On Parallel Process in Social Work Supervision

The recognition and study of parallel process in social work supervision offers both the social work supervisor and supervisee a rich learning opportunity at the moment when an impasse seems unworkable. The parallel process is an unconscious replication in the supervisory session of therapeutic difficulties which a supervisee has with a client. This replication may originate with the supervisor unwittingly modeling behavior that is then taken by the social worker into the therapeutic interaction with the client. This paper reviews the need for social workers to grasp the dynamics of the parallel process, discusses the literature for the historical development of the phenomenon, addresses supervisory methods that will uncover the process, and illustrates the supervisor's stages of exploration and modeling in addressing the parallel process.     

The Intersubjective Experience of the Physical Body in the Clinical Setting of Eating Disorders

This paper will illuminate one dimension of self-disclosure as it relates to the inescapable presence of the body in treatment, and the female clinician’s ability to bring her physical body into clinical discussions during an encounter with a female client with an eating disorder. Although the clinical literature on eating disorders validates that transference and countertransference issues are particularly powerful, it generally neglects the exploration of these issues specific to the body’s physical presentation. Since body dissatisfaction is increasingly normative for women today, female clinicians need to have a theoretical road map on which to rely when they encounter a shared body experience. Thus, in order to encourage discussions of the therapist’s body in clinical social work practice, the body needs to be situated in a larger theoretical framework within which it can be explained and located; this framework is object relations theory viewed through an intersubjective lens. Concepts from object relations theory will demonstrate the importance of the body in the clinical exchange by highlighting the parallel between Winnicott’s ‘good enough’ mother and the ‘good enough’ therapist’s body. When the therapist is able to judiciously invite discussions of her body into the clinical arena, the client is given the opportunity to move from object relating to object usage. A case presentation exemplifies how this conceptual framework can be applied to clinical social work practice, strengthening the relationship between knowing and doing.     

The role of empathy in supervision

Empathy plays an important role in clinical supervision. It is the link between the client whose treatment is being supervised, the clinician/supervisee, and the supervisor. The supervisor uses an empathic capacity as well as theoretical knowledge to understand the clinical work and build the supervisory relationship. Often the progress of a case can be traced through the development of empathic understanding in the supervision. The transmission of empathy requires creativity and openness and is one of the major challenges in supervision. By analyzing the different uses of empathy in clinical supervision we can increase our understanding of the supervisory process.     

Relational Quandaries in the Treatment of Forensic Clients

This article examines the sources of relational difficulties inherent in clinical work with forensic clients. Left alone, common countertransference feelings, responses, and defense mechanisms can disrupt and ultimately derail treatment. Concepts relating to the management of countertransference offer a path with which to integrate therapists’ affective reactions as a mechanism of therapy. A relational framework utilizing the affective dynamics between client and therapist to develop and promote treatment goals is introduced and the process of formulating it is described. Practice examples are offered.     

Supervision of trainees: Tending the professional self

This article seeks to demonstrage how self psychological concepts can be applied to the process of training psychotherapists in a variety of clinical and community settings. The author examines the role of clinical supervision in the development, consolidation, and maintenance of a cohesive professional self. The role of selfobject experience, needs, transference, and countertransference as manifested in the supervisory relationship is elaborated. Supervisor and supervisee form a self-selfobject unit, through which the trainee's anxieties and vulnerabilities can be managed. This selfobject matrix enables maintenance of self-esteem, expansion of cognitive understanding, and structure building in the arena of the professional self. To achieve these ends, the supervisor forms an empathic alliance with the internal, subjective experience of the therapist. The importance of focusing on the self experience and selfobject needs of the therapist in training via an empathic mode of observation is illustrated by several examples and vignettes. The application of theory to practice is emphasized, with examples chosen from a variety of clinical settings and modalities.     

THE RELATIONSHIP AMONG SELECTED SUPERVISOR,THERAPSIT, AND CLIENT BEHAVIORS*

This study examined the extent to which supervisory phone-ins were related to change in both immediate therapist behaviors and subsequent change in resistant behaviors of client family members. Of specific interest was whether the congruence of supervisor and therapist behaviors (referred to as isomorphism by some family therapy authors) would be related to immediate change in client resistance. The quality of supervisor's Support and Teach behaviors was foundj to be significantly related to the change in the quality of the threrapists' Support and Teach behaviors. Moreover, in instances where both supervisors and their supervises demonstrated effective Support and Teach behaviors, clients generally tended to either remain cooperative or become cooperative more frequently than when both effective supervisor and supervisee behaviors where not present.     

Developing a Working Model of Cross-Cultural Supervision: A Competence- and Alliance-Based Framework

Despite numerous suggestions to integrate culture, diversity and social justice issues in clinical supervision, empirical studies on cross-cultural supervision indicate limited uptake of such recommendations. We suggest that a comprehensive model of cross-cultural supervision could benefit the field by guiding supervisors in this task. A working model is proposed based on a foundation of the supervisory alliance and a focus on social work practice competence, integrating strategies to promote self- and relational-reflexivity within the supervisory relationship. The model is comprised of four components: component 1: goal setting to contract on cross-cultural integration in supervision; component 2: active listening for cross-cultural markers; component 3: bonding through the supervisor’s self-reflexivity to foster the supervisee’s self-reflexivity; and component 4: working through tasks for cultural integration in supervision by modelling the supervisor’s relational reflexivity in case formulation and treatment to foster the supervisee’s relational-reflexivity.     

