Psychotherapy Supervision

[fiatslug]

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I am sad to say I have not had great experiences with psychotherapy supervisors. My supervisor for PGY-3 year was herself undergoing analysis 😳, and I often felt like we'd get bogged down psychoanalytic navel gazing when I was hoping for more... I don't know, I don't even know what good psychotherapy supervision is supposed to feel like!

And I loathe and despise process notes. I hate the extra hour of my life it takes to write them, and I hate that these essentially ficitionalized recollections of what took place in session are nitpicked to death in supervision: "I wonder why at that time you elected to say 'Hmmm...' in that moment" when in all likelihood I said "Ah" in the room.🙄 Our PD keeps nudging us to take on additional psychotherapy supervisors, but I'm not enthusiastic--there are a lot of old circling-the-drain analysts in our supervisor pool who know absolutely zero about psychopharm (or anything current, and not originally written in German 😛).

Have you had good supervisors? Curious to hear about others' experiences.

 

[whopper]

Problem I got with this is depending on the type of psychotherapy, its hard to gauge exactly what is good and what isn't good.

CBT perhaps is one of the only forms of psychotherapy that has an objective structure & produces clearly defined objective results.

The other forms are highly subjective. So even if it is good (or bad), how will you be able to tell?

I don't know how to give you an easy & objective answer, other than to avoid obvious mistakes such as don't lie to the patient, don't counter-transfer, etc.

Tests done on psychotherapy, from what I do know is they often grade success simply on improvement by the patient since many forms are so subjective. I have seen psychotherapy that I thought was good--because I had the gutt feeling it was going well, and others that were bad because of a gutt feeling. How do you rate it on an objective basis?

I got my degree in undergrad in psychology and took a few psychotherapy classes in undergrad. I got heavily tested on various forms of psychotherapy but was never able to really use it on the field. In my program, it seems to me that I'm getting a lot of practice in the field but little in formal & organized education on the various forms of psychotherapy. I don't know if my program is better or worse compared to other programs because its not like I've been in several programs and can comparison judge.

 

[Anasazi23]

I am sad to say I have not had great experiences with psychotherapy supervisors. My supervisor for PGY-3 year was herself undergoing analysis 😳, and I often felt like we'd get bogged down psychoanalytic navel gazing when I was hoping for more... I don't know, I don't even know what good psychotherapy supervision is supposed to feel like!

And I loathe and despise process notes. I hate the extra hour of my life it takes to write them, and I hate that these essentially ficitionalized recollections of what took place in session are nitpicked to death in supervision: "I wonder why at that time you elected to say 'Hmmm...' in that moment" when in all likelihood I said "Ah" in the room.🙄 Our PD keeps nudging us to take on additional psychotherapy supervisors, but I'm not enthusiastic--there are a lot of old circling-the-drain analysts in our supervisor pool who know absolutely zero about psychopharm (or anything current, and not originally written in German 😛).

Have you had good supervisors? Curious to hear about others' experiences.

Sounds like another therapy-hating, biologically based med management psychiatrist in the works.

Welcome to the club, friend. The secret handshake for the 'Psychotherapy Haters Union of Medicating Psychiatrists (PHUMP) will be emailed to you.

 

[Therapist4Chnge]

PHUMP..........

You can join my club (I don't have a cool acronym for my club yet. 🙁 ) if you DO want to be psychodynamic, while also believing in the biological side, join my yet to be named club!

-t

 

[prominence]

I don't know how to give you an easy & objective answer, other than to avoid obvious mistakes such as don't lie to the patient, don't counter-transfer, etc.

How does a therapist/provider avoid countertransference?

It's always present. It's important to be aware of one's countertansference and recognize how it plays itself out in the room.

 

[Doc Samson]

PHUMP..........

You can join my club (I don't have a cool acronym for my club yet. 🙁 ) if you DO want to be psychodynamic, while also believing in the biological side, join my yet to be named club!

-t

I'm a charter member... how about Treaters Equally Comfortable with Meds And Psychotherapy... TEC-MAP?

 

[Anasazi23]

I'm a charter member... how about Treaters Equally Comfortable with Meds And Psychotherapy... TEC-MAP?

You're a rare and respected breed. 🙂

I'm being facetitious of course, but I must say that the more psychotherapy I "do," the more I just can't stand it. I've never in my life had 45 minutes go so friggin' long.

I've developed no less than 6 techniques that tricks the patient into thinking that my yawn is a natural benign motor movement. I've also rearranged my desk so that the clocks are strategically placed both behind the patient's head, and near eye level where their head would be across from my desk. And yes, I do have it so that my office is in the traditional medical model structure....unsafe, with a big 'ol desk between me and the patient. None of this crossing your legs and have both sets of knees almost touching while you rest your head on your hand and pretend to be empathic nonsense.

