The Shift from "Ordinary" to "Extraordinary" Experience in Psychodynaimc Supervision

The Shift from “Ordinary”
to “Extraordinary” Experience
in Psychodynamic Supervision
James Tobin, Ph.D.
1

The Shift from “Ordinary”
to “Extraordinary” Experience
in Psychodynamic Supervision
James Tobin, Ph.D.
2

The Shift from “Ordinary” to “Extraordinary”
Experience in Psychodynamic Supervision
James Tobin, Ph.D.
Private Practice, Newport Beach, CA
Assistant Professor of Clinical Psychology
Argosy University, Orange County, CA
phone: 949-338-4388
web: www.jamestobinphd.com
email: jt@jamestobinphd.com
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Introduction
In this presentation, I will present an approach
to psychodynamic supervision inspired by my
work with one particular student.
Her use of the word “extraordinary” in a
discussion helped me to conceptualize an
important process in dynamic supervision: the
shift from “ordinary” to “extraordinary”
experience; this has become a central
organizing metaphor in my work and I will
attempt to describe its heuristic value in this
talk.
4

Introduction
If we agree, as Ablon and Jones (2005, p. 564-565)
observed in their empirical work on the analytic
process, that “psychological knowledge of the
self can develop only in the context of a
relationship within which the psychotherapist
endeavors to understand the mind of the patient
through the medium of their interaction”, then I
hope this presentation will provide a pragmatic
framework for how to support supervisees in
creating this medium through the metaphor of
the “extraordinary.”
5

Psychotherapy Training: A Fairly Bleak Picture
Numerous researchers and writers have
portrayed a fairly bleak picture of the efficacy
of psychotherapy training at all levels of
professional development, including the
training of psychoanalytic candidates.
6

Psychotherapy Training Issues
Major problems with current training approaches
are well documented in a comprehensive review
by Fauth et al. (2007) and include:
• Too narrow of a focus on therapeutic micro-skills;
• Emphasis on technical adherence to theoretical
orientations at the expense of more global
capacities;
7

Psychotherapy Training Issues
• Strict adherence to manual-guided
techniques;
• The failure to foster durable improvements in
overall therapeutic effectiveness.
8

Binder’s Critique
In two important papers in which he evaluated
the empirical and theoretical literature re:
psychotherapy training, Binder (1993, 2002)
concluded that we lack a research-informed
pedagogy for formal psychotherapy education
and training at the graduate level, and that
the effectiveness of our academic programs is
assumed largely on faith.
9

Binder’s Critique
He observed that clinical psychology programs
customarily teach specific procedures and
skills in a progression from simple to more
complex performances, with an emphasis on
micro-skills in which discrete teaching
modules expose students to particular facets
of the clinical situation and interventions
(e.g., active listening, open-ended questions,
etc.).
10

Binder’s Critique
He stated, “It appears, however, that while
these ‘micro’ components of interviewing can
be effectively taught, the components do not
easily gel into the more complex performance
skills actually used in clinical interviewing”
(Binder, 2002, p. 4).
11

Binder’s Critique
Curricula expose students to theories and
procedures linked with various treatment models
followed by “an abrupt transition to ‘practicing’
with real patients” (Binder, 2002, p. 5).
Conceptual knowledge is not readily useable to
guide a practical understanding and skillful
performance in the real world; there is little
information available to students about how a
treatment is actually conducted.
12

Binder’s Critique
Binder (1993) suggested that it is likely
supervision is being conducted incompetently
by many supervisors.
13

Negative Perceptions of Supervision
Many supervisees view supervision to be an
unhelpful and, at times, a highly negative
experience (Fauth et al., 2007; Ramos-Sanchez
et al., 2002).
Galante (1998), for example, found that 47% of
trainees had experienced at least one
ineffective supervisory relationship.
14

Lack of Training/Not a Distinct Professional Activity
Little formal training is offered for supervisors
(Russell & Petrie, 1994) and supervision itself
is not typically perceived as a distinct
professional activity with its own unique
processes and goals.
15

Stylistic Preferences and Rigidity of Roles
The personality of the supervisor tends to
correspond to broad supervisory styles (task-
oriented, interpersonally-focused, etc.)
(Freidlander & Ward, 1984; Shanfield & Gil,
1985) that unwittingly shape and determine
the supervision experience.
Many supervisors approach supervision in a
vague, undetermined way (Milne & James,
2002), often resulting in their being primarily
didactic or adopting a largely supportive or
collegial role.
16

Perpetuation of Poor Supervisory Models
Supervisors also tend to repeat the mistakes
made by their own supervisors (Worthington,
1987).
17

Ladany’s “Litmus Test”
Ladany (2007) observed that we have not done
a good job in determining graduate school
admission criteria that reliably predict
psychotherapy competence.
18

Ladany’s “Litmus Test”
He (2007) wrote, “It should not surprise us, then,
that a decent percentage of students graduate
who are not well equipped to be reasonably
good therapists. A good litmus test for this
supposition is to ask ourselves whether we
would refer a family member (that we liked!)
to a therapist whom we are graduating. I
would venture a guess that about a third of
the time the answer would be no” (p. 395).
19