Supervising Mental Health Clinicians in The Context of Complex Organisational Dynamics

This article discusses the complex dynamics and challenges of providing supervision to mental health clinicians working within an organisational context when the supervisor is not part of the organisation and has no formal managerial or accountability responsibility. It considers two models of supervision and their application to three supervisory relationships in an organisational context. It concludes that for supervision to be effective there needs to be a consideration of the social defences in operation within the organisation and how they are met by the anxieties and defences of the supervisor and supervisee. This requires a mixed approach by the supervisor of the technical with the inter-subjective as a reliance on one model of supervision risks limiting the effectiveness of the intervention. The role of the supervisor can enable the supervisee to establish a clinical framework and the necessary environment essentials for their practice.     

Resolving Some Therapeutic Impasses by Disclosing Countertransference

Clinical social workers have been shifting their conceptualization of countertransference from the traditional classical modal of a one-person psychology nearer to a two-person psychology, thereby moving the ideal of the blank screen model to one of participant observation. With a two-person psychology now more in vogue, clinical social workers feel much more inclined to share some of their countertransference responses with their patients. Where there is limited consensus is embodied in the question: “Under what circumstances is countertransference disclosure most helpful to our patients?” This paper is an attempt to demonstrate through case vignettes how countertransference disclosure can resolve certain types of therapeutic impasses.     

Countertransference with adolescent clients of the same ethnicity

This article addresses countertransference in therapeutic relationships involving therapist and client from the same ethnicity. A case illustration of a Japanese adolescent and a Japanese therapist is used to develop the thesis that obvious similarities in race, or culture may lead to invalid assumptions about shared beliefs and values and subtle countertransference manifestations which have the potential to disrupt or prevent the development of a working relationship.in private practice.     

Responsive Persistence Part I: Therapist Influence in Postmodern Practice

Feminist and social constructionist developments in family therapy highlighted the importance of attending to therapist–client power relations and incorporating clients' understandings and preferences as a part of therapy. Significantly, less attention has been given to how postmodern therapists do use their power and influence. This is an important topic because it is therapists who have the major responsibility for guiding the interaction with clients and persisting in this so that change is facilitated. Therapist persistence in various forms and across dimensions of therapy process is examined to expand understanding of therapist influence in postmodern and collaborative work. An analysis of responsive persistence in a session with Karl Tomm as the therapist is presented to illustrate this conceptual framing.     

In the Shadow of Death: Relational Paradigms in Clinical Supervision

The process of clinical supervision is a complex undertaking that is influenced by multiple factors, including the personalities and characteristics of the supervisory dyad, developmental considerations, social attitudes, ecological factors and the parallel process. The supervisory interchange becomes even more difficult and complex when it occurs in the context of HIV and AIDS related practice, which introduces the reality of untimely death accompanied by grief and loss. In this paper, I will review the literature in regards to developmental aspects of the supervisory relationship, transference and countertransference paradigms and the parallel process. These particular issues will be framed within a relational perspective and the ways it shapes the supervisory process. The focus of this paper will be clinical work with clients diagnosed with HIV and AIDS and the impact of death and dying on the supervisory paradigm. The literature review will be elaborated on through a clinical vignette followed by an extended discussion.     

Mechanisms for Building Working Alliances in Clinical Supervision

While social workers and researchers acknowledge the importance of a positive working alliance between service providers and clients, less is known about mechanisms for developing working alliances between supervisors and supervisees. The Alliance Building: Learning to Engage (ABLE) model was developed to measure and enhance the supervisory relationship. The ABLE model consists of a tool for continuous measurement of the supervisory working alliance as well as several research supported resources. This two part study assessed the reliability and validity of the ABLE supervision tool (ABLE-S), and then a randomized control trial pilot study was conducted to determine if the use of ABLE in supervision improves the professional quality of life and occupational self-efficacy for supervisees. Analyses revealed the ABLE-S tool is a reliable and valid form for measuring supervisory working alliance, but the use of ABLE in supervision did not have a significant effect on supervisee outcomes compared to the control group. The findings suggest additional training on proper implementation of ABLE and expanded measurements to capture several confounds inherent in the supervisory context are needed in future studies. Practical implications of using ABLE include effective strategies for promoting positive supervisee development and reducing negative effects of stressful work environments that often exist in the social service field.     

Field practice supervision of social work students: a psychodynamic view on the emotional context of the process and the setting during the client assessment phase

This empirical study is a psychodynamic view of the supervision setting and key emotional parameters during the client assessment process. The supervisor, through reflectivity, studied his own supervision practice with undergraduate social work students during their first field practice placement. By using supervision critical incidents, he formulated the basic characteristics of the supervision setting, and followed it up with discussion on the key emotional parameters of the supervision process. Particular emphasis was laid on psychodynamic understanding of the supervision process and the consequences of supervisor's interventions for both supervisees and clients. The emotional context of the supervision process during the client assessment phase was predominantly shaped by four emotional parameters: (i) the supervisor identifying with both client and supervisee needs; (ii) the supervisor concentrating on exclusively the educational character of supervision by avoiding dealing with student's personality issues; (iii) the supervisor dealing with client and supervisee ‘transferences to the setting’; and (iv) the supervisor setting and safeguarding the supervision limits and boundaries.     

