Supervision in Counseling and Therapy

In this article we use cybernetics as a model of departure to discuss how first- and second-order stances inform a psychotherapy supervisor's development. We see a first-order stance as typical of a modernist approach, while a second-order stance reflects a postmodern paradigm. We postulate that these stances are not two opposing positions, but developmentally different stages through which supervisors move in their professional lives. In addition, we discuss the conditions for supervisors' transition from a first-order to a second-order stage, and conclude that such development includes a life-long process of maturation and progression from lower- toward higher-order integration of professional and personal selves.

The article introduces discourse analysis as a fruitful approach to psychotherapy change-process research. Extracts are presented from a successfully resolved, client-specified, problematic theme that was selected from a successful 8-session psychodynamic-interpersonal therapy of a female client presenting with a major depressive episode. The study offers a heuristic demonstrating (a) how resolution of the client's problem evolved from implications raised by the client's own description of her predicament and involved the therapist's legitimation of a morally defensible account of the client's actions and (b) how cultural meanings can be brought into the consulting room as intimately personal problems. The implications of studying therapeutic change as a discursive activity comprising the use and negotiation of sociocultural meanings are discussed.

This chapter sets out to identify what kinds of models of supervision are appropriate to coaches.  In undertaking this objective, models and lessons from the supervision of counsellors and psychotherapists will be explored.  There are three reasons for this.  Firstly, many current practicing coaches are professionally trained and have practiced, or are practising, as counsellors or psychotherapist.  Secondly, there has been over 30 years of debate and analysis of alternative models of supervision from which lessons for coaching supervision can be drawn.  Thirdly, even when coaching focuses ostensibly on business issues, personal, experiential and problem-based themes often flow out of the coaching process.  These include ‘red flag’ issues when the coachee may be experiencing psychological difficulties.  As Whybrow and Palmer (2006) suggest, even non-clinical populations contain potentially vulnerable clients.  It seems, therefore, that (arguably) supervision models from a counselling or psychological background may have some relevance for all business and evidence-based coaches.

Therapy can be confusing: two people converse in a private room, one in distress, the other described as a helpful expert. At least one of the two is likely to express thoughts and feelings usually kept secret. In other circumstances, the exchange of such intimacies may herald a more physical relationship. For therapists, however, the professional relationship explicitly precludes such contact. The BACP Ethical Framework for Good Practice in Counselling and Psychotherapy,1 for example, requires that practitioners must not abuse their client’s trust in order to gain sexual, emotional, financial, or any other kind of personal advantage. Sexual relations with clients are prohibited, along with sexualised behaviour.

While psychotherapists and counsellors generally acknowledge that sexual attraction is a common and often ordinary human response to another, they also recognise that acting on such feelings in therapy will quickly become problematic. The early psychoanalytic community had to confront and respond to such instances as Jung’s relationship with Sabina Spielrein.2 Rosie Alexander’s3 description of the times she sat on her therapist’s knee and felt his erection, elicits a mixture of emotions in the reader, not least shock, and the narrative is saturated with a sense of betrayal.

There have been several types of research investigating boundary breaches and sexual boundary violations.4 In spite of these, however, there is little certainty about how common sexual boundary violations are, as the sources of information about them (confession, client reporting, complaints to organisations, and knowledge of colleagues’ conduct) are all vulnerable to error. Further studies have attempted to identify characteristics of transgressing therapists and the factors that contribute to such events (see Moggi et al5 for an example), and to understand the effects on clients who have experienced therapist-client sex.6 If sexual feelings are ubiquitous and sexual attraction a real possibility in the context of the therapy relationship, how are these managed in therapy? Complaints about sexual boundary violations form a small proportion of complaints about therapists and health professionals.4, 7, 8 Is it the prospect of opprobrium from colleagues or the threat of sanctions from regulatory agencies that contains the relationship within professional boundaries? Do reported violations represent only a small proportion of actual sexual boundary violations? .......

