.:: SUPERVISION

We are offering professional supervision in Transactional Analysis and Integrative Psychotherapy. Supervision is possible also in English or Croatian/Serbian language internationally through the use of Skype.

Supervision in Integrative-relational Transactional Analysis

(c) Gregor Zvelc, Provisional Teaching and Supervising Transactional Analyst

Keith Tudor (2002) has provided a very informative synthesis of existing transactional analysis supervision. He views supervision as a ‘metactivity requiring metaskills on the part of the supervisor or practitioner, who is at the center of this process of understanding or making sense’ (p. 40.). He integrates many ideas on supervision in meta-framework, which includes three basic parts that are important in understanding the supervision process. They are: Philosophy, Practice and Theory. All this parts are in dynamic interrelationships and influence each other. At the center of this model is also the Practitioner involved. The Philosophy, Practice and Theory of supervision are not acontextual but exist in specific cultural and social context. This framework is useful in understanding not only TA supervision but also other psychotherapy approaches.

Philosophy of supervision

My philosophy of TA supervision is rooted in basic TA philosophy and method. That means that in supervision I see importance of positive and mutual respect which includes the supervisor, supervisee and the client concerned (I’m OK, You’re O.K, and They (the client) are OK). Central to TA philosophy is also a belief in personal responsibility and autonomy. This belief influences a method of doing supervision which involves (Tudor, 2002):
1.) Commitment to a clearly defined relationship in which there is joint responsibility for the process of learning
2.) Commitment to open communication

My thinking of philosophy of supervision is also influenced by integrative-relational framework that is the center of my TA theory and practice (Erskine, Moursand, & Trautmann, 1999; Safran and Muran, 2002). I see therapeutic relationship as a central to psychotherapy and parallel to that I see also a supervisory relationship central to supervisory process. Supervision occurs in specific relational context, which includes the supervisor, supervisee and the client concerned. They are all interconnected and the supervision is in this way co-creation of all persons involved. All this basic assumptions influence my practice of supervision.


The Practice and Theory of Supervision

The first questions I would like to address is: What are the tasks and goals of supervision?
Barnes (1977) describes the main developmental goal in supervision: ‘To create a context in which clinical trainees can become aware of and develop their potential as therapists and experienced therapists can improve their effectiveness through the use of Transactional Analysis.’ (cited in Tudor, 2002, p. 46).
Tudor (2002) in his thinking about functions of supervision expands Kadushin’s and Proctor’s views and applies them to TA supervision. According to this view there are three main functions of supervision:
1.) Administrative/Normative – this includes the TA supervisor’s responsibility to ensure that the supervisee’s work is appropriate, ethical and professional in the context of relevant codes of ethics and professional practice and any organizational considerations and contracts.
2.) Educative/Formative – this includes the theoretical, skills, and professional development of the supervisee and supervisor’s responsibility to provide educative/formative feedback to the supervisee
3.) Supportive/restorative – includes the supervisor’s response to the practitioner’s anxiety and distress in response to and as evoked by his client’s material.

As beginning supervisor I found very informative Brief supervision checklist (Clarkson, 1992). This checklist is very useful for learning how to do supervision, because it includes basic tasks of supervision and reminds us about priorities. I find it as meta-model in which many ideas of other writings on supervision can be included. This checklist includes:

1. Contract fulfilled

Contracting is central to TA practice and also to TA supervision. At the beginning of supervision it’s good to start with encouraging supervisee to identify a theme for supervision and come to mutual agreement about supervisory goals. In addition to that during the supervisory session is very important to make process contracts to encourage autonomy and responsibility of trainee for learning.

2. Key issues identified

Focus is on supervisor’s ability to assess, discriminate and identify the major issues in supervision. Clarkson (1992) describes the following main issues in supervision:

Diagnosis and treatment planning. The focus is on diagnosis of the client and planning of the treatment. Both diagnosis and specific phase of the treatment influence the choice of therapeutic techniques.
Strategies and intervention techniques. Here is the focus on training in particular treatment strategies and intervention techniques. For example: How to conduct the Parent interview?
Parallel process. The focus her is on the reflection of aspects of the client/psychotherapist dyad and the supervisee/supervisor dyad in each other. So what occurs in psychotherapy with the client is mirrored in the supervisory relationship.)
Countertransference. Supervision can focus on therapist’s counter-transference. The purpose of supervision is identification of personal issues of the therapist that interfere with psychotherapy process. It includes also possible use of counter-transference for understanding and therapy of the client.
Ethics and professional practice. This embraces issues of ethics and professional practice as these relate to the supervisee and his relationship to the clients.

3.) Reduction of the probability of harm.

In supervision this refers to not inflicting harm or causing harm in relationship to the client.

