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BookREVIEW: Supervision Essentials for Psychodynamic Psychotherapies

Joan E. Sarnat
2015 
American Psychological Association
pp170

Reviewer Anne Fullam

My reviewing of this book is timely; I have been undertaking a supervision training for which this book has been a good companion.  On mentioning the course to some colleagues, I have been asked why someone with more than 10 years post qualification experience would undergo such a training?  Why not take the grandparent route where the supervisor has their work overseen by another supervisor in order to fulfil criteria to become a registered supervisor?

That question is, in part, answered by this book.  It has been written primarily for psychodynamic and psychoanalytic supervisors and aspiring supervisors who wish to deepen their knowledge of the art of supervision.  However, the content could be of interest to any supervisor or supervisee, no matter what their theoretical orientation.

The main focus throughout the book is individual supervision – group supervision and all the various complicated dynamics, whilst acknowledged, are not covered.  Someone wishing to consider the dynamics of group supervision would need to look elsewhere.

Clearly written with both authority and humility, Sarnat’s book focuses on a relational model of supervision.  Although I would say all psychotherapy is in one way or another relational in that the relationship is key to a ‘successful’ psychotherapy, this book provides a way to thinking about supervision in the same way. Through the examination of the relationship between the supervisor and supervisee, knowledge is gathered and thought about.  It can then be utilised for the benefit of the patient, as well as to enhance the development of both the supervisee and supervisor.

The book starts with an introduction to the relational model and how Sarnat came to work in this way. She continues by defining the model in terms of three dimensions:

  • supervisor’s view of authority
  • the nature of the material discussed
  • the supervisor’s mode of participation.

Sarnat compares and contrasts the relational model with other more classical forms and ideas of psychoanalytic supervision.  She includes vignettes with good effect to illustrate how both the supervisee and the supervisor’s work can develop through attending to the three dimensions.

Using research literature, Sarnat evidences her hypothesis that the relational supervision model is effective.  As someone from a research background, who now finds themselves in a world often suspicious of research, with some justification, I found this inclusion refreshing and enlightening. Used sensitively, with thought, I believe research can help us become more effective both as therapists and supervisors. Mirroring research into a good enough psychotherapy, the literature review supports the need for what Sarnat calls ‘relationship competence’ (p44).

Research shows a preference amongst supervisees, perhaps unsurprisingly, to be in supervision with supervisors who are able to work openly with conflict, who can self-reflect, who are comfortable working with personal and professional issues together (without crossing boundaries that take them into a therapeutic role), and who provide a secure base.  In addition the findings confirm the importance of various other aspects of the supervision relationship, for example working in the here and now and parallel process.

Sarnat then considers supervisory methods that she considers distinctive to a relational psychodynamic approach.  These include techniques involved in assessment, negotiating a way of working, how material is presented, evaluation of supervisees, documentation of the process and supervisees’ difficulties.

I found a chapter based on the transcript of a supervision session really useful and interesting; it encapsulates Sarnat’s practise and philosophy of supervision.  It brings alive beautifully the various considerations present in the work – the class difference between the client and therapist, the anger the patient feels when her therapist moves consulting rooms, both the human and therapeutic reactions the therapist has towards the client’s anger, how the therapist experiences the shift from being idealised to being denigrated, the disconnection apparent between the patient and therapist and also between therapist and supervisor. All these elements play out in the dynamics of the supervisory relationship as supervisee and supervisor grapple with the material of the session and Sarnat, as a relational supervisor, “tries to adapt her methods to the context in which she is supervising, the needs of her supervisee, and what is being evoked by the particular patient who is under discussion” (p68).

Further chapters cover working with difference, legal and ethical issues; all are written in the same accessible style. Working with difference is a very important aspect of psychotherapy that was lacking depth in my original psychotherapy training. I am pleased it is present in this book, as I think it is a subject that deserves our greater attention. Sarnat believes that the relational perspective is “helpful in facilitating the process of acknowledging difference, sensitising supervisors to complex issues involved, and supporting the emotional work required to address those issues” (p101).  She acknowledges contradictions and blind spots in psychotherapy when it comes to difference; how as a profession we generally focus on training and treating the “relatively privileged” (p101). Sarnat cites the work of Layton on the ‘normative unconscious’, which describes how our cultural assumptions operate outside awareness and shape our attitudes towards and interventions with others, be they clients or supervisees.

The final chapter of the book looks to the future of supervision and a hope for increased psychodynamic supervisory effectiveness. Sarnat envisages a continuing evolution of supervision through trainings, supervision of supervision and teamwork. She hopes that supervisors will draw on research findings to inform their practice and utilise relational and experiential techniques and new technology to enhance their work.

Sarnat closes her book, stating that her intention on writing it was to “enlarge my readers’ sense of what is possible in supervision and to embolden them to try something new” (p139).  From my perspective, Sarnat has achieved what she set out to do. I embarked on my supervision training as I believe that although someone may be a skilled clinician, it does not follow that they will be a skilled supervisor. My course has helped me see that there is far more to supervision than I had imagined. Through the training, most of which is aptly experiential, I have realised how complex and fascinating a process it can be and this book compliments it.  Whilst I consider supervision to be key in maintaining an ethical therapeutic practice, there is far more to a supervisory alliance than the facilitation of this – it is a working relationship rich with possibilities.

Anne Fullam is an Integrative Psychotherapist and supervisor working in North and Central London.  Her work is informed by psychoanalytic thinking.