A cloud and a box: an embodied triangle of imagery work in relational body PTSD psychotherapy supervision

This paper considers the place of imagery in supervision and their relational and corporeal resonances in the supervisory relationship. Drawing on Keleman's (1985) formative psychology concepts in order to explore clinical material through a composite case vignette from her supervision practice, the author considers her parallel process and describes the role of her countertransference in the embodied triangle of supervisor, supervisee and client.     

Supervision of Supervision: How Many Mirrors Do We Need?

This paper explores the purpose and process of supervision of supervision and considers reservations about its usefulness. Relevant research which might inform the use of supervision of supervision is described and discussed. Three vignettes explore how a relational model of supervision of supervision can support supervisors when the supervision relationship is in trouble; in the examples of group supervision the group dynamics are considered. The three dyads involved in the supervisory chain are discussed in terms of their couple dynamics. The role of holding and containing by both the supervisor and the consultant are discussed.     

Relational Mentoring in Clinical Supervision: The Transformational Supervisor

Effective clinical supervision naturally incorporates many elements of mentoring. In this article, we us the Mentoring Relationship Continuum (MRC) model to frame a discussion of transformational supervision. We define transformational supervision as a rich developmental relationship characterized by increasing relational reciprocity, a greater range of career and psychosocial mentoring functions, and a strong sense of collegiality. As a strong supervisory relationship approaches the transformational end of the MRC, the supervisor offers increasing levels of support, empowerment, authenticity, and reciprocity; over time, the relationship has a more interdependent, egalitarian, and communitarian character. We employ a case example to illustrate excellent transformational supervision.     

Couple therapy and relational body psychotherapy: Healing childhood wounds

This paper presents an approach to healing childhood wounds through the use of Imago relationship couple therapy in conjunction with relational body psychotherapy. Working with couples in crisis arouses powerful and confusing questions regarding the transference and counter-transference tensions within all aspects of the therapeutic triangle: intra-subjective in each member of the couple, their inter-subjective space, their interaction with the therapist and within the therapist herself. One of the ways of coping with these multifaceted dyads is the use of somatic cues in all three members of the triad. The paper provides three clinical vignettes, which illustrate some of the advantages of the combination of the two theories in relational couple therapy.     

Clinical Supervision of Psychotherapy: Essential Ethics Issues for Supervisors and Supervisees

Clinical supervision is an essential aspect of every mental health professional's training. The importance of ensuring that supervision is provided competently, ethically, and legally is explained. The elements of the ethical practice of supervision are described and explained. Specific issues addressed include informed consent and the supervision contract, supervisor and supervisee competence, attention to issues of diversity and multicultural competence, boundaries and multiple relationships in the supervision relationship, documentation and record keeping by both supervisor and supervisee, evaluation and feedback, self‐care and the ongoing promotion of wellness, emergency coverage, and the ending of the supervision relationship. Additionally, the role of clinical supervisor as mentor, professional role model, and gatekeeper for the profession are discussed. Specific recommendations are provided for ethically and effectively conducting the supervision relationship and for addressing commonly arising dilemmas that supervisors and supervisees may confront.     

Learning in Psychotherapy Group Supervision: Transcending Complementarity and the Generative Potential of Group Conflict

At the site of interpersonal conflict resides the potential for learning. This paper presents psychodynamic theories, empirical research and a fictional case study of psychotherapy group supervision. Supervision is discussed in terms of teaching and learning, triangular relations, and group and organizational perspectives. We examine the interconnectedness of patterns of distress that emerge within dynamic relational systems at the levels of the macro‐social, organizational, group and individual. The concepts of equivalence, parallel process and reflection process provide frameworks for this discussion. We explore the constraints and dynamic influence of the organization upon the supervision relationship and the ethical tensions that construct im/possible positions for the supervisor. The case study tells a fictional story of a supervision group situated in an organizational context – a university psychotherapy education programme. A collapse of the group into complementarity, that is into polarized conflicted positions, proffers a vitalizing opportunity for learning. Through the clinical discussion, we reveal how this is contingent on the group's capacity to think together about the meaning of their struggle and to transcend a binary conflict and achieve ‘the third’.     

