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Clinical Supervision: Models, Role, Legal & Ethical, Cultural Competency, & Transference
Clinical Supervision: Models, Role, Legal & Ethical, Cultural Competency, & Transference

Section 46
Introduction: Transference and Countertransference in Clinical Practice and Supervision

Question 46 | Test | Table of Contents | Supervision
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

Distortions in Supervision

This section deals with transference and countertransference in clinical practice and supervision. We will discuss distortions and self-esteem, sense of loss, …..

Regarding therapist self-care and transference issues we will discuss: secondary traumatic stress, feeling inadequate, positive uses of countertransference, denial and resistance, the arrogance trap, thurman and watson landmark cases, and ensuring your safety.

Self-Esteem Needs of the Supervisor

Distortions in the Supervisor’s Ability
As you know, transference and countertransference operate as powerful forces in supervision, just as they do in treatment between supervisee and client. Although they are regarded as important influences in the supervisee-client situation; they may often be overlooked in the supervisory relationship. Unrecognized and uncorrected, these reactions may lead to distortions in the supervisor’s ability to listen to and to process the supervisory material. In addition, such difficulties inevitably distort not only the teaching and learning process between supervisor and supervisee, but the supervisee-client treatment as well.

Self-Esteem Needs of the Supervisor
I have found that when countertransference reactions occur in supervisors, a similar parallel process may occur in the supervisee, regarding their clients. When this countertransference between the supervisor and supervisee occurs, the self-esteem needs of the supervisor may distort the supervisor’s ability to assess the content of his or her supervision sessions. This type of reaction is often a sign that the supervisor has become too invested in gaining confirmation of the value of his or her own efforts. When this overinvestment in the value of effort happens, it may be easy for the supervisor to forget about or disregard the varying stresses the supervisee is experiencing as well. Have you found yourself experiencing countertransference reactions in sessions with your supervisee? What do you think you could do to adjust your behavior or reactions in these situations in order to best help your supervisee?

Ending of the Supervisory Period
In addition, supervisors may be significantly affected by the ending of the supervisory period with a supervisee. Unless the supervisor is aware of his or her reactions, much of what he or she communicates to the supervisee about the termination process may be significantly distorted.

Sense of Loss
One example of this is a supervisor who found himself unexpectedly intervening to offer support to a supervisee who was experiencing a sense of loss during the final weeks of a long supervisory period. The supervisor realized that his readiness to support the supervisee was a reflection of the sadness that he was feeling regarding the ending of his work with the supervisee. Can you relate? If you have already been providing supervision, recall your behavior towards your supervisee as the supervisory period was ending. Did you perhaps intervene unnecessarily to soothe feelings of loss, grief, etc.?

Risk Factors for STSD

In this section, we will focus on a supervisee’s personal countertransference reactions to a battered woman's traumatic events. As you may know, these reactions have the potential to create burnout for a supervisee.

First, let's look at a common reaction from a supervisee, Janelle, as she hears about a battered woman's trauma. Battered women experience traumatic and terrifying events, and these events and fears are brought out in therapy. Have you found, like I, that this can often result in a Secondary Traumatic Stress Disorder from the supervisee? As you know, STSD is the traumatic stress that the supervisee takes on from the client's trauma. Do you feel that STSD is a form of countertransference?

There are four key risk factors to Secondary Traumatic Stress Disorder. As you read these, imagine how your Janelle might feel at the end of her last session with a battered client. Do any of these sound familiar?

4 Key Risk Factors for STSD

Risk Factor #1: Empathy
Clearly, empathy is a major resource for supervisees in assessing the problem and formulating a treatment approach because the perspectives of the battered woman must be considered. However, research on supervisees’ Secondary Traumatic Stress Disorder suggests that empathy is a key factor in the transference of traumatic material from the primary to the secondary victim. Thus, by empathizing with a traumatized battered woman, the supervisee may become traumatized as well.

Exercise for the Supervisee
In the next session with your supervisee, consider bringing up the following exercise to help teach your supervisee about the effects of STSD.
Think back to the last session the supervisee had with a battered woman and your supervisee’s level of empathy with her. Do you feel you took the appropriate self-care measures to minimize residual countertransference effects of Secondary Traumatic Stress your supervisee may have experienced?

