Supervising Systemic Couple Therapists

Transcription

1 Supervising Systemic Couple Therapists Cheryl L. Storm What is unique about supervising couple therapists? A beginning answer to this question is that couple therapists need supervisory support to develop specific proficiency in areas key to successful couple therapy, more so than for other relationally oriented therapy (Storm, 2007). A contextually informed best practice recommendation is for supervisors to develop proficiency within their scope of supervision practice, such as supervising couple therapists (see Chapter 17 in the accompanying book). In this resource, I discuss three of the areas supervisors can focus on with systemic therapists to help them be proficient with couples. The first area is assisting supervisees to uncover their own and their clients values and beliefs about coupling, especially in areas linked to effective CT such as gender (Johnson, 2003; Johnson & Lebow, 2000; Knudsen-Martin & Mahoney, 2005; Lebow, Chambers, Christensen, & Johnson, 2012). The second area is supporting systemic therapists in developing and maintaining the therapeutic alliance, which has a unique complexity in CT. The final area is helping supervisees to be comfortable with the expression of emotion that is prevalent in CT and to work with it constructively to effect change. These areas are based on themes that have emerged in my experience of supervising systemic couple therapists, and have been supported by evidence regarding effective systemic couple therapy (see the review of research on systemic therapy with couple distress (Lebow et al., 2012)). As a result, they have some theoretical and pragmatic credibility. However, the research and literature upon which it is based is heavily weighted toward European and North American, heterosexual, The Complete Systemic Supervisor: Context, Philosophy, and Pragmatics, Second Edition. Edited by Thomas C. Todd and Cheryl L. Storm John Wiley & Sons, Ltd. Published 2014 by John Wiley & Sons, Ltd.

2 2 middle-class couples. Readers are referred to the developing literature for additional specific knowledge and capabilities that are required by systemic couple therapists to be proficient in working with other types of couples, such as same-sex couples, cross-cultural/racial couples, or couples diverse in other ways. Each of the supervision tasks is briefly discussed later with a suggested supervisory intervention. Further discussion and case supervision illustrations can be found in Storm (2007). Uncovering Values and Beliefs about Coupling in Supervision Attending to the meaning of gender roles and relationship equality, the meaning of commitment, marriage, acceptance of same-sex coupling and marriage, and cultural ideas of relationship (e.g., individualistic, collectivist) come to the forefront in supervision and therapy when supervisees are working with couples. Supervisees values and beliefs play a vital role because they often subtly affect the process of CT. A primary supervisory task therefore is to help supervisees do selfof-the-therapist work to identify, understand, and clarify their own and their clients values and beliefs about coupling, and to help them assess the intentional and unintentional effects on CT. These values and beliefs are often a result of intersecting multiple social identities, such as religious/spiritual beliefs, ethnicity, and gender. For example, some supervisors and supervisees may have strong beliefs about same-sex marriage or gender roles stemming from these intersections, which need to be uncovered in order for effective supervision and therapy to occur. In order to accomplish this goal, supervisors create a climate for respectful dialogue in supervision concerning their own and supervisee s values and beliefs about coupling. Supervisors may wish to make a statement that includes information about their values and beliefs and invites their supervisees to do the same: Supervisees and couples I have worked with have values and beliefs that are at times very different than mine. For example, sometimes supervisees and couples have viewed one partner (usually the woman in a heterosexual couple) as having far less power as the ideal, when I believe in more egalitarian relationships. These beliefs about coupling and marriage stems from a combination of my ethnic, generational, racial, and class influences and can lead me to focus intensely with supervisees on engaging both partners in CT in order for shared information and mutual participation in resolving relationship difficulties. I am interested in what your views are about coupling and in your experiences with couples you have worked with up to now. This type of supervisor self-disclosure, when done as an invitation, has led to fruitful discussions in supervision about the meaning of coupling and its effect on CT, especially in supervision groups where there is likely to be divergent perspectives. Two instruments that can also stimulate discussion are The Power Equity Guide that focuses on gender and power differentials in CT during