Aim: To identify therapists’ views on sexual boundaries and the strategies they employ to manage them in therapeutic practice. Method: In-depth qualitative interviews were conducted with a sample of 13 accredited, experienced practitioners of psychotherapy or counselling. A grounded theory approach, informed by principles from Free Association Narrative methodology, was employed, in which team members used debriefing sessions for extending depth of understanding of the interviews. Findings: There is consensus about boundaries at the extremes, but variability about fantasy, flirtation and touch. A core process was generated from accounts of successful management of sexual attraction. We identified four problematic ways of reacting to boundary pressure, each with potential to harm clients and therapy. Discussion: A participant-observer stance was conceptualised as essential for managing threats to boundaries, consistent with the empathic stance. Minor boundary crossings were viewed by interviewees as both potential precursors of more serious transgressions, and as opportunities for understanding the client's difficulties. Implications for practice: These span training, accrediting organisations, supervision and therapy practice.

An overview of relational-cultural theory and Relational-Cultural Therapy (RCT) is provided. First, a summary of the overarching framework for relational-cultural theory is offered. The theory's roots in feminist and psychodynamic theories are discussed, along with distinguishing aspects of relationalcultural theory. The practice of RCT is reviewed, including research support regarding assumptions, practice applications, and effectiveness. The unique role that teaching RCT can play in building counseling competencies is explored with a focus on competencies related to therapeutic relationshipbuilding skills and awareness of individual-cultural diversity. It is contended that RCT can provide an organized, systematic structure for the development of therapeutic relationship-building skills and a framework on which to build when asking counseling trainees to reflect on issues of power, privilege, oppression, and marginalization, including the ways in which those issues influence counseling. Specific examples are provided to illustrate the application of RCT in fostering these counseling competencies.

A reference work for specialists in student counselling and for those who employ counsellors in mental health services. It provides an analysis of research in this area and provides useful information on the extent and severity of student mental health problems and the effectiveness of counselling and psychotherapy across the student population. This is the first publication to systematically identify, assess and review research in this area.

The aim of this article is to present a succinct review and evaluation of the main areas of contention in the false memory debate and, from this basis, to suggest ways in which the best from both sides can be utilized. We examine the potential pitfalls of therapy in terms of the fallibility and suggestibility of autobiographical memory and therapists and therapeutic techniques as the architects of false memories. We then evaluate the case for false memory formation examining if some researchers hold misconceived views of psychotherapy, if experimental studies lack ecological validity, and the effect of trauma on memory. Finally, we explore how the potential pitfalls of therapy can be avoided in practice, reflecting on the usefulness of British Psychological Society guidelines, how clinicians can implement research findings, and how research on the false memory debate can be improved. We conclude that the way forward is researcher–clinician collaboration in the development of ecologically valid research paradigms.

Having been trained in a psychoanalytic supervision model in the early 1970s, and through his subsequent therapeutic practice in a relational approach, Robert Kafes has developed his own supervision model based in psychoanalytic Self Psychology – Emotionally Attuned Supervision.  Using his own therapeutic work as a foundation for his supervision work, Emotionally Attuned Supervision is grounded in Self Psychology by including concepts such as mirroring, idealizing, twinship, adversarial needs, efficacy needs, vitalizing needs, and spirituality (the first six are from Self Psychology, the seventh is added by Kafes).  The supervisor-supervisee dyad occurs within the framework of the more post-modern relational model, as described by DeYoung (Relational Psychotherapy: A Primer, 2003), from which Kafes focuses on the monitoring (the supervisee-client relationship) and mentoring (the supervisee as a therapist) of the supervisee.

