Supervisory Sessions Research Articles

Neuroscience Insights That Inform Clinical Supervision

This article makes links between neuroscience literature that helps to inform a clinical supervision relationship. There has been a beginning, but limited, application of neuroscience to clinical supervision; this article offers vignettes of supervisory dyads that illustrate how understanding right-hemisphere communications between the supervisor and supervisee can further a more complex understanding of the clinical processes that are being discussed in supervision. The article draws from supervision theory that has been conceptualized using relational theory and trauma theory. The article encourages supervisor and supervisee to pay heed to their bodily reactions when discussing clinical material. Individuals expose their right-hemisphere reactions to the content of the therapy and/or supervisory sessions through a variety of well-known behavioral manifestations, including facial expression, tone, and prosody of the voice; bodily manifestations of anxiety or “tightness” in the chest or stomach; and averted eye glance, to name a few. The vignettes describe supervisory dyads that deconstruct supervisee reactions in the face of working with neo-natal intensive care infants, suicidality, and trauma.

Am I Doing Expressive Arts Therapy or Creativity in Counseling?

PERSPECTIVES is a special feature included in this issue of the Journal of Creativity in Mental Health that provides mental health professionals with an opportunity to discuss their positions on a variety of creativity-related topics. In this article, 2 counselor educators, Christina M. Rosen and Sally S. Atkins, share their perspectives on the use of expressive arts in counseling and therapy. These perspectives emerged from a supervisory session between the 2 authors. As their discussion expanded, issues of definition, ethical practice, theoretical grounding, credentialing, and supervision emerged. The authors explore these issues by means of personal story, literature, and dialogue, and they encourage counselors to trust their intuition and creative ways of working with clients while staying mindful of their professional spectrum of competence and ethical guidelines.

Religious Coping in Schizophrenia Patients: Spiritual Support in Medical Care and Pastoral Counselling

Abstract: Following an introduction focusing on the role of religion in the treatment of psychosis, the first part of this paper describes an initial study in which the role of spirituality and religiosity was assessed in 115 patients with schizophrenia in Geneva (Switzerland) and 126 in Trois-Rivières (Quebec). These themes have been shown to be highly prevalent for these patients, though their clinicians are often unaware of this prevalence. The following part of the paper presents a second study where religious supervision was offered to clinicians in Geneva. Comparison between forty patients who received spiritual assessment and opportunities to work on religious topics with their clinicians was made with thirty patients without religious intervention. In the supervisory sessions, six different types of religious interventions were suggested. Outcomes at three months show that patients of the intervention group maintain their interest for help in religious matters while clinicians' interest in integrating religious topics in discussions with their patients has decreased. The third and main part of the paper is devoted to an analysis of the suggested interventions from the viewpoint of the study of religions. Five aspects of religion are distinguished, and explanations of the reasons some of them are easier to manage for clinicians are proposed. The paper concludes with proposals for the education of clinicians to help them to differentiate different kinds of religious coping and to recognize when it could be helpful to refer the patient to a pastoral counsellor.

The Influence of Supervision on Manual Adherence and Therapeutic Processes

To identify the effectiveness of psychotherapy supervision on therapists' immediate (next session) and long-term (1 year) adherence to time-limited dynamic psychotherapy (TLDP). Sixteen therapists from the Vanderbilt II psychotherapy project were assigned new cases in pretraining, training, and booster/posttraining year-long cohorts. Technical adherence to the manual, as well as general therapeutic relational processes, were rated for clinical supervisory sessions in which the third therapy session was discussed. The therapy sessions immediately before and after the supervisory sessions were also rated for technical adherence and relational processes. Postsupervision adherence increased from the presupervision session during the training cohort. In supervision, therapists' discussion of techniques and strategies from the manual in supervision was significantly related to technical adherence in the session prior to (but not after) supervision. However, supervisors' discussion of specific techniques predicted therapists' total technical adherence in the therapy session after (but not before) supervision. In terms of the type of techniques, supervisors' influenced postsupervision therapy adherence on TLDP's unique approach to formulation, the cyclical maladaptive pattern, but did not influence technical adherence on the therapeutic relationship. In supervision, therapists tend to focus on how they adhered to techniques from the previous session, whereas supervisors' comments about specific techniques predicted how the therapist would adhere to techniques in the next therapy session. The findings provide support for the immediate effects of supervision in shaping therapist techniques as well as highlighting the challenges of altering common relational processes through technical training.

