Clinical Supervision

Supervision CEUs - Supervision Continuing Education

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3 Supervision Courses to choose from:

Clinical Supervision - 7 hours

Models of Supervision - 8 hours

Ethics in Supervision - 3 hours

All courses are online with instant certificates of completion.

All supervison courses are accepted by the BBS and are APA approved for continuing education credit.

Clinical Supervision and Models of Supervision are NASW or National Association of Social Workers approved.

Course Objectives

1.  Describe the multicultural issue facing clinicians today.

2.  Describe supervisee resistance and identify ways to counteract it.

3.  Recognize and describe the need for a group supervision approach for trainees.

4.  Identify the methods for reviewing counselor-client sessions including live supervision.

5.  Describe the term enactment as it pertains to sexually acting out clinicians.

 

Resistance in Supervision

Implicit in the definition of supervision is an ongoing relationship between supervisor and supervisee; the supervisee's acquisition of professional role identity; and, the supervisor's evaluation of the supervisee's performance. Although the goal of helping the supervisee develop into an effective counselor may appear simple, it can be anxiety-provoking experience. Supervision-induced anxiety causes supervisees to respond in a variety of ways, with some of the responses being defensive. It is these defensive behaviors, which serve the purpose of reducing anxiety, that are referred to as resistance.

Although the purpose of this writing is to describe supervisee resistance and identify ways to counteract it, we want to stress that supervisee resistance is common. While resistance can be disruptive and annoying, the supervisor must keep in mind that resistance is not synonymous with "bad person" or "bad behavior." Instead, resistance occurs because of the dynamics of the supervision process and, in fact, can be an appropriate response to supervision (e.g., supervisor conducting therapy instead of supervision). In other instances, resistance is a response to anxiety whereby it becomes the supervisor's role to deal with anxiety so that the need for resistance will be reduced or perhaps eliminated.

Resistant Behaviors

Supervisee resistance, consisting of verbal and nonverbal behaviors, is the supervisee's overt response to changes in the supervision process. Liddle (1986) concluded that the primary goal of resistant behavior is self-protection in which the supervisee guards against some perceived threat. One common threat is fear of inadequacy; although supervisees want to succeed, there is a prevalent concern of not "measuring up" to the supervisor's standards. Other supervisee resistance occurs because supervision is required. Supervisees may not accept the legitimacy of supervision because they perceive their skills to be equal, if not superior, to their supervisor's. Supervisee resistance may be a reaction to loss of control and can evolve into a power struggle between supervisor and supervisee. Supervisees may fear and be threatened by change, and consequently, respond with defensive behaviors. The fact that supervision has an evaluative component can provoke anxiety because a negative evaluation by a supervisor may result in dismissal and/or failure to receive necessary recommendations. Supervisee resistance also may result from the supervisor failing to integrate multicultural information into the supervision sessions. Regardless of form, resistant behaviors are coping mechanisms intended to reduce anxiety.

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 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 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.

Counteracting Resistance

Although resistance is a common occurrence in supervision, counteracting resistance is not simple. Two major factors influence methods used for counteracting resistance. First, the relationship is critical. A positive supervisory relationship grounded by trust, respect, rapport, and empathy is essential for counteracting resistance. The second factor in counteracting resistance is the way the supervisory relationship is viewed. Supervisors viewing the relationship as the focal point in supervision usually advocate full exploration of conflicts. In contrast, supervisors viewing therapeutic work as the primary supervisory focus advocate a more limited exploration of conflicts.

Viewing resistance as a perceived threat, Liddle advocated that the conflict be openly discussed. First, she stated the focus should be on identifying the source of anxiety or threat. Next, the focus should be on brainstorming to locate appropriate coping strategies for dealing with the conflict. Kadushin stated that the simplest way to cope with supervisee resistance exhibited in games is to refuse to play. He concluded it is more effective to share awareness of game-playing with the supervisee and focus on the disadvantages inherent in game-playing rather than on the dynamics of the supervisee's behavior.

Bauman discussed several techniques for managing supervisee resistance. Interpretation, the most direct confrontation, includes describing and interpreting the supervisee's resistance. Although less confrontive, feedback is also a form of direct confrontation. Clarification uses restatement to aid the supervisee in understanding his/her behavior. Generalizing resistance to other settings takes the focus away from the supervisory relationship and helps the supervisee recognize his/her maladaptive behaviors. Ignoring resistance is recommended only if the behavior can be eliminated without confrontation. Role-playing and alter-ego role playing, although more threatening, may be helpful in identifying the cause of resistant behavior. Audio taping supervision sessions is helpful for managing resistance. Bauman noted that the success of a technique is dependent on the personalities of supervisor and supervisee and on the interaction between them. If confrontation is deemed inappropriate, Masters suggested positive reframing for reducing resistance. Positive reframing includes: empowering the supervisee, increasing the supervisee's self-esteem, and modeling effective methods of coping with thoughts, feelings, and behaviors.

Regardless of purpose, resistance in supervision is a common experience and will be encountered irrespective of the supervisor's skill level. The supervisor who believes he/she can proceed through the supervision process without encountering resistance is setting an unrealistic expectation. Although usually annoying, supervisee resistance should not be perceived as a negative encounter or maladaptive behavior. On the contrary, an effective supervisor who is knowledgeable about the dynamics behind supervisee resistance can redirect the resistance to create a therapeutic supervision climate. In essence, the ability of the supervisor to take resistance and turn it into a supervisory advantage may be the hallmark for determining success or failure in supervision.

Ethical and Legal Dimensions of Supervision

In recent years, it has become generally accepted that supervision draws upon knowledge and skills that are different than, and go beyond, those of psychotherapy. Similarly, the ethics and legal imperatives regarding supervision both encompass psychotherapy issues and go beyond them. Furthermore, because supervision is a triadic rather than a dyadic relationship, the supervisor must always attend to the need for balance between the counseling needs of clients and the training needs of the counselor.

