Avoid the trap of narcissistic co-narcissistic relationships in supervision

Supervision is a term that often causes much debate within counselling and psychotherapy circles. It was once considered to be something you ‘got landed with’ by virtue of being the most experienced practitioner within an organisation.  Implicit in this view was that therapy should be conducted in a right way and, therefore, not in a wrong way, and that supervision should be arranged and facilitated by the most senior and most experienced therapist, regardless of their competence, knowledge base, attitude or management skill.  This hierarchical view of supervision is possibly reflected in working practices within organisational settings where managers are worried of things going wrong and being the subject of a claim or complaint. The NHS is a case in point whereby supervision is more likely to be for those further down the food chain. Consultants in the NHS are not routinely offered clinical supervision as part of their working arrangements. Whilst some might engage in loose forms of reflective practice listening with their colleagues there is no formal supervision arrangements, certainly not as psychotherapists would understand it.

Some therapists see supervision as a box filling exercise, and something which they are required to undertake, whilst others view it as an opportunity to merge with the person who they like and respect. I recall from my training days when certain trainees would choose their personal private supervisor on the basis that they were similar in outlook and where there was a great deal of deference and admiration. In such cases I was left wondering about the motivations of such individuals in their choice of supervisor.

Clients can also have differing views on how supervision could be defined and what the process entails although they rarely show much interest. When they do they sometimes wonder if their personal material will be discussed with a stranger and consequently if their privacy and confidentiality could be compromised and can, as a result, be defensive about the thought that the therapist is engaging in such a process.

So, how is clinical supervision defined by professional accrediting bodies?

The UKCP defines supervision as a reflective and evaluative process conducted within an articulated working relationship between a qualified or trainee psychotherapeutic practitioner and an appropriately knowledgeable supervisor. The BACP Ethical framework says the following: ‘A specialised form of mentoring provided for practitioners responsible for undertaking challenging work with people. Supervision is provided to ensure standards, enhance quality, advance learning, stimulate creativity, and support the sustainability and resilience of the work being undertaken.’ In Hawkins and Smith 2006 Professor Hawkins defined supervision as: “The process by which a Coach with the help of a Supervisor, can attend to understanding better both the Client system and themselves as part of the Client / Coach system, and by so doing transform their work and develop their craft.”

Clinical supervision is different to consultative supervision and informal reflective practice. Consultative supervision and reflective practice can potentially take place with anyone whereas clinical supervision might typically take place with another therapist who is appropriately qualified, and usually accredited (although a lot of supervision training is not associated with a formal accrediting body). Supervision is now a core component of continuing professional accreditation (cpd) and, indeed, is now viewed as a discipline in its own right with its own training route.

Supervisors should not follow outdated rulebooks

Supervision is not personal therapy. However, it would be naïve to think that the therapist’s personal material is not also relevant within the discussions in a supervision session. I recall from my training days a strict demarcation enforced by some supervisors between what was considered appropriate for the content of clinical supervision and what was considered personal material. I felt at the time that this demarcation to be a bit mechanical, as if the supervisor was following an outdated rulebook. It was almost like the supervisee could not refer in any way to any personal material possibly triggered by client material.  Such material was considered to be something that should be taken to personal therapy.  This approach, I feel, can be potentially shaming for the supervisee. It is my view that a good supervision session allows for a wide ranging airing of views and should not be restricted to strict mechanical ways of working. Supervisees should, of course, remain open-minded and inquisitive about other options when presented with a view about ways of working in supervision but should also avoid the temptation to hand their authority and accreditation away to others.

I wonder if the work of David Rennie on deference in the client therapist relationship could also be usefully applied to the supervisee–supervisor relationship. Indeed, I often muse if the word supervision almost unconsciously sets up the potential for a narcissist co-narcissist relationship. The supervisee can potentially be approaching the supervisor in the child ego state rather than entering into an adult to adult form of communication or as one professional to another.

Themes of control, management, hierarchy and power are often associated with the term supervision, particularly in periods of formal training. This ethos of deference is probably not that surprising since trainees need the supervisor to effectively approve them during periods of continuous assessment. However, the good trainees will be the ones who form their own opinions and learn to trust their own intuition rather than deferring to another.

Putting supervisors on pedestals is dangerous

Liking your supervisor is perhaps not an all together bad idea but putting them on pedestals is dangerous, as this is when narcissistic co-narcissistic relationships can take hold. The co-narcissist part of the relationship has the potential for an ego driven supervisor to feel boosted when in receipt of such admiration. When this happens the supervisor can fill the role of being a know-it-all.

