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Current ideas in supervision theory and practice
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The Supervision Quarterly

Autumn 2015

Welcome to the Autumn edition of The Supervision Quarterly.

This issue is dedicated to exploring ways to integrate reflective practice and therapist ‘self-awareness' in supervision. It comes from my background in family therapy supervision where increasingly there is awareness of the importance of helping therapists in supervision recognise and deal with personal issues that may interfere with clinical practice and manage stressful therapeutic situations.

Reflective practice enables supervisees to think creatively, be insightful and develop a range of perspectives regarding clinical formulation, practice and the interplay of self within the therapeutic relationship.  Reflective supervision strives to develop awareness of the personal as well as the professional self, which at times can touch on sensitive self-schema. 

In this newsletter family of origin as a supervisory consultative resource will be explored and some practice ideas will be offered for both supervisors and supervisees on how to notice and apply ‘awareness of self-issues and family of origin’ in the clinical context. 

I hope you enjoy this newsletter and welcome any feedback.

Christine

The Importance of Family of Origin Work

Within clinical supervision I believe there is a balance between teaching, supervision of case material and experiential learning. Within psychotherapy training it is required that the trainee undertake personal therapy to meet the needs of both educational and emotional objectives.

This is not the case for most other mental health professional training. The subject of experiential training or therapy is pretty contentious with some believing it facilitates understanding of internalised relationship models while others believe it doesn’t contribute to the clinician being more clinically effective.

My personal belief is that undertaking the experience of personal reflection of family of origin provides a unique understanding of family relationships and interactions which persist to adulthood and are influential in shaping the way a therapist works clinically. I found this is particularly the case when working therapeutically with families.

Framo (1992) states ‘when we train students formally we continue the training they got from their parents, brother, sisters, grandparents, aunts and uncles' ... and by spending time on personal growth this can improve the capacity of the clinician to work therapeutically.  A shift from focusing on family of origin work for the personal growth of the therapist is linking family of origin work with the clinical material the therapist brings to the supervision session. 

Let me give you an example. Typically, a therapist brings to supervision a problem for discussion – something they are struggling with or that they have a question about.  Supervision is focused on enhancing cognitive understanding (unpacking of the assessment and treatment to date) or further understanding of the dynamics of the system (clinical formulation). 

What happens though when applying different techniques to stimulate change does not result in improvement in therapeutic outcome?  Could this be related in some way to how the therapist is relating to the client? Or, could it be related to the therapist's past family of origin experience? A shift of focus at this point in supervision can take place whereby the supervisor-supervisee dyad analyses the complexities of the therapeutic relationship, including transference and countertransference, self-reflection and the possible interplay of self within the therapeutic context.

It is at this point that family of origin can be used as a resource in the supervision context. Therapists who explore family of origin work in supervision have opportunities for improved intentional awareness (Brown 1999; Renshall et al, 2013), are able to differentiate ‘self’ and/or family of origin issues from client issues, and are better positioned to work with stressed families where similar problems exist.  Haber & Hawley (2004) and Senediak (2014) note that professional impasses often resonate with family-of-origin themes. 

There are different ways the contributing factors impacting on professional impasses can be examined within supervision.  My first introduction was in 1985 when I started my family therapy training. Trainees spent the weekend early in the course exploring their family of origin, researching the family emotional system, roles and patterns.  I found the exercise both challenging and foreign because my training in undergraduate and postgraduate psychology never required that I reflect on myself in any way. It introduced me to being more alert to family values, patterns, rules and structure and the impact this has on the change process when a client presents.

This training was undertaken in the 80s and it influenced my work as a young psychologist working with clients presenting with complex mental health concerns.  Instead of applying my instinctive individually focused and technically oriented CBT for which I had been trained, I became more confident to work with whole family groups and challenge systemic change. It also meant that I was focussed on client issues and felt increasingly secure and capable to deal with challenging clinical issues.

Later in 2002 I undertook an intensive practicum with Professor Maurizio Andolfi in Rome along with a small group of international health professionals.  We spent two weeks exploring the nature of our clinical practice: our therapeutic impasses (or ‘personal handicaps’), how this was linked to our historical and personal stories and most importantly, the way we brought this information into the work with did with clients.  To say that it was challenging is an understatement as I had not experienced that personal level of experiential work before, even compared to my early family therapy training.  I embraced this experience and in hindsight believe the difference between these two experiences of family of origin work was related to my willingness and maturity to examine these impasses. Both were worthwhile and both shifted my ways of working therapeutically so that I was secure in being part of the observing system rather than just outside it.

Personal Exploration:

Does it have a place in supervision?

In clinical practice therapists deal with a lot of information:  theory, past clinical experience; data from the session itself, reflections of previous cases, personal experience of successes and failures, feelings towards the client/s in the room and other workplace issues. Our way of managing all this data over time is to develop a personal style to working therapeutically that integrates all this information and experience and for much of the time, applying this in the clinical moment helps us to deal with specific clinical circumstances.

