Supervision styles: CBT, psychodynamic, etc.

[psychRA]

I come from a grad program that is almost exclusively rooted in evidence-based therapies.
I'm familiar with (for lack of a better label) CBT supervisors, and I have no problem talking about case conceptualization in terms of symptoms, patterns, and history. I'm used to coming up with different ways to apply various evidence-based treatment approaches in a flexible way. Very rarely, we'll talk about my own responses a particular patient.

Now that I'm on internship and have a couple of psychodynamic supervisors, and I don't think that they have been less helpful, but I do feel less familiar with the supervision style. I don't know a lot of the terminology, of course, but I'm also not used to talking about my feelings about myself, the patient, and the supervisor/supervisee relationship. With CBT supervisors, feedback is typically very concrete (e.g. "you might try being more directive with the patient by doing X, Y, and Z"), and it throws me for a loop when a psychodynamic supervisor makes a comment that is more diffuse (e.g. "when we're in the room together, your demeanor seems very X and Y, and you tend to elicit Z responses from me").

I don't have a specific question, I guess, but I'm curious about your experiences with different types of supervision styles. Have you found certain approaches to be more or less comfortable/helpful? Have you had to make adjustments when dealing with unfamiliar orientations?

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[erg923]

I come from a grad program that is almost exclusively rooted in evidence-based therapies.
I'm familiar with (for lack of a better label) CBT supervisors, and I have no problem talking about case conceptualization in terms of symptoms, patterns, and history. I'm used to coming up with different ways to apply various evidence-based treatment approaches in a flexible way. Very rarely, we'll talk about my own responses a particular patient.

Now that I'm on internship and have a couple of psychodynamic supervisors, and I don't think that they have been less helpful, but I do feel less familiar with the supervision style. I don't know a lot of the terminology, of course, but I'm also not used to talking about my feelings about myself, the patient, and the supervisor/supervisee relationship. With CBT supervisors, feedback is typically very concrete (e.g. "you might try being more directive with the patient by doing X, Y, and Z"), and it throws me for a loop when a psychodynamic supervisor makes a comment that is more diffuse (e.g. "when we're in the room together, your demeanor seems very X and Y, and you tend to elicit Z responses from me").

I don't have a specific question, I guess, but I'm curious about your experiences with different types of supervision styles. Have you found certain approaches to be more or less comfortable/helpful? Have you had to make adjustments when dealing with unfamiliar orientations?

I am surprised you never got alot of talk/feedback about your reactions to clients, the client reaction to you, nonverbals, relationship, cultural influences and the like. That was a HUGE part of supervision for me in the beginning (first year, especially) since, at that point, you are typically just learning how to be in the room with another emotionally vulnerable/troubled human being.

 

[psychRA]

I am surprised you never got alot of talk/feedback about your reactions to clients, the client reaction to you, nonverbals, relationship, cultural influences and the like. That was a HUGE part of supervision for me in the beginning (first year, especially) since, at that point, you are typically just learning how to be in the room with another emotionally vulnerable/troubled human being.

I guess I should clarify that we had a TON of supervision about the client's reactions to us, as well as cultural factors in therapy and nonverbal aspects of communication. I feel compelled to state that I feel that I received excellent training and feel very confident in my clinical abilities. However, I would say that we talked very little about non-intellectual aspects of our own reactions. In general, I would say that feedback about our own style and technique was much more clinical, whereas psychodynamic feedback seems more personal.

 

[HomeworkHelper]

I guess I should clarify that we had a TON of supervision about the client's reactions to us, as well as cultural factors in therapy and nonverbal aspects of communication. I feel compelled to state that I feel that I received excellent training and feel very confident in my clinical abilities. However, I would say that we talked very little about non-intellectual aspects of our own reactions. In general, I would say that feedback about our own style and technique was much more clinical, whereas psychodynamic feedback seems more personal.

Hi PsychRA, I hear ya. My background sounds quite similar to yours--initially a heavy focus on a CBT-consistent style of supervision, followed by a round of supervision by someone with a psychodynamic perspective. I have a hard time describing how they were different, but your explanation seems close. I took the approach of wanting to take as much as I could from the different perspective, and in some ways I feel like I had a second big jump in my skills after working with this individual (the first jump likely would have been my first year doing therapy). I might discuss with your supervisor, if you haven't already, the difference in your perspectives, that it will take time to adjust, and that there may have to be some "translating" now and then since the terminology can be different (but sometimes, the concepts can be similar). My supervisor did a great job of helping make connections between perspectives, and that made it all the more understandable and helpful!

 

[Mein Traum]

psychRA,

I was in a similar situation when I attended an experiential group at a professional conference. Yes, I knew that I was entering psychodynamic territory, I wanted to learn more about the model, and I thought that by reading the suggested advance reading material that I would be prepared. I have to commiserate with you that it does take one aback to encounter this strange world for the first few times. This is not a value judgement but, an acknowledgement that it is very different.

If it were me and this was going to be an ongoing situation, I would ask these supervisors what books or specific theorists they would suggest that I read in order to better prepare and understand this model. They will almost certainly have favorites.

