Please join our clinical discussion on material from this course at: http://www.psychceu.com/forum/default.asp

Note: This journal appeared anonymously in our e-mail box. With it was this note:

"Please use this as a supervision course. I am staying anonymous, because it contains very raw and honest countertransference material, and I am afraid that it will ruin my reputation when therapists see how my shadow emerged when I was supervising. I am particularly embarrassed about the times when I had an urge to 'throttle my intern'. I do hope that you will publish this as a course, however. I think it will help supervisors to hear about a truthful account of supervision. I also included the law and ethics stuff, but the journal is mostly about my experience as a supervisor. Thank you."

 

(Choose one or both of the following statements as true:)

I sat down, eager to meet my new supervisee. I remembered, over the years, supervising many, many interns and trainees, with varying degrees of experience. I always looked forward to the first session, as everyone who I have supervised to date has brought me new awareness and insight into the art and science of psychotherapy.

or
I sat down, reluctant to meet my new supervisee. I remembered, over the years, supervising many, many interns and trainees, with varying degrees of experience. I always dreaded the first session, as everyone who I have supervised to date has brought me new awareness and insight into my own shadow.

(I think I would have to choose both!)

 

 OK, your turn...what is the public side of your supervision? What are the 'ego-syntonic' feelings that arise when you supervise a new intern?

What is the private side...the shadow..the stuff you don't really want to admit to yourself, much less anyone else? Please...acknowledge something, otherwise I will feel too exposed here!

(We did get a call recently; someone said, "I have never felt the way that Anonymous feels; I never wanted to throttle an intern. I love my interns!" When this feedback was shared with Anonymous, Anonymous agreed, saying, "In spite of all the horrible things I admit to in my journal, I do enjoy and appreciate my interns. I have learned so much from them, and I value them immensely!")

'Daniel' (all names and identifying details have been changed) followed me into the consultation room, glancing at me through wire-rimmed glasses, not really making eye contact. He immediately took out a pen, to start taking notes. He looked scared; no doubt concerned that I would judge him, finding him inexperienced, incompetent, and whatever else his self-doubt could throw at him. (Boy, was I wrong about Daniel! After our session, I ran to my well-thumbed copy of the DSM-S - The DSM-Supervisors, and realized that I had succumbed to DSM-S 378 -Engaging in an Act of Projection onto Intern by Supervisor.) He had been assigned to me by the Counseling Center, and this was our first meeting. My agenda was to begin to get to know him, to put him at ease, and to review the legal and ethical implications of being an intern.

He looks awfully serious, I think. Maybe in his early thirties. This is his first placement; I remember when I first started seeing clients, in my first internship, when I was 24. I felt so scared! I knew I didn't know anything, although I would never admit it to my supervisor. I hope Daniel's in therapy; and, unfortunately, the Counseling Center cannot require therapy for its interns. Learning to be a therapist is really painful at times. I think the closest model is that of initiation. If it feels excruciating, and that every bone is broken, and every part of your psyche activated, then you will probably end up being a good therapist. If you just cruise through, you won't ever be able to go to the depths with your clients. Poor Daniel! I bet he doesn't have a clue what he is in for!

There is a resonance in the field between supervisee and supervisor, a 'parallel process' that occurs in supervision, so I wanted to model for Daniel the feeling of an initial session, as he would soon be starting to see clients. Initial sessions can be problematic in supervision, as there is a lot of ground to cover regarding responsibilities, law and ethics, paperwork, things to review, as well as the most important part, which is beginning to get a sense of the person. In some ways this is akin to an initial therapy session, particularly in a clinic setting where there are intake forms, releases, notification of intern status, etc.

Kaiser (1992), addressing the issue of supervisory relationship in family therapy supervision, highlighted the “phenomenon of isomorphism; what happens in supervision is reflected in the therapy” (p. 284). This is referred to later in this entry as the “parallel process,” in which the interaction between supervisor and supervisee directly affects the relationship between the social worker and the client. In reviewing the literature from the fields of social work, psychology, and marriage and family therapy, Kaiser identified four consistently cited issues: “the process of accountability (maintaining objectivity), the need for promoting the supervisee's personal awareness, the importance of establishing trust, and the need to attend to power and authority issues” (p. 284). (Shulman, L., “Supervision and Consultation”, From: A Social Policy Course at University of North Carolina, at Pembroke, taught by Stephen M. Marson, Ph.D., ACSW)

The concept of parallel process has its origin in the psychoanalytic concepts of transference and countertransference. The transference occurs when the counselor recreates the presenting problem and emotions of the therapeutic relationship within the supervisory relationship. Countertransference occurs when the supervisor responds to the counselor in the same manner that the counselor responds to the client. Thus, the supervisory interaction replays, or is parallel with, the counseling interaction. (Sumerel, Marie B., 1994, Parallel Process in Supervision. ERIC Digest ED372347)

I also wanted Daniel to get a sense of who I was, as we would be spending one hour a week for the next nine months together, unless something drastic happened. Whenever I consider this, my thoughts go to the other nine months in our lives, the time in the uterus. My job was perhaps like that of the mother, to create the 'free and protected place' as Dora Kalff used to say, for a therapist to develop. There are many ways in which therapists and supervisors err with regard to boundaries. One way to guard against this is to imagine that the therapeutic container is "sacred space", a temenos or 'free and protected' place. Conceptualize psychotherapy and supervision as a 'safe harbor' in which competent help is given in a clear and respectful manner, a place where the psyche of the client is honored above all. Anything that interferes with this is unethical and possibly illegal. That includes most contact outside of the therapeutic hour, including having coffee or lunch with a client or supervisee, bartering with a client for supervision or therapy in exchange for services or products, working with a client in more than one capacity, and most certainly, having a sexual relationship with a client.

My first supervisor was brutal; supervision with him was the opposite of the 'free and protected' place. When I reported to him after my first session as an intern, he told me that it was the "worst session he had ever supervised." It didn't help that all my friends had raved about him as a professor, although, years later, I realized that none had had him as a supervisor. Teaching, doing therapy and supervision are quite different at times! The person who creates the unconditional safe space of therapy may in fact be a lousy supervisor, unwilling to confront the supervisee. By the same token, the professor with many publications, who is his or her own harshest critic, may also be a poor supervisor. Such was the case with Dr. M and me. His blunt style and high expectations were a poor match for a feeling type, brand new baby therapist. I never wanted to do that to anyone I supervised.

Years later I realized that those who have been initiated cruelly will tend to be cruel in their initiation of others. It is the 'wounded who wound', unless they find within themselves the archetype of the wounded healer. Having been hurt by my first supervisor, I knew to be careful, to not repeat history. In fact, I tell my students and interns "It is a 'practice' that we do, not a perfect!"

I introduced myself to Daniel, and asked him to tell me about himself. I knew that if I had been interviewing him to be my intern (rather than him being assigned to me by the counseling center) that I could not ask his age, marital status, ethnic background, whether he has children, his religion, whether he has any disabilities or health problems, etc.; basically anything that could be considered discriminatory. In fact, a supervisor cannot even ask if an intern or supervisee is in therapy!!! (source: Riemersma, Mary, The Do's and Don't of Interviewing Interns and Trainees, May/June 1992 issue of The California Therapist)

I follow these guidelines when students are assigned to me, as I think they serve three purposes: they protect the intern against feeling judged unfairly or discriminated against; they protect the psyches of both the intern and supervisor from any prejudice, conscious or unconscious that might be there, and they afford some legal protection. I always notice (much like in a therapy session) at what point the intern trusts me enough self disclose about who he or she is.

Daniel didn't tell me much about himself, other than that he felt quite ready to see clients. I asked him what part of seeing clients excited him, and he responded that actually he was not very excited about seeing children, that this placement had been his second choice. He had applied to a Psychoanalytic Center, but they turned him down, saying he needed experience before he could be accepted there.

Great! Just what I need! A person who doesn't want to be here!
But then I got a little bing in my brain, and realized in some ways this was perfect, because many of the children and adolescents Daniel would be seeing would not want to go to therapy; but rather it was imposed on them from outside sources: school or parents.

So, I asked Daniel how it felt to be here, when he really didn't want to be here.

I knew I had to be careful here, as I didn't want to cross the boundary between supervisor and therapist. I tried the old open-ended question, and Daniel stammered a bit, and was clearly uncomfortable with my question about how he felt. It seemed that, so far, in this initial session, that I was doing a lousy job of establishing rapport with Daniel. I reminded myself to trust that when and if I needed to know more, it would be revealed. But I do hope whatever ambivalence he has about being here has been worked through in therapy.

This is an issue in supervision that comes up again and again; where is the line between supervision and therapy? How much does a supervisor need to know about an intern in order to be an effective supervisor?

So, I tried again. "Daniel, can you please tell me something about yourself?" I asked.

He bent down to his briefcase and pulled out his resumé. It stated that he was 33 years old, had graduated with honors, from a very prestigious school, with a major in electrical engineering. His job experience had been in the field of computers, and he had entered Psychology graduate school one year ago. There were references listed, all in his former field. He stated on the resumé that he was single, with no children. There was nothing in his resumé at all related to psychotherapy. I had no idea how he had gotten from computers to psychology. I was wary, however, in the process of what had occurred. Not red flag alarmed; more like a yellow warning sign. It seemed as if he was being very open, and self-disclosing, by offering his resumé; but in fact, it told me nothing.

The Interactive Field

Here I fell back on my trusting the process. By and large, whatever needs to be revealed, will be revealed. If Daniel's issues regarding changing fields were to become a factor in his work, I trusted that I would know about them when I needed to. I also tuned into my own process as Daniel and I were talking, and realized all my images were about my own scientific and technical ineptness. I know that I am what is considered to be a 'feeling type', and Daniel was certainly presenting like a 'thinking' type. This would explain the blank expression he had when I asked how he felt about being here.

So, taking a deep breath, I tried a different tactic.

"Daniel, what do you think about being here?" Suddenly, Daniel was speaking about being at the counseling center, and all that he had done to prepare for his internship. Time and time again, when I reflexively asked him how he felt, he drew a blank. When I asked about the exact same issue, but instead remembered to ask him what he thought, then he would address the issue at hand. This is a type of diversity, I feel, that often is overlooked. "Typology Diversity" seems largely ignored, yet in some ways typology seems to be 'hardwired 'into how we process information. A smart feeling type (DSM-S 133.33, Supervisor talking about self in a way that no one is supposed to know that she is talking about herself) is often considered not bright, because abstract thinking can take a back seat to feeling in our schools and Western culture. While it is much easier to supervise someone of one's own typology, supervising those who are different stretches us. An example is with one intern I had years ago. When it came time to evaluate her, I marked her as somewhat defensive and oppositional. When she asked why, I told her it was because she seemed to fight me on everything I said. She looked puzzled, and asked for an example. I gave her one, and then she said, "That's thinking! I was thinking about it." (Thank you, Annabelle!) And she was right!

What I had felt to be oppositional, was really her thinking about what I was saying.

For an online typology test, please go to: http://www.humanmetrics.com/cgi-win/JTypes2.asp

I asked Daniel if he had any other thoughts or concerns about becoming a therapist. "No" he said. "I feel ready, I already have the first session mapped out." The little red warning light went off in my brain. I was psychically starting to hyperventilate, as can happen in the presence of the opposite type. I pulled myself back from the edge of hysteria. I cannot imagine how someone could have a treatment plan without having seen the client, nor know anything about him or her!!!

Fortunately, my training stood me in good stead, as I assumed the 'poker face' of the therapist or supervisor who has been taken off guard. "Hmmm.." I said to Daniel. No response. So I tried again. "Hmmm..can you say more about that?"

Daniel again bent down to his briefcase, pulling out a bibliography of many pages. "You see", he said, "I made a quantitative analysis of initial sessions, and have figured out exactly what has the best chance of success. You see, here it says you need a complete developmental history, and here is the diagram that you need to figure out the core issue. It is an equation with .333 weight given to the symptom, .333 to the family history or family of origin, and .333 to how the client is while in the session. Then you find out what these issues have in common, and when that is isolated, then you have the 'core' issue. From there, every thing you say or do relates to the core issue."

"Hmmm.."I said. "Daniel, have you given any THOUGHT to how this will apply with a seven year old? Or a teenager?"

"Well," he said, "that was my reason for wanting to work with adults at the psychoanalytic institute. But I have prepared this form to get an accurate history." Here he handed me a copy of his 20 page developmental history form. "I think with young children, I will send home the developmental history form for the parents to fill out. Latency age children might need some assistance, but they could do it primarily by themselves. I know I could have, when I was that age. Adolescents would certainly have the capacity to complete the questionnaire on their own."

Now, many of the children who he would be seeing in the schools had parents who had recently immigrated, and spoke little or no English. When I looked over the form, mentally filling it out regarding my 11 year old son, I realized that there was no way that my son could do it, and doubtful that I could fill it out. Maybe I have no memory left, but I cannot imagine why it would be relevant to know at what age his third tooth came in! I actually feared asking Daniel why that was on his developmental history, not wanting another bibliography to come out of his briefcase.

"Hmmm..." I said. And wondered what trickster had assigned Daniel to me!

And because, quite frankly, I didn't know what to say, I brought the interview back to his tasks, and general issues about being an intern.

We spent the rest of the first hour talking, and I reviewed with Daniel the basics of being an intern. We would have at least one other session before Daniel was assigned any clients, so I hoped in the next session I could develop some rapport with Daniel and we could begin to get to know each other. I went over my expectations of him, and I made sure he knew of the legal and ethical aspects of being an intern.

Legal and ethical aspects

Daniel realized that he would be telling people that he was an intern, not a licensed therapist, and working under supervision. I stressed to him that personal relationships with patients and dual relationships would not be condoned. We talked about what would constitute a dual relationship. I also asked him, once he started seeing patients, to please let me know if he had any fantasies or dreams about a patient.

I reminded myself about the importance of therapeutic boundaries in the supervisory relationship, to avoid all dual relationships with my supervisees. I keep my own journal of feelings, fantasies and my reactions regarding about my supervisees, and discuss them in my consultation group. I had learned that the unconscious feelings stirred up in me by my supervisees and my patients can lead to the very heart of the supervisory and therapeutic process, if I have the courage to really look at them.

Therapeutic boundaries

Daniel and I discussed why a sexual boundary should never be crossed.  Both therapy and supervision are relationships of power. If we become unconscious of the power shadow, then it wreaks havoc upon us! 

According to California laws:

Any kind of sexual contact, asking for sexual contact, or sexual misconduct by a therapist with a patient is illegal, as well as unethical, as set forth in Business and Professions
Code sections 726, 729, 2960(o), 4982(k) and 4992.3(k).

“Sexual contact” means the touching of an intimate part of another person, including sexual intercourse.

“Touching” means physical contact with another person, either through the person’s clothes or directly with the person’s skin (Business and Professions Code section 728).
Sexual contact can include sexual intercourse, sodomy, oral copulation, fondling and any other kind of sexual touching. Sexual misconduct also covers a broader range of activity, including nudity, kissing, spanking, verbal suggestions, innuendoes or advances.
This kind of sexual behavior by a therapist with a patient is sexual exploitation. It is unethical, unprofessional and illegal.

In California there is a pamphlet that we are required to give to our clients who have had a sexual relationship with a therapist. It is a Department of Consumer Affairs publication entitled "Professional Therapy Never Includes Sex".  It is available on-line at: www.psychceu.com/proftherapy.pdf

The contents include:

 
Patient Bill of Rights
Definitions and warning Signs
Where to Start
What Can You Do?
Reporting Options
Administrative Action
How the Complaint Process Works
Professional Association Action
Civil Action
Finding an Attorney
Criminal Action
Where to Get Help Finding a Therapist
Self-Help Support Groups
Frequently Asked Questions

You will need Adobe Acrobat in order to read this. Please get this free downlaod at: Adobe Acrobat is certified virus free

 

Therapists have been disciplined by their licensing boards for not supplying this pamphlet to clients who have had a sexual relationship with a previous therapist. Single copies of the publication are available at no charge from Publications Office, California Department of Consumer Affairs, PO Box 310, Sacramento California 95802. 

Please take a moment and honestly evaluate yourself for the following behaviors in your clinical work and supervision, which are considered "warning signs" in the pamphlet:

Warning Signs
In most sexual abuse or exploitation cases, other inappropriate
behavior comes first. While it may be subtle or confusing, it usually
feels uncomfortable to the patient. Some clues or warning signs are:

Telling sexual jokes or stories.

“Making eyes at” or giving seductive looks to the patient.

Discussing the therapist’s sex life or relationships excessively.

Sitting too close, initiating hugging, holding the patient or lying next to the patient.
Another warning sign is “special” treatment by a therapist, such as:

Inviting a patient to lunch, dinner or other social activities.

Dating.

Changing any of the office’s business practices (for example, scheduling late appointments so no one is around, having sessions away from the office, etc.).

Confiding in a patient (for example, about the therapist’s love life, work problems, etc.).

Telling a patient that he or she is special, or that the therapist loves him or her.

Relying on a patient for personal and emotional support.

Giving or receiving significant gifts.

Providing or using alcohol (or drugs) during sessions.
Signs of inappropriate behavior and misuse of power include:

Hiring a patient to do work for the therapist, or bartering goods or services to pay for therapy.

Suggesting or supporting the patient’s isolation from social
support systems, increasing dependency on the therapist.

Any violation of the patient’s rights as a consumer (see “Patient Bill of Rights,” page 24).

Therapy is meant to be a guided learning experience, during which therapists help patients to find their own answers and feel better about themselves and their lives. A patient should never feel intimidated or threatened by a therapist’s behavior.
 

