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[Kelly75]

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[ItsNotMe_ItsYou]

We've all had difficult supervisors before, some worse than others, but, to me, it doesn't sound like she has done anything so morally reprehensible that it couldn't be worked out with a little self-reflection and self-assertiveness.

Regarding the letter, why did you omit the borderline diagnosis from your rewrite? If your supervisor's reasoning behind not giving the pt a letter has relevance, ask her to share some of her experiences with you, so you know what to look out for in the future. I'm not saying following her advice, but listen to what she has to say. If you feel that strongly about the girl getting the letter, get approval from your supervisor to ask her if you can fax a copy to whomever needs it. That way, she's not in possession of the letter. Personally, I wouldn't make a big fuss over it. At the end of the day, it's your supervisor's license, not yours.

Many supervisor's recommend therapy for one reason or another. Before you got defensive, did you ever stop to think that maybe she has a point? I believe all psychologists and psychologists-in-training should engage in therapy at some point, particularly if you're dealing with a difficult patient population. You mentioned a pt with borderline personality, which is a challenging condition to work with and can stir up lots of feelings and emotions in a therapist.

You mentioned you practiced for several years with your MA before starting your Psy.D., so technically, are you a new therapist? Regardless of your previous practice, you apparently do want your clients to like you. That means you are likely paying more attention to yourself and how you come across (in an effort to be liked), which takes the main focus of your attention away from the patient. I would self-reflect on what your supervisor has said (without judgment). It's okay to not be perfect, no one is, but it is important to at least be self-aware.

 

[ItsNotMe_ItsYou]

I removed to preserve your confidentiality.

Interesting. Your supervisor has a bias against BPD. I wonder if she is using you as an instrument to inconvenience your patient as some sort of power play or exhibit control. Her fear of being sued is an odd reason to deny a patient a letter, especially if these types of letters are given to other patients. So this fear is probably limited to patients with BPD? So wrong. I'm with you on that now. Sounds like she's the one who needs therapy! You're already doing what you need to do. Hopefully, whatever the outcome of this may be, you're still on good terms with her.

 

[msgeorgeeliot]

Yes, you are having an overreaction. You admit to a need for patients and supervisors to like you. You are also *gifted* to have a *new* supervisor with *decades* of experience. Humble yourself, ask for her feedback. Take what you like and leave the rest. Ffs

 

[ItsNotMe_ItsYou]

You and your edits, lol.

I recognize there are areas that I might not be able to see as clearly, and with this supervisor I feel much less comfortable, especially given that she shared the personal details about me with the other student.

She told the student: "I'm working with another woman who works too hard in her sessions, she's too active, she wants her clients to like her too much" etc.

Your supervisor's comments about you to the other student created a rupture in your relationship. What was it about the comments that hurt you? Did you feel shame, anger, betrayal? Does it bother you more that they could possibly be true? What if your supervisor's comments had all been positive and praising your work? Would you have the same response, given that she would still be divulging personal information about you, albeit in a more flattering light?

Try not to take what she said as personal. Her words have no impact on who you are as a person, they are not you. Easier said than done, but it helps when hearing or receiving unpleasant feedback.

I would challenge you to bring up this "rupture" in your relationship during your next supervision session, which she may appreciate since she's psychodynamic. Make an effort to repair the relationship, so then she can turn around and rupture it all over again.

 

[ItsNotMe_ItsYou]

So the details don't matter so much as the fact that I wasn't afforded the privacy I expected, I guess.

Your supervisor should have reviewed the limits of confidentiality with you at the commencement of your relationship. She has a responsibility to maintain confidentiality, not just with clients, but also you.

Thomas, J. T. (2007). Informed consent through contracting for supervision: Minimizing risks, enhancing benefits. Professional Psychology: Research and Practice, 38, 221-231.

 

[ClinicalABA]

Many supervisor's recommend therapy for one reason or another. Before you got defensive, did you ever stop to think that maybe she has a point? I believe all psychologists and psychologists-in-training should engage in therapy at some point, particularly if you're dealing with a difficult patient population. You mentioned a pt with borderline personality, which is a challenging condition to work with and can stir up lots of feelings and emotions in a therapist.

I don’t know about all this. I think you need to be very cautious assuming that this stuff is a given. I fall in the camp of thinking that supervisors are responsible for the clinical work and professional growth of the supervisor. They should have an expectation that the supervisee comes to work mentally and emotionally prepared to do the job, despite any clinical training needs that they might have. If there are non-cinical-training related concerns, the supervisor should recommend that the supervisee seek out resources in there training program or through their private mental/medical heart providers. Therapy should only be recommended following a sound clinical evaluation (including detailed assessment of current symptoms, environmental factors, and history) which is well outside of the domain of what a clinical supervisor should do. As for working with difficult populations- yes, it can be emotionally and physically taxing. This should not be conflated as a psychopathology needing therapeutic intervention, but as a somewhat normal reaction to stressful events. It is the supervisors (and agencies’) responsibility to give you the clinical training and professional skills to be better with this. Farming that out some other therapist is, imho, inappropriate and somewhat lazy.

