The culture of psychotherapy supervision

Psychotherapists in training and beyond are expected to receive regular clinical supervision. In Britain many practitioners are required to have life long supervision. This paper draws on recent research into supervision, and highlights a number of areas that have been identified as problematic, including: power and control, spirituality, touch, ethical issues and secrecy. It is suggested that a professional culture of supervision has been constructed that may not reflect the best interests of either clients or practitioners. The implications of this perspective are explored.     

Attention and working memory capacity: insights from blocking, highlighting, and knowledge restructuring

The concept of attention is central to theorizing in learning as well as in working memory. However, research to date has yet to establish how attention as construed in one domain maps onto the other. We investigate two manifestations of attention in category- and cue-learning to examine whether they might provide common ground between learning and working memory. Experiment 1 examined blocking and highlighting effects in an associative learning paradigm, which are widely thought to be attentionally mediated. No relationship between attentional performance indicators and working memory capacity (WMC) was observed, despite the fact that WMC was strongly associated with overall learning performance. Experiment 2 used a knowledge restructuring paradigm, which is known to require recoordination of partial category knowledge using representational attention. We found that the extent to which people successfully recoordinated their knowledge was related to WMC. The results illustrate a link between WMC and representational-but not dimensional-attention in category learning.     

Race,racism and systemic supervision

The idea of ‘race’ and the social reality of racism have gained increasing attention in family and systemic psychotherapy. This article seeks to extend this attention by focusing upon the influence of race and racism in the supervision of family and systemic psychotherapy. The way in which the idea of race might be conceptualized is discussed, before looking at how race and racism have been addressed in the field. Attention is then turned to systemic supervision, focusing upon the ideas generated about how supervisors might position themselves in relation to these issues, the implications this might have for the supervisory relationship and the relationships between supervisees and client families. It is proposed that by virtue of the supervisor's position of power over the supervisee, it is the supervisor's responsibility to initiate conversations about race and racism. A proposal for this task is outlined, which recognizes that these conversations are ongoing. A concluding assertion is made that such conversations should form part of the evaluative process for trainee supervisors.     

Toward a research-informed,evidence-based psychoanalytic supervision

The first paper on the subject of an analyst's pregnancy appeared more than 50 years ago, and was followed by a complete silence on the subject for the following 17 years. Slowly, a few substantial papers began to emerge, and there has been a gradual expansion in this area of the psychoanalytic literature particularly over the past 25 years, so that by now we have at least 60 papers on the subject, several chapters in books, and at least one complete book that I am aware of. There is of course a substantial separate literature on the subject of pregnancy itself, which is of direct relevance to an understanding of the subject of the analyst's pregnancy. In addition, the literature on special events in the course of therapy is pertinent to the subject too. I have limited my own review of the literature specifically to that related to the analyst's pregnancy but I have included all the references I could trace in the bibliography at the end of this issue.

I have grouped the papers to some extent around key areas of interest as they emerge from the whole literature. In particular, I have noted that the earliest papers began to outline some generic responses to the analyst's pregnancy, ranging in intensity from supposedly minor turbulence in men to intense transference storms in women. The early papers seem to have regarded pregnancy solely as an interference in the treatment process. Later papers began to place more emphasis on the analyst's countertransference response and to acknowledge that the therapist herself is confronted at this time with issues involving her own identity, integration of new roles, maternal identification and redefinition of important relationships in her own life. At the same time she is having to find a way of functioning as an analyst in the face of intensified transference reactions. If the analyst can negotiate the challenges to her own pre-existing psychological equilibrium which pregnancy confronts her with, she will be better placed to address the stormy period in therapy which her pregnancy is likely to provoke in her patients, and some therapeutic gains can be made over this phase of the analysis.

Later papers attempt to differentiate male from female responses to the pregnancy, and the demarcation is not surprisingly found to track psychosexual development along familiar gender lines. Examination of responses of homosexual patients, whether male or female, emphasizes the point. In addition, attempts to differentiate responses to the event according to the core psychopathology in the patient, confirm the pattern of anxieties and defences to be expected in particular configurations.

A few papers examine the responses of patients to the therapist's pregnancy in different treatment modalities, and although there is some evidence to suggest that patients having group treatment are more likely to present with issues of sexual curiosity, sexual identity, or sibling rivalry, compared with patients in individual therapy, in the final analysis all patients confirm a core complex of fear of abandonment and feelings of loss of the fantasized exclusive mother-infant relationship.

