PHILOSOPHY OF SUPERVISION
By Rachel Sacharoff
Evidence of Systemic Thinking
Focusing on process over content in the therapy room and supervisory experience is the most accurate way I can describe myself as a systemic thinker. The MFT concept of circular causality is paramount in that all relationships are reciprocal and constantly influencing each other. According to Becvar and Becvar (2003), “Causality is understood as circular and recursive, and families are seen as error activated and goal directed systems” (p. 216.) A systemic supervisor is one that recognizes this concept both in the therapy room and the supervision room. They use this understanding to both establish clear goals for supervision and works towards meeting those goals by providing feedback to their trainees when they bring client focused issues into the room. By examining patterns of interaction in each system trainees can learn to focus on identifying where problems are being maintained and where they can most effectively intervene to help their clients, as well as themselves, shift into new ways of interacting. As the supervisor, I can model this process by identifying where in the trainee’s work they too are enacting patterns that may be preventing them from making the progress with their clients that they would like to. Minuchin (1974) proposed that all families have an underlying structure that organizes and dictates the ways in which family members interact. In supervision, there is also the underlying structure of how supervision sessions are conducted that will dictate the way in which the supervisor and trainees interact. I will work with those in training to join well, much in the same way as I would with a client to create a safe space for them to speak openly about their experiences in supervision. Through positive feedback I would hope to help my trainees move into a new way of interacting and thinking about their clients from a purely systemic viewpoint.
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Clarity of Purpose and Goals for Supervision
“Relational/Systemic Supervision is the practice of developing the clinical competencies and professional growth of the student as a trainee, consistent with the relational/systemic philosophy, ethics and practices of marriage and family therapy profession” (COAMFTE, 2017, p. 2-3). As a former educator and a therapist who utilizes psychoeducation consistently in my own client caseload as a way to help clients understand and enact change, I see my goals for supervision as similarly established. I embarked on training for supervision with the goal of using those educator skills to help new therapists in the field become rooted in the systemic models that they were taught in graduate school and to learn how to apply the concepts to their own work as therapists. Enhancing clinical skills ensures that the clients that my trainees see are receiving the best care possible. By ensuring both professionalism and ethical conduct in the field through focusing on how to maintain professionalism in the room with clients and exploring ethics of practice in supervisory sessions, I am ensuring that the trainees are constantly thinking about their roles as professionals and exploring the ethics of their actions in that role. In focusing on these three areas, I am ensuring that I am aiding in the development of competent and thoughtful MFTs.
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Clarity of Supervisory Roles and Relationships
In my experience as a supervisor, I agree with Morgan and Sprenkle (2007) that “beginning clinicians need more structure and task focus, while advanced clinicians do better with a collaborative, conceptual focus” (p. 7). I identify with the developmental models of supervision and see myself taking the role of educator in working with newer clinicians on models of therapy and how to integrate the systemic lens into their work. Early clinicians also need support around structure with regard to writing notes and creating treatment plans, which is more of an administrative role. One area of development I have noticed in my trainees is feeling competent and effective, and as a strengths-based clinician, I use those skills to focus on clinical strengths to work on confidence in newer clinicians. By exploring self of the therapist in supervision sessions, we can explore the therapists’ own experiences and how they are influencing their work. As Aponte and Kissil (2012) stat, “self-of-the-therapist work is crucial in the development of effective therapists”(p. 11). As clinicians develop, I see myself move into more of a collaborative role, mentoring and coaching the new clinician through their experiences. I agree with Lee and Nelson (2022) in that “interventions flow from goals within the context of the supervisory relationship and the training system, informed by the supervisor’s and trainee’s contexts” (p. 27). The most important aspect of the relationship between supervisor and trainee is the mutual respect and understanding developed in the identification of goals for supervision and the expectations of both the trainee and the supervisor in that relationship.
