In this paper, presented to Division 39 (Psychoanalysis) at the 2012 APA Conference in Orlando, Florida, Dr. Tobin argues that the trainee and novice clinician may create a therapeutic setting in which the therapist manifests an attitude and demeanor drawn largely from standards forms of interpersonal interaction and the mores constituting typical social discourse. Clinical supervision may also reflect an investment in restricted forms of experience, thus leading to “sterile supervision” characterized by defensive processes and false manifestations. Dr. Tobin argues that the clinical situation is an "extraordinary" social experience that sacrifices most forms of standard social discourse in order to create an open space in which therapist and patient are unhindered by that which normally is. Supervision, therefore, should be focused on developing in the supervisee a therapeutic persona mobilized by the trainee's experience of new freedoms encountered in supervision.
The Shift from "Ordinary" to "Extraordinary" Experience in Psychodynaimc Supe...James Tobin
Presented by James Tobin, Ph.D. at the American Psychological Association annual conference in 2012, this paper argues that psychotherapists-in-training often rely on various forms of social etiquette when relating to their patients and conducting treatment. He argues that an important goal of supervision is to help the trainee cultivate a clinical attitude and environment which is "extraordinary" in nature, an interpersonal and intrapsychic space unencumbered by political and benevolent tendencies. Dr. Tobin describes the modeling component of supervision in which the supervisee is exposed to a new way of being in the atmosphere of the supervisor's mindfulness, independence, spontaneity, creativity, and subversiveness.
Clinical Psychology Case Formulation and Treatment Planning: A PrimerJames Tobin, Ph.D.
The aim of this primer is to support the learning of clinical case conceptualization and treatment planning for graduate students in clinical psychology, other trainees in the mental health professions, and early-career psychologists and mental health workers.
This document summarizes the treatment of a 51-year old woman named Paula for chronic depression using an existential psychotherapy approach. Paula had a long history of depression and anxiety and previous unsuccessful treatment using cognitive-behavioral therapy. The therapist adopted an existential perspective to help Paula explore issues of identity, meaning, and purpose. Treatment goals included managing depressive symptoms, improving relationships, and helping Paula reconnect with her identity as an artist. The therapist integrated existential and other therapeutic models to build on past progress and provide a meaningful context for Paula to address her core identity issues and chronic depression.
Specifying the “Critical Thinking” Construct in Clinical Psychology Training:...James Tobin, Ph.D.
Critical thinking is a complex multidimensional construct whose presence in academic and training curriculums in psychology has largely been limited to scientific courses on research methodology that focus on the logical analysis of data, hypothesis support/refutation and inference-making. Yet the CT competencies required to function as a clinical psychologist expand beyond the analytic and inferential skills pertinent to the scientific method. Graduate training in clinical psychology has been criticized for not cultivating in students a more refined and contextualized set of CT skills that is directly applicable to their future career roles. Specifically, an alternative model of CT that emphasizes specific dispositional and attitudinal components central to self-experience has been lacking. For the psychotherapist, utilizing self-experience in a reflective and informed manner is a primary meta-cognitive ability that appears highly related to the capacity to form efficacious relationships with clients and to treatment outcome. The current project seeks to conceptualize an alternative model of CT uniquely relevant for clinical psychology training.
Clinical Case Formulation & Treatment Planning: A Fact-to-Inference Strategy...James Tobin, Ph.D.
Clinical case formulation and treatment planning are core competencies of clinical psychologists and other mental health professionals. Yet there is no clear consensus regarding how to support the development of these skills in formal academic and clinical training. According to Dr. Tobin, the standard approach to supporting the development of these skills is "hierarchical learning," i.e., the trainee is first taught objective facts (declarative knowledge) and then required to transition to more subjective (inferential) forms of thinking in order to understand the cause and maintenance of the patient's problems. Dr. Tobin suggests that this approach is flawed on numerous levels, Instead, using a scene from the film "Dead Poets Society," he argues for the primary need to "subjectify" learning for the clinical trainee. The accomplishment of this initial goal will personalize all subsequent academic and clinical training, thus securing inferential capacities even before object knowledge is fully achieved.
This document summarizes a research study evaluating the effectiveness of a cognitive behavioral therapy group for adolescents who engage in self-harming behavior. The study took place at a community mental health center with 3 participants referred for self-harm indications. The 6-week CBT group focused on emotion regulation and positive coping skills to reduce self-harm impulses. A literature review found that deliberate self-harm is often linked to difficulties regulating emotions and trauma histories. Research suggests CBT and related therapies like dialectical behavior therapy can help challenge thoughts and behaviors related to self-harm by improving emotion regulation and problem-solving skills. The study aimed to evaluate whether the CBT group was effective in treating self-harming behaviors and associated emotions
Socializing the Psychotherapist-in-Training to an Alternative Form of Related...James Tobin, Ph.D.
