Literature on models of process focused supervision

[00851341032]

I am very much a CBT person and as such my supervision in the I have had in the past has been very skills based with little to no expectation of self-disclosure on my part towards my supervisor.

I have through a series of events out of my control landed at a practicum site this year that does not align well my theoretical orientation and my general comfort in terms of how I relate to others in a professional environment.

I knew going into this practicum that these discrepancies would be a challenge but I was feeling up to the challenge. Now I am feeling though like this is making me hate clinical work and it is causing me a lot of anxiety about whether I will be able to get a good recommendation letter from the site at the end of this.

I have had conversations with my research advisor about plans for the future and I think we have a good plan (and a back up plan and a back up for the backup) for working with my DCT to help me get a better fit for my practicum next year. In the meantime I need to get through things in the location I am at without burning any professional bridges or harming my ability to get intership letters.

I am feeling very thrown off by this process approach that is used. I understand parts about the idea of disclosing parts of my identity that may interact with how I react to a client. However where I feel very tripped up and uncomfortable is the emphasis I am getting by from supervisors about then giving me feedback on how they react to me and then them desiring a lot of information from me about how I feel about the feedback from them. There's also a heavy emphasis on me giving them feedback.

In another other professional contexts when I have been given feedback it has been done in a way where I acknowledge faults that have been pointed out, talk about ways I plan to improve and ask for clarification on any areas that I don't understand. However in this setting that appears to not be sufficient. There is something that they want in terms I think of my emotional response to this type of feedback. It makes me extremely uncomfortable and it's not even clear to me the exact nature of what is needed. I have repeatedly expressed uncertainty about what response they are looking for but do not feel I am getting useful responses clarifying what is needed.

I have talked about this extensively with my personal therapist because this has been a large life stressor for me. He has suggested that it sounds like they are using feminist supervision models. I did some reading on this and I think it does partially map on but I also think my supervisors are taking a more eclectic approach too. My personal therapist has been careful to hold a boundary related to this topic of discussion and is taking care to stay in his therapist role and not slide into the role of a supervisor for me (And I greatly respect that). As such he can't really help me with some of the direct questions I am having.

I am wondering if anyone can suggest literature that related to supervision models of this type so I can better understand what is being expected of me. I feel I am often in a situation where no matter how I try to respond that it is somehow not what my supervisor wants.

I am particularly interested in literature that discusses the fuzzy boundary that can be created in this situation. I feel at time like my supervisor is asking me questions are are more appropriate for my personal therapist to ask than my supervisor (e.g. emotion focused questions directed at me in the moment about interactions while not interacting with clients). I am having a difficult time parsing what is possible situations where my supervisors may be crossing lines of acceptable practice and things that are more an issue of me coming from a program with a very different culture from that at my practicum site.

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[Ollie123]

Sounds like you could be at my old site!

I found it quite aggravating. Hint - don't ask them for references. It does not go well. They just started asking me how I felt about not having any literature base and I had to bite my lip to keep from replying "It makes me feel like you are poorly trained and unqualified to be working as a psychologist" and just up and leaving the practicum. I absolutely believe there is a time and place for discussing your own reactions to patients and what implications that holds, but when a novice therapist is trying to figure out what to do with someone in the other room who appears to be at imminent risk....it is NOT that time.

Anyways, I wish I had advice but all I can offer is empathy. I did a lot of digging to try to uncover legit frameworks/literature on the topic that entire year and did not succeed in finding anything worthwhile or helpful. Learn to throw around lingo (I just started using the word countertransference a lot - doesn't even matter if its used accurately - to them it was "everything" so pretty much anything I said on the topic had to be at least partially true), don't take them too seriously and see if there are other folks in the vicinity (peers, other faculty) you can consult with when you need guidance about actually helping people.

 

[deleted343839]

You are being very patient, but you need not try to legitimize this bad supervision. That's really all this is. Like Ollie said, play the part as well as you can, make sure your DCT is aware of what is going on there, and have a good laugh about it when you're done.

