AN OVERVIEW OF SUPERVISION OF PSYCHOTHERAPY AS A COMMUNICATIVE RELATIONSHIP (Part 2 of 3)
An Overview of the Supervisory Situation
[If the reader is not familiar with what goes on in supervision of psychotherapist training, the verbatim source material for Example 1, in Appendix A, below [see note in text of Example 1, for explanation why Appendix A is omitted here], provides a sample. The reader may wish to read that excerpt from a supervisory relationship along with this subsection, to help "flesh out" what here will be presented more discursively.]
Supervisor and supervisee can enter into their relationship in a number of ways. The training institute may unilaterally assign a student to a particular supervisor. The student may be given opportunity to select a supervisor from an institute-approved list. In this case, the student may choose from among the more active faculty members whom he or she knows from the context of classwork; the student may choose based on "word of mouth" reports of other students' experiences; the student may systematically check out the list and interview unfamiliar candidates.... Sometimes a student may even get special dispensation to have a supervisor who is not associated with the training institute (in this case, both the student and the institute generally expect that the evaluative reports the supervisor submits to the institute will likely be unrevealing[, and, in consequence, like a defendent "taking the fifth amendment", the very fact that the student didn't pick a "better" supervisor generally constitutes evidence against the student's progress, both in training, and also in "analysis"]). In any case, the supervisor and supervisee arrange to meet, usually at a regular time, once a week, for a 45 or 50 minute session (this logistical form is most common where the supervisor is a therapist in private practice and the supervision comes to occupy one of the "therapy-hour" slots in the therapist's schedule).
To each session, the supervisee brings news of what transpired between him or herself and his or her clients in their therapy sessions since the last supervisory session. The supervisor listens to this material and talks with the supervisee about specific points in the new material, more general issues the material may suggest, perhaps also material from previous sessions which is still pending or may relate to the new material, etc. If there is important case management work to be done, it will likely receive priority; when there is no pressing "business," conversation may go off to gossip about the student's training program, the supervisor's reminiscences about his or her own training, or altogether extrinsic matters.
But the core of the supervisory interaction is the supervision of the supervisee's work with current clients. As previously noted, there are two main foci here: (1) protecting the client against possible negative consequences of the supervisee's inexperience (the supervisor frequently has legal liability in this regard), and (2) helping the supervisee improve his or her competence as a therapist. It is not an exaggeration to say that, within these very broad parameters, the communicative interaction between the two persons can be "pretty much anything." To give some flavor of the range of possibilities, I will examine in some detail three salient issues in the theory of supervision.
The student tells the supervisor what happened in the student's therapeutic work. This reportage can take many forms. There is an extensive literature on this topic, to which I have little that is new to contribute except to come down even more strongly on one side of the debate than do its supporters in the literature. The debate, in brief, is between verbatim and expressive reporting -- whether it is more important for the supervisor to find out exactly what happened between the student and the patient, or for the supervisor to find out what the student's existential engagement is with what went on (and is still in process...).
From a communication theory point of view, the supervisor who wants to "know what really happened" is pursuing a chimera. Even video and audio tapes do not capture the internal processes of student and patient (see, e.g., Glover, 1955, p. 111). For a variety of reasons, patients are not asked to write up their unreported thought processes for later study (one reason being that a patient is not supposed to have any such processes, but rather to report everything that comes to mind to the analyst on the spot). Even if patients did produce such reports, the results would be interpretations from memory, prepared with a certain audience in mind. There is greater chance of getting the student to write up his or her unvoiced material, but this too would be ipse dixit evidence, and, in addition, knowing he or she had to do this would often interfere with the student having the very processes he or she was supposed to report (due to fear of consequences of concealment, self-revelation, etc.).
Even assuming that one can get "good enough" material to do a rigorous analysis of the therapeutic interaction, it might be well to recall Ray Birdwhistell's report that in close study of conversation in which he was involved,
...techniques were developed that reduced recording and analysis time (when working with conversants speaking American English) from about 100 hours per second to less than 1 hour per second." (Birdwhistell, 1970, pp. xi-xii)
Even granting the unlikely prospect of another 100-fold productivity increase, one could still study only 1 minute of a single psychotherapy session in an entire 45 minute supervisory session. To try to really find out what happened in the therapy interaction (instead of making lots of assumptions and glossing over a lot of potentially diacritical details, etc.) would destroy the supervisory process.