The Ingredients of Supervisor Failure

Trainees all too often learn more about how not to conduct supervision than how to conduct supervision effectively. The purpose of this article is to present a conceptualization of the theoretical, empirical, and practical elements of supervisor failures. Specifically, the article attends to the following behaviors that may lead to supervisor failure: (a) denigrate the supervisory relationship; (b) demonstrate multicultural incompetence; (c) become an unethical supermodel; (d) use evaluation instruments that could not pass for an undergraduate thesis; (e) teach your trainee how to diagnose narcissism by example; (f) apply psychotherapy models in supervision as if there is a theoretical or empirical basis; (g) infantalize your trainee; (h) collude with your trainee; (i) make your trainee your surrogate psychotherapist; and (j) go on a date with your trainee. Recommendations for increasing supervisor success and limiting supervisor failure are provided.     

Ten Changes Psychotherapists Typically Make as They Mature Into the Role of Supervisor

Stage models have largely informed scholarship on supervisor developmental processes. We argue that understanding this development as occurring along dimensions is more useful for both supervision practitioners and educators as well as for those engaged in research on supervisor development. Building on the work of Heid ( 1997 ) and working with a panel of 7 supervision experts, we identify 10 themes and validate their salience to supervisor development using a sample of 22 clinical supervisors. We describe and elaborate on each theme, and then present and discuss a case vignette that illustrates many of the supervisor developmental themes.     

Clinical Supervision: The State of the Art

Since the recognition of clinical supervision as a distinct professional competence and a core competence, attention has turned to ensuring supervisor competence and effective supervision practice. In this article, we highlight recent developments and the state of the art in supervision, with particular emphasis on the competency‐based approach. We present effective clinical supervision strategies, providing an integrated snapshot of the current status. We close with consideration of current training practices in supervision and challenges.     

Apprehending the Translucent in the Art of Supervision

The supervisory relationship is complex and multi‐layered, given the multiple sources of unconscious dynamics between patient, supervisee and supervisor. The concept of the parallel process has brought greater depth and understanding to the supervisor's countertransference as reflective of the dynamics within the analytic relationship. The tendency, however, is to consider the parallel process as occurring in one direction only: from the analytic relationship into the supervisory one. In this paper, I consider the multidirectional movement of transference and countertransference between both relationships, including where the supervisor might be the point of origin, rather than the recipient. Clinical material from two patients brought to supervision is analysed from four different vertices: the parallel process; the developmental aspects of the supervisory relationship and of the supervisee; my own potential transferences onto the supervisee and/or the patient; and the potential effect of my transference onto the supervisee, the patient and their interaction. I also refer to some paintings by Richard Diebenkorn, as these offer a powerful metaphor for understanding the challenges in supervision of creating a secure frame, while also allowing for a more ‘translucent’ space, within which the multi‐layered dimensions can be imagined and become capable of continual transformation.     

Traversing distance and proximity: the integration of psychodrama and dance movement therapy techniques in supervision

This article explores the potential for intermodal methods in person-centred supervision, focusing on the application of techniques from dance movement therapy (DMT) and psychodrama. The article proposes how specific structures combining psychodrama and DMT allow the supervisee to negotiate between proximity and distance, offering ways to hone in, step out or create alternative perspectives. Somatic congruence is introduced as a person-centred principle that enables the supervisor to understand and/or share somatic reactions in response to the supervisee’s material or the supervisor’s own personal process. Embodying roles and projective techniques are illustrated in the article through examples from the author’s supervisory DMT practice, demonstrating how these interventions may help symbolically crystallise supervisory issues. Caveats to these interventions and cautions to practitioners are presented, contributing to critical analyses of cross-disciplinary work. The article presents a constructive view towards future research and professional development on intermodal, creative supervisory practice.     

SOME THOUGHTS ON SUPERVISION

The practice of supervision is increasingly seen today as a pedagogic activity in which knowledge and skills are transmitted from one party to another. Debates around supervision, however, have historically been concerned with a number of other issues, most notably transference and countertransference. We examine the central arguments of these debates in the psychoanalytic tradition, and discuss some of the theoretical and clinical consequences that follow from them. Taking unconscious dynamics into account forces us to recognize that supervision cannot be seen as a ‘neutral’ exercise of accumulating knowledge, but rather confronts both supervisee and supervisor with significant questions about their own position and self-image.     