4. Increased developmental direction.

This means a focus on further growth and development of supervisee. Supervisor’s responsibility is to offer challenges, direction or support for extending the trainee’s horizons.

5. Supervisor models process

Supervisor is a model for supervisee. So it’s very important that supervisor through supervision models the desirable process. This means congruence between social and psychological levels of communication.

6. Equal relationship – I’m OK – You’re OK.

This is the main philosophical principle of TA and means the acceptance of the supervisee as a valuable and important person. This doesn’t mean that we agree with all supervisee behaviour, but is indication of respect of ‘being’ of another person.


Clarkson’s model is very compatible with Hawkins and Shohet (1989, Tudor, 2002) understanding of the process of supervisory relationship. They identify six modes:
1. Reflecting on the content of the therapy session
2. Exploring the strategies and interventions used by therapist
3. Exploring the therapy process and relationship
4. Focusing on the therapist’s counter-transference
5. Focusing on the parallel process
6. Focusing on the supervisor’s counter-transference
Comparing to Clarkson’s model they add the focusing on supervisor’s counter-transference, which can be also important information for understanding what’s happening within supervisory and also primary therapeutic relationship.


Relational context of supervision and supervisory alliance

Supervision occurs in specific relational context. It’s impossible for the supervisor to convey information to the trainee that has meaning independent of the relational context in which is conveyed (Safran and Muran, 2000).
A series of survey studies (Rock, 1997, Safran and Muran, 2002) have found that good supervisors are experienced by trainees as attuned to their emotional and learning needs.
In this case the supervisory relationship is experienced by supervisees as reciprocal, mutual and trusting. When there is no trust in supervisory relationship, trainees attempt to conceal their difficulties and counter-transferential issues. So I think it’s very important that supervisors monitor the quality of the supervisory relationship in an ongoing fashion that parallels the ongoing monitoring of the quality of alliance in psychotherapy. When the alliance is adequate, the supervisory relationship becomes the background and does not need to be explicitly addressed. When ruptures or tensions emerge in relationship, the exploration of supervisory relationship would assume priority over all the other forms of supervision (Safran and Muran, 2002).
In Transactional Analysis we have a very good framework for working with ruptures in the alliance. The methods of Integrative TA (Erskine, Moursand, & Trautmann, 1999) are very useful not only in therapy with clients but also within supervisory relationship. So when thinking about the methods of doing supervision I found very important the Inquiry, Attunement and Involvement. However there are specific differences in using these methods with clients and within supervisory relationship. In the supervision the primary goal is not the personal therapy of the supervisee, but enhancement of supervisee’s work with clients. When impasses occur in supervisory relationship, it’s important collaborative exploration of both partners’ contribution to the impasse. Methods of Inquiry, Attunement and Involvement can enhance working through supervisory impasses. This can provide supervisee with valuable experiential learning about the process of working through relational impasses.

Inquiry involves respectful exploration of the supervisee's phenomenological experience which occur in his relationship with client and/or relationship with supervisee. The supervisor invites the supervisee to search for answers, to think in new ways and to explore new avenues of awareness. The supervisor's Inquiry must be empathic with the supervisee's subjective experience and construction of meaning. The primary focus is here on process of discovering in which supervisee finds new understanding of the relationship with client and/or supervisor
Attunement goes hand in hand with Inquiry. Erskine and Trautmann (1993/1997) describe Attunement as a two-part process: 'the sense of being fully aware of the other person's sensations, needs, or feelings and the communication of that awareness to the other person.' (p. 90 The supervisor can be attuned to a wide variety of supervisee’s behaviors and experiences, specially to his rhythm, nature of affect, cognition, developmental level of psychological functioning and relational needs. Involvement means that the therapist is willing to be affected by what happens in the relationship with the client (Erskine, Moursand, & Trautmann, 1999). Parallel to that is also the supervisor’s involvement within supervisory relationship. For example when the supervisee’s is experiencing that his is a very bad therapist in response to very regressed and suicidal patient, the supervisor can normalize his experience.

The use of these methods in supervision can provide effective supervisory alliance and resolution of its ruptures (supervisee will feel respected and safe). Another important benefit is supervisor’s modelling of the desirable process, which can have impact on therapist’s work with clients. Relational model assumes that there are many connections and influences between therapy and supervisory relationship. The direction of the influence can be:

1) Bottom up (classical parallel process). In conventional parallel process framework the assumptions is that what happens in psychotherapy can be manifested (reflected) in supervisory relationship. In this way therapist triggers an enactment in the supervisory relationship through identification with the patients’ conflict (Safran and Muran, 2002).
2) Top down. What happens in supervisory relationship can translate into therapeutic relationship. Impasses in the supervisory relationship can translate in the impasses in therapeutic relationship. A therapist who is feeling judged by his supervisor is more likely to feel critical with his patients
3) Bidirectional. The direction of influence can be bi-directional. What happens in therapy is reinforced in supervision and in turn influences the therapeutic relationship. A therapist who is feeling stuck in therapy can become self-critical in supervision, and can elicit critical response from the supervisor. This in turn influences the therapeutic relationship in a negative fashion and intensifies therapists’ self-criticism in supervision.

