Supervision - the heart of therapy

Written by listed counsellor/psychotherapist: Vanessa Gajewska MSc, BACP Snr. Accred, Clinical Supervisor, Workplace Mediatior

11th September, 20130 Comments

As both a counsellor and a counselling supervisor I have come to value the support, ‘holding’ and opportunities for learning afforded by the counselling community and, in particular, by the underpinning matrix formed by its extensive network of supervisors. If therapists are the life blood of the healing endeavour then the supervisory relationship beats at its heart providing a focus for reflection, exploration and containment while on numerous levels engaging with the impact of the demanding and complex therapeutic work we do. 

Indeed, counsellors and psychotherapists within the ‘helping professions’ belong to a broad church which includes a rich diversity of groups and individuals with varying approaches, political ideologies and cultural influences as well as theoretical constructs and beliefs. In an egalitarian sense, supervision is a great leveller as well as a unifier. Regardless of experience/stage of development or standing, we are all required to be professionally accountable and through the commonality of this experience are connected.

When I consider what supervision means to me, my thoughts immediately turn to wondering what my professional life as a counsellor would be like without it? This alternative deficits outlook appears desolate: not having an arena where I can voice the unspeakable, share my vulnerability and feelings of incompetence, examine the intersubjective interface between me and my clients, where regularly I can tap into learning, develop my practice, explore creatively, celebrate achievements and sob over tragedies. Indeed, imagining a landscape populated by client work and an absence of the matrix of trusted colleagues in whom I can confide and rely upon to challenge, stimulate and look out for me and my clients while being supportive of my practice appears bleak and unsustainable.

While the BACP requires all working members to engage in continuous and ongoing supervision to a minimum standard (1) I am also aware of significant cross-cultural differences in views on supervision. For instance, in the United States while most psychotherapy and counselling trainings insist students engage in supervision, on qualification this expectation ceases and many practitioners continue to work unsupervised. Furthermore, supervision cannot be regarded as a term that means the same in different contexts. Even where there is conceptual and ideological agreement on its meaning the perception, quality and practice of supervision can be highly variable (2). 

While this fluidity and variety offers an opportunity to select supervisor/supervisee ‘best fit’ as well as a wealth and a breadth of experience, the potential for harmful and negative outcomes also exists. Indeed, while much of the existing research focuses on what constitutes ‘good’ supervision, there is also evidence of less positive outcomes. Research into unhelpful supervision suggests that a supervisee’s engagement with and response to challenge may be related to their attachment style and consequently that interventions experienced as counterproductive by supervisees can have significant, far-reaching and long-lasting effects (3). This further demonstrates the supervisory relationship as a ‘system of reciprocal mutual influence’ (4) and the importance of this in containing both mutually positive and affirming experiences as well as the potentially more difficult aspects of human interactions including conflict and negative responses. 

I am aware that historically many counsellors and psychotherapists have slipped seamlessly into taking on the supervisory mantle in response to requests, pressing needs and circumstantial drivers without recourse to further training and possibly consideration of the different skills set, bias, complexities, demands and responsibilities of what is a very distinct role. For others, I wonder if becoming a supervisor may be regarded simply as a developmental sequel and a marker of accomplishment and longevity within the profession. This often seems to be based on an assumption which links wisdom with age and experience, along with a tacit sense that experienced practitioners are naturally able to facilitate and enhance safe and effective practice in others, which of course may or may not be true. 

Worth also acknowledging is the complexity of the tasks related to the supervision of supervisors. This is a further dimension within the intricate weave of the matrix and yet another tier which brings its own set of multilayered ethical and professional challenges. Inherent in this role is the capacity for holding a meta-perspective spanning a host of cultures and contexts related to the incrementally multiplied client base (albeit at a distance and twice removed) adding to the complexity of the role. 

Given a culture which understandably focuses on the needs of clients, I wonder about the tensions in bringing supervision work into the supervisory arena particularly when time and resources are limited. Anecdotal evidence gained from discussions with colleagues suggests that the BACP baseline of one and a half hours each month for supervision is often gauged in relation to client hours with less regard to caseload complexity, developmental indicators and diversity. Consequently attention to the demands and intricacies of a concurrent supervisory practice may be marginalised, particularly where most counselling caseloads are weighted towards weekly clients as opposed to a comparative minority of monthly supervisees. 

Viewed from a gestalt perspective, it’s would seem all too easy for the supervisory matrix to remain ‘ground’ rather than ‘figure’ (5). It feels important to recognise just how crucial supervision has become to the vitality and integrity of our work.

References:                                                

1.  Mearns D. How much supervision should you have? BACP Information Sheet 2008

2.  Carroll M F Counselling Supervision: International Perspectives.  In Borders LD (Ed): Exploring the Effective Components of Supervision. North   Carolina: ERIC/CASS Digest1994  

3.  Ramos-Sanchez L, Esnil E, Riggs S, WrightLK, Goodwin A, Ratanasiripong P, Rodolfa E.

Negative Supervisory Events: Effects on Supervision Satisfaction and Supervisory Alliance. Professional Psychology. Research and Practice 2002; Vol 33 No 2 197-202

4.  Beebe B and Lachmann F.  The Contribution of Mother-Infant Mutual Influence to the Origins of Self- and Object Representations. Psychoanalytical Psychology1988a; Vol 5, 305-337

5.  Perls F, Hefferline R, Goodman P. Gestalt Therapy Excitement and Growth in the Human Personality. London: Souvenir Press 2003.