With the increase of litigation in American society over the past generation, ethics and law have become intermingled. It is important for the supervisor to remember, however, that ethics call the supervisor to a standard of practice sanctioned by the profession while legal statutes define a point beyond which a supervisor may be liable. For our purposes here, the functional interconnectedness between ethics and the law will be accepted.

Competence

Competence is an increasingly complex issue as mental health and supervision have become more sophisticated enterprises. Implications of both counselor competence and supervisor competence will be described here briefly.

Supervision CEUs - Supervision Continuing Education

Counselor Competence

By definition, a supervisee is a person who is not yet ready to practice independently. It is for this reason that supervisors are held responsible for what happens with clients being seen by the supervisee. At the same time, counselors must be challenged in order to become more expert. This, then, is the supervisor's tightrope: providing experiences that will stretch the counselor's ability without putting the client in danger or offering substandard care. Whenever a close call must be made, supervisors must remember that their obligation is to the client, the public, the profession, and the supervisee -- in that order. Therefore, the supervisor continually decides if the supervisee is good enough on a consistent basis to work with any particular client.

Supervisor Competence

First, the supervisor needs to know everything, and more, than is expected of the supervisee. Secondly, the supervisor must be expert in the process of supervision. It is not enough that clients are protected as a result of supervision; the contract between supervisor and supervisee dictates that supervision must ultimately result in better counseling skills for the supervisee. In order to accomplish this, it is generally accepted that the supervisor receive training in performance of supervision as well as supervision of supervision.

Dual Relationships

For both counselors and supervisors, any dual relationship is problematic if it increases the potential for exploitation or impairs professional objectivity. There has been greater divergence of opinion about what constitutes an inappropriate dual relationship between supervisor and counselor than between counselor and client. Ryder and Hepworth, for example, stated that dual relationships between supervisors and supervisees are endemic to many educational and work contexts. Most supervisors will, in fact, have more than one relationship with their supervisees (e.g., graduate assistant, co-author, co-facilitator). The key concepts remain "exploitation" and "objectivity." Supervisors must be diligent about avoiding any situation which puts a supervisee at risk for exploitation or increases the possibility that the supervisor will be less objective. It is crucial, however, that supervisors not be intimidated into hiding dual relationships because of rigid interpretations of ethical standards. The most dangerous of scenarios is the hidden relationship. Usually, a situation can be adjusted to protect all concerned parties if consultation is sought and there is an openness to making adjustments in supervisory relationships to benefit supervisee, supervisor and, most importantly, clients.

Therapeutic Relationships

As part of the mandate of competence, the supervisor must determine not only if the supervisee has the knowledge and skill to be a good counselor, but if he or she is personally ready to take on clinical responsibility. The issue of personal readiness can lead the supervisor to blur the roles of supervisor and therapist in an attempt to keep the supervisee functional as a counselor. This is problematic for two reasons: (1) it compromises the objectivity of the supervisor, especially in terms of evaluation; (2) it may allow an impaired counselor to continue to practice at the risk of present and future clients.

Informed Consent

Informed consent is key to protecting the counselor and/or supervisor from a malpractice lawsuit. Simply, informed consent requires that the recipient of any service or intervention is sufficiently educated about what is to transpire, the potential risks, and alternative services or interventions, so that he or she can make an intelligent decision about his or her participation. Supervisors must be diligent regarding three levels of informed consent: (1) the supervisor must be confident that the counselor has informed the client regarding the parameters of counseling; (2) the supervisor must be sure that the client is aware of the parameters of supervision (e.g., that audiotapes will be heard by a supervision group); and (3) the supervisor must inform the supervisee about the process of supervision, evaluation criteria, and other expectations of supervision (e.g., that supervisees will be required to conduct all intake interviews for a counseling center in order to increase interview and writing skills).

Due Process

Due process is a legal term that insures one's rights and liberties. While informed consent focuses on the entry into counseling supervision, due process revolves around the idea that one's rights must be protected from start to finish. Again, supervisors must protect the rights of both clients and supervisees. An abrupt termination of a client could be a due process violation. Similarly, a negative final evaluation of a supervisee, without warning and with no opportunity to improve one's functioning, is a violation of the supervisee's due process rights.

Confidentiality

Confidentiality is an often-discussed concept in supervision because of some important limits of confidentiality both within the therapeutic situation and within supervision. It is imperative that the supervisee understands both the mandate of honoring information as confidential (including records kept on the client) as well as understanding when confidentiality must be broken (including the duty to warn potential victims of violence) and how this should be done. Equally important is a frank discussion about confidentiality within supervision and its limits. The supervisee should be able to trust the supervisor with personal information, yet at the same time, be informed about exceptions to the assumption of privacy. For example, supervisees should be apprised that at some future time, their supervisors may be asked to share relevant information to State licensure boards regarding their readiness for independent practice; or supervisors may include supervision information during annual reviews of students in a graduate program.

Liability

Supervisors should not shun opportunities to supervise because of fears of liability. Rather, the informed, conscientious supervisor is protected by knowledge of ethical standards and a process that allows standards to be met consistently. There are three safeguards for the supervisor regarding liability: (1) continuing education, especially in terms of current professional opinion regarding ethical and legal dilemmas; (2) consultation with trusted and credentialed colleagues when questions arise; and (3) documentation of both counseling and supervision, remembering that courts often follow the principle "What has not been written has not been done".

As gatekeepers of the profession, supervisors must be diligent about their own and their supervisees' ethics. Ethical practice includes both knowledge of codes and legal statutes, and practice that is both respectful and competent. "In this case, perhaps more than in any other, supervisors' primary responsibility is to model what they hope to teach".

