Why is it that some clients find their way into supervision from the beginning, while others barely get a look in?
How do you decide which clients to take to supervision? That sounds like a straightforward question for any of us to ask, as part of good reflective practice. However, scrutinising a question can often be more productive than replying to it – so, instead of giving an answer, let’s look at some of the basic premises underlying this one. I reckon four key assumptions are made.
The first assumption is that deciding which clients to take to supervision must be a conscious, deliberative process. Really? If you say you consciously decide, does this mean they are never unconsciously selected as well? We could get clever (or pretentious) on this point by engaging with neuroscientific findings about the reality of ‘free will’ and so on – but let’s work instead with an ordinary notion we’re all familiar with: the hunch.
They say a hunch is stronger than a guess but not as strong as an intuition. Although we employ ‘the professional hunch’ a lot of the time, we tend to underestimate its true value. Of course, we make carefully considered decisions too, but let’s not overlook the sudden wisdom of our hunches. For example, when it ‘comes to mind’ that I need to take a particular client to supervision, even if I then wonder about what’s going on with me and that person, I’m still not ‘choosing’ to take them for any obvious reason – but this does become clear later in supervision. When a piece of client work is seriously baffling or disturbing, I am very likely to take it, but other clients arrive in the supervisory space without any conscious intention on my part.
The second assumption is that choosing is necessary and unavoidable because it would be practically unworkable to take all your clients. This depends on what kind of supervisory arrangements you’ve devised for yourself. I know someone who runs six to eight therapy sessions a week. She has one-hour fortnightly supervision with me and two-hour monthly co-supervision with a colleague. This set-up means she can fulfil her self-imposed requirement to ensure all her client work is supervised. I admire her commitment, but some therapists might feel over-supervised in that situation.
One of my past supervisees had 15 appointments per week and saw me for one-and- a-half hours every month – ie the recommended absolute minimum* – so several of her clients were never mentioned, let alone discussed. I asked her to write a caseload summary every other month, with a thumbnail description of the work with each client, plus brief queries. With this ongoing information about all her clients, I could request we give some time to certain cases that caught my eye, but which she did not choose or intend to bring. Preparing in advance for clinical presentations of clients is often essential, but I believe it’s just as productive sometimes to bring them ‘unrehearsed’ and ‘unrefined’ – not so time efficient, perhaps, but still valuable for therapeutic insight and learning.
The third assumption is that supervision is always for the benefit of clients, therefore as many clients as possible should be taken to supervision. We assume supervision can benefit clients, and very often we feel it to be the case. In fact, we’re in the peculiar position of believing it’s beneficial, while knowing there is hardly any research evidence to support our belief. It would be more accurate to state that supervision is primarily for the benefit of supervisees. To put it in plain terms: we trust that whatever good stuff a supervisee derives from their supervision sessions, one way or another, it really does get passed on to their clients.
I hope that what you get mostly from supervision is support, understanding, challenge, development and encouragement for yourself, so that you are then well resourced, refreshed and ready to maintain the same or similar beneficence for your clients. If clients do benefit from supervision, it is mostly through a subtle, indirect transmission. The point is this: in order to gain the benefit of the supervisory space for yourself, it’s not a good idea to squeeze as many clients as you can into the room.
The fourth assumption is that clients themselves have no say in the matter. In principle, if they’ve read in your contract that you consult confidentially with a supervisor, any client could ask if you talk about them in supervision. A few practitioners tell some of their clients about their supervisory discussions anyway, and the remote supervisor can become a useful transferential figure. So, in some cases, the client’s own intentional input into the supervision process is central to the work.
What intrigues me is how certain clients leap straight into supervision from their first encounter and settle themselves there for a long time. They may be welcome, but who actually invited them? And then there are clients who suddenly ‘pop in’ while you’re presenting another case. I’m sure some clients unconsciously let the counsellor know they need to be supervised. In this sense, clients ‘bring themselves’ to supervision.
In contrast, people you conscientiously put on your ‘take to supervision’ list may never show up. They ‘get lost in transit’, or you always run out of time. Or, if you do introduce them, you soon find yourself trailing off. In this instance, it’s important to ‘hear’ what that individual’s psyche could be telling you about their absence from supervision. Perhaps some clients unconsciously instruct us not to share anything of their story with anyone. With this in mind, we can invigorate our sense of choosing who we take to supervision – reluctantly or otherwise.