3 3 supervision (Haddock, Zimmerman, & MacPhee, 2000) and The Sexual Orientation Matrix for Supervision (Long & Lindsey, 2004) that focuses on supervisors and supervisees level of acceptance of same sex relationships. Long and Serovich (2004) also make specific recommendations for supervisors regarding how to proceed with supervisees who have strong beliefs that make it difficult for them to work with LGB clients. Developing and Maintaining the CT Therapeutic Alliance The therapeutic alliance is critically important in CT because early research found premature termination is higher than in individual therapy (Bischoff & Sprenkle, 1993), and evidence indicates it is necessary for effectiveness (Bedi & Horvath, 2004; Garfield, 2004). However, it is more complex. It involves establishing multiple alliances, one with each partner and the therapist and one simultaneously with the dyad. In addition, the therapist must accomplish this when the dyad relationship is itself the focus of therapy. A primary supervisory task is to assist supervisees in understanding, developing, and maintaining this type of therapeutic alliance throughout CT. This involves processing with supervisees their experience of the therapeutic alliance and helping them to learn how to do so with each partner and the couple so they can maintain a strong alliance as therapy progresses. This requires supervisees to accommodate the potentially divergent interests, motivations, goals, and values of each partner in the context of the tripartite therapeutic conversation (Bedi & Horvath, 2004, p. 67). When a split alliance (i.e., a working relationship with one but not both partners) occurs, supervisors help supervisees address the situation. Supervisors can use the questions such as those below to guide them in processing supervisees experiences of the therapeutic alliance: Are supervisees creating a safe, trusting environment where they establish a bond with each partner, validate and understand both partners perspectives simultaneously while refraining from side-taking and invalidating either partner s experience? Were supervisees drawn to one or the other s viewpoint; and if so, what drew them there? Was there a balance of speaking time and focus on concerns of each partner? What could supervisees explore in the next session that could help them understand each particular person s viewpoint? Information from these questions can help systemic supervisors determine what to focus on in supervision with supervisees and how to guide them in determining possible therapeutic responses. Supervisors may wish to refer their supervisees to Garfield s (2004) guidelines for establishing and maintaining the alliance in CT. They can also encourage

4 4 supervisees to check with clients frequently to determine if there is agreement in therapy about goals, tasks, and whether couples overall expectations for therapy are being met all indications of a solid alliance (Odell, Butler, & Dielman, 2005). If only one partner shows for therapy, supervisors may want to remind supervisees to explore their alliance with each partner and the couple; some therapists (especially novices) may unintentionally promote a split alliance by agreeing with the perspective of the participating partner in therapy and may need supervisory support to find ways to improve the alliance with the missing partner and the couple as a whole in this situation. Supervisors and supervisees may find listening to the supervisee s language (i.e., watching for negativity or subtle agreement with one partner over the other) in therapy as helpful in identifying alliance issues. And finally, supervisees often report that they are drawn to the perspective of one partner over the other, even reporting struggling with disliking a partner. Supervisors help supervisees work through these feelings and strengthen, or even establish an alliance with the unlikeable partner and the couple as a unit. Sometimes just bringing the feelings out into the open and helping supervisees to understand them in context are enough to start the process of repairing the alliance. The supervision alliance is as crucial for the supervision process as it is for the CT process; establishing it and maintaining it is always a central supervisory task. For example, a secure supervisory alliance is stressed in the emotionally focused supervision model used in training couple therapists (Palmer-Olsen, Gold, & Woolley, 2011). The supervisory alliance is stressed in almost all systemic supervision models. See Chapter 16 in the book for a discussion of potential problems in the supervision relationship. Becoming comfortable with the expression of emotion and constructively working with it Couple interaction is often intensely emotional. Effective couple therapists are comfortable with emotional intensity, including having the ability to slow down couple interaction, use repetition to process strong emotions, and be proactive in structuring therapy sessions to facilitate interaction between partners (Johnson, 2003; Johnson & Lebow, 2000). There is evidence that marital distress is associated with the expression of emotion by a spouse that is ignored by his or her partner (Johnson, 2003). As a result, a primary supervisory response is to assist supervisees in becoming comfortable with the expression of emotion and working with it constructively in CT so supervisees refrain from shutting down emotion prematurely or allowing it to escalate unproductively in sessions. Supervisors should assess their supervisees for their ability to intervene with couples using enactment-based interaction (i.e., couple interaction that is guided by the therapist, which evidence suggests is preferred by couples (Butler & Wampler, 1999; Estarda & Holmes, 1999)). Davis and Butler (2004) offer a conceptual step-by-step framework for facilitating enactments with couples that can be used across therapy models, and Butler and Gardner (2003) provide guidance for enactments over the course of CT. Palmer-Olsen et al. (2011)