Supporting Early Childhood Practitioners Through Relationship-Based, Reflective Supervision

Reflective supervision is a relationship-based practice that supports the professional development of early childhood practitioners. Reflective supervision helps practitioners cope with the intense feelings and stress that are generated when working with at-risk children and families. It allows them to focus on the purpose and goals of the program and maintain their role boundaries. This article describes the need for and purposes of reflective supervision in early childhood programs and lays out the stages of relationship formation between supervisors and practitioners. Through the use of a vignette, this article illustrates the process of reflective supervision within the context of a supervisory session.

Promoting supervision of midwifery to women

Promoting supervision of midwifery to women

Religious Coping in Schizophrenia Patients: Spiritual Support in Medical Care and Pastoral Counselling

Abstract:

Use of data to assess performance and promote outcome achievement by public and private child welfare agency staff

Despite the emphasis on evidence-based practice in the literature, little is known about the extent to which child welfare workers routinely use data to assess the effectiveness of their practice, or consider an array of evidence informed practices such as peer record review, supervisory sessions or program evaluation as useful in improving their performance. This study, conducted as a part of the planning phase for a larger research and demonstration project measured frontline staff perceptions in both the public and private sectors in one state regarding these and other outcome-focused activities. Statistically significant differences were noted between public and private agency staff. In addition, the relationship between staff's use of data and their assessment of their own skill and the support provided by their agency for an array of out-of-home care practice activities are described. Implications for building the use of evidence-informed practice in child welfare are discussed.

Process-Centered Group Supervision

This article will present an experientially focused, process-centered approach to group supervision that may be used in practice and fieldwork settings, as well as in the classroom. The approach is derived from a combination of relational psychoanalytic theory, rooted in interpersonal and object relations theory, and social constructionism. Beginning with a review of the concepts of acting out, projective identification, and parallel process, this article will examine how these concepts are applicable to process-centered group supervision. A detailed description of the approach will be provided, along with a review of the group guidelines. Through actual case vignettes of two process-centered supervisory sessions, elements of transference and countertransference occurring between and among participants will be identified, and their utility for supervision and practice will be examined.

A Synergistic Model to Enhance Multicultural Competence in Supervision

The Synergistic Model of Multicultural Supervision is an integration of 3 existing models to provide concrete and practical guidance for supervisors wishing to enhance supervisee multicultural competence in personally meaningful and developmentally appropriate ways. The model attends to both content and process within the supervisory session and promotes multicultural counselor competence through increasing cognitive complexity, self‐reflection, and structured interventions.

My Late Night Hypnagogic Fantasy: Conversation With Heinz Kohut (II)1

This “imaginary” conversation focuses on certain recurrent questions about the nature of the analyst's responsiveness to the patient's selfobject transference. Specifically, it focuses here on what mirroring is and how this is actually done in the psychoanalytic process. This leads me to recount what I learned in supervision with Heinz Kohut many years before and appreciatively attributed to his “supervisory pedagogy.” Kohut's statement “let the patient teach you how to analyze him” left a lasting impact on my development as a psychoanalyst, supervisor and teacher. He avoided direct suggestions as to how I should respond but drew me out to report to him about all aspects of my verbal and non-verbal interactions (as far as those became available to me on reflection in the supervisory sessions) which then led me interventions that emerged from such experiences. His pedagogy was to let me discover what I need to understand and how that had to be conveyed to the patient.