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Evidence of Awareness of Personal and Professional Experiences that Influence Supervision
Entering into the field in mid-life, as a woman who has children, went through both marriage and divorce, has had several careers and multiple graduate degrees, I often felt that expectations were different for me than they were for other clinicians that were in my position but younger and with less life experience. From the outset of my experiences, I encountered supervisors who assumed that I was competent and did not need as much input and guidance as my peers. In my work as a supervisor, I find that I often check in with my trainees to make sure that I am not leaving them wanting more support or guidance in our work together. I am also acutely aware of the power differential and the role that I play in their growth as a therapist. In graduate school I remember feeling shut down by a supervisor who was dismissive of a view I had tried to share. This experience has shaped the way in which I work with my clinicians in that I do not ever dismiss their ideas or actions when I don’t understand them or agree, but rather explore them with curiosity so that they can see how to do the same with their clients and maintain the therapeutic bond. “It has been said that the hallmark of successful supervision is the resolution of conflict that occurs naturally because of the power imbalance of the supervisor and supervisee” (Muller & Tell, 1972, p.12). I have also had experiences of impasse with a supervisor where that supervisor reached out to repair the rupture. In that experience I learned how to do the same with my own trainees should we come to an impasse or disagreement. My goals in supervising as a result of these experiences are similar to the ideas presented in the Kissil article, “the trainers themselves need to be conscious of their own personal issues and be able to use that self-awareness in a conscious and active manner in their interactions with trainees.” Personally, I do not have certain experiences that my trainees may bring to session, such as religious beliefs, cultural identities or sexual preferences that are different from my own. My role in these instances is to practice curiosity and openness and work with the clinician on self- of the therapist to see where these factors may be influencing their work with their clients.
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Preferred supervision model or practices and their connection with your own therapy model
I see myself as a predominantly structural family therapist who is also influenced by the ideas presented in the Bowen model of family therapy. In my client sessions I focus on patterns of interaction, boundaries, rules and hierarchy. I often start with a genogram to identify the participants in the system and get a sense of the types of relationships and boundaries that exist within it. Minuchin writes, “Structural Family Therapy is a therapy of action” (Families and Family Therapy, 2009,p. 14 ) and goes on to discuss how the therapist joins the system to enact change. In this way I see supervision as a similar endeavor where the supervisor joins the system of the trainee and helps them to change by guiding their growth in the field. In supervision my trainees are challenged to identify the patterns they are enacting, in their own work and in the client’s experiences that they are working with. We focus on process over content and craft interventions that will throw wrenches in the existing patterns to create new patterns that will lead the system towards change. When exploring the approaches to supervision, I identified most with being collaborative and directive with my trainees. I often am directive with my trainees to be more directive with their clients and to challenge them, and raise intensity to help those clients move towards change. As a therapist, I see myself in the same way, collaborating with my clients to help them figure out how to solve their problems and being directive with the things they can try to achieve their goals. There is definitely a process of isomorphism occurring in both my own work as a therapist and as a supervisor.
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Evidence of Sensitivity to Contextual Factors
My graduate training was infused with cultural sensitivity, social justice and recognizing both our own inherent bias as well as the biases our clients may face in the larger community. While I feel that I am keenly aware of differences between myself and those I work with, this is an area that I believe needs constant attention and continued growth in order to be effective as a therapist. “We must be mindful that clients’, trainees’, and /or supervisors’ identified cultures or social locations are different from one another.” ( Lee & Nelson, 2022, P.133) Because of this mindset, as a supervisor I am consistently focusing on the trainee’s experience of their client and where they have relatable experiences vs where they do not. We discuss cultural differences, systems of oppression and privilege that both they and their clients exist in and how those factors impact both supervision and their clinical work. In my practice I train my clinicians to take genograms on the first meeting with a client where they identify the client’s background and family experience, and then do a comprehensive bio/psycho/social intake where they explore the client’s identity further. I encourage them to be curious and sensitive when presented with ideas and culture they are unfamiliar with, and to ask questions with sensitivity and grace. One thing I took away from the supervisor course is to do a genogram with my trainees when I start working with them to identify their own cultural identity and to foster awareness of all aspects of the self that they bring into their work. “The cultural genogram not only helps therapists become more conversant with their cultural identities, but also highlights culturally linked issues that may impede effective treatment.” ( Hardy & Laszloffy, 1995, P.9) In doing this work with my trainees, I hope to have a better understanding of who they are and where they come from as well as model for them how to do the same work with their own clients.