Risk Factor #2: Intrusive Imagery
As you know, intrusive imagery is a hallmark of PTSD and STSD as well. Through working with the battered or the batterer, supervisees may also experience intrusive imagery, often images of the scenes that the battered woman has described vividly. Certain images may hit very close to home and become nearly impossible to shake. At the end of this section, we will discuss some measures I have found to effectively decrease or rid myself of these images.

Risk Factor #3: Pessimistic Views
As I listen to the battered woman describe the batterer's capacity for cruelty, I can thereby begin to develop a more pessimistic view of others and their motives. Excitement and energy to meet a new client and be exposed to new ideas may be replaced by a sense of cynicism, doubt, and self-protectiveness towards the batterer. This cynisicm may depend upon my level of countertransference as I listen to the batterer’s capacity for cruelty.

Exercise for the Supervisee
In the next session with your supervisee, consider bringing up the following exercise to help teach your supervisee about the effects of STSD.
Think of those words for a minute: cynicism, doubt, and self-protectiveness. Think back to your first days and weeks on the job. Have you become more cynical or distrusting, doubting, and self-protective than you were on your first days on the job as a therapist treating battered women?

Risk Factor #4: Perceived Inadequacies
Supervisees may experience difficulty maintaining a positive attitude in light of their perceived inadequacies in their role as a helper. Questions may arise. At times your supervisee may feel overwhelmed with a seemingly endless flow of stories of suffering and feel unable to address the roots of the problem to prevent further pain. In your next session with your Janelle, consider asking her to rate her perceived adequacy on a scale of 1 - 10: 1 being totally inadequate, and 10 being totally adequate.

5 Steps to Alleviate STSD
Now that we have discussed four elements of Secondary Traumatic Stress, let's discuss five steps your supervisee can take to alleviate some of these feelings. These 5 steps are discussed as if talking directly with the supervisee.

Step 1. Do you have a system within your agency for supportive sessions with a co-worker who understands the dynamics of Secondary Traumatic Stress and has had experience dealing with domestic violence?

Step 2. Do you, or are you able to... organize your case load in such a way as to balance your daily schedule so you intersperse seeing battered clients with doing paperwork?

Note to the supervisor: As you know, scheduling domestic violence clients back-to-back may be creating added stress for your supervisee, rather than interspersing them with other tasks or clients with other problems. Obviously, this is a viable suggestion, only if your supervisee’s caseload permits.

Step 3. Have you taken time to identify your personal and social resources and supports? You do this all the time for a client. But how about for yourself? Take a minute to think about who and what your resources are that act as a pressure release valve for you. Do you need to use these people or activities more often?

Step 4. Do you know your own limitations? When you know your domestic violence client's issues may be too close to home for you, can you set your ego aside and consider referring your client to a colleague? Is the atmosphere in your agency supportive of these types of referrals? If it isn't as supportive as you'd like, are there any steps you might consider taking to increase the encouragement of referrals to colleagues?

Step 5. How comfortable are you admitting that you may have made a mistake or used poor judgment in a session with a battered woman?

Note to the supervisor: I have found that my own self-criticism and second guessing after a session with a battered woman can trigger many of the reactions mentioned earlier in this section related to intrusive imagery, pessimistic views, and my perceived inadequacies.

In this section, we have discussed four risk factors to the development of Secondary Traumatic Stress Disorder that may occur as a countertransference reaction to treating battered clients. These four risk factors are: empathy, intrusive imagery, pessimistic views, and perceived inadequacy. We have also discussed five steps that can alleviate these feelings. These five steps are: supportive session, caseload organization, resources, knowing limitations, and accepting mistakes. In the next section we will be discussing what I feel is the biggest trigger for STSD and possible burnout. This trigger is the perceived inadequacies that result from a battered woman's cycle of leaving and returning, only to leave and return again and again.

What are four risk factors to the development of Secondary Traumatic Stress found in supervisees treating battered women and batterers?
To select and enter your answer go to Test.

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