But the Good News Is We Are Making Forward
Progress
Despite these training problems and the
corresponding lack of a consensual model for
conceptualizing and implementing
supervision, we are making significant strides!
20

Expansion of the Supervisory Function
The supervisor’s task is no longer viewed as
solely didactic or focused on merely imparting
technical or theoretical knowledge; instead,
the supervisory function consists of
numerous interrelated roles that include
supportive, technical and modeling
components directed toward the cultivation
of a therapeutic identity (Milne and James,
2002).
21

Developmental Stage Models
Developmental stage models (e.g., Heppner &
Roehlke, 1984; Stoltenberg & Delworth, 1987,
1988) have helped to define approaches to
supervisory intervention based on the
supervisee’s level of competence and
experience.
22

Relational Emphasis
The supervisory relationship (Ekstein &
Wallerstein, 1972; Hedges, in press; Watkins,
1997, 2011; Worthen & McNeil, 1996) has
also been emphasized as a primary framework
for understanding how complex, co-creative
interpersonal patterns of interaction and
enactment between supervisor and
supervisee may correspond to the trainee’s
relationships with her patients.
23

Relational Emphasis
This emphasis reflects the notable empirical
finding (which has transtheoretical
implications) that, more than any other factor,
the quality of the psychotherapeutic
relationship remains the strongest predictor
of treatment outcome (Hedges, in press;
Norcross, 2002; Orlinsky et al., 1994).
24

The Educational Pyramid
A triadic model (Bernstein, 1982; Seidman &
Rappaport, 1974) in which the inter-
relationships of the three figures of
psychotherapy training (client, trainee, and
supervisor) has contributed to the design of
empirical research programs and a
supervisory focus on clearly connecting
theoretical and didactic learning with
interventions and outcomes.
25

Moving from Micro-Skills to Super-ordinate Goals
Micro-skills continue to be addressed in
supervision yet are so within a broader set of
therapeutic competencies and super-ordinate
goals that more realistically reflect the
professional role of therapist.
26

Moving from Micro-Skills to Super-ordinate Goals
For example, Binder (2002) defined 4 super-
ordinate goals for the student in supervision:
(1) to conceptualize clinical material; (2) to
select and apply therapeutic interventions; (3)
to develop professional beliefs and values; and
(4) to behave ethically.
For Binder, the best supervisors find ways to link
these 4 goals into a cohesive learning
experience for the trainee.
27

Self-Awareness as a Therapeutic Competency
Beyond knowledge- and skill-based approaches
to supervision intervention, there has been
increasing interest in encouraging the
supervisee’s self-awareness and ability to
understand and use the self in the clinical
situation (Ladany, 2007).
28

Tuckett’s Three Frames
In an attempt to conceptualize the competence
of psychoanalytic candidates, Tuckett (2005)
theorized that advanced skill level is
characterized by the capacity to sustain three
linked lenses or frames: (1) participant-
observational, (2)conceptual and (3)
interventional.
29

Tuckett’s Three Frames
As described by Sarnat (2010, p. 21), Tuckett
(2005) defined the participant-observational
frame as “ ‘the way the analyst is with the
patient’ (p. 37), and emphasized the analyst’s
capacity to bear and process, rather than act,
on the emotional states that the patient
evokes within her or him.”
30

Self-awareness/Use of the Self: The Lack of a Clear
Pedagogic Method
Self-awareness and the use of the self in the
clinical situation are contextually valid and
fundamental components of therapeutic
work, especially evident in highly-skilled
experienced therapists.
But the capacity to identify and use self-
experience is highly difficult to cultivate and
refine in trainees and often is not even
approached by supervisors (due, in my
opinion, to the lack of a clear pedagogic
method for how to do so).
31

A Major But Under-emphasized Issue:
“Sterile” Supervision
In my reading of the literature, and upon
reflection on my own work and the work of
my colleagues, I have often wondered if the
lack of a clear pedagogic method for
promoting the supervisee’s use of self-
experience causes “sterile” supervision.
32

Sterile Supervision
Sterile supervision is characterized by content
and process factors which dilute the
authentic experience of the supervisee (and
of the supervisor as well), attenuating the
interaction significantly and restricting the
range of interpersonal experience and
psychological inquiry to safe comfortable
zones.
33

Sterile Supervision
Sterile supervision, in my opinion, arises from
pressures (within the supervisee, the
supervisor, and/or within the institution in
which treatment and supervision are
occurring) toward standard forms of social
etiquette and decorum that tend to
predominate the supervisory interaction.
34

Sterile Supervision
We have all heard about or even experienced
supervisory sessions that seem no different in
tone or content from formal business
transactions, classroom experiences or dinner
parties!
Although these modes of interaction are, at times,
reasonable and appropriate for the supervisory
relationship, I think the patterned and consistent
dilution of the supervision experience
represents a more insidious problem.
35

