Some Aspects of Supervision by David Holt
This pamphlet offers guidelines for the supervision of case work done by counsellors in training. It is based on experience over five years at the Westminster Pastoral Foundation, and assumes therefore that the training Agency offers long term as well as short term counselling.
At the WPF, the supervision groups are all led by qualified analysts or psychotherapists. The guidelines here offered do not assume that other training Agencies can always draw on the same resources. But they do suggest what such supervision implies, both for student counsellor and client, and how it might be possible to work towards similar standards in other contexts.
The place of supervision in the life of the counselling Agency
Supervision occupies a central position in the life of a counselling Agency. It is where the Agency’s two responsibilities, for training students and helping clients, come together.
The coming together of these two responsibilities raises problems which the Agency has to learn to articulate and to work on. These problems are open ended, and we should not necessarilv expect to solve them. But working on them must be part of the ongoing corporate life of the Agency.
They can be thought of as occupying a kind of magnetic ‘field’ between a private and public pole in the experience of staff, students, and clients. The problem, or crisis, or symptom, which the client brings has a dimension which is public, objective, sharable. It can be recognised as such, and dealt with as such. But it also has a dimension which is private, subjective, which resists being shared. If counselling needs to deal with this private dimension (and not all counselling does), then something happens between the counsellor and the client which involves the privacies of the counsellor just as much as of the client.
Supervision must be concerned with both the private and public poles of this ‘field’, and with the tension, the dynamic tension, between the two. From the Agency’s point of view, this means that it must allow the supervisor ‘space’, psychological space, of a special kind.
Both client and counsellor need psychological space in which to meet and be present to each other. Space is also needed in which privacy can be shared, while allowing for natural and proper resistance to that sharing. A good supervisor generates this special kind of space. He does so, as we shall see, by attending to what is called ‘the transference’. But if he is to do this, he must have the understanding of the Agency as a whole.
At the WPF we have been fortunate in having this understanding. In what follows, we try to convey something of what this implies.
The framework of supervision
Supervision can either take place in a group, or individually.
There are evident advantages of a practical and economic kind to group supervision. But there are also psychological advantages. Student members of the group can learn from each other’s comments much which they do not learn from the supervisor. It is, for instance, often possible for a fellow student to criticise case work with a sharpness and personal intensity which can be accepted and used by a colleague in a way which the more ‘authoritative’ criticism of the supervisor would prevent. There are also times of great stress for a student in his or her encounter with a particular client, when the corporate support of a group, of varied age, sex, and experience, can mean much more than the support of a solitary supervisor.
If supervision is done in groups, the right size is probably between three and six. The ideal number depends on the case load of each counsellor, and on the frequency with which the group meets. At the WPF, our supervision groups meet once a week for 45 weeks in the year. If the group meets for one and a half hours, which is our normal practice, this normally allows for discussion of two cases each week. Perhaps some groups should meet more frequently.
Of every supervision group, the questions should be asked: what is its total case load? how frequently can each case be presented? is this adequate in relation to the experience of the student counsellors? And, however great the short term practical and economic pressures may be we must never forget that the quality of the work done – especially in terms of ‘privacies’ – will be in proportion to the size of the total case load. It is the supervisor’s responsibility constantly to remind the Agency that the kind of work it does, both with its clients and its students, depends on this equation.
Individual supervision can be recommended in certain cases, where a particular experienced trainee counsellor is carrying a case load of, say, eight or more clients, she or he may need and be able to use intensive personal supervision. The value of this kind of supervision should be judged in terms both of the clients and the student. There are times in the learning career of a student counsellor when a particular ‘threshold’ in his or her subjective competence may only be recognised if the Agency can offer a sustained period of individual supervision. And until it is recognised it cannot be crossed consciously. One of the serious dangers in training for counselling work is the unconscious crossing of thresholds of competence.
Another model which we are developing at the Foundation is peer group supervision. In this group, accredited counsellors working as members of staff, meet weekly to present their cases to each other. A peer group such as this plays an important part in the corporate ‘coming of age’ of a counselling Agency. Once it is established it must then be integrated into the other supervisory work of the Agency so that a new kind of criticism and self-awareness can be fed back into the earlier stages of training.
Supervision and the client
How does supervision relate to the client’s experience of the Agency, and the Agency’s experience of the client?
Five stages can be distinguished.
(1) Intake.
