Socializing the Psychotherapist-in-Training to an Alternative Form of Relatedness:The Transition from “Being Nice” to “Being Therapeutic” in Clinical Supervision

 James Tobin, Ph.D.

Argosy University, Orange County, CA

Introduction: “Sterile”

Supervision

Supervision as Metaphoric Experience

Seven Guiding Principles and Supervision Techniques Summary

The supervisory relationship is arguably the student therapist’s most significant experience in clinical training (Ekstein & Wallerstein, 1972). However, an approach to supervision that offers supervisees, especially those early in their training, exposure to a way of being with clients in which relational processes are emphasized over micro-skills such as rapport building and reflective listening has not yet been articulated. Many supervisors approach supervision in an undetermined way (Milne & James, 2002), often resulting in their being primarily didactic or adopting a collegial role. Consequently, a sterile supervision often evolves in which standard forms of social etiquette and decorum associated with the roles of educator and student predominate the supervisory interaction. Arising from pressures within the supervisee, the supervisor, and/or the institution in which treatment and supervision are occurring, each member of the supervisory couple may collude in a mutual avoidance of conflict and the processing of complex emotions and experiences.

The pedagogic principle I would like to propose is that supervision must facilitate in the supervisee a transition from common forms of social discourse and convention centered on conflict avoidance, compliance, and benign repartee (i.e., “being nice”) to an alternative form of relatedness that inherently values spontaneous relational experience, uncensored communication, and discovery (i.e., “being therapeutic”). Without this exposure, the supervisee is poised to embody cultural and institutional norms of relatedness directed toward tension reduction, avoidance, and conformity with his or her own psychotherapy patients. In my view, supervision should provide a “metaphoric experience” that exposes the supervisee to the ambience of a therapeutic process. In this way, the supervisee glimpses the intense self- and self-other relational experience possible in an authentic therapeutic experience unencumbered by the restrictions of social mores.

I view the main task of supervision, particularly with students new to clinical work, as attempting to cultivate in the supervisee a therapeutic stance vis-à-vis the patient that is qualitatively distinct from social convention. This process entails debunking the student’s preconceived notions about what it is to be “therapeutic,” notions often linked to unconscious assumptions about aiding, helping, and curing. The supervisor must unveil to the supervisee how new and, at first, unusual ways of being with themselves and their patients have clinical utility; I suggest seven supervision principles and corresponding techniques: (1.) Notice and Resist Social Convention. I attempt to create an atmosphere in supervision relatively devoid of social conventions that emphasize appealing to the other and obstruct the supervisee’s freedom of self-expression. The supervisee’s hypervigilance about patients’ discomfort in sessions and fears of not being liked or viewed as “good”/helpful by me or by patients are typical examples of conventional social experience I try to jettison in the supervisee.(2.) “Don’t just do something, sit there!”. As a central supervisory technique, my listening approach to what the supervisee brings to me is primarily neutral/abstinent, embodying the spirit of “Don’t just do something, sit there!” (Alonso & Rutan, 1996). As I listen, I hope to model a “self-reflective capacity” (Sarnat, 2010, p. 24) in which I aim to expose the supervisee to a therapeutic position that inherently opposes the reactivity and action so common in most other forms of human experience (see Fauth et al., 2007).(3.) Promote Mindfulness. In supervision sessions, I attempt to model the meta-cognitive skill known as “mindfulness” (i.e., the moment-to-moment awareness of one’s experience) (e.g., Binder, 2002, 2004; Fauth et al., 2007). As I listen mindfully to the supervisee, it is my hope that the supervisee begins to contact his or her inner experience more fully, which will likely diminish an eagerness for clinical solutions or lessons about clinical theory or technique.(4.) Attend to Shame. The experience of shame in therapists is ubiquitous (i.e., the therapist wants to help or cure the patient and, almost inevitably, fails in this wish). Whenever possible, I attempt to highlight and normalize this wish within the supervisee while simultaneously demonstrating its futility. It is my hope that the supervisee gradually begins to realize that he or she is not acting on the patient so much as the patient is acting upon him or her! For most supervisees, this realization unburdens them from shame reactions emanating from naïve, idealized views of the therapeutic process and notions of change and transformation. (5.) Dispel Expectations of Progress. I try to dispel the trainee’s expectations about where he or she thinks she “should be” in terms of development and clinical skill level, especially when comparisons with peers are routinely made (which, again, is another form of social convention). My attempt here is to socialize the supervisee into a view of self and his or her clinical development as unique and acceptable, just as therapy is a forum for the patient to define and contend with his or her own individuality.(6.) Promote Acceptance of Unconscious Relational Forces. I attempt to downplay academic views of therapeutic course and action. Instead, I emphasize an acceptance of what is occurring in the clinical process as reported by the supervisee, especially its thorny and unclear nature. In this way, I attempt to move the supervisee away from “inert clinical knowledge” (Binder, 2002, p. 11) to a valuing of his or her own subjective experience of clinical work. (7.) Explore “Professional Me”/“Natural Me” Tensions. I actively conceptualize the learning process as attempting to negotiate the presence of the “professional me” and the “natural me” in clinical work. This often fosters an exploration of how the supervisee may be unwittingly exposed to the patient (Aron, 1991; Hoffman, 1983), and how the therapist’s own identity is not only not concealed, but greatly revealed, in the therapeutic experience. This is yet again another realization that debunks unconscious and naïve assumptions about, and longings for, the role of psychotherapist.

In this presentation, I have outlined an approach to supervision that seeks to engender in the supervisee an attitudinal and behavioral shift from various forms of social convention to an alternative relational position vis-à-vis the patient. My supervisory approach is based on the notion that an invaluable function of the supervisor is to model a way of being that transcends standard forms of social etiquette in order to offer the supervisee an experience of spontaneous and uncensored relatedness. In this way, internal representations are formed within the supervisee, not only of the supervisor as role model (Gabbard, 2010; Gitterman, 1972), but also of the relational experience the supervisor enacted with the trainee. I believe having this relational experience available as a prototype for the psychotherapy experience will support the supervisee's continued learning and ultimate therapeutic potential.

Contact InformationJames Tobin, Ph.D.Email: jtobin@argosy.edu Phone: 714-620-3629