Evidence of Sterile Supervision
For years, anecdotal evidence and empirical
research have suggested that the supervisory
interaction is frequently inauthentic, falsified,
and/or censored.
Gabbard (2010) notes that supervisees’
presentation of clinical material is commonly
filtered or distorted.
36

Compliance and Social Desirability
Many supervisees, of course, experience a
conflict between presenting what makes them
“look good” to their supervisor vs. sharing
their struggles and difficulties “which may
maximize the learning process but could
result in a less glowing evaluation” (Gabbard,
2010, p. 193).
37

Compliance and Social Desirability
In my own discussions with students and
practicing professionals, some quite
sophisticated, many indicate that they still feel
as if they have “to be” a certain way clinically
in order to appeal to the overt and covert
preferences of their supervisors or peers in
consultation groups.
38

Empirical Evidence of Compliance in Supervision
Further, there is a growing body of research that
indicates strong bidirectional processes of
control, compliance/submission and social
desirability in clinical supervision.
39

Using an intensive case study method to
evaluate speech acts throughout one
semester of supervision, Martin et al. (1987)
found that the supervisor being evaluated
frequently acted in a more controlling and
assertive manner as compared to the more
compliant supervisee.
40

Alpher (1991), in a study of short-term
psychodynamic treatment, found that the
interpersonal process between supervisor and
trainee frequently consisted of control
behaviors on the part of the supervisor and
submitting behaviors on the part of the
trainee. Interestingly, these observations
corresponded with additional data showing
that, at times, the patient viewed the
trainee-therapist to be controlling as well.
41

Empirical Evidence of Compliance Supervision
Alpher (1991) also noted that as the supervisor’s
controlling acts evoked a greater degree of
submission on the part of the trainee, the
supervision gradually became narrowed in
scope, with content condensing to the
trainee’s requests for specific instructions
from the supervisor and submission to the
supervisor’s insights.
42

Alpher concluded that control and submission
appear to be dominant interactive evocations in
supervision, and that such evocations provide
evidence of parallel process in which
“interdependent transactions occur in a
coherent manner across the dyads” of
supervisee-supervisor and supervisee-patient
(Alpher, 1991, p. 228).
43

Alpher’s (1991) data and inferences are
particularly relevant for my concerns because
they imply that sterile supervision likely
corresponds to sterile therapy (more on this
later!).
44

The Supervisor’s Social Desirability
Also contributing to sterile supervision is the
need on the part of supervisors to be seen
favorably by their supervisees, particularly in
settings in which trainees’ ratings are
perceived by administrators as indicative of
supervisor competence.
45

The Supervisor’s Social Desirability
Supervisors face a conflict between what they
personally value as meaningful for teaching
and supervision and the prevailing rules,
norms, and policies of the organization in
which the therapy and supervision are taking
place (Fauth et al., 2007).
46

Supervisors’ Desire to Protect, Shield and Prevent
Narcissistic Injury
I also believe there is a tendency among many
supervisors who, conscious of the trainee’s
fears, naiveté, demoralization and low
professional self-esteem, over-compensate by
attempting to shield the supervisee from
common realistic challenges of the therapy
situation and self-experience (e.g.,
narcissistic injury) often associated with the
growing pains of learning the complex task of
psychotherapy.
47

Supervisors’ Desire to Protect, Shield and Prevent
Narcissistic Injury
I once heard a story of a supervisor who, when
the potential to add family therapy as a
treatment modality in his training clinic was
being discussed, vehemently argued against
the idea.
He felt trainees were having enough difficulty
with individual therapy and anticipated that
the complexity of family therapy would be
overwhelming.
48

An Implicit Rule: “We have a very nice relationship …”
An additional factor contributing to sterile
supervision is the mutual avoidance of conflict or
dissonance in the supervisory relationship.
Recihelt and Skjerva (2002, p. 770) claim that an
implicit rule is often embedded in the
supervisory process and mutually reinforced by
both supervisor and trainee: “We have a very
nice relationship, and do not want to say or do
anything that may make it less pleasant” (as
cited by Binder, 2002, p. 18).
49

The Avoidance of “Touchy Issues”
Similarly, Lizzio et al. (2009, p. 129) noted about
the supervisor’s role: “However, it is not only
important to provide support, but also to do so
at an appropriate level. While a perceived
lack of supervisor support can have negative
consequences for supervision, too much
support, in the absence of other important
supervisory relating behaviours, can also
inhibit the effectiveness of supervision. For
example, if a supervisor is
50

The Avoidance of “Touchy Issues”
overly concerned with ‘being supportive’ they
may become too permissive and not address
‘touchy issues’ such as supervisee competence
or performance. This can result in a ‘phoney’
supervision relationship where the needs of
the client are relegated behind the
supervisor’s need for acceptance and
approval or their avoidance of conflict ...”
51