Strategies and Methods of Effective Supervision

A variety of strategies and methods are available to supervisors for use with counselors whom they supervise. This summary is designed to acquaint supervisors with techniques for enhancing the counseling behavior of their supervisees while also considering individual learning characteristics as depicted by the supervisee's developmental level.

To improve a supervisee's skills in working with clients, some form of assessment must be done while counseling is taking place (rather than with clients who have terminated). Using strategies that examine a supervisee's counseling behavior with current clients allows a supervisor to correct any error in assessment, diagnosis, or treatment of the client, and thus increases the probability of a successful outcome.

Whether the supervisor's purpose is to improve a supervisee's skills or to ensure accuracy, actual counselor-client interaction must be examined. Although the traditional method of counselor self-report is often used, this form of data-gathering is notoriously inaccurate. The more reliable forms of data-gathering are review of a client's case history; review of results of current psychodiagnostic testing, including a structured interview (such as a mental status exam); and, particularly, examination of the counselor-client sessions via methods such as audiotape, videotape, and observation through a one-way mirror or sitting in the session.

Of the methods for reviewing counselor-client sessions, the use of live supervision (observation via television or one-way mirror) provides an opportunity to give a supervisee immediate corrective feedback about a particular counseling technique and to see how well the counselor can carry out a suggested strategy. Live supervision is effective for learning new techniques, learning new modalities (e.g., family counseling), and gaining skills with types of clients with whom the counselor is unfamiliar. A live supervision strategy can be supplemented by review of a session immediately following the session or delayed a day or more.

Supervision conducted immediately following a counseling session or delayed a day or two could use an audiotape or videotape of the counseling session or use non-recorded observation through a one-way mirror or television system. Supervisors are advised to review audio or videotapes of a supervisee's counseling session prior to the supervision session in order to plan a strategy of intervention. The supervisee also should review the tape to prepare questions and discussion topics.

In immediate and delayed supervision sessions, the supervisor should focus on what the supervisee wanted to do with the client, what he/she said or did, and what he/she would like to do in future counseling sessions. Regardless of when the review of the counseling session is conducted (live, immediate, or delayed), the supervisor will have examined an actual work sample of the supervisee and no longer must rely solely on self-report. This examination is likely to aid in the supervisor's credibility in reporting on a supervisee's competence to school or agency administrators regarding retention or promotion, to state licensing officials, or to courts, should that be necessary.

Although group and peer supervision are powerful approaches, individual supervision is likely to be the main form of reviewing supervisee performance. When using individual supervision, a supervisor must consider most carefully the developmental level of the supervisee. Specifically, how skilled is the supervisee in general and specifically with the type of client in question, how anxious is the supervisee when reviewing his/her work, and what is the supervisee's learning style? Although these factors may vary somewhat independently, it is likely that less skilled counselors will be somewhat anxious. Additionally, developmental level has been conceptualized as cognitive or conceptual level and has been associated with challenging a supervisee to grasp increasingly more sophisticated concepts.

With novice supervisees, a high degree of support and a low amount of challenge or confrontation is advisable. When learning style is considered, a micro-training approach focusing on specific skills might be used, demonstrated by the supervisor, and then practiced in the supervision session by the supervisee in a role-play. However, some novice or anxious supervisees learn best by a macro approach; that is, having a clear overview of the goals of the session, expected role of the counselor, client typology, and specific client characteristics such as race, gender, culture, socioeconomic status, family background, and personality characteristics. For these supervisees, use of written case study materials or an IPR (Interpersonal Process Recall) approach might be better than a micro-training approach.

With more competent supervisees, the focus may be placed on more advanced skills or on more complex client issues. Either a micro or macro approach may be used. Using videotape is suggested for these supervisees, as they are more likely to be able to assimilate the larger amount of data provided by videotape compared to that provided by audiotapes, which are suggested for use with less competent supervisees.

With more skilled and more confident supervisees, exploration of issues usually found to be threatening also may be examined. Such issues include relationship of theoretical orientation to technique employed, personal style, counselor feelings about the client, and learning new and innovative techniques or modalities (individual, group, or family counseling).

Developmentally, a supervisor should expect that supervisees progress to more independent functioning whereby supervisees pick the clients and client issues which they wish to review as well as the personal issues or client dynamics they wish to examine. Audio or videotape segments can be selected for review rather than listening to entire tapes. At this more advanced stage of supervision, the supervisor may feel more like a colleague or a consultant than a teacher, which allows the supervisor to share more examples of his/her own counseling experience conveyed either through self report or via audiotapes. With more skilled and confident supervisees, collaboration such as co-leading a group or co-counseling with a family can be conducted. Although such collaboration strategies have been advocated for novice counselors, maximum benefit more likely may be achieved by supervisees who are more confident in their skills and who have developed basic skills sufficiently to be able to perceive and learn the complex skills that a supervisor is likely to use when working with a group or family.

Supervision for the clinical/counseling functions of counselors in schools and agencies should focus on actual work samples. Using a micro-training versus a more macro approach should depend on what works best for a particular supervisee, along with the supervisee's level of skill and confidence.

Required Reading: Enhancing Supervisory Relationships

Group Supervision

Fostering Counselors' Development in Group Supervision

A counselor's learning and continued development typically is fostered through concurrent use of individual and group supervision. Group supervision is unique in that growth is aided by the interactions occurring among group members. Counselors do not function in isolation, so the group becomes a natural format to accomplish professional socialization and to increase learning in a setting that allows an experience to touch many. Supervision in groups provides an opportunity for counselors to experience mutual support, share common experiences, solve complex tasks, learn new behaviors, participate in skills training, increase interpersonal competencies, and increase insight (MacKenzie, 1990). The core of group supervision is the interaction of the supervisees.