For students to do such in-depth analysis of therapeutic interactions a few times as part of their training would, I believe, be highly useful -- not, however, for any possible direct effects (benefits) the results the particular exercises undertaken might have for the therapies from which the material analyzed was taken. Instead, the benefit would be in giving the student a richer sense of the subtle complexity of human communicative interaction, in general, and making the student perhaps a bit less naively sanguine about the validity status of the many conclusions to which, in doing real therapy in the real world, he or she will frequently have to jump.
Micro-communication analysis of therapist-patient interaction is, of course, not what so-called "verbatim reporting" is about. In many cases the assumption is that by listening to a recitation of "who said what to whom," with occasional annotation of accompanying non-verbal phenomena ("Here the patient cried," etc.), the supervisor can "read off" what happened, and, further, what it meant, by applying typical patterns of interpretation to any case material thus reduced to a standardized presentational form. It is plausible that this kind of communicative interaction "deutero-teaches" the student (by example) to similarly gloss over patients' material, even while the supervisor may lecture the student on the importance of attending to details of context.
The other important use to which verbatim reporting is put is to focus on a small interactional sequence and point out to the supervisee how to fine tune his or her interaction with the client (the Masterson approach to treating "character disorders," for one, uses this approach extensively). This approach seems strongly to conduce toward treating the interaction between therapist and patient strategically, so that the treatment may cease to be psychodynamic even though it uses theoretical constructs of a psychodynamic theory.
The first objection to verbatim reporting can be addressed by the supervisor acknowledging its limitations:
Look, A, from what you've reported to me it sounds like [such and such] is going on with P. Since I wasn't there then, and none of us can go back now and get more information that would clarify things further, this can only be an educated guess. Check out what I've said, and see if it helps, or not.
This direct instruction, with its self-consistent effect of diminishing (making provisional) the credibility of the supervisor's interpretation, would likely help the student, if the student follows his or her teacher's example from supervision and jumps to conclusions in therapy, at least to present these conclusions to the patient as tentative hypotheses to check out and not as dogma (for a patient who has always been told dogmatically what to do by authority figures, this self-restraint by the therapist authority figure may be helpful). I see no way, however, of even equivocally redeeming the second use of verbatim reporting, in which supervisor and supervisee mutually preen their ideological feathers which they have tarred to the patient's back.
As an occasional measure, however, verbatim reporting has its uses. In these cases, sometimes even better than a transcript is audio or video tape. If there is something about the client's presentation which the student feels he or she cannot adequately describe, a recording may be an effective aid to communication.
Where there is sufficient trust between supervisor and supervisee that the supervisee really is fairly secure in exposing him or herself to "his" or "her" [the personal pronoun here indicating positive cathexis[, not inability to shake off an incubus...]] supervisor, if the two listen to or watch a tape of the student's performance and imaginatively associate to it, they may come up with lots of ideas possibly worth exploring. Of course, then the material is just a kind of catalyst for the associative process, and other material with different concomitant interactional properties (e.g., a case report from the literature) might suffice (or even do better).
This consideration segues into the expressive model of reporting, but, to finish this look at the verbatim approach, it may be of value to consider a bit further its implications as a communication medium (irrespective of the messages being conveyed). Stated as a quasi-mathematical relation: the higher the quality of the report (the more detailed, comprehensive and exact it is), the more the student is "put on the spot." If the supervisor criticizes something the student recalls from memory, the student can say maybe he or she didn't quite remember it right; if the student reads from verbatim notes, he or she can say the words don't capture some of the non-verbal material; if the student's behavior is captured on high-quality audio-video recording, the student can only protest that the camera gives a false impression; if the supervisor was watching, in vivo, behind a one-way mirror, the student may not even feel it worth trying to explain him or herself. A deutero-message here is that one had better watch one's steps. Verbatim reporting is a fundamentally persecutory setup in which the only possibility of safety is the beneficence of the supervisor. In this -- best -- case, the student iatrogenically develops a strong bond of dependency to the supervisor, which is at odds with psychodynamic therapy's aim of fostering personal autonomy.