Toward a Definition of “Ordinary” Experience
The many factors contributing to sterile
supervision suggest a patterned interpersonal
dynamic between supervisee and supervisor
restricted to conventional relatedness in
which discomfort, tensions and anxieties are
suppressed or avoided via numerous
conscious and unconscious activities falling
within a profile of affirmation, decorum,
censorship, politeness, rapport, compliance
and social desirability (i.e., the “ordinary”).
52

Toward a Definition of “Ordinary” Experience
Phony or sterile supervision is supported by the
collusion of supervisor and trainee to reside
within a sanctioned safe zone relegated to
fundamentally ordinary ways of being with
each other to which both parties are well-
accustomed.
53

The Press Toward the Ordinary
Unfortunately, many of our training institutions
embody a culture of ordinary experience that
fails our students and supervisees in
numerous ways, including not socializing
trainees to the potential power of a true
therapeutic environment unencumbered by
social mores.
54

Relegation to the ordinary in sterile supervision
does not engage the trainee in an
“interpersonal atmosphere for generating an
appreciation of the power of the professional
relationship itself” (Hedges, in press),
especially components of self-experience that
may be controversial or viewed as
inappropriate when conceived of in the
context of usual social discourse.
55

Consequently, stimulating and refining the
trainee’s self-awareness/use of self in the
clinical situation is not really possible; self-
experience is censored because it is
categorically associated with conventional
social discourse.
In this way, a venue for the trainee is not
provided that adheres to the distinct social
discourse characterizing a
psychoanalytic/psychodynamic model.
56

I think the press toward the ordinary may be
due, at least in part, to a misguided,
exaggerated use of the conclusions drawn
from the large body of work on the relational
paradigm (e.g., Bordin, 1983; Frawley-O’Dea
& Sarnat, 2008; Gill, 2001; Hedges, in press;
Ladany, 2004; Watkins, 2011).
57

Emphasis on the alliance often becomes
reduced conceptually and interactively (both
by supervisor and supervisee) to an
exaggerated focus on rapport-building and
the avoidance of discomfort, conflict and
distress -- at the expense of other vital
elements of the therapeutic process.
58

Many supervisors also seem to fundamentally
misconstrue what will ultimately promote the
supervisee’s self-assuredness, confidence and
deeper learning (Lizzio et al., 2005;
Ronnesttad & Skovholy, 1993); standard forms
of assurance and corrective feedback seem
less productive in this regard than exploring
and legitimizing the supervisee’s experience
of learning to be a therapist.
59

My Central Critique
My main point thus far is that due to benign and
protective motives on the part of many
supervisors, as well as more insidious
processes of control, submission and
compliance, the supervisee’s subjective
experience as therapist,
learner and person
is ordinarily
thwarted.
60

My Central Critique
Overly-protecting, supporting or instructing the
supervisee may, in fact, have the unintended
consequence of ultimately invalidating her
self-experience, the accessing of which and
using is a crucial therapy competence and
serves as both an anchor and compass for
negotiating the challenges of actual clinical
work.
61

The Supervisee’s Self-Experience
In my view, it is the supervisor’s primary task to
explore extensively the supervisee’s self-
experience with relative abstinence in order to
preserve its validity and model for the
supervisee a mode of “being with” another’s
experience.
62

Being “Supported Away”
Many of the supervisees I encounter are
discouraged or demoralized because their
own views have apparently never been
inquired about or allowed to stand as valid
sentiments (e.g., a supervisee once told me
she felt like all of her concerns as a therapist-
in-training were “supported away”).
63

A Common Realization of Trainees
What is most difficult for many trainees is their
newly-emerging realization that they cannot
combat or overcome the severity and
refractory nature of the dilemmas and
characterological problems in patients who
present for treatment.
64

Drama of the Gifted Child
This realization is especially unbearable for some
students who are encountering, perhaps for the
first time, the limitations of their long-held
proclivity to heal, a proclivity born in their own
personal histories and that evolved a way of
being in the world which inspired their very entry
into the mental health profession (e.g., Alice
Miller’s Drama of the Gifted Child); feelings
related to this cannot and should not be
supported away!
65

Supervision as “Metaphoric Experience”
The traditional notion that personal therapy is
the best way to gain self-awareness and one
of the best ways to learn how to actually do
psychotherapy (Ladany, 2007, p. 393) is a bit
misguided, from my standpoint.
Instead, I believe the supervisory experience can
provide a “metaphoric experience” of the
psychodynamic therapy situation, which, at its
core, revolves around one mind attempting
to make contact with and understand deeply
the mind of another.
66

Supervision as “Metaphoric Experience”
This sentiment is reflected in Sarnat’s writings:
“Although the supervisory and clinical tasks
are different, the supervisor demonstrates
competencies in supervising that are closely
related to those she is striving to develop in
her supervisee” (Sarnat, 2010, p. 26).
67