5 5 suggest supervisory strategies, such as practicing choreographing enactments, that supervisors can use to assist supervisees in the mastery of enactments in emotionally focused therapy (EFT). In addition, supervisors ensure that supervisees routinely structure sessions to assess for domestic violence in CT and intervene if it is present. Supervisees may need to debrief the intense emotions expressed in CT and assist supervisees to regulate their emotions as well (Palmer-Olsen et al., 2011). They may also need to guide supervisees in selecting among methods for working with emotion that fit with their styles and preferred ways of practicing CT (c.f., Dattillio (2000) for ways of changing schemas associated with emotion in cognitive-behavioral CT, or Sinclair and Monk (2004) for a discursive process to help couples negotiate conflict). The Rewards of Supervising Systemic Couple Therapists Supervising couple therapists can be particularly rewarding because of the emerging body of solid evidence regarding the abilities needed by supervisees to work with couple distress in general and for some specific types of couples; supervisors have something concrete on which to base their supervision and the specific skills to help their supervisees develop. It can also be rewarding because it enables supervisors and supervisees alike the opportunity to focus overtly on change in relationships when those involved in the interaction are active participants; a hallmark of systemic work but somewhat of a rare experience in today s complex therapeutic environment. References Bedi, R. P., & Horvath, A. O. (2004). Balanced versus biased alliance: Perceptions of own and partner s alliance and psychotherapeutic outcome in short-term couples therapy. Journal of Couple and Relationship Therapy, 3(4), Bischoff, G., & Sprenkle, D. (1993). Dropping out of marital and family therapy: A critical review of the research. Family Process, 32, Butler, M. H., & Gardner, B. C. (2003). Adapting enactments to couple reactivity: Five developmental stages. Journal of Marital and Family Therapy, 29, Butler, M. H., & Wampler, K. S. (1999). Coupleresponsible therapy process: Positive proximal outcomes. Family Process, 38, Dattillio, F. (2000). The restructuring of family schemas: A cognitive-behavioral perspective. Journal of Marital and Family Therapy, 31, Davis, S., & Butler, M. (2004). Enacting relationships in marriage and family therapy: A conceptual and operational definition of an enactment. Journal of Marital and Family Therapy, 30, Estarda, A., & Holmes, J. (1999). Couples perceptions of effective and ineffective ingredients of marital therapy. Journal of Sex and Marital Therapy, 25, Garfield, R. (2004). The therapeutic alliance in couples therapy: Clinical considerations. Family Process, 43, Haddock, S., Zimmerman, T. S., & MacPhee, D. (2000). The power equity guide: Attending to gender in family therapy. Journal of Marital and Family Therapy, 26,

6 6 Johnson, S., & Lebow, J. (2000). The coming of age of couples therapy: A decade review. Journal of Marriage and Family Therapy, 26, Johnson, S. (2003). The revolution of couple therapy: A practitioner-scientist perspective. Journal of Marital and Family Therapy, 29, Knudsen-Martin, C., & Mahoney, A. R. (2005). Moving beyond gender: Processes that create relationship equality. Journal of Marital and Family Therapy, 31, Lebow, J. L., Chambers, A. L., Christensen, A. J., & Johnson, S. M. (2012). Research on the treatment of couple distress. Journal of Marital and Family Therapy, 38, Long, J., & Lindsey, E. (2004). The sexual orientation matrix for supervision: A tool for training therapists to work with same-sex couples. Journal of Couple and Relationship Therapy, 23, Long, J., & Serovich, J. (2004). Incorporating sexual orientation into MFT training programs: Infusion and inclusion. Journal of Marital and Family Therapy, 29, Odell, M., Butler, T., & Dielman, M. (2005). An exploratory study of clients experiences of therapeutic alliance and outcome in solutionfocused marital therapy. Journal of Couple & Relationship Therapy, 4(1), Palmer-Olsen, L., Gold, L. L., & Woolley, S. R. (2011). Supervising emotionally focused therapists: A systematic research-based model. Journal of Marital and Family Therapy, 37, Sinclair, S., & Monk, G. (2004). Moving beyond the blame game: Toward a discursive approach to negotiating conflict within couple relationships. Journal of Marital and Family Therapy, 30, Storm, C. (2007). What is unique about supervising couple therapists? A beginning answer. In J. Wetchler (Ed.), Handbook of clinical issues in couple therapy (pp ). New York: Routledge.