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On the last track, we discussed three key ethical issues
involved in the supervision of a therapist: proper knowledge and skill; avoiding
dual relationships; and fair and balanced assessment evaluations.
this track, we will present methods to help improve your supervisee's therapist-client
In my experience as a supervisor, I prefer to review the
basics of a client session initially with a supervisee in four steps to make sure
we're on the same page. The fours parts I use are preparation; beginning; exploration;
and creating contracts. Of course, you will have your own system, but I feel it's
important not to assume that your supervisee is aware of some therapy basics,
so I state, "Let's make sure we're on the same page."
4-Step Review of a Client Session
The first step in therapist-client relationships that I believe
a supervisee should keep in mind to improve the therapist-client relationship
is preparation. Before actually setting foot into a room with the client, it would
be beneficial for the supervisee to prepare him or herself as much as possible.
In these cases, the supervisee would obviously review the client's history, whether
there had been: 1. Cases of abuse or other trauma issues in the past, 2. Whether the client is susceptible to suicide or other bodily harm, or 3. Whether their
history is entirely lacking in mental disorder.
On the supervisee's part, I feel
it would be useful to consult you, the supervisor, to identify any objectives
that should be considered before the first session. However, as you are aware,
as the supervisee's experience increases, the need for a preparatory consultation
with a supervisor will decrease. In readying a supervisee's empathy, I ask him
or her to consider what types of emotions a certain client will most likely bring
to a session based on their preparatory review and exploration. Preparatory empathy
could also include taking into account the client's cultural aspects.
Because preparatory empathy I feel is one of the more
key preparation tasks, I ask some of my supervisees to undergo an "Empathic
Exercise" technique prior to working with their first client. In this technique,
I relate to the supervisee a scenario and ask him or her to write down their emphatic
One of my scenarios is the following: "Assume that you are a therapist
in a general hospital. This morning, a physician contacts you and asks that you
accompany her while she informs the mother and father of a 16-year-old boy that
their son has AIDS. The physician wants you to provide support to the family after
she informs them of the diagnosis and prognosis." Many times, the supervisee
states: grief, anger, maybe resentment. Also an occasional sense of loss and failure
as parents. I also ask them to take into account the potential sexuality question,
whether or not the client is homosexual and if the parents are aware of this.
Step # 2 -
The second phase in covering therapist-client relationships
with your supervisee is the actual beginning of the first session with a client.
Two Parts to Beginning the First Session with a Client
As you know, this stage formally begins when a supervisee in the role of a therapist
and the client encounter one another. First impressions are vital, so it's necessary
to review proper introduction etiquette. Here are the basics that bear repeating.
They are so basic, I find that many supervisors overlook them and assume their
supervisee has learned this in grad school.
The supervisee usually starts by identifying
him or herself by full name and profession, and by agency or departmental association. For example, a supervisee might say, "Hello Mr. and Mrs. Doe" and at
this point the supervisee would offer a hand to shake and continue, "I'm
Dr. Colby. I'm a therapist here at the family service agency. I specialize in
helping people who are dealing with family issues of one kind or another."
The next step in the beginning phase would be describing initial purpose for the
visitation. The supervisee would state clearly and succinctly, "During our
meeting today, I'd like to explore in detail with you the nature of your marriage,
its history, and how it developed to this point. As we both gain a better understanding
of the circumstances, we can decide together what to do next."
As you can
see, though the therapist clearly stated the purpose of the meeting, he left it
open for the client to outline his or her own roles. Also remember to explain
to your supervisee the importance of discussing ethical and policy factors to
the client such as confidentiality, reporting laws, or any other such legality
Step # 3 - Exploration
In addition to preparation
and beginning, the third phase in therapist-client relationships when covering
the basics is exploration in which the supervisee engages the client in a mutual
exploration of the person, issue, or situation.
7 Exploration Skills
As you know, the skills most applicable
to the exploration phase are: 1. Asking questions that led to the situation
the client now finds him or herself. 2. Seeking clarification on statements
that may seem unclear. 3. Reflecting content in communicating your understanding
of the factual or informational part of the message. 4. Reflecting feelings in communicating your understanding of the feelings expressed by the client. 5.
Reflecting feeling and meaning by using the format "You feel this emotion
because of this situation." 6. Partializing is used to break down several
aspects and dimensions of the person-issue-sitatuation into more manageable units
to address them more easily. 7. Going beyond what is said to extend slightly
what the client has actually said according the supervisee's empathic understanding
of the client.
By emphasizing these skills to your supervisee, you can help
them more efficiently explore the dimensions of a client's situation.
Step # 4 -
In addition to preparation, beginning and exploration,
a fourth phase in the basics of therapist-client relationships that I cover with
my supervisee is creating
contracts. Creating contracts involves reflecting an issue, clarifying issues
for work, and establishing goals.
Two Steps to Creating a Contract
A. Reflect an Issue
To reflect an issue, I ask my supervisees to
try the following format: "As you see it, one of the issues you'd like to
address in our work together is_____" As you can see, the supervisee, through
this format, can demonstrate to clients that he or she understands their views
of an identified topic of concern.
B. Clarify Issues
To clarify issues for work, I ask my supervisees
to extract these issues from those the client has identified, those the supervisee
has contributed, or some negotiated combination of the two.
To facilitate relationship
with clients, I ask supervisees just starting out in a session to try the following
format: "I think we agree about the primary issues that we will address in
our work together, Let's review them and I'll write them down so that we can refer
to them as we go along. First there is the issue of _____. Second, the issue of
_____. Third, _______. What do you think? Is this an accurate list of the issues
that we'll address together?" Notice that the supervisee is always including
the client's opinions on a course of action.
On this track, we discussed methods to help improve your supervisee's therapist-client relationships
by relating the basic method of an interview session with a client in four steps:
preparation; beginning; exploration; and creating contracts.
the next track, we will examine ways to evaluate and identify problems in the
supervisor-therapist relationship and in the therapist-client relationship: identifying
avoidance of conflict; and the "Interview Session Checklist".
The Relationship Between Therapist–Client Modality Similarity
and Psychotherapy Outcome
- Herman S. M. (1998). The relationship between therapist-client modality similarity and psychotherapy outcome. The Journal of psychotherapy practice and research, 7(1), 56–64.
5 What are four steps in an interview session with a client that might
benefit the therapist-client relationship of a supervisee? To select and enter
your answer go to CEU Test.