There is very little discussion in the literature on the impact of an analyst's absence due to unsuccessful pregnancies and it is postulated that this remains an area of great difficulty for the patient and the analyst, to the extent that it is almost obliterated. I can find only three papers on this topic. However, a few papers are published on the patients' responses to an analyst who has had two pregnancies. While this constitutes a particularly complex challenge to both patient and analyst, the overview suggests that there are additional therapeutic gains to be made in terms of working through, in the course of the second pregnancy.

Numerous authors address the subject of the inevitable changes in technique that follow from the fact of the analyst's pregnancy. Some of these changes are felt to be directly related to the physical and psychological changes with which the therapist is confronted at this time, and by association so is her patient. The more these changes can be acknowledged by the therapist, within herself, the more likely it is that she will be able to continue to function as an analyst. It is also apparent that the role of the supervisor is of particular importance during and immediately following this life-changing event (Imber 1995 Goldberger, M, Gillman, R, Levinson, N, Notman, M, Seeling, B and Shaw, R. 2003. On supervising the pregnant psychoanalytic candidate. Psychoanalytic Quarterly, 72: 439–463. [Taylor &; Francis Online] , [Google Scholar], Goldberger et al. 2003) and this is described in some detail in these two recent papers.     

Convergence,commonality, and context in psychoanalytic supervision

ABSTRACT

What are the binding commonalities that demark and define any and all psychoanalytic supervision perspectives? What do we all do as psychoanalytic supervisors that practically matters? Furthermore, might there be a unifying model that anchors those binding commonalities together into a supervision meaning-making, explanatory framework? In this two-part paper, I take up those questions. In Part I, based on a century-spanning literature review, I identify 50 (non-exhaustive) common Support and Learning factors that appear present across the panoply of psychoanalytic supervision perspectives. Relational, educational, and interventional, these 50 factors reflect the very stuff of which psychoanalytic supervision is made. In Part II, I present and elaborate upon the Contextual Psychoanalytic Supervision Relationship Model (CPSRM) – a theoretically-grounded model that anchors and contextualizes those common Support and Learning factors. Because common factors can be seen as nothing more than atheoretical amalgamation (i.e., lists of desirable characteristics endlessly strung together), the CPSRM is proposed as a theoretically-based antidote. A supervisory extrapolation of Wampold’s contextual psychotherapy relationship model, the CPSRM accentuates relational connection, expectations/goals, and educational action as preeminently supervisee change inducing and learner affecting.     

Self‐supervision,surveillance and transgression

Transgression is not only an inevitable part of systemic supervision but is also necessary if we are to work towards innovative and inclusive supervisory and therapeutic practice. Defying culturally generated ‘rules’ of systemic practice can allow for more relevant and productive ways of talking. Systemic practitioners are increasingly finding themselves trying to practice systemic therapy in employing authorities and training courses which are dominated by inflexible professional narratives and manualised procedures. Our profession is committed to ethical inner and outer dialogue, to self‐ and relational reflexivity as distinct from the rule‐bound surveillance culture in which we live and work. Systemic supervisors and therapists may find themselves at odds with monological institutional discourse and attempts from within our own profession to manualise practice. I introduce examples from supervisory conversations to illustrate how supervisors can develop more culturally sensitive practices through supporting practitioners to hear and have heard their own marginalised and oppressed voices and those of their clients.     

Systems-centered supervision

The systems-centered (SCT) approach to supervision frames the dynamics of both groups and individuals as isomorphic systems. In this chapter, the SCT supervisory experience, its goals, and its approach to transference and countertransference are addressed; the orientation of the seven questions that structure the SCT supervisory process are identified; and the thinking that is required to answer them is discussed. SCT supervisees locate their supervision issues in the context of the phases of system development; consider interventions as hypotheses that can be tested in the therapeutic context; and provide feedback to all parties about the validity of the theory of living human systems, the reliability of its systems-centered practice, and the accuracy of the therapist's hypotheses about the isomorphic dynamics of the systems of member, subgroup and group as a whole. Illustrations are taken from tape recordings of supervisory sessions.     

The time-line genogram: highlighting temporal aspects of family relationships

The genogram, or family diagram, is an assessment tool widely used by clinicians to study family members and their relationships over several generations. The standard genogram format is limited, however, because it does not show temporal patterns directly. An alternative, the Time-Line Genogram (TLG), which plots time on the vertical axis to display life events and changes in relationships when they actually occurred, highlights temporal aspects of family history that the standard format sometimes obscures.     

