APA Format & No Plagiarism Identify attributes of leadership styles and approaches that facilitate quality supervision.Evaluate the supervisory and leadership skills demonstrated in the Petrakis case study by identifying which supervisory and leadership skills the supervisor demonstrated.Explain whether the supervisor in the video demonstrated quality supervision, and why. Provide specific examples to support your evaluation.NOTES please read: File: “Supervision Wk8example.docx” please just make it not Plagiarism Additional reference: https://www.enotes.com/research-starters/authorita…
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Clin Soc Work J (2011) 39:301–307
DOI 10.1007/s10615-010-0304-3
ORIGINAL PAPER
Teaching the Use of Self Through the Process of Clinical
Supervision
John P. McTighe
Published online: 29 September 2010
Ó Springer Science+Business Media, LLC 2010
Abstract In their efforts to learn the skills involved in the
use of self, clinical social work supervisees are faced with
the daunting task of integrating information coming not
only from the patient but also from their own complex set
of responses. The clinical supervisor serves a key role in
guiding the trainee through this process. Grounded in
contemporary psychodynamic theory, this paper discusses
an approach to helping the supervisor model the use of self
in the context of the supervisory relationship. A supervisory case example is used to illustrate.
Keywords Use of self  Clinical supervision 
Countertransference  Psychodynamic theory
Among the greatest challenges for the novice clinical social
worker is the process of learning to incorporate and make
sense of the myriad information that is communicated and
received throughout the course of even a single psychotherapy session. At a time in training when the student’s
emerging sense of professional identity is often quite
fragile (Gill 2001), the task of sorting out the internal
responses evoked by the patient from those emerging from
one’s own history, all while attempting to conceptualize
case material through the lens of one’s increasing font of
academic knowledge, can seem insurmountable. Beginning
therapists are learning to sort out the complex implications
of issues such as race, gender, and perceived socio-economic status (both of the clinician and the patient). They
J. P. McTighe (&)
Department of Counseling, Health & Wellness, William
Paterson University of New Jersey, 300 Pompton Road,
Wayne, NJ 07470, USA
e-mail: mctighej@wpunj.edu
are dealing with their responses to the material that the
patient is presenting, especially when this material is
experienced as taboo or otherwise provocative (e.g. issues
of abuse). At the same time, they are learning to attend to
the many levels of conscious and unconscious communication that are occurring throughout the treatment. Making
therapeutic use of this material by means of well-conceived
and well-crafted interventions can thus seem a Herculean
task well beyond the grasp of the trainee. It falls in large
measure to the clinical supervisor to accompany the neophyte therapist in the process of growth, discovery, and
integration.
Grounded in contemporary psychodynamic theory, this
paper will explore processes by which the supervisor can
assist social work supervisees in incorporating the use of
self into their practice. In addition to surveying briefly the
history of the concepts of countertransference and use of
self as well as their perceived role in therapeutic treatment
since the time of Freud, it will consider the skills that we
seek to develop in supervisees, and the role of the supervisor as teacher and model of use of self. In particular, it
will consider ways in which the supervisor can model a
stance of non-judgmental, reflective attention to one’s
internal responses in the clinical situation, and make use of
these as a tool for understanding and intervening with
patients. Existing models for educating trainees about the
use of self will be reviewed. A detailed supervisory case
example will be used to illustrate.
Historical Perspectives on Countertransference
and the Use of Self
Beginning with Freud, much attention has been paid to the
phenomenon of countertransference and its impact on the
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clinical situation. Freud (1910) first described countertransference as ‘‘a result of the patient’s influence on his
[i.e. the analyst’s] unconscious feelings’’ (p. 144). Later,
Freud (1912) used the image of the telephone to describe
the nature of communication between the analyst and
analysand, encouraging the analyst to be receptive to the
patient’s transmittal of unconscious material. Thus, it fell
to the analyst to do all in his or her power to eliminate
interference with this process. The classical tradition, then,
encouraged awareness of the complex set of personal
reactions and responses to the patient known as countertransference with a view to decreasing its influence in the
therapeutic situation and facilitating the neutral stance of
the therapist (Edwards and Bess 1998; Jacobs 1991; Racker
1988/1957; Thompson 1988/1956).