A more mature approach to supervision might be to view the process as one professional exchanging unconscious material with another in an open-minded pursuit of different perspectives. In such an open-minded approach it can perhaps be useful to flirt with your hypothesis but not to marry it.

Parallel processing might result when the supervisor and supervisee re-enact in their relationship something that the client is not expressing. This form of projective identification might feel uncomfortable for the supervisee, and might not feel enjoyable, but could ultimately prove very useful for understanding the client better. An example of this might be a client who presents with historical shame and the therapist starts to connect with their own shame with the supervisor. This might be what Margaret Rioch referred to when she wrote about increased self-awareness for both parties. Feeling discomfort might actually be where the crux of the work might be residing rather than the apparent comfort zone when seeking to merge with the supervisor. Working in this way would be difficult if one party has been put on a pedestal by the other.

Role reversal can be useful, as the Gestaltist author Yontef suggests in the Handbook of Psychotherapy Supervision (Watkins, 1997 p158), in the exploration of counter-transference and gaining a different perspective. This can potentially involve the therapist playing the role of their client and acting in an ‘as if’ capacity. The therapist can act as if they are the client in the supervision setting and this way of working can be transformative in helping to realise unconscious material. This way of working might be difficult in a narcissist co-narcissist relationship.

Supervision should be like going on retreat

Rather than supervision, I prefer the terms ‘all vision’ or even ‘independent consultation’ as a process whereby the therapist can explore client material with a professional colleague. Supervisees should not feel like they need to justify their interventions with clients, or have to ponder too long as to whether they are ‘doing it right’. I don’t believe that the supervision consultation should be about right and wrong ways of working but for the exercise to have value it can offer the opportunity for the therapist to gain access to their own blind spots in their unconscious material and to consider other ways of working. Approaching the process in this manner will help protect against the risks associated with the creation of a narcissist co-narcissist relationship.

I like how Lady Diana Whitmore refers to supervision as akin to going on retreat where the therapist can explore client material in an uncensored way. This approach is very different to the tick box exercise when the therapist is required to fulfil professional accreditation and licensing requirements or to satisfy organisational demands. Supervisees attend sessions to stop and listen and to open their awareness. However, for the process to be effective it needs to be a two way process. The supervisor is providing the space for retreat, the holding for retreat and the transpersonal context for retreat, not sharing their own frustrations with their working day or the state of the profession.  I like what Houston says (1995, p95) that the supervisor takes the supervisee forward at the right pace toward self-confidence based on reality and toward abundant motivations.   This is when supervision is a containing and an enabling process rather than an educational or even neccessarily a therapeutic process.

See also

Hawkins and Shohet devised the 7 eyed model of supervision. See my interview with Robin Shohet. 

The 7 eyed model of supervision is:

Eye 1: Focus on the Client
Eye 2: Focus on Interventions
Eye 3: Focus on Client-Therapist Relationship
Eye 4: Focus on Therapist’s Process
Eye 5: Focus on Therapist-Supervisor Relationship
Eye 6: Focus on Supervisor’s Process
Eye 7: Focus on Wider Context

Share

Consultation or all vision, not supervision

Therapy Today Noel BellThis is my letter to Therapy Today, (you will need to scroll down to page 42), which was printed in the November issue, in response to an article on training in psychotherapy, (scroll to page 26), which appeared in the October issue (just click on the highlighted links). As an integrative therapist I try not to fit the client into one approach but endeavour to use whatever theoretical approach that suits and I believe that a good therapist is entirely flexible. Similarly, I believe it is also better that supervisors remain open to flexibility in their theoretical orientation rather than sticking to a fixed way of working.
The word supervision has apparently been debated for many years in our world as to the appropriateness of the term. Themes of control,management,superiority and power can often be associated with the description. I have often wondered whether the term itself sets up the potential for an unconscious creation of a narcissist–co-narcissist relationship. Some have argued that ‘independent consultation’ might be a more accurate term, as is often used in the USA.  I like the term ‘all vision’.

Share

Reflections on two years of my psychotherapy training

Holiday time finds me reading books which I had failed to read throughout the year, such as I’m OK you’re OK as well as books which I want to read out of pure interest.  I also find myself reflecting on the last two years as I pass the mid point in my training. I recall what tutors said on the opening evening of the course. They said that we as students would develop as counsellors in our own unique way throughout our time at the Centre.  There was not a CCPE way to developing as a therapist but that we would grow in our own individual way and find our own truth.  I am reminded of this as I write.