I once had a practicum supervisor like this. He was a graduate of one of the Argosy schools. It became clear that my training background in empirically supported treatments was some sort of issue for him, and I found his supervision incredibly awkward and intrusive. Fortunately, neither my DCT nor anyone at the training site took his feedback seriously.

 

[smalltownpsych]

Give them back what they want even if you feel like you have to fake it. It doesn't sound like a very healthy supervision process to me. I don't think asking about your feelings about the supervisor is really very appropriate. How can you really be honest when they are in an evaluative stance? I had a supervisor like this and the truth was that they made me very uncomfortable and what was I supposed to say, "I think you are a weird, controlling b****?" The irony is that my primary orientation has always been psychodynamic and process based and theirs was supposedly CBT. One thing I did learn from that experience is that I am naturally a pretty open and likable person and that can cause certain individuals who are more closed off and not well-liked react negatively toward me. When I interact with these types now, I intentionally keep myself more closed off. For myself, I had to recognize that my own "need to be liked" was making me more vulnerable in these types of situations.

 

[00851341032]

Thank you guys for your validating responses here. It especially helps to hear this reaction given that I think if anything in this post I think I have downplayed some of the issues at hand.

 

[CheetahGirl]

I have talked about this extensively with my personal therapist because this has been a large life stressor for me. He has suggested that it sounds like they are using feminist supervision models.

That sounds entirely sexist.... and tell your therapist I said so.

Any how...I googled it and found these articles (one on feminist group supervision)...so it is a real thing. But IMO, you do not need to conform your supervisor's style and you can hold your own with your theoretical style. (Just a major anecdotal side-note, but I've learned of more problems with CBT supervisors and now graduates of 'professional psychology program' supervisors crossing boundaries with supervisees than university-based psychodynamically trained supervisors, which is not surprising to me.)

I come from a balanced psychodynamic/CBT program. The only appropriate supervision gauge for supervisor to supervisee is "How did this person make you feel in the (therapy) room?" to assess countertransference, which in relational orientations can be extremely informative and as smalltownpsych noted, assess the process, either parallel process between you & patient or you & supervisor (I'm on fire tonight in my insomnia, and found another article on parallel process in supervision) .

When the supervisor crosses that line of assessing how the patient makes you feel to help inform how you will treat that particular patient going forward, you need to draw a line. Sounds like this supervisor has very loose boundaries. And you could respectfully begin to 'nip it in the bud' by saying something like "Hmmm. I'm going to think about that question, but that may be something I could explore in my own therapy, but thanks for the direction (while not really implying that you're in your own therapy - b/c that is not really his/her business either and really your privilege to share if you want)...but you need to let the supervisor know he/she crossed the line. You can say professionally, "I would rather not say," or "I need to think about how this [question] is relevant" while always being respectful and thanking the supervisor for his/her direction.

I had a highly inappropriate supervisor on internship and I had to flat out tell this person, that "I did know how furthering this particular discussion would benefit my work with this patient." I was hot under collar, dry-mouthed...but I spit it out and the supervisor backed down. It took a lot of courage, and this (CBT) supervisor had no genuine clue that he/she was being inappropriate...believe or not. The supervisor probably got wind of it after I left his/her office, but there was no facial recognition of transgression in the moment...so perhaps the supervisor was also a sociopath (...just kidding).

I am wondering if anyone can suggest literature that related to supervision models of this type so I can better understand what is being expected of me.

I also want to add that what is expected of you should be discussed with your program advisor/DCT. But, in my experience, at extern and internship sites, they want you to bring authenticity to the table, with supervision and your patients. You need to find a balance with how you can be true to yourself and your job in the service of your patients without feeling stepped on or intruded upon. When that happens, listen to the warning bells going off in your mind, and respond confidently. Being any kind of therapist does not mean everyone gets all of you, all of the time. Bottom Line: Your supervisor gets your professionalism...not your innermost thoughts and Facebook friendship (until you become colleagues...and somewhat equals). Save your innermost thoughts and emotions for your therapist and/or loved ones - they get that privilege. IMO.

One last edit: I agree with Ollie...try to get a rec letter from someone else. This supervisor may not ever get it and it is not your burden to teach him/her how to supervise. I actually went to another supervisor (my former supervisor's supervisor) and asked him/her to be my point of contact...and that went over well. The supervisors's supervisor knew exactly where I was coming from when I made my request.

