How does supervision differ from psychotherapy?

How does supervision differ from psychotherapy?

 A difficult issue for clinical supervisors is distinguishing between providing supervision or psychotherapy to their supervisees. When supervisees appear to be struggling with their own feeling states or countertransference reactions, it’s tempting to move into a therapist role, which is never the best direction. There can be a fine line between a supervisory intervention and a therapy intervention. Although a supervisory intervention can be and often is therapeutic, the function is different. A simple guideline to remember is that in supervision we recognize and name supervisee's psychological material that may be affecting their client's treatment. It is the domain of psychotherapy to explore and work through these issues. Although theoretical orientation and supervisory style will affect the form of the training experience, supervisory goals remain distinct from those of psychotherapy. For in depth discussion of supervision topics go to www.supervisionCEU.com which provides BBS approved Continuing Education Units.

   Taylor arrived late to supervision and burst into tears. She took a moment to compose herself and apologized for being late. My head filled with several responses. Starting with a basic human to human one, “what’s the matter, are you OK?” Is this wrong to say, will it open a dialogue that is not appropriate for supervision? Taylor tells me that clients are cancelling or no showing. She feels like a failure who cannot maintain a connection with anyone. Taylor then bursts into tears again saying that she is in the midst of a difficult break up of a long term relationship. In response to my “I’m sorry things are so painful” she begins to describe the details. Uh-oh, now what do I do?

Here are 6 pointers:

Support: Express your authentic concern and then ask where she is getting support, e.g. friends, family, personal therapy.

Focus the frame: Normalize that all therapists have personal life crises and that in supervision we discuss how such stressors may affect the clinical work.

Caution: We can potentially do our best work during hard times, increasing our capacity for empathy and allowing us to be present in new ways. However, we can also make mistakes if we are feeling overwhelmed, e.g. loosen boundaries or self-disclose in ways that are not helpful to clients.

Assess: Discuss Taylor’s caseload to assess actual client retention. Explore specific cases to see the impact, if any, of Taylor’s feelings of being a failure who is unable to connect. Have there been any empathic breaks with clients that may be due to her countransference?

Address countertransference: Examples:  “Perhaps you are assuming that B’s cancellation reflects his negative feelings about you rather than accepting that he had the flu.” “You may have experienced your client asking for relationship advice as inappropriate and burdensome because of your own fears right now of not knowing enough to keep a connection in your personal life.” “I noticed you were encouraging your client to end her relationship rather than focus on exploring her feelings. Let’s look at any countertransference that may be affecting your intervention choice.”

Follow up:  For example, how has it been at work for you this week? Where you able to connect with any of the support we discussed last time? Discuss client attendance and continue to explore the quality of connection Taylor is experiencing in the therapy with specific clients.

It is the job of the supervisor to identify therapist-client interactions that reveal what Taylor may be doing/not doing/missing with the client due to her own feelings that may be intervening. Providing support and guidance on managing supervisee feeling states that impact clinical work is an essential aspect of supervision. However, the goal of supervision is to both ensure quality care to clients while providing an optimal learning environment to our supervisees.