The Psychotherapy Supervisor as an Agent of Transformation: To Anchor and Educate, Facilitate and Emancipate
Publication: American Journal of Psychotherapy
Abstract
Objective:
The objective of this review was to answer the question, What do supervisors actually do in promoting transformative change in the beginning therapist supervisee? New therapist trainees, lacking treatment skills and a sense of “therapist identity,” are prone to experience self-doubt, feel anxious and demoralized, and think of themselves as impostors. Psychotherapy supervision can be helpful and encouraging to beginning therapists in their process of development.
Methods:
Using Mälkki and Green’s concepts of liminality, edge emotions, and boundary confusion as framework, the author examines the pivotal role of the supervisor in striving to create a transformative supervision space.
Results:
The author identifies and elaborates on three transformative streams of supervisory action—to anchor and ground, to educate and facilitate, and to liberate and emancipate. The constituents of each action stream are also identified.
Conclusions:
Psychotherapy supervisors serve foremost as agents of transformation, their chief objective being to actuate and actualize a transformative process of therapist development. The crucial processes by which supervisors achieve that transformative objective reside in the three streams of supervisory action. Accordingly, psychotherapy supervision is best conceptualized as a transformative learning pedagogy.
Highlights
•
Beginning psychotherapy supervisees, engaged in the transformative process of becoming a therapist, are best aided by a transformation-minded supervisor who understands their therapist-defining struggle of disruption, disorientation, and development.
•
Psychotherapy supervision, conceptualized through a transformative learning lens, involves the supervisor leaning into liminality and the edge emotions, striving to create a rich learning laboratory, and serving as an agent of transformation.
•
Three primary forms of supervisory action contribute to the beginning supervisee’s transformative learning experience: to anchor and ground (cultivating connection), to facilitate and educate (stimulating reflection), and to liberate and emancipate (fostering learning processes that free).
Learning in supervision is transformational (not just transmissional) (1).
The psychotherapy supervisor works to anchor and emancipate beginning therapists in their struggle to better define a sense of “therapist identity.” That struggle to define and refine a therapist identity is crucial to the process of “therapist becoming.” But in what ways do supervisors concretely contribute to making that shift a reality for beginning supervisees?
Because psychotherapy supervision is an adult learning endeavor, adult learning theory can be especially useful in framing the “what” and “why” of supervisory conceptualization and conduct (2, 3). Transformative learning theory has emerged as the most robust, internationally favored, and empirically examined adult learning theory (4, 5). Concepts from transformative learning theory, in particular the recent contributions of Mälkki and Green (6, 7), are used to guide this presentation. Whereas transformation can be defined as “a restructuring of a person’s way of being in the world” (6), the restructuring of the beginning therapist’s way of being in the psychotherapy world is examined here.
Why Have a Psychotherapy Supervisor at All?
Purposes of Supervision
Psychotherapy supervision refers to “the formal provision, by approved supervisors, of a relationship-based education and training that is work focused and which manages, supports, develops, and evaluates the work of colleague(s) [and student trainees]” (8). It serves several key purposes: developing and/or enhancing the therapist’s conceptual and treatment skills, developing and/or crystallizing an identity as a psychotherapist, developing conviction about the meaningfulness of psychotherapy, and monitoring treatment efforts and safeguarding patient care (9, 10). Supervision is international in reach (11), interdisciplinary in scope (12), and perhaps the single most powerful contributor to the development of psychotherapist competence and practice excellence (13, 14), and has been dubbed the signature pedagogy of the mental health professions (i.e., the characteristic form of instruction by which psychotherapy practice is learned) (15). Nearly 30 years ago, Bent et al. (16) stated that much of a psychotherapist’s formal training involves learning through supervision; that remains so today.
As the signature pedagogy, supervision strives to cultivate and inculcate habits of head, hand, and heart—the respective content, skills, and values so necessary for the beginning therapist supervisee to engage in “good work” (15, 17). Transformative in purpose and design (18, 19), supervision draws on practical experience and reflection in developing new intervention behaviors and practice understandings (20). “In professional education, it is insufficient to learn for the sake of knowledge and understanding alone; one learns in order to engage in practice” (21) (italics in original). Supervisors ideally use a host of available methods in fostering supervisee learning (e.g., live observation, video review, case discussion) (2, 22).
Impact of Supervision
Research findings offer strong support for supervision’s positive impact on supervisees (23). Furthermore, both therapists in training and practicing professionals identify supervision as being a significant contributor to their development (24–26). Supervisors hope that supervision’s positive impacts are eminently transportable—transferring out of the supervision situation, transferring into the treatment situation, and having positive effects there (27, 28).
Supervision and the Beginning Supervisee
Supervision, potentially valuable across the career lifespan, may have its greatest impact early on. Absent treatment skills and a sense of therapist identity, beginning therapists can understandably feel set adrift. They often experience a learning regression or de-skilling (i.e., questioning their fitness to serve, self-doubting, feeling fraudulent) (25, 29, 30). Beginning supervisees are best served when provided with a supervision experience that is characterized by healing involvement (24, 25). Although not every supervisee will necessarily experience the process of becoming a therapist as painful, data through the decades suggest that some degree of struggle, internal conflict, and pain is common (24–26).