THE DAWN OF A NEW IDENTITY: ASPECTS OF A RELATIONAL APPROACH TO PSYCHOTHERAPY WITH A TRANSSEXUAL CLIENT

The importance of developing a certain consciousness in which one is present and autonomous while being intimately interconnected with larger meaning is an important dimension of a relational approach to psychotherapy. Based on the premise that both client and therapist bring something of themselves and of their respective past emotional experience to the therapeutic relationship, a relational approach to therapy is very attentive to the dynamics in the therapy room. It stresses the co‐creation of the therapeutic relationship at conscious, explicit verbal levels and unconscious, implicit levels of functioning, and establishes the therapist's emotional behaviour as a significant factor in fostering change ( Aron, 1996 ). Therapist responsiveness to client's affective impact is discussed with emphasis on its centrality to clinical practice and its relationship to countertransference. A case study of the psychotherapeutic journey with ‘Dawn’ (previously ‘David’), a 53 year‐old client who was awaiting sex‐reassignment surgery, is presented which illustrates how the therapist's struggle in the countertransference represents part of a complex relational body/mind system of parallel processes, re‐enactment and potential for therapeutic change.     

Countertransference and empathic problems in therapists/helpers working with psychotraumatized persons

Countertransference in therapists working with patients with posttraumatic stress disorder (PTSD) differs from countertransference in other psychotherapeutical settings. In this article we discuss the specificities of counter- transference in treating PTSD patients and its relation to empathy. The most difficult countertransference problems occur in treating multiply traumatized patients. Countertransference may occur towards an event (e.g., war), patients who have killed people, as well as to colleagues who avoid treating PTSD patients, or towards a supervisor who avoids, either directly or indirectly, supervision of therapists working with PTSD patients. Our recommendation for the prevention of problems in treating PTSD patients include : 1) careful selection of the therapist or helper, both in the personality structure and training; 2) prevention by debriefing and team work and peer supervision; and 3) education - theoretical, practical, and therapeutical.     

Beyond Criterion A1: the effects of relational and non-relational traumatic events

Trauma research has historically focused on Criterion A1 traumas, neglecting many other negative interpersonal events that have been shown to lead to posttraumatic stress disorder (PTSD; S. L. Anders, P. A. Frazier, & S. Frankfurt, 2011 ). Trauma research has also focused primarily on PTSD and neglected other important outcomes, such as relationship functioning. This study aimed to assess a broader range of events, including many Criterion A1 interpersonal events; assess the cumulative impact of event exposure; and examine the relation between event exposure and a broad range of outcomes, including relationship functioning. A sample of 181 undergraduate students completed measures assessing exposure to a broad range of events, their worst lifetime event, and current psychological (e.g., psychological distress) and relationship (e.g., partner trust) functioning. Results suggested that non-Criterion A1 relational events were very common in our sample. The number of lifetime relational events experienced, whether Criterion A1 or non-Criterion A1, was strongly and consistently associated with all outcomes. The number of lifetime Criterion A1 non-relational events experienced was significantly associated with current PTSD symptoms but was not associated with other mental health and relationship outcomes. No differences were found between Criterion A1 relational, non-Criterion A1 relational, and Criterion A1 non-relational worst events on any of the mental health or relationship measures. Implications for further research and interventions are discussed.     

Walking the tightrope: developing an attachment-based/relational curriculum for trainee psychotherapists

I describe how the Centre for Attachment-based Psychoanalytic Psychotherapy (CAPP) in London has gone about developing an attachment-based/relational curriculum for training psychotherapists. A key problem the training is meant to address is how to maintain a balance between enabling students to absorb research and clinical knowledge of psychological processes at the same time as they learn to maintain the flexibility necessary to address the uniqueness of each individual encounter in the consulting room. I describe the task of the training in terms of a linguistic metaphor: the training needs to ensure that students are theoretically multi-lingual while developing higher levels of fluency in the language of attachment-based/relational psychotherapy. In the pursuit of this approach, my colleagues and I developed a set of ten key propositions - the spine of the relational world - which we felt encapsulated the main theoretical assumptions of attachment-based practice that students need to understand and explore. This has been used to evolve a spiral curriculum, designed to help students engage constructively with the often confusing emotional aspects of clinical work, and with the multiplicity of clinical viewpoints that characterises contemporary psychoanalytic psychotherapy.     