According to Dr. Tobin, the supervision of psychologists-in-training must facilitate a central transition for the trainee. A major aspect of the trainee is socially-normed attitudes and tendencies which infiltrate the clinical situation and typically impede the development of a distinct "space" or interpersonal field on which psychotherapy relies. Dr. contends that the the supervisory situation and the unfolding dynamics between the supervisor and trainee should optimally support the trainee's capacity to experience him- or herself, and the other, in a more refined mode that liberates the dyad from the psychological and emotional restraints and inhibitions associated with social conventionality.
The Shift from "Ordinary" to "Extraordinary" Experience in Psychodynaimc Supe...James Tobin
Presented by James Tobin, Ph.D. at the American Psychological Association annual conference in 2012, this paper argues that psychotherapists-in-training often rely on various forms of social etiquette when relating to their patients and conducting treatment. He argues that an important goal of supervision is to help the trainee cultivate a clinical attitude and environment which is "extraordinary" in nature, an interpersonal and intrapsychic space unencumbered by political and benevolent tendencies. Dr. Tobin describes the modeling component of supervision in which the supervisee is exposed to a new way of being in the atmosphere of the supervisor's mindfulness, independence, spontaneity, creativity, and subversiveness.
Clinical Psychology Case Formulation and Treatment Planning: A PrimerJames Tobin, Ph.D.
The aim of this primer is to support the learning of clinical case conceptualization and treatment planning for graduate students in clinical psychology, other trainees in the mental health professions, and early-career psychologists and mental health workers.
This document summarizes the treatment of a 51-year old woman named Paula for chronic depression using an existential psychotherapy approach. Paula had a long history of depression and anxiety and previous unsuccessful treatment using cognitive-behavioral therapy. The therapist adopted an existential perspective to help Paula explore issues of identity, meaning, and purpose. Treatment goals included managing depressive symptoms, improving relationships, and helping Paula reconnect with her identity as an artist. The therapist integrated existential and other therapeutic models to build on past progress and provide a meaningful context for Paula to address her core identity issues and chronic depression.
Specifying the “Critical Thinking” Construct in Clinical Psychology Training:...James Tobin, Ph.D.
Critical thinking is a complex multidimensional construct whose presence in academic and training curriculums in psychology has largely been limited to scientific courses on research methodology that focus on the logical analysis of data, hypothesis support/refutation and inference-making. Yet the CT competencies required to function as a clinical psychologist expand beyond the analytic and inferential skills pertinent to the scientific method. Graduate training in clinical psychology has been criticized for not cultivating in students a more refined and contextualized set of CT skills that is directly applicable to their future career roles. Specifically, an alternative model of CT that emphasizes specific dispositional and attitudinal components central to self-experience has been lacking. For the psychotherapist, utilizing self-experience in a reflective and informed manner is a primary meta-cognitive ability that appears highly related to the capacity to form efficacious relationships with clients and to treatment outcome. The current project seeks to conceptualize an alternative model of CT uniquely relevant for clinical psychology training.
Clinical Case Formulation & Treatment Planning: A Fact-to-Inference Strategy...James Tobin, Ph.D.
Clinical case formulation and treatment planning are core competencies of clinical psychologists and other mental health professionals. Yet there is no clear consensus regarding how to support the development of these skills in formal academic and clinical training. According to Dr. Tobin, the standard approach to supporting the development of these skills is "hierarchical learning," i.e., the trainee is first taught objective facts (declarative knowledge) and then required to transition to more subjective (inferential) forms of thinking in order to understand the cause and maintenance of the patient's problems. Dr. Tobin suggests that this approach is flawed on numerous levels, Instead, using a scene from the film "Dead Poets Society," he argues for the primary need to "subjectify" learning for the clinical trainee. The accomplishment of this initial goal will personalize all subsequent academic and clinical training, thus securing inferential capacities even before object knowledge is fully achieved.
This document summarizes a research study evaluating the effectiveness of a cognitive behavioral therapy group for adolescents who engage in self-harming behavior. The study took place at a community mental health center with 3 participants referred for self-harm indications. The 6-week CBT group focused on emotion regulation and positive coping skills to reduce self-harm impulses. A literature review found that deliberate self-harm is often linked to difficulties regulating emotions and trauma histories. Research suggests CBT and related therapies like dialectical behavior therapy can help challenge thoughts and behaviors related to self-harm by improving emotion regulation and problem-solving skills. The study aimed to evaluate whether the CBT group was effective in treating self-harming behaviors and associated emotions
Socializing the Psychotherapist-in-Training to an Alternative Form of Related...James Tobin, Ph.D.
According to Dr. Tobin, the supervision of psychologists-in-training must facilitate a central transition for the trainee. A major aspect of the trainee is socially-normed attitudes and tendencies which infiltrate the clinical situation and typically impede the development of a distinct "space" or interpersonal field on which psychotherapy relies. Dr. contends that the the supervisory situation and the unfolding dynamics between the supervisor and trainee should optimally support the trainee's capacity to experience him- or herself, and the other, in a more refined mode that liberates the dyad from the psychological and emotional restraints and inhibitions associated with social conventionality.