 

[Bayside]

So I'm thinking about the ethics code, 7.04 which seems relevant here.

Ethical principles of psychologists and code of conduct

The American Psychological Association's Ethical Principles of Psychologists and Code of Conduct provides guidance for psychologists in professional, scientific and educational roles. The Ethics Code also outlines standards of professional conduct for APA members and student affiliates.

www.apa.org

My view is supervisors should avoid probing into students personal information except as it comes up / is raised by them and directly relevant to the clients’ situation. You felt uncomfortable and unsafe and should pay attention to those feelings. There’s a real danger to students when supervisors don’t adequately maintain boundaries (eg clients don't get graded at the end of treatment, students do). We all have our own issues, (though wanting to be liked by clients isn't a bad thing per se) but probing into personal history is therapy not supervision. Giving feedback to a student therapist might well include “ it sounds as though you're working harder than the client in this session ..... how might you do things differently next time to allow the client more opportunity to explore ...”
This is a tricky situation to navigate with a supervisor so I would suggest being pragmatic and trying to figure out what to do to both protect yourself and get the best possible outcome. Also, document - keep a log of supervision sessions, and perhaps consider getting permission to tape them might be helpful - allowing you to review and see if there are things you’re missing when you feel defensive.

 

[WisNeuro]

So I'm thinking about the ethics code, 7.04 which seems relevant here.

Ethical principles of psychologists and code of conduct

The American Psychological Association's Ethical Principles of Psychologists and Code of Conduct provides guidance for psychologists in professional, scientific and educational roles. The Ethics Code also outlines standards of professional conduct for APA members and student affiliates.

www.apa.org

This is a tricky situation to navigate with a supervisor so I would suggest being pragmatic and trying to figure out what to do to both protect yourself and get the best possible outcome. Also, document - keep a log of supervision sessions, and perhaps consider getting permission to tape them might be helpful - allowing you to review and see if there are things you’re missing when you feel defensive.

Probably won't find many supervisors who are comfortable with students taping supervision sessions. Instead, what many of us already do, take notes and review them weekly about supervision during the week, and both the supervisor and supervisee sign them. As a supervisor, that's the best thing I have if I need to put someone on remediation. Nice to have a paper trail from both sides.

 

[ItsNotMe_ItsYou]

I don’t know about all this. I think you need to be very cautious assuming that this stuff is a given. I fall in the camp of thinking that supervisors are responsible for the clinical work and professional growth of the supervisor. They should have an expectation that the supervisee comes to work mentally and emotionally prepared to do the job, despite any clinical training needs that they might have. If there are non-cinical-training related concerns, the supervisor should recommend that the supervisee seek out resources in there training program or through their private mental/medical heart providers. Therapy should only be recommended following a sound clinical evaluation (including detailed assessment of current symptoms, environmental factors, and history) which is well outside of the domain of what a clinical supervisor should do. As for working with difficult populations- yes, it can be emotionally and physically taxing. This should not be conflated as a psychopathology needing therapeutic intervention, but as a somewhat normal reaction to stressful events. It is the supervisors (and agencies’) responsibility to give you the clinical training and professional skills to be better with this. Farming that out some other therapist is, imho, inappropriate and somewhat lazy.

I don't assume that it's a given at all, I said "many therapists recommend," not all therapists, which is true. Regardless of whether or not supervisors should be recommending their supervisees seek out therapy, they do it. I believe the OP's supervisor was inappropriate by asking her personal questions, then asserting that she needs therapy. In the context of clinical supervision, I agree her supervisor crossed a line. That said, I am still of the mindset that therapy may be beneficial for therapists in training regardless of the presence or absence of clinically significant psychopathology. It wasn't that long ago that many doctoral programs required students to engage in their own personal therapy. To gain perspective of what it's like to be "on the other side of the room" can be helpful and beneficial to budding therapists. Should it be long-term? No, unless it is warranted.

Part of why the OP's supervisor recommended she attend therapy is due to her desire for clients to like her. That is not a normal reaction to working with stressful or difficult clinical populations, she brings that into the therapy room with her. It's not countertransference, which would be appropriate to discuss in supervision. If/when an issue arises, you're saying you would recommend the supervisee seek out resources from his or her own medical/mental health providers, which I agree is an excellent response. Doesn't it feel reallllly close to implying therapy, as you're essentially saying, "Go see someone for X issue," minus the word therapy? Do you feel that the desire to be liked by patients should ever be discussed in supervision? I'm asking in general terms.

 

[ClinicalABA]

If/when an issue arises, you're saying you would recommend the supervisee seek out resources from his or her own medical/mental health providers, which I agree is an excellent response. Doesn't it feel reallllly close to implying therapy, as you're essentially saying, "Go see someone for X issue," minus the word therapy? Do you feel that the desire to be liked by patients should ever be discussed in supervision? I'm asking in general terms.