Air Force Colonel (ret.) John Boyd, in a lecture at IBM Research (1983), explained in a different context the fundamental problem of verbatim reporting, and how to avoid it. Boyd said that the German officer corps in World War II had a bond of mutual trust based on shared traditions. Within this underlying structure, orders were generally given orally, not in writing, so that if, at the point an order was actually to be executed, the responsible officer decided it was not appropriate to the reality of the situation (as opposed to what the people who issued the order thought in past and elsewhere), the officer could disobey and do what he thought was right without having to fear that, if things turned out badly, he could summarily be court marshaled. Since the order was only verbal, the officer could always say he didn't get it or he misheard it, without fear of the transcript coming back to haunt him.
In psychotherapy work, where, just as in war, lives are at stake, the same desiderata seem applicable: If you cannot trust a person then do not entrust that person with an important mission (rather than trying to check up on them to keep them in line). If a person is conscientious, then his or her self-respect should not depend on someone else's deigning to not use against him or her evidence which has little other reason for being produced. (If ever there was a practical application for implementing Heidegger's notion that human existence [a.k.a. Dasein] is a clearing in the midst of the density of being where things can come into the open and manifest themselves as being what they are, surely it is here.)
Of course there is need for the supervisor to know what's happening with the student's patients. But verbatim reporting can even be a way for the student to hide incriminating material. If the student has 5 client hours to report and time to cover only 2, the student has a 60% chance of "lucking out" by just doing what he or she is supposed to do, and "telling everything" (in a certain order, of course).
I can see a verbatim-recording oriented supervisor protesting here: "Wait a minute, that's not what I meant. Of course A should volunteer his or her mistake first thing in the supervisory session!" If verbatim reporting does not, by its formal structure, accomplish the tasks for which its employment is introduced better than less oppressive alternatives, if its efficacy no less than theirs depends on the participants' good will and good sense in using it, it seems difficult to justify it unless its oppressive attributes are genuinely valued for their own sake. One alternative would be for the supervisor to tell the supervisee at their first meeting:
You don't know me and you don't have any reason to trust me, at least until I earn your trust. But I'm legally responsible for what you do with your clients. So one thing I demand is if you do anything that you in any way suspect has the least chance of anybody getting hurt or getting us sued, you have to tell me ASAP, or you're out of here. Not for what you did (which may turn out to be no big deal), but for hiding it. This has nothing to do with you personally; I tell it to every supervisee before I know enough about him or her to have any idea whether it will ever apply to the person. If you have any problems with this, then let's stop before we start and I hope you find a supervisor you can work with. Other than that, I'll try to work with you however you want and I'll help you any way I can.
Expressive reporting is not immune from possibilities of abuse. Whatever the supervisee says, there's likely some way a determined supervisor can humiliate him or her with it. But expressive reporting, as a medium (form of communicative interaction), is not intrinsically disempowering. The student tells the supervisor what the student feels is important, in a way the student feels presents it (and him or herself) fairly, and, balancing ethical duty against personal shame and the limits of his or her trust in the supervisor, the student can choose to report mistakes he or she has made which the student suspects might have reality repercussions and keep to him or herself other actions from which he or she has already "learned a lesson" in his or her own mind (or which the student even believes are right but fears would not be looked upon favorably by the training institute) and just doesn't feel comfortable enough to share with the supervisor. A deutero-message of the expressive reporting model, used constructively, is that the student has the competence to do and report on his or her own therapeutic work, not in the sense that he or she knows how to handle every eventuality, but that, if he or she doesn't know what to do, he or she does know enough to know that and take initiative to ask for help. An unhelpful way of using expressive reporting would be for the supervisor to tell the student to just say whatever he or she wants, and, if the student replied he or she didn't know how to proceed, for the supervisor to just sit and stare at the student until the student did figure out something to do.