Collaborative learning is a pivotal benefit, with the supervisees having opportunities to be exposed to a variety of cases, interventions, and approaches to problem solving in the group (Hillerband, 1989). By viewing and being viewed, actively giving and receiving feedback, the supervisee's opportunities for experimental learning are expanded; this characterizes group supervision as a social modeling experience. From a relationship perspective, group supervision provides an atmosphere in which the supervisee learns to interact with peers in a way that encourages self-responsibility and increases mutuality between supervisor and supervisee.

Groups allow members to be exposed to the cognitive process of other counselors at various levels of development (Hillerband, 1989). This exposure is important for the supervisee who learns by observing as well as speaking. Finally, hearing the success and the frustrations of other counselors gives the supervisee a more realistic model by which they can critique themselves and build confidence.

Models of Group Supervision

Bernard and Goodyear summarized the typical foci of group supervision: didactic presentations, case conceptualization, individual development, group development, organization issues, and supervisor/supervisee issues. Models for conducting group supervision detail experiential affective approaches designed to increase the supervisees' self-concept and ability to relate to others, and/or cognitively focused activities, such as presenting cases which broaden the counselor's ability to conceptualize and problem-solve. While the literature provides information on how to conduct these activities, less obvious are the reasons why certain activities are selected and when the activities are most appropriate to use.

Borders offered a model that details reasons with the suggested activities. Groups may be used to increase feedback among peers through a structured format and assignment of roles (e.g., client, counselor, and other significant persons in client's life) while reviewing tapes of counseling sessions. "Role-taking" encourages supervisees to assume more responsibility in the group as feedback is offered from several viewpoints.

Models provide almost no attention to how the supervisor is to make judgments about the use of "group process." The supervisor has little guidance about how to use the collective nature of the group to foster counselor development.

Similarly, the development of the group has not been the focus of researchers--only a few empirical studies have been conducted to examine group supervision. Holloway and Johnston (1985), in a review of group supervision literature from 1967 to 1983, suggested that peer review, peer feedback, and personal insight are all possible to achieve while doing supervision in groups. Focus on the development of the group is not apparent in these studies, yet the term "group supervision" is defined with an emphasis on the use of group process to enhance learning.

Group Process

As above indicates, the group supervision format requires that supervisors be prepared to use their knowledge of group process, although how this is to be done is very unclear. A recent naturalistic study of four groups across one semester provided some initial insights. Werstlein (1994) found that guidance and self-understanding were cited by supervisor and supervisees as the most important "therapeutic factors" (Yalom, 1985) present in their group. In addition, the initial stages of group development were apparent. Less noticeable were the later stages of group development which are characterized by higher risk behaviors that increase learning (Werstlein, 1994). Clearly, additional work is needed to clarify the process variables of group supervision and the role of the group leader (supervisor).

Supervisor as Group Leader

Based on existing group supervision literature and small group literature, the following guidelines are offered to supervisors who wish to address process in group supervision:

1. Five to eight supervisees meeting weekly for at least one and one half hours over a designated period of time (i.e., semester) provides an opportunity for the group to develop.

2. Composition of the supervision group needs to be an intentional decision made to include some commonalities and diversities among the supervisees (i.e., supervisee developmental level, experience level, or interpersonal compatibility).

3. A pre-planned structure is needed to detail a procedure for how time will be used and provide an intentional focus on content and process issues. This structure can be modified later in accordance with group's climate.

4. A pre-group session with supervisees can be used to "spell-out" expectations and detail the degree of structure. This session sets the stage for forming a group norm of self-responsibility and does not interfere with group development.

5. Supervisors may use "perceptual checks" to summarize and reflect what appear to be occurring in the here-and-now in the group. Validating observations with the supervisees is using process. Be active, monitor the number of issues, use acknowledgements, and involve all members.

6. Supervisees' significant experiences may be the result of peer interaction that involves feedback, support, and encouragement (Benshoff, 1992). Exploring struggles supports learning and problem-solving.

7. Bernard and Goodyear (1992) provided an excellent overview of the group supervision literature. Many ideas are available for structuring case presentations and the entire group sessions. Also, reviewing materials on group facilitation with a particular focus on dealing with process is essential.

8. Competition is a natural part of the group experience. Acknowledge its existence and frame the energy in a positive manner that fosters creativity and spontaneity.

In preparation for group supervision, communicate the following to the supervisees about how to use group process:

1. Learning increases as your listening and verbal involvement increases. Take risks and reveal your responses and thoughts.

2. Decrease your personalization of frustration by sharing with your peers. You will be surprised how often other supervisees are experiencing the same thoughts and feelings.

3. Intentionally look for similarities as you contemplate the relationships you have with your peers in the group with the relationships you are having with clients. Discuss similarities and differences.

4. Progress from client dynamics to counselor dynamics as you present your case. Know ahead of time what you want as a focus for feedback and ask directly. Supervision CEUs - Supervision Continuing Education

Integration of knowledge and experience is greatly enhanced by group supervision. Existing literature emphasizes the importance of a structure that outlines procedures for case presentation and supervisee participation; less obvious are approaches to address group development. It is essential the we fill in these gaps in the literature by systematically gathering data that establishes the unique aspects of using groups for supervision.

Spirituality, Religion and Supervision

Counselor competency, conceptualization of spirituality, cross-cultural awareness, and the similarity of clients' and counselors' values form a foundation for developing effective intervention and supervision strategies. Spirituality and religion are important aspect of client diversity in psychotherapy and supervision.  Despite the emphasis on spirituality in supervision and psychotherapy literature, scholars report finding little emphasis in the counselor supervision literature regarding spirituality and the supervision process.  Because the counselor supervision literature addresses a wide variety of client, counselor, and supervisor issues, it is unfortunate that little attention has been given to the issue of spirituality and religion. How is it possible to educate counselors to competently and effectively address spiritual issues in the counseling process if religion and spiritually issues are not addressed in the counselor supervision process?