Sometimes I have to turn on the air conditioner and have the cold air shoot directly on my neck in order to help keep me awake. An old truck-driver trick.

I'm just not interested in anyone for 45 minutes, unless it's a sick, complicated pharm case with lots of variables that I'm struggling with.

In the words of hedonism bot, "I apologize for nothing!"

 

[Therapist4Chnge]

How does a therapist/provider avoid countertransference?

It's always present. It's important to be aware of one's countertansference and recognize how it plays itself out in the room.

Exactly. It is really about acknowledging when it happens, and then dealing with it appropriately. It is bound to happen, so avoiding it isn't realistic, though failure to address it will set yourself up for issues down the road.

-t

 

[Therapist4Chnge]

I'm a charter member... how about Treaters Equally Comfortable with Meds And Psychotherapy... TEC-MAP?

I dig it!

I've never in my life had 45 minutes go so friggin' long.

It really depends on the case. I prefer working with severe and complex cases (if they have at least somewhat of an ability to attempt work. I've had psychotic and/or compromised pts who couldn't even attempt to try to do work. If it is run of the mill case....it can really drag on, especially if they are chronic and lack insight.

I've also rearranged my desk so that the clocks are strategically placed both behind the patient's head, and near eye level where their head would be across from my desk.

I run into a ton of co-morbid personality dx's.....so time management is a big deal. Invariably you'll have 5 minutes left and they drop the, "Oh yeah....I was molested, I cut, and I'm going to kill myself" They completely ignored when you inquired about those areas earlier, but now that you are about to end the session, they want to keep it going.

-t

 

[Anasazi23]

I dig it!

It really depends on the case. I prefer working with severe and complex cases (if they have at least somewhat of an ability to attempt work. I've had psychotic and/or compromised pts who couldn't even attempt to try to do work. If it is run of the mill case....it can really drag on, especially if they are chronic and lack insight.

Even colorful cases have me getting antsy after 20-30 minutes. It's not just me either. Others in my clinic complain of the same thing. Maybe I have ADD 🙄

I run into a ton of co-morbid personality dx's.....so time management is a big deal. Invariably you'll have 5 minutes left and they drop the, "Oh yeah....I was molested, I cut, and I'm going to kill myself" They completely ignored when you inquired about those areas earlier, but now that you are about to end the session, they want to keep it going.

-t

I think it's fair to say that many or most therapy cases have some semblance of a personality dysfunction. I don't care if they tell me they have a plan to kill the president. If time's up, you're out. I don't need a lecture on duty to warn (which is misunderstood anyway). 😛 That was an exaggeration.

Time management is not an issue for me. I'm quite good at "we'll pick this up next time."

 

[whopper]

Exactly. It is really about acknowledging when it happens, and then dealing with it appropriately. It is bound to happen, so avoiding it isn't realistic, though failure to address it will set yourself up for issues down the road.

True.

 

[maranatha]

I've developed no less than 6 techniques that tricks the patient into thinking that my yawn is a natural benign motor movement. I've also rearranged my desk so that the clocks are strategically placed both behind the patient's head, and near eye level where their head would be across from my desk. And yes, I do have it so that my office is in the traditional medical model structure....unsafe, with a big 'ol desk between me and the patient. None of this crossing your legs and have both sets of knees almost touching while you rest your head on your hand and pretend to be empathic nonsense.

!!!! Not sure I'll share your view during my psychotherapy training, but that is the freaking funniest thing I've heard today. After a looooooong week on neuro, i needed the laugh!

 

[MBK2003]

Have you had good supervisors? Curious to hear about others' experiences.

No offense, but sounds like you've got a bad batch of supervisors. I had predominantly good supervisors (with a few notable exceptions). My twice-weekly psychodynamic supervisors were all analysts, but all of them also prescribed meds (and not just SSRIs and benzos) so could speak to issues of transference around the little pill. As far as process notes, I took them in session or videotaped sessions. Getting supervisors to agree to watching videotape was a chore, but once I got them hooked on it the supervisions were MUCH more helpful.
Also make sure that you get supervisors who are skilled in CBT, IPT, DBT, MI, RPT, etc, even if this means culling people from the psychology department. I would make sure your training director is acutely aware that you need strong clinical supervisors in these modalities and he/she needs to scrounge them up whereever they be. I used exclusively videotape for CBT and MI supervisions and it was GREAT, so much more elucidating than me trying to recreate the session through my notes. I feel that my skills as a therapist now are directly related to my comfort in switching between different frames of reference and skill sets from each of the "schools of thought."

MBK2003