This article offers an original model for the professional development of coaches that integrates models of coach supervision with mentoring -the supervisor-mentor. Many coaches are new to the profession and may lack experience of managing their own business. It is likely that these and many other coaches could benefit from the support and guidance of more experienced practitioners. One answer is a supervisor, but the functions of supervision often focus on helping the development of the coach as a professional, including skills development, emotional support and understanding the ethical principles in coaching. Supervisors are not necessarily responsible for the career development of coaches, nor do they normally provide advice on, say, business strategy or marketing principles for the coach's business. This article argues that there exists a significant gap which can be filled by another kind of helping intervention -a mentor. The article explores three potential models of coach mentoring: constellation, complementary and integrated supervisor-mentoring -the latter combining coach supervision with mentoring. Recommendations are made for future research in this area. (Word count: 174).

Research into the use of transitional objects (Winnicott, 1971) by adult clients in psychotherapy has given little attention to the question of how a transitional object (TO) works. This question is addressed through the use of a semi-structured interview. Data was collected on the clinical practice and theoretical understanding of TO emergence and use of three psychodynamic-interpersonal (PI) and three Gestalt psychotherapists. A grounded theory analysis suggests that a TO works by a process of embodiment which can be structured with reference to a four-level model consisting of physical, process, contextual and conceptual levels. Therapists of both orientations emphasized the TO as a focus of intersubjectivity within the therapeutic relationship. Differences between the PI and Gestalt therapists are also examined. The clinical implications of this four-level model of embodiment for the use of TOs in psychotherapy are explored, together with suggestions for further research.

Background: Research evidence on unprofessional relationships across the caring professionsc onsiders a range of activities and definitions (Halter, Brown & Stone, 2007). The evidence on sexual boundary violations (SBVs) in psychological therapy is sparse, but suggests that SBVs are under-reported; there is also a small but significant component of complaints. Conversely an increasing literature exploring client experience of SBV suggests that the effects are profound (Ben-Ari & Somer, 2004; Somer & Nachmanil, 2005). The prevalence literature is primarily quantitative, often using survey methodology. Conclusions have limited accuracy; there are issues raised, for example, when considering recruitment and sample characteristics, response rates, and questionsand definitions used. Some studies identified general characteristics associated with SBVs, including middle age, being male, working alone and outside the public sector; more recent literature, however, has been critical of the notion of the 'bad apple'. Halter, Brown and Stone (2007) conclude that provision of information is insufficient; evidence for the effect of recent innovations in training is promising, but evaluation of these is necessarily limited. It is unlikely, however, that UK accredited practitioners are ignorant of the code of ethics to which they have signed up; other reasons are more likely to play a part in sexual boundary violations.

Research Aims and Questions: The aims of the current research were to (1) Identify the indicators that signal potential or actual sexual boundaryviolations by healthcare providers who are relevant to the remit of the British Association for Counselling and Psychotherapy; (2) Explore how practitioners manage these in their therapy work and the effects of such management strategies; (3) Make detailed recommendations to minimise risk of sexual boundaryviolations by such healthcare providers.

Methodology: Thirteen practitioners were interviewed about their experiences of managing the risk of sexual boundary violations. Inclusion criteria were: accreditation as a counsellor or psychotherapist within specified counselling or psychotherapy organisations; a preparedness to confirm that he or she had not committed, or been subject to an investigation concerning, a sexual boundary violation; extensive experience of clinical work since qualifying, some of this being outside the NHS. To maximise the potential variety in participants and accounts, participation was invited through advertising and electronic distribution lists. The sample was completed through purposive sampling; to ensure that the sample varied sufficiently in terms of sex, disclosed hetero or homo-sexual orientation, age, cultural background, experience and time since qualified, working environments, therapy models, registering body and geographical location, four participants were identified through personal and professional contacts. The sample therefore included individuals from both higher and lower risk categories. Semi-structured interviews were used to elicit therapist experiences. The focus was on gaining detailed accounts of boundary breaches and potential SBVs, on reactions,choices and strategies adopted by practitioners, and opinions and judgements. Data were analysed thematically (Miles & Huberman, 1994; Braun & Clarke, 2000), each interview analysed initially by pairs consisting of an academic and a clinician. Principles of Free Association Narrative (Hollway & Jefferson, 2000) were employed when extending the analysis beyond the participan's opinions and explicit themes, using the interviewer's experience to understand the complexities of the constructed account.