I hope that this suggestion helps and if not at least you know that you are not alone. I wish you the best.

M.T.

 

[Ollie123]

This sounds reminiscent of one of my practicum experiences. I did it because I wanted to branch out a bit but kind of regretted it by the end. Fortunately the cases were fairly simple so I didn't require a lot of supervision because what I did receive was not remotely useful.

As others have said, I'm quite used to discussing my reactions with regards to how it might impact therapy, the client, etc. This was quite different. All we really talked about was metaphors. Any attempt to reflect on a case was me channeling a clients ruminative thinking. Encouraging depressed clients to engage in pleasurable activities was forcing them to reexperience their early childhood experiences with their parents telling them what to do. Any mention of the fact that I didn't find this helpful with regards to deciding what to actually do differently in therapy meant I was getting defensive. Requests for literature were outright ignored.

Helped me realize why we have so much troubles getting reimbursement though....and solidified my belief that many practitioners are more in it for their own entertainment than the benefit of the clients.

 

[thewesternsky]

This sounds reminiscent of one of my practicum experiences. I did it because I wanted to branch out a bit but kind of regretted it by the end. Fortunately the cases were fairly simple so I didn't require a lot of supervision because what I did receive was not remotely useful.

As others have said, I'm quite used to discussing my reactions with regards to how it might impact therapy, the client, etc. This was quite different. All we really talked about was metaphors. Any attempt to reflect on a case was me channeling a clients ruminative thinking. Encouraging depressed clients to engage in pleasurable activities was forcing them to reexperience their early childhood experiences with their parents telling them what to do. Any mention of the fact that I didn't find this helpful with regards to deciding what to actually do differently in therapy meant I was getting defensive. Requests for literature were outright ignored.

Helped me realize why we have so much troubles getting reimbursement though....and solidified my belief that many practitioners are more in it for their own entertainment than the benefit of the clients.

This sounds awful. 🙁 I've never had a straight psychodynamic supervisor, and I'm guessing there's some variance in how useful they are. This sounds like the bottom end of that continuum. 🙁

That said, I've had a number of third-wave CBT supervisors reflect on process issues with me in ways that I think have allowed me to grow as a therapist. For example, it can be hard to remain nonjudmental and empathic when clients are not yet motivated for change. I think in cases like that, exploring your own feelings about the client and working with a supervisor to understand and re-frame your reactions can be very helpful. It took me a couple of weeks to get used to discussing my feelings in detail in supervision, but I'm glad I was pushed to do so!

 

[phillydave]

This sounds awful. 🙁 I've never had a straight psychodynamic supervisor, and I'm guessing there's some variance in how useful they are. This sounds like the bottom end of that continuum. 🙁

I agree, it sounds very much like the bottom end of the continuum. My experiences with psychodynamically oriented supervisors have been excellent, no focus on metaphors (it sounds like this supervisor didn't really know what he/she was doing). My experience with my assessment practicum supervisor, who was CBT oriented, was also really great, surprisingly even with projective measures. My experience is that it can be really hit or miss with supervisors, regardless of the prestige of the site.

 

[Ollie123]

It definitely wasn't ideal, but in the grand scheme of things not a big deal - gives me something to talk about on internship interviews. I actually sought out the experience to push me out of my comfort zone a bit, just got more than I bargained for. Well...actually not so much with my comfort zone, just with the lack of utility. For the record, this was not done in a "mean-spirited" way or anything of the sort. It was just...useless. I knew that the standards of evidence used by dynamic practitioners are generally much lower than other areas. I was not prepared for them to literally be unable to provide sources of any kind to support what they were doing (even completely non-empirical).

I'm not big on wasting time. It would have been different if I felt like I was learning something good, but all it really did was solidify my view that those who don't practice EBP should not be allowed to practice at all. If it doesn't change what I'm doing with the client...what is the point in discussing it?

 

[Pragma]

The one psychodynamic supervisor I had was during my first year of practicum. I actually was very happy to have the experience. It was good because the supervisor wasn't pushing the orientation on me, but was much more process oriented. It challenged me a lot and I grew a lot. Then I switched over to a CBT supervisor and preferred it, but I was grateful for the early experience. I have a feeling I may have felt more like Ollie had the experience happened later in my training.

 

[LivingOffLoans]

This is a good post.

I really enjoy psychodynamic theory and have a had a couple of supervisors who use this approach, but like Pragma's experience, mine was also more process oriented, without the focus on the relationship in the room between supervisor and supervisee. I enjoyed it.

I can see how an interpersonal dynamic supervision could be a good learning experience, but I can also see how it could be really uncomfortable. I believe it depends on how authoritative the supervisor is, what their motivation is in using self-disclosures, etc... For example, if my supervisor made self-disclosures but their intention behind it was to strengthen the relationship/connection, I would enjoy it and learn how to bring it into my practice. But if the self-disclosure was, essentially, about how pissed off and uncomfortable they were with me for whatever reason, that would be very unprofessional. The example I read in the OP's post did not sound like the focus was on the the clinician's individual growth, which should be the primary aim of supervision.

In any case, I chalk it up less to the modality/theory of supervision and more to the positive learning experience that may or may not take place in any supervision.