Emulation of the Ordinary
Exposure to sterile supervision leaves the
supervisee with a constricted perspective of
therapeutic relatedness experienced vis-a-vis
the supervisor.
A natural consequence is the supervisee’s
proclivity to emulate the “ordinary” with her
own psychotherapy patients, manifested in
similar or identical forms of tension
reduction, avoidance and
conformity/control/submission dynamics
experienced in supervision.
68

My Approach: The Shift to Extraordinary Experience
The pedagogic principle I am proposing is that
psychodynamic supervision should facilitate in
the supervisee a transition from common
forms of social discourse and convention
including conflict avoidance, compliance and
social desirability (“ordinary” experience) to
an alternative form of relatedness that
inherently values an ambience of inquiry,
uncensored subjectivity and acceptance
(“extraordinary” experience).
69

The supervisee is approached not as a
narcissistically vulnerable figure who needs
consistent support and cheerleading, but as a
maturing professional whose therapeutic
identity will be promoted primarily by a close
inspection and understanding
of her particular experience.
70

As in psychotherapy, this approach assumes that
due to a variety of interpersonal and
intrapsychic factors there will be resistance to
the expression, examination and tolerance of
the supervisee’s uniquely personal experience.
71

Therefore, I see my primary task as one of
coaxing into expression the supervisee’s self-
experience; my sense is that if the
supervisor's self-experience cannot be
engaged and validated, then meta-cognitive
competencies underlying psychodynamic
psychotherapy including the use of the self,
intuition, pattern recognition, spontaneity and
self-assuredness will not be promoted.
72

Supervision Vignette
• A supervisee, in her first practicum placement
in a university psychology clinic, discusses her
patient who has recently no-showed for a
session; the supervisee begins to reflect on
what it has been like for her to work with this
particular patient; in one supervision session,
she says, “I find myself oscillating between
being my self and being a professional self,
and this makes me feel anxious, not in
balance.
73

• When I am too much the professional me, I
become blocked in my thoughts, in my
perceptions and in my freedom during
sessions. Often, I get this way with her. With
other clients, I am more natural and there
seems to be a balance of the real me and the
professional me. I find myself and I find a
professional identity almost at the same time.
74

• But with her, I get kind of defensive; I don’t
think I really am all that defensive in actuality,
I just feel it. At those times, I become too
much of a therapy-me. Again, it’s the issue of
feeling too much of one vs. too much of the
other. But sometimes with her I get too
reactive and I become too much me. It’s
strange. I am unable to integrate this all into
one me. Wow! That’s cool. (I inquire about
what’s cool.)
75

• I didn’t realize this all before. Just describing
it really helps. It’s not really anxiety, now that
I reflect on it, it’s just that with her I
sometimes get uncomfortable ... Yeah, this is
cool. (Cool?) Just the fact that I am seeing
how I am with her, naming the way I feel
when I am with her. I have not been able to
describe it before or even identity it. So
you’re helping me capture it now.
76

• Sometimes I’ll be more spontaneous, the
natural me, but I feel like it’s too much me
with her … Yeah, I’ve read about stuff like this,
I’ve had courses where it’s been talked about,
but to actually experience it is exciting, it’s
extraordinary, really. I’m actually
experiencing it, I am in it, rather than just
reading about it. I am seeing myself as I am
with her.
77

• I am blurting this all out to you now, without
really thinking about it or organizing it …. I
guess I allow myself to be spontaneous with
you, ironically as I am talking about not
being able to be that way with her. That’s
funny, really. With her, when I allow myself to
be spontaneous I feel like it bleeds into being
impulsive, and when that happens, I get really
restrictive and rigid again.
78

• I then become my professional self, and I think
that makes me withdraw from her. I feel a
distance between her and me and I can’t
connect with her, it’s a kind of psychological
distance. When I am more me-me, I feel like
her buddy, I feel closer to her and comfortable
with her, the way I’d be with someone I know
and am close to. I seem to be one way or the
other with her.
79

• And I guess this all isn’t really a bad thing,
I’m just putting it into words. This is really
exciting. (It’s exciting because?) It’s exciting
because the person who did the original
assessment on her described her as borderline.
I am not sure about that view of her, but I
obviously feel a certain split and maybe it has
to do with something in the patient or with
something in me in being with her. I don’t
know. I just don’t know.
80

• At some point in my last session with her, I
couldn't bring myself to tell her what I really
wanted to say. I was fighting back the
natural me and I don’t know why; maybe it
was because I have some fear of expressing
the natural me. That if I did, I would be in
trouble somehow. I would easily say what I
was thinking to a friend, but with her I didn’t
sense she could tolerate or use what I wanted
to say, so I just held onto my ideas.
81

• So there’s this professional me and a natural
me, and I am realizing as I talk to you that
this is all a part of me getting to know her.
Just thinking about it is really helpful. This is
all a bit of a roller coaster ride. (Roller
coaster?) Extreme, intense. But it’s nice to just
be able to ramble on about it all. Talking
about it and verbalizing my thoughts is really
good. And you seem to be able to prod me
along.”
82