If you find that any of these behaviors describe your actions in your work, PLEASE, PLEASE get some consultation NOW!! 

Daniel and I talked about confidentiality, and how he was going to handle questions from parents, teachers, other children (which is a very common occurrence working in a school setting), as well as outside agencies (foster homes, protective services, etc.).

We talked about laws and ethics, including:

5150 (involuntary psychiatric holds)

informed consent,

accountability,

competence,
scope of practice,
client welfare,
what constituted an emergency, and
how emergencies would be handled.

I asked Daniel about how we (notice the 'we', not 'he') could protect a client's confidentiality. It is a paradox of supervision that we are training our interns to uphold the confidentiality of their clients as we ask them to break it in supervision. We talked about how to inform clients about confidentiality, and what would be grounds for breaking it. We discussed Tarasoff (which in 25 years of practice, I have never had to use); child abuse; elder abuse; suicide; and 5150, in which a client needs to be involuntarily hospitalized for their own protection.

I told Daniel a bit about my experiences breaking confidentiality, and how kind and supportive both child protective services and the local police (when I had to 5150 someone) have been. I wanted him to realize that therapists only break confidentiality for very good reasons: abuse, and life or death issues. When we do break the container, it is our task, as much as possible, to ensure that the people who are called to intervene are compassionate and truly protective.

There is however another paradox of supervision, which is something I wrestle with every semester. How confidential is supervision? How can I create a safe and protected place for my interns when I have to evaluate them, and report on our work in the supervisors' meetings?

We discussed the agency policy that patient files are not to be removed from the office, under any circumstances, nor did the agency permit photocopies of records, due to the possible breach of confidentiality and the difficulty safeguarding these records.

We went over how clients were to pay, that any checks received would not be made out to him, but to the Counseling Center. (If he had been a private practice intern, the client checks would be made out to me, as the supervisor, not to the intern.)

I had to be very conscious not to get into "robot" mode as we went over laws, rules, regulations, paperwork, etc. (While these are my least favorite parts of supervision, I know the importance of establishing an intern's knowledge of the laws and ethics regarding psychotherapy. Ultimately, our laws and ethics are there for the protection of the client, the therapist, the supervisor, and the therapeutic process. Clear boundaries make possible the creation of the 'free and protected' space.)

In a study of supervision, Kadushin (1974) conducted a national survey of 750 supervisors and an equal number of supervisees. The purpose was to identify the sources of satisfaction for both supervisors and supervisees. Supervisors in the study took great satisfaction in helping supervisees grow and develop professionally; their greatest source of dissatisfaction related to dealing with administrative red tape. Supervisees identified being able to share responsibility with supervisors and being able to obtain support for difficult cases as their greatest source of satisfaction. A majority of both the supervisors and supervisees in Kadushin's study believed that as the supervisee gained experience, the relationship became one of consultant–consultee, a form of supervision preferred by many social workers. Strong dissatisfaction with supervision was reported by many social workers, who believed the authority of the supervisor was exercised in a negative manner. (Shulman, L., “Supervision and Consultation”, From: A Social Policy Course at University of North Carolina, at Pembroke, taught by Stephen M. Marson, Ph.D., ACSW)

I reviewed with him the Counseling Center's grievance policy if either of us found it impossible to work with each other. If Daniel had been a private practice intern, I would have made it clear (both in writing and verbally) that he was hired "at will." (At this point, though, I thought that Daniel would be the least likely person who I would hire in my practice! - See the DSM-S 899.99 Negative Countertransference from Feeling type Supervisor to Thinking Type Student in the Initial Session.) "At will," means that I could "fire" him, "at will", or for any reason whatsoever, with or without cause. I have had to do this once, for severe ethical lapses on the part of a private practice supervisee, who simply would not respect therapeutic boundaries with her clients. I never want to go through that again!

I gave Daniel the website address of the Frequently Asked Questions for MFT Interns and Trainees and LCSW Associates at the California Board of Behavioral Science at http://www.bbs.ca.gov (Which, of course, he already had...)

If you are not a California therapist, please go to your Licensing Board for relevant information. We have some links listed in our website at http://www.psychceu.com/statece1regs.html.
Please e-mail us your state information, so that we may include it in future versions of this course! Thank you!

Note:
Although the information regarding supervisor requirements are current at the time of this writing, it is your responsibility to stay current with the regulations. We recommend that you periodically check with your professional organization and licensing board for updates. As a psychologist supervising interns and trainees with different licenses, you must also stay aware of the requirements of each of the licenses you are supervising!

The California BBS has a page on their website of "Forms and Publications at: http://www.bbs.ca.govwhich includes the following:

APPLICATION PACKAGES

• Intern Registration application package
• Associate Registration application package
• Associate Extension application package
  
  
• MFT License application package
• LCSW License application package
• LEP License application package
  
  

APPLICANT MATERIALS

• MFT Experience Verification
• MFT Weekly Summary of Hours of Experience
• MFT Supervisor Responsibility Statement
  
• Clinical Social Worker Experience Verification
• LCSW Supervisor Responsibility Statement
• Supervisory Plan
• Termination of Supervision

Being a believer in "as above, so below", meaning that in order to keep the power dynamic balanced, I gave myself the same homework assignment. When I got home, I went to the CA BBS site and reviewed the

California Board of Behavioral Science Laws And Regulations Relating To The Practice Of Marriage, Family, And Child Counseling, Licensed Clinical Social Work, And Licensed Educational Psychology.

 

Mandatory Continuing Education

(A) Effective January 1, 2000, supervisors who are licensed by the board shall complete a minimum of six (6) hours of supervision training or coursework every two years. This training or coursework may apply towards the continuing education requirements set forth in Sections 4980.54 and 4996.22 of the Code. (B) Supervisors who are licensed by the board who have completed a minimum of six (6) hours of supervision training or coursework between January 1, 1997, and December 31, 1999, may apply that training towards the requirement described in subsection (A).
(C) Supervisors who are licensed by the board who commence supervision on and after January 1, 2000, and have not met requirements of subsection (A), shall complete a minimum of six (6) hours of supervision training or coursework within sixty (60) days of commencement of supervision.

I hope he uses the journal, although he did look at me like I was a bit of an alien, from who knows which planet!! (DSM-S 536.99a: Supervisor imagines he or she is being perceived as an alien by intern; unable to verify, because it is too soon in the process for supervisor to ask intern if he or she is perceiving supervisor as an alien. Differential diagnosis: 536.09n: Supervisor imagines he or she is being perceived as 'nuts' by intern, unable to verify, because it is too soon in the process for supervisor to ask intern if he or she is perceiving supervisor as 'nuts'.)

I find the journal an invaluable tool for staying in touch with my own countertransference, and my own truth. I hope he feels that it is a safe place for him to process how it feels to be becoming a therapist. I am a bit concerned that this meeting had been a big zero, with no real connection made between the two of us. I usually hate these types of sessions, in which most of our time is spent with paperwork, and the legal and ethical aspects of supervision, but Daniel was very prepared. Either I always fear that I have forgotten something crucial, or that the laws have changed. I have no doubt that if they do, that Daniel will be aware of it, as he told me he has been a student member of every professional organization that he could join, and that he has a system for weekly monitoring of their websites.

I admit that I was exhausted after this session!

While our session was still fresh in my mind, I started a file on Daniel for my records.

Daniel's file included forms provided by the counseling center, that he had signed as we ended:

• the written agreement between the school, employer and supervisor setting forth each party's responsibility.
• Intern job description and note taking responsibilities for client notes.
• a copy of a signed statement that he understands and will follow procedure regarding Tarasoff, child abuse, elder abuse, 5150, and suicide issues.
• His emergency phone or pager number (I also made sure that he had my emergency numbers.)
• Whom to contact in case of an emergency involving him
• His resumé
• My supervision notes

Once he starts seeing clients, then I include:

• Copies of his weekly summaries of experience, once he started to keep them
• Copies of Intake files on his clients
• Treatment plans

If he had been a private practice intern, I would also include:

• a copy of his malpractice insurance
• statement of employment and termination at 'at will"
• W2
• If he already had her degree, a copy of the receipt showing that the intern or associate is currently registered.

Supervising Psychological Assistants

For psychologists, please go to http://www.psychboard.ca.gov/
as there are new laws in effect. (This version reflects the most recent changes, thus has two letters for some of the items.)

Mandatory Continuing Education

If you are supervising aspiring psychologists you are also required to obtain six hours of training in supervision. Effective January 1, 2003, primary supervisors who are licensed by the board shall complete a minimum of six (6) hours of supervision coursework every two years.

From the California Board of Psychology:

Supervision at a Glance - Quick Reference Guide to Psychology Supervision Regulations

"The following is offered as a quick reference to understanding section 1387 of the CA Code of Regulations regarding supervised professional experience. This chart is offered for convenience and to promote understanding of this complex regulation and is not offered as a substitute for knowing the regulation in its entirety. For all of the requirements relating to supervised professional experience, please directly consult with section 1387 which is available at the board's website (www.psychboard.ca.gov) from under the "Laws and Regulations" button.
Supervision Condition

Supervision Condition	Intern (2911 B&P)	Psychological Assistant (2913 B&P)	Exempt Setting Employee (2910 B&P)	Registered Psychologist (2909 B&P)
Supervisor must be licensed three years	No	Yes (1391.5 (a) CCR)	No	No
Supervisor must be able to certify to competence to supervise (1387.1(b) CCR)	Yes	Yes	Yes	Yes
Supervisor presence on-site	Must be employed by the same agency 50% of the hours being worked by the supervisee (1387(b)(6) CCR)	Must be physically on-site 50% of the time that supervisee is working. (1391.5(a) CCR)	Must be employed by the same agency 50% of the hours being worked by the supervisee (1387(b)(6) CCR)	Must be employed by the same agency 50% of the hours being worked by the supervisee (1387(b)(6) CCR)
Supervisor availability on or off-site	Must be available 100% of the time supervisee is working (1387(b)(6) CCR)	Must be available 100% of the time supervisee is working (1387(d)(1)(A) CCR)	Must be available 100% of the time supervisee is working (1387(b)(6) CCR)	Must be available 100% of the time supervisee is working (1387(b)(6) CCR)
Primary Supervisor must be licensed psychologist (1387.1)	Yes	No - 2913 of the B&P Code allows Board Certified Psychiatrists to employ and supervise psychological assistants1	Yes	Yes
MFT's and LCSW's can serve as primary supervisor (1387.1)	No	No	No	No
Primary supervisor must provide a minimum of one hour of direct, individual, face-to-face supervision in every week in which the supervisee accrues hours (1387(b)(4)	Yes	Yes	Yes	Yes
Supervision must account for at least 10% of total hours worked by the supervisee (1387(b)(4)	Yes	Yes	Yes	Yes
The experience must be accredited by the APA or a member of or meet membership requirements of APIC or CAPIC (1387)	Yes	No	No	No
Method by which pre-doctoral hours can be accrued (1387(a)(1))	Yes	Yes	Yes	No
Method by which post-doctoral hours can be accrued (1387(a)(2))	No (2911 B&P, 1387 CCR, by definition, internship is pre-doc as it is part of the doctoral program)	Yes	Yes	Yes
Supervisee must maintain SPE log (1387.5)	Yes	Yes	Yes	Yes
Number of supervisees per supervisor	Not limited in laws or regulations	3 (2913 B&P Code)	Not limited in laws or regulations	Not limited in laws or regulations
Supervisor must notify client in writing prior to services being rendered that supervisee is unlicensed and is functioning under the direction and supervision of a licensed psychologist (1387.1(g))	Yes	Yes (1391.6(b) CCR)	Yes	Yes

SUMMARY OF VARIOUS OTHER REQUIREMENTS THAT APPLY TO ALL SUPERVISION SITUATIONS:
1. Supervisees shall have no proprietary interest in the business of the primary or delegated supervisor and shall not serve in any capacity that would hold influence over the primary or delegated supervisor's judgment in providing supervision (1387(b)(3)).
2. Supervisees cannot pay or otherwise remunerate supervisors to provide supervision (1387(b)(3)).
3. Supervisees cannot function under another license or in another professional capacity while accruing supervised professional experience (SPE) (1387(b)(8)).
4. Supervisors must ensure all SPE including record keeping is in compliance with the APA Ethical Principles and Code of Conduct (1387.1(e); 1387.2(e)).
5. Primary supervisors are responsible for monitoring the welfare of the supervisee's clients (1387.1(f)).
6. Primary supervisors are responsible for monitoring the clinical performance and professional development of the supervisee (1387.1(h)).
7. Supervisors are responsible for ensuring that both they and the supervisees have the education and training in the areas to be supervised (1387.1(h)&(i)); 1387.2(h)).
8. Supervisors and supervisees shall at all time be in compliance with the laws and regulations and with the Ethical Principles and Code of Conduct of the American Psychological Association (1387.1(c), (d), (e), (k); 1387.2(c), (d), (e), (i)).
9. Supervisors shall have no familial, intimate or other relationship with the supervisee which would compromise the supervisor's effectiveness (1387.1((k); 1387.2((i)).
10. Supervisors shall not supervise a supervisee who is now or has ever been a psychotherapy patient of the supervisor (1387.1(l), 1387.2(j)).
11. Supervisors shall not exploit or engage in sexual relationships with supervisees (1387.1(m); 1387.2(j)).
12. Primary supervisors shall provide each supervisee with a copy of the pamphlet "Professional Therapy Never Includes Sex" (1387.1(m)).
13. Primary supervisors must monitor the supervision performance of all delegated supervisors (1387.1(o)).

Thanks to Steven Sultanoff, PhD for inspiring the format and content of this document

If you are supervising persons pursuing the psychology license, you are required to file an annual report that addresses specific criteria.

Please visit for the NBCC's Code of Ethics.

For the California Board of Behavioral Science Examiners Laws And Regulations Relating To The Practice Of Marriage, Family, And Child Counseling, Licensed Clinical Social Work, And Licensed Educational Psychology.

For the American Psychological Association's Code of Ethics

Please visit for the American Counseling Association Code of Ethics and Standard Procedures.

Please visit the California Association of Marriage and Family Therapists' Code of Ethics

Please visit the National Association for Social Workers' Code of Ethics

Please visit the Association for Play Therapists' Code of Ethics

After Daniel left, I was very glad that I had a free hour in which to process. I try, whenever possible, to schedule a break after anyone new, either client or supervisee. It helps me to 'cement' who the person is in my psyche, and to give me time to record my fantasies, projections, and countertransference. This process seems to allow me to let go of the session more easily, so that it does not linger in my psyche, and bleed into the next person's hour. I find if I am still thinking about a session, then usually either there is something left undone, or my countertransference is activated. I realized, that as supervisors, we carry a lot! We are charged with:

1. training a new therapist,

2. holding our own countertransference,

3. trying not to become the

• parent
• authority figure
• therapist

of the intern

4. at the same time holding the intern and ALL of the psyches of his or her clients within ourselves!

5. Add to this that the supervisor's license is on the line for legal and ethical lapses on the part of the intern!

Jenny's First Session

My next session was with 'Jenny'. (I hope this is not too confusing, to go between Daniel and Jenny. One of the challenges of both therapy and supervision is the ability to switch gears completely, so that you are present with the new client, and have no lingering trace in your psyche from the previous tenant of the 'hot seat', the therapy/supervision chair!)

Jenny followed me into the consultation room, glancing at me from under her bangs. She looked scared; perhaps concerned that I would judge her, finding her inexperienced, incompetent, and whatever else her self-doubt could throw at her. Or perhaps not..I have learned that my lightning quick intuition was very often wrong! With her long dark hair, Jenny seemed young, tentative, and tender. She had been assigned to me by the Counseling Center, and this was our first meeting. My agenda was to begin to get to know her, to put her at ease, and to review the legal and ethical implications of being an intern.

She looks awfully young, I think. Maybe in her mid-twenties. This is her second placement; she seems so young to be working with adolescents, but it might be a good thing, in terms of establishing rapport with teenage clients. She must think that I am ancient! I remember when I first started seeing adolescent clients, in my first internship, I felt so scared!

Learning to be a therapist can be like a deep sea journey. I think the closest model is perhaps being swallowed by a whale, or even, at times, swimming with the sharks. If it feels that you might drown (or be eaten) and every part of your psyche is activated, then you will probably end up a good therapist. If you just stay on the surface, you won't ever be able to go to the depths with your clients.

Has this been your experience? Did every bone have to be broken for you to become a good therapist? If so, does the same apply for supervision?

Poor Jenny! I  wonder if she knows what she is in for! I hope Jenny is in therapy; and, unfortunately, the Counseling Center cannot require therapy for its interns.

I feel that the same holds true for supervision. If I supervise someone and no countertransference material is elicited, then I am just going through the motions.

I don't think therapy or supervision is effective without countertransference. If nothing is elicited in the psyche or the therapist or supervisor, then nothing is happening in the session. Rather than a horrid thing to overcome, I feel that countertransference reactions are essential, and the key to healing. When I am in touch with my countertransference, then the 'field' of healing and relationship is activated.

 

Where do you place yourself in the spectrum of countertransference definitions? Do you agree with this, from Pat Savola, B.S.F., M.A., R.C.C?