Cognitive behavioural therapy (CBT) leads to significant improvements in functioning and quality of life for chronic pain conditions like low back pain. Several studies show CBT is as effective or more effective than other therapies or medications for issues like reducing catastrophizing thoughts, pain levels, and disability. While evidence is limited, online CBT and web-based interventions show promise in improving outcomes for chronic low back pain. Overall, CBT aims to help patients better manage their pain by changing maladaptive thoughts and behaviors.
The document discusses the interplay between a therapist's personal characteristics and qualities (therapist variables) and a client's theory of change. It argues that the most effective therapy occurs when the therapist is aware of how their variables may influence the therapeutic alliance and adapts their approach to align with the client's theory of change. Case studies are presented to illustrate therapists monitoring client feedback to improve outcomes. Effective therapists recognize when their approach does not match a client's needs and make adjustments to better facilitate the client's process of change.
This document compares the relationship between metacognitive states and coping styles with stress in gifted and normal students. It finds that gifted students have higher self-monitoring abilities and use compromising coping styles more than normal students. There is a positive correlation between compromising styles and metacognitive states in both groups. The study also finds normal students use non-compromising styles and isolationism more to cope with stress compared to gifted students.
1) The study examined whether coping strategies mediate the relationship between personality traits (Big Five factors) and psychological distress.
2) Results found several Big Five factors (agreeableness, conscientiousness, neuroticism) were correlated with psychological distress and certain coping strategies (wishful thinking, self-criticism, social withdrawal).
3) Further analysis showed these coping strategies (wishful thinking, self-criticism, social withdrawal) partially mediated the relationships between some Big Five factors (agreeableness, conscientiousness, neuroticism) and psychological distress.
In this presentation, Dr. Tobin utilizes Alice Miller's characterization of the "gifted child" to suggest that many graduate students in clinical psychology and psychotherapy trainees have suffered early emotional trauma. A consequence of this trauma is a psychological and emotional investment in the mental healthcare professions as a means of continuing to adhere to a particular relational role. For Dr. Tobin, what is problematic about this professional aspiration is the characterological residue from early deprivations which often emerges in trainees' narcissistic and/or co-dependent tendencies as they begin to engage in the therapeutic role. Breaking from these tendencies affords greater perceptional and relational freedoms, an important training and supervisory milestone for trainees and early-career psychotherapists.
Achieving Clinical Excellence HandoutsScott Miller
This document discusses achieving clinical excellence in psychotherapy. It provides three steps to superior performance: 1) determining your baseline effectiveness rate, 2) obtaining and using feedback to improve retention and outcomes, and 3) designing optimal practice environments and activities. It also announces the first annual "Achieving Clinical Excellence Conference" in October 2010 in Kansas City.
1. The working alliance theory places the therapeutic relationship in historical context and defines it as comprising bonds, goals, tasks, and views between the therapist and client.
2. Building the working alliance requires addressing bonds through core conditions, interpersonal style, and transference/countertransference. It also requires aligning the views of the therapist and client on salient issues.
3. Establishing goals and tasks that both the therapist and client understand and agree upon is important for an effective working alliance. The role of the therapist is to balance expertise with equality, coping with mastery, and use self-disclosure, affect, and encouragement strategically.
This document summarizes a mixed-methods study examining the relationship between mental health therapists' attitudes towards evidence-based practices (EBPs), perceptions of organizational factors, and degree status. The study found that doctoral-level therapists with positive attitudes reported more autonomy, while those with less positive attitudes reported requirements to use CBT and lack of time. Non-doctoral therapists reported lack of resources, space, funding, and regular client access as barriers. Managerial support was a facilitator for all therapists. The study provides insight into implementation challenges faced in community clinics from front-line perspectives.
Interpersonal Psychotherapy. A Guide To The Basics. (Stuart, 2006)Sharon
Interpersonal psychotherapy (IPT) is a time-limited psychotherapy that focuses on improving interpersonal relationships and social support systems. IPT is based on attachment theory, communication theory, and social theory. The main targets of IPT are relieving psychiatric symptoms, resolving or changing interpersonal problems related to conflicts, transitions, or losses, and strengthening social support networks. Key tactics include using an Interpersonal Inventory to identify problem areas and an Interpersonal Formulation to synthesize relevant relationship information and guide treatment. IPT aims to help patients improve communication, work through emotional difficulties, and develop supportive relationships.
This document describes a study that used interpretative phenomenological analysis to examine the experiences of 3 participants in a Positive Mindfulness Programme (PMP). 5 themes emerged from interviews with the participants: 1) The program challenged participants' sense of identity and led them to question their purpose and who they are at their core. 2) Participants discovered positive emotions and traits within themselves that they had forgotten or not fully accessed previously. 3) The program improved participants' relationships and sense of connection with others. 4) While beneficial, the program also presented emotional and practical challenges in embedding the knowledge and skills learned. 5) Future research could examine these programs' impacts in broader contexts and use grounded theory to develop theoretical explanations.
This document discusses attitudes, theories of attitude formation and change, and behavior modification therapy (BMT). It defines attitudes as predispositions involving thoughts, feelings, and behaviors. Major theories discussed include Heider's balance theory, Festinger's cognitive dissonance theory, and the Yale attitude change approach. BMT techniques are described that are based on classical conditioning principles like systematic desensitization and flooding, operant conditioning using reinforcement, and cognitive therapies aimed at changing thoughts. Factors influencing attitudes include beliefs, social factors, personal experiences, and institutions.