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Clarity of Preferred Process for Supervision
As a trainee, I experienced almost every type of supervision that existed at the time, including small group, one way mirror, phone calls, individual sessions and larger group supervisions. What I found to be most helpful largely depended on the person running the supervision. “An essential focus of supervision must be on the relationship between the supervisor and trainee” ( Lee & Nelson, 2022, P. 15) Because of this, my preferred process for supervision initially is individual supervision. In individual supervision, the trainee is more open to sharing their own experiences and less intimidated by the hierarchies that exist between therapists and their time in the field, age and experiences. In my group practice, I meet with my trainees weekly to review cases and discuss administrative or ethical issues that arise in their caseload. Then, we meet monthly for group supervision where trainees and clinicians are given the opportunity to present cases by sharing (anonymous) client genograms and case history to get feedback and ideas from others on their work. With my individual trainees, I review their notes and treatment plans which allows me to monitor their case conceptualization and interventions and be knowledgeable when they bring their cases to supervision. All of our case notes, including my notes for supervision, are kept on our HIPAA compliant EHR and safeguarded. My practice for notes on supervision covers presenting problem, goals for therapy, goals for trainee and a short summary of what is discussed, as well as notes on modalities used, topics covered, ethical concerns and any conflicts that may arise. In this way, I am tracking and evaluating the trainees as we work together and have records to review with them when and if any issues arise that require remediation. Group supervision is collaborative and collegial and for those reasons I enjoy running those groups in my practice. But I find that individual supervision is where we can dive into self of the therapist and more detailed explorations of the trainee’s experience as a therapist. In my contract and initial session we identify goals for supervision and check in on them every three months to ensure that we are working in the best interests of the trainee. Through case consultation and in monitoring the trainee’s confidence and ability to use the structural model in their work, I am able to evaluate their progress and satisfaction with their supervision. I also plan on creating and implementing evaluation forms to use for this purpose. I particularly liked the Basic Skills Evaluation Device included the article by Nelson & Johnson.
Evidence of Sensitivity to and Competency in Ethics and Legal Factors of Supervision
I agree wholeheartedly with Lee and Nelson in that “supervisors have the obligation to assure the community that trainees are operating in rational, learned and ethical ways.” (Lee & Nelson, 2022, P. 155,) In my experiences as a trainee, I was, more often than not, put in situations that I felt were unethical and worked in environments were legally questionable practices occurred. One of the reasons I left agency work and started private practice was to be in control of these aspects of my work. As a group practice owner and supervisor to my employees, ethics and legality of practice are the two most important things to me. When interviewing and hiring clinicians, I am explicit that this is an area I focus on heavily with regard to client interactions, note taking, treatment planning and conduct. We discuss why we do things the way we do as well as how to do them in a way that is ethically and legally compliant. Non-malfeasance to the client is encouraged to be the top priority and first thought when working with clients in my group. In order to ensure that all of my employees are aware of and current with state statutes as well as their codes of ethics, any time something comes up with a trainee around these topics, we discuss them in supervision and then I get permission from that trainee to share with the rest of the staff so that we are all constantly being educated about situations we may encounter and what our duties are as therapists to manage them. Some of the things we do in our practice to maintain good ethical and legal practices are reviewing intake documents and informed consent and making sure that the clients are well informed about practices such as mandated reporting and HIPAA laws, keeping detailed notes and treatment plans and records of all client communication. We use a HIPAA compliant platform to safeguard client information and have clear sections in both my supervisory contracts as well as employment contracts regarding the ethical and legal responsibilities of the trainees.
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REFERENCES
Aponte, H. J., & Kissil, K. (2012). “If I can grapple with this I can truly be of use in the therapy
room”: Using the therapist's own emotional struggles to facilitate effective therapy. Journal of Marital and Family Therapy, 40(2), 152–164.
Becvar, D. S., & Becvar, R.J. (2003). Family therapy: A systemic integration. United Kingdom: Allyn and Bacon
Lee, R. E., & Nelson, T. S. (2014). The contemporary relational supervisor. Routledge/Taylor &
Francis Group.
Minuchin, S. (1974). Families & family therapy. Cambridge, Mass.: Harvard University Press.
Morgan, M. M., & Sprenkle, D. H. (2007). Toward a common factors approach to supervision.
Journal of Marital and Family Therapy, 33, 1-17.
Muller, W. J. & Kell, B. L. (1972). Coping with conflict: Supervising counselors and psychotherapists. New York: Appleton-Century-Crofts
Nelson, T. S., Johnson, L. N. (1999). The basic skills evaluation device. Journal of Marital and
Family Therapy, 25, 15-30.