In BACP documents, the figure of one-and-a-half hours per month is always stated as the minimum for accreditation purposes. I’ve met many practitioners who wrongly take this to mean a ‘sufficient’ or ‘correct’ amount.
1. Wheeler S, Richards K. The impact of clinical supervision on counsellors and therapists, their practice and their clients: a systematic review of the literature. Counselling and Psychotherapy Research 2011; 7(1): 54–65.
2. Davies N. Research and literature overview of supervision within the counselling professions. Good Practice in Action 043. BACP 2016.
Jim Holloway is a senior accredited counsellor and supervisor, a partner in Cambridge Supervision Training, and a co-author of Practical supervision: how to become a supervisor for the helping professions (JKP 2014).
Summer 2017 Private Practice 25
Encouragement: An Essential ingredient of Supervision - Anthea Millar
Supervision comes in many shapes and sizes, inspired by numerous models and theoretical orientations. Yet when ‘unpeeled’, it seems there is a common ingredient at the heart of all effective supervision practice: encouragement. This is also an essential value at the heart of our Cambridge Supervision Training courses and the book Practical Supervision: How to Become a Supervisor for the Helping Professions co-authored with my colleagues Penny Henderson and Jim Holloway.
Adler, over 80 years ago, took an optimistic view of human nature, believing that a need to belong and contribute to the group is inborn in each individual. However, humiliation and shame, disconnection and disgrace, inferiority and deficiency are deeply threatening dangers to us all, and prompt us to lose courage (feel discouraged) in making positive connections and contributions. So we may resort to patterns of self-destructive behaviours if, in our family of origin, we experienced these forms of discouragement. Adler also suggested that neither heredity nor environment is the ultimate determiner of personality. Instead he believed that this desire for pro-social behaviour is embedded in us, and we all have the capacity for constructive change (Ansbacher and Ansbacher 1956). And crucially, this change is most likely to occur in a relationship with a person who is encouraging.
Encouragement has been described as: ‘…the process of facilitating the development of the person’s inner resources and courage towards positive movement. The encouraging person helps the discouraged person remove some of the self-imposed attitudinal road blocks.’ (Dinkmeyer and Losoncy 1980 p 16). Looking more specifically at supervision, Lemberger and Dollarhide (2006) state that the process of encouragement can ‘..assist the supervisee to aspire to the highest possible level of professional competence. Encouragement is literally “entering the courage” and assets possessed by the supervisee….(it) can further buttress the working relationship between the supervisor and supervisee and open up new meaning-making opportunities for both…’ (p119).
In a bid to identify the many forms that encouragement can take, and having a bit of fun with alliteration, I have created a diagram that aims to illustrate my thoughts about the main Elements (or ‘E’s) of supervision. These elements are ordered to echo key phases in the supervision process, and are framed by encouragement.
Where there is a clearly contracted working alliance that is underpinned by a strong ethical framework, such as that provided by the BACP, both supervisor and counsellor can work more courageously. The increased courage comes from being supported by a set of principles that are not there to ‘police’ but to encourage mature reflection. Without the encouragement of an ethical frame, dilemmas can seem insurmountable; or of much greater concern, we may miss the dilemma altogether, and unwittingly enter into unethical practice, becoming both discourager and discouraged.
The Essential ‘E’s
Equality and Empathy‘To be human means to have inferiority feelings’(Adler 1964 p54). Adler suggested that the development of inferiority feelings result in large part from subjective childhood comparisons with other family members. As these feelings are so uncomfortable, we compensate by striving to overcome them through such patterns as superiority and perfectionism. Here’s where problems can arise in the supervisory relationship. This ‘slippery pole’ dynamic of inferiority and superiority will show itself as a discouraging power imbalance, that destroys a sense of equality.
Equality does not mean that the supervisor and supervisee need to have the same level of experience, values or theoretical orientation – what it does mean is that there is a cooperative partnership that acknowledges and honours difference. By not getting caught into ‘How am I doing in comparison to others’, and reflecting instead on: ‘What am I doing?’, we then offer a supervision space based on equality that encourages supervisees to risk disclosure of problematic issues much more readily.
Most counselling and supervision approaches have empathy as a fundamental basis to the relationship and I certainly see this as essential to offering an encouraging frame for the supervision work. However encouragement is always about authenticity, where a willingness to be honest (congruent) with a supervisee is as important as offering of empathic understanding.