The Beginning Supervisee, Liminality, Boundary Confusion, and Edge Emotions
The beginning therapist supervisee, seen through a transformative learning lens (31–33), can be viewed as caught in a liminal purgatory, subject to the gnawing, disorienting edge emotions, and experiencing boundary confusion (6, 7, 34–36). Liminality is that place, space, or state of being that is in between two different planes of existence, “where all that was stable has become fluid” (7) (italics in original). It is the reality of being neither here nor there, in intermediacy, searching, a being potentially “on the way”, simultaneously expectant and fearful (35, 37). The polarities of cognitive, affective, and behavioral experience abound (e.g., approach and avoidance, dejection and elation). That to which the learner is subjected ideally becomes objectified for scrutiny (38), as does a shift from a maintenance to a creative disposition (6, 7, 36). The beginning therapist supervisee, being laden with liminality, feels the weight of possibility, the hope and threat of change, and is awed by the struggle of becoming.
Edge emotions refer to those feelings that are experienced when meaning perspectives are challenged, where the comfort of that which is set and predictable gives way to discomfort, the unsettled, and the unpredictable (34, 36, 39). “These [edge] emotions. . . appear when we are forced out of our comfort zones or are at the edges of it” (7). As Mälkki (34, 36, 39) has indicated, these very emotions—typically resisted as comfort threatening—point the way toward growth and transformation. Beginning therapist supervisees are accordingly called upon to step out of lived comfort and step into the lived discomfort of their edgy affective experience (40–42).
The Supervisor Leaning Into Liminality and the Edge Emotions
Supervisors strive to help their beginning therapist supervisees deal with identity and boundary confusion, that lingering state of uncertainty and being perplexed about the question, Who am I? and to shift from a preponderating sense of “I am not (a therapist)” to a preponderating sense of “yes, I am (a therapist)” (25, 43, 44). Supervisors ideally lean into liminality and the edge emotions and make them a ready part of the supervision process. But what exactly do psychotherapy supervisors do to make that happen?
Building Transformative Learning Possibilities in Psychotherapy Supervision
By recasting an earlier learning-based model (45), three cohering streams of potentially transformative supervisory action are proposed (Figure 1): to anchor and ground (accentuating readying and preparing, creating a safe space within which supervisee learning can blossom); to educate and facilitate (accentuating instructive learning and discovery, whereby interventions that stimulate supervisee learning are deployed); and to liberate and emancipate (accentuating action and implementation, whereby those practices and processes that free and fortify supervisee learning are engaged). Affective, cognitive, and psychomotor learning ripple across these intersecting streams of action (46–48).
FIGURE 1. Actions for transformative learning change in psychotherapy supervisiona
a Source: Watkins, 2018 (63). Adapted with permission from the Journal of Unified Psychotherapy and Clinical Science.
For beginning therapist supervisees, to anchor and ground is the stream of action that leans most heavily on the affective domain; to educate and facilitate is the action stream that most readily invokes the cognitive and affective domains (e.g., by stimulating reflectivity); (35, 49); and to liberate and emancipate is the action stream that adds in the importance of the psychomotor domain (repeated practice and stamping in learning). Figure 1 shows some of the key components of these three action streams. Beginning supervisees seemingly pass through a repeating cycle of exposure (to practice), reflection (on practice), and reorganization (of practice) in the process of becoming a therapist (50), and in response supervisors accordingly engage in a facilitative process of relationship, reflection, reorganization, where they build a safe relational space that contributes to reflective intervention utilization and maximizes intervention impact (51).
To Anchor and Ground: Cultivating Connection and Relationship
Critical components of to anchor and ground are the supervisory alliance, supervisory real relationship, supervision role orientation and induction, and supervisor facilitative conditions and behaviors.
The supervisory alliance.
First proposed over half a century ago (52), the supervisory alliance consists of three elements: the supervisor-supervisee bond, the goals collaboratively established to guide the supervision experience, and the tasks collaboratively agreed upon by which those goals are pursued. The alliance is a working pact formed between supervisor and supervisee to facilitate the work of supervision and define how that work will be conducted. Just as the therapeutic alliance provides the common relational conditions and structure for patients to safely transition from one plane to another (37), the supervisory alliance provides comparable conditions and a comparable structure within which beginning therapist supervisees can start to safely transition from not being a therapist to being a therapist. The alliance has not lacked for research scrutiny and may well be the evidence-based anchor of psychotherapy supervision, the most robust, empirically supported, cross-culturally applicable, and uniformly embraced supervision common factor (53, 54).
The real relationship.
Whereas the alliance is about the supervisor-supervisee work bond, the real relationship is about their personal bond. Some examples of the real relationship are social conversation, chit chat, friendly interest, and feelings that are expressed about significant life events or each other (e.g., sadness over supervision termination). The real relationship speaks to the humanness and humanity of the supervisory relationship; provides a dose of connectedness via professional belongingness, social relatedness, and attachment; and plays a pivotal role in the development of a safe learning container (55, 56). Real relationship research, a recent phenomenon, has been construct supportive thus far (e.g., 57).