Borderline Personality Disorder: Foundations of Treatment

The move from social work practitioner to supervisor can cause a crisis in identity for some social workers, a point at which professional values, roles and commitment are questioned and re-analysed. Yet it is an area in which there appears to be little written to assist the worker to normalise their fears and anxieties, or to assist with making the process smoother for both supervisor and supervisee. Drawing on practice experience in a range of health and community service settings, the present study will examine some of the feelings, issues, challenges and dilemmas faced by new social work supervisors. It will also explore the preparation of supervisors, the use of power in the supervisory relationship and the need for training. It will then discuss tips and conditions for improving the supervisory relationship.     

Teaching the Use of Self Through the Process of Clinical Supervision

In their efforts to learn the skills involved in the use of self, clinical social work supervisees are faced with the daunting task of integrating information coming not only from the patient but also from their own complex set of responses. The clinical supervisor serves a key role in guiding the trainee through this process. Grounded in contemporary psychodynamic theory, this paper discusses an approach to helping the supervisor model the use of self in the context of the supervisory relationship. A supervisory case example is used to illustrate.     

Tape recorders in clinical sessions: Deliberate and fortuitous effects

Literature indicates that tape recorders have five purposes in clinical work: observation of sessions; teaching, research, recording, and treatment adjunct. Experience indicates that when a tape recorder is used for any of these purposes, client responses to the tape recorder can express transference or psychopathology. Such client responses can be used to deepen sessions. Experience also indicates that therapist responses to the tape recorder occasionally impede practice. However, therapists using tape recorders typically work at peak levels, because the tape recorder symbolizes recognition by others.     

Constructing Critical Conversations in Social Work Supervision: Creating Change

Clinical social work supervision is not immune to enactments of racial and social injustice, prejudice, power and privilege rampant in our social environment and institutions. These dynamics are active in all social interactions. Most often felt on impact, these remain underground and unevenly experienced—though predominantly by people representing intersecting marginalized identities. Such real enactments can be misunderstood or avoided in social work supervision. Negative consequences not only impede learning for the supervisee and supervisor, and affect clinical understanding of client care they also perpetuate injustice based on power and social locations. Social work supervision provides space for critical analysis to identify and alter dynamics of power, privilege, and social oppression. The critical conversations (CC) model provides a framework to illuminate and examine power dynamics in order to produce change with parallel insight and action—supervisee, supervisor, and client care. Supervisee and supervisor gain capacity to engage in reflection, examine personal and professional values, hold tension and tolerate ambiguity, use one self critically, articulate ideas and insights thoughtfully and effectively, as well as inform clinical understanding of clients. The need for critical dialogue in social work supervision regarding dynamics of sameness, differences, intersectional identities, power and privilege is emphasized. Theoretical grounding is offered to elucidate how complex structural forces of oppression and privilege, cultural patterns and narratives are internalized. A definition of CC, its theoretical underpinnings and the CC model are presented with a case scenario to illuminate the application of the CC model in clinical supervision.     

Less assessment and more suggestions please: Factors contributing to effective supervision of counsellors at different experience levels

Abstract

Twenty-two supervisors and 60 supervisees working in community counselling services in Melbourne were asked to rate the importance of 46 supervisory behaviours to good supervision, as well as listing behaviours that contribute to and detract from good supervision. In general, supervisors saw good supervision as relating primarily to feedback to the supervisee, while supervisees were interested in learning new skills and gaining assistance with conceptualisation in supervision. The responses confirmed evidence of differing supervisee and supervisor perceptions of supervision seen in previous research of students' supervisory needs in America.

Differences in responses from supervisees in this sample to the American sample suggest some cultural differences and some differing needs attributable to different levels of experience. Responses in the current research support a developmental model of supervision; that supervisees have different needs as they gain experience. Applying a process model to behaviours believed to contribute to and detract from good supervision revealed that the bulk of responsibility for a good supervisory relationship is attributed to supervisors. Neither supervisors nor supervisees indicated a high level of supervisee qualities and skills that contribute to good supervision. This has obvious training implications.     

A study of live supervisory phone-ins in collaborative family therapy: correlates of client cooperation

The behavior of five supervisors, 19 trainee family therapists, and 20 clients before, during, and after 88 live supervisory phone-in events was examined in this study to determine the correlates of client cooperation. Following supervisory phone-in conversations, client cooperation was associated exclusively with the presence and quality of the collaborative behavior shown by the therapist. Isomorphism between the behavior of the supervisor and therapist was not associated with subsequent client cooperation, nor was any particular category of supervisor behavior. Surprisingly, isomorphism between the quality of supervisor and therapist behavior preceded those events where client resistance occurred.