Findings: Participants described SBV as one extreme on a continuum of boundary breaches; many accounts focussed on recognition and management of small breaches. Experiences of sexual attraction originating from client and therapist were seen as ubiquitous and unavoidable, and occurred without reference to sex of therapist and client, or sexual orientation; the management of the experience was seen as critical in determining whether a serious breach had taken place. Definitions of breaches and boundary violations varied, especially in views on touch. The key factor identified in definitions of boundary breaches concerned motive, i.e. whether the practitioner was acting in their own interests rather than for the client's benefit. For some, boundaries and their management, including sexual boundaries, were integral to therapeutic work. Elements of the steps involved in the therapeutic management of boundaries were developed into a process model created through analysis of what seemed to work positively for therapists and clients. The model articulates the following process: (1) noting; (2) facing up to it personally; (3) reflecting; (4) processing; (5) formulating; (6) working for therapeutic benefit. This model represents an ideal; therapists viewed the process as an ongoing struggle. Practitioners described a tension between engagement and sense making; we came to view this as a participant/observerstance, with similarities to Celenza's (1995) definition of empathy. Some accounts of managing boundaries were deemed problematic, even though they were not descriptions of sexual boundary violations, by participant or research team; for example, the strategies adopted for managing pressure on therapeutic boundaries sometimes resulted in distress to clients and difficulties with therapeutic work. These were grouped into a typology of four categories: self-protective/defensive; moralising/omnipotent; neediness/over-identification, and over-protective anxiety. A feature of all examples was a difficulty in maintaining a constructive balance between participation and observation. Supervision was seen as the primary source of support for successfully managing boundaries; we focussed on experiences of supervision and views of its functions. Supervisors were expected to focus on client benefit, manage the supervisory relationship, facilitate understanding, and an ethical and therapeutic stance. These mirror the practitioner's roles, so that supervisors might support therapist work at any point. One of the major aims of supervision seemed to be the development of an internal supervisor (Casement, 1985). Additionally, supervisors were expected toprovide quality checks, monitoring the therapist's account and their own experience, speaking of difficulties, so that threats of boundary breaches could be discussed. This extended for some to a responsibility to report serious unprofessional misconduct.

Conclusions and Recommendations: These findings are not inconsistent with the literature and research on sexual boundary violation, victims and transgressors, even though participants had avoided sexual boundary violations and had experience of successfully managing boundary threats. The sample tended to favour more conservative stances towards boundary limits such as touch; this may have been a protective factor. Recommendations for practice have been framed as issues for reflection for practitioners, supervisors, employing organisations, accrediting bodies, and training organisations. These include: increasing clarity over reporting; support during investigation; training in boundary management; supervisor contracting; formulation of practitioner learning needs; for practitioners to develop and own a rationale for therapeutic boundaries and prohibitions. There are finally suggestions for future research.

The aim of this study was to examine how transitional objects (TOs) work from the perspective of adult clients in psychotherapy. Data were collected using a semistructured interview with 6 female clients in humanistic psychotherapy. Grounded-theory analysis of this material suggests that a TO works through a 5-phase process of ‘holding’ in which the client successively integrates 3 themes: (a) the continuity of the therapist's existence, (b) connectedness with the therapist, and (c) the development of a new sense of self. A spiral microtheory is proposed that shows how these themes interact across time and relate to the client's experience of shame. The analysis suggests a use of TOs that is broader than D. W. Winnicott's (1953) conception and includes selfobject functions (H. Kohut, 1971).