Understanding mutuality: Unpacking relational processes in youth mentoring relationships

Evidence suggests that a close interpersonal bond is important for the success of youth–adult mentoring relationships. Mutuality has been suggested to be important for developing a close interpersonal bond (Rhodes, 2002, 2005), but mutuality remains an abstract construct, difficult to understand and cultivate. Using thematic analysis of mentor and mentee (n = 42) interviews, we investigate how mentoring pairs reflect on mutuality. Results suggest that mutuality is understood as a combination of 2 dimensions: shared relational excitement and experiential empathy. Shared relational excitement is felt when there is a genuine desire by both the mentor and the mentee to invest in the relationship. Experiential empathy is the process through which mentors connect with, advise, and normalize the experiences of their mentees by sharing their own relevant experiences. This work has implications for mentor training, program development, and future research on youth–adult relationships.     

Decision‐making for non‐invasive prenatal testing for Down syndrome: Hong Kong Chinese women's preferences for individual vs relational autonomy

Individual autonomy in antenatal screening is internationally recognized and supported. Policy and practice guidelines in various countries place emphasis on the woman's right to make her own decision and are related to concepts such as self‐determination, independence, and self‐sufficiency. In contrast, the dominant perspective in Chinese medical ethics suggests that the family is pivotal in making medical decisions, hence providing support for relational autonomy. This study explored Hong Kong Chinese pregnant women's preferences for individual vs relational autonomy for non‐invasive prenatal testing (NIPT) for Down syndrome. A qualitative study was carried out using semi‐structured interviews with 36 women who had undertaken NIPT in Hong Kong. The findings show that most Hong Kong Chinese women valued aspects of both relational and individual autonomy in decision‐making for NIPT. Women expected support from doctors as experts on the topic and wanted to involve their husband in decision‐making while retaining control over the outcome. Somewhat surprisingly, the findings do not provide support for the involvement of family members in decision‐making for NIPT. The adequacy of current interpretations of autonomy in prenatal testing policies as an individual approach needs discussion, where policy developers need to find a balance between individual and relational approaches.     

Recurrent miscarriage: Psychological and relational consequences for couples

Recurrent miscarriage is a rare condition that has been described as a traumatic event for couples. Although symptoms of depression, anxiety and lowered self‐esteem have been related after recurrent miscarriage, little is known about its impact on couple sexuality and on gender differences in attitude and the grief that follow. The objectives of this study are to describe the consequences of recurrent pregnancy loss for the couple's relationship, and explore gender differences in attitudes and grief intensity toward this kind of reproductive failure. Each member of 30 couples with at least 3 recurrent miscarriages answered a set of questionnaires, including the Impact of Events Scale ( Horowitz, Wilnwe, & Alvarez, 1979 ), the Perinatal Grief Scale ( Toedter, Lasker, & Qlhadeff, 1988 ), the Partnership Questionnaire ( Hahlweg, 1979 ) and the Intimate Relationship Scale ( Hetherington & Soeken, 1990 ). Results showed that men do grieve, but less intensely than their partners. Although the couple's relationship seemed to not be adversely affected by recurrent miscarriage, couples described sexual changes after those events. Grief was related to the quality of communication in the couple for women, and to the quality of sex life for men.     

Supervision from a Lacanian Perspective Considered Closely: A Qualitative Study

This study aims at mapping and interpreting what is at stake in Lacanian psychoanalytic supervision. Using interview data of participants’ personal accounts of supervision, the authors applied a thematic analysis to gain insight into what they believe are crucial components in these accounts of supervision. We interpret the data within the context of Lacan’s text, ‘Direction of the Treatment and the Principles of its Power’, in which he articulates his conceptualization of psychoanalytic treatment. His views on interpretation (tactics), transference (strategy), and lack-of-being (politics) as the three elements that structure the actions of the analyst, guided our data-analysis. Participants indicate how their supervisor focuses on the symbolic dimension of speech, helping them avoid getting deceived by the dimension of the imaginary. During the supervision process, the supervisor does not respond from a master position, nor coach the supervisees. Supervisees develop their own style and framework for clinical work. Through discussing cases, supervisees learn to construct cases and focus on the singularity of the case, beyond structural diagnosis. Lastly, Lacanian supervisors only focus on the cases discussed, not on the person of the supervisee.