In 1935, when psychoanalytic education was still in process of being born, Helene Deutsch stated the case for expressive reporting in a way which leaves little to add:
The [supervisor's] first task... is to recognize the candidate's own difficulties and complex attitudes.... The second one is, to get a clear picture of the patient and the current [treatment] situation before intervening in any active manner with advice or corrections. I know that to attain this, some colleagues ask the candidate [for verbatim transcripts]. At the beginning I did this too; the technique which I have gradually worked out for myself is based on two factors: one is the well-known importance of the "incidental remarks" which betray the patient's unconscious, and which are beyond the young analyst's conscious grasp. According to my experience, writing down the material seriously disturbs the young analyst's intuitive attitude and makes him concentrate too much on the second factor in analytic work, on the intellectual working up of the material.
Another factor to which I should like to call your special attention as [supervisors], is the following: The candidate's unconscious actually absorbs the material given him by the patient at a time when he is still completely free from understanding its importance. If the candidate is allowed to reproduce the material in free association, one can see how much more wisdom his unconscious shows in the reproduction than does his conscious knowledge. (Deutsch, 1983, pp. 64-5)
Excepting in cases where important pragmatic issues are involved, in general it does not so much matter exactly what happened in the sessions being reported as what are the possibilities for action in the sessions to come. Any scenario supervisor and supervisee examine, whether from magnetic recording or uncertain memory, has its value in the imaginative play through which the supervisee explores alternatives to improve his or her general orientation to the therapy situation. Indeed, to determine exactly what happened in a certain session and exactly how best to respond to that event, which can never recur in the exact same form, will generally be less productive than schematically hypothesizing several possibilities for what happened in the session and a variety of ways to handle each and comparing them all to gain a better handle on kinds of situations which are likely to occur in future, and, further, to develop higher-order coping strategies.
Further benefits of the expressive style of reporting include developing the student's competence and self-assurance in organizing and managing his or her caseload (see, e.g., Fleming & Benedek, 1983, p. 36) ("What is most important for me to talk about in supervision today? What can I handle myself? What can my supervisor really help me with?...").
To repeat a point Deutsch made, expressive reporting need not be a privilege the student "earns" after having done a stint of verbatim reporting. A perceptive supervisor hears important clues in whatever the student, even in the most naive unawareness, may say. If a goal of training is to break candidates' spirits, however, then forcing them to do verbatim reporting at first, when it is most threatening to their self-esteem, may be highly effective.
Student versus Patient
One way or another or in a combination of ways, the supervisee reports his therapeutic efforts to the supervisor. The supervisor here faces a major issue which is generally "not black and white but shades of gray," and which allows for wide variation in supervisory style and its effects on both supervisee and patient. The two alternatives here are: (1) for the supervisor to focus on the supervisee's development as a therapist and, except for serious contingencies, leave the supervisee to do the therapy without supervisory intrusion. In this form of "trickle-down" pedagogy, the quality of the particular patient's therapy improves as a side-effect of the student's overall professional growth. Or: (2) the supervisor can focus on the patient's therapy (the verbatim mode of reporting is helpful here) and tell the student what to do for the patient to get the best therapy. In extreme cases, the patient gets therapy from the supervisor by proxy, with the supervisee functioning approximately like a message courier. In this form of "trickle-down" pedagogy, the student's professional growth is expected to occur as a side-effect of the student carrying out the supervisor's directives. (Below, I shall propose a third option which overcomes limitations of both these alternatives.)
The obvious compromise between the two extremes is for the supervisor to teach the supervisee by focusing on the supervisee's interaction with the patient. Thus the student learns something which is also helpful to the client. I do not, however, see how this compromise overcomes the difficulties of each approach in isolation.
Teaching the student does not directly connect with the patient even if what the student is being taught is something about the patient, because the object of learning in that case is not the existential patient but rather an idea of a type of patient. Between the notion and the person lies the problem of application, a gap which no amount of instruction can bridge. The situation here is like teaching someone to ride a bicycle by talking with them about how to ride the bicycle.
Conversely, whatever instructional content is conveyed to the student can never be sufficient. The teacher cannot anticipate and cover all possibilities. The student goes back to the patient and does what he or she has learned and the patient replies in an unexpected way; either the student doesn't even notice the discrepancy and proceeds blithely as if something else or nothing had happened, or else the student does notice that something has happened for which he or she does not know "the next move" and then [the outcome will depend on the chain of fallback coping skills in the student's behavioral repertory].