The following vignettes provide a starting point for the consideration of issues of spirituality in supervision.

Vignette I

A 22-year-old woman came to counseling for help in deciding whether or not to terminate her pregnancy. The father of the child wanted to be a part of the child’s life.  He was willing to support the mother and child but did not want to get married. The patient struggled with guilt over the pregnancy and had not told her parents because of their religious beliefs. The patient clearly indicated that she believed abortion was wrong, and she did not want to damage her relationship with God. She felt tremendous stress and had not been sleeping well.  She was emotionally upset about the pregnancy and did not want to continue with the pregnancy because of the impact the birth of a child would have on her future relationships and career choices.

Vignette II

A patient with whom your supervisee has been working for several months has shown significant improvement in his ability to cope with work-related stress. He has frequently described how he felt supported by several friends with whom he shared similar spiritual beliefs. The client asked your supervisee's opinion about the role of spirituality in the resolution of his problem. Even though the patient had openly described the spiritual discussions he has had with his friends, the counselor had not offered commentary related to the issue of the client's spirituality. Because the patient wanted to understand the reasons for his improvement and to synthesize his improvement with his spirituality, he wanted to understand the therapist's insight.

Vignette III

Your supervisee is currently on practicum assignment. She has recently read, on her own initiative, several articles on the topic of spirituality and the impact of prayer in promoting well-being. While listening to an audiotape of a therapy session, you hear the trainee spend part of the most recent counseling session praying with the client. On the tape, the client indicated intense gratitude for the counselor's care and concern. Although the client seems to have benefited from the counselor's actions, you feel uneasy about the situation.

Factors in Supervision

The purpose of this article is to help supervisors and supervisees enhance their awareness of spiritual values in the supervision process and to promote the integration of spirituality with the counselor supervision process in order to improve the competency of counselors in dealing with this aspect of client diversity. Consideration of the following factors related to counseling and psychotherapy can enhance the preparation of counselors and supervisors to deal with situations similar to the ones previously outlined.

Mental health professionals are invested in ensuring that the public is served well. Organizations such as the American Psychiatric Association (1995) and the Council for Accreditation of Counseling and Related Educational Programs  invest significant ongoing effort in publishing and enforcing codes of ethics and practice guidelines, with emphasis on the recognition of and appropriate accommodation of human diversity and respect for clients' rights. In addition, there has been a particular emphasis on directing training programs to ensure that graduates have attained adequate skills to competently deal with clients' spirituality and religious values. Therefore, the counselor's main responsibility is to provide the utmost respect for the client and to do no harm. This respect extends to all aspects of the person, including his or her religious and spiritual values. Except for institutions that are church affiliated or programs that are of an explicitly religious nature, counselor education programs do not typically offer courses that address spirituality.

Supervisors may wish to consider several options for responding to the vignettes presented at the beginning of this article. In dealing with Situation 1. it may be useful to discuss with the counselor her or his beliefs about abortion in terms of the moral implications as well as in terms of the client's emotional functioning and the relationship she has with the baby’s father. The supervisor may wish to review with the counselor the community-based resources (e.g., crisis pregnancy counseling, adoption, and medical clinics) that can be useful to the client. It is also important to direct the counselor to explore past personal experiences that may contribute to countertransference into the counseling session. Furthermore, it may be important for the supervisor to seek consultation regarding countertransference issues.

In supporting the counselor in Situation 2, the supervisor may want to role play with the supervisee a variety of responses for use in the session. The counselor likely needs to engage in self-exploration regarding a personal position on the issue of the role of spirituality in mental health.  You can encourage dialogue in supervision about whether spirituality should be integrated and synthesized into or compartmentalized and separated from the counseling process.

In Situation 3, it is important for the supervisor to explore why feelings of unease were experienced. It may be necessary for the supervisor to review information with the counselor about policies and procedures as they relate to particular agency requirements and limitations for including spiritual practices, such as prayer, in the counseling session. Because prayer, as an intervention, seems to have been beneficial for the client, it seems unreasonable to summarily prohibit it; rather, it seems important to establish clear expectations for the counselor to discuss such interventions with his or her supervisor prior to their implementation in session, thus helping to assure the supervisor that the counselor can competently use the desired intervention.

Definition of Spirituality

In addition to supervised experience, competence is enhanced, in part, through knowledge and understanding. Having a basic understanding of spirituality is needed to form a foundation for gaining skills in the supervision process. Counselors and supervisors need to understand how religion and/or spirituality are significant components of being human. At this point, it should be pointed out that although religion and spirituality are interrelated, they are not synonymous. Since the "beginning of time," those things that we consider transcendent have affected the way we view the universe and the way we give credit for the outcomes of our actions. Spirituality is not only a significant and integral part of human experience, but spirituality is also an integral part of human development.

Spirituality may be defined as: the animating force in life, represented by such images as breath, wind, vigor, and courage. Spirituality is the infusion and drawing out of spirit in one's life. It is experienced as an active and passive process. Spirituality is also described as a capacity and a tendency that is innate and unique to all persons. This spiritual tendency moves the individual towards knowledge, love, meaning, hope, transcendence, connectedness, and compassion. Spirituality includes one's capacity for creativity, growth, and the development of a values system. Spirituality encompasses the religious, spiritual, and transpersonal.

Religion, on the other hand, has been defined as the logical outcome and organized attempt to give a framework to the sense of awe for the transcendent. Religion also tells its adherents what life is about and how one is to live that life. Both religion and spirituality can be found across cultures and are expressed in dynamic and diverse ways.