Exploration and Enabling InsightEnabling the supervisee to present and explore what is going on, whilst keeping a careful eye on the client’s well being, is a complex task. As supervisors, we may be tempted to come in too early with our theories, interpretations and answers. Equally, with the aim of being empathic, we may delay intervention, listen attentively, but offer no focused input to the supervisee. One example of very many interventions that can encourage supervisees to explore and gain insight is the process of Socratic questioning (Millar 1999).
Using Socratic questions, the supervisor does not play the role of expert or authority. The skill of the supervisor is in having an idea of what direction would elicit the most useful information, clarification, or insight. Each new question is based on the supervisee’s previous answer or statement. Gradually, the supervisees are led to their own insight, and make their own conclusions as to what they are doing, and what they could be doing more effectively.
Education and ExtensionWhether in the role of supervisor or supervisee, taking risks and extending our skills is often deeply encouraging. Our learning can be particularly rapid after making mistakes or discovering gaps in our knowledge. However it is at exactly these moments that we can feel most vulnerable to inferiority feelings. By protecting ourselves from this discomfort, we are not protecting the client, and poor practice may be perpetuated. Supporting the supervisee to have ‘the courage to be imperfect’ (Dreikurs 1970) through feedback that will educate and extend, is an essential aspect of taking supervisory authority (Henderson 2006). So how can this verbal feedback be offered encouragingly so that it is neither punitive nor unhelpfully praising? (Dreikurs 1958, Dweck 1999, Kohn 1993).
Adlerian practice puts the emphasis on first identifying a person’s strengths, before presenting areas for development and change. This provides a firm base from which we can be more receptive to other forms of feedback. A similar process can be used both for identifying strengths and challenging areas for growth, as verbal encouragement, differentiated from praise, focuses on what the person is doing, rather than how the person compares with others. This is achieved by avoiding the use of single adjectival labels such as ‘good’ ‘unethical’, ‘clever’, ‘non empathic’, and also by keeping in mind the assets and positive intentions of the supervisee. By using descriptive language, paying particular attention to verbs, feedback offered is very specific, identifying what the supervisee has actually been doing. From this base, the supervisor may add their view, or provide educative information as appropriate.
EffectivenessLast, but not least, is the need to assess not only the supervisee’s competence, but our own effectiveness as a supervisor. Some crucial ways for the supervisor to ensure this include regular opportunities for mutual feedback between supervisor and supervisee, supervision for the supervision work, ongoing professional development and further supervision training.
Encouragement is a many faceted process that is the essential ingredient for supervision. But it is not easy. I have continually to deal with my own tendency to move into a superior and judgmental mode, but have discovered, gratifyingly, that when I am more encouraging, I actually feel more encouraged. So I would invite all supervisors to reflect on what they might develop further to ensure encouragement is at the heart of their supervisory practice. This practice will in turn encourage and enable the most important person of all: the client.
ReferencesAdler, A. (1964) Social Interest: A Challenge to Mankind. New York: Capricorn. (Original work published 1933)
Ansbacher, H.L. & Ansbacher, R.R. (Eds). (1956) The Individual Psychology of Alfred Adler. New York: Harper & Row
Dweck, C (2000) Self Theories: Their role in Motivation, Personality, and Development. Philadephia: Psychology Press.
Dinkmeyer, D. & Losoncy, L.E. (1980) The Encouragement Book. New Jersey: Prentice Hall
Dreikurs, R. (1958) The Cultural Implications of Rewards and Punishment. The International Journal of Social Psychiatry. Vol IV, No 3, Winter 1958
Dreikurs, R. (1970) The Courage to be Imperfect. In Articles of Supplementary Readings (Chicago: Alfred Adler Institute 1970)
Henderson, P. (2006) Learning to take Supervisory Authority. In P.Prina, K.John, C.Shelley, A.Millar (Eds). UK Adlerian Year Book 2006. London:ASIIP pp 40-49
Henderson, P., Holloway, J. and Millar, A. (2014) Practical Supervision: How to Become a Supervisor for the Helping Professions. London: Jessica Kingsley Publishers.
Kohn, A. (1993) Punished by Rewards New York: Houghton Mifflin.
Lemberger, M.E. & Dollarhide, C.T. (2006) Encouraging the Supervisee’s Style of Counseling: An Adlerian model for Counseling Supervision. The Journal of Individual Psychology. Vol. 62:2, pp106-125
Millar, A. (1999) The Use of Socratic Questioning in Classical Adlerian Therapy. In P.Prina, C.Shelley, C.Thompson (Eds). UK Adlerian Year Book1999. London:ASIIP