What seems frequently to happen in practice is a triumph of deutero-truth and deutero-learning with a big help from Sullivan's dictum that "in the end we are all more simply human than otherwise" -- at least insofar as the student's training does not spoil this unwitting [human] competence. The student, by trial-and-error, by going over the same lessons over and over with his or her supervisor in various contexts, etc. gradually reaches a point at which he or she feels he or she is beginning to make sense of "it all." If most students go through a similar process, that process, no matter how much it impedes itself (as Kohut, 1984, p. 26, and others have remarked), will appear natural to everybody. Beyond this point the student has acquired sufficient competence (or at least familiarity with the lay of the land) that he or she increasingly is able to make use of the instruction, if only in the sense of absorbing it nonconflictually into his or her newly "jelled" patterns of behavior. Any social process that doesn't self-destruct is self-validating, as Margaret Mead (1975, pp. 147, 158 and passim) showed for the Manus people who recognized that their form of social organization harried them to constant dissension in life and early deaths, and resented it, but couldn't do anything about it until external circumstances radically altered their social ecosystem.
To return to the analogy of learning to ride a bicycle by discursive instruction: Once one learns to ride, the talk may in retrospect be interpreted as having been more helpful than it was, and it was helpful in a way, if only by keeping pressure on the learner to keep trying, and, hopefully, by being encouraging; also, after learning the basics, further (as well as prior) verbal instruction may be in fact more helpful because of the now acquired intuitive framework into which it can be assimilated.
Teach or Treat
However the supervisor mixes and matches attending to the student's needs for help in professional development and the student's patients' needs for therapeutic help, part of the supervisor's attention, perforce, must focus on the student, if only to deal with difficulties transmitting instructions via the student to the patient, and getting back the patient's responses through the student. Here the alternatives -- and, again, it is not an "either/or" situation but rather a question of how much of each alternative to employ -- are: (1) to teach the student what he or she does not already know, in order to overcome errors due to ignorance, and (2) to treat the student's personal problems which interfere with the student effectively implementing what he or she in some way already knows (see, e.g., Ekstein & Wallerstein, 1972, chap. XIV). (Here, as with the preceding item, I will propose a third option which avoids limitations of both alternatives.)
One approach is initially to address each of the student's problems in doing therapy as a problem of learning (i.e., ignorance); then, if after having been given the requisite instruction, the student proves unable to make use of it, to reclassify the trouble as a problem about learning (i.e., a personality problem in the student) (see, e.g., Tarachow, 1963, pp. 303-7). At this point, or if a limited exploration of personal factors does not resolve the problem, often the supervisor will recommend that the student "take it up in his or her personal analysis," because exploration of the student's personal life, beyond its direct impact on patients, is not considered an appropriate function of the supervisory relationship. Due to the reporting role of the supervisor, this is a realistic limitation (in practice, however, this boundary is not so clear, since often the student's analyst is part of the training institution and the training analyst too may have formal reporting responsibilities or, despite formal regulations mandating confidentiality, "things have their ways of getting out").
An only seemingly paradoxical variant here occurs in training programs which, unlike psychoanalysis, do not require students to undergo therapy as part of their training. Here, sometimes, the supervisee will attempt to turn the supervisory relationship into a therapeutic relationship, in order to get help the student feels he or she needs which is otherwise unavailable (for personal problems) and/or to avoid intrusion in the area where help is available (for the student's therapeutic interaction with clients) (Ekstein & Wallerstein, 1972, pp. 154-5).
Taking Stock of the Supervisory Situation
The relationship between supervisor and supervisee in psychotherapist training shows itself to be a complex communicative situation which, ideally and often in reality is conversation about conversation: communicative action between supervisor and supervisee oriented toward nurturing communicative action between supervisee and client (which latter, in its turn, is oriented toward improving the client's communicative insertion into his or her social surround). Due to various factors, among them, the evaluative reporting role of the supervisor, communication in the supervisory situation can become mystified, manipulative and strategic. Due to factors such as narrowly technical pedagogical orientation (e.g., the Masterson approach), the conversation between supervisor and supervisee can be conversational but have as its content planning strategic communication vis-à-vis an objectivized client.