Re-submit 7711565 - Does positive rumination predict resilienceMolly Tuck
This study aimed to determine if positive rumination predicts psychological resilience in undergraduate students. 30 students completed questionnaires measuring positive rumination, problem solving, social support, emotional regulation, and resilience. A multiple regression found positive rumination did not predict resilience. Problem solving was the strongest predictor of resilience. While preliminary, these results suggest enhancing problem solving may increase resilience more than positive rumination. Further research with larger, more diverse samples is needed to better understand the relationship between positive rumination and resilience.
"Validity, Reliability and Factor Structure of the Mindfulness based Self-Efficacy Scale (MSES)", presented at the National conference of the New Zealand Psychological Society, 21 April 2012: Existing self-report questionnaires have been criticised for several reasons. Presents on a new self-report questionnaire to measure self-efficacy before, during and after mindfulness-based therapy or mindfulness training outside the therapy context. To try the MSES online and obtain instant results (at no cost), follow the link: http://www.mindfulness.net.au/mses
The diagnostic assessment and treatment and treatment planning in psychiatry is a dynamic process that integrates the biological, psychological, social, and behavioral paradigms to develop a plan of action that provides a rational for the types of interventions employed to sustain the therapeutic alliance and relieve suffering.
Interpersonal psychotherapy for postpartum depression. (Grigoriadis & Ravitz,...Sharon
This article reviews interpersonal psychotherapy (IPT) as an effective treatment for postpartum depression (PPD). IPT focuses on addressing the important interpersonal changes and challenges that women face during the postpartum period. Evidence from studies supports IPT as a treatment for PPD. The principles and guidelines of IPT can be easily integrated into primary care settings to help patients work through interpersonal difficulties arising during the postpartum period. IPT is particularly relevant for PPD as it addresses the stressors women experience at this life transition.
Psychodiagnosis refers to the process of classifying information about an individual's emotional and behavioral state in order to understand their psychological functioning. It aims to develop both a classification or label for any disorders (categorical diagnosis) as well as a deeper understanding of the individual's personality and experiences (characterological diagnosis). The objectives of psychodiagnosis are to describe psychopathology, provide diagnoses, formulate case studies to understand causes, and guide treatment planning.
This document provides an overview of integrative theories of change from a narrative therapy and collaborative language systems perspective. It discusses how change is viewed differently depending on the therapeutic model used. Narrative therapy views problems as arising from dominant narratives and sees change occurring through re-authoring these narratives by discovering unique outcomes. The role of the therapist is as an editor who helps clients re-author their own stories. Collaborative language systems views problems as residing in language and sees them as socially constructed through dialogue. Both models emphasize fluid problem definitions and equal participation between therapists and clients in defining problems.
The document discusses the goals and methods of counseling and psychotherapy. The main goals are to help clients adjust to change by resolving trauma, reconciling emotions, and challenging long-standing beliefs. Therapists do this by exploring the purpose and meaning of clients' problems, behaviors, and symptoms within relational contexts. They also continuously evaluate and refine treatment goals and plans to introduce new perspectives that disrupt rigid patterns and beliefs. The overall aim is to facilitate genuine human encounters that allow for personal and relational growth for both clients and therapists.
The document summarizes a study that evaluated the effectiveness of an 8-week mindfulness training program for mental health professionals. Key findings include:
1) Compared to baseline measures, participants demonstrated significant increases in mindfulness knowledge and attitudes, therapeutic mindfulness skills, and well-being after completing the training.
2) Participants reported being more confident and intentional about integrating mindfulness into their clinical work after training.
3) While therapeutic mindfulness increased, this seemed to be more due to changed attitudes like acceptance rather than clear gains in attention regulation skills.
4) The study provides preliminary evidence that a brief, standardized mindfulness training can achieve positive outcomes for therapists and potentially improve client care, but more research is still needed.
BBabcock - Research Summary - Coaching and Chronic Conditions - May 2013 v3Barbara Babcock, ACC
This document provides a summary of a research dissertation on the impact of coaching on the wellness and wellbeing of adults with Transverse Myelitis (TM) and their primary caregivers. The research found that a systemic coaching approach enhanced clients' wellness and reduced stress by addressing issues like control, uncertainty, loss, and family relationships. Limitations included a small sample size and focusing more narrowly may have provided clearer results. Practical implications suggest coaching can increase quality of life for those with chronic conditions, and family-based interventions are recommended.
Psychotherapy supervision serves several critical functions: it provides feedback and guidance to supervisees, allows them to get different perspectives on patient cases, enhances their learning and formation of a therapist identity, and ensures quality control of patient care. Supervision is an evaluative relationship between a senior and junior therapist that extends over time to improve the supervisee's skills and ensure ethical and competent services are provided to patients. Supervisors act as gatekeepers by determining if supervisees are ready to practice independently or require remediation before entering the field.