At the WPF, intake is a specialised department, separate from supervision. There are always a number of cases seen at intake who are then referred elsewhere, cases of which the supervisors are only occasionally aware as constituting a part of the Agency’s total exposure to public need. But it is important to realise that by the very fact of their referral elsewhere, these cases have a part in defining what supervision is about. The intake department has a more comprehensive view of the public demand on the Agency, and of the Agency’s response to that demand, than any supervisor.
The intake department also sees all clients. With rare exceptions, the supervisor does not see the clients for whom she or he is responsible. The supervisor exercises responsibility through the person of the student counsellor. This is a very significant limitation on the ongoing process of supervision, a limitation that nevertheless has the advantages of establishing psychological distance between supervisor and client. If the advantages of this limitation are to be available to the client, then the Agency must ensure the closest possible liaison between intake and supervision.
(2) Allocation.
At the WPF, we have a weekly meeting to allocate clients to particular counsellors. Apart from Bank Holiday weeks, this meeting is held throughout the year. It is attended by the Director, Director of Training, intake workers and intake secretary, supervisors, and leaders of therapy groups. Clients are allocated either to staff counsellors or student counsellor for individual counselling, or to group therapy. (No significant distinction is here intended between counselling and the therapy.)
This meeting is at the heart of the Agency’s corporate life. Here the tension between the claims of student and of client has to be recognised and dealt with. Here theory and practice meet, and, we hope, conjugate.
For the supervisor, the importance of the allocation meeting cannot be over-emphasised. It is Foundation policy that all supervisors must attend this meeting. But apart from the wider life of the Agency, allocation is critical for subsequent supervision as being the first and most comprehensive attempt to diagnose the client’s problem, and to defIDe what the Agency expects to be able to do for him or her. The supervisor responsible takes from the allocation meeting an agreed, though provisional, expectation of the kind of help the client is to be offered. The client is being attended to by a team.
(3) Being counselled under supervision.
The client may be under the supervisor, whom she or he never meets, for two or three weeks, or for two or three months, or in some cases for much longer. During this time the supervisor is responsible for as· sessing in what way the client’s behaviour or situation presents as a problem, and how the counsellor, and being behind the counsellor, the Agency, can help with that problem.
Does this person need on-going counselling? What is wrong with them? What is happening between them and their counsellor? Is anything happening? If it seems that nothing is happening, then why do they want to go on meeting? What are the present goals of counselling? How do these relate to the initial expectations? Is the student’s need for training experience imposing a sense of being-a-problem on the client? When is it going to stop? These are the questions constantly in the supervisor’s mind as he or she considers his joint responsibility to client and student.
In answering them we have an. essential reference point in the ‘contract’. The first and last responsibility of the supervisor is to ensure that a proper contract is made between counsellor and client, and that his contract is kept constantly under review.
This contract between counsellor and client is not something formal, legalistic, inert. It is alive and open ended and – this is the crucial point – as dynamic and controversial as the problem, crisis, or symptom, which the client is presenting to the Agency. Because the contract is made between three, not two, parties. It is made between client, counsellor, and problem complained of.
This triangular structure and dynamism of the contract needs emphasis.
Superficially, the contract is how client and counsellor agree to take account of the problem, crisis, or symptom, of which the client is complaining. The problem remains, as it were, objective to the relationship between client and counsellor. Much valuable work can be done on this basis, usually of a short term kind.
But latent within the contract is another possibility:
that the problem will get inside the client-counsellor relationship, so that it ceases to be something extraneous, and becomes instead a function of what they are doing together. When this happens, it feels as if what is going on between helper and helped has itself become infected by whatever it is they are trying to deal with.
Any helping relationship which gets to grips with ‘neurotic’ behaviour problems tends to show this kind of infection, either actively in the form of shared commitments, or evasively in the form of more or less elaborate defensive arrangements. It is as if the latent triangularity of the contract has opened up in earnest. It is no longer simply a. question of how client and counsellor have agreed to take account of the problem. We have to ask how the client and the problem have agreed to take account of the counsellor. How much are ‘they’ (or is it ‘we’?) prepared to tell about ‘their’ (‘our’) secret? And, as a corollary to this, we have to ask if anything is going on between the counsellor and the problem which bypasses the conscious awareness of the client. Is there perhaps some secret ‘understanding’ on their side of the triangle, from which the client is excluded?