The kinds of communication that occur in supervision are extremely varied both in kinds and (to use Goffman's word:) laminations. At one extreme, there is the supervisor who threatens and humiliates the supervisee; at the other end of the spectrum is the supervisor who, like Mary's mother in Leonardo da Vinci's painting and drawings of the Madonna and Child and Ste. Anne, is unobtrusively near at hand to help the young therapist but does not impose him or herself.
Ekstein and Wallerstein sum up the attributes of a well-functioning supervisory relationship:
If personal supervision were simply a didactic experience in which a body of knowledge is transmitted, not much would have to be said at this point about its function. Our purpose though is to describe supervision---that is, the supervisory process---not simply as the transmission of knowledge and skills, but rather as a complex process that goes on between the supervisor and the student. This process is a helping process in which the student is being helped to discover his problems as a psychotherapist, to resolve them with the help of the supervisor, and to develop toward higher integrations as a learner and as a psychotherapist. This process includes affective problems, interpersonal conflicts, problems in being helped, as well as in helping, and is therefore truly itself a helping process. (Ekstein & Wallerstein, 1972, p. 251)
At its best, the supervisory relationship is supportive and trusting. The student can tell "his" or "her" supervisor (not just "the" supervisor, but a person with whom the student feels genuine accord) things that trouble him or her, not just in his or her therapy work, but ways his or her personal life affects his or her therapeutic efforts, and the supervisor will respond not just with technical advice but also human sympathy and encouragement. When the student has a difficult client who would strain even an experienced therapist's patience, the supervisor can even offer him or herself as a "shoulder to cry on," to help support the student's "hanging in there" with the client.
What Judith Herman says about therapists who work with victims of childhood sexual abuse and other gross traumas applies to all therapeutic work, albeit in each case and at different times in the course of each treatment, with varying degrees of intensity and urgency:
Engagement in this work thus poses some risk to the therapist's own psychological health. The therapist's adverse reactions, unless understood and contained, also predictably lead to disruptions in the therapeutic alliance with patients and to conflict with professional colleagues. Therapists who work with traumatized people require an ongoing support system to deal with their intense reactions. Just as no survivor can recover alone, no therapist can work with trauma alone....
The work of recovery requires a secure and reliable support system for the therapist....
It cannot be reiterated too often: no one can face trauma alone. If a therapist finds herself isolated in her professional practice, she should discontinue working with traumatized patients until she has secured an adequate support system. (Herman, 1992, pp. 141, 151, 153)
Many therapists in training do not have this kind of rapport with their supervisors. While Jeffrey Masson's experience (Masson, 1990) is, one hopes, rare (although anecdotal evidence suggests it is not), far more frequent are cases where supervisor and supervisee never get deeply into either conflict or rapport because somehow (generally not through direct discussion of the matter, but by each "sensing" the other's "sensitive" spots) they come to a mutually tolerable standoff the main objective of which, at least for the student, is to mark time until he or she can get out of the relationship unharmed:
One of the few supervisors who reports more than one experience in supervision, Grotjahn... recalled that "in my work in recent years, I have found supervision becoming more and more of a problem, a challenge, and a reason for dissatisfaction to me . . . when I asked others what they remembered about their own experience of being supervised, several of my senior colleagues . . said in effect 'I always saw to it that I went to a supervisor who would interfere with me as little as possible.'" Grotjahn decided "to return to the role of supervisee . . . this experience was so educational that I can recommend it to other psychoanalysts, no matter how late they may be in their careers...." (Schuster, Sandt & Thaler, 1972, pp. 77-8)
Sometimes students have other supports in their lives, for instance, sympathetic fellow students, friends and family. These resources can help students survive their training program and the stresses of dealing with their clients' problems, but they cannot likely be a substitute for a good supervisory relationship, since usually none of these persons is expert either in doing psychotherapy or supervising it. Family and friends rarely have any idea of the specific nature of the issues with which the student is dealing (unless they are psychotherapists or in similar work themselves -- a possibility I shall deal with forthwith). And fellow students, while they may share the same problems, generally have no more mastery of possible solutions. While friends and family can provide little more than "sympathy and encouragement" (which can be very helpful!), the help of fellow students may even exacerbate an individual's problems if the peers abet each other with good intentions in unwittingly but ultimately unconstructive directions.