Cognitive behavioural therapy (CBT) leads to significant improvements in functioning and quality of life for chronic pain conditions like low back pain. Several studies show CBT is as effective or more effective than other therapies or medications for issues like reducing catastrophizing thoughts, pain levels, and disability. While evidence is limited, online CBT and web-based interventions show promise in improving outcomes for chronic low back pain. Overall, CBT aims to help patients better manage their pain by changing maladaptive thoughts and behaviors.
The document discusses the interplay between a therapist's personal characteristics and qualities (therapist variables) and a client's theory of change. It argues that the most effective therapy occurs when the therapist is aware of how their variables may influence the therapeutic alliance and adapts their approach to align with the client's theory of change. Case studies are presented to illustrate therapists monitoring client feedback to improve outcomes. Effective therapists recognize when their approach does not match a client's needs and make adjustments to better facilitate the client's process of change.
This document compares the relationship between metacognitive states and coping styles with stress in gifted and normal students. It finds that gifted students have higher self-monitoring abilities and use compromising coping styles more than normal students. There is a positive correlation between compromising styles and metacognitive states in both groups. The study also finds normal students use non-compromising styles and isolationism more to cope with stress compared to gifted students.
1) The study examined whether coping strategies mediate the relationship between personality traits (Big Five factors) and psychological distress.
2) Results found several Big Five factors (agreeableness, conscientiousness, neuroticism) were correlated with psychological distress and certain coping strategies (wishful thinking, self-criticism, social withdrawal).
3) Further analysis showed these coping strategies (wishful thinking, self-criticism, social withdrawal) partially mediated the relationships between some Big Five factors (agreeableness, conscientiousness, neuroticism) and psychological distress.
In this presentation, Dr. Tobin utilizes Alice Miller's characterization of the "gifted child" to suggest that many graduate students in clinical psychology and psychotherapy trainees have suffered early emotional trauma. A consequence of this trauma is a psychological and emotional investment in the mental healthcare professions as a means of continuing to adhere to a particular relational role. For Dr. Tobin, what is problematic about this professional aspiration is the characterological residue from early deprivations which often emerges in trainees' narcissistic and/or co-dependent tendencies as they begin to engage in the therapeutic role. Breaking from these tendencies affords greater perceptional and relational freedoms, an important training and supervisory milestone for trainees and early-career psychotherapists.
Achieving Clinical Excellence HandoutsScott Miller
This document discusses achieving clinical excellence in psychotherapy. It provides three steps to superior performance: 1) determining your baseline effectiveness rate, 2) obtaining and using feedback to improve retention and outcomes, and 3) designing optimal practice environments and activities. It also announces the first annual "Achieving Clinical Excellence Conference" in October 2010 in Kansas City.
1. The working alliance theory places the therapeutic relationship in historical context and defines it as comprising bonds, goals, tasks, and views between the therapist and client.
2. Building the working alliance requires addressing bonds through core conditions, interpersonal style, and transference/countertransference. It also requires aligning the views of the therapist and client on salient issues.
3. Establishing goals and tasks that both the therapist and client understand and agree upon is important for an effective working alliance. The role of the therapist is to balance expertise with equality, coping with mastery, and use self-disclosure, affect, and encouragement strategically.
This document summarizes a mixed-methods study examining the relationship between mental health therapists' attitudes towards evidence-based practices (EBPs), perceptions of organizational factors, and degree status. The study found that doctoral-level therapists with positive attitudes reported more autonomy, while those with less positive attitudes reported requirements to use CBT and lack of time. Non-doctoral therapists reported lack of resources, space, funding, and regular client access as barriers. Managerial support was a facilitator for all therapists. The study provides insight into implementation challenges faced in community clinics from front-line perspectives.
Interpersonal Psychotherapy. A Guide To The Basics. (Stuart, 2006)Sharon
Interpersonal psychotherapy (IPT) is a time-limited psychotherapy that focuses on improving interpersonal relationships and social support systems. IPT is based on attachment theory, communication theory, and social theory. The main targets of IPT are relieving psychiatric symptoms, resolving or changing interpersonal problems related to conflicts, transitions, or losses, and strengthening social support networks. Key tactics include using an Interpersonal Inventory to identify problem areas and an Interpersonal Formulation to synthesize relevant relationship information and guide treatment. IPT aims to help patients improve communication, work through emotional difficulties, and develop supportive relationships.
This document describes a study that used interpretative phenomenological analysis to examine the experiences of 3 participants in a Positive Mindfulness Programme (PMP). 5 themes emerged from interviews with the participants: 1) The program challenged participants' sense of identity and led them to question their purpose and who they are at their core. 2) Participants discovered positive emotions and traits within themselves that they had forgotten or not fully accessed previously. 3) The program improved participants' relationships and sense of connection with others. 4) While beneficial, the program also presented emotional and practical challenges in embedding the knowledge and skills learned. 5) Future research could examine these programs' impacts in broader contexts and use grounded theory to develop theoretical explanations.