Good Luck!

 

[Ollie123]

(Just a major anecdotal side-note, but I've learned of more problems with CBT supervisors and now graduates of 'professional psychology program' supervisors crossing boundaries with supervisees than university-based psychodynamically trained supervisors, which is not surprising to me.)

I begin to see where some of our past disagreements have come from, as my experiences have been entirely the opposite of this. The CBT folks seemed to be drawn from a reasonably normal distribution of human behavior, while the dynamic folks have been universally weird/awkward/wildly inappropriate or D - All of the above, whether talking about personal or professional interactions. Oddly enough, that also was not surprising to me so perhaps there is some confirmation bias at work here

 

[CheetahGirl]

Confirmation bias indeed. (Although, I've had one particularly *awesome* CBT supervisor that rocked the house! Learned so much from him in internship.) Plus sometimes a good disagreement is healthy. Shows you care enough.

 

[smalltownpsych]

I have found it easier to work with a good supervisor regardless of theoretical orientation than a bad supervisor regardless of theoretical orientation. I have reviewed some of the research on this during a particularly bad supervision experience. What I remember was two bad types: passive and controlling. Sort of reminded me of permissive and authoritarian parenting. The problems are at the extremes. The other factor that plays a role was narcissism and especially narcissitic defenses against feelings of inadequacy. If you have a supervisor with a high need for control and a narcissitic defense all you need is a vulnerable intern for a perfect storm. My solution was to be less vulnerable hence the research review.

 

[EmotRegulation]

I'm currently teaching a seminar on supervision, and I've not stumbled across anything that is supervision specific which would be helpful to you. Nor was it clear to me what theraputic orientation this supervisor (these supervisors?) are operating from, and that matters, as we are woefully undertrained in supervision and people tend to do in supervision what they would do in psychotherapy (e.g., psychotherapy based models of supervision).

I have a bit of a different perspective than others here, I think. I'm CBT trained and bred, but I definitely use more of an interpersonal approach in supervision. I think it *can* be useful to have discussions about the supervisory relationship in supervision, and that these are not inherently unprofessional. Is it unprofessional to ask your emotional reactions to last week's Scandal episode? Yes. But to ask about your response to a supervisor, to discuss the relationship as it is unfolding? Not (inherently) unprofessional. Often uncomfortable, sure. I guess I wonder, is it possible to be transparent about what you are experiencing? As in, mentioning that the request for feedback is uncomfortable due to the power dynamic, and/or inconsistent with your training? Are there readings they might suggest about *their* training model that would help you understand the function of the questions they are trying to ask? Can *you* do some thinking about what this says about your boundaries around supervision, and areas of discomfort for you, and then share those with your supervisors?

If I operate under the assumption that these are not horrible supervisors (note: I'm not actually saying that, just trying to see their perspective here), it sounds as though they are trying to get you to be genuine with them about your in-supervision responses. As uncomfortable as that might sound to you, CBT teaches us that doing what is uncomfortable usually decreases the discomfort via habituation. So.....you could, you know, try it. Sounds like the idea is causing you suffering, and thinking about it is stressing you out. Perhaps just doing it would be the quickest path?

 

[Nahsil]

yeah, I'd like to say that I know a lot of process-oriented therapists and supervisors, and it sounds like you may be having a bad experience with one--I'd be wary about demonizing the approach itself. The one person I'm thinking of in particular is very careful about power imbalances and makes great efforts to let the supervisee lead, without demanding things that would be obviously uncomfortable or even career-jeopardizing. Just a thought.

Emot's idea about being transparent about your discomfort with the setup is brilliant, by the way, and could solve the whole issue, giving them the transparency and self-disclosure they're seeking while also maintaining your boundaries and professionalism, while ALSO signaling to them that they're putting you and possibly others into a complicated, potentially problematic position.

personally I think there's a lot of potential for growth as a clinician in this approach, so if you can find ways to engage with it in a safe, contained way, you may be surprised at what you get out of it.