EMOTIONALLY ATTUNED SUPERVISION: ROBERT KAFES 1

Emotionally Attuned Supervision: An interview with Robert Kafes, DCSW, ACSW, LCSWBy William Harryman

To suggest that Sigmund Freud and his psychoanalytic model have fallen out of favor in the education of contemporary counseling students would be a gross understatement. Most students get little more than the id, ego, and super ego, along with a brief discussion of transference and countertransference and psychological defenses. While there may be lip service paid to the development of object relations, attachment theory, Self Psychology, and maybe even relational psychotherapy from Freudian concepts, there remains a stigma associated with Freud and psychoanalysis. Stephen Mitchell has tried to dispel some of the myths about psychoanalysis (Freud and Beyond, 1995), but many of them persist, even in counseling programs.

Despite the dearth of teaching on psychoanalytic thought, there are many practitioners and students who use this model in part or in whole. Robert Kafes, a licensed clinical social worker and board certified diplomat, has been working in the psychoanalytic tradition as long as he has been practicing (1971). He has been conducting psychoanalytically-informed supervision for almost as long, since 1973, having been trained through an exercise of recording and critiquing process notes line by line. His psychoanalytic supervision training focused on the awareness of transference, countertransference, defenses, and resistance in the supervisee. Kafes continued to pursue his own education, reading and researching the newest models and techniques, as well as teaching and co-teaching supervision courses for the National Association of Social Workers (NASW), the Board of Behavioral Health Examiners (BBHE), and the Southwest School.

As a result of his supervision experience and in working with the various existing models over the years, Kafes has developed his own model based in psychoanalytic Self Psychology – Emotionally Attuned Supervision. His supervision model, in many ways, is similar to his therapeutic model. The foundations of his model are in Self Psychology, including concepts such as mirroring, idealizing, twinship, adversarial needs, vitalizing needs, and spirituality. Added to that framework is the more post-modern relational model, as described by DeYoung (Relational Psychotherapy: A Primer, 2003). The following is a paraphrase of how this particular supervision model might be defined, using Kafes’ definition of relational therapy as a foundation:

Supervision is a supervisee-directed relationship used systematically and purposefully to integrate and facilitate the supervisee’s potential. Growth occurs through transforming dimensions of intimacy between supervisor and supervisee. The supervisor’s professional use of self becomes a primary human connection through which development happens. Within their evolving participation, both supervisee and supervisor create a coherent narrative about who the supervisee is as a therapist while engaging in the act of making sense of that process together. (Kafes, personal communication, 2011)

While this may appear lofty and abstract as it is defined, it’s a whole other thing in practice.

The Supervision Process Kafes understands his primary responsibilities as a supervisor to be monitoring (the supervisee-client relationship) and mentoring (the supervisee as a therapist). When the

supervision relationship begins, there is a very specific contract created between Kafes and the supervisee, spelling out in detail the perceived goals and how progress will be measured or assessed. This contract is a written agreement, although it can be revised from time to time through the supervision process. In addition, Kafes continually monitors and assesses the supervisee’s progress and development – at all times, he is ultimately responsible for the care of the client.

In many instances, the supervisee has been the subject of ABBHE censure, and the supervision process is mandated by the Board as a condition of remaining licensed. In these cases, Kafes bases his assessments on a form provided by the Board and the benchmarks that must be met are determined by the adjudication ruling. In other situations, there is a three-way contract between the agency, the supervisee, and the supervisor. In whatever situation the supervision occurs, Kafes first and foremost seeks to assess the developmental stage of the supervisee. Although it was not discussed in the interview, Kafes likely employs a developmental model similar to the Rønnestad and Skovholt Model (Bernard and Goodyear, 2009, p. 97) in determining the experience level of supervisees.