Supporting presence in teacher education: The connection between the personal and professional aspects of teaching

This study follows one individual student teacher during a period of one single school year in which she was supported in developing ‘presence’ while teaching. The notion of ‘presence’ was formulated by the teacher herself, and coincides with the growing interest in this aspect in psychology, and in theories about becoming a teacher. In her supervision, the so-called core reflection approach was used, which strongly builds on the concept of presence and on positive psychology. Based on analyses of audio taped supervisory sessions, six stages were identified in the teacher's development. These stages are described and related to theories about positive psychology and core reflection. The supervisor's interventions leading to the transitions between the stages were identified, analysed, and related to key principles of core reflection. It appeared that the teacher's growth not only led to experiencing ‘presence’ while teaching, but also to a greater use of her personal qualities. Taken together, it appeared that after the supervision the teacher was much more ‘in flow’, and that she was more effective as a teacher. In this article, both the teacher's growth and the supervisor's interventions are described in detail, and illustrated using quotations from supervisory sessions, logbooks, and interviews. A case is made for connecting professional and personal aspects in supervising student teachers.

A New Understanding of Clergy Compassion Fatigue for Facilitators of Trainings for the Prevention of Sexual Misconduct

Abstract Compassion fatigue (CF) has been described by Charles R. Figley as “the cost of caring.” Clergy compassion fatigue (CCF) will be discussed in this article from both personal experience and current research, the latter of which has shown that religious leaders are viewed as attachment figures in times of great need. Clergy who facilitate trainings for the prevention of sexual misconduct need to be aware of the potential for a traumatic stress response when viewing films and hearing case studies in group discussions. Facilitators may avoid painful loneliness, loss of hope, and failure of confidence by sharing their reactions with others through appropriate supervisory sessions and by creating intentional self-care protocols as part of their ministry.

Making It Real: Enhancing Curriculum Delivery Through the Use of Student-Generated Training Videos

ABSTRACT This article describes and critiques the creation of a student-centered, reality-based training video undertaken by students and faculty from the departments of social work and visual arts at a northeastern university. There are several key and innovative aspects to this video. It is a collaboration between faculty and students of the schools of social work and the arts: social work students play themselves and students and affiliates of the school of the arts play clients and were responsible for all technical aspects of the video. The interactions portrayed are based on real social work student process recordings, and client-worker interactions are followed by a supervisory session, underscoring the importance of feedback for learning. The relevant literature on a variety of teaching techniques on which we based our work, including the use of role plays, simulated clients, and video technology, is reviewed. Social work educators are encouraged to develop their own videos depicting their students' unique experiences, using the interdisciplinary, collaborative, problem-based process presented. The technological capacity to deliver video on the web further enhances the accessibility and flexibility of this teaching strategy.

Pastoral care in a time of global market capitalism.

The author defines pastoral theology as "the study of the micro-world of intrapsychic and interpersonal interactions with the tools of theology and the social sciences for the purpose of support and healing. In a typical class or supervisory session, we analyze the words, voice inflection, pace, and gestures of an intimate conversation between two people, looking for clues to the deep structure of personality and intimate relationships. The hope of such study is that we will see the revelation of God is love and power in action to validate and challenge the theological traditions that give us eyes to see and invite us to see more clearly."

Correspondence between supervisors and trainees in their perception of supervision events.

The focus of this study is on how the participants in 16 supervisory dyads perceive the content and process in a supervisory session, and on the meaning they attach to supervisory events. A central issue is to what degree the participants in each dyad correspond in their perceptions and evaluation of supervisory events. Another question is how lack of correspondence affects the trainees' experience of satisfaction with the supervision. A majority of the dyads were rated low or moderate in correspondence, and it is discussed whether the influence of low correspondence on trainee satisfaction may be related to supervisory intentions and style characteristics. A main point in the discussion is whether role ambiguity may be related to obscure communication and reduced correspondence, and it is suggested that more attention should be paid to negotiating and renegotiating rules for the supervisory relationship.

