Note: This was originally published in Binah Magazine, in the ongoing column Therapy: A Sneak Peek Inside.
Here's a secret about therapy.
Therapists often go for supervision.
Here's a common scenario (although for reasons of confidentiality, I am using a scenario that has NEVER occurred—yet!):
I walk into my supervisor's office one day.
“I don't know what to do about Client X,” I say between clenched teeth.
“Sit down,” my supervisor says. She knows me for years and doesn't get fazed by my intensity. “Relax. What's going on?”
I laugh. “It's my client, Mr. X. He is my first appointment on Fridays, and I am late every week. I even leave the house early, and something always happens to make me late. Or I walk in by the skin of my teeth, panting from running to get there on time. It's driving me crazy.”
Let me explain about supervision.
All responsible therapists go for regularly scheduled supervision. Weekly, monthly, bi-monthly, whatever. A therapist can pay for supervision or can join a peer supervision group. Some therapists do both, or even have multiple supervisors to guide them in different aspects of their practice. So if a therapist works with disabled children, and also with adult survivors of abuse, she may go for supervision to receive guidance specific to disabilities in children as well as a second course of supervision addressing the impact of abuse in adults. Supervision is ongoing training for a therapist. In my opinion, and in the opinion of those seasoned professionals that I trust, you (okay, not you, but me) are never too experienced or too good for supervision. Or at least, a responsible therapist always feels he or she is in a constant flux of learning, although supervision is in addition to ongoing training that, again, any responsible therapist makes it her business to attend on a pretty regular basis.
A newly graduated and licensed social worker (LMSW) needs a minimum of two thousand hours of clinical hours within six years plus almost weekly supervision until she can apply for her clinical license (LCSW). Personally, I would not touch a therapist who ever stops going for supervision even if she/he is in the field over thirty years. Therapy is a very personal work in which the therapist's self is a crucial tool in therapy. And if that is the case, the therapist's self needs to be constantly in training to be with the times and with the program. Any therapist who thinks his/her self is perfect is not one who I would trust to perfect mine in therapy!
Many states requires a certain amount of training credits to be acquired over a two year period in order to maintain a social work license; although any self-respecting therapist will attend these training without that state requirement anyway. While trainings and workshops keep therapists informed about the newest ideas, interventions, and updated information, ensuring a therapist in the loop, supervision helps keeps the therapist's inner self grounded so that the daily grind of listening to problems and perhaps experiencing vicarious trauma does not impair her ability to be present and effective. Supervision also gives the therapist insight into how she functions as a therapist, and where her pitfalls are when working with specific populations and problems. It helps take away any blind spots in her vision when in the driver's seat of the therapist's chair.
Although supervision is not therapy, there are very interesting studies that show how the client-therapist alliance sometimes goes through a similar pattern that is enacted between supervisor and therapist.
So here I am struggling with Mr. X and my unnerving problem of showing up late—or almost late—for our appointments despite my protestations that I leave my house in a timely manner.
Who are we kidding? I know, because when a client of mine arrives late, even if only once, my antennas are up wondering what subconscious forces are at play that makes my client, despite his or her protestations, resistant to therapy that is manifesting itself in lateness?
So here is how supervision works:
Depending on years of experience and knowledge, my supervisor may talk about therapeutic concepts of resistance, transference, countertransference, and/or defenses. Then my supervisor will use different methods, be it Socratic questioning, confrontation, or talk to help me understand the forces that make me want to avoid therapy with this client.
And because supervision is fascinating, fun, and frustrating, I may learn a few things about myself that have been lurking in my blind spot.
Maybe I have been avoiding Mr. X because he reminds me of someone in my past that I disliked immensely (my halacha teacher in ninth grade)? Maybe because I feel ineffective in helping him solve his problems, and instead of dealing with my feelings of helplessness, I choose to run away (or come late?). Or, maybe the issue is simply because he brings a body odor into the room that I don't know how to address.
So my supervisor will model for me effective therapy tools that I will learn and pass on to my clients. She will help me build awareness of how my dislike of him may be rooted in my dislike of someone he reminds me of, that it really has nothing to do with him. And that needs to be addressed so I can see him for who he is: a person in pain who needs my help, so that I can genuinely like him and respect him. She will build on my strengths and help me uncover ways in which I can destroy those helpless feelings that I have, and probably he has as well; and empower myself and him to improve his life in ways which are important to him. She will trust me to figure out ways in which I can either help him with hygiene, or cope with the odor if it would not be in his best interests to become aware of how his odor affects me at this time.
And the funny thing is, although I may not be aware of it, my supervisor may be talking to her supervisor how she barely comes to sessions with me on time, and she doesn't know why it's happening. And her supervisor may help her uncover her reasons for avoidance...and then we all live happily ever after.
So now you know another therapy secret.
You gonna be on time next session?
My book, Therapy, Shmerapy, can be found in bookstores or online