Evidence of the Supervisee’s Growth: Reduced Self-
Criticality
This supervisee began work with me with a
heightened degree of self-consciousness and
self-criticality, along with a constant worry that
she wasn’t “doing it” right.
For a long time, she would not even directly expose
me to her work (via listening to audiotaped
recordings of sessions) and I often felt that our
sessions were overly cordial and inauthentic.
This clearly has changed!
83

Evidence of the Supervisee’s Growth: Reduced Self-
Criticality
She now approaches her own reflections
without judgment, although fears of “doing
something wrong” when with her patient still
remain; she observes that her ideas and
feelings, and the troubling dynamics with her
patient, are not necessarily “bad,” just a part
of how she is getting to know and understand
her patient.
84

Evidence of the Supervisee’s Growth: Disinhibition
The clinical process previously made her
extremely anxious, clearly not excited, and she
certainly didn’t view it with any wonder or
awe as she does now.
Now, she is remarkably spontaneous with me,
free to blurt out things whereas previously the
degree of censorship and inhibition she
exhibited was palpable.
85

Evidence of the Supervisee’s Growth: Autonomy and
Fewer Preoccupations
Before, she seemed to rely heavily on me and
other prior supervisors for direction.
Now, she is relatively autonomous in most of her
work, and she seems content to use
supervision primarily as a space for her to
identify her self-experience without being
preoccupied with the need to determine
meaning or formulate interventions.
86

Evidence of the Supervisee’s Growth: Recognition of
the Patient’s Character Structure and Relational
Dynamics
While the supervisee previously seemed to
objectify her patients (she tended to “fit” the
patient to a theoretical idea or intervention),
she is now beginning to appreciate the
complexity of her patient’s character
structure and how it impacts their relational
connection.
87

Evidence of the Supervisee’s Growth: Recognition of
the Patient’s Character Structure and Relational
Dynamics Stemming from It
This development reflects Sarnat’s (2010, p. 20)
view:“Effective psychodynamic intervention is
derived from what the psychotherapist has
experienced, processed, and conceptualized
about the relationship with the client and
about the client’s internal object world.”
88

Evidence of the Supervisee’s Growth: Emergence of a
Therapeutic Identity
Formerly, the supervisee seemed to lack a
professional-therapeutic identity; her
interventions were frequently impulsive and
largely devoid of her own humanity.
Now, her progression is striking: she clearly has
a therapeutic identity (manifested in her
naming of it) and is devoting attention to
issues and drawbacks re: integrating her
personal and therapeutic identities.
89

Evidence of the Supervisee’s Growth: A Shift Out of
the Ordinary
Overall, as the supervisee’s therapeutic identity
begins to emerge, she recognizes she cannot
merely be a “me-me” in her work with
patients, which represents one element of a
shift out of the ordinary.
She now appears invested in creating an
ambience with patients and within herself
that is fundamentally different from how she
typically is in her “real life.”
90

the Ordinary
Moreover, she is newly cautious about
introducing her own personhood into the
clinical situation in ways that may not be
helpful for her
client or that her
client may not
be able to use.
91

the Ordinary
At the same time, she also is attending to
reasons why the best of her spontaneity with
friends (her “natural me”) does not yet carry
over into her relationship with her patient –
potentially suggesting the need in ongoing
supervision to understand lingering
reservations and fears of deeper, more
intimate contact with patients
unencumbered by social convention.
92

Techniques and Guiding Principles
In conclusion, I would like to propose 6
supervisory techniques and guiding principles
emerging from my work with this student and
other supervisees like her who have informed
my approach.
93

Techniques and Guiding Principles:
(1.) Limit Convention and Compliance/Social
Desirability
Fundamentally, I attempt to create an
atmosphere in supervision relatively devoid
of social convention that obstructs the
supervisee’s exposure to an alternative form
of relatedness.
94

Desirability
For example, I directly observe to the supervisee
“ordinary” social phenomena as it occurs
(both in relation to me and between the
trainee and her client), and I invite an
exploration of its purpose and utility within
the clinical situation as well as within
supervision.
95

Desirability
Head nodding in standard social discourse is an
easily recognizable example of the many
forms of social convention to which I attempt
to sensitize the supervisee.
Therapists-in-training often cue their patients
(and their supervisors) with head nods.
96

Desirability
I work hard to sensitize the supervisee to this
social convention and how it, like many other
conventional behaviors, generally promotes
an inauthentic (“ordinary”) relational
experience that restricts the more expansive,
wide-ranging and uncensored quality of the
distinctive therapeutic experience.
97

Desirability
Many supervisees have reported to me how
striking and productive it is when they begin
to practice not returning the head nods of
their patients (or not do offer a head nod
themselves!) -- which often promotes in
supervision important discussions of
traditional analytic notions of abstinence and
neutrality and their continued relevance.
98

Desirability
As supervision proceeds, I hope to continue to
engender the supervisee’s relinquishing an
“ordinary persona” characterized by social
convention and, in turn, cultivating an
alternative therapeutic persona.
99