While a narrow version looks at "blind spots, unprocessed or unresolved personal fear and pain, or the defenses against it", a broader interpretation sees countertransference as ubiquitous, inevitable and an invaluable source of information when acknowledged. We tend to be unaware of countertransference unless it's causing us problems. The more inclusive interpretation of countertransference includes understanding projective identification to incorporate thoughts, feelings, impulses, wishes, sensations and energetic phenomena. Trauma therapists must also attend to traumatic countertransferences. Many women are especially uncomfortable with "offender countertransference" and therapists with their own abuse histories may have difficulty with "victim countertransference."
The therapeutic relationship is profoundly intimate; I have heard intimacy defined as "what only I can say to only you." For the most part, we are alone with these relationships. Clinical supervision is one of the ways in which we can work to support and challenge ourselves within the context of vulnerability that is engendered by the solitary nature of the work. In the words of Margo Rivera, from the Plenary of the 1991 Education/Dissociation Conference at OISE, Ontario:

In summary, good psychotherapy is an intimate interpersonal experience. I think if it doesn't touch us, if it doesn't stir us, then something's wrong. Countertransference has got to be inevitable, especially in a therapy situation where, day in and day out, one is being asked to contain unbearable material. When there are jarring discontinuities in the therapeutic relationship, new experiences place us in a position of not knowing and of having to learn. And having to learn yesterday. I think it's crucially important that we come to understand our own countertransference patterns so that we can engage in a combination of continuing education, supervision, consultation, networking and, in many cases, therapy of our own. Only when we're honest and at least somewhat objective about all the ways in which we use ourselves in our work can we offer our clients the most effective therapeutic process possible with the least possible interference from our own personal limitations.
(Pat Savola, B.S.F., M.A., R.C.C)

 

I also wanted Jenny to get a sense of who I was, and to feel safe in supervision. I know from personal experience, on both sides of the supervision spectrum (supervisor and supervisee) that if a trainee or intern does not feel safe in supervision, then the sessions will be permeated with game playing and defensive maneuvering.

SUPERVISEE GAMES
Resistance often takes the form of "games" played by supervisees who either consciously or unconsciously attempt to manipulate and exert control over the supervision process. Although all supervisees do not play games, many do. Kadushin (1968) defined four categories of supervisee games. Manipulating demand levels involves games in which the supervisee attempts to manipulate the level of demands placed on him/her. Often the supervisee uses flattery to inhibit the supervisor's evaluative focus. Redefining the relationship occurs when the supervisee attempts to make the relationship more ambiguous. For example, in the game of self-disclosure, the supervisee would rather expose himself/herself instead of counseling skills. Reducing power disparity occurs when the supervisee focuses on his/her knowledge. In this game, the supervisee tries to prove the supervisor "is not so smart." If successful, the supervisee can mitigate some of the supervisor's power. In controlling the situation, the supervisee prepares questions to direct supervision away from his/her performance. Other means for controlling supervision include requesting undue prescriptions for dealing with clients, seeking reassurance by reporting how poorly work is progressing, asking others for help to erode supervisor authority, or selectively sharing information to obtain a positive evaluation. A more hostile and angry form of control involves blaming the supervisor for failure.
In describing supervisee games, Bauman (1972) discussed five types of resistance. Submission, a common form of resistance, occurs when the supervisee behaves as though the supervisor has all the answers. Turning the tables is a diversionary tactic used by the supervisee to direct the focus away from his/her skills. "I'm no good" occurs when the supervisee pleads fragility and appears brittle; the attempt is to prevent the supervisor from focusing on painful issues. Helplessness is a dependency game in which the supervisee absorbs "all" information provided by the supervisor. The fifth type of resistance projection, is a self-protection tactic in which the supervisee blames external problems for his/her ineffectiveness. More thorough discussions of supervisee (and supervisor) games are presented by Bernard and Goodyear (1992) and Bradley (1989).

(Bradley, Loretta J. - Gould, L. J., Supervisee Resistance. ERIC Digest.

 

Let me think, way back to the dark ages, when I was an intern, which games did I play? What games did you play? (Did you notice that I didn't ask if you played games, but which games...? What games do supervisors play? I wish we could sit down and talk about this!)

 

Jenny and I would be spending one hour a week for the next nine months together, unless something drastic happened. My job was to create the 'free and protected place' as Dora Kalff used to say, for Jenny to develop as a therapist. There are many ways in which therapists and supervisors err with regard to boundaries. One way to guard against this is to imagine that the therapeutic container is "sacred space", a temenos or 'free and protected' place. Conceptualize psychotherapy and supervision as a 'safe harbor' in which competent help is given in a clear and respectful manner, a place where the psyche of the client is honored above all. Anything that interferes with this is unethical and possibly illegal. That includes most contact outside of the therapeutic hour, including having coffee or lunch with a client or supervisee, bartering with a client for supervision or therapy in exchange for services or products, working with a client in more than one capacity, and most certainly, having a sexual relationship with a client.

I went back in time to my second placement. It was a bit strange, switching to a new client population, new agency, new rules and forms, and of course, a new supervisor. It was like setting out in a little boat (my skills and confidence) into a huge, roiling sea (working with teenagers and adults) with an unknown co-captain (my supervisor) who I wasn't sure that I could trust.

My new supervisor was wonderful; she was kind, supportive, able to give constructive feedback that somehow got in through my defenses. When I reported to her after my first session as an advanced intern, she told me I had done fine, and that the skills I had learned working with young children (through jobs and my previous internship) would be invaluable with older populations. She was right; having a solid base of child development and clinical experience with children should be a prerequisite to becoming a therapist. Every adolescent, and adult has a child within them, as do we as supervisors. It is helpful, when working with an older client, to be able to see the child within them. And, of course, for issues like our countertransference it is an enormous help to know what age we are manifesting in any given moment.

 

 Where do you draw the line? How does therapy differ from supervision? How is it the same? Do you think that therapy should be required for interns? How about for therapists? For supervisors?

The Interactive Field

Here I fell back on my trusting the process. By and large, whatever needs to be revealed, will be revealed. This process may be different with Jenny, though, than with the people who I have supervised who are Caucasian. Jenny was Asian American, Chinese. She had not yet addressed how it felt to have a Caucasian supervisor. I don't know how much of her reticence to self-disclose was that she didn't know me, her personality (introverts tend to be more judicious in their self-disclosure than extraverts) her personal history, her family's pattern of people talking about themselves, her previous experience in supervision, or our cultural differences. So for now, I decided to wait and see how and if Jenny would open up about herself.

ERIC Identifier: ED372346 Publication Date: 1994-04-00 Author: Fong, Margaret L. Source: ERIC Clearinghouse on Counseling and Student Services Greensboro NC. Multicultural Issues in Supervision. ERIC Digest. THIS DIGEST WAS CREATED BY ERIC, THE EDUCATIONAL RESOURCES INFORMATION CENTER. FOR MORE INFORMATION ABOUT ERIC, CONTACT ACCESS ERIC 1-800-LET-ERIC INTRODUCTION Perhaps two of the most important changes within counseling and counselor education in the past twenty years have been (a) recognition of the need for a multicultural perspective in all aspects of counseling and education and (b) the evolution of supervision models and practices. Recently, these changes culminated in two sets of competency and standards statements that will most certainly guide counselor preparation and evaluation of counselor practice. The Association for Multicultural Counseling and Development (AMCD) approved a document outlining multicultural counseling competencies and standards (Sue, Arredondo, & McDavis, l992) and the Association for Counselor Education and Supervision (ACES, 1990) adopted comprehensive standards for eleven aspects of counseling supervision. Now counselors are recognizing the need to consider multicultural issues in supervision and methods of multicultural supervision. The multicultural perspective will become essential as we move into the twenty-first century. It is projected that by the year 2010 twelve of our most populous states, containing about half of the nation's young people, will have significant minority populations (Hodgkinson, l992). Thus, the supervision triad of client, counselor, and supervisor will most likely contain persons of differing racial-ethnic backgrounds who are confronting problems and concerns in a diverse social environment. Controversy surrounds the inclusiveness or exclusiveness of the term multicultural so, for clarity, multicultural in this paper will be defined as in the AMCD Standards (Sue et al., 1992), referring to visible racial-ethnic groups, African-Americans, American Indians, Asian Americans, Hispanics and Latinos, and Whites. Currently, very little descriptive and even less research literature on multicultural supervision is available (Leong & Wagner, in press). This paper will summarize two different aspects of multicultural supervision: the inclusion of multicultural issues during supervision and the multicultural supervisory relationship. MULTICULTURAL ISSUES IN SUPERVISION Bernard and Goodyear (1992) advocated that the supervisor is responsible for assuring that multicultural issues receive attention in supervision. Generally, whenever the client is a minority group member, and sometimes when either the supervisee or supervisor is a minority person, supervisors will recognize the relevance of addressing cultural concerns. However, all counseling and supervision contacts have cultural, racial-ethnic aspects which shape core assumptions, attitudes, and values of the persons involved and which may enhance or impede counselor effectiveness. Majority cultural patterns and the culture of counseling and psychotherapy are often accepted by the supervisor and counselor without thought, what Bernard and Goodyear (1992) label the "myth of sameness" (p. 195). Recent work on white racial identity (Rowe, Bennett, & Atkinson, l994) has underscored the need for majority counselors to develop an awareness of being White and what that implies in relation to those who do not share White group membership. Thus, regardless of apparent "sameness", at some point in all supervision, and preferably early in the process, multicultural issues must be explored. Logical extensions of this view of multicultural supervision are models that advocate supervision as a method to assist multicultural counselor development. As reviewed by Leong and Wagner (in press), these models propose that supervisees move in stages from minimal racial-ethnic awareness, to awareness of discrepancies between cultures and within self, and then to development of a multicultural identity. The supervisor's role is to promote supervisee growth by challenging cultural assumptions, encouraging emotional expression, and validating conflict of attitudes and values. These multicultural models lack empirical support, but seem to integrate well with developmental models of supervision (Bernard & Goodyear, l992) and direct the supervisor to assess the multicultural awareness level of each supervisee. A number of supervision techniques have been proposed to insure that the cultural dimension is addressed, though none have research support (Bernard & Goodyear, l992; Leong & Wagner, in press). Planned discussion of culture and the culture of counseling; exploration of supervisee and supervisor cultural backgrounds; required use of videotape (which provides visual recording of nonverbal cultural components); modeling by the supervisor; inclusion of cultural considerations on all intake, case management, and other written supervision reports; and experiential exercises are methods that can be used in individual and group supervision. MULTICULTURAL SUPERVISORY RELATIONSHIP While the above section dealt with the multicultural "content" of supervision, the multicultural supervisory relationship is the "process" of supervision. ACES counseling supervision standard 4 (1990) addresses the knowledge and skills related to the supervisory relationship. Only one substandard of nine (Standard 4.1) directly addresses multicultural issues, noting the "supervisor demonstrates knowledge of individual differences with respect to gender, race, ethnicity, culture, and age and understands the importance of these characteristics in supervisory relationships" (p. 30). The second half of Standard 4.1 is the difficult piece, as there is a paucity of empirical knowledge about the dynamics and experiences of the multicultural supervisory relationship. Leong and Wagner (in press), critiqued the four studies published to date and concluded: (1) race can have a profound influence on the supervisory process, particularly in terms of trainee's expectations for supervisor empathy, respect, and congruence, (2) race can influence a trainee's perception of supervisor liking, and (3) there are some circumstances under which race does not seem to influence supervision.(p. 20) These conclusions point to the critical importance of the initial sessions in the multicultural supervisory relationship. Cultural differences in worldview and communication styles may particularly affect supervisee perceptions of the supervisor as supportive and empathic. Such perceptions have been associated with satisfaction in multicultural supervision (Leong & Wagner, in press). Early discussion of supervisor and supervisee racial-ethnic backgrounds and expectations about supervision may help establish a base for the development of trust and empathy. Another critical dimension of the multicultural supervisory relationship is the management of power. The supervisor is viewed as having expertise and has the responsibility of evaluating the supervisee, both contributing to an unavoidable power differential in the relationship. In situations of a minority supervisee and a White supervisor or a White supervisee and a minority supervisor, both participants may attribute power to majority group membership. This additional perceived power differential and past experiences with power abuses by Whites may make trust formation difficult and result in cautious, guarded communication. This, in turn, may result in the opposite of the personal self-disclosure and openness to feedback required in supervision. Early and recurring discussion of supervisor and supervisee expectations of performance, orientation as to how to best use supervision, and clear statements of evaluation criteria are methods to promote fairness and share the evaluative power. Such discussions should be coupled with exploration of how expectations of performance and perceptions of fairness in evaluation may be altered by each person's cultural background. The supervisor will need to continue to consider the influence of minority experiences of oppression and prejudice on perceptions of power throughout the supervision process. CONCLUSIONS While there is some convergence of opinion, the identified issues and suggestions for interventions in multicultural supervision are currently based on personal experiences rather than empirical study. A consistent theme in the literature is the critical role of the supervisor: in promoting cultural awareness; in identifying cultural influences on client behavior, on counselor-client interactions, and on the supervisory relationship; and in providing culture-sensitive support and challenge to the supervisee. This is a daunting responsibility! As all supervision is some form of multicultural supervision, supervisors will need to be proficient in the multicultural competencies identified by Sue et al. (1992). All supervisors-in-training should work with supervisees from racial-ethnic groups other than their own and receive supervision of multicultural supervision. Likewise, experienced supervisors will need to seek continuing education, consultation, and focused supervision of supervision with a multicultural emphasis to meet gaps in experience and education. REFERENCES Association for Counselor Education and Supervision. (1990). Standards for counseling supervisors. Journal of Counseling and Development, 69, 30-32. Bernard, J. M., & Goodyear, R. K. (1992) Fundamentals of clinical supervision. Boston, MA: Allyn and Bacon. Hodgkinson, H. L. (1992). A demographic look at tomorrow. Washington D.C.: Institute for Educational Leadership. Leong, F. T. & Wagner, N. M. (in press). Cross-cultural supervision: What do we know? What do we need to know? Counselor Education and Supervision. Rowe, W., Bennett, S. K., & Atkinson, D. R. (1994). White racial identity models: A critique and alternative proposal. The Counseling Psychologist, 22, 129-146. Sue, D. W., Arredondo, P., & McDavis, R. J. (1992). Multicultural counseling competencies and standards: A call to the profession. Journal of Counseling and Development, 70, 477-486. ----- Margaret L. Fong, Ph.D. is Professor and Chair of Counseling, Educational Psychology and Research, Memphis State University, Memphis, Tennessee. ----- ERIC Digests are in the public domain and may be freely reproduced and disseminated. This publication was funded by the Office of Educational Research and Improvement. Opinions expressed in this report do not necessarily reflect the positions of OERI or ERIC/CASS. Title: Multicultural Issues in Supervision. ERIC Digest. Document Type: Information Analyses---ERIC Information Analysis Products (IAPs) (071); Information Analyses---ERIC Digests (Selected) in Full Text (073); Descriptors: Counselors, Cultural Awareness, Cultural Pluralism, Ethnicity, Racial Differences, Supervision, Supervisors, Supervisory Methods Identifiers: ERIC Digests

If Jenny's cultural and ethnic identity were to become part of our work, I wanted to wait a bit to see if she would raise the issue herself. If not, then there would come a point when I would, but I wanted to see what she did first. I also knew that I would have to examine my own conceptions and beliefs about people who are Chinese, to make sure that I was not being unconsciously racist. There also is the element of social and economic class that might need to be addressed. If Jenny grew up as a first generation immigrant, perhaps with non-English speaking parents, her experience would be different than if she grew up in a family that had been in the United States for a generation or more.

The same held for Jenny's adolescent issues, if they were to become a factor in her work, I trusted that I would know about them when I needed to. I kept going back to her phrase, "as a teenager, I would have benefited from counseling, but didn't have access to it." Her phase about her adolescence resonated in my psyche.

As I tuned into my own process as Jenny was talking, I realized all my images were about my own acting up in adolescence, and the secrets I had from my parents. The little red warning light went off in my brain. I knew that I had a fine line to walk..how not to become Jenny's parent, how not to become her therapist, and how not to collude with adolescent acting out! I knew that I would have to revisit my adolescence so that I would be very clear with what were Jenny's adolescent issues, which were her clients', and which were mine (both my own teenage years, and those of my stepchildren). Suddenly I felt very old and tired!

I asked Jenny what else about becoming a therapist made her excited or nervous, but she didn't say much more. It was as if suddenly I was in the room with a teenager! Her body language changed, she slumped down in the chair, hid behind her hair, and shut down. Oh no..here we go! She is being moody and adolescent, and she hasn't even seen any clients yet! If just talking about working with teenagers is constellating this much, we may have a rough road ahead of us. I had started to unconsciously match Jenny's body language, then remembered that I was to be Jenny's supervisor, not her therapist. Again and again I would catch myself in this role confusion. I was grateful for the consultation group for supervisors that I attended!

(Then I started to second guess my assumptions about Jenny's body language. Was this the 'ghost of teenager-hood past', as I had thought, or was this part a cultural body language? Or is it racist to even ask myself this? And does it matter? Under our skins, aren't we all the same, human? Where does culture, race and ethnicity fit in to our psyches? How about the idea "that the 'counselor culture' has at its core a set of white cultural values and norms by which clients are judged." (Katz, J. H. "The Sociopolitical Nature of Counseling." THE COUNSELING PSYCHOLOGIST" 13 (1985): 615-623., Lauver, P. J. "Extending Counseling Cross-Culturally: Invisible Barriers." Paper presented at the annual meeting of the California Association for Counseling and Development, San Francisco, CA. ED 274 937 cited in Issues in Multicultural Counseling. Highlights: An ERIC/CAPS Digest.