For counselors, it is not always easy to approach clients' concerns regarding spirituality or religion. Historically, counselors have been encouraged to focus on a secular approach to counseling that emphasized a negativistic bias regarding the influence of spirituality or religious values on psychological well-being Counselors tend to take a detached view of the spirituality of clients. This means that in a counseling session, counselors may avoid issues that deal with spirituality or religious practice. Addressing such issues with clients had several benefits by helping counselors in the following ways: (a) better understand the [client's] psychological conflict, (b) design interventions that are more acceptable to the [client] and congruent with their world view (and thus more likely to be complied with), (c) identify healthy religious resources that may bring comfort and support, (d) recognize psychological roadblocks that prevent the [client] from utilizing potentially powerful spiritual resources, and (e) strengthen the therapeutic relationship (because this demonstrates sensitivity to an area that may be very meaningful to the client.

Information regarding the impact of the similarity of client and counselor values, as well as cross-cultural elements in the counseling process, can further help counselors and supervisors appreciate the importance of client spirituality.

Values

A goal of counseling is to promote client welfare and the evidence is clear that counseling and psychotherapy help clients to improve. Although counselors and clients may generally share the goal of improvement, there may be sharp differences in opinion about what constitutes significant improvement and about what factors contribute to improvement. There is evidence that individuals in the current culture in the United States consider spirituality and/or religion to be important and helpful parts of their daily lives. There is a growing amount of literature that supports the positive impact of spirituality or religious practices on the well-being of individuals in a variety of circumstances.  Evidence suggests that progress toward mental well-being and emotional health is enhanced by a positive focus on spirituality.

In spite of the growing amount of literature on spirituality, counseling professionals and supervisors continue to struggle with the acceptance of spirituality as a significant part of the counseling process. This discrepancy between counseling professionals and the clients they serve perpetuates barriers, particularly because clients may be suspicious of what they may consider an unfriendly environment that will discount, negate, or conflict with their religious values or spiritual world view. To further illustrate the point about barriers, consider the perspective of Worthington (1986) regarding the position of clients who espouse conservative Christian perspectives on spirituality. These potential clients may be reluctant to receive intervention from "secular therapists" because they fear therapists may (a) neglect religious concerns; (b) deal with religious beliefs and events as pathological or psychological; (c) fail to discern religious language and ideas; (d) presume that religious clients share nonreligious cultural norms; (e) promote therapeutic conduct that contradicts clients' own particular sense of morals; or (f) make presumptions, explanations, and suggestions that clients' account of revelation is not valid epistemology. Rather than emphasize the apparent disparity between counseling professionals and clients, it is important to focus on ways to shrink the gap. The development of counselor awareness and of the ability to deal with the cultural diversity of clients has been an area where counselors have gained significant ability to encourage and promote the welfare of clients.

When contemplating the challenges presented in the vignettes at the beginning of this article, several issues are apparent. First, how does the counselor effectively attend to the spiritual issues presented by the client in the immediate situation? Second, how does the counselor present these issues in the supervision process? Third, how does the supervisor respond to these issues in the supervision process? We recognize that factors such as counselor competency, culture, one's conceptualization of spirituality, and the similarity of clients' and counselors' values form a foundation for developing effective intervention and supervision strategies.

The development of counselor competency is enhanced through the acquisition of specific skills. Skill development is critical because spirituality is a central part of the human experience that pervades virtually all aspects of psychological and emotional functioning.  Several suggestions aimed at helping counselors become more competent in addressing spiritual issues in the counseling process: (a) help the client to feel that his or her religious values are an accepted part of the therapeutic process; (b) view religious values as part of the solution to the client's problem, not just as part of the problem; (c) become more educated about cultures, religious values, beliefs, and practices and strive to understand how these issues are integrated with psychological theory and counseling practice; (d) become involved with community or professional activities that promote interactions with persons from diverse cultures who have a variety of religious values; (e) explore and evaluate personal religious values; (f) be aware of what counselor resistance toward or cautious maneuvering around religious issues may convey to clients; and (g) develop a simple straightforward language to use in communicating with clients about religious values.

To strengthen a foundation for developing effective supervision strategies, we are calling for an infusion of spirituality into the supervision process. Regarding the application of these ideas to supervision, we urge counselors, trainees, and supervisors to (a) engage in dialogue regarding the nature of spirituality, its definition, and its relevance to counseling and particularly to supervision; (b) spend regular time in self-examination and contemplation regarding personal experiences in spiritual matters; and (c) develop specific scientific bases for the inclusion of spirituality in the supervision process. This final area includes at least two sub components. First, it is essential to expand existing models of supervision to include a place for spirituality as it relates to the client, supervisee, and supervisor. Second, it is necessary to derive specific hypotheses from these models and put the hypotheses to empirical test.

Multicultural Issues in Supervision

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 and the Association for Counselor Education and Supervision 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. 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, 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. This paper will summarize two different aspects of multicultural supervision: the inclusion of multicultural issues during supervision and the multicultural supervisory relationship.

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 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 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. 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 addresses the knowledge and skills related to the supervisory relationship. Only one substandard of nine 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". 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.

These conclusions point to the critical importance of the initial sessions in the multicultural supervisory relationship. Cultural differences in world view 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. 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.

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.

Multicultural Counseling

Multiculturalism has been defined as the fourth force in psychology, one which complements the psychodynamic, behavioral and humanistic explanations of human behavior. Pedersen defined multiculturalism as "a wide range of multiple groups without grading, comparing, or ranking them as better or worse than one another and without denying the very distinct and complementary or even contradictory perspectives that each group brings with it" . One of the most important debates within the field has to do with how this definition relates to specific groups within the context of a culture. Pedersen's definition leads to the inclusion of a large number of variables, e.g., age, sex, place of residence, education, socioeconomic factors, affiliations, nationality, ethnicity, language, religion, making multiculturalism generic to all counseling relationships. Locke, among others, advocates a narrower definition of multiculturalism, particularly as it relates to counseling. The narrower view is one where attention is directed toward "the racial/ethnic minority groups within that culture".