Supervision of Inexperienced Therapists

This paper is based on a qualitative study of supervision of inexperienced trainees. Eighteen supervisor-student dyads were interviewed listening to the same sequences of a tape from a supervisory session. They were also given a semi-structured interview relating to general aspects of supervision. The purpose of the study was to provide understanding of supervision that questionnaires may not make apparent, and to explore them in relation to supervision issues. It appeared that most supervisors had an ideal of a symmetrical position and tried to refrain from being didactic or instructive. This position was mostly appreciated by the trainees. The findings are discussed in relation to the emphasis on didactic training for inexperienced trainees in supervision literature, particularly with regard to possible contextual variables influencing how the trainee perceives and reacts to supervision.

Supervision: A containeræcontained approach

The authors illustrate an approach to the supervisory process as a learning experience for both supervisee and supervisor built on the containment of unconscious anxieties. It is argued that a core function of psychoanalytic supervision is to help contain the emotional turbulence and the unconscious anxieties arising and evolving in the two interacting domains of the analytic and the supervisory sessions. From this perspective, the analyst‐patient interaction and that of the supervisee and supervisor can be understood as twin, tiered transformational arenas, the supervisory one being at the service of holding and grasping the roles the supervisee/analyst goes through as part of the analytic process. On the basis of detailed clinical material from a disturbed 7‐year‐old girl, the authors explore the interrelated issues and difficulties in containing anxieties and turbulence in both the analytic and the supervisory situation. When emotional containment is adequately handled, the supervision helps the understanding and development of the supervisee's use of his/her own personality as a treatment instrument, as advocated by Fleming and Benedek decades ago. The supervisory session thus furthers the resolution of clinical issues through symbol‐formation, clinical sessions and supervision being twin domains for recording and understanding emotional evolution.