Where does the fact that Jenny and I are both women, and both have chosen to become therapists, fit in? Does this make us more alike than different? Or is this thinking the product of being a part of the race that has had the majority of the power in this country? Where does it fit in that I am twice as old as Jenny? That I am her supervisor? Ay-ai-ai!

My brain was spinning so fast, that I was in danger of losing track of the session!

Jenny's level of discomfort seemed to be rising, whether from my psychic absence at that moment, or from unresolved issues of adolescence, I did not know. Regardless, I decided to bring the interview back to her tasks, and general issues about being an intern.

We spent the rest of the first hour talking, and I reviewed with Jenny the basics of being an intern. We would have at least one other session before Jenny was assigned any clients, so I hoped in the next session Jenny's comfort level would be higher, and we could begin to get to know each other. I went over my expectations of her, and I made sure she knew of the legal and ethical aspects of being an intern.

 

Daniel's second session

Daniel came to the second session prepared (why was I not surprised!!); he had gone to the licensing board website, and joined even more professional associations as a student member. This gave him subscriptions to various journals, as well as access to the 'members only' section of the websites, which contained valuable articles, forums for discussion, etc. He had printed out more information from the licensing board, as well as the relevant Code of Ethics, as well as almost every article posted online from the previous years of The California Therapist.

I was pleased that he was taking his internship so seriously, and wondered about his level of preparation. Usually, interns come to beginning supervision a bundle of nerves; Daniel's rigidity and over-preparation seemed somewhat defensive to me. I was worried about what would happen when Daniel started seeing a 'real 'child in therapy, as opposed to a statistical survey of what children do. Was he going to be capable of being spontaneous? Would he be able to play?

I asked him if he had any questions from our last session, and he said he didn't. I wondered (out loud, to him) if he had any questions for me, about me...who I was, my experience, etc. He said he didn't, that he had researched my credentials, and read everything that I had written. I left the door open, so to speak, telling him if he did wonder about me, to please feel free to ask.

The reason I did this was because he had been assigned to me. Now, if I remember correctly from my schooling, counseling centers were a hot bed of gossip, rumor and innuendo. Most students knew a lot about their prospective supervisor, much of it untrue. I wanted to elicit Daniel's projections to me, as an authority figure, as that would be a part of his clinical work. The people he saw as a therapist would perceive him as an authority, and to know his own process and projections around this power dynamic would be helpful in his work.

I also know from reading, that if the supervisor's authority came solely from the agency, that the supervision tends to be less effective than if the authority came from the person of the supervisor.

Supervisor–Supervisee Relationship
Other models of supervision focus on the nature of the supervisor–supervisee relationship. These have been described in the literature as ranging from more traditional, authoritarian models in which the supervisor's authority emerges from agency sanction on one end, to more collaborative models in which the authority emerges essentially from the supervisor's competence on the other end.
Munson (1981, 1983) surveyed 65 supervisees and 64 supervisors. He focused on models of supervision in three areas: (1) structure (traditional–individual, group, and independent); (2)authority (sanction versus competence); and (3)teaching (Socratic, growth, and integrative). He examined the impact of the use of different models on social worker satisfaction with supervision and integration. Munson (1981) found that “The structural models did not produce significantly different outcomes regarding interaction and satisfaction, but the authority models did. The competence model of authority was the most productive in all respects” (p. 71). This was the model in which the supervisor's authority was derived from competence and skill rather than from agency sanction.
(Shulman, L. “Supervision and Consultation”, From: A Social Policy Course at University of North Carolina, at Pembroke, taught by Stephen M. Marson, Ph.D., ACSW Sources cited: Munson, C. E. (1981). Style and structure in supervision. Journal of Education for Social Work, 17, 65–72. , Munson, C. E. (1983). An introduction to clinical social work supervision. New York: Haworth Press.)

Daniel and I talked about the initial session in therapy. He, of course, knew all the paperwork he had to go over with his clients, so now we could focus on the dynamics of the first session. Daniel had two roles at the agency: to go to the schools and work with students, from elementary through high school, and to see clients at the Counseling Center. After our session, he would be assigned his first in-school client, and see his first client at the counseling center. As the semester progressed, more clients would be added to his caseload.

He said he had thought a lot about working with children and had some questions for me about technique and theory. He pulled out a long list from his briefcase, and started asking away. He wanted to know what to do if the presenting problem was encopresis, in a latency age child, what to do with a hyperactive preschooler, a sexually acting out teenager, etc. His list was very specific, and I felt that I had to move him into more general territory. I talked about establishing rapport, and how to create the 'free and protected place' in therapy so that the client will feel safe enough to disclose who they really are.

Daniel knew that his first client in the school was a 8 year old girl who we shall call 'Maria'. Maria had been referred to the counselors seeing students in the schools because of a suspected diagnosis of ADHD, and acting out behavior. Her mother had recently given birth to a boy, after a tenuous pregnancy, which involved almost 5 months of bedrest. Maria's brother, born prematurely, was fine now.

I suggested to Daniel that he could ask Maria why she thought she was seeing a counselor, and what she wanted to do. If Daniel could hear what Maria said, Maria would not only be letting Daniel know how to work with her, but also would get clues to Maria's transference.

Daniel thought about what projections he might carry, and realized that he might have a 'father' or 'big brother' transference from his clients. He started to take out his print outs regarding ADHD and oppositional defiant disorder, but I stopped him. I asked him what he thought about play.

He looked a bit confused, and again reached for the briefcase. "Daniel" I said (trying really hard not to be impatient), "Play? What was your favorite thing to do as a child?"

"Umm, well, I guess I played a lot of video games. And I had my picture in the Lego magazine when I was in latency, for a Lego ship that I built. Games? I don't really remember much about my childhood. Let's see, I was very good at chess, and was always in the chess club at school. Play? That's about it really. I was an only child, of two professors, who were quite old when I was born, so I didn't really play with a lot of other children. I was always in the accelerated learning courses. On weekends I would do my homework, read, and then play the video games."

"But what does this have to do with me seeing a child in therapy?"

Daniel would soon find out!

Jenny's Second Session

Jenny came to the second session prepared; she had gone to the licensing board website, and joined the professional association (in her case, California Association of Marriage and Family Therapists) as a student member. This gave her a subscription to their Journal, as well as access to the 'members only' section of the website, which contained valuable articles. She had printed out information from the licensing board, as well as the relevant Code of Ethics.

I was pleased that she was taking my suggestions so seriously, and wondered about her level of compliance. Again, something struck me as 'young' about Jenny. It almost felt as though she was showing me how 'good' she could be. (I stopped myself for a moment, wondering if there were any racist assumptions in this thought. I didn't think so, as the older I got, the younger all of the interns and trainees seemed to be. Probably this thought is more 'ageist' than racist...) I was a bit wary, though, as I knew from experience that those supervisees who start out 'good' inevitably become 'bad'!

I asked her if she had any questions from our last session, and she said she didn't. I wondered (out loud, to her) if she had any questions for me, about me...who I was, my experience, etc. She said she didn't. I left the door open, telling her if she did wonder about me, to please feel free to ask.

The reason I did this was because she had been assigned to me. Now, if I remember correctly from my schooling, counseling centers were a hot bed of gossip, rumor and innuendo. Most interns knew a lot about their prospective supervisor, much of it untrue. I wanted to elicit Jenny's projections to me, as an authority figure, as that would be a part of her clinical work, The people she saw as a therapist would perceive her as an authority, and to know her own process and projections around this power dynamic would be helpful in her work. As Jenny would be working part-time in the schools, we reviewed some of the tenets of school counseling, and I reviewed supervision of school counselors.

ERIC Identifier: ED372353
Publication Date: 1994-04-00
Author: Henderson, Patricia
Source: ERIC Clearinghouse on Counseling and Student Services Greensboro NC.

Supervision of School Counselors. ERIC Digest.

THIS DIGEST WAS CREATED BY ERIC, THE EDUCATIONAL RESOURCES INFORMATION CENTER. FOR MORE INFORMATION ABOUT ERIC, CONTACT ACCESS ERIC 1-800-LET-ERIC

THE NEED

Professionally appropriate supervision is emerging as a highly effective means of nurturing school counselors' professional development. New challenges in schools and increased understanding of the complexity of professional development dictate the need for increased attention to and use of effective supervision practices. Today's children and youth need highly skilled help in managing the complicated situations in which they live. School counselors see an increasing number of suicidal children as well as adolescents. The upsurge in substance abuse, gang involvement, and violence are well publicized. Increasingly, parents turn to the schools to help them solve problems that face them, including those posed by their children. In order to effectively help children in their classrooms, teachers seek consultative help from counselors. The comprehensive guidance programs (Gysbers & Henderson, 1994) being implemented in today's schools call for school counselors to use all of their professional skills.

Focused and constructive supervision is of benefit to all practitioners whether they are novices or experienced, highly competent or insufficiently trained. Due to reductions in caseloads, renewed commitment to elementary counseling, and retirement of counselors who entered the field in the 1960's, the number of new school counselors is increasing. As noted by Matthes (1992), "we expect novice counselors to assume the same responsibilities as experienced counselors" (p. 245). They encounter the same complex problems posed by today's students and they face similar ethical dilemmas. Such problems require the consultative and educative assistance of a competent counselor supervisor.

Wiggins' (1993) longitudinal study adds urgency to the need for supervision by experienced counselors. He found that "more than 28% of the total group...were independently rated as low in effectiveness...10 years previously [and] were still rated in that manner--and still employed as counselors" (p. 382). Clearly, in the ten year period, supervisory interventions would have helped some of these counselors improve the quality of their performance!

THE PROCESS

Although it is a relatively new discipline, supervision is compatibly defined in both education and in counseling. The purpose of supervision is the growth and enhanced effectiveness of the practitioner (Borders, 1991; Sergiovanni, 1984). "It is characterized by a cycle of feedback, practice, and additional feedback" (Borders, 1991, p. 253), based on interpretation of gathered data in light of established standards.

Because of the emphasis on skill-based performance evaluations generated by educational reform, many states (e.g., Mississippi, North Carolina, Texas) have defined school counselors' roles and needed competencies: program management, counseling, guidance, consulting, coordinating, student appraisal, and referral. With these behavioral standards as a basis, supervisors and counselors operate with the same definitions for effective performance. The value of timely feedback has been reinforced in the career-ladder-related-teacher-appraisal systems, setting the climate for the same practice for all categories of educators.

CLINICAL, DEVELOPMENTAL AND ADMINISTRATIVE SUPERVISION

When competently done, supervision not only enhances the quality of counselors' skills, but also helps hone professional judgment, "encourages greater self-awareness, and fosters an integrated professional and personal identity as a counselor" (Borders, 1991, p.253). Barret and Schmidt (1986) outlined a useful schema for distinguishing between the kinds of supervision needed for/by school counselors: clinical, developmental, and administrative. In this distinction, the purpose of each supervision type accounts for the different procedures used by the various supervisors available in schools.

The purpose of clinical supervision is enhancement of counselors' professional skills and ethical functioning. The data sources which support clinical supervision include observations of counselors applying their professional skills and values. In the school setting, the typical opportunities for gathering data to support clinical supervision are available (e.g., live and/or recorded observations, case presentations, and consultations). Clinical supervisors must be counselors who are competent in the school counselor functions and in supervision practices.

The purpose of developmental supervision is improvement of the guidance and counseling program and counselors' pursuit of professional development. Data sources which support developmental supervision are recordings of goals and activities undertaken to attain goals and measures of goal attainment, program plans and implementation calendars, self-reports, and consumer satisfaction surveys. Developmental supervision is best provided by competent school counselors from the same system as the supervisee.

The purpose of administrative supervision is assurance that counselors have worthy work habits, comply with laws and policies, relate well with other school staff and parents, and otherwise work effectively within the school system. Data sources supporting administrative supervision are such things as work schedules, recordkeeping and documentation systems, and evidence of team efforts. Either school counselor supervisors or building administrators may be providers of administrative supervision.

PERFORMANCE IMPROVEMENT SYSTEMS

Particularly relevant in the school setting is clarifying the place of supervision in the overall system for helping counselors' improve their performance. Whether or how data used in supervision will apply to summative evaluation needs to be spelled out. Supervision provides opportunities for personalizing the professional development processes. The combination of feedback from supervision and from performance appraisal is data which counselors and their supervisors use as the basis for professional development goals.

SUPERVISORS

The cyclical nature of the supervisory process is enhanced by the lengthy supervisor-supervisee relationships typical of elementary and secondary school settings. The multiple opportunities for supervision over significant lengths of time allow supervisory relationships to be rich ones.

The primary obstacles to fully effective school counselor supervision are caused by the insufficient number of school counselor-competent supervisors. Where there are such supervisors, there is little or no relevant counselor-supervisor training available and/or no specialized certification required. Although the building principals can provide useful administrative supervision, it is unlikely that they are current in the clinical functions of counseling. Competent school counselors are usually available to fulfill the developmental and clinical supervision roles, but they often lack training and certification in supervision.

Although development of the appropriate job descriptions and provision of the relevant training at this time are the responsibility of local school districts (Henderson & Lampe, 1992), the Standards for Counseling Supervisors (Dye & Borders, 1990) and the Curriculum Guide (Borders et al., 1991) provide the guidelines needed. A pool of potential clinical and/or developmental supervisors are available in many communities. Current school counselors can fulfill roles as peer supervisors. An increasing number of mid-sized school systems employ central office-based guidance supervisors. Some intermediate education agencies and some state departments of education provide such expertise. Schools are also contracting with community-based, Licensed Professional Counselors, or counselor educators.

THE STATUS

Supervision of professional practice is an effective, but perhaps underutilized means of nurturing the professional development of new and experienced school counselors. It is a personalized vehicle for assuring that children, their families, and teachers benefit from quality services. For counselor supervision to be practiced more universally in the nation's schools, states need to require appropriate certification, counselor education programs need to offer appropriate counseling supervisor training, and schools and district counseling supervisors need to report their counselor supervision practices and findings.

REFERENCES

Barret, R. L., & Schmidt, J. J. (1986). School counselor certification and supervision: Overlooked professional issues. Counselor Education and Supervision, 26, 50-55.

Borders, L. D. (1991). Supervision =/= evaluation. The School Counselor, 38, 253-55.

Borders, L. D., Bernard, J. M., Dye, H. A., Fong, M. L., Henderson, P., & Nance, D. W. (1991). Curriculum guide for training counseling supervisors: Rationale, development and implementation. Counselor Education and Supervision, 31, 58-80.

Dye, H. A., & Borders, L. D. (1990). Counseling supervisors: Standards for preparation and practice. Journal of Counseling and Development, 69, 27-32.

Gysbers, N. C., & Henderson, P. (1994). Developing and maintaining your school guidance program. Alexandria, VA: American Counseling Association.

Henderson, P., & Lampe, R. E. (1992). Clinical supervision of school counselors. The School Counselor, 39, 151-157.

Matthes, W. A. (1992). Induction of counselors into the profession. The School Counselor, 39, 245-250.

Sergiovanni, T. J. (1984). Effective department leadership. Boston: Allyn & Bacon.

Wiggins, J. D. (1993). A 10-year follow-up of counselors rated high, average, or low in effectiveness. The School Counselor, 40, 380-383.

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Patricia Henderson, M.Ed. is Director of Guidance in Northside Independent School District in San Antonio, Texas.

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ERIC Digests are in the public domain and may be freely reproduced and disseminated. This publication was funded by the Office of Educational Research and Improvement. Opinions expressed in this report do not necessarily reflect the positions of OERI or ERIC/CASS.

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Title: Supervision of School Counselors. ERIC Digest.
Document Type: Information Analyses---ERIC Information Analysis Products (IAPs) (071); Information Analyses---ERIC Digests (Selected) in Full Text (073);
Descriptors: Counselor Training, Elementary Secondary Education, Professional Development, School Counselors, Supervision, Supervisors, Supervisory Methods
Identifiers: ERIC Digests

Jenny knew that her first client in the school was a 14 year old Hispanic girl who was being transferred from Beverly, a student who had finished her internship. Jenny wasn't sure of how much of the previous work to address with her new client, whom we shall call 'Francesca'  or 'Franny'. Franny had been seeing Beverly because of ADD, and acting out behavior, including suspicions on the part of school staff of drug use and sexual activity. Jenny knew that Beverly was an older woman, entering the field after her children were grown. Beverly was known to be very warm and nurturing to her clients, and would be missed by the Counseling Center.

Jenny thought about how Franny would perhaps miss Beverly's presence in her life, and wondered about how to ask her about it. Jenny said she was worried that if she did address the issue, that Franny would immediately find her lacking in age, experience, and warmth. I suggested a few open ended questions that Jenny could ask Franny about Beverly.

This is where 'parallel process' can be helpful, because Jenny had had a previous supervisor. I asked Jenny about her previous supervision, what had worked well for her and what hadn't, and how she was processing the loss and the change. I did this as a way to model how she could talk with Franny about the switch from Beverly. Jenny responded that I was 'different' from her last supervisor, Sue. Nothing else...I guess I would have to wait to see what would be revealed.

I remember my first, awful session as a therapist, when I was too frightened to ask the client about the previous therapist, fearing how inadequate I would be found to be. My supervisor raked me over the coals for that, but had never mentioned that it was something I should do. I probably learned it somewhere in grad school, but had been too frightened in my first session with a client to ask about it. (Maybe that first supervisor was right, and it was the 'worst initial session ever.' Do you think the Guinness Book of World Records would be interested?)

I suggested to Jenny that she could ask Franny what Beverly did that was particularly helpful, or what she felt didn't help. If Jenny could hear what Franny said, Franny would not only be letting Jenny know how to work with her, but also would get clues to Franny's transference. We then talked about how Jenny would carry different projections than Beverly did, because of  Jenny's age and ethnicity.