Desirability
Similarly, I try to sensitize the supervisee to a
host of dynamics and events between
themselves and their clients (including
violations of the frame, hypervigilance re: the
other’s discomfort, fears of not being liked or
viewed as good/helpful, avoidance tactics, a
rigid unconditional positive regard) that
represent adherence to social convention and
a loyalty to the ordinary persona within the
trainee as well as her patient.
100

(2.) “Don’t just do something, sit there!”
As a central supervisory technique, my listening
approach is primarily neutral/abstinent,
embodying the spirit of “Don’t just do
something, sit there!” (Alonso & Rutan, 1996).
101

As I listen, I hope to model a “self-reflective
capacity” (Sarnat, 2010, p. 24) in which I
demonstrate a highly attuned experiencing of
the supervisee and what she is telling me.
I am also attempting to expose the supervisee to
the fact that this capacity is not concerned
with reactivity or action “of an automatic,
habitual pattern” (i.e., that often constitutes
“ordinary” experience).
102

Occasionally I will offer questions and educative
instruction, and will self-disclose, but I
generally maintain a stance of listening,
experiencing and reflecting.
I also attempt to limit discussions of highly
abstract theoretical concepts and a “Q and A”
rhythm to supervisory sessions, which more
often than not reinforces the supervisee’s
dependency and impedes self-agency.
103

(3.) Promote Mindfulness Via the Extraordinary
In listening to and experiencing the supervisee, I
attempt to model a residence in the
“extraordinary” promoted by the meta-
cognitive skill known as “mindfulness” (i.e.,
the moment-to-moment awareness of one’s
experience) (e.g., Binder, 2002, 2004; Fauth et
al., 2007; Germer, 2005; Safran & Muran,
2000, 2001).
104

“... psychotherapist mindfulness represents ...
sustained attention toward the immediate
experience of the session, accompanied by an
attitude of acceptance and compassion, as
opposed to judgment, toward all that arises”
(Fauth et al., 2007, pp. 386-387).
105

Bishop et al. (2004, p. 235) indicated that “in a
state of mindfulness, thoughts and feelings
are observed as events in the mind, without
over identifying with them and without
reacting to them in an automatic, habitual
pattern of reactivity” (as cited by Fauth et
al., 2007, p. 387).
106

As I listen mindfully to the supervisee, I hope to
provide a metaphoric experience in which the
supervisee feels closely attended to, not
judged or acted upon – and begins to
experience the moment-to-moment process
of supervision as a process in and of itself
worthy of investigation and inquiry (rather
than it merely being a mandatory
appointment in which therapy sessions are
reviewed and the supervisee is evaluated).
107

(4.) Attend to Shame
The experience of shame in therapists,
particularly those early in their careers, is
ubiquitous (i.e., the therapist wants to help or
cure the patient and fails). Yet, to my
knowledge, shame in not extensively
addressed in the supervision literature.
108

Shame is a universal human experience that has
been conceptualized in numerous ways (e.g.,
Alonso & Rutan, 1988; Gans & Weber, 2000;
Nathanson, 1987).
With regard to supervision, the perspective on
shame I am most aligned with is the affective
experience arising from the failure to achieve
a desired response from an important object
(Alonso & Rutan, 1988); for the trainee, this
important object is her patient.
109

Inevitably, though, the trainee begins to realize
she will not be able to achieve what she
wants from her client including a preferred
form of relatedness (Winnicott’s [1969, 1975]
distinction between “object usage” and
“object relatedness” is relevant here) which, in
my terminology, is essentially “ordinary”
experience.
110

Processing shame reactions is thus a major
component of my work with supervisees; I
help the supervisee contend with the fact that
patients, more often than not, will manifest
“object usage” (as opposed to object
relatedness) in treatment – often to the
disappointment of the trainee who has little
experience with being related to in ways that
deviate from her preference (i.e., generally,
social mores).
111

Shame is often the main affective response as
the supervisee begins to acknowledge this
emerging dilemma and becomes more aware
of her reluctance and corresponding
attitudinal and behavioral responses to being
used, not related to, by the patient.
112

(5.) Dispel Expectations of Progress and Social
Comparison
113
I try to dispel the trainee’s expectations about
where she thinks she “should be” in terms of
development and skill level, especially when
comparisons with peers are routinely made.
Similarly, I try to directly challenge
the supervisee’s vision of her
patients – these often reflect
curative fantasies and a
narcissistic desire to heal.