As a result I find that I ask myself what is my way?  Have I read enough? What is my approach to counselling and psychotherapy?  What does it mean for me to be an integrative psychotherapist? These are questions that will be perhaps a constant line of questioning throughout my journey as a therapist.

My second year at CCPE has been a time when I have revisited early life issues and experiences. Indeed, Rosemary Cowan [1] points out that the developmental model that CCPE suggested was very helpful to her.  She notes that trainees in the first year were likened to wide-eyed, enthusiastic primary school children; in the second year, like pre-teens, they gain confidence and independence but may also be ‘know-alls’ who overstretch themselves; in the third year they reach the rebellious, argumentative, difficult teenager stage; in the fourth year, with increased maturity and stability, they become more rounded, finished characters.  I am not sure where I fit in with this model but it is an interesting theory.

 I became more conscious of the emotional effects of group-work

I learned a lot about my early childhood experiences and how I act in groups following 16 weeks of group process. Families are, after all, our first blueprint for how we act in groups. It became evident to me that my early experiences were constellating in my life as an adult. I like what Bion [2] said about experiential groups. When under attack it is far more beneficial to one’s own learning process to try to observe that one is being attacked, and take in what that experience really feels like, rather than reacting to the source of the attack.It was also interesting to sit with how I felt about those in the group who didn’t participate in the group’s discussions.

My placement gave me an insight into the limitations of psychotherapy.

I had been fortunate to secure a psychiatric observational placement at an NHS Mental Health Trust where medical students were also on placement. It proved to be an amazing experience from a learning point of view as there were many specialist services in the Trust.

I had been familiar with Cognitive Behavioural Therapy (CBT) before the start of my placement through my lectures and my own prior knowledge. However, I attended a team meeting in a sexual behaviour unit in a forensics unit and learned about the Dialectical behaviour therapy treatment programme.  It was welcome to see that Zen techniques have been incorporated into the treatment models, even in the NHS.

My placement gave me an insight into the limitations of psychotherapy.  Some patients are so ill they lack the capacity for insight and a pharmacological treatment plan is critical for their recovery.  I believe we need to proceed with great caution when working with clients with psychotic conditions as there is often an absence of a healthy ego.

Gestalt Psychotherapy proved to be one of the most powerful components of the course so far

I have enjoyed the second year lectures starting off with short term therapy.  I found the lecture on short term therapy to be very helpful from a practical point of view given that I see clients for an initial period of six weeks at Help Counselling.   One or two lectures (though thankfully the minority) were uninspiring and at times I wondered whether we were really on a postgraduate level course given the poor quality of discourse in the room.

We had a three day weekend on Gestalt Psychotherapy, which for me, proved to be one of the most powerful components of the course so far.  The word gestalt is used to describe a phenomenon/concept in which the ‘whole’ is considered as greater than the sum total of all its parts.  I found the empty chair technique to be a good technique for dialoguing with absent parents, friends or colleague, dealing with unfinished business.

I believe that in psychotherapy clients make theory rather than theory making therapy. I need, therefore, to remain open-minded and use early life theory as a map which might be helpful in the navigation rather than as a set of rules. Pattern recognition is essential to good therapy. The primary difference between talking to our friends or Aunt Dorris is that counsellors are trained to look for patterns.

I believe that transpersonal psychotherapy is not alone in encompassing spirituality into treatment. Indeed, other modalities allow for the spiritual in their therapeutic approach but transpersonal psychotherapy actively involves the spiritual element in the client work.

 

[1] Therapy Today July 2012
[2] What is a Group? A discussion of Bion’s Experiences in Groups Antony Froggett 2005
Share

Group Supervision

I have now had my first group supervision session for my drop in centre.  It was an amazing experience to be amongst about 18 trainees bringing all sorts of issues to group discussion.  Confidentiality of client issues at drop in centres is usually within the context of the organisational framework and thus at group supervision you will hear  all sorts of presenting issues from drop in clients (counsellors maintain their own notes for their contracted clients who they might see at the centre).  I was struck by the dynamic in the room and of the incredible morale in the group.  Sir Alex Ferguson would have been proud.  Some trainees (in the 4th year) were having their last session that day and it was encouraging to hear their tribute to the group and the feedback they received from others.  They provided a very telling testimonial of their time at the centre and the benefit of having a robust group supervision framework in place.

Share