The value of Supervision for Complementary Health Practitioners
Within the counselling and psychotherapy professions the value of supervision has long been recognized. It is seen as best practice for a counsellor/psychotherapist to have regular supervision with an experienced fellow practitioner. Within the complementary health world its position is less well established. It is becoming a requirement on many training courses for trainees and newly qualified practitioners to receive supervision for their client work. In this article I argue for its relevance to all complementary Health practitioners and particularly for its role in supporting the maturation of a practitioner's work.
What is supervision?
Meeting regularly with an experienced practitioner with a contract to explore and support the practitioners client work, supervision has many advantages and functions. When working well it helps the practitioner to feel supported and backed up, deepening their confidence in their work and resources. It can decrease the feelings of isolation when working in private practice. Supervision can help lighten the emotional load of holding clients, especially when working with clients who are struggling with their life and/or health.
I find supervision is invaluable in my and my supervisees continual professional development. In what ever discipline we work, the training we do is the beginning of a working life's journey. There is a vast amount of theory and practice from different modalities that it is possible to integrate into ones practice. There are always new things to learn about the complexity of supporting another human being.
Supervision can provide a measure of safety for our clients. Someone else is there to help us see our inevitable blind spots; to support our exploration of how we habitually trip ourselves up. When we are more supported in our work we have more internal resources, are less likely to overstretch ourselves and to work within our competency.
Probably where supervision is most invaluable is when a practitioner gets into difficulties with a client. Supervision can provide space for reflection, feedback and a way forward. My experience is that the majority of a therapists problem times come from difficulties in the relationship with their clients. It is usually relatively straight forward to know what treatment to give a client; the hard part can be when something gets in the way of giving that treatment or the client receiving it.
Exploring the therapists motivation
Most practitioner's have strong motivation for their work, drawing from powerful personal experiences and beliefs. An important stage in any practitioner’s development is the exploration of what drew them to the work in the first place. Most people are drawn to the helping professions primarily to help others, to be of service, to be useful and to ease distress. However, when our motivations go unexamined (especially when they are powerful) they can act to limit our work and potentially undermine us.
A number of years ago I went through a long process in my supervision to unpick the habitual ways that I was relating to my clients. I explored my needs that I was frequently putting onto my clients such as; the need to be liked, to make things betterand to rescue when a client is in deep distress. It has felt a very creative process to free myself and in turn my clients from behaving in habitually restrictive ways.
What draws us to our work can have positive and negative aspects to it. Sometimes we can still be stuck trying to replay and heal our original family situation. Trying to do what we couldn't do as children can be played out in subtle ways. Our universal wish to be helpful can at times be unhelpful for our clients; especially if we are attached to being seen that way. Our clients need many things from us; an important quality is the ability to witness their experience and lives. We need to be able to offer more than a dynamic where we are the helpful one and they the receiver. Sometimes we need to listen to their anger, disappointment and to be able to hold a client who isn't finding us helpful. It's a very hard thing to step outside of our habitual needs but at times it is what our clients most need from us.
Contradictions within the Health Practitioner role
Clients come to see Complementary Health practitioners to be made better, to heal from an ailment. Central to practitioners work is their belief in wholeness in the inherent healing capacity of human beings. At the same time the practitioner is the expert who makes better and the one who facilitates the clients own healing. Clients usually expect the cure to come from the expert, the one who is a bit like a doctor. Practitioners will vary in where they place their work on the spectrum of a medical model at one end, to facilitating a process at the other. It’smy experience that both these concepts of treatment are informing a practitioners work and that there are inherent contradictions within the work.
Clients bring their expectations and ambivalences about being made better and the people who offer to do so. All these factors set up relationship dynamics between client and practitioner that are important to explore. Clients can often bring strong hopes and expectations, putting the practitioner on a pedestal, seeing them as knowing what’s best. Clients may put themselves in a disempowered position. Clients may swing from idealization of a practitioner to disillusionment, depending on how well the treatment unfolds. When a person is very ill these dynamics can intensify.
Clients come asking to be made better, but they also bring their resistance, the parts of themselves that don't want to change; getting better means real change often in deep unexpected, threatening and challenging ways. We all want to change and we all want to remain the same. The relationship with our clients is inherently complex and part of our maturation as practitioners is to embrace the complexity and contradictions.
Each client therapist relationship is unique
For practitioners who see individual clients regularly they can become an important part of the client’s life (and the client part of the therapist’s life); the relationship becomes more intense. Each client therapist relationship is unique; when two people meet they each effect and influence one another. The atmosphere with each client is subtly different. We find ourselves doing and saying slightly different things with each person. For those practitioners who are interested this can be a very useful source of information about the client. In this way we can use ourselves and our experience of the relationship as a resource in our client work.
Working Relationally
When working with clients the most difficult challenges have come when the relationship has become stuck, painful, when trust seems to have broken down. At these times it can feel very hard to turn things around and return to a creative working relationship. Supervision can provide a space to unload, to let of steam. A space to disentangle what of the therapist’s material has been stirred and perhaps to let go of it. Reflection, space and calming can be invaluable in these situations. What may become clear, either in supervision or with the client is that a replaying, a reenactment of the clients original wounding has happened. This happens surprisingly often, sometimes it can be experienced as very threatening; hopefully if it can be recognized and talked about it can be trans-formative for the client.
Supervision with a practitioner who works with the relationship can really open up new ways of thinking about our interactions with clients. Often our clients start doing unhelpful or strange things like arriving late, forgetting to pay or to come to appointments. Sometimes we start feeling and behaving in unusual ways towards certain clients, for instance getting frustrated, disliking them or being attracted to them. We often get 'dreamt up' to play a certain role for our clients. Sometimes we can feel pulled into making mistakes, these mistakes can be very accurate in hitting a clients wound, despite our best intentions not too. We all need to aim to work as ethically as we can. But our mistakes need to be seen within the complex context of the relationship with our clients. Sometimes our mistakes are just mistakes and sometimes they can be the very healing that our clients need.
It can be really helpful to talk through these kinds of experiences, to make sense of what’s going on. Someone who is outside but watching in onto a therapist work can be invaluable. Working with a supervisor who works with the relationship can open up new perspectives for a practitioner, and potentially turning difficulties into insights.
Conclusion
Supervision can help us expand our working horizons and learn more from our own and other disciplines. Group supervision and peer supervision can be very rich, especially when there is a diversity of approaches present. Central to the maturing of ones practice is the ability to think about, stand back from and process ones work. As our work matures we essentially internalize the role of the supervisor, so that we have that part of our selves as a resource in the room with our clients.
I have argued that the function and value of supervision is multi faceted and can provide invaluable insight into the complexity of the client therapist relationship. I believe that most practitioners can benefit from reflection on their client work with a supervisor.
Allison Priestman works as a Body Psychotherapist, Supervisor and Trainer in Stroud Gloucestershire. She can be contacted on 07814 891772,