web analytics

A Look at Clinical Supervision

chair-insideGroup supervision is similar to group critiques in a creative writing class. You present your case and then people chime in to try to help you with it. Sometimes you need help with practical matters — like what to do ethically or what clinic protocol demands — but usually the cases you bring to supervision are the ones that have you banging your head against the wall.

Case presentation looks something like this:

My client is this age and ethnicity. My client came to counseling because of this reason. Here is what is most important for you to know. (That might include her diagnosis if she has one; her background and history; her progress so far.) This is how often I’ve seen her.

And then the big question:

Here is how I am stuck.

The point of group supervision is not to throw a bunch of theories at the presenting clinician or for participants to show off with how much more they know. The point of group supervision — and individual supervision — is a lot like the point of counseling; it’s to help the clinician to find the answers in her own experience. Sure, we share things we know with each other — research we’ve read or similar cases we have experienced — but only if doing so will illuminate the presented case for the presenting clinician. Very often we spend a lot of time asking questions not only to clarify the case for ourselves but in the hope that giving us the answers will clarify the case for the presenter.

In graduate school we used a Gestalt technique where someone would listen to the case presentation and write down aspects that seemed particularly relevent. If we were to do it for say, Harriet the Spy after her notebook was stolen and her parents take her to the psychiatrist* then the list might include: Notebook, parents, Ole Golly, spying, isolation and friendship. Then each person would pretend to be something on that list and speak as that thing out loud. I know it sounds silly (and it can feel silly doing it) but it can also lend unexpected insight.

The person playing the notebook might say, “I am Harriet’s notebook. I hold all of her secrets and keep them safe for her. I let her examine things from all sides and speak without reservation. I am a reflection of her innermost thoughts. I let her take those thoughts out and give them room to breathe. I help her open up space in her busy mind.”

It’s all open to interpretation, of course, and the person pretending to be an aspect of the case could certainly be wrong but that doesn’t matter. The exercise is meant to give the clinician a different perspective.

Perhaps the therapist listens to the person playing the notebook and she starts to think, “Without her notebook Harriet must feel so cramped and trapped. Perhaps she feels like she can’t think without it.” And it might change the course of their treatment in some small way that lets the clinician get unstuck.

While I don’t like role plays where you play the client and I play the clinician or vice versa, I did like this technique. It was often so jarring (“You be the client’s entrenched views about her mother’s religion; you be the client’s nightly vodka tonic; you be her beloved poodle; you be the man she met on the internet) that even when it wasn’t my case I was sure to learn something new to bring to my clients the next morning.

* If I remember correctly, Harriet’s therapist gives her a notebook and she spends the whole session scribbling in the corner, frantic to write because her parents have taken her others away. When she goes out to the waiting room clutching the notebook her parents remove it from her possession and she doesn’t see the therapist again. Do I have that right? Probably her dad calls the therapist a fink. There’s a lot of finking in that book.

1 Comment

  1. This sounds so much like the Psychodrama women’s group I attend. I love it! And using these techniques in group supervision is such a great idea.

    Reply

Submit a Comment

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>

x

Get the monthly newsletter

Find out what groups, workshops and classes are happening each month!