The Internet: Vision and Supervision
by Marc G. Schramm, Psy.D., C.G.P
We'll call her Amy. Amy is a budding psychotherapist who recently began an outpatient practicum. One day, during a group supervision session, she confronts her supervisor with accusations of inappropriate boundaries, and of trying to develop a dual relationship. She suggests that if the situation doesn't change, she will bring the matter to the attention of the state board.
What brought things to this pass? Financial exploitation? Sexual harassment? No, no, something much worse: the supervisor tried to run an experiential supervision group.
I have heard from supervisors in person and over the net about variations on this theme, and have had a similar experience myself. I suppose that any establishment-types who have completed the relevant rites-of-passage always complain about what's wrong with the next generation. Whenever supervisors get together one is bound to hear at least one or two horror stories. I've shared a few myself (and I suppose that my former supervisors still regale their colleagues with woeful tales about me).
That having been said, I'm genuinely concerned over the frequency of the sort of scenario noted above. The discomfort experienced by many trainees is certainly normal, even healthy, but the radical way in which that discomfort is expressed has a chilling effect on the training process. Discord can play an important role in the dynamics of any group, providing wonderful opportunity for experiential learning. But the sorts of accusations referred to above violate the supervisory relationship by effectively forbidding experiential resolution: Attempts to work the issue through by way of the group process would be exactly what the supervisee is so strenuously objecting to. The supervisory process is shut down.
This violation reflects the trainee's belief that the supervisor has committed a violation. The essence of the complaint is typically that the supervisor is attempting to practice psychotherapy on the supervisees. The line between supervision and therapy, though fuzzy, is nonetheless quite real. I stress to my supervisees that if questions arise (about countertransference, for instance) that touch upon issues too sensitive to share with me or the group, then these issues should instead be considered by the supervisee individually, and perhaps taken up with their therapist if they have one.
Such boundaries amplify attention to here-and-now issues by the supervision group, with there-and-then focus more on the trainees' therapy cases than on their personal histories. When personal information is relevant, I may set a boundary even if trainees don't, stopping them from sharing such matters too intimately. When, for instance, a supervisee has shared having been a victim of abuse, details and emotional catharsis have been deferred to more appropriate venues.
The line is drawn more tightly for group than for individual supervision, though it may gradually loosen over time in a long-term supervision group. In my experience, most supervisors employ good boundaries. While the concerns that trainees have about the supervision process are not frivolous, the extreme reaction so often seen is out of proportion to the level of exposure asked for (not demanded).
I think the crux of the matter can be divined from supervisees characterization of these groups as psychotherapy: some trainees cannot tolerate any role suggestive of a client. Perhaps this is due to their perceptions about status and power in the therapeutic relationship, or discomfort with self-disclosure and vulnerability.
Complaints of group supervision as therapy appear to be vastly more common than for individual supervision, even though the boundary between supervision and therapy in the latter case is usually less well defined. The greater breadth of exposure in a group situation arouses far greater anxiety and feelings of vulnerability. Putting one's issues on display before one's peers more easily triggers patient-role schemas. But how can we ask our patients to do that which we ourselves find intolerable? And when we ask anyway, are we really capable of empathizing with rather than condescending to our clients?
If these problems exist in many of our trainees, they are but little less frequent in many of us full-fledged practitioners. The stigma attached to seeking psychotherapy, which we so loudly decry, is nevertheless one that we are not immune to. To a greater or lesser extent we all perhaps fear what others think of us, especially with regard to our mental health. Our focus on psychopathology can lead us to overpathologize, and thence to overdistance ourselves from our patients.
I'd like to end by briefly noting that the opposite problem exists as well: overfocus on patients' strengths. In such cases, just as in cases of overpathologizing, the underlying issue is difficulty tolerating the pain and pathology of our patients. We will look more at underpathologizing at a later time.
Marc G. Schramm, Psy.D., is a Founding Certificant of the National Registry of Certified Group Psychotherapists, a clinical member of the American Group Psychotherapy Association, and President of the Tri-State Group Psychotherapy Society. He is currently Cincinnati-Dayton Regional Director for Counseling Consultants, Inc. Call Dr. Schramm at 513-984-9222
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