I’d say/have said something along the lines of:
“It’s important for you to show up to work physically and mentally prepared to do the job. If you feel/I currently feel you’re not, as evidenced by x,y, and z. If x,y,and z continue, you may not be able to continue with your current position. The reasons for x, y, and z are not appropriate topics for our supervision. If you feel you need help in addressing x,y, and z, you should consult with (an appropriate professional).”
Note that this is a conversation I’ve also had with employees who aren’t psych students. Do it kindly and carefully, and offer reasonable accommodations As appropriate to the needs of the facility and the training goals of the supervisee.

As to discussions about needing all clients to like you, early career (or early in a new position or with new population), that’s not a pathology needing therapy. It’s a skill deficit that is often within the scope of supervision. I’m not getting into why you have a greater need to be liked, what it means about you as a person, existentially, etc. I’m addressing it along the lines of being liked by the client is not a necessary condition of said client making progress. Heck, I really want to be liked by all my clients and their families. This motivates me to be kind, professional, thoughtful, thorough, and honest. I am bothered when they show signs of not liking me. That motivates me to examine if there is anything I need to do better next time (sometimes there is, sometimes there is not). As hard as it can be to not be liked, I’ve developed strategies for not taking it personally and leaving that stuff at work. I would work with supervisees to hone similar techniques.

 

[ItsNotMe_ItsYou]

I’d say/have said something along the lines of:
“It’s important for you to show up to work physically and mentally prepared to do the job. If you feel/I currently feel you’re not, as evidenced by x,y, and z. If x,y,and z continue, you may not be able to continue with your current position. The reasons for x, y, and z are not appropriate topics for our supervision. If you feel you need help in addressing x,y, and z, you should consult with (an appropriate professional).”
Note that this is a conversation I’ve also had with employees who aren’t psych students. Do it kindly and carefully, and offer reasonable accommodations As appropriate to the needs of the facility and the training goals of the supervisee.

As to discussions about needing all clients to like you, early career (or early in a new position or with new population), that’s not a pathology needed therapy. It’s a skill deficit that is often within the scope of supervision. I’m not getting into why you have a greater need to be liked, what it means about you as a person, existentially, etc. I’m addressing it along the lines of being liked by the client is not a necessary condition of said client making progress. Heck, I really want to be liked by all my clients and their families. This motivates me to be kind, professional, thoughtful, thorough, and honest. I am bothered when they show signs of not liking me. That motivates me to examine if there is anything I need to do better next time (sometimes there is, sometimes there is not). As hard as it can be to not be liked, I’ve developed strategies for not taking it personally and leaving that stuff at work. I would work with supervises to hone similar techniques.

Thank you for the detailed response, that was excellent! Much appreciated.

 

[Kelly75]

I’d say/have said something along the lines of:
“It’s important for you to show up to work physically and mentally prepared to do the job. If you feel/I currently feel you’re not, as evidenced by x,y, and z. If x,y,and z continue, you may not be able to continue with your current position. The reasons for x, y, and z are not appropriate topics for our supervision. If you feel you need help in addressing x,y, and z, you should consult with (an appropriate professional).”
Note that this is a conversation I’ve also had with employees who aren’t psych students. Do it kindly and carefully, and offer reasonable accommodations As appropriate to the needs of the facility and the training goals of the supervisee.

As to discussions about needing all clients to like you, early career (or early in a new position or with new population), that’s not a pathology needed therapy. It’s a skill deficit that is often within the scope of supervision. I’m not getting into why you have a greater need to be liked, what it means about you as a person, existentially, etc. I’m addressing it along the lines of being liked by the client is not a necessary condition of said client making progress. Heck, I really want to be liked by all my clients and their families. This motivates me to be kind, professional, thoughtful, thorough, and honest. I am bothered when they show signs of not liking me. That motivates me to examine if there is anything I need to do better next time (sometimes there is, sometimes there is not). As hard as it can be to not be liked, I’ve developed strategies for not taking it personally and leaving that stuff at work. I would work with supervisees to hone similar techniques.

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[LadyHalcyon]

Since she is psychodynamically oriented, I wouldn't be surprised if she views supervision as a parallel process to what occurs in therapy between you and your clients. I think you best bet, at least initially, is to discuss the relationship rupture in supervision and maybe tie it back to your desire to want your clients to like you. Through that lens, It makes sense you would also want your supervisor to like you (which I think most of us very much wanted during earlier training stages). I do not think this is ALL your stuff and I would encourage you to bring up what you considered to be a breach in supervision confidentiality. If you own your part in the rupture and honestly express your feelings about how her behavior has impacted you, she may respond in a way you weren't expecting. It is not at all uncommon to have issues/conflicts with supervisors. Addressing the situation in a vulnerable, yet direct, way can not only fix the problem with your supervisor, it can also lead to both personal and professional growth.