I propose the best way of handling the unfortunate situation where a student cannot secure a truly supportive supervisory relationship is for the student privately to find an experienced psychotherapy professional whom he or she can trust, and use this person as Dante used Virgil to guide him through Hell. (For obvious reasons, I have not come across statistics on how frequently this happens.) There are numerous difficulties here: One difficulty is finding such a person and having the person agree to take on the role. If the person is neither a family member nor a personal friend (probably the more frequent case), then the student almost certainly will have to pay for this service, and most psychotherapists in training are already paying more than they can afford. The greatest obstacle, however, may be Margaret Mead's "empty imagination" problem, which one psychotherapist, Gordon Hirshhorn succinctly formulates as follows: "Other then chance encounters, a person can encounter in reality only what he has previously encountered in fantasy" (personal communication, 1982).
<a name="NoIdea">Many students</a> do not even have the notion that such an advocate is possible, and, consequently (this is a strict logical implication!) they cannot even want one, much less try to find one. This is an example of how "deep" my argument that the foundation of psychotherapist training should be cultivation of conversation runs (or cuts): Part of conversation is for the speaker to actively nurture the listener's autochthonous faculty of judgment vis-à-vis what the speaker says to the listener. In psychotherapy training, a corollary of this would be -- at least so long as training institutes are a necessary part of becoming a psychotherapist -- for the institute to tell each student "up front":
We believe we are going to give you a solid education to become a psychotherapist, and we also believe we are going to provide a supportive environment for you to learn. We believe we are here to help you, certainly not to hurt you. But, as Alice Miller and others have said, persons often do hurtful things to others with the sincere conviction that it is for the victims' own good.
Therefore we encourage you to check out everything that happens here and judge it for yourself. But that will not be enough, since often you will not know what the range of possibilities is. Therefore we encourage you to find an external advisor, someone knowledgeable whom you can trust and who has no connection with us, with whom to share your experiences here to help you get a better critical perspective on it all. [If you cannot find such a person, read Brad McCormick's doctoral dissertation as a partial substitute.]
Of course it will please us if you find that, as you prove all things, you find the things we offer are good to hold onto. But we will try to doubt your compliments and take seriously your complaints, and also try to guess what we might be doing which you are afraid to tell us about, and hope that your experience with us teaches you far more of what is directly good than of things of which, in your practice as a therapist, you shall find you need to undo the harmful effects.
<a name="need">In</a> those cases where the candidate really needs such a mentor, however, the student's training program (including his or her supervisor) is something the student does not need but rather must endure because otherwise he or she will not gain the social opportunity to practice his or her aspired-to profession. Such a training program, if the student is able to survive it, can, with the guidance of a mentor, become an intense and illuminating practicum in psycho- and socio-pathology -- in a way the program itself would never imagine [(the reader may make some plausible speculations about the author's experience in this regard...)]. It also calls to mind an interchange from Bertolt Brecht's play, Galileo (1952/1966, p. 115):
Andrea...: "Unhappy is the land that breeds no hero."
Galileo: No, Andrea, "Unhappy is the land that needs a hero."
To return, however, to all the supervisory relationships which are good,
of which there are [at least I hope there are!] many. Even here, it is important to
remember that every supervisor arrived at that position by having been a
supervisee him or herself, and then functioning as therapist and, eventually,
supervisor, in the social milieu of other therapists and supervisors who became
therapists and supervisors in the same way. There is a "cultural unconscious"
for psychotherapy supervisors too. Most supervisors have had no formal training
to be supervisors (see, e.g., Wallerstein, Ed., 1981, p. 38). For the sake of
argument, let us assume all supervisors meet Ekstein and Wallerstein's criteria
as quoted above. They will do much good and little harm. However: returning
once again to Margaret Mead's notion of the "empty imagination," it is still
possible they may be altogether oblivious of possibilities which would make their
good will immensely more effective (I shall make specific recommendations in
this regard below).