Homosexuality and the Mental Health Professions: The Impact of Bias

Back to table of contents Previous article Next article Book ReviewsFull AccessHomosexuality and the Mental Health Professions: The Impact of BiasDennis Martin, R.N., L.I.C.S.W.Dennis MartinSearch for more papers by this author, R.N., L.I.C.S.W.Published Online:1 Feb 2001https://doi.org/10.1176/appi.ps.52.2.250AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This monograph, formulated by the committee on human sexuality of the Group for the Advancement of Psychiatry, aims to examine the roots of antihomosexual bias in our culture, and, more specifically, how it affects the practice of clinical psychiatry, psychotherapy, and the mental health professions as a whole. This is the 144th report published by the group since 1946, when it was founded to produce position papers on relevant and controversial psychiatric issues.The text is concise, practical, and richly illustrated by 26 clinical vignettes drawn from inpatient and outpatient treatment settings, psychiatric residency programs, supervisory sessions, and medical school education.The book begins with an exploration of the cultural biases against gay and lesbian people that have emerged from biblical interpretations, organized religion, antisexual Victorianism, idealization of the two-parent nuclear family, and heterosexism, demonstrating their historical influence on the practice of dynamic psychology. The degree to which dynamic psychology itself, via early "pathologizing psychoanalytic constructs," reinforced and shaped the antihomosexual bias of the larger culture is also well covered.The remainder of the monograph is pragmatic and focused on practice. Discussed in separately developed chapters are antihomosexual biases in the clinical setting, the impact of antihomosexual bias on supervision and professional training, legal aspects of antihomosexual bias and mental health, and the relationship between HIV and antihomosexual bias.Clinical vignettes and academic research studies are skillfully juxtaposed to demonstrate the blatant—and sometimes very subtle—ways in which bias infiltrates the practice of psychiatry and psychotherapy. This feature both strengthens the work and makes it quite interesting to read.Although psychiatry has come a long way from the position articulated in DSM-I in 1952 that homosexuality was a sociopathic personality disorder, and in DSM-II in 1968 that it was a sexual deviation, biases against gays and lesbians are still present and active in clinical work even though "personality measures, projective tests, rates of psychiatric symptoms, and lifetime prevalence of psychiatric disorders, with few exceptions, do not distinguish between homosexual and heterosexual subjects." Pathologizing patients because of their homosexuality, stereotyping people on the basis of sexual orientation, empathic failure, heterosexism, and unsolicited attempts to change a patient's sexual orientation are still frequently found in psychotherapy, according to research cited in the text.Biases against gay and lesbian people begin in medical school, where a negligible amount of curriculum time is spent on studying healthy homosexual lifestyles, making them a virtually invisible population; curriculum time devoted to gay men is typically in the context of HIV-related illnesses. "Students who have no frame of reference for treating gay and lesbian patients other than as examples of psychopathology or as patients at high risk for contracting and spreading AIDS are likely to treat their patients in stigmatizing and prejudicial ways."Especially well developed in the book is the degree to which HIV's initial emergence in gay men has created a dynamic that more potently stigmatizes both gay people and persons with AIDS regardless of their sexual orientation.The book discusses the mutual influences the legal and mental health systems have on one another and how gay and lesbian people are affected by these influences. Clinicians are challenged to become more aware of the mental health burdens borne by gay and lesbian clients in the face of laws concerning marriage, tax planning, health care proxies, and so on, which affect their lives but were created with heterosexual presumptions.The committee also encourages gay and lesbian psychiatric professionals to more frequently risk disclosing their sexual orientations to influence the biases of the mental health professions and their culture at large. Fears of losing one's place in a medical school or residency program, of losing status or career advancement at one's university or hospital, and of losing patients are cited as reasons why relatively few gay men and lesbians have "come out" professionally. More disclosure would provide more role models for people entering the psychiatric and mental health professions.Although this book primarily addresses the field of psychiatry, it is an excellent text for all readers in the mental health professions, medicine, or human services who seek to refine their clinical skills and sensitivities and to better understand deeply seated cultural dynamics influencing their work.Mr. Martin is affiliated with the Rose Hawthorne Lathrop Home in Fall River, Massachusetts.by the Committee on Human Sexuality; Group for the Advancement of Psychiatry Report No. 144; Hillsdale, New Jersey, Analytic Press, 2000, 132 pages, $29.95 FiguresReferencesCited byDetailsCited ByNone Volume 52Issue 2 February 2001Pages 250-250 Metrics History Published online 1 February 2001 Published in print 1 February 2001

Residential institutions requesting supervision: a theoretical analysis of an empirically studied problem

This study was based on vague but persistent problems of uncertain origin permeating treatment and care in Swedish residential institutions treating emotionally disturbed and socially disadvantaged children. The purpose was to generate a reliable, empirically grounded theory, sufficient to describe and explain these problems, which were first observed in supervisory sessions. The main methods used were grounded theory (Glaser & Strauss 1967; Strauss & Corbin 1990, 1998) and abduction (Peirce 1914/1990; Fann 1970; Josephson & Josephson 1996). During a three-year period, 17 respondents from three strategically chosen institutions were individually interviewed twice. The results suggest that artificial family institutions, enjoying family privileges, may develop out of family ideas. Under certain conditions, such institutions may be transformed into non-professional institutions that fail to carry out their official task, but that instead effect unconscious psychological tasks – tasks that are both hidden behind and obstruct the institution’s official mission. The possibility of avoiding this development is dependent partly on the quality of the emotional content, called the need for reparation, within the institution, and partly on the methods used to control this need. This notion was tested in practice in a separate part of the study in which the method action-cum-research (Trankell 1973) was used. One of the studied institutions was then observed for two years during a process of planned change in organization, treatment routines and attitudes. After two years, the final resistance to the official task had disappeared, and the former non-professional institution now worked in a task-orientated manner. This result has broad implications for planning and support of care institutions, as the same phenomena might arguably occur in any care organization.