Beginning in the 1940s a shift was noticed in the way in
which countertransference was viewed (Thompson 1988/
1956). This shift involved a reconsideration of the nature
and therapeutic value of countertransference. Increasingly,
these internal responses came to be seen as a potentially
valuable tool that the clinician might use to advance the
clinical work with the patient. In his writing, for example,
Tauber (1988/1954)) notes that an analyst may be so
concerned with avoiding the possible impingement of
countertransference that he or she may not be able to attend
fully to the contents of the material that the patient is
presenting. To remedy this, Tauber encourages the conservative and responsible use of the countertransference
material as long as the analyst is willing to take responsibility for the effects of doing so in the treatment and not to
react with defensiveness. In this way, he suggests, issues of
resistance may be more easily worked through.
For her part, Thompson (1988/1956) adds that the analyst should be open to the patient pointing out what may be
blind spots in the analyst’s personality, and calls upon the
analyst to respond in a non-defensive manner, thus
encouraging the analyst’s naturalness and spontaneity. She
draws attention to the notion that the whole person of the
analyst and the whole person of the patient exert a mutual
influence upon each other.
In decades since, the emergence of the relational,
interpersonal, and self-psychological traditions has contributed further to our understanding of the meaning and
role of countertransference in psychotherapy. In these
views, the internal experience of the therapist is seen less
as a hindrance and more as an integral part of the therapeutic process. This inner dynamic serves not only to help
the therapist understand the unconscious communication of
the patient, but also to craft interventions that utilize and
build upon the therapeutic relationship. It is this relationship and the interface of the subjectivities of therapist and
patient that is seen as central to the helping, healing process
(Brown and Miller 2002). The whole self thus becomes the
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Clin Soc Work J (2011) 39:301–307
instrument or tool of the therapist (Thompson 1988/1956).
In this view, not only is it undesirable to eliminate the
impact of the clinician’s subjectivity from treatment, it is
downright impossible (Lewis 1991). This has important
implications for the supervisory relationship as a key place
where beginning clinicians learn to make use of their self in
their work.
Cultivating the Supervisee’s Use of Self Through
Supervision
Various methods have been proposed for teaching the use
of self to students of psychotherapy. Edwards and Bess
(1998) focus their attention on the central importance of
self-awareness on the part of the therapist as a way of
integrating personal and professional selves (Reupert 2007,
2008). To this end they advocate a three-pronged approach
to the exploration of the self. First, they suggest, the
therapist must make an inventory of the self. This includes
a self-examination of personality traits that contribute to
her identity as a therapist. They encourage reflection on
questions such as what one enjoys about being a therapist
and a consideration of the role that this plays in the therapeutic work. Secondly, they call for the development of
self-knowledge. This especially concerns beliefs and attitudes on the part of the therapist about the nature of life’s
problems and how they are best solved. Finally, the authors
point to the need for an acceptance of risks to the self. That
is to say, therapists must remain open to self-discovery
with all the challenges that accompany it. Only in this way,
they suggest, can therapists hope to understand their
patients better.
For his part, Lewis (1991) has developed a modular
training program for therapists that includes one section
devoted the development of use of self. This module
contains various elements. Lewis begins with the consideration of the impact the therapist makes upon a patient by
virtue of factors such as appearance, size, movement,
posture, office setting, among others. Furthermore, he
suggests that students will benefit from as much insight as
possible into their interpersonal style and how this impacts
others. Thirdly, growth in the use of self demands attention
to the therapist’s developing feelings (including sexual
feelings) about the patient. Finally, Lewis utilizes an
exercise in which trainees discuss and elaborate fantasies
about themselves and their patient as a way of uncovering
underlying countertransference.
Glickauf-Hughes (1997) describes a model of supervision in which supervisees are taught in both didactic and
experiential ways how to manage patients’ use of primitive
defenses such as splitting, projection and projective identification and their impact on the clinical situation. Citing
Clin Soc Work J (2011) 39:301–307
the work of Bion (1962) on containment, Glickauf-Hughes
notes that therapy provides a new opportunity for patients
to have their difficult feelings and behaviors effectively
contained thereby allowing for the possibility of an interpersonal dynamic with the therapist that is different from
the one to which they have become accustomed. In order
for this kind of containment to occur, therapists must be
able to acknowledge, sit with, and wonder about their
experience of a range of affective states that are often
difficult to tolerate, particularly in the clinical context.
Examples of such states might include anger, shame,
incompetence, boredom, and sexual arousal.
These considerations highlight in a particular way the
issue of personal psychotherapy as an element of training
in clinical practice. Personal psychotherapy has long been
considered to be of great benefit to the developing psychotherapist, not only to prevent unresolved personal issues
from adversely affecting the treatment as discussed previously, but in fact to free up areas of the therapist’s personality for greater use in the therapeutic relationship
(Thompson 1988/1956; Wolstein 1988/1959). Edwards and
Bess (1998) suggest that personal psychotherapy affords
the student the opportunity to have a therapist who may be
a model for practice, provides a first-hand understanding of
the therapeutic process, and facilitates the integration of
one’s personality with one’s professional learning. In
keeping with the perspective presented here, personal
psychotherapy can provide new clinicians with a safe space
in which to grow in comfort with the exploration of a wide
range of emotional experiences as they deepen their selfawareness.
Still, the narcissistic vulnerability to which new therapists are subject can make the practice of attending to the
many internal and external aspects of treatment seem
extremely daunting. Psychotherapy trainees of any discipline who are trying on an unfamiliar role are commonly
preoccupied with issues of competence such as following
the rules, doing things correctly and well, understanding
the patient’s presenting problem, and using effective
techniques and interventions. Thus, they may find it quite
difficult to listen deeply to their internal responses in the
ways that have been suggested. An example serves to
illustrate.
Ms. K was a second year social work student placed in
an outpatient mental health clinic. Eager to learn, she
nonetheless expressed normal doubts about her ability
since she had never before conducted individual psychotherapy with patients. She felt full of questions on issues
ranging from the initial orchestration of the formalities of a
session to the complex work of assessment, diagnosis, and
intervention. Her supervisor, while providing needed
answers to her task-oriented questions, reassured her that
he would be there to support her, and encouraged her to be
303
patient with herself and to allow the process to unfold. In
this way he attempted to shore up her vulnerable sense of
self as a student and emerging professional.
As Ms. K began treating her first patients, her supervisor
noted that her process recordings were peppered with selfrecriminations about the ‘‘badness’’ of her reactions to her
patients. Statements such as, ‘‘I’m feeling like I want to
take care of the patient, and I know that is really bad,’’
were common. The supervisor asked her what she believed
was bad about her feelings. Ms. K. stated that she believed
she had to maintain a neutral and distant stance in order to
help her patients. The supervisor clarified that this belief
was grounded in a particular theoretical system and suggested that her countertransference might in fact be helpful
in her work. He encouraged Ms. K to suspend judgment of
her reactions and suggested an observation of the material
that emerged both from the patient and herself, taking all of
this as information that would help her to understand her
patient better. This would serve as a framework for the
interpretation of future countertransference reactions.
Bion (1970) exhorted the analyst to come to the session
without memory, desire, or understanding. Trained in eastern traditions of philosophy, Bion believed that such a stance
created the condition for the possibility of openness on the
part of the therapist. If the supervisee can be encouraged to
begin from a stance of non-judgment, both of the patient and
of herself, the kind of observation and active wondering that
the use of self demands may be facilitated. Having thus
cleared away much of the static that can result from
expectable initial self-consciousness and doubt, the student
can be guided to consider and make use of her self experience
in a more integrated way with the patient and to translate this
experience into effective interventions.
The Supervisor as a Model of the Use of Self
As already noted, the task of guiding the beginning clinical
social worker in the development of the use of self falls
largely to the clinical supervisor. What, then, are the attitudes
and tasks that this requires of the supervisor? Like the novice
or experienced therapist, the supervisor may be encouraged
to follow the advice of Bion (1970) by approaching the work
of supervision without memory, desire, or understanding.
Thus, while the supervisee is being encouraged to attend not
only to the accuracy of assessment, understandings, interpretations and other interventions, but also to the role of
countertransference in the weaving of the therapeutic relationship, so too must the supervisor attend not only to the
work of teaching (i.e. the transmittal of information)
and skill development, but to the impact of countertransference reactions on the supervisory relationship itself
(Kindler 1998).
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Furthermore, several authors discuss the mutual interaction or influence of the supervisor, the supervisee, and the
patient in the context of supervision. Here too, the supervisor
serves as a model for the use of self. Strean (2000), for
example, notes that attention to one’s own countertransference with the supervisee can be useful in working through
difficulties in the student’s clinical work inasmuch as these
difficulties often get unconsciously enacted in the supervisory relationship. He recommends judicious suspension of
the anonymity of the supervisor so as to facilitate the
student’s work. The student is likewise assisted in the
development of the use of self when the supervisor acts as a
model in this way. For example, Knox et al. (2008) found that
supervisors’ self-disclosure of their reactions to supervisees’
patients helped normalize supervisees’ feelings, served as a
teaching tool, and strengthened the alliance between supervisor and supervisee.
In her method of teaching students to deal with patients’
use of primitive defenses, Glickauf-Hughes (1997) notes
that due to their primitive nature and the complexity of
dealing with them, such defenses may be enacted by
students in the supervisory relationship. This may serve as
an unconscious way of communicating to the supervisor
what is happening in the treatment (Bromberg 1982).
Furthermore, this parallel process offers the supervisee the
opportunity to experience the containment of these difficult
dynamics by the supervisor. Other examples of students’
manifestation of their efforts to manage patient’s primitive
defenses might include rejecting the supervisor’s attempts
to help, feeling dejected because of a patient’s devaluation
of them, expressing intense anger towards the patient, and
wishing to terminate the therapy precipitously. GlickaufHughes recommends a variety of techniques for dealing
with this including various combinations of teaching,
clarification, modeling, and role playing.
Kindler (1998) discusses supervision from a self-psychological perspective. Borrowing from Fosshage’s (1995)
thinking regarding the analyst’s experience of listening
from a variety of positions, Kindler applies this construct to
the supervisory relationship. In addition to her stance as
supervisor, she may also take the position of the supervisee
as well as the patient. Furthermore, the supervisor may
listen from the perspective of empathy (e.g. from the
patient’s perspective) or from an other-centered perspective (e.g. as someone in relationship to the patient). By
taking this stance, the supervisor may more effectively
listen and understand not only the patient’s internal process, but the dynamic process between the supervisee and
the patient. This facilitates not only the treatment but the
development of the supervisee as well. Confirmation of this
development may be seen in the supervisee’s increased
capacity for self-righting, the expansion of self-awareness,
and symbolic reorganization.
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Clin Soc Work J (2011) 39:301–307
Kindler goes on to emphasize the importance of the
supervisor’s empathic listening to the supervisee, even if
this seems to preempt the discussion of patient material.
This activity is viewed as not only modeling the process of
self-psychologically-oriented treatment, but also serving
self-cohesion and vitality functions for the supervisee thus
enabling her to focus more adeptly on the subjectivity of
the patient. Likewise, consistent with a self-psychological
orientation, he recommends a close and non-defensive
attention to the supervisee’s experience of the supervisor to
promote feelings of safety and the growth of the supervisory relationship.
From a related school of thought, Brown and Miller
(2002) add an intersubjective nuance to the discussion by
viewing the supervisory process as a triadic intersubjective
matrix. While akin to Fosshage’s (1995) notion of multiple
perspectives, Brown and Miller see the supervisory relationship as the ‘‘point of interaction’’ (p. 814) of three
unconscious processes. By viewing the supervisory experience as a ‘‘space for listening’’ the authors seek to attend
to the unconscious communication between supervisor,
supervisee, and patient. Such a perspective does not come
without its perils, according to the authors. Attending to the
confluence of unconscious processes in this way runs the
risk of blurring the line between supervision and the
supervisee’s personal treatment—a hazard not uncommonly encountered in the supervisory relationship. Likewise, supervision in this vein depends upon the willingness
of both supervisor and superv …
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