These are realities in counselling a wide range of behavioural problems. They are perhaps difficult realities for some beginners to take seriously. But they are fundamental to the whole problem of different levels of counselling intervention. If counsellors are to do more than help solve problems at a cognitive and practical level, they must be equipped to deal with them.
This living, open-ended, and triangular, contract is the sheet anchor of supervision. It involves the client in the diagnosis and prognosis of his or her own problems. It ensures that the client is an active patient. Properly made, the contract does more than just ensure this: it enables activity in a situation where previously there has only been passivity. If the contract is properly made, this enablement is what answers the questions of which the supervisor is constantly re-minding the counsellor, and, through the counsellor, the client: what are you doing together? why are you doing it? where is it taking you?
An essential part of this contract is the question of fee.
At the WPF we accept clients regardless of the size of the fee they can pay. No one is turned away on grounds of money. But we believe that money is essentially involved in a person’s enjoyment of his or her emotional resources. Properly managed, the question of fee identifies and realises the emotional resources appropriate to the problem being complained of. If the Agency is to enable its clients to participate in the diagnosis and prognosis of their own problems, then it must involve them in matching their problem with their resourcefulness.
When talked about theoretically, this question of money can sound all too familiarly political, full of stale dissension, barren. In practice, it is rarely so. On the contrary: it can be extraordinarily exciting to see how once the dreaded and (for many people) obscene subject of money is incorporated into the triangular contract, the presenting problem or symptom redefines itself. It redefines itself as a way ahead, rather than as a dead end.
The problem-itself suggests initiatives which had previously just not ‘occurred’ to the client.
There are questions here which need much wider public discussion. Perhaps this is where the counselling profession, and the clients who are turning to us for help, have an as yet unrealised contribution to make to political debate, to what the social anthropologists call ‘the social construction of reality’.
(4) Closure.
When the counsellor’s work with the client draws to a close, it is an important part of the supervisor’s job to see that this doesn’t just ‘happen’, but that it is ‘made’. Counselling has to prove its value not only at the time it is going on, but in the months and years afterwards. In retrospect, it is important for clients that they feel that the counsellor ‘knew what she was doing’ when, together, they made an end to their work with each other.
This is the stage when both student counsellor and supervisor feel most acutely aware of the need for a theoretical model of what counselling is all about. This is when counselling has to show itself able to make sense of the immense variety of problems and persons with which it deals. This is when the client, without knowing it, may make a significant contribution to the ongoing, open ended, integration of theory and practice on which the Agency should be constantly working.
To help us in this work, at the WPF we use a ‘closure form, which the counsellor has to complete. The form includes questions that can be answered by a yes or no, but also questions which leave it open to the counsellor to use his or her own language in describing what is always a particular, unique, case. In judging the work which has been done, the need is to relate variety, uniqueness, particularity, with what is common and general.
When they fill in this form, students often find themselves drastically reassessing not only the quality but also the content of the work they have been doing with this client. Looking back at the ‘wood’, they become aware of patterns and forces which they couldn’t recognise while more or less lost in the ‘trees’. It is. an important part of the supervisor’s job to see that this new awareness is used to stimulate other cross references between theory and practice, in relation to other case work carried by that student, or other members of the supervision group. In this way, clients are affecting each others’ experience in ways in which they are themselves not aware.
Here the supervisor has a responsibility to ‘the client’ which is general rather than particular. How are we using our accumulating experience for improving the quality and content of our future work?
(5) Feedback.
The supervisor’s work is not done when a case is closed. He must see to it that the lessons of that particular client’s involvement with the Agency are fed back into the continuing process of intake and allocation.
In the pressure of daily and weekly work, it is easy for the supervisor to overlook this need. He should not do so, nor should the Agency allow him to do so. Experience at the WPF has shown that the need for this feedback, and the difficulty of organising it on an ongoing institutional basis, grows with every year. We have not ourselves been able yet to develop a satisfactory feed back procedure, but we would hope that our counselling agencies, who want to learn from our experience, will recognise the need for such feedback at an early stage in their history. The sooner it is started, the better.
Supervision and the student counselor
The supervisor is responsible for important aspects of the student’s training. These can be distinguished as practical, theoretical, and personal.