Supervisory relationship can because of described reflection process become an important mediator of change in primary therapy relationship. Resolution of supervisory alliance impasse can positively affect therapist dealing with alliance rupture in the relationship with the client.

Developmental framework and specific techniques

The use of interventions in supervision must be in accordance with the level of development of the supervisee. Erskine (1982) describes three main stages of trainee’s development: beginning, intermediate and advanced.

In the beginning stage of training the aim of supervision is skill development. The focus is on gaining information, techniques and finding a solid theoretical base for clinical interventions. This can be done in number of different formats: supervision of audio or video recordings of therapy work, descriptions of the client, role-playing a client with supervisor, another trainee, or self as the therapist. The aim is on connections between clinical observations and theory and development of treatment plan. Reading assignments can be particularly helpful to underscore the ideas discussed. After the trainees have mastered specific psychotherapy skills, the aim of supervision is on development of a sense of confidence and well being as a psychotherapist.
In the intermediate stage supervision is aimed at building an identity as a therapist and refining the therapy approach. Supervisor can ask trainee for self-evaluation, discuss theory used and ask for summary. Therapy for the trainee (if appropriate to training context) and peer group supervision is also important in this stage of training. In advanced stage (multhi-theoretical) the aim is in developing trainee’s flexibility and integration of multiple theoretical frames of references.

Gilbert and Evans (2003) describe two important traditions of supervision. The first is psychoanalytical, which focuses on counter-transference of the psychotherapist and on analyst process with the client. The second tradition comes from counselling trainings, where the main goal is teaching appropriate skills. Here the main focus is not on broader overview and understanding of the therapeutic relationship over time. The focus is more on live supervision and on tape recordings of the psychotherapy work. I agree with Gilbert and Evans that it’s important to integrate these two traditions. Listening to tapes can be very good for understanding the micro process occurring moment to moment, but that should be integrated with an overall understanding of psychotherapy process with specific client (Novellino, 2003; Zalcman and Cornell, 1983; Tudor, 2002)

Other specific techniques in supervision can include awareness-oriented role plays (Safran and Muran, 2002). Therapists can role-play a segment of the session, either with the assistance of a training group member who plays the role of patient or therapist, or playing both roles themselves. The goal of this type of experiment is to facilitate the exploration of feelings, thoughts, and fantasies relevant to the case that is being focused on. It can also be an opportunity to experiment with different ways of intervening and exploring feelings that block the ability to intervene in certain ways. In such role-plays also supervisor can play the therapist role and in this way acts as a model for the supervisee’s. Another technique is that all members of the group in pairs play the role of therapist and patient. In this way all members of training group can be involved in experiential mode of learning.

References

Berne, E. (1964). Games People Play. New York: Grove Press.
Clarkson, P. (1992). Transactional analysis psychotherapy. An integrated approach. London and New York: Routledge.
Cornell and Zalcman (1984). Teaching Transactional Analysts to Think Theoretically. TAJ, Vol. 14, No.2.
Erskine, R. G. (1982). Supervision of Psychotherapy. Models for Professional Development. Transactional Analysis Journal, Vol. 12, Num.4., p.314-321.
Erskine, R. G., Moursand, J. P, & Trautmann, R. L. (1999). Beyond empathy: A therapy of contact-in-relationship. Philadelphia: Brunner/Mazel.
Gilbert, M. and Evans, K. (2003). Supervision. Workshop presentation. European Association for Integrative Psychotherapy.
Moursand, J. P. & Erskine, R. G. (2004). Integrative Psychotherapy. The Art and Science of Relationship. Pacific Grove, Ca: Brooks/Cole.
Novellino, M. (2003). On closer Analysis. Unconscious communication in the Adult ego state and a revision of the rules of communication within the framework of Transactional Psychoanalysis, in Sills, C., & Hargaden, H. (Ed.) Ego states. London: Worth Publishing., p.149-169.
Safran, J. D., & Muran, J. C. (2000). Negotiating the Therapeutic Alliance. A Relational Treatment Guide. New York: The Guilford Press.
Tudor, K. (2002). Transactional Analysis Supervision or Supervision Analyzed
Transactionally?. Transactional Analysis Journal, Vol. 32, No.1, 39-55.
Zalcman. M. J., & Cornell, W. F. (1983). A Bilateral Model for Clinical Supervision. Transactional Analysis Journal, 13(2).

   
 
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