External supervision offers health and social service practitioners opportunities for exploring their work, professional development, and associated relationships. Within a context outside of the workplace, the supervision relationship allegedly supports practice within the workplace. There is a range of understanding within the sectors about the relationship between supervisor and practitioner. This paper explores the potential of closer relationships between agency and supervisor and the subsequent possibilities for greater accountability of the supervision work. Reflecting on our own practice as supervisors both within agencies and external to agencies, this paper invites readers (supervisors and practitioners) to draw on their own supervision experiences. The intention is to critique, challenge, and support critical reflection upon current and potential supervision arrangements for practitioners who participate in supervision that is external to their agencies.

A study through the lens of Supervision This study explored the experience of five Munster based practitioners, an enquiry into how they keep their practice of supervision and psychotherapy relevant to these changing times. It addresses the question of how they keep their practice alive, vital and relevant, whilst simultaneously being able to integrate the conflicting demands of the role. It is a summary of the findings and seeks to address the impact of changing times on the practice of psychotherapy & supervision. METHODOLOGY The participants interviewed came from different training orientations and modalities. Each had over 30 years' experience; maintain a practice that includes psychotherapy and supervision and were or are involved in the training of therapists and the supervision of supervisors. They each work from different philosophical stances and theory bases having their own individual style. Two are involved in the training of supervisors. These conversations were transcribed and the data was reviewed using a thematic analysis. Quotes in italics are taken directly from the transcriptions. CONTEXT Ireland is in the middle of huge change; a different world with a different set of pressures. We have recently experienced a great deal of social, economic, state and religious change. There has been a seismic shift in attitudes to gender, relationships, family and sexuality. Assumptions and structures that were familiar to us have been challenged. What was once perceived as a relatively stable experience of life is in a state of flux; 'liquid modernity' to use Bauman's (2002) description. His idea is that we have moved from a solid to a fluid phase of modernity, in which nothing keeps its shape, and social forms are constantly changing at great speed, radically transforming the experience of being human. In this, he speaks of our thirst to create order and reduce uncertainty. Could it then be said that as a result of this that we have become a procedural led country, resulting in the strong desire for evidence based outcomes, check lists flow charts, throughput and output figures, measurement of productivity and turnover. In turn these then become the work pressures and external stressors of these times. It is particularly significant in the helping and caring professions. Practitioners are working under a great deal of performance pressure; they are working in a culture of fear and are afraid of getting it wrong. Supervision as a process offers a unique opportunity for those in frontline work to take time out and reflect on the important rather than the urgent. Thus, it is important for us as Supervisor Practitioners to remain in relationship and connected whilst simultaneously remaining flexible and being robust.

This article discusses multicultural competency education options for early career rehabilitation counsellor supervisors. It specifically addresses the importance of the cultural awareness and competencies in supervised supervision. Multicultural counsellor competencies in clinical supervision are considered in the context of rehabilitation counsellor professional preparation programs in the United States. Diversity considerations are important to operationalising the construct of the working alliance in the context of clinical supervision training for early career rehabilitation counsellor supervisors. Acquiring, retaining and cultivating multicultural clinical supervision competencies in self and others is a lifelong process.

In der Supervisionsszene werden unter dem Begriff Supervision verschiedenste Konzepte, Formate, Haltungen und vieles mehr verstanden. Der folgende Text geht der Frage nach, was es mit dem Phänomen, das Supervision genannt wird, aus professionalisierungstheoretischer Perspektive auf sich hat. Dazu werden unterschiedliche Formen der Hilfebedürftigkeit einer Handlungsinstanz herausgearbeitet, auf die jeweils bestimmte Helfer antworten. Als professionalisierte Hilfe antwortet Supervision auf Handlungsprobleme professionalisierter Helfer und kann in vorbeugende und beratende Supervision unterschieden werden. Ein solch strukturell begründetes enges Verständnis von Supervision steht dem inflationären Gebrauch des Supervisionsbegriffs heilsam entgegen. Zugleich zeigt der Beitrag, wie wissenschaftliche Theoriearbeit zur begrifflichen Explikation intuitiver praktischer „Wahrheiten“ beitragen kann.