Regardless of how one defines the term or the degree to which the concept is restricted or broadened in a particular context, multiculturalism encompasses a world of complex detail. Hofstede (1984), identified four dimensions of cultures. These dimensions are:

1. Power distance--the extent to which a culture accepts that power in institutions and organizations is distributed unequally.

2. Uncertainty avoidance--the extent to which members of a culture feel threatened by uncertain or ambiguous situations.

3. Individualism--a social framework in which people are supposed to take care of themselves and of their immediate families only. Collectivism refers to a social framework in which people distinguish between in-groups and out-groups, expecting their in-group to look after them, and in exchange for that owe loyalty to it.

4. Masculinity/Femininity--the extent to which the dominant values within a culture are assertiveness, money and things, caring for others, quality of life, and people.

A number of generic counselor characteristics are necessary, but not sufficient, for those who engage in multicultural counseling. To be effective, a counselor must be able to:

1. Express respect for the client in a manner that is felt, understood, accepted, and appreciated by the client. Respect may be communicated either verbally or nonverbally with voice quality or eye contact.

2. Feel and express empathy for culturally different clients. This involves being able to place oneself in the place of the other, to understand the point of view of the other.

3. Personalize his/her observations. This means that the counselor recognizes that his/her observations, knowledge, or perceptions are "right" or "true" only for him/herself and that they do not generalize to the client.

4. Withhold judgment and remain objective until one has enough information and an understanding of the world of the client.

5. Tolerate ambiguity. This refers to the ability to react to new, different, and at times, unpredictable situations with little visible discomfort or irritation.

6. Have patience and perseverance when unable to get things done immediately.

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Counselors bring with them their own degree of effectiveness with these generic characteristics. They also bring with them their cultural manifestations as well as their unique personal, social and psychological background. These factors interact with the cultural and personal factors brought by the client. The interaction of these two sets of factors must be explored along with other counseling-related considerations for each client who comes for counseling. The effective counselor is one who can adapt the counseling models, theories, or techniques to the unique individual needs of each client. This skill requires that the counselor be able to see the client as both an individual and as a member of a particular cultural group. Multicultural counseling requires the recognition of: (1) the importance of racial/ethnic group membership on the socialization of the client; (2) the importance of and the uniqueness of the individual; (3) the presence of and place of values in the counseling process; and (4) the uniqueness of learning styles, vocational goals, and life purposes of clients, within the context of principles of democratic social justice.

The Multicultural Awareness Continuum was designed to illustrate the areas of awareness through which a counselor must go in the process of counseling a culturally different client. The continuum is linear and the process is developmental, best understood as a lifelong process.

Self-awareness. The first level through which counselors must pass is self-awareness. Self-understanding is a necessary condition before one begins the process of understanding others. Both intrapersonal and interpersonal dynamics must be considered as important components in the projection of beliefs, attitudes, opinions, and values. The examination of one's own thoughts and feelings allows the counselor a better understanding of the cultural "baggage" he or she brings to the situation.

Awareness of one's own culture. Counselors bring cultural baggage to the counseling situation; baggage that may cause certain things to be taken for granted or create expectations about behaviors and manners. For example, consider your own name and the meaning associated with it. Ask yourself the cultural significance of your name. Could your name have some historical significance to cultures other than the culture of your origin? There may be some relationship between your name and the order of your birth. There may have been a special ceremony conducted when you were named.

The naming process of a child is but one of the many examples of how cultural influences are evident and varied. Language is specific to one's cultural group whether formal, informal, verbal, or nonverbal. Language determines the cultural networks in which an individual participates and contributes specific values to the culture.

Awareness of racism, sexism, and poverty. Racism, sexism, and poverty are all aspects of a culture that must be understood from the perspective of how one views their effect both upon oneself and upon others. The words themselves are obviously powerful terms and frequently evoke some defensiveness. Even when racism and sexism are denied as a part of one's personal belief system, one must recognize that he/she never-the-less exists as a part of the larger culture. Even when the anguish of poverty is not felt personally, the counselor must come to grips with his or her own beliefs regarding financially less fortunate people.  

Exploration of the issues of racism, sexism, and poverty may be facilitated by a "systems" approach. Such an exploration may lead to examination of the differences between individual behaviors and organizational behaviors, or what might be called the difference between personal prejudice and institutional prejudice. The influence of organizational prejudice can be seen in the attitudes and beliefs of the system in which the counselor works. Similarly, the awareness that frequently church memberships exist along racial lines, or that some social organizations restrict their membership to one sex, should help counselors come to grips with the organizational prejudice which they may be supporting solely on the basis of participation in a particular organization.

Awareness of individual differences. One of the greatest pitfalls of the novice counselor is to over generalize things learned about a specific culture as therefore applicable to all members of the culture. A single thread of commonality is often presumed to exist as interwoven among the group simply because it is observed in one or a few member(s) of the culture. On the contrary, cultural group membership does not require one to sacrifice individualism or uniqueness. In response to the counselor who feels all clients should be treated as "individuals," I say clients must be treated as both individuals and members of their particular cultural group.

Total belief in individualism fails to take into account the "collective family-community" relationship which exists in many cultural groups. A real danger lies in the possibility that counselors may unwittingly discount cultural influences and subconsciously believe they understand the culturally different when, in fact, they view others from their own culture's point of view. In practice, what is put forth as a belief in individualism can become a disregard for any culturally specific behaviors that influence client behaviors. In sum, counselors must be aware of individual differences and come to believe in the uniqueness of the individual before moving to the level of awareness of other cultures.

Awareness of other cultures. The four previously discussed levels of the continuum provide the background and foundation necessary for counselors to explore the varied dynamics of other cultural groups. Most cross-cultural emphasis is currently placed upon African Americans, Native Americans, Mexican Americans or Hispanics, and Asian Americans. Language is of great significance and uniqueness to each of these cultural groups, rendering standard English less than complete in communication of ideas. It is necessary for counselors to be sensitive to words which are unique to a particular culture as well as body language and other nonverbal behaviors to which cultural significance is attached.