No matter the circumstances of how one enters into supervision, however, Kafes sees his role, again, as similar to his role as a therapist – to create a “safe harbor” or safe space, to be trustworthy and reliable. Being a good supervisor requires being empathic with the supervisee’s needs and emotional states. This is the foundational element of psychoanalytically-based relational psychotherapy:

[Kohut] argued that the appropriate response is an empathic or “experience-near” understanding of the individual’s needs to take in and utilize the other (the self-object) in a manner that silently performs missing functions within one’s own self—without necessarily acknowledging these significant external contributions. (Pollack, 2003, p. 1208)

One apprehends in this definition issues around mirroring, idealizing, twinship, and modeling – all of these are as important in the supervision process as they are in the therapeutic relationship. For the supervisee, the mentor/supervisor can often become an idealized image serving as both a model and an idealized other and, in this exchange, the possibility of transference and countertransference arises as a means of growth.

Psychoanalytic SupervisionAs mentioned above, the four essential elements in psychoanalytic supervision are

transference, countertransference, defenses, and resistance. Each of these is a relational construct in that it takes two or more people to create the transference or the resistance, for example. Another example of how these processes might play out between the supervisor and the supervisee, and therefore become part of the supervisory relationship, might appear as follows:

Unresolved or problematic matters that reverberate between therapist and patient can be unconsciously transported and enacted in the supervisory relationship, for example, the patient might elicit a harsh, judgmental response from the therapist who, when discussing the patient in supervision, elicits like treatment from the supervisor (see Langs & Searles, 1980, p. 132); conversely, matters between supervisor and supervisee may make their

way into the therapeutic relationship (e.g., where the supervisor repeatedly acts toward the supervisee in an unnecessarily harsh fashion and the supervisee carries that rage forth, treating the patient with anger). (Watkins, 2010, p. 395)

From the relational perspective, the growth and the development of the supervisee is dependent on these processes coming into play, although one clearly would want to minimize the occurrence of “harsh” actions or reactions toward the supervisee. Moreover, it is the responsibility of the supervisor to remain attuned emotionally and empathically to the subjectivity of the supervisee so as to create the “safe space” that is understood to be necessary for personal and professional growth. If the supervisor is attuned, harsh reactions are unlikely.

As Herron and Teitelbaum (2001) observe, however, misattunements are bound to happen – try as one might, it is not possible to always be fully attuned (relating subject to subject rather than subject to object):

Because of the narcissism of both people in a dyad, the recognition and respect for the subjectivity of the other will vary, so that there will often be times in which the subject-object relationship style predominates. Thus Benjamin (1995) points out, ‘‘breakdown is a common feature within intersubjective relatedness--what counts is the ability to restore or repair the relationship’’ (p. 47). (Heron &Teitelbaum, 2001, p. 152)

When the supervisor repairs these empathic failures, however, s/he is modeling for the supervisee how to do this same work with the client. A lot of what happens in the supervisory relationship is a form of teaching by example, wherein the supervisor models the appropriate clinical behavior so that the supervisee can both experience it and begin to integrate it as a potential behavior.

According to Kafes, this is true of the supervisory relationship as well. How the supervisor and supervisee are in relationship is an experiential model that the supervisee can then take into the relationship with the client. In the psychoanalytic literature, this triadic relationship is referred to intersubjectivity (although this term has other meanings as well).

Intersubjectivity in clinical supervision involves the subjective reactions of the client, therapist, and supervisor to one another, reflecting the unfinished business and personality of each member of the triad (Brown & Miller, 2002). The intersubjective perspective is emerging as a contemporary model for understanding the co-participatory nature of psychotherapy, as well as the reciprocal mutual influence processes of supervision (Fiscalini, 2004; Frie & Reis, 2005). (Southern, 2007, p. 280; see also Heron &Teitelbaum, 2001)

Kafes stressed this element of the supervision process – the attunement between the supervisee and supervisor is then carried into the supervisee relationship with the client. Of course, this intersubjective relationship will bring up issues in both the supervisee and the supervisor, which can look very much like therapy.