An illustrative analysis is offered demonstrating the potential of conversation analysis for psychotherapy research. Extracts are presented from an unresolved problematic theme selected from an unsuccessful eight-session psychodynamic-interpersonal therapy of a female client presenting with a major depressive episode. The authors identify descriptive devices and communicative skills on which the client and therapist draw in the process of problem formulation. They demonstrate the way in which differing versions of the client’s problems were presented and how the client and therapist pursued differing attributional projects. Specifically, the authors examine how internal and external accounts of the client’s underlying problems were accomplished and warranted and how the therapist attempted the transformation of problems. The quality criteria pertaining to conversation analysis are indicated, the implications for therapeutic practice explored, and the relationship between the present findings and previous research discussed.

This form is used by Counseling Supervisors at the 6 month and year-end point of the one-year period of supervision for Intern Counselor members of the College of Mental Health Counseling http://www,collegemhc.com

Supervisors should be familiar with the College training manual to understand the content acquired by the Intern Counselor. The manual can be reviewed here http://www.amazon.com/Effective-Counseling-Skills-therapeutic-statements/dp/1442177993

The aim of this study was to further understanding of blame in systemic therapy. Five families were chosen by their therapeutic team as engaging in blaming of a kind that the therapists found difficult to work with. Couples from each of the five families participated. A video extract from therapy identified by therapists as typifying blaming within the family was used as a focus for semistructured interviews with each parent. Transcripts were analyzed according to the procedures of grounded theory. On the basis of this inductive qualitative analysis, a framework of understanding emerged from the data consisting of the core category, “dialectical understanding,” and an accompanying set of overarching themes. These themes capture the way in which participants oscillated among 13 dialecics in their discussion of blame within their family and within family therapy. The model provides a framework for analyzing the style and content of therapy conversations with a view to helping therapists facilitate therapeutic change in this difficult client group.

This article offers an original model for the professional development of coaches that integrates models of coach supervision with mentoring – the supervisor-mentor.  Many coaches are new to the profession and may lack experience of managing their own business.  It is likely that these and many other coaches could benefit from the support and guidance of more experienced practitioners.  One answer is a supervisor, but the functions of supervision often focus on helping the development of the coach as a professional, including skills development, emotional support and understanding the ethical principles in coaching.  Supervisors are not necessarily responsible for the career development of coaches, nor do they normally provide advice on, say, business strategy or marketing principles for the coach’s business.  This article argues that there exists a significant gap which can be filled by another kind of helping intervention – a mentor.  The article explores three potential models of coach mentoring: constellation, complementary and integrated supervisor-mentoring – the latter combining coach supervision with mentoring.  Recommendations are made for future research in this area.

This article discusses multicultural competency education options for early career rehabilitation counsellor supervisors. It specifically addresses the importance of the cultural awareness and competencies in supervised supervision. Multicultural counsellor competencies in clinical supervision are considered in the context of rehabilitation counsellor professional preparation programs in the United States. Diversity considerations are important to operationalising the construct of the working alliance in the context of clinical supervision training for early career rehabilitation counsellor supervisors. Acquiring, retaining and cultivating multicultural clinical supervision competencies in self and others is a lifelong process.

This article discusses multicultural competency education options for early career rehabilitation counsellor supervisors. It specifically addresses the importance of the cultural awareness and competencies in supervised supervision. Multicultural counsellor competencies in clinical supervision are considered in the context of rehabilitation counsellor professional preparation programs in the United States. Diversity considerations are important to operationalising the construct of the working alliance in the context of clinical supervision training for early career rehabilitation counsellor supervisors. Acquiring, retaining and cultivating multicultural clinical supervision competencies in self and others is a lifelong process.