The practical involves all technical details of working with clients as a member of the Agency. How to make the initial contact after allocation, and how to manage, either directly or through the intake department, contact with other persons professionally concerned with the client: doctors, hospitals, social workers, probation officers, clergy; how to keep whatever records the Agency requires, so that the work can if necessary be picked up by another counsellor; how to manage the payment of fees – these need constant attention. For some students they prove comparatively straightforward. For others they can prove unexpectedly difficult in a way that can go to the heart of the student’s own training needs: for example, the need to recognise thresholds of competence of which he or she had been unaware.
More complex are the details which relate practice to theory. Here the making of the original contract, and its reassessment in the light of the developing relationship with the client, is of central importance. To help with this, we have developed a procedure which has proved of great value, and which we recommend: the completion of a special form after every presentation to the supervisor. On this form, the student counsellor gives brief details of (a) the points he or she emphasised in their presentation, and (b) the comments made by the supervisor and the group. This form is then given to the supervisor who can add criticisms and further comment. By giving both student and supervisor the opportunity for second thoughts on the particular presentation, this procedure serves for greater integration of theory and practice, and for ongoing evaluation of the student’s work.
But supervision has a more explicit theoretical function. Supervision is where the student learns to relate the various, perhaps even contradictory, theories about human behaviour which he is being taught in lectures and seminars, to what actually goes on when he meets his clients. We aim to train counsellors to be themselves, and ‘to do their own thing’, not to work from a text book. But we aim to train them ‘to do their own thing’ well. This means they must learn to watch what happens between them and their client, and to criticise what happens in terms of various models, so that they can develop a competence and style which are appropriate to their own personalities, but which can also stand up to public debate. The supervisor’s job is to encourage them to exercise their potentialities to the full, and in that exercise to discover for themselves their own limits.
Experience has proved that this requires a third dimension to supervision. The supervisor must pay attention to the personal, intra-psychic, development of the student.
In our early years at the WPF, we tended to work on the assumption that this was a dimension which did not need explicit attention in supervision. We have changed our views on this, and we recommend those wanting to learn from our experience to weigh carefully the implications of this for their own practice.
Our supervisors now expect to know whether or not their students are in any kind of personal ‘looking at oneself’, whether this be called psychotherapy or psychoanalysis, or just plain analysis, and for this information to be shared in the group. It is common practice for the supervisor to ask the student presenting whether she or he has felt the need to raise a particular facet of the relationship with this client in their personal therapy or analysis (this question is incorporated in the closure form that has to be completed for all case work). On some occasions, the student feels able to share with the supervisor and the group something relevant from their own analysis – a dream about the client, perhaps, or some comment made by their analyst on how he sees the work with his client affecting the student’s own intrapsychic state. When this happens, supervision crosses a threshold of an altogether new kind.
Since invoking this third dimension, supervision at the WPF has proved more effective in integrating theory and practice. This personal and intrapsychic dimension to supervision is much more emphasised in one to one supervision, and is perhaps one of the main reasons for recommending individual supervision for certain students at certain stages in their training. But whether in individual or group supervision, the use made of this personal dimension depends on the supervisor’s, and the Agency’s, approach to ‘the transference’.
The Transference
Transference is the name given by psychoanalysis to the special bond that develops between doctor and patient, between professional helper and client. Historically, this bond was recognised long before the rise of psychoanalysis. In modern times, its recognition can be traced back into the eighteenth century and the first encounters between the secular, scientific, spirit, and the centuries old tradition of religious exorcism. More recently, the history of psychoanalysis itself has been marked by continued argument and disagreement as to how the transference should be understood.
In deciding what kind of service it aims to offer to its clients, and what kind of training to its students, a critical question for any counselling agency is: what is our attitude to the transference? There is widespread agreement in the helping professions that the bond between professional helper and client needs careful attention. But there is also widespread suspicion of the psychoanalytic understanding of this bond, which many experienced people believe amounts to the cultivation of the bond for its own sake.
At the WPF, all supervision is at present done by qualified analysts or psychotherapists. We believe that personal experience of ‘working with the transference’ is an essential qualification for supervising work of the kind we offer our clients. The kind of service we offer includes helping those human conditions traditionally described as ‘neurotic’. This means that we are prepared to work with psychological dynamisms of the kind described by depth psychology in terms of ‘resistance’ and ‘projection’. In accepting neurotic clients for allocation to our counselling staff, we claim to be able to work with resistance and projection, and to train some of our students to do likewise. This necessarily involves a training in the transference.