Awareness of diversity. The culture of the United States has often been referred to as a "melting pot." This characterization suggests that people came to the United States from many different countries and blended into one new culture. Thus, old world practices were altered, discarded, or maintained within the context of the new culture. For the most part, many cultural groups did not fully participate in the melting pot process. Thus, many African American, Native American, Mexican American, and Asian American cultural practices were not welcomed as the new culture formed.

Of more recent vintage is the term "salad bowl" which implies that the culture of the United States is capable of retaining aspects from all cultures (the various ingredients). Viewed in this manner, we are seen as capable of living, working, and growing together while maintaining a unique cultural identity. "Rainbow coalition" is another term used in a recent political campaign to represent the same idea. Such concepts reflect what many have come to refer to as a multicultural or pluralistic society, where certain features of each culture are encouraged and appreciated by other cultural groups.

Skills/Techniques. The final level on the continuum is to implement what has been learned about working with culturally different groups and add specific techniques to the repertoire of counseling skills. Before a counselor can effectively work with clients of diverse cultural heritage, he or she must have developed general competence as a counselor. Passage through the awareness continuum constitutes professional growth and will contribute to an increase in overall counseling effectiveness, but goes much further than that. Counselors must be aware of learning theory and how theory relates to the development of psychological-cultural factors. Counselors must understand the relationship between theory and counselors' strategies or practices. Most importantly, counselors must have developed a sense of worth in their own cultures before attaining competence in counseling the culturally different.

PREVENTION OF BOUNDARY VIOLATIONS

 Prevention of boundary violations is a laudable goal, but attaining it is unfortunately about as likely as eliminating crime and poverty. The point of view described in this article leads to several suggestions, though. The prevention of boundary violations depends, in large measure, on education of therapists, clergy, and other professionals. It is important that training programs include peer discussions and readings orienting trainees to the field's standards. There are numerous publications addressing the field's standards and the boundaries of clinical work. Such readings and peer discussions not only educate trainees to the field's standards, but also offer practical tips about warning signs of impending boundary violations. However, it is not enough to identify warning signs and teach that boundary violations are wrong because they violate our code of ethics. We would do well to educate therapists and other professionals to think of their dyadic work as located within their discipline's larger, supraordinate context. The educational process should help individuals join the values of their field, not simply be trained in a discipline that they are then authorized to practice independently. It is the recognition that we carry out our work in a larger context, that we have joined a field and joined its values, and that we and our patients each have a role that is subordinate to the larger task of treatment, that stands to help therapists and other professionals learn to reorient themselves when they begin to become lost in the work.

One concrete way of helping professionals stay aware of the larger context is through supervision or other perspectives on the dyad from outside it. Prevention of sexual misconduct depends on making easily available to therapists, clergy, and other professionals the possibility of consultation with others in the field, particularly at times of impasse. Therapists who routinely present their work to others in consultation, supervision, peer discussion groups, or case presentations are probably at less risk of becoming isolated and lost in the dyad in their work. This is not a simple matter in the current clinical climate, where financial pressures have squeezed treatment settings and therapists in a way that leaves little room for clinical conferences or case discussion.

Educating practitioners and students about central psychodynamic notions like transference, countertransference, and enactment, and teaching them the importance of accepting and tolerating the transference offered by the patient, seems wise. In therapeutic work, if the transference fits, wear it—even if it hurts! Awareness of the concept of enactment, in particular, has a double benefit. First, it teaches therapists about an inevitable therapeutic phenomenon that places them at risk for sexual misconduct but that also offers an opportunity to deepen their work. Second, knowledge of the concept of enactment reminds therapists that we are all inevitably vulnerable human beings. This awareness serves to minimize the unhelpful we/they split that can provide a false sense of security to therapists who believe that sexual misconduct can't happen to them. Unfortunately, in psychiatry today little is taught to residents about psychodynamics, much less about the complexity of tolerating intense transferences and the importance of enactment. These trends in training, coupled with the current focus on behavioral and symptom-focused treatment approaches that exclude attention to transference and countertransference, do not help. Despite all the good that comes from a focus on patient satisfaction, this trend may have the unfortunate effect of reinforcing therapists' inclination to refuse negative transferences.

It seems wise to cultivate humility in ourselves as clinicians and teachers of younger professionals, emphasizing the inevitability of our own fallibility in this complex work. However great our expertise, we remain fallible human beings, doing our work along a fine and fragile boundary.

Additional Required Reading: Improving the Supervisory Working Alliance: A Pilot Study of Personality Differences Between Novice and Experienced Counselors

 

References:

Bernard, J. M., & Goodyear, R. K. Fundamentals of clinical supervision. Boston: Allyn & Bacon.

Liddle, B. Resistance in supervision: A response to perceived threat. Counselor Education and Supervision

Worthen, Vaughn E.; Isakson, Richard L.,

Newgent, Rebecca A.; Higgins, Kristin K.; Mulvenon, Sean W.; Balkin, Richard S.

Hart, Gordon M.. Eric Digest ( ED372341), 1994-04-00 Supervision Ceus, Online Supervision continuing education ceus, Social Workers, Mft, Mfcc, Social Workers and Counselors

Loretta  Bradley and L. J.Gould, Supervisee Resistance

Werstlein, Pamela O., Fostering Counselors' Development in Group Supervision

Fong, Margaret L., Multicultural Issues in Supervision,

Supervision CEU for Psychologists, Lmft, Social Workers and Counselors. Supervision continuing education course online. Supervision ceus continuing education for supervisors, BBS, NASW and state approved ceu in Supervision.

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