At times however, the therapist experiences uncomfortable feelings, a sense of stuckness or the client does not improve.  This is when broader issues can be explored in the supervisory context.  This is when exploration of ‘self’ issues can be worthwhile 

There is an ethical consideration however, in merging potential personal vulnerabilities in the professional setting (Deveaux & Lubell, 1994; Haber & Hawley, 2004; Renshall et al, 2013). To do so, must be done with permission, sensitivity and within the specific context of developing therapist self-awareness for the purpose of improving therapeutic skills. 

Some guidelines:

  1. The supervisor needs to have a solid understanding of the meaning of ‘family of origin’ work

  2. The supervisor should have had personal experience of undertaking ‘family of origin work’

  3. The supervisor needs to have a solid understanding of the literature

  4. Work should be done individually or in small groups

  5. A clear contract needs to be articulated (purpose; specific guidelines for individuals and group members)

  6. There should be clear guidelines to why family of origin work is being undertaken and related to specific clinical scenarios

  7. There should be clear limits to personal exploration linked to developing insights for clinical effectiveness

  8.  That while personal issues will be identified, individual therapy will not take place (referral to a therapist may be necessary)

  9. Techniques for ongoing self-supervision will be modelled and encouraged (promoting self-dialogue of the personal and professional – “inner conversation” (Rober, 2011)

  10. ‘Professional Handicaps’ are seen as opportunities to discover ‘Handy-Capable’ responses – that is, learning from impasses further enhances therapeutic understanding and clinical practice (Haber & Hawley, 2004).

Integrating a Family of Origin Approach

in Supervision


There are a variety of different ways to introduce family of origin work in the supervisory context. 

Here are some ideas…….

1. A good starting point is at the pre-supervisory meeting when meeting with the supervisee. 

It is important to introduce yourself and how you work: your preferred methods of supervision and why you might apply family of origin concepts in the supervisory context.  There would be many therapists who might not want to address self-issues and readiness on the part of the supervisee is very important.  When I introduce myself the supervisee knows about my previous training, my clinical interests and what has informed my work as an educator, trainer, clinician and supervisor.  Dialogue in supervision consists of systemic thinking and the importance and attention to awareness of self-issues.  Together in supervision we examine relationship factors in the clinical context.

I do not automatically introduce family of origin work in supervision but the supervisee knows that if issues arise in the supervisory context that lend themselves to look at self-issues I will invite them to do so in a safe and structured format.


2. In family therapy training, family of origin coaching can be introduced.

It is good to include family of origin work within a training context: it is time limited and has a defined purpose.


3. Family of origin work can be introduced when the supervisee repeatedly identifies stuckness. 

The supervisor can link the issue at hand to possible personal restraints. Inviting the supervisee to undertake some self-reflection around the issue using the ‘Self Reflection’ handout  is a starting point  http://www.clinicalsupervisionservices.com.au/wp-content/uploads/2014/03/Self-supervision-handout.pdf


 

4. A genogram offers a schematic representation of the three generational relationship system of the supervisee’s own family. 

The supervisor and supervisee can explore relationship and communication patterns using the genogram. 

Within supervision there is a focus on discussing how relationships within the family of origin possibly repeat within current interpersonal relationships and can be explored when analysing the therapist's work with the client/family in treatment. (For example, a supervisee presented with marked frustration dealing with the dominant father in the family he was seeing and despite various therapeutic interventions he never felt he was able to communicate effectively to the father in the session.  Linking this therapeutic relational pattern to his family of origin helped unpack similar restraints within the therapist’s family and experiences with his dominant father.  By recognising the similarities between his own and the client’s family, he was able to ‘step outside’ his own feelings/reactions and address the family dynamics in the session more confidently. 


Such a focus allows for reflection on the emotional reactions of the supervisee AND is linked to the clinical context, further developing the supervisee’s insight and clinical repertoire. 

In conclusion...

It is worthwhile to think about family of origin as a supervisory resource and whether you have had experiences as either a supervisor or supervisee when it might have been helpful to think beyond technique and ponder on relational issues.  I’d be interested in your thoughts or experiences and invite any feedback to clinicalsupervisionservices@gmail.com

Until next time,
Christine 

Looking Ahead: 2015 Training


There are a few events coming up for those that are interested in supervision training:

1. 17-18 April 2015: PsyBA Supervisor Full Training 
Mary MacKillop Conference Centre North Sydney
http://
www.clinicalsupervisionservices.com.au/supervision-workshop-registration/

2. 8 May 2015: PsyBA Master Class: Managing Difficulties and Ethical Issues in Supervision 
Byron Bay Community Centre 
http://www.clinicalsupervisionservices.com.au/supervision-workshop-registration/

3. 4-5 September 2015: Family of Origin as a Resource: Use of Self in Therapy and Supervision Intensive
Wahroonga 
NB: (strictly limited to 8 participants)
Register your interest at clinicalsupervisionservices@gmail.com

 
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