Locally Bayesian learning with applications to retrospective revaluation and highlighting

A scheme is described for locally Bayesian parameter updating in models structured as successions of component functions. The essential idea is to back-propagate the target data to interior modules, such that an interior component's target is the input to the next component that maximizes the probability of the next component's target. Each layer then does locally Bayesian learning. The approach assumes online trial-by-trial learning. The resulting parameter updating is not globally Bayesian but can better capture human behavior. The approach is implemented for an associative learning model that first maps inputs to attentionally filtered inputs and then maps attentionally filtered inputs to outputs. The Bayesian updating allows the associative model to exhibit retrospective revaluation effects such as backward blocking and unovershadowing, which have been challenging for associative learning models. The back-propagation of target values to attention allows the model to show trial-order effects, including highlighting and differences in magnitude of forward and backward blocking, which have been challenging for Bayesian learning models.     

Cross-cultural patterns in emotion recognition: highlighting design and analytical techniques

This article highlights a range of design and analytical tools for studying the cross-cultural communication of emotion using forced-choice experimental designs. American, Indian, and Japanese participants judged facial expressions from all 3 cultures. A factorial experimental design is used, balanced n x n across cultures, to separate "absolute" cultural differences from "relational" effects characterizing the relationship between the emotion expressor and perceiver. Use of a response bias correction is illustrated for the tendency to endorse particular multiple-choice categories more often than others. Treating response bias also as an opportunity to gain insight into attributional style, the authors examined similarities and differences in response patterns across cultural groups. Finally, the authors examined patterns in the errors or confusions that participants make during emotion recognition and documented strong similarity across cultures.     

Developing insight through supervision: relating, then defining

By the use of tape recordings, I attempt to understand the main ways in which a supervisor helps the supervisees to gain insights into their work with their patients. Through this research I became aware that insights come into being by way of a process involving unconscious identity and differentiation. I have use supervisory examples to illustrate the ways in which the supervisor interacts with the supervisee.     

Pastoral supervision today

The introduction of clinical pastoral education as a prerequisite to many forms of ministry and the initiation of D. Min. programs in theological schools call for a reappraisal of the process and substance of pastoral supervision. Effective models of supervision for D. Min. programs have not yet been identified, yet a CPE model is inherent in the requirements for the degree. The meaning, goals, content, and styles of supervision are discussed. A scale is included to assist students and supervisors to evaluate supervisory conferences.     

On psychoanalytic supervision

The author provides both a theoretical context for, and clinical illustrations of, the way in which he thinks and works as a psychoanalytic supervisor. The analytic supervisory experience is conceived of as a form of 'guided dreaming'. In the supervisory relationship, the supervisor helps the analyst to dream (to do conscious and unconscious psychological work with) aspects of the analytic relationship that the analyst is unable to dream or is only partially able to dream. It is the task of the supervisory pair to 'dream up' the patient, that is, to create a 'fi ction' that is true to the supervisee's emotional experience with the analysand. To carry out this work, the supervisor must provide a frame that ensures the supervisee's freedom to think and dream and be alive to what is occurring in the analytic and the supervisory relationship, as well as in the interplay between the two. In one of the clinical illustrations presented, the author illustrates his conception of the importance of the feeling on the part of supervisor and supervisee that (at least occasionally) they have 'time to waste'. Such a state of mind may provide an opportunity for a type of freely associative thinking that enhances the range and depth of what can be learned from the supervisory experience. In another clinical example, the author describes his own experience in supervision with Harold Searles, which contributed to his conception of the supervisory process.     

Rules, culture, and fitness

Behavior analysis risks intellectual isolation unless it integrates its explanations with evolutionary theory. Rule-governed behavior is an example of a topic that requires an evolutionary perspective for a full understanding. A rule may be defined as a verbal discriminative stimulus produced by the behavior of a speaker under the stimulus control of a long-term contingency between the behavior and fitness. As a discriminative stimulus, the rule strengthens listener behavior that is reinforced in the short run by socially mediated contingencies, but which also enters into the long-term contingency that enhances the listener's fitness. The long-term contingency constitutes the global context for the speaker's giving the rule. When a rule is said to be "internalized," the listener's behavior has switched from short- to long-term control. The fitness-enhancing consequences of long-term contingencies are health, resources, relationships, or reproduction. This view ties rules both to evolutionary theory and to culture. Stating a rule is a cultural practice. The practice strengthens, with short-term reinforcement, behavior that usually enhances fitness in the long run. The practice evolves because of its effect on fitness. The standard definition of a rule as a verbal statement that points to a contingency fails to distinguish between a rule and a bargain ("If you'll do X, then I'll do Y"), which signifies only a single short-term contingency that provides mutual reinforcement for speaker and listener. In contrast, the giving and following of a rule ("Dress warmly; it's cold outside") can be understood only by reference also to a contingency providing long-term enhancement of the listener's fitness or the fitness of the listener's genes. Such a perspective may change the way both behavior analysts and evolutionary biologists think about rule-governed behavior.