts the experiences of two different long term psychodynamic psychotherapy groups in which a patient suicided. The acute reactions and longer term process of each group is described in detail and discussed. The reactions of the two leaders, married to each other and in a shared supervisory group with the late Anne Alonso, and their own working through of the traumatic losses are explored. Their experiences highlight the importance of open discussion of the suicides in the groups, consultation with senior colleagues, and continual processing of their own reactions as a means of fostering posttraumatic growth. The authors discuss their experience in light of the literature on trauma in groups and the emerging literature on posttraumatic growth and they reflect on implications for the community of group therapists.     

The supervisory relationship in psychotherapy over time

This study investigated changes in the supervisors' and supervisees' perceptions of the supervisory relationship and the extent to which their perceptions were congruent. Salient dimensions of supervision were identified which predict the quality of the relationship. Twelve supervisory dyads involved in predominantly ongoing supervisory relationships completed an adapted Vanderbilt Psychotherapy Process Scale after each supervisory session for 10 consecutive weeks. The participants' perceptions of the supervisory relationships were relatively stable and positive. However, supervisees felt less dependent over time. With that exception, agreement among participants did not change significantly. Supervisors viewed supervisees' participation and increased assertiveness as significant positive elements in assessing the quality of the relationship. Supervisees' greater exploration and dependency was associated with negative ratings by supervisors. Since supervisors selected the supervisees for the study, the results primarily validate their judgments of the components of a positive continuing supervisory relationship.