However, our various supervisors have been trained in different traditions. In terms of our training and experience outside the Foundation, we disagree with each other in our understanding of what ‘this thing called transference’ is all about. We have had to develop a common approach through sharing in the corporate responsibility for the Foundation’s case work. This development is ongoing and open ended. We would expect the experience of other agencies to be similar.
But we have found one distinction valuable, and we recommend it to those wanting to learn from our experience. This is the distinction between a passive and an active approach to training in the transference.
The passive approach trains the student to recognise the possibility of transference situations which she or he cannot manage, so as to avoid opening up dynamisms of a certain kind in the work with a client. Obvious examples of this kind can be described as erotic, hysteric, infantile, psychotic.
There is nothing inferior about such a training. It gives the student competence to do valuable work of a particular kind: competence grounded in a trained awareness of the limits within which he or she has chosen to operate. What is decisive for the effectiveness of such counselling is that the limits have been consciously chosen. As we have said earlier one of the serious dangers in training for counselling work is the unconscious crossing of thresholds of competence.
This choosing is what much supervision work is about. The student discovers the nature of the choice that is open to him by observing his own experience with clients, and comparing it with what his colleagues have to say about their clients. He learns to recognise various ‘thresholds’ in the interaction between himself and his clients, and discusses with the supervisor whether or not he should cross them.
Here we are at the heart of supervision. Here the distinction between a passive and an active approach to transference becomes the centre not only of the student’s training commitment, but also· of the Agency’s obligation to the client. For if the counsellor’s attitude to the transference is passive, then we must recognise that this restraint can, as it were, join hands with the client’s fear of just that ‘innovation’ or ‘initiative’ which he or she is needing. To meet this situation, it is essential that student, Supervisor, and Agency, should all three be committed to as conscious a choice as possible. Without this commitment, we fail in our responsibility to the client.
If counsellors are to be trained to be aware of the transference so that they can avoid being drawn into relationships which they cannot handle, then they, and their training Agency, have to accept that they are choosing to operate in a particular psychological frame of reference. At some stage in their work with a client, however much care is taken at allocation, they .may reach a threshold beyond which they cannot, and should not, go. It is the supervisor’s job to identify this threshold for the student. But in relation to the client, the supervisor must then recognise that something which could have been done for this person has been left undone. This is one of the most anxious and responsible moments in the work of supervision, and indeed of the life of the counselling Agency as a whole. It is here that the need for proper feedback from supervision into intake and allocation is felt most acutely.
From the student’s point of view, identification of this threshold can be the crucial moment in their training, the moment when personal and intrapsychic privacies touch the theoretical and practical learning process. As a result of their experience on this threshold, many, but by no means all, students become interested in the possibility of a more active training in the transference. What does this involve?
We have already touched on this question in describing the triangular structure and dynamism of the counselling contract. It involves the student in the need to be constantly ‘looking at himself’. This is why we recommend some kind of formal ‘looking at oneself’ as a necessary part of training in counselling. We can think of it almost as a psychological analogue to physical exercise. If he is to work actively in, and with, the transference, the counsellor has to know enough about himself to be able to exercise those parts of his own personality which are touched, or even infected, by the client’s problem, particularly by those aspects of the problem which prefer to remain secret.
The aim of supervision must be to enable the counsellor to choose. at what level to work with a particular client. Once again, what is important is that the choices made are as conscious and articulate as possible. And for this reason, we would recommend most strongly that any counselling agency must be constantly working to correlate the kind of interpersonal help it is offering with its approach to the transference.
The need for this correlation involves supervisor and Agency alike in an on-going, open ended questioning of what counselling is about. In our WPF Guide No. I, on the Training Programme, we made the point that counselling has two aims: to relieve someone’s suffering and confusion, and to improve the quality of his or her life in general. In supervision, where the Agency’s responsibility to student and client come together, we have to integrate these two aims. This integration requires a discriminating judgement of what can be expected to happen between two persons. For student and supervisor alike, this judgement turns on the question: what are we going to do about the transference?
This returns us to the point made earlier in this pamphlet about the need for a special kind of psychological space if supervision is to be effective. The question: what are we going to do about the transference? is about how we can generate, as an Agency, the space in which privacies can be worked on while allowing for natural and proper resistance to that sharing. This is the space needed if clients are to participate in the diagnosis and treatment of their own problems. We are training students to make this space, as the essential prerequisite for any counselling which aims to do justice to the unlimited variety of human problems. The supervisor’s job is to mediate between the Agency, client, and counsellor, in studying the architecture of this space.