The Supervisory Relationship: A Contemporary Psychodynamic Approach (Book Review)

Author:  Frawley-O’Dea, Mary Gail and Joan E. Sarnat
Publisher: New York: Guilford Press, 2000
Reviewed By: Karen W. Saakvitne, Spring 2002, pp. 45-47

Practicing What You Preach: The Lessons of Relational Supervision and Consultation

The Supervisory Relationship: A Contemporary Psychodynamic Approach is a very important book. It enriches an all-too-small literature on supervision and consultation. It invites supervisors and clinical consultants to examine their theoretical positions on the supervisory process and consider their technique. Ultimately, the authors encourage the readers to challenge their underlying assumptions about the task and process of supervision and consultation. The book is rich with clear arguments and compelling examples of supervisory dyads in the midst of a complex relational process of both observation and participation.

Supervision provides many of us with some of our most important relationships in the course of our professional development. Yet, despite what we know about human relationships and what we understand about the influence of supervision on the therapeutic relationship and the self of the therapist, we have let this relationship remain invisible. These powerful relationships often shape more than one’s therapeutic relationships, but one’s professional identity and sometimes, the direction of one’s career. This is a sobering responsibility; it underscores the necessity that we apply the same level of thoughtfulness and care to understand the supervisory process as we do for the therapeutic process.

As a profession, however, we pay little attention to issues of technique, theory, and methods of supervision. How many of us have had a course in clinical supervision? How many of us have received supervision on our supervisory work? How many of us are familiar with the literature on supervision? How many of us have examined not only the influence of clinical supervision on the therapeutic dyad (or couple, or family system, or group dynamic), but on the professional identity and development of the supervisee (therapist)?

I ask these questions, not to rebuke, but to highlight the valuable resource with which Mary Gail Frawley-O’Dea and Joan Sarnat have provided us. The Supervisory Relationship is organized around the basic premise that we can and should apply relational principles to our supervisory relationships. Specifically, Frawley-O’Dea and Sarnat urge supervisors to focus on the nuances of the supervisory relationship itself and to address these relational patterns explicitly. They note that the dynamics of the supervisory relationship provide fertile ground for examining the conscious and unconscious dynamics of the therapeutic relationship, of the therapist’s (supervisee) learning process and identity formation, and of the parallel (to the therapeutic process) process enacted within the second dyad of the supervisory relationship. Further, they suggest that this approach provides the most respectful and useful environment for the developmental process of the supervisee. Attention to the relational dynamics of the supervisory dyad is an obvious extension of the attention to the evolution of the therapeutic relationship.

In their overview chapter on supervision, Frawley-O’Dea and Sarnat, offer a simple but elucidating framework for categorizing approaches to supervision. They identify three dimensions for evaluation: 1) The nature of the supervisor’s authority in relationship to the supervisee; 2) the supervisor’s focus, i.e., the relevant data for supervisory processing; and 3) the supervisor’s primary mode of participation. These three dimensions and their various combinations summarize the major theoretical perspectives in supervision. I also found these dimensions provide a template for any supervisor to assess either his or her own practice of supervision or a particular supervisory relationship.

To introduce their proposed method of supervision, Frawley-O’Dea and Sarnat review three primary models of supervision (five, with subsets) using these three dimensions. They discuss five models, reviewing their strengths and weaknesses: Patient-centered (Classical) model; Therapist-centered (which includes three subsets: Learning Problem or Ego Psychological; Empathic or Self-Psychological; and Anxiety-focused or Object Relational); and finally their own model, Supervisory-Matrix centered (Relational) Model. This approach allows the reader to locate him or herself (and his or her experience) in relation to the subsequent material in the volume. This organization directs the reader’s attention to specific aspects of the interaction between supervisory task and the relationship between supervisor and supervisee. In doing so, it keeps the analysis crisp and focused rather than over-generalized and vague.

A strongly persuasive and helpful aspect of this book is its use of detailed examples. I have rarely seen books on supervision that capture the conversations that are part of the work. Because of the multiple tasks and levels of analysis inherent in the endeavor, there are countless choice points in every supervisory session. It is invaluable to see the specific comments and responses, and to consider their subsequent analysis by the authors. Here as they have elsewhere (Sarnat, 1992; Davies & Frawley, 1994), the authors show their talent at capturing the real drama of clinical and supervisory work.

The examples show enormous respect for the complex person of the therapist. Without pathologizing, Frawley-O’Dea and Sarnat address the impact on psychotherapies of the therapist’s anxiety and fears, personal history, current life events, and transference to the supervisor. They address the essential issues of therapist dissociation and regression without censure. They offer examples of direct and compassionate invitations for the therapist to understand the interaction of their personal experience with their clinical work. Again, these topics are underrepresented in our professional literature and yet part of every therapist’s professional experience. I was glad to see the piece addressing the impact of a patient suicide on the therapist, another topic on which we are too often silent.