Supervision role orientation and induction.
As Bernard and Goodyear (12) have stated, it “is very difficult later in a supervisory relationship to recover from a disorganized beginning.” A supervision agreement, whereby roles and responsibilities are concretely defined, can be useful in creating a good beginning by placing supervisor and supervisee on the same page (58); it is a discussion stimulus that sets the stage for working together. Ellis (59) provides one such comprehensive, ready-to-use document as an example. The more that supervisees are fully informed about the supervision process and the more that all matters are made transparent from the outset, the better will be the experience in working together and forming a meaningful, mutative supervision relationship.
Supervisor facilitative conditions and behaviors.
Empathy, respect, and genuineness—foundational for psychotherapy—are every bit as foundational for psychotherapy supervision (60–63). Patience, flexibility, encouragement, and reassurance, potentially important at any point in the supervisee development process, may be especially important in working with beginning supervisees (24–26). It may well be that, although specific supervisor interventions (e.g., teaching) readily contribute to supervisee learning enhancement, these supervisor relational conditions and behaviors are what most endure (64).
Perhaps the primary significance of the action stream to anchor and ground, comes down to situating the supervisor in the mind of the supervisee as a faithful, trustable learning ally and facilitative companion (65). In such situating, three inextricably intertwined concepts emerge as important: relational safety, ontological security, and epistemological trust (7, 66). Each of these intersubjective realities, given life in the supervisee’s mind, might best be reflected as follows, respectively: “I am safe with you,” “I am secured in our relationship,” “I know you are trustable and trustworthy.” It is the supervisee coming to trust in the mind and person of the supervisor as a generative other. If the supervisor is to provide both facilitation and challenge, if the supervisee is to feel relationally anchored enough to risk, then a supervisory foundation of safety, security, and trust must be in place.
To Educate and Facilitate: Stimulating Reflection and Dialogue
Critical components of the action stream, to educate and facilitate, are the particular interventions that supervisors use to stimulate discussion, dialogue, and learning. Supervisors use a host of interventions for that purpose. Relational examination (via parallel process), learning needs assessment, education, and reflection questions are all tools upon which the supervisor draws (22, 67–69). Supervision’s six most critical interventions may be case conceptualization, provision of feedback, discussion, teaching and instructing, modeling (including role play), and reflective questions (15, 27, 61). However, the essence of intervention for beginning supervisees always comes back to reflection. Reflection, the learning methodology and “life-blood of supervision” (20), refers to the unsettling of assumptions to induce change (49, 69). Supervisors strive to stimulate reflection to help supervisees employ a thoughtful perspective about their current clients, the work of therapy, and the therapist-client relationship and cultivate and embed that reflective perspective so that supervisees can carry forward that internalized process in advantaging all future work with clients. Supervisors facilitate reflective engagement through continued discourse (70). In facilitating that dialogue, supervisors serve as reflective instigators, mentalization maximizers, and curiosity conveyers (51, 63).
To Liberate and Emancipate: Fostering Learning Processes That Free and Fortify
Critical components of the action stream, to liberate and emancipate, are those learning processes by which supervisees grow and that supervisors strive to foster. Supervision involves risk, where supervisees ideally are willing to try out and try on different interventions, ways of interacting, and risk and learn from failure (40, 42–44). Supervisees must come to increasingly tolerate the ambiguity of treatment, push through the anxious borderland of liminality and the anguish of the edge emotions, and appreciate the safe uncertainty and constructive disruption that supervision provides (25, 26, 71). Because becoming a therapist is predicated on practice, the blueprint of therapist identity only takes form through the doing of treatment. Supervision of this “doing” helps supervisees develop and refine that blueprint. Exploring, experimenting, confronting, and working through are integral to supervisee development. Supervisors foster such supervisee actions and processes via relationship and interventions, hoping to develop practitioners whose treatment perspectives are more inclusive, discriminating, open, permeable, reflective, and integrative (32, 33, 70).
Cultivated Connection, Realized Reflection, and Evolving Emancipation
Where connection is cultivated and reflective engagement is realized, an evolving emancipatory process is actuated for supervisees. Relationship in conjunction with reflection makes supervisee development and reorganization increasingly likely. Whereas beginning therapists proceed through a process of repeated practice of psychotherapy, thinking about and changing their practice (50), supervision readily maps onto and supports that experiential learning process (51).
Conclusions
Beginning therapist development is best galvanized by a transformation-minded supervisor, an emancipatory educator, who strives to provide a supervision experience characterized by the action streams of to anchor and ground, to educate and facilitate, and to liberate and emancipate. Where supervision has mutative effects, therapist identity takes substantive form, identity expansion occurs, and the supervisee comes to have and to hold the internalized and ineradicable conviction: “I am a therapist.”
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Received: 28 April 2019
Revision received: 7 July 2019
Revision received: 25 August 2019
Accepted: 13 September 2019
Published online: 6 January 2020
Published in print: June 01, 2020
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The author reports no financial relationships with commercial interests.
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