This document discusses attitudes, theories of attitude formation and change, and behavior modification therapy (BMT). It defines attitudes as predispositions involving thoughts, feelings, and behaviors. Major theories discussed include Heider's balance theory, Festinger's cognitive dissonance theory, and the Yale attitude change approach. BMT techniques are described that are based on classical conditioning principles like systematic desensitization and flooding, operant conditioning using reinforcement, and cognitive therapies aimed at changing thoughts. Factors influencing attitudes include beliefs, social factors, personal experiences, and institutions.
Re-submit 7711565 - Does positive rumination predict resilienceMolly Tuck
This study aimed to determine if positive rumination predicts psychological resilience in undergraduate students. 30 students completed questionnaires measuring positive rumination, problem solving, social support, emotional regulation, and resilience. A multiple regression found positive rumination did not predict resilience. Problem solving was the strongest predictor of resilience. While preliminary, these results suggest enhancing problem solving may increase resilience more than positive rumination. Further research with larger, more diverse samples is needed to better understand the relationship between positive rumination and resilience.
"Validity, Reliability and Factor Structure of the Mindfulness based Self-Efficacy Scale (MSES)", presented at the National conference of the New Zealand Psychological Society, 21 April 2012: Existing self-report questionnaires have been criticised for several reasons. Presents on a new self-report questionnaire to measure self-efficacy before, during and after mindfulness-based therapy or mindfulness training outside the therapy context. To try the MSES online and obtain instant results (at no cost), follow the link: http://www.mindfulness.net.au/mses
The diagnostic assessment and treatment and treatment planning in psychiatry is a dynamic process that integrates the biological, psychological, social, and behavioral paradigms to develop a plan of action that provides a rational for the types of interventions employed to sustain the therapeutic alliance and relieve suffering.
Interpersonal psychotherapy for postpartum depression. (Grigoriadis & Ravitz,...Sharon
This article reviews interpersonal psychotherapy (IPT) as an effective treatment for postpartum depression (PPD). IPT focuses on addressing the important interpersonal changes and challenges that women face during the postpartum period. Evidence from studies supports IPT as a treatment for PPD. The principles and guidelines of IPT can be easily integrated into primary care settings to help patients work through interpersonal difficulties arising during the postpartum period. IPT is particularly relevant for PPD as it addresses the stressors women experience at this life transition.
Psychodiagnosis refers to the process of classifying information about an individual's emotional and behavioral state in order to understand their psychological functioning. It aims to develop both a classification or label for any disorders (categorical diagnosis) as well as a deeper understanding of the individual's personality and experiences (characterological diagnosis). The objectives of psychodiagnosis are to describe psychopathology, provide diagnoses, formulate case studies to understand causes, and guide treatment planning.
This document provides an overview of integrative theories of change from a narrative therapy and collaborative language systems perspective. It discusses how change is viewed differently depending on the therapeutic model used. Narrative therapy views problems as arising from dominant narratives and sees change occurring through re-authoring these narratives by discovering unique outcomes. The role of the therapist is as an editor who helps clients re-author their own stories. Collaborative language systems views problems as residing in language and sees them as socially constructed through dialogue. Both models emphasize fluid problem definitions and equal participation between therapists and clients in defining problems.
The document discusses the goals and methods of counseling and psychotherapy. The main goals are to help clients adjust to change by resolving trauma, reconciling emotions, and challenging long-standing beliefs. Therapists do this by exploring the purpose and meaning of clients' problems, behaviors, and symptoms within relational contexts. They also continuously evaluate and refine treatment goals and plans to introduce new perspectives that disrupt rigid patterns and beliefs. The overall aim is to facilitate genuine human encounters that allow for personal and relational growth for both clients and therapists.
The document summarizes a study that evaluated the effectiveness of an 8-week mindfulness training program for mental health professionals. Key findings include:
1) Compared to baseline measures, participants demonstrated significant increases in mindfulness knowledge and attitudes, therapeutic mindfulness skills, and well-being after completing the training.
2) Participants reported being more confident and intentional about integrating mindfulness into their clinical work after training.
3) While therapeutic mindfulness increased, this seemed to be more due to changed attitudes like acceptance rather than clear gains in attention regulation skills.
4) The study provides preliminary evidence that a brief, standardized mindfulness training can achieve positive outcomes for therapists and potentially improve client care, but more research is still needed.
BBabcock - Research Summary - Coaching and Chronic Conditions - May 2013 v3Barbara Babcock, ACC
This document provides a summary of a research dissertation on the impact of coaching on the wellness and wellbeing of adults with Transverse Myelitis (TM) and their primary caregivers. The research found that a systemic coaching approach enhanced clients' wellness and reduced stress by addressing issues like control, uncertainty, loss, and family relationships. Limitations included a small sample size and focusing more narrowly may have provided clearer results. Practical implications suggest coaching can increase quality of life for those with chronic conditions, and family-based interventions are recommended.
Psychotherapy supervision serves several critical functions: it provides feedback and guidance to supervisees, allows them to get different perspectives on patient cases, enhances their learning and formation of a therapist identity, and ensures quality control of patient care. Supervision is an evaluative relationship between a senior and junior therapist that extends over time to improve the supervisee's skills and ensure ethical and competent services are provided to patients. Supervisors act as gatekeepers by determining if supervisees are ready to practice independently or require remediation before entering the field.