An inestimable benefit of both the model and the detailed examples they offer is the humility and non-defensiveness of the supervisors. I think that these qualities are essential for successful relational work. It is not, however, possible to teach a therapist to be open and non-defensive without modeling it relationally. Traditional supervisory relationships built on the assumption that the supervisor is the authority with the “correct” answer, tend to convey the message that a therapist is either correct or a bad therapist. This belief can lead not only to the presentation of a false self in supervision, but also to the development of a rigid and defensive stance when a patient or client challenges the therapist. As a consultant, I have seen many therapies founder on this very issue; when a therapist reacts out of shame, she or he withdraws from connection, often hiding behind a protective cloak of authority (Saakvitne, 1998). When clinical supervision intensifies shame, it can result in the therapist needing to maintain rigid defenses to protect his or her self-esteem. The relational model illustrated in The Supervisory Relationship offers an alternative. When the supervisor can model non-defensiveness and mutuality in constructing the supervisory relationship, the therapist is given permission to be fallible and skills to examine and renegotiate a therapeutic relationship.

My primary disappointment with The Supervisory Relationship is its restricted scope of influence; by defining the focus of the book so narrowly, the authors severely limited the audience for which it is written. I think the ideas in this book are valuable to all clinical supervisors and all students and professionals receiving clinical consultation and supervision. One limit stems from their assumption that supervision is a relationship between a senior clinician and a student or psychoanalytic candidate. In fact, supervision and consultation relationships not only should, but do take place over the course of a professional lifetime and attention to the relational dynamics in each of these relationships is just as valuable and complex as it is in an explicitly hierarchical model.

A second limit is their exclusive focus on psychoanalytic practice. I had hoped the use of psychodynamic in the title implied a broader audience, but the repeated referral to institutes and candidates suggested the book was written for a select few, the psychoanalytically devoted. I believe there a many clinicians who practice psychoanalytically informed or psychodynamic psychotherapy and who seek and/or practice clinical supervision for whom the topic of the book could offer invaluable ideas and insights. Third, the authors define the term relational solely within the realm of contemporary psychoanalysis, without so much as a nod to the feminist contributions to the concept of relational psychology (i.e., The Stone Center). This chauvinism (if you will) is unfortunate, since the perspectives can only enrich one another. Psychoanalytic theory does not develop in a vacuum and we need to acknowledge the cross fertilization of many influences on our ideas and values.

The core of this book is rich and could easily be elaborated to explore various implications or corollaries to the theory. What are the implications when the supervisor and supervisee are from different mental health disciplines? How does the dynamic work when the supervisor has personal life experiences that are similar to those of the client? Or when the supervisor has overlaps in life experiences with the therapist (supervisee)? How would this theory work in a peer supervision model, or a group supervision model? How does this model facilitate or inhibit attention to the self of the therapist, including addressing issues of vicarious traumatization, vulnerability, and impairment? In short, the book was excellent and left me hungry for more elaboration.

I spend a third of my professional work life as a clinical consultant and supervisor. I am delighted to have this thoughtful and thought provoking book to help me grapple with the plethora of choice points in the complex, multi-level relational process of a clinical supervision. Elsewhere, I have written about the power of relational teaching in mental health, that is, using a teaching style that models the use of an empowering, respectful therapeutic stance (Saakvitne, 2002). I can think of no venue better suited to relational teaching than clinical supervision.

References

Davies, J.M. & Frawley, M.G. (1994). Treating the Adult Survivor of Childhood Sexual Abuse: A Psychoanalytic Perspective. New York: Basic Books.
Saakvitne, K.W. (2002). Relational Teaching, Experiential Learning: The Teaching Manual for the Risking Connection Curriculum. Lutherville, MD: Sidran Press.
Saakvitne, K.W. (April 25, 1998). After Sexual Betrayal in Therapy: Anticipating Impasses in Subsequent Treatment. Paper given in Section III Symposium, The Role of Gender and Sexuality in Therapeutic Impasses and Ruptures. American Psychological Association Division of Psychoanalysis Spring Meeting, Boston, MA
Sarnat, J. E. (1992) Supervision in relationship: Resolving the teach-treat controversy in psychoanalytic supervision. Psychoanalytic Psychology, 9, 387-403.

Reviewer Note

Karen W. Saakvitne is the clinical director of the Traumatic Stress Institute/Center for Adult & Adolescent Psychotherapy in South Windsor, CT, and Northampton, MA. She has co-authored three books on the treatment of trauma and the self of the therapist, and a fourth book on relational teaching. She is a nationally known consultant and teacher.

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