Comparison
My attempt here is to socialize the supervisee
into a view of herself and her training and
development as unique and acceptable, just
as therapy is a forum for the patient to define
and contend with his/her individuality.
Comparisons with others, then, represent
another form of conventionality and
“ordinary” experience I am attempting to free
the supervisee from.
114

Comparison
In a similar vein, I make ongoing attempts to
disengage the trainee from my own value
system and clinical approach; e.g., supervisees
often ask me, “Is that what you would do?,”
and I respond, “It doesn’t matter what I
would do – you and I are different.”
More often than not, this drives home the point
that all interventions are motivated by some
element of our unique personhoods which
simultaneously may limit and expand our
potential with particular clients.
115

(6.) Promote Acceptance of Unconscious Relational
Forces
I attempt to downplay standard views of, rules
about and conventional opinions on
therapeutic course and action; instead, I
emphasize an acceptance of what is occurring
in the supervisee’s clinical process, especially
its thorny and unclear nature, and the
ongoing evaluation of its many potential
meanings.
116

Forces
To expand on this idea, I attempt to move the
supervisee away from “inert clinical knowledge”
(Binder, 2002, p. 11) and, instead, encourage her
to become her own repository of clinical
experience, including all failures and
achievements, intentions and outcomes;
This hopefully marks the transition from Am I doing
it right? or Do you agree with what I did? to This
is what happened between us at that moment.
117

Forces
To this end, in supervision I often claim that
“there are no mistakes in therapy” to
encourage supervisees to move past a right/
wrong approach to their work and begin to
appreciate the mutually co-constructed
unconscious dynamics between client and
therapist that profoundly impact how each
thinks, feels and acts upon the other.
118

Forces
For example, trainees are often terrified as they
begin to see clearly, from the perch of
supervision, how they have “acted out” with
their patients countertransferentially.
Acknowledging the strength and complexity of
unconscious relational forces is initially
startling for many trainees, but gradually
these forces become viewed more benignly as
constituents of psychoanalytically-informed
treatment.
119

(6.) Pursue “Professional Me”/“Natural Me” Tensions
Finally, I actively conceptualize the learning
process for trainees as contending with the
emerging tensions of disparity and
integration vis-a-vis the presence of the
“professional me” and the “natural me” in
clinical work.
120

Pragmatically, this often translates into
encouraging inhibited supervisees to bring
into sessions more of their “natural me,” and
encouraging disinhibited supervisees to
develop a greater degree of caution.
121

At a deeper level, it fosters an exploration of
how the supervisee may be unwittingly
exposed to herself, her patient (Aaron, 1991;
Hoffman, 1983) and her supervisor in the
course of psychotherapy and training, how to
tolerate these exposures, and how to make
use of them clinically.
122

Summary
Given the unchartered territory of
psychotherapy, supervisees typically rely on
what has worked for them so far in their
personal and professional lives (i.e.,
conventional attitudes and relational
tendencies), many of which are non-
transferrable and often disadvantageous for
psychoanalytically-informed psychotherapy.
123

Summary
In this presentation, I have outlined an approach
to supervision that seeks to engender in the
supervisee an attitudinal and behavioral shift
from “ordinary” (i.e., social convention) to
“extraordinary” experience in which the
patient's subjectivity, and that of the
therapist-in-training as well, is authentically
expressed, acknowledged and understood.
124

Summary
For numerous reasons I have described, both
the supervisee and supervisor may collude in
a press for the ordinary which detracts from
exposing the supervisee to an alternative
mode of self- and self-other relatedness akin
to the psychoanalytic model.
Consequently, qualities of sterile supervision are
often emulated and transferred into the
trainee’s work with her own patients.
125

Summary
My supervisory approach emphasizes that an
invaluable function of the supervisor is to model a
way of being that transcends standard forms of social
etiquette.
In this way, internal representations not only of the
supervisor as role model (Gabbard, 2010; Gitterman,
1972), but of the relational experience the
supervisor enacted with the trainee, support the
supervisee's therapeutic potential.
126

Discussion and Evaluation
The Shift from “Ordinary” to “Extraordinary”
Experience in Psychodynamic Supervision
James Tobin, Ph.D.
Private Practice, Newport Beach, CA
Assistant Professor of Clinical Psychology, Argosy
University, Orange County, CA
phone: 949-338-4388
web: www.jamestobinphd.com
email: jt@jamestobinphd.com
127

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136

Biography: James Tobin, Ph.D., Licensed Psychologist
PSY 22074
Dr. Tobin is a licensed psychologist in private
practice in Newport Beach, CA, and is Assistant
Professor of Clinical Psychology at Argosy
University/The American School of Professional
Psychology in Orange, CA, where he currently
supervises graduate students at the Argosy
University Therapeutic Assessment and
Psychotherapy Service (AUTAPS). He also participates
in an ongoing supervision group at the Newport
Psychoanalytic Institute with Lawrence Hedges,
Ph.D., the institute’s founder.
137

Biography: James Tobin, Ph.D., Licensed Psychologist
PSY 22074
Dr. Tobin is a former advanced candidate in
psychoanalysis at the Psychoanalytic Institute of New
England, East and former staff psychologist in the
Department of Psychiatry at the Massachusetts
General Hospital and Clinical Instructor, Harvard
Medical School. Dr. Tobin received an A.B. magna
cum laude in Psychology and Social Relations from
Harvard University, and a Ph.D. in Clinical Psychology
from The Catholic University of America in
Washington, D.C.
138

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