This study investigated whether providing client feedback data to supervisors for use in supervision would influence supervision and counselor self-efficacy. Trainees were assigned to either a continuous feedback condition, where feedback was provided to supervisors, or a no-feedback condition. Results showed that trainees in both conditions improved client outcomes over the year, but those in the feedback condition improved more. However, ratings of supervisory alliance and satisfaction did not differ between conditions. The relationship between counselor self-efficacy and outcomes was stronger for those in the feedback condition, suggesting feedback may facilitate a more accurate assessment of skills.
Cognitive behavior therapy and interpersonal therapy have both shown efficacy in treating major depressive disorder among adolescents and emerging adults. Cognitive behavior therapy focuses on identifying and changing maladaptive thoughts and behaviors, while interpersonal therapy examines interpersonal relationships and communication styles. Research has found that both therapies effectively reduce depressive symptoms, though cognitive behavior therapy may be more effective for severe depression. Overall, cognitive behavior therapy and interpersonal therapy provide clients with skills to aid them post-treatment.
The "Wounded Healer" or the "Worried Well"? What We Know About Graduate Stu...James Tobin, Ph.D.
Doctoral programs consistently struggle with professional competence among their trainees, and numerous studies report significant numbers of expulsions from graduate study based on academic or nonacademic grounds. Widely attributed to Jung (1951), the wounded healer archetype assumes that clinicians, like all persons, have been negatively impacted by their personal histories, traumas, and interpersonal stressors. According to co-authors James Tobin and Anya Oleynik, a key role and responsibility of graduate programs in the helping professions and advanced training sites involves not only a gatekeeping function, but the capacity to identify and remediate students whose own personal challenges may be effectively resolved and transformed into the strengths ascribed to the wounded healer ideal.
Model of TreatmentEducation and its EvaluationProblem.docxhelzerpatrina
Model of Treatment/Education and its Evaluation
Problem(s)
Will Power +
Common Factors +
Any Specific Factor (any treatment model EBP or other) +
Feedback Informed Treatment + Deliberate Practice =
Effective Outcome
SPECIAL ARTICLE
How important are the common factors in
psychotherapy? An update
BRUCE E. WAMPOLD
Department of Counseling Psychology, University of Wisconsin, Madison, WI, USA; Modum Bad Psychiatric Center, Vikersund, Norway
The common factors have a long history in the field of psychotherapy theory, research and practice. To understand the evidence supporting
them as important therapeutic elements, the contextual model of psychotherapy is outlined. Then the evidence, primarily from meta-
analyses, is presented for particular common factors, including alliance, empathy, expectations, cultural adaptation, and therapist differ-
ences. Then the evidence for four factors related to specificity, including treatment differences, specific ingredients, adherence, and compe-
tence, is presented. The evidence supports the conclusion that the common factors are important for producing the benefits of psychotherapy.
Key words: Common factors, contextual model, psychotherapy, alliance, empathy, expectations, cultural adaptation, therapist differences,
specific ingredients
(World Psychiatry 2015;14:270–277)
The so-called common factors have a long history in psy-
chiatry, originating with a seminal article by S. Rosenzweig
in 1936 (1) and popularized by J. Frank in the various
editions of his book Persuasion and Healing (2-4). During
this period, the common factors have been both embraced
and dismissed, creating some tension (5-9). The purpose of
this paper is not to review or discuss the debate, but to pro-
vide an update, summarizing the evidence related to these
factors.
To understand the evidence for the common factors, it is
important to keep in mind that these factors are more than a
set of therapeutic elements that are common to all or most
psychotherapies. They collectively shape a theoretical mod-
el about the mechanisms of change in psychotherapy.
A particular common factor model, called the contextual
model, has been recently proposed (8,10). Although there
are other common factor models (e.g., 4,11), based on differ-
ent theoretical propositions, the predictions made about the
importance of various common factors are similar and the
choice of the model does not affect conclusions about the
impact of these factors. The contextual model is presented
below, followed by a review of the evidence for the common
factors imbedded in the model.
THE CONTEXTUAL MODEL
The contextual model posits that there are three path-
ways through which psychotherapy produces benefits. That
is, psychotherapy does not have a unitary influence on
patients, but rather works through various mechanisms.
The mechanisms underlying the three pathways entail
evolved characteristics of humans as the ultimate social spe-
cies; as such.
Model of TreatmentEducation and its EvaluationProblem.docxroushhsiu
This document discusses the importance of common factors in psychotherapy. It outlines the contextual model of psychotherapy, which posits that there are three pathways through which psychotherapy produces benefits: 1) the real relationship between therapist and patient, 2) the creation of expectations through providing an explanatory model of the patient's difficulties, and 3) the enactment of health-promoting actions. It then reviews evidence from meta-analyses supporting several important common factors, finding large effects for the therapeutic alliance, goal consensus/collaboration, and empathy. The evidence supports the conclusion that common factors, as conceptualized in the contextual model, are important for producing the benefits of psychotherapy.