Supervision vs. Therapy (and other ethical issues)As Bernard and Goodyear (2009) point out early in their textbook on supervision, there

are going to be elements of that relationship that resemble therapy. The key distinction for them,

as well as for Kafes, is that in the supervisory relationship, any therapeutic interventions must be limited:

Therapeutic interventions with supervisees should be made only in the service of helping them become more effective with clients: To provide therapy that has broader goals is ethical misconduct (see, e.g., Ladany, Lehrman-Waterman, Molinaro, & Wolgast, 1999; Neufeldt & Nelson, 1999). (p. 9)

For some psychoanalytically trained therapists, these boundaries, while acknowledged and respected, are a little less rigid, but this is only a recent development resulting from the increased influence of the intersubjective models (see Sarnat, 1992). While acknowledging that there will be times when the supervision process does become therapeutic – in that the material interfering in the therapy is deep-seated in the supervisee – Kafes prefers to maintain those boundaries as much as possible. When necessary, he refers supervisees out for more in-depth and long-term therapy.

While the therapeutic aspect is one common ethical issue in supervision, the more common issues Kafes sees in supervisees are boundary crossings and boundary violations. Interestingly, he said that he would rather work with supervisees who cross boundaries (short of the bigger issues such as sex or harm) than those who do not take those risks. In his experience, it is easier to reign in and contain a supervisee with good intentions – who cares a lot about the client – but who has poor boundaries than it is to train a supervisee who is less caring or involved to become more so. He can teach “holding to the frame,” but he cannot make people more empathic or more caring if that is not their nature.

Finally, Kafes views self-disclosure in supervisors much the same as in therapists – does it further the work? However, there are different layers involved in this triadic relationship. Very often this issue is not about supervisors self-disclosing, but rather about the supervisee self-disclosing with the client. This is far too broad a topic to be handled here, but Weinstein, Winer, and Ornstein (2009) offer an excellent overview of the relevant issues for the supervisor, including a “close study of a supervisory session dealing with self-disclosure” as a way to “to develop a more general conceptual framework” for thinking about supervision (p. 1380).

ConclusionOne of the most salient characteristics of Kafes’ interpersonal psychoanalytic model –

Emotionally Attuned Supervision – is its adaptability to a variety of theoretical perspectives. While a supervisee looking for clearly defined and mirrored Cognitive Behavioral supervision would be advised to look elsewhere, Kafes’ model is open to various perspectives because his focus is on the relationship the supervisee forms with the client more than the techniques employed (although this is also important). His passion is for helping the supervisee be the best and most caring therapist possible. Perhaps this is why his consultation groups are so highly praised by working therapists in Tucson.

ReferencesBernard, J.M. & Goodyear, R.K. (2009). Fundamentals of Clinical Supervision, Fourth Edition.

Upper Saddle River, NJ: Pearson Education, Inc.DeYoung, P.A. (2003). Relational psychotherapy: A primer. New York: Brunner-Routledge.

Herron, W.G., & Teitelbaum, S. (2001). Traditional and intersubjective supervision. The Clinical Supervisor, 20(1), 145-159. doi:10.1300/J001v20n01_11

Mitchell, S. A., & Black, M. J. (1995). Freud and beyond: A history of modern psychoanalytic thought. New York: Basic Books.

Pollack, W.S. (2003). Relational psychoanalytic treatment for young adult males. Journal of Clinical Psychology/In Session, Vol. 59(11), 1205–1213. DOI: 10.1002/jclp.10211

Sarnat, J.E. (1992, June 1). Supervision in relationship: Resolving the teach-treat controversy in psychoanalytic ssupervision. Psychoanalytic Psychology, 9(3), 387-403.

Southern, S. (2007, Oct. 1). Countertransference and intersubjectivity: Golden opportunities in clinical supervision. Sexual Addiction & Compulsivity, 14:279–302. DOI: 10.1080/10720160701480808

Watkins, Jr., C.E. (2010). Psychoanalytic constructs in psychotherapy supervision. American Journal of Psychotherapy, 64, 4; ProQuest Psychology Journals: 393-416.

Weinstein, L.S., Winer, J.A. & Ornstein, E. (2009, Dec.). Supervision and self-disclosure: Modes of supervisory interaction. Journal of the American Psychoanalytic Association, vol. 57 no. 6: 1379-1400. doi: 10.1177/0003065109356576