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|"How can therapy help combat addictive behaviour? Here, we publish an extract from BACP Information sheet 'Working with clients with addictive behaviours'" |
|"One size does not fit all. Clive Perraton Mountford challenges the sacred hour in a thought-provoking discussion on client-determined session length – not something to launch into unsupervised, but definitely worth our attention"|
Linda’s descriptions of her abusive marriage prompt powerful personal feelings in her counsellor, Gareth. His online supervision session with Maureen is an opportunity to explore his response
Online supervision: when a therapy issue arises
Maureen watches Gareth’s words appear on her screen describing his new client Linda
Gareth: Linda is minimising her alcohol use, as far as I can see. It’s not really clear yet just how much she is drinking, haven’t really got into that. Her first session was taken up with her talking about how difficult things were in the past, and we over-ran the session. It was really hard to end it; she was very emotional. It felt like this was the first opportunity she’d had to really talk. I think she’s very isolated, he controls her and puts her down – she seems to have little confidence.
Maureen reflects for a moment on what Gareth is saying. She can appreciate that his new client may be talking about herself and her experiences for the first time to someone who genuinely listens. She knows from her own experience how difficult it can sometimes be to contain the outpouring within the therapeutic hour. Her concern is split, for Linda and what she was experiencing and trying to cope with, and for Gareth and how he is being affected.
Maureen: A lot of emotion was expressed. This must have affected you?
Gareth: That first session was really intense, and tiring. I had to go and get some fresh air afterwards, clear my head a little. It’s not been quite so intense since, but I am having difficulty containing the session and we run over each time.
Maureen: By how much?
Gareth: Fifteen minutes. I find it hard to stop the sessions. It felt like there was so much that she needed to say.
Maureen: So much that she needed to say and you were unable to hold that end of session boundary?
Maureen wants to hold the focus, mindful of wanting to explore in more detail what is happening that is making it so difficult for Gareth to hold the boundary. She knows as well that there isn’t always that much time between clients and wonders what effect over-running is having on the next appointment. She notes there is a pause before Gareth responds.
Gareth: I really feel for her, you know?
Maureen: Sorry for her?
Gareth: Yes, I guess so.
Maureen ponders on her response. She notes again Gareth’s pause before replying. She senses that there’s a lot going on for him and she doesn’t want to disturb whatever internal processing he may be experiencing.
Maureen: Can you tell me what thoughts and feelings are with you at the moment?
Gareth: To be honest, I want to make things better, and I can’t, and I’m ashamed because I’m a man and she’s suffering from the actions of her husband, and it feels like there’s lot in me that this is setting off.
Maureen: I really appreciate your being able to be open about what you are experiencing, Gareth, I really mean it. Can’t be easy.
Gareth: No, but it’s there, and it resonates
Gareth: Thought I’d dealt with it. My father could be a bastard towards my mother. I heard the rows as a child, I’ve seen the effects of violence and control, and, yeah, it’s got to me.
Maureen: All feels very present and real.
She pauses, aware that clearly the issues are running deep for Gareth. Supervision isn’t the place to deal with it – it’s the place to process Gareth’s reaction to Linda, to enable him to be emotionally available for her. It’s important that his responses to what Linda is presenting are genuinely empathic, with minimal disturbance from his own past. Gareth has not yet responded. Should she simply empathise and allow Gareth’s processing of what has arisen to take its own course, or should she mention now that this might be more of an issue for him to take to therapy, rather than supervision?
Maureen: It will be good to unpack some of this now but maybe there’s some therapy time needed as well.
Points for reflection
Caro Bailey explores the issues raised for the supervisor by this scenario
Richard Bryant-Jefferies (RJ-B): What are you own reactions to the supervision dialogue as it unfolded?
Caro Bailey (CB): I’m feeling, ‘Oh heavens, poor fellow! Gareth’s become far too entangled in the emotion of Linda’s story – why is that?’ – as well as thinking about my supervisory responsibilities. ‘Boundaries! Boundaries!’ is screaming in my head – or, rather, lack of here. I’m very conscious of the importance of modelling firm boundaries, particularly around issues of abuse.
RJ-B: Was Maureen’s final response the best one, or should she have waited longer for Gareth to respond?
CBMaureen has expressed her empathy for Gareth and indicated that supervision is not the appropriate place to explore his personal connections with the issue his client has brought. As his supervisor, Maureen needs to address not only the importance of Gareth seeking therapy soon but also the effect his own story is having on his work with Linda. There seems to be a parallel process here, not just between supervisee and client, but also potentially between supervisor and supervisee.
RJ-B: When a supervisee lapses into silence and it is thought they are processing something that has arisen, is this likely to be handled differently online than it would if it occurred in a face-to-face session?
CB: As different as working on the telephone. Our sensory perceptions are limited when we’re working in either of these ways, while our imaginations may work overtime. Face-to-face, we have all the information the person opposite is offering – not only through body language but also that which is unspoken between us. The co-creativeness that is such an important part of any relationship is so partial when it is limited to only one way of communicating.
RJ-B: As a supervisor, how would you see the supervision session developing and what areas do you feel you would specifically want to address with Gareth?
CB: I believe Gareth has supplied sufficient information about his own story for Maureen to urge him to seek therapy and to check how possible this might be. With this in mind, I would like to check out how the rest of his day works out when he over-runs to this extent and what this throws up for him. For example, how do his other clients feel about being kept on hold because his session with Linda has over-run? I also need to help Gareth explore how he might be able to end sessions on time with Linda. And before we end the session, I need finally to briefly explore how he is now feeling.
RJ-B: Is this a therapy issue? How do you distinguish a therapy issue from a supervision issue?
CB: It’s both. It’s an issue for therapy as well as being an issue about good practice in supervision. Essentially, I believe that supervision is primarily work-focused, while therapy attends to predominantly the personal. But we are one and the same person whatever role we are in. What this scenario throws up is that cusp between the personal and the professional: we cannot look at the task of supervision without addressing first the maintenance of the person offering it. Nevertheless, the emphasis and balance of what is offered in supervision is the ever-present third party work with the client.
What do you think? How would you have handled this situation? To respond to these points for reflection or join the discussions, email firstname.lastname@example.org
Caro Bailey has been counselling, supervising and training for over 30 years and is a co-tutor on the CASCADE diploma in individual and group supervision
Richard Bryant-Jefferies has written a number of books on counselling and alcohol use, in particular using fictitious dialogue to allow the reader to engage with characters and processes within the counselling room. He has been a counsellor and supervisor in the NHS and in private practice. www.richardbj.co.uk