This document summarizes a proposed research study that aims to evaluate the in-home mediator model of autism intervention. Specifically, the study will conduct in-depth interviews with 10-15 parents who recently completed an autism intervention program to understand their experiences as mediators and identify any factors that influenced the effectiveness of the intervention. Insights from the interviews will be used to inform improvements to the services provided and guide future research comparing the mediator model to in-clinic treatment models. The interviews will be structured around five factors identified in previous research as influencing interventions: the home environment, training received, skills developed, perceptions/emotions, and areas for service improvement.
This paper describes the process of reviewing literature to identify a valid and reliable assessment for evaluating students' reflection assignments. The review identified two potential assessments: a questionnaire and a four-code assessment. Both were found to demonstrate validity and reliability. The four codes classify reflection at different levels from non-reflection to critical reflection. As occupational therapy educators, developing students' critical reflection skills is important for preparing them to address current healthcare challenges through evidence-based practice and influencing policy.
Training Therapists in Evidence-Based Practice A Critical.docxjuliennehar
Training Therapists in Evidence-Based Practice: A Critical
Review of Studies From a Systems-Contextual Perspective
Rinad S. Beidas and Philip C. Kendall, Department of Psychology, Temple University
Evidence-based practice (EBP), a preferred psychologi-
cal treatment approach, requires training of community
providers. The systems-contextual (SC) perspective, a
model for dissemination and implementation efforts,
underscores the importance of the therapist, client, and
organizational variables that influence training and con-
sequent therapist uptake and adoption of EBP. This
review critiques the extant research on training in EBP
from an SC perspective. Findings suggest that therapist
knowledge improves and attitudinal change occurs fol-
lowing training. However, change in therapist behaviors
(e.g., adherence, competence, and skill) and client out-
comes only occurs when training interventions address
each level of the SC model and include active learning.
Limitations as well as areas for future research are
discussed.
Key words: dissemination and implementation, evi-
dence-based practice, systems-contextual perspective,
therapist training. [Clin Psychol Sci Prac 17: 1–30, 2010]
The American Psychological Association (APA) and the
American Academy of Child and Adolescent Psychiatry
(AACAP) support the provision of evidence-based prac-
tice (EBP; American Academy of Child and Adolescent
Psychiatry, 2006; American Psychological Association,
2005). However, a report by the United States Surgeon
General (1999) suggests that the majority of clients with
mental illness do not receive EBP. There are obstacles in
the dissemination and implementation (DI) of EBP into
clinical practice (e.g., criticism of treatment manuals,
inadequate training, and unsupportive organizational
climates). Understanding how to best disseminate EBP is
paramount to reducing the gap between research and
practice (Addis & Krasnow, 2000; Hayes, 2002;
Herschell, McNeil, & McNeil, 2004).
Multiple terms have been used interchangeably, and
at times inaccurately, in this area (Kendall & Beidas,
2007). EBP1 as defined by the American Psychological
Association (2005) is ‘‘the integration of the best avail-
able research with clinical expertise.’’ ESTs refer to
psychological interventions that have been evaluated
scientifically (e.g., a randomized controlled trial, RCT)
and satisfy the criteria outlined in Chambless and
Hollon (1998). DI research includes the purposeful
distribution of relevant information and materials to
therapists (i.e., dissemination) and the adoption and
integration of EPB into practice (i.e., implementation;
Lomas, 1993). Our focus is on training as it relates to
DI research: How does training influence therapist
knowledge and behavior (adherence, competence, and
skill), and how does the therapist’s context (organiza-
tional support and client population) influence adop-
tion and implementation of interventions ...
Perfectionism As A Multidimensional Personality...Camella Taylor
The San Diego Quick Assessment is a brief reading assessment tool used by middle school teachers to evaluate the reading levels of over 100 students. It provides a faster alternative to more extensive assessments. The assessment involves having students read one-minute passages and answer multiple-choice questions about the passage. Scores are used to determine independent, instructional, and frustration reading levels for students. The brief nature of the assessment allows teachers to evaluate many students in a short period of time to inform reading instruction.
This document provides an overview of different approaches to forming an alliance between a psychotherapist and client. It discusses the Miller Group's contribution, focusing on using outcome and session rating scales to measure client progress and the quality of the relationship. The scales are used to guide therapy based on the client's needs and assessments. Systemic and narrative theories emphasize understanding problems as socially constructed through language within a context. In systemic therapy, problems are defined by the client's description, and hypotheses are developed dialogically between therapist and client based on both of their experiences and understandings.
Veterinary drenches are oral liquid formulations used to deworm livestock by killing internal parasites. There are different types of drenches including suspensions, solutions, and emulsions. Drenches can treat a broad or narrow range of internal parasites. They contain active ingredients from different chemical groups that act on parasites in specific ways. Regular drench testing and careful administration are important to ensure effectiveness and prevent resistance. Combining different drenches can help reduce resistance issues. Drenches are a necessary tool for parasite control on farms.
What did you learn about yourself and your abilities to be a t.docxlillie234567
What did you learn about yourself and your abilities to be a teacher of
young children, and how you worked as part of a teaching team?
As I take this class, I see