Jenny thought about what projections she would carry, and realized that she might have a 'big sister' transference from her clients, rather than that of 'mother'. She said it might be hard for her, because she was the youngest in her family, so never had been the big sister. She said her sister was six years older than she was, and her sister was married with two children. She said her sister had always been 'perfect', and had been her father's favorite.

I was pleased that Jenny was opening up a bit, although it was interesting to me that she was talking about her sister, rather than herself. If this had been a therapy session, I would have commented on that. As it was supervision, I asked Jenny what she thought it would be like to be perceived as the 'big sister'.

She seemed flustered by the question, and even seemed a bit defensive. "I don't want to be like that. All I know about big sisters is betrayal! Taking a little sister's secrets and blabbing them all over! I am never going to do that." She crossed her arms and glared at me.

My little red flags went up again. It felt as though the issues about adolescence that Jenny had alluded to in the first session were alive and well in her psyche. My concern about Jenny was that while she needed to protect her clients' secrets, or confidentiality, she could not hide them from me, as her supervisor. Yet the parallel process was pulling at me already, as I am the oldest of the three girls in my family, so I am a 'big sister' in real life to two younger sisters.

What should I do now? Who should I be? Not Jenny's therapist, although I really hoped she had one. I didn't want to be the big sister of Jenny's childhood, even though I sensed that was coming. It seemed inevitable that supervision, as does therapy, recreates unresolved relationships.

It seemed like some strange pyramid scheme:

Franny perhaps projecting big sister transference onto Jenny

Jenny trying to resolve her sense of betrayal by her own big sister.

Jenny projecting big sister onto me,

Me trying to not be the big sister of Jenny's childhood.

My own stuff (isn't that a lovely clinical term?) regarding being a big sister.

I looked myself up in the DSM-S (The DSM for Supervisors). I would have to diagnose myself as DSM-S 367.00S-SS (The Supervisor's own stuff; sister stuff). In the same category is, of course DSM-S 367.00-MS, FS and BS (Mother Stuff, Father Stuff and Brother Stuff.)

My head was spinning! And all of this before Jenny had even seen Franny, before we even knew if Franny would project big sister onto Jenny. It feels as though the presence of Jenny's relationship with her big sister was already activated.

My task was to be aware of it, as it played out in Jenny's sessions, and in our supervision. If Jenny projected the betraying older sister onto me, I had to watch to make sure that I did not get caught. Projections are powerful, they can have a life of their own. The task of the supervisor, as well as the therapist, is to stay awake, to remain conscious.

Jenny and I reviewed the ethical and legal obligations of being a therapist:

• confidentiality
• Tarasoff
• child abuse
• elder abuse
• suicide
• 5150

Our session was about to end, and Jenny asked me a few questions about my experience. She asked a good question, if it was hard when I had to break the container. I told her how painful it was, and what carried me through was that confidentiality is broken to protect people. Jenny seemed quite heartened by my struggles around this, and how seriously I took confidentiality. She seemed to have welcomed me talking about my need to break confidentiality, and how I had struggled with the ramifications of reporting abuse or having to hospitalize someone involuntarily.

Daniel sees Maria

Daniel came into our next session looking somewhat dejected. "I saw Maria, and I don't think it went very well. She didn't seem to know why she was there, and didn't understand about confidentiality and Tarasoff. She couldn't even read my developmental history form, and kept wiggling all around when I tried to do the paperwork with her. She struck me as extraordinarily immature for an 8 year old ."

"I tried to explain about being an intern, and that I would be discussing the work with my supervisor. I reviewed with Maria the reasons I would have to break confidentiality, and then asked Maria if she had any questions. All she said was 'no, who cares, blah blah blah!' and then she laughed. And asked if she could play."

"All she wanted too do was play. And the worst thing was, when I suggested chess, she laughed at me, again! I can see exactly why she is considered defiant."

"And all she wanted to do was play Candyland! She didn't even want to do a House-Tree -Person drawing for me, or play with something that had some symbolic content to it, like doll house play or sandplay, which I have read extensively about. No, all she wanted to do was play Candyland!"

I asked Daniel what he did.

"I played Candyland. For 45 minutes, I played Candyland. And the galling thing is, there is no strategy about Candyland, no skill, no logic. I can see why my parents never let me play Candyland. I almost think it should not be the playroom, it has no educational value whatsoever."

I was concerned here on two counts:

1. Daniel did not really seem to know how to play

2. He was still very tied in to his parents' belief system

I wondered if he was experiencing the inflation that often happens as an intern learns to be a therapist. Frequently the fears are so great that a compensatory inflation gets established in the psyche, and the intern acts as if he or she is omnipotent. Then supervision becomes a minefield, as the supervisor must be simultaneously gentle with the defense while deflating the grandiosity. This can work, but I have ended up with either an intern who is enraged, as he or she struggles to maintain the defenses, or has dissolved into a puddle of tears when the underlying doubts and fears surface.

I did not want to cross the supervision/therapy boundary, so decided to hold these thoughts in abeyance, and address Maria's desire to play Candyland.

He said that he had been thinking of Candyland in the psychoanalytic tradition, and that it seemed to be about the earliest stages of development: the oral stage. He said that is why he wanted to know about if Maria was breastfed, and, if so, for how long.

I asked Daniel if perhaps he thought Maria was drawn to Candyland because she was feeling somewhat deprived. She had lost her mother's attention for a long time, during her bedrest and preoccupation with her difficult pregnancy. The birth of a premature baby, such as Maria's new brother, can be very disruptive to the older child in the family. Did Maria miss her parents? Did Maria fear the new baby would die? Did she, at some level, want the new baby to die? Could Candyland be comforting to her? Could it represent 'yummy' times? Counter a feeling of deprivation? (I doubt that many children would play a game called "Vegetableland" in which the goal was to attain a big salad, or a plate of broccoli.) Did Maria need to be somewhat regressed? Was she going back in time, to when she had more of her parents? Did the randomness of Candyland help her master how out of control her life had become?

Daniel looked at me as if I were nuts! (DSM-S 536.09n: Supervisor imagines he or she is being perceived as 'nuts' by intern, unable to verify, because it is too soon in the process for supervisor to ask intern if he or she is perceiving supervisor as 'nuts'. Differential diagnosis: DSM-S 536.99a: Supervisor imagines he or she is being perceived as an alien by intern; unable to verify, because it is too soon in the process for supervisor to ask intern if he or she is perceiving supervisor as an alien.) How could a stupid game like Candyland reveal all of this? "No thanks," his body language seemed to say, "I am sticking with my theory, not yours!"

As he was leaving the session, Daniel said, "Oh! I wanted to tell you. The baby's name is 'Daniel' but they call him 'Danny'.

It never ceases to amaze me how often a client or intern will 'drop the bomb' at the end of the session. I wondered if Daniel realized the significance of the fact that Maria's little brother had the same name as Daniel. How would that play out? What did it mean, coming at the end of the session?

I reread this article, Strategies and Methods of Effective Supervision, keeping in mind how developmental considerations interface with supervision. As a supervisor to a first semester intern, I knew that my supervision would be primarily supportive and educational. Often it takes interns until they are in their second year of training to be less frightened, and confident enough to really grapple with parallel process.

Jenny sees Franny

Jenny came into our next session excited, almost bubbly. "I did it! I saw Franny, and I think she likes me!" I was glad to see a more open side of Jenny. I asked her how the session went. She said, "Good, except at first I was so nervous! I kind of thought that I was a fraud, you know, and that Franny would see that and just leave. But then I realized if she left, she would have to go back to her math class, and that no matter how bad I was, I was probably better than math!" Jenny laughed as she told me this.

I am always so heartened when people can laugh at themselves! 

Jenny then talked about the session, how she had told Franny that she was an intern, and that she would be discussing her work with her supervisor. She reviewed with Franny the reasons she would have to break confidentiality, and said she asked Franny if she had any questions. "All she said was no, that she knew all this from seeing Beverly."

Jenny continued, "That's when I got a little nervous. I was going to ask her about Beverly, but not right at the beginning! But here it was, kind of 'in my face'. So I asked her if she missed Beverly. She said she kind of did. I then remembered what we had talked about in our last supervision session, so I asked her what Beverly had done that was helpful, because I remembered you saying that Franny would tell me what she needed if I could just listen."

"Franny said Beverly listened to her, and that was good. They played a lot of card games, and board games, and sometimes Franny said she did a sandtray. She said she kind of liked playing games with Beverly, because it gave her hands something to do. And when she was little, her Mom was too busy ever to play games with her. She said she thought it was a little weird to be playing with a grown-up, but it was kind of nice, too."

"I tried to get her to talk about her feelings about the loss of Beverly, but she didn't say much. I was thinking she might be feeling abandoned, but when I asked her, she just kind of stared at me. And then she crossed her arms over her chest, and didn't say anything. Then I asked her about if there was anything about Beverly's work that didn't work for her, and she seemed like she wanted to say something, but didn't want to be disloyal. I felt like I was really blowing it, like Franny was shutting down."

"So I remembered what you had suggested, so I told her that while I imagined that she missed Beverly, that it would help my work to know what had been helpful to her, and what she hadn't found good, in her previous sessions. Then I told her that I was just starting out, and could use her help, so to please tell me if things worked or didn't work. I admit it was hard to tell her that I was just beginning."

"It was amazing then what happened. Franny looked so surprised that I was asking for her help, that she just opened up, She talked about Beverly, and then talked about her mom, and how her mom never took the time to listen, because she was always too stressed. Oh, and she said her Dad yelled a lot, telling the kids to be quiet, and that he sat around drinking beer."

"Franny has twin brothers who are younger than she is, and they have all sorts of learning difficulties, and Franny has an older brother, who has been in jail, and an older sister, so she is the middle child." Jenny continued to talk about the session, and how she felt like she was getting a sense of Franny.

"I asked Franny what she wanted to do, and she immediately went to the shelf and took out a pack of cards. She wanted to play 'Go Fish'. I was kind of surprised, actually, because I had heard 'Go Fish' is such a baby game, you know, it is the first card game a lot of kids play. So, maybe it was a test of me, to see if I would say something. And I almost did! I caught myself about to ask if that was what she REALLY wanted to play, because there was chess in the room, and other games, and cards, but I didn't. But I didn't know the rules, as I have never played the game. Franny looked at me very strangely when I told that I didn't know how to play, so she taught me. Then we played 'Go Fish'. I didn't like it at all."

Jenny had inadvertently stumbled upon a good  therapeutic technique. By asking a client to teach you something, you enter the realm of "I don't know"in therapy. One of the world's master's in this is Dr. Hayao Kawai, the first Jungian analyst in Japan. Professor Kawai has also been designated as "Person of Cultural Merits" by the Japanese Government. Dr. Kawai feels that when the therapist says 'I don't know" (usually in reference to dream or symbol interpretation) it ultimately empowers the patient to find his or her own answers.

I use this technique sometimes in supervision, with advanced students. I have found that for beginner therapists, it scares them too much to think that their supervisor doesn't know! However, with more experienced interns, it does open the doorway for them to trust their own experiences more, and gives them permission to explore the issues more thoroughly. Sometimes I think it is just another way to say "Do you have any associations?", but, by changing the power dynamic, it does build confidence in a client or student.

In using this technique with children, it is helpful to pay attention not only to the content of what they are teaching, but the tone they use. If a child teaches me something in a very impatient way, telling me to "Pay Attention", or "Listen!!", then I know that is how the child experiences having been taught. It allows for me to get a more immediate empathic connection to the child, that otherwise I might have to get 'one step removed', through the child's narration of how the teacher or parent is while they are teaching the child.

Jenny reported that as Franny told her the rules of 'Go Fish', her demeanor was somewhat impatient, with Franny rolling her eyes and she had the "duh" attitude that many teenagers espouse. Jenny said that Franny seemed almost not to believe that Jenny did not know how to play, and seemed to almost be wondering if this was some kind of trick. Franny's version of 'Go Fish' was: "Each of us gets seven cards. You try to make pairs, like two sevens, or two Queens, or, with this pack, two of the same kind of fish. When it's your turn, you ask me for a card (but it has match a card that is already in your hand). If I have it, you put the pair down on the table. If I don't have it, I say "Go Fish!" and you pick a card out of the pile. Oh, and if you get what you asked for, either from me or the pile, you get another turn. The person who has the most pairs at the end wins. It's really simple...Beverly knew how to play...how come you don't know how to play?"

Jenny said she felt very inadequate at that moment, being compared to Beverly. She said that she apologized to Franny for not knowing how to play, but did not follow up on Franny's comment about Beverly.  Instead, she told Franny that she didn't really play cards when she was little. She said that Franny looked up at her and said, "Oh, I thought it was because you were Chinese." Jenny said she was so surprised by Franny's comments that she didn't know what to do. Jenny had known from her coursework that cultural differences were important in therapy, but this was the first time anyone had so blatantly brought up Jenny's ethnicity. Jenny said that she didn't know what to say, so she told Franny that many Chinese-American people play cards, but that she had never learned how to play. Jenny said to me that she hoped her answer was OK, but she was afraid she sounded defensive.

We then talked about ethnicity in therapy.

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Issues in Multicultural Counseling. Highlights: An ERIC/CAPS Digest.

THIS DIGEST WAS CREATED BY ERIC, THE EDUCATIONAL RESOURCES INFORMATION CENTER. FOR MORE INFORMATION ABOUT ERIC, CONTACT ACCESS ERIC 1-800-LET-ERIC

TEXT: OVERVIEW

Traditionally, the United States has been defined as a melting pot in which various cultures are assimilated and blended as immigrants mold their beliefs and behavior to the dominant white culture. The melting pot image has given way to a more pluralistic ideal in which immigrants maintain their cultural identity while learning to function in the society. Not only are immigrants still flocking to America from Cuba, Haiti, Vietnam, Guatemala, El Salvador, and other countries (LaFromboise, 1985), but minorities already living in the United States have asserted their right to have equal access to counseling (Arcinega and Newlou, 1981). This diversity creates three major difficulties for multicultural counseling: the counselor's own culture, attitudes, and theoretical perspective; the client's culture; and the multiplicity of variables comprising an individual's identity (Pedersen, 1986).

THE COUNSELOR'S CULTURE

A major assumption for culturally effective counseling and psychotherapy is that we can acknowledge our own basic tendencies, the ways we comprehend other cultures, and the limits our culture places on our comprehension. It is essential to understand our own cultural heritage and world view before we set about understanding and assisting other people (Ibrahim, 1985; Lauver, 1986). This understanding includes an awareness of one's own philosophies of life and capabilities, a recognition of different structures of reasoning, and an understanding of their effects on one's communication and helping style (Ibrahim, 1985). Lack of such understanding may hinder effective intervention (McKenzie, 1986).

Part of this self-awareness is the acknowledgement that the "counselor culture" has at its core a set of white cultural values and norms by which clients are judged (Katz, 1985; Lauver, 1986). This acculturation is simultaneously general, professional, and personal (Lauver, 1986). Underlying assumptions about a cultural group, personal stereotypes or racism, and traditional counseling approaches may all signal acquiescence to white culture. Identification of specific white cultural values and their influence on counseling will help to counter the effects of this framework (Katz, 1985).

Adherence to a specific counseling theory or method may also limit the success of counseling. Many cultural groups do not share the values implied by the methods and thus do not share the counselor's expectations for the conduct or outcome of the counseling session. To counter these differences, effective counselors must investigate their clients' cultural background and be open to flexible definitions of "appropriate" or "correct" behavior (LaFromboise, 1985).

Another counseling barrier is language. Language differences may be perhaps the most important stumbling block to effective multicultural counseling and assessment (Romero, 1985). Language barriers impede the counseling process when clients cannot express the complexity of their thoughts and feelings or resist discussing affectively charged issues. Counselors, too, may become frustrated by their lack of bilingual ability. At the worst, language barriers may lead to misdiagnosis and inappropriate placement (Romero, 1985).

THE CLIENT'S CULTURE

As counselors incorporate a greater awareness of their clients' culture into their theory and practice, they must realize that, historically, cultural differences have been viewed as deficits (Romero, 1985). Adherence to white cultural values has brought about a naive imposition of narrowly defined criteria for normality on culturally diverse people (Pedersen, 1986). Multicultural counseling, however, seeks to rectify this imbalance by acknowledging cultural diversity, appreciating the value of the culture and using it to aid the client. Although the variety of cultures is vast, the following examples indicate the types of cultural issues and their effects on the counseling situation.

In the cultural value system of Chinese Americans, passivity rather than assertiveness is revered, quiescence rather than verbal articulation is a sign of wisdom, and self-effacement rather than confrontation is a model of refinement (Ching and Prosen, 1980). Since humility and modesty are so valued, it is difficult for counselors to draw out a response from a Chinese American in a group setting. The reticence which reinforces silence and withdrawal as appropriate ways of dealing with conflict may be interpreted as resistance by the uneducated counselor. Democratic counselors may also be uneasy with the role of the "all-knowing father" that the Chinese respect for authority bestows on them (Ching and Prosen, 1980).

Africans place great value on the family, especially their children, who are seen as a gift from God, and on social relationships, with a great emphasis on the community and their place in it. In this context social conflict resolution becomes important, so that peace and equilibrium may be restored to the community, while personal conduct becomes secondary (McFadden and Gbekobov, 1984).

Many African values also influence contemporary American Black behavior, including the notion of unity, the survival of the group, oral tradition, extended kinship networks, self-concept, concept of time, and control of the environment.

In his discussion of counseling the Northern Natives of Canada, Darou (1987) notes that counseling is seen as cultural racism when it does not fit native values. These values are: cooperation, concreteness, lack of interference, respect for elders, the tendency to organize by space rather than time, and dealing with the land as an animate, not an inanimate, object.

Bernal and Flores-Ortiz (1982) point out that Latin cultures view the family as the primary source of support for its members. Any suggestion that the family is not fulfilling that obligation can bring shame, added stress, and an increased reluctance to seek professional services. Involving the family in treatment will most likely insure successful counseling outcomes with Latinos.

INDIVIDUAL DIFFERENCES

There is always the danger of stereotyping clients and of confusing other influences, especially race and socioeconomic status, with cultural influences. The most obvious danger in counseling is to oversimplify the client's social system by emphasizing the most obvious aspects of their background (Pedersen, 1986). While universal categories are necessary to understand human experience, losing sight of specific individual factors would lead to ethical violations (Ibrahim, 1985). Individual clients are influenced by race, ethnicity, national origin, life stage, educational level, social class, and sex roles (Ibrahim, 1985). Counselors must view the identity and development of culturally diverse people in terms of multiple, interactive factors, rather than a strictly cultural framework (Romero, 1985). A pluralistic counselor considers all facets of the client's personal history, family history, and social and cultural orientation (Arcinega and Newlou, 1981).

One of the most important differences for multicultural counseling is the difference between race and culture. Differences exist among racial groups as well as within each group. Various ethnic identifications exist within each of the five racial groups. Some examples include: Asian/Island Pacific (Japanese, Korean, and Vietnamese); Black (Cajun, Haitian, and Tanzanian); Hispanic (Cuban, Mexican and Puerto Rican); Native American (Kiowa, Hopi, and Zuni); and White (British, Dutch, and German). Even though these ethnic groups may share the physical characteristics of race, they may not necessarily share the value and belief structures of a common culture (Katz, 1985). Counselors must be cautious in assuming, for instance, that all Blacks or all Asians have similar cultural backgrounds. McKenzie (1986) notes that West Indian American clients do not have the same cultural experience of Afro-American Blacks and are culturally different from other Black subculture groups. Counselors who can understand West Indian dialects and the accompanying nonverbal language are more likely to achieve positive outcomes with these clients.

CONCLUSION

Although it is impossible to change backgrounds, pluralistic counselors can avoid the problems of stereotyping and false expectations by examining their own values and norms, researching their clients' backgrounds, and finding counseling methods to suit the clients' needs. Counselors cannot adopt their clients' ethnicity or cultural heritage, but they can become more sensitive to these things and to their own and their clients' biases. Clinical sensitivity toward client expectation, attributions, values, roles, beliefs, and themes of coping and vulnerability is always necessary for effective outcomes (LaFromboise, 1985). Three questions which counselors might use in assessing their approach are as follows (Jereb, 1982):

(1) Within what framework or context can I understand this client (assessment)?
(2) Within what context do client and counselor determine what change in functioning is desirable (goal)?
(3) What techniques can be used to effect the desired change (intervention)?

Examination of their own assumptions, acceptance of the multiplicity of variables that constitute an individual's identity, and development of a client centered, balanced counseling method will aid the multicultural counselor in providing effective help.

FOR MORE INFORMATION

Arcinega, M., and B.J. Newlou. "A Theoretical Rationale for Cross-Cultural Family Counseling." THE SCHOOL COUNSELOR 28 (1981): 89-96.

Bernal, G., and Y. Flores-Ortiz. "Latino Families in Therapy: Engagement and Evaluation." JOURNAL OF MARITAL AND FAMILY THERAPY 8 (1982): 337-365.

Ching, W., and S.S. Prosen. "Asian-Americans in Group Counseling: A Case of Cultural Dissonance." JOURNAL FOR SPECIALISTS IN GROUP WORK 5 (1980): 228-232.

Darou, W. G. "Counseling and the Northern Native." CANADIAN JOURNAL OF COUNSELING 21 (1987): 33-41.

Ibrahim, F. A. "Effective Cross-Cultural Counseling and Psychotherapy." THE COUNSELING PSYCHOLOGIST 13 (1985): 625-638.

Jereb, R. "Assessing the Adequacy of Counseling Theories for Use with Black Clients." COUNSELING AND VALUES 27 (1982): 17-26.

Katz, J. H. "The Sociopolitical Nature of Counseling." THE COUSELING PSYCHOLOGIST" 13 (1985): 615-623.

LaFromboise, T. D. "The Role of Cultural Diversity in Counseling Psychology." THE COUNSELING PSYCHOLOGIST 13 (1985): 649-655.

Lauver, P. J. "Extending Counseling Cross-Culturally: Invisible Barriers." Paper presented at the annual meeting of the California Association for Counseling and Development, San Francisco, CA. ED 274 937.

McFadden, J., and K.N. Gbekobov. "Counseling African Children in the United States." ELEMENTARY SCHOOL GUIDANCE AND COUNSELING 18 (1984): 225-230.

McKenzie, V. M. "Ethnographic Findings on West Indian-American Clients." JOURNAL OF COUNSELING AND DEVELOPMENT 65 (1986): 40-44.

Pederson, P. "The Cultural Role of Conceptual and Contextual Support Systems in Counseling." AMERICAN MENTAL HEALTH COUNSELORS ASSOCIATION JOURNAL 8 (1986): 35-42.

Romero, D. "Cross-Cultural Counseling: Brief Reactions for the Practitioner." THE COUNSELING PSYCHOLOGIST 13 (1985): 665-671.

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This publication was prepared with funding from the Office of Educational Research and Improvement, U.S. Department of Education, under OERI contract. The opinions expressed in this report do not necessarily reflect the positions or policies of OERI or the Department of Education.

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Title: Issues in Multicultural Counseling. Highlights: An ERIC/CAPS Digest.
Document Type: Information Analyses---ERIC Information Analysis Products (IAPs) (071); Information Analyses---ERIC Digests (Selected) in Full Text (073);
Available From: ERIC/CAPS, University of Michigan, School of Education, Room 2108, 610 East University Street, Ann Arbor, MI 48109-1259 (free).
Descriptors: Client Characteristics (Human Services), Counselor Attitudes, Counselor Characteristics, Counselor Client Relationship, Cultural Influences, Cultural Pluralism, Ethnic Stereotypes, Individual Differences
Identifiers: ERIC Digests, Multicultural Counseling

OK, looking at race and ethnicity, we have to take into account several different dynamics:

The patient's transference and projections onto the intern



  The intern's countertransference and projections onto the patient
The intern's transference and projections onto the supervisor

The supervisor's countertransference and projections onto the intern

The supervisor's countertransference and projections onto the patient

All of this occurs in the dominant culture's setting.

We also use this same model for every type of issue that arises in therapy, including gender, religion, age, health, family dynamics, parents, socioeconomic levels, number of generations in this country, sibling order, developmental level, learning styles, typology, body size, sexual orientation, childhood experiences, loss, trauma, etc. (I have even seen the transference/countertransference dynamic operate with regard to hair length, and confess to having 'wooed' an adolescent into therapy by promising to reveal my hair growing secrets!) The general rule I use is "Everything and anything is activated in the therapeutic relationship, and when you add the supervision relationship, it increases and reverberates logarithmically."

I would like to sit down with you now, over our cup of coffee, and talk about this. In your view, is race or ethnicity the most important factor in determining who we are? How much importance does it have in your work, both with your clients and your supervisees? Where do you place ethnicity, race and culture within the whole constellation of who a person is? Intuitively, it would seem that if you are a member of a minority group, that it would be more important than if you were not, because it is always a factor in how you are seen by the dominant culture. Probably the most obvious examples of this are for African American men, who describe many people's first reaction to them as one of fear, and for people of Middle Eastern descent, and followers of Islam, post September 11. (What terrible things we do to people!) I know that my rule, in general, is to try to find an opening in the first few sessions to name an ethnic or racial difference between the client and myself, opening the door to talk about it. I feel that by naming it, I am acknowledging that we are different, and giving the client permission to talk about it when she or he feels ready, or when it comes up in our work.

From The APA Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations:
Psychological service providers need a sociocultural framework to consider diversity of values, interactional styles, and cultural expectations in a systematic fashion. They need knowledge and skills for multicultural assessment and intervention, including abilities to:
1. recognize cultural diversity;
2. understand the role that culture and ethnicity/race play in the sociopsychological and economic development of ethnic and culturally diverse populations;
3. understand that socioeconomic and political factors significantly impact the psychosocial, political and economic development of ethnic and culturally diverse groups;
4. help clients to understand/maintain/resolve their own sociocultural identification; and understand the interaction of culture, gender, and sexual orientation on behavior and needs.

Please go to: http://www.apa.org

for the complete article.

Excerpted from The APA Guidelines for Multicultural Education and Training, Research, and Practice in Psychology:
1. Ethical conduct of psychologists is enhanced by knowledge of differences in beliefs and practices that emerge from socialization through racial and ethnic group affiliation and membership and how those beliefs and practices will necessarily affect the education, training, research and practice of psychology.
2. Understanding and recognizing the interface between individuals' socialization experiences based on ethnic and racial heritage can enhance the quality of education, training, practice, and research in the field of psychology.
3. Recognition of the ways in which the intersection of racial and ethnic group membership with other dimensions of identity (e.g., gender, age, sexual orientation, disability, religion/spiritual orientation, educational attainment/experiences, and socioeconomic status) enhances the understanding and treatment of all people.
4. Knowledge of historically derived approaches that have viewed cultural differences as deficits and have not valued certain social identities helps psychologists to understand the under representation of ethnic minorities in the profession, and affirms and values the role of ethnicity and race in developing personal identity.
5. Psychologists are uniquely able to promote racial equity and social justice. This is aided by their awareness of their impact on others and the influence of their personal and professional roles in society.
6. Psychologists' knowledge about the roles of organizations, including employers and professional psychological associations are potential sources of behavioral practices that encourage discourse, education and training, institutional change, and research and policy development, that reflect rather than neglect, cultural differences....
(source: http://www.apa.org/pi/multiculturalguidelines/introduction.html)

From the NASW Code of Ethics:

1.05 Cultural Competence and Social Diversity

(a) Social workers should understand culture and its function in human behavior and society, recognizing the strengths that exist in all cultures.

(b) Social workers should have a knowledge base of their clients' cultures and be able to demonstrate competence in the provision of services that are sensitive to clients' cultures and to differences among people and cultural groups.

(c) Social workers should obtain education about and seek to understand the nature of social diversity and oppression with respect to race, ethnicity, national origin, color, sex, sexual orientation, age, marital status, political belief, religion, and mental or physical disability.
(source: http://www.socialworkers.org/)

 

From the California Association of Marriage and Family Therapists Ethical Standards:

3.6 Marriage and family therapists actively strive to understand the diverse cultural backgrounds of their clients by gaining knowledge, personal awareness, and developing sensitivity and skills pertinent to working with a diverse client population. Marriage and family therapists who provide therapy over the Internet or by other electronic media take extra measures to identify and understand the diversity, ethnicity, and cultural sensitivity of such patients.
3.7 Marriage and family therapists are aware of how their cultural/racial/ethnic identity, values and beliefs affect the process of therapy.
(http://www.camft.org/)

I wanted to shift the session from Jenny reporting about Franny to Jenny's work as a therapist, so I asked Jenny to talk about what it was like when Franny had assumed that, because she was Chinese, she did not know how to play cards. She said that  she was quite surprised, that usually people were not so blatant in expressing their their cultural ignorance. "I wasn't offended; I mean it didn't strike me as particularly racist, just ignorant." I asked Jenny if she felt that Franny's comment would make it hard for her to work with her. Jenny looked at me, sighed, and said, "If I pulled away from everyone that made assumptions about me due to my race or culture, I would just have to stay in Chinatown and never venture out. This is minor, and actually rather refreshing, that someone is so direct about ethnicity. Often it is the unexpressed assumptions that hurt, like when I am quiet, maybe because I am thinking, and people assume I am being 'inscrutable.' Oh! I hate that term so much! I can barely even say it! That is racist, not some kid wondering about why I don't play cards."

I took in what Jenny said, and wondered if it was racist on my part to even think that Franny's comment about Jenny would interfere with Jenny being able to treat Franny. I really didn't think it was inappropriate to ask Jenny about it, but maybe, given what she had just said about 'unexpressed assumptions' maybe I needed to ask her about my asking her about it. (This is getting rather circular here...) So, I asked Jenny how it was for her that I had asked her how Franny's comments had affected her.

She said it surprised her, that I would wonder about about it. She said she thought it was because I was "old", which she quickly amended to "from another generation" that I would even think that comments like this would interfere with her work.

Maybe this was wrong, but I burst out laughing, and then Jenny started to laugh as well. We both realized the parallel process that had just occurred. As Franny had made an assumption based upon Jenny being Chinese, so Jenny had made an assumption based upon my age. I realized that the question I had to ask myself was, "Does Jenny making an assumption about me based upon my age make it impossible for me to work with Jenny?" I realized that for me the answer was "Of course not" as there seemed to be no ill intent about Jenny's comment. We talked about the parallel process that had just occurred, and then went on to discuss the rest of the session.

Jenny reported that she never really felt 'therapeutic', except when she asked Franny about feeling abandoned, and that 'just shut Franny up.' "So it was kind of strange, like it only worked when I wasn't 'therapeutic', only when I just let Franny talk. I was so nervous about how Franny just shut down when I asked her about feeling abandoned, that I kind of went on tiptoes the rest of the time, not really helping Franny, but just letting her talk. And playing that awful game, 'Go Fish'."

"It was a little strange. I had been so looking forward to making these brilliant insights, and all I did was hear about Franny's family." Here Jenny started to talk again about Franny, so I gently moved the conversation back to Jenny. I asked her how it was for her, hearing about Franny's family. Jenny looked a bit blank then said, "I guess it was good. I felt like just a friend of Franny's though, not like a therapist. I kept thinking about my family systems class, and my substance abuse class, and wondered it Franny's dad was an alcoholic. But when I asked her,she just kind of did that 'uh' thing that teenagers do. So then I told her about alcoholism, but then she seemed to be tuning me out."

Jenny looked at me and then said, "I guess it was too soon to talk about stuff like that, or feeling abandoned." I was very pleased that Jenny had figured this out on her own, and remembered something one of my teachers had said years ago: "The best 'Aha!'' is the one you don't make", meaning that if the client or supervisee makes the connection, it is much more powerful.

Jenny then went on to talk about her feelings of being a therapist, and how surprised she was that Franny seemed to just accept Jenny as a therapist, and didn't see how unsure that Jenny felt. The session continued in this vein, and Jenny started to think about what her treatment plan for Franny would entail. As she was walking out the door, Jenny said,"Oh! I forgot to tell you. At the end, Franny called me 'Maria' by mistake. I thought maybe she would call me Beverly, but she called me Maria. So I asked who Maria was...it is her older sister!"

"So I quickly asked her about Maria, and Franny said she was the "good one" in the family, that she could do no wrong, she was the favorite, and she was married and that she recently had her second baby. (Jenny said Franny said this really fast, because the session was ending.)

Here it was again; important information coming at the end of the session! Franny's slip to Jenny indicated her projection onto Jenny had been activated. She did it at the end of the session, just as Jenny had "remembered" about this only at the end of the supervision session!

 

Daniel - The Next Sessions

We continued in this vein for several more sessions, with Daniel starting to see additional clients, including high school students, and a family at the Counseling Center. His main energy however centered on Maria, so, for the purposes of this course, we will stay with Daniel's experience with Maria.

Maria's mother had returned Daniel's developmental history form to him. He was shocked. It was sticky with some kind of baby food, and the answers were terse. For the first five pages, questions on Maria's intrauterine development and the pregnancy, Maria's mom had scrawled 'easy'. On the other fifteen pages, Daniel's precise questions about teeth coming in, walking and talking, the answers were, "OK. " The only thing that indicated any problem was at the very end, when he asked about the reasons for the child being in counseling at this time, and any symptoms. The answer was, "Things are hard now. She is not so happy."

Several of his more elaborate questions were marked with ??? for answers. Daniel was "appalled that a parent could care so little for his or her child not to take the time to answer important questions." It was much later that Daniel realized that answering questions did not correlate to love, and that his questions might be hard for a parent to answer if English was not his or her primary language. After a few more parents either failed to return his developmental questionnaire, or had brief or no answers to most of the questions, Daniel acknowledged that perhaps the questionnaire wasn't working.

I was very glad that he came to that conclusion on his own!

Daniel had a hard time thinking that playing games was therapeutic. I asked him to read The Therapeutic Powers of Play by Charles E. Schaefer, Ph.D. (Editor). He learned that:

Game play contributes to a child's cognitive, emotional, and social development. Since games involve rule-governed behavior, ego control must be stronger than impulse-driven behavior. Game play also prepares children for their roles in the social world, including both competitive and cooperative roles. Among other ego-enhancing powers of games are: (1) helping distractible children focus and sustain their attention, (2) seeing the immediate consequences of one's actions in a game develops a sense of an inner locus of control of the environment; the challenge inherent in games helps overcome feelings of boredom and dullness. (p.13)

But to no avail.

There were times when I dreaded seeing Daniel. It was exhausting to feel that I had to document every suggestion with copious amounts of research. I often felt that, no matter what I told Daniel, it was not good enough. (DSM-S 140.00 Supervisor's Unresolved Stuff Arises in the Process of Supervision.) I felt devalued by Daniel's style, and knew that I needed to work on my issues and past experiences as my negative countertransference appeared.

And then was the scandal: it came to be known as

GATE.

Another intern came in to supervision upset because Candyland was missing from the playroom. Now, every child therapist knows that toys do get up and walk away, so money was requisitioned for another set of Candyland. But then the first set mysteriously reappeared, then the following week both sets were gone, and then both were back again!

Playing detective, I realized that the second intern, who had discovered the loss of Candyland, used the playroom directly after Daniel did. So, I asked Daniel about it, and he sheepishly admitted that he so despised Candyland that he would remove it from the playroom before he saw children there. And a few times he had gotten so wrapped up in his process notes that he forgot to return it.

I gently explained to him that the toys had to stay in the playroom..all of them!

And that perhaps he needed to make peace with Candyland.

Daniel just didn't get it. No matter how much he read, he couldn't quite understand how game playing, especially Candyland, could actually be therapeutic. So, feeling desperate (DSM-S 004.78 - Engaging in an Act of Desperation by Desperate Supervisor; subcategory games) I pulled out my ratty old game of Candyland. Daniel looked surprised, to say the least, horrified might be more accurate. This was role play in its most playful form; actually playing!

"OK, Daniel, let's play!"

And so we played Candyland.
At first, Daniel didn't like the one rule of Candyland, which was that the youngest goes first. Even though this was to his advantage, being almost a generation younger than I am, he didn't think it was "fair".

For those of you who forget (or never played) the game is played by choosing cards, and advancing to that place on the board. The winner is the first one who gets to the castle at the end.

Daniel was very intense as he played, and kept getting flustered by "Plumpy"

Plumpy is the card in the deck that sends you back almost to the beginning.

No one likes Plumpy, but I think of the game as a highly evolved, spiritual game, in that it lets us know what we can control (taking turns, not cheating) but is like life, in that there is much we cannot control, like love, or birth or death. So, when a Candyland player is going along, and is suddenly swept up to the Queen Frostine card, or cast down to the little plum, Plumpy, then that is a lesson in things we cannot control. For children, much of their lives are involve things over which they have no control: where they live, who their teachers are, whether their parents get divorced, or stay together, etc. So I love Candyland.

But Daniel did not.

At one point he was scowling so much I feared that I had made a huge mistake, having him play.

Then I feared perhaps he was diabetic, and candy had been forbidden to him.

Or that his parents had been dentistry professors. I worried that perhaps he had an eating disorder...

But as we played, he began to open up.

After he got a particularly good card (Princess Lolly) while I was stuck in the Molasses Swamp, he actually laughed.

And then Daniel started to talk about never playing games as a child, because there were never any children around. He said his one game was chess, and that he had learned to please his father. His parents were very intellectual, and serious about their 'miracle', late in life child, Daniel. As a result, he was not allowed to play rough and tumble games, and only allowed to choose the same number of pieces of candy as his age on Halloween to eat. The rest had to be thrown out. "I remember really wanting to be 50, so I could eat 50 pieces of candy. It never occurred to me that 50 year olds don't trick or treat!"

He suddenly sat up, as if startled. "I am remembering something else...when I was in preschool, I played Candyland. And when Mother came to pick me up, she told the teacher that I couldn't play Candyland anymore. I think she thought it wasn't educational enough, or maybe it would make me want to eat candy." He then said that in his three sessions a week psychoanalysis he had never been able to remember much about his childhood. He said that he would see his analyst later in the day, and tell him about his "breakthrough".

This is a paradox of supervision, of course. As we are charged with upholding legal and ethical standards, making sure our students have the information they need, and respecting our authority, we can't really (and shouldn't) run supervision sessions like therapy sessions. Time and time again I would catch myself mirroring my intern's body language and feelings, then would have to pull back and teach, or, in some cases, lay down the law. A balancing act, to be sure. I was very glad to hear that Daniel was in therapy.

He said that it was easier to talk when he didn't have to concentrate so much, and that playing this game might actually not be a bad thing.

And then he said, "I think I have perhaps been a little too controlling with Maria in our sessions."

The best 'Aha!'' is the one you don't make!

And so it went, Daniel learning how to play, with little Maria leading the way. I kept thinking about what Winnicott wrote:

Psychotherapy takes place in the overlap of two areas of playing, that of the patient and that of the therapist. Psychotherapy has to do with two people playing together. The corollary of this is that where playing is not possible the work done by the therapist is directed towards bringing the patient from a state of not being able to play into a state of being able to play... Furthermore: It is in playing and only in playing that the individual child or adult is able to be creative and to use the whole personality, it is only in being creative that the individual discovers Self. (Playing and Reality, pp. 38, 54)

The paradox here was that Maria was teaching Daniel to play!  Again and again, I am struck by how our patients are our teachers. I often feel that it is never an accident who comes to us for therapy (and supervision). I wondered what Daniel was going to teach me!

Finally, it seemed time to get some more objective information, rather than rely solely on Daniel's self-report.

Jenny - The Next Sessions

Jenny started to see additional clients, including elementary school students, and some families at the Counseling Center. She confronted the Counseling Center Director, who assigned clients to interns, when she realized that she was getting every family of Asian descent who came for counseling. Her main energy however centered on Franny, so, for the purposes of this course, we will stay with Jenny's experience with Franny. Jenny continued to struggle with "Go Fish'.had a hard time thinking that playing games was therapeutic. She seemed uncomfortable especially with card games. I asked her to look at the introduction to Play Therapy with Adults by Charles E. Schaefer, Ph.D. (Editor): The Healing Potential of Adults at Play by Dottie Ward-Wimmer. Jenny learned that:

PLAY AND PSYCHOLOGICAL ADJUSTMENT
Play, joy, and spontaneity are rooted in all of our hearts. Infants, driven by curiosity in their quest for survival, playfully explore with their entire bodies the universe around them that is then translated into an inner world. Manipulation of the relationship
between this inner self and the external world is a primary tool for growth. For adults, play continues as an important vehicle because it fosters numerous adaptive behaviors including creativity, role rehearsal, and mind/body integration.

Creativity
Carl Jung once said, “The small boy (himself ) is still around, and possesses a creative life which I lack. But how can I make my way to it?” (Jung, 1965, p. 174). He subsequently learned that a key to unlocking his creative potential was to engage in the constructive play he had particularly enjoyed as a child. Frey (1983) describes four categories of children’s play: physical, manipulative, symbolic, and games. Adult activities in each of these categories hold enormous creative potential. In her book Your Child’s Growing Mind, Dr. Jane Healy
(1994) discusses techniques for creative people. These include play, humor, dramatizing, moving, imagining, listening, expressing, originating, and incubating. These qualities, too, are an intrinsic part of growth and are found in the literature on play therapy for adults.

Role Rehearsal
In their play, animals practice survival skills by engaging in play fighting and hunt and pounce games. We humans aren’t so different. Children bandage imaginary hurts; spend hours pretending to cook, shop, travel, and go to school; and be everything from a firefighter to ballet dancer. They enact funerals, weddings, births, and literally all of life’s milestones as they practice adaptive behaviors and grown-up roles.
Adults do the same thing, although in much subtler ways. How many of us have thought about or even had conversations aloud with ourselves in anticipation of a
talk with someone else? How long do we stand in front of our mirrors trying on outfits, swaying to imagined music to be sure of how it (or I ) will look? How often do we sit in awe at the circus and wish we could ride the elephants, too? And of
course, there is the old favorite Halloween when, at last, we’re allowed to play dress up!

Mind-Body Integration
Play is a wholistic experience in that it invites our total being into the process. Starting at the top: It uses both hemispheres of our brain. The left, analytical, side is essential in deciding what to do next, which strategies get us the win, and how how it can be verbalized. The right, artistic, side allows us to enjoy the experience of turning the shapes of the clouds into magical creations. Moreover, the value and impact of beta-endorphins on our overall sense of well-being is well known.

Moving down into the body, we can look at other major systems. When we are laughing, singing, moving about happily, or simply engrossed in a pleasant diversion (i.e., play), we tend to take fuller breaths, thus getting a better oxygen exchange. When our digestive process relaxes, we reduce the chances of gastrointestinal disorder-not to mention the easing of cardiac tension. General muscle tension is eased, as well, when we play, which reduces fatigue and generalized body aches and stiffness.

We also discussed Franny's favorite game, 'Go Fish', and how it involved asking for something, and  how that might resonate with Franny's feelings of maternal deprivation, of being lost in the shuffle of her siblings. Jenny thought about it, and agreed with that idea, saying that she had been noticing Franny's joy when she 'got what she asked for', and that her normal state seemed to be that she would be frustrated, and not get her dependency needs satisfied. Jenny said sometimes she was tempted to 'throw' the game, to allow Franny to win. "Like when I know she has a certain card, and I get it from the pack, I won't ask her for hers, because I feel guilty taking  her cards."

We went on to talk about the role of the therapist, and how important it was to be aware of the feelings elicited by any particular client. Jenny said she had wondered about that, as another child she was seeing was a boy in the GATE (Gate and Talented Education) program, and how she felt like she really wanted to beat him at games, to show him he wasn't so great, so smart. This lead to a discussion of Jenny's school life, in which her older sister was in the gifted students program, while Jenny was not. Jenny said she always felt dumb, and guessed that seeing a child in the GATE program triggered her own feelings of inadequacy.

Over the next few sessions, Jenny continued to grow in her awareness of herself, her feelings, and those of her clients. She continued, however, to be quite adverse to playing cards with her clients. She said that each time Franny wanted to play cards, she resisted. I knew it was time to push her a bit, and probe into her resistance. When I asked her, point-blank, "Jenny, what is it about card games that you  don't like?" I expected to hear that card games bored her. Instead, she looked away when I asked her. I sat silently, until she was able to look at me. She had tears in her eyes when she finally looked up, and said, "I don't think you or most people understand. My grandfather had a very serious gambling problem. He lost our family's first business through  gambling. He lost everything. He would beat my grandmother when he came home after a big loss. Many Chinese families have hidden gambling problems. I was raised never to play cards because it could lead to problems, kind of like we learned in the substance abuse course, that children of alcoholics should never have even a sip of alcohol."

I was horrified at my cultural insensitivity, that I had so little awareness of this issue. I asked Jenny if she could tell me more, admitting that she was right when she said that she didn't think I would understand her reluctance to play cards.

She talked about the pain that her grandfather's gambling had brought to her family, and how every time she looked at the Chinese language newspaper, it was clear that casinos were targeting Asian Americans in their advertising. She referred me to several articles, although said many of the most helpful were written in Cantonese or Mandarin. One article, entitled "Addicted to Big Money — and Bad Odds: Asian Americans targeted by casino marketers" quoted Dr. Evelyn Lee,

“The gambling problem is an old, old problem in our community, but we are continuing to move forward to address it.”
A 1997 survey done by NICOS found that 70 percent of 1,800 Chinese Americans surveyed in San Francisco believed that gambling was a serious problem in their community...
“Two to 6 percent of the mainstream population are problem gamblers, but in the Chinese community it is some 20 percent,” said Dr. Eddie Chiu of the Richmond Area Multi Service Center. “These people leave early from work to gamble; they don’t go to school to gamble; they can’t stop.”
According to Chiu, classic problem gamblers bet to escape from their own problems and anxieties. They bet at extremely high rates and when they stop gambling they go through depression, similar to withdrawal from drug addiction.
Gambling is seen as the root cause for many family problems, such as domestic violence. (Banerjee, AsianWeek Archives, April 6 - 12, 2001at http://www.asianweek.com/2001_04_06/bay1_gambling.html)

Jenny subsequently brought in a poster that was available in Chinatown, (available at http://www.psychceu.com/super/POSTER_ILLfin.pdf. She told me about a bilingual online test to see if you or your spouse is a problem gambler (online at http://www.nicoschc.com)

She said she was very angry, because in all of her classes, and especially those on addiction, gambling was never taught, or even mentioned. She was right!  I knew that in my training, there had been nothing ever said about gambling. I knew it was time to educate myself, so I researched gambling, using the Internet. Most of the gambling addiction links were on casino websites! I found the Gambler's Anonymous website to find out more, and read:

What are some characteristics of a person who is a compulsive gambler?
1. INABILITY AND UNWILLINGNESS TO ACCEPT REALITY. Hence the escape into the dream world of gambling.
2. EMOTIONAL INSECURITY. A compulsive gambler finds he or she is emotionally comfortable only when "in action". It is not uncommon to hear a Gamblers Anonymous member say: "The only place I really felt like I belonged was sitting at the poker table. There I felt secure and comfortable. No great demands were made upon me. I knew I was destroying myself, yet at the same time, I had a certain sense of security."
3. IMMATURITY. A desire to have all the good things in life without any great effort on their part seems to be the common character pattern of problem gamblers. Many Gamblers Anonymous members accept the fact that they were unwilling to grow up. Subconsciously they felt they could avoid mature responsibility by wagering on the spin of a wheel or the turn of a card, and so the struggle to escape responsibility finally became a subconscious obsession.Also, a compulsive gambler seems to have a strong inner urge to be a 'big shot' and needs to have a feeling of being all powerful. The compulsive gambler is willing to do anything (often of an antisocial nature) to maintain the image he or she wants others to see.
Then too, there is a theory that compulsive gamblers subconsciously want to lose to punish themselves. There is much evidence to support this theory.
What is the dream world of the compulsive gambler?
This is another common characteristic of compulsive gamblers. A lot of time is spent creating images of the great and wonderful things they are going to do as soon as they make the big win. They often see themselves as quite philanthropic and charming people. They may dream of providing families and friends with new cars, mink coats, and other luxuries. Compulsive gamblers picture themselves leading a pleasant gracious life, made possible by the huge sums of money they will accrue from their 'system'. Servants, penthouses, nice clothes, charming friends, yachts, and world tours are a few of the wonderful things that are just around the corner after a big win is finally made.
Pathetically, however, there never seems to be a big enough winning to make even the smallest dream come true. When compulsive gamblers succeed, they gamble to dream still greater dreams. When failing, they gamble in reckless desperation and the depths of their misery are fathomless as their dream world comes crashing down. Sadly, they will struggle back, dream more dreams, and of course suffer more misery. No one can convince them that their great schemes will not someday come true. They believe they will, for without this dream world, life for them would not be tolerable.

I found a fascinating study, Gambling and Spirituality, A New Anthropological Perspective by Kathryn Gabriel, © 1998, 1999, 2000 in which the author states, in a section entitled "Gods Consulted through Gaming Pieces" that  "In some parts of the globe, the gambling pieces were associated with the gods and were consulted for advice. In ancient Chinese temples, for example, the patterns made by a handful of tossed reeds corresponded to the intricate diagrams of yin and yang in the I Ching."

Soon after our talk about gambling, Franny spontaneously gave up wanting to play "Go Fish", saying it was a "baby game', and moved onto just wanting to talk with Jenny, or do art projects. Jenny was quite relieved, and began to look forward to her sessions with Franny, rather than dread them. 

Did Franny stop playing cards in part because Jenny was able to name her resistance? I don't think that we will ever know the truth about  this, but I am struck by how frequently a client or intern spontaneously 'gives up' a behavior or activity that causes me pain immediately after I do my own work on why it disturbs me so much. This is one of the "reverberations in the invisible energetic field" between two people. Is the offending behavior given up because something has changed in the client or intern, unrelated to me? Or does the person sense that I disapprove of it? I don't think that either of those explain the timing, that the activity is discarded when I finally 'get it'. Yet I also fear it is too narcissistic to think that it is all in relation to my achieving insight.

So the best explanation I have is that once I 'get it', that my unconscious reaction somehow changes, and the client no longer needs to pursue the behavior. Perhaps to illustrate this, imagine that there are energetic waves, unheard and unseen that go between two people. Imagine ripples in a pond.

 

When one person  sends out something (perhaps a feeling, thought, behavior, or memory) it is like a stone dropped in the water. If the receiver, or witness,  is neutral, these ripple hit the opposite shore and are reflected back to the sender. This is therapy or supervision (or any relationship) in its most neutral form. But, there is rarely anyone who can truly reflect the emanations back without it sparking some of their own issues, So imagine then, as the 'sender' drops their stone in the water, the 'receiver' also drops a stone in, in reaction to the first stone. Then we have two circles of ripples in the pond, meeting each other. If healing is to occur, for both sender and receiver, these ripples must be made conscious in at least one person. Often it is the therapist, in his her her own person, who becomes conscious of the dynamic.  He or she does not have to name the  'stone' they threw in, but must become aware of it. When healing happens, both therapist and client, supervisor and supervisee, are healed.

If one person unconsciously changes the vibration of the waves emanating from him or herself, then the other person will sense that, and send back slightly altered waves. This seems to be why people who are borderline are so good at tuning in and finding the most vulnerable places in the psyche of the therapist. They are able to "push our buttons" so well because they are more in touch with this place. Living closer to the 'border' between the seen and the unseen, between the place of psychosis and ego-centered consciousness, they are able to unconsciously tune into this energy. People who are psychotic live totally in this realm, without the shielding effect of the ego, which blocks awareness of most of these energetic transmissions. Infants live in this realm as well, which is why they are so exquisitely tuned into the emotional and energetic state of their primary caregivers.

Please think for a moment about your experience with this energetic field. Have you noticed how adept people who are borderline are at "getting under your skin"? Have you found that a person who is in touch with his or her own "self', or who has done deep inner work, is soothing to be around, because the unconscious energetic field is much clearer? It is not that people who have done depth work on themselves don't transmit energy, it is that it is more imbued with awareness. There are fewer projections in the field, and more sense of personal awareness and responsibility. This is why it is vital or anyone doing therapy to have done their own work.

“Every person broadcasts information about his inner world. As a collection of dense matter betrays its presence through electromagnetic transmissions, a person’s emotional Attractors manifest themselves in a radiant aura of limbic tones. If a listener quiets his neocortical chatter and allows limbic sensing to range free, melodies begin to penetrate the static of anonymity….As the listener’s resonance grows, he will catch sight of what the other sees inside that personal world, start to sense what it feels like to live there.”
(A General Theory of Love by Thomas Lewis, M.D., Richard Lannon, M.D., and Earl Amini, M.D. Vintage Books, 2001., p. 169)

Jenny never told Franny about her discomfort in playing card games, and never told her about her family history of gambling. Yet the moment Jenny became aware of her resistance, and named it, Franny stopped wanting to play card games. Will we ever really know why?

Finally it seemed time to get some more objective information, rather than rely solely on Jenny's self-report.

 

Observing Daniel

There is an ever increasing sentiment in the field of supervision on the benefits of directly observing interns at work. Research tends to find that "Although the traditional method of counselor self-report is often used, this form of data-gathering is notoriously inaccurate." (Hart, Gordon M., Strategies and Methods of Effective Supervision.)

Generally, one of three methods are employed:

• tape recording the session
• videotaping the session
• direct observation via two-way mirror.

Which method you choose will depend upon not only upon your preference, but the equipment available where you supervise.

Supervisors may choose from a variety of interventions, including direct approaches (e.g., audiotape and videotape review, co-therapy, live observation, and live supervision), and more indirect approaches (e.g., self-report, case conferences, review of case notes). There is evidence that, without regulations, supervisors rely almost exclusively on counselors' self-reports (Borders, Cash well, & Rooter, 1995; Borders & Usher, 1992), and there is ample evidence that self-reports are unreliable if not biased accounts of counseling sessions (Bernard & Goodyear, 1992; Borders & Led dick, 1987). The need for a balance of both direct and indirect approaches is cited in two ACES statements of standards, the "Standards for Counseling supervisors" (Dye & Borders, 1990) and the "Ethical Guidelines for Counseling Supervisors" (Hart, Borders, Nuance, & Paradise, 1995). (Source: Borders, L. DiAnne, Supervision Issues in Counselor Credentialing )

In the case of the schools, there was no opportunity for either direct or video supervision, so I broached with Daniel the idea of getting Maria's and her parents' permission to tape a session, for purposes of supervision. (Asking the child for permission is not a legal requirement, but one that I feel is an ethical one.) We discussed that if Daniel presented the idea of taping as a help to Daniel, and not about Maria, that Maria and her parents would feel more willing to consent.

Daniel did get their permission to tape the session, and brought the tape and a transcript to a later session. (We had discussed when both Daniel's and Maria's comfort level would be such that taping would show some of Daniel's counseling techniques. Daniel chose a date about 3/4s of the way through the first semester.)

One trick I had stumbled upon accidentally was to be at the school when an intern was leading the client either to or from a session. One time I had been at the school to observe a child client of mine in the classroom, and happened to be there at a time in which an intern was leading a very reluctant student to a counseling session. The interesting thing was that to listen to the intern, this student was the most cooperative and enthusiastic counseling client ever! So, by spying, I saw another side of what was going on. I have since always tried to see the intern having some contact with the client.

While observing another child at the school, I had seen Maria. She was on the small side, with dark eyes and hair. She was very animated in the classroom, very chatty with her friends. I could see why she was considered to have ADHD. I was not able to time my visit to see Daniel with Maria, but it struck me that she was probably the opposite of studious, serious Daniel in many ways. I was looking forward to hearing Daniel's tape of the session, and reading his transcript.

What I learned from the tape

I was impressed with Maria's ease with Daniel, how spontaneously she chattered away with him. She talked about school, and her friends, and she showed Daniel her "Owie", a bruise on her leg. Daniel asked what happened. She said she bumped her leg on her bed. She told Daniel how her best friend Audrey had been mean to her, not sharing her dessert at lunch. Maria told Daniel that she was never going to give Audrey even a tiny bite of her lunch, ever!

Daniel tried to reason with Maria, explaining that maybe that was a bit drastic. Maria didn't seem to take in what Daniel was saying, instead said, "Blah, blah blah. What do you know? Let's play!"

Out came the Candyland, and Daniel did very well here, playing the game without resistance, and even laughing and groaning when he had setbacks in the game. As they were playing, Daniel asked Maria how things were at home. She started to talk about her new brother, Danny, and how he cried a lot. She said that she wished he would hurry up and grow up, so that he could play with her. She said, "I wish he was Daniel, not Danny, and big like you. Then he could play Candyland with me."

Daniel did quite well here. Maria seemed to feel safe enough to open up to Daniel, and Daniel, for the moment, was doing quite well at letting Maria talk, and not trying to reason her out of her feelings. Later he said how touched he was by Maria's comments; that he felt something 'soften' inside himself.

Maria was talking more about how much baby Danny cried: "All the time! It drives me crazy." Daniel picked up on the feelings, and asked Maria what it was like to have Danny crying so much. Maria talked about how tired and cranky her mother was, and how Danny stayed up all night, just crying. She said her mom sometimes couldn't get Maria any breakfast, so Maria got herself some cereal. And today was a bad day, because Maria spilled the milk all over when she was pouring it, and her mom started screaming at her. Maria said she didn't like it when that happened.

Then Daniel said he could help her. He told Maria that at eight years of age she should know how to pour milk out of a carton. He said, "Let's practice." He got a pitcher of water, and a paper cup, and went over to the sandtray. He put the cup in the tray, and asked Maria to watch while he poured. "See! It's easy! All you have to do is focus and take your time. You try it."

Maria came over and poured the some water into the cup, but some spilled over. "No!" Daniel said, "Like this" and again, he demonstrated, spilling nothing.
When it was Maria's time to try, she poured the entire pitcher of water into the cup, overflowing the cup and flooding the sandtray.

"Maria!" Daniel said. "This is inappropriate behavior!"

There was silence on the tape, and then I could hear the sound of wet sand flying around.

"Stop! Maria, stop!" I heard Daniel say.

It was clear that Maria was not stopping. I heard her voice on the tape, "Stupid! I am so stupid! I can't even do anything right. Everyone yells at me!"

I wondered if Daniel would realize what had happened, that he had inadvertently recreated the morning's milk episode. Maria had once again failed, and gotten yelled at.

I listened for his next intervention.

"Maria," he said, "Is this what happens to you in school? That you feel stupid?"

Maria replied, "Dummy!" not specifying whether it was herself or Daniel she was addressing.

Daniel seemed taken aback, not knowing what to do. There was a pause, and Daniel said, "I will help you clean up this mess."

Silence on the tape, then the sound of paper towels being ripped off the roll.

Daniel's voice got very stern on the tape. "Come here, NOW, Maria, and help me clean this up. Now, Maria."

(At this point, listening to the tone in Daniel's voice, my reaction was the classic DSM-S (the DSM for supervisors) 139.82: The urge to throttle an intern! Then I realized this was Parallel Process in Action! Much as Maria's mother had yelled at her, and then Daniel had yelled at Maria, I wanted to yell at Daniel.)

Daniel then asked Maria if her mother ever hit her when she was mad at her.

Maria said nothing.

"Or does she ever shake you? Or say mean things? How often do you have to get your own breakfast?""Do you always have lunch? Do you always have clean clothes?"

Then Maria started to cry, then sob. She said, "My mommy loves Danny more than me. She yells at me every morning!"

Daniel seemed like a bloodhound chasing a scent.

"What else does your mom do? Or your dad, does he ever hit you?"

Maria was sobbing very loudly now. Finally, Daniel said, "It is OK Maria. It is OK. I know you didn't mean to spill the water when I asked you to pour it."

Daniel was quiet for a moment, then he said, "Maria! I am so sorry. I yelled at you for spilling, didn't I?"

"I am sorry. Is this what happened this morning with your mom?"

More silence on the tape.

Then Daniel said, quietly, empathically, "It must be hard."

Maria said only, "Let's play Candyland."

And they played until the session ended.

When Daniel came for supervision, I replayed this part of the tape for him. He said he was very concerned that Maria was being neglected, in light of the comments her mother had made on Maria's developmental survey.

I was a bit confused about what Daniel meant. "Well," he said, "She is obviously neglected if her parents can't take the time to fill out the answers, or give her breakfast."

My reaction was the DSM-S 126.90348558: "What planet is this intern from? Doesn't he know that having a newborn in the house, and no sleep, is incredibly stressful? And don't all parents yell at their kids in the morning?" Then I went into my own self doubt, thinking that maybe I was a bad mother, for yelling at my son in the morning! Oh dear! Maybe it was not normal to yell at your child, especially when he wouldn't get ready for school. I pulled myself back from my crisis of self-doubt, and struggled to find a neutral place inside myself, and asked Daniel what he meant.

"Obviously, the child is neglected. I am thinking that I need to make a Child Protective Services report. That's why I asked her what else her parents did to her. I know that we are charged with reporting child abuse. Her mentioning that bruise was quite suspicious, I think. And the fact that she is not fed breakfast is significant. "

I knew that I had to pull back my countertransference, and not blast Daniel. I didn't want to recreate in the supervision what Daniel had done in the session, when he yelled at Maria for spilling the water and throwing the sand.

As Daniel's task with Maria was delicate, so was mine with Daniel. How much of this parallel process should I discuss with Daniel?

 

How did this happen, that I was as frustrated with Daniel as he was with Maria; that I was as judgmental of him as he was of Maria's mother?? To understand, I started researching “Somatic Consciousness”. I read in “A General Theory of Love” that:

“The first part of emotional healing is being limbically known – having someone with a keen ear to catch your melodic essence.”( p. 170)

A responsive therapist feels the traction of his patient’s mind, and he comes to share in some of those silent emotional convictions – to know what the other knows. His perceptions, memories, and expectations bend in the winds of another’s storm.”( p. 185)

In the midst of movement and chaos,
keep stillness inside of you.
Deepak Chopra

"A gathering cloud looms over the patchwork landscape of psychotherapy: the growing certainty that, despite decades of divergent rectification and elaboration, therapeutic techniques per se have nothing to do with results….Strip away a therapist’s orientation, the journals he reads, the books on his shelves, the meetings he attends – the cognitive framework his rational mind demands – and what is left to define the psychotherapy he conducts?

Himself. The person of the therapist is the converting catalyst, not his order or credo, not his spatial location in the room, not his exquisitely chosen words nor denominational silences. So long as the rules of a therapeutic system do not hinder limbic transmission – a critical caveat – they remain inconsequential, neocortical distractions. The dispensable trappings of dogma may determine what a therapist thinks he is doing, what he talks about when he talks about therapy, but the agent of change is who he is….

But if therapy works it transforms a patient’s limbic system and his emotional landscape forever. The person of the therapist will determine the shape of the new world a patient is bound for; the configuration of his limbic Attractors fixes those of the other. Thus the urgent necessity for a therapist to get his emotional house in order. His patients are coming to stay, and they may have to live there for the rest of their lives."
(A General Theory of Love, p. 186-187)

From physics, comes the concept of Quantum Entanglement:

“Particles that have interacted at some point retain a type of connection and can be entangled with each other in pairs in a process called correlation. No matter how great the distance between the correlated particles, they will remain entangled as long as they are isolated.”
"entanglement" occurs when two subatomic particles are somehow connected or "entangled" with one another, so that when something happens to one particle, the same thing simultaneously happens to the other particle, even if it's miles away. However, this concept violates the theory of special relativity, since communication between two places cannot occur faster than the speed of light."(Aczel, Ami D. , Entanglement: The Greatest Mystery in Physics; Raincoast Books,)

 

For a mathematical explanation of this phenomenon, please go to: Quantum Entanglement, courtesy of MathPages.com

Einstein called this "spooky action at a distance"

This means if a pair of particles have intersected at some point, they will retain a connection forever. No matter how many millions of light years apart they are, they will remain entangled.

 

Albert Einstein also said, "We should take care not to make the intellect our God; it has, of course, powerful muscles, but no personality. It cannot lead; it can only serve."

Schore suggests that it is “the therapist’s resonance with this right brain state, in turn, triggers “somatic countertransference” (Lewis 1992) and these “somatic markers” (Damasio 1994) may be physiological responses that receive (or block) the patient’s distress-inducing projective identifications” (1997 p. 48). This ability is also known to parents of infants, suggesting that it may have an evolutionary purpose or instinctual roots. Parents often feel a sympathetic earache when their baby pulls at his or her ear, or an itchy scalp the moment their child comes home from school with head lice.

Therapists can amplify this innate ability by mirroring the body language, the sensory system of the language used (visual, kinesthetic or auditory), and by matching the breathing of their patients. These techniques will tend to create a state of rapport between the patient’s cells and that of the therapist, and allow the therapist to become more receptive to somatic information. The therapist can then more readily attend to any somatic sensations that arise in their own bodies, and ask themselves if they are the patient’s projected sensations or their own.

“What makes love communicable is limbic resonance, a sort of physical mind-reading. The brain has three components: reptilian, limbic, and neocortal.

This triune brain is a piling on of evolutionary developments, from the most primitive (reptilian), which is barely more than involuntary instinct, to the limbic brain, the evolutionary advancement allowing mammals to care for their young. It is the seat of emotionality. The neocortex is the human addition: the location of language centers and higher thought. Love is largely subconscious, operating from the limbic brain through limbic resonance, which is defined as "a symphony of mutual exchange and internal adaptation whereby two mammals become attuned to each other's inner states." It's what makes watching an action film in a packed theater so much more exciting than seeing it with only a few other people, it's how panic works a crowd, how your cats know you're in a bad mood as soon as you open the door.”
A HARD-WIRED DRIVE: Two Books Approach Love from Different Directions by Adriana Grant

“The human brain is exquisitely prewired to experience love and attachment, and requires such experiences every bit as much as food and oxygen for its healthy development. …love is not only a human passion but a profound way of understanding and learning about the world. The cortex learns about the world of things and ideas and thinks in terms of cause and effect, but the limbic system learns about people and is grounded in intuition. From the moment of birth, our limbic system is preadapted to connect with our caretakers, just as the limbic systems of our caretakers are exquisitely designed to connect with us. Our subcortical brains are wired to read each other's emotional states and to resonate with them. This "limbic resonance," …is another way of describing the biological dimension of intersubjectivity, the fundamental way that we re connected to other people.

We learn about who we are and what we should expect in relationships through our attachments to others--first and foremost our parents--and this learning is not usually conscious. The knowledge is subcortical, limbic, and intuitive. If we're loved for who we really are, we develop the capacity to love and be loved by others in relationships of true mutuality.
If we're not understood, if we're inordinately rejected or overpowered, we grow up with a sense of ourselves as embattled and disconnected. These self-images and expectations seem quite normal to us, patterned as they are after the traumatic attachment patterns of childhood. These patterns, it now seems, are anchored deep within our brains in the form of neural networks that become reinforced over time. In this sense, when an early attachment is insecure or otherwise problematic, neural pathways are laid down that become the pathological templates for later relationships. Psychologists have always known that problems in attachment to one's caretakers cause depression and other emotional disorders.

[Science is now discovering what play therapists have always known:]
that most people don't change when a therapist explains to them the reasons for their psychological problems because explanations are a form of cortical knowledge, while the problems they're intended to address are encoded in subcortical structures. If we learn to become "ill" via nonconscious and intuitive pathways, we can't unlearn our neuroses through rational interpretations. When psychotherapy does help people change …it works by providing them with new experiences. These new experiences are transmitted and received on a limbic level in the context of the therapy relationship, offering new attachment patterns from which patients can intuit new ways of seeing themselves and the world. The resistance to change in psychotherapy derives from the fact that when people are offered a new model of attachment, it contradicts the familiar models associated with the earliest and most important relationships of their lives. To change means to risk momentarily feeling alone, bereft of familiar modes of connection.[We are finally realizing scientifically ] the tremendous value of empathy. When a mother "reads" her child's cues correctly, that child is affirmed and emboldened, limbically energized and cortically more coherent. [When a therapist "reads" his/her patient's cues correctly, that person is affirmed and emboldened, limbically energized and cortically more coherent.]

Michael Bader, What's Love Got to Do With It?… Everything - Review
Tikkun, Sept, 2001

References:
Schore, A. (1997). Interdisciplinary developmental research as a source of
clinical models. In Moskowtitz, M., Monk, C., Kaye, C. and Ellman, S.
(Eds.), The neurobiological and developmental basis for psychotherapeutic intervention. (pp. 1 –71). NY: Jason Aronson (Library of Clinical Psychoanalysis)

I decided not to go into the parallel process at that moment, but inside to focus on Daniel's content. Like in therapy, the supervisor often has to choose between making a PROCESS intervention, versus a CONTENT comment. It seemed to me where Daniel was going was potentially explosive, so I asked him what other signs of abuse or neglect he was sensing.

"Well, her clothes often have spots on them. And she is very skinny. This isn't the first bruise that I have noticed, and she always has a story to tell me about how she got hurt. When I asked him to say more, he said, "She always tells me how she got hurt. Her stories are pretty wild, like swinging on the playground equipment, and falling off. Or having a contest  with her friend Audrey about how high she could swing, and then jump off. Or bumping into things. I think I need to call CPS."

None of this seemed necessarily suspicious to me - Daniel was describing the injuries of an active, impulsive child. I asked Daniel if there was anything else. He said no.

I pulled out of my notebook a definition of child neglect, from the National Clearinghouse on Child Abuse and Neglect Information: