Therapeutic Supervision

[sun seeker]

Has anyone had their therapist ask for and receive supervision because of issues in their treatment? How did it go? Did the experience in therapy improve? Does the client have any input into what is discussed or a chance to work as part of a team made up of therapist, supervisor, and client, or does it all take place between therapist and supervisor (and then, how do you know how it went and whether your concerns were taken seriously)?

Lost of questions. I'm in this situation now and wondering what to expect.

 

[Lucycat]

My therapist told me from the start that he has regular supervision from a consultant psychiatrist with an interest in trauma. He tells me when I am up for discussion and the outcome, but I also understand that he has many other clients to consider.

Has it helped? How can I tell. I am thoroughly impressed with my T , but I cannot say whether it is his supervision that helped - or just the way he is!

 

[sun seeker]

So that sounds like a different situation, @Lucycat. There is regular supervision so you wouldn't know the difference if it was happening or not. I'm in a situation where therapy is not going well and the supervision is one of the steps we are taking to address the problems.

 

[Suzetig]

In my experience supervision is usually a relationship and process between the therapist and their supervisor very much focussed on what's happening with the therapist in the work they're doing. So in your case I'd expect the supervisor to be exploring with your therapist what it is about them and their way of working that's getting in the way. A good supervisor will be able to pick away at a therapists defensiveness and help them refocus on the client and their relationship with them. It's not usually a place for the therapist to either deny there are problems or to blame the client.

I'm saying all of that, I also know of situations where the client has had communication with the therapists supervisor or met with the therapist and the supervisor. In those situations it's very much been about the supervisor helping the therapist to hear what the client feels about their therapy and what they need moving forward to inform the supervisors work with the therapist.

I've said elsewhere I think the process of supervision is so essential for good, safe long term therapy that I wouldn't consider seeing someone who didn't access it on a fairly regular basis.

 

[sun seeker]

A good supervisor will be able to pick away at a therapists defensiveness and help them refocus on the client and their relationship with them.

Thanks, that is what I was concerned about, because we've gotten to a tricky place where my therapist is doing a few things that are actually retraumatizing me and grinding progress to a halt, but he seems to be in denial about them and in recent communications, is making the problem about me rather than taking responsibility for his own irresponsibility and inconsistency, which I hate to say are pretty extreme and just not okay when working with survivors of extreme trauma. I was afraid that since it has gotten to that point, his supervisor wouldn't find out what the real problems are or how extreme they have become. He has a few traits or habits that he recognizes but doesn't seem willing to work on (or maybe just doesn't know how), and they are getting in the way in a huge way. The deflection onto me is a new one though, so I am guessing he has gotten to a point where he is running into a wall he is going to have to deal with but is resisting in a big way.

I also know of situations where the client has had communication with the therapists supervisor or met with the therapist and the supervisor.

So maybe we will do some of both. That might be the best solution. I think he really does want to work this out, but there is something blocking him.

 

[joeylittle]

he seems to be in denial about them and in recent communications, is making the problem about me rather than taking responsibility for his own irresponsibility and inconsistency, which I hate to say are pretty extreme and just not okay when working with survivors of extreme trauma. I was afraid that since it has gotten to that point, his supervisor wouldn't find out what the real problems are or how extreme they have become.

If his supervisor has an ounce of training in psychology, they should be able to see what's going on without the therapist fully disclosing anything. Remember, supervisors do what they do specifically because they also feel confident identifying the issues, the things that go wrong, in therapeutic relationships.

You could, if you wanted, send an email to your therapist outlining what your experience has been and ask him to share it with his supervisor. If you structure it based on his action, your interpretation, the feeling/experience that follows, and your question (i.e. am I interpreting this correctly, I'm not sure how to react to this, how can I cope with this better), it should be helpful (whether he passes it on or not).

You might feel too enmeshed right now to do that, it's really only a suggestion.

My therapist had to get supervision after working with me for about a year. He wanted feedback on whether he was 'working with me correctly'. He explained that as wanting to know if he was using the right tools the right way. I gave permission, and when I followed up, he said that he felt better having talked to the supervisor, got some confirmation that he was on the right road, and some new tools. I felt like a science experiment briefly, then got over it. I think it helped him, I'm not sure if it had an impact on me directly, but that was OK for me. I think your situation is more complicated because it's not about the therapy, it's about the interpersonal between you and he - but that's why I'm suggesting that you probably could make a contribution to the conversation, if it would give you some relief to know that you've put it out there.

 

[sun seeker]

I can relate to feeling like a science experiment. The nature of my trauma is fairly unusual and there are next to no therapists who know how to treat it. He has openly admitted that sometimes he doesn't know what he is doing. Sometimes I really wish he did.

You could, if you wanted, send an email to your therapist outlining what your experience has been and ask him to share it with his supervisor.

I think maybe what I should do is write that list in collaboration with him in our next session. It might feel more like a collaboration and less confrontational.

It is also possible we could do a three-way session with his supervisor. I've already talked to her a little bit and outlined the problem in very general (and tactful) terms.

I think your situation is more complicated because it's not about the therapy, it's about the interpersonal between you and he

Right, though that is part of the therapy too, at least this variety of therapy. I think that is where he is running into a problem, and maybe this is the first time it's come up because I don't think he's been doing this very long and I may be the client who has gone the furthest along this route. So possibly he is running into a wall he didn't realize was there, where his personal issues clash with the demands of the stage of therapy I am at.

 

[sun seeker]

Right, though that is part of the therapy too, at least this variety of therapy.

And the good thing is his supervisor is, so I've heard, extremely skilled at working on interpersonal issues. I think I'm in good hands.

 

[sun seeker]

I've already talked to her a little bit and outlined the problem in very general (and tactful) terms.

I feel like I should clarify, I contacted her originally because I was hoping for some emergency help since I was in crisis, my therapist had shut me out, and she is the only person in the area besides him that I thought remotely capable of working with me. It was after she got back to me and said she's away at the moment, that I went into the general idea of what is going on and asked for some help. I already knew he had, or intended to, contact her about me. After that, I sent him a brief note saying I'd talked to her. I'm really trying to keep everything open here. Not so easy when one of the concerned parties is being so uncommunicative at the moment, but I'm still trying!

 

[joeylittle]

Not so easy when one of the concerned parties is being so uncommunicative at the moment, but I'm still trying!

Personally, I think you are doing great.

Just remember - since part of the issue is about boundaries, I don't think your therapist is being uncommunicative so much as he is in the process of re-drawing the lines. In the past, he has shared too much of what was going on with him, and it affected you adversely. You aren't going to be privy to his entire process with this. And that will be frustrating, because your best role in this is to communicate very openly - almost to over-communcate, and I don't mean that in a bad way. The more uncensored information both he and the supervisor have about your experience, the better equipped they are to develop and implement a strategy that will solve the problem.

His role is to back the bus up and re-evaluate how he relates and what he relates vis-a-vis you, and communicate openly and fully with Supervisor; your role is to share everything you experience (which isn't the same as reporting everything he's done objectively; your POV is what matters) and the supervisor's role is to sort through all that and help the therapist devise and implement a better strategy going forward.

It's great you were able to make contact with her; and since you've already done that, you may consider it useful to check in with her again, in terms of ways you may be able to get help for yourself while this process is ongoing - that seems to be the tough part for you, if I"m reading you right.

 

[Anarchy]

Hi Sunseeker,

The professional bodies for psychotherapy here, REQUIRE that their members undertake (and pay for) supervision meetings with more experienced practitioners, one hour a fortnight would represent a minimum.

Trainees (?and practising therapists) are also required to undergo psychotherapy themselves (35 to 40 hours a year as a bare minimum), in order to help them remain focussed on their clients, rather than becoming overwhelmed and sucked into issues of their own, when they get triggered by what their clients are bringing up.

 

[Suzetig]

I think it's important to reiterate what @joeylittle is saying. Your therapists supervision is primarily his safe place and needs to stay that way if he's to benefit from the process so, he needs to redraw boundaries which might feel like he's being defensive and uncommunicative. I wouldn't, for example, expect him to tell you the content of his discussions with his supervisor - tbh I wouldn't expect him to say anything much beyond him telling you he receives supervision.

That relationship needs to be between him and his supervisor, unless he agrees to the three of you meeting - him not agreeing doesn't necessarily mean he's not being open with you and his supervisor, just that he wants to preserve the safety of that relationship. It might help to think about it in terms of you inviting a close friend or family member to your therapy - you might be reluctant, need to agree particular boundaries or just not be ok with it any circumstances.

If his supervisor is worth their salt and their relationship works as it should, the supervisor will get to the bottom of it, if that's not the case, you being there won't make a blind bit of difference. I think you're doing great at trying to find a collaborative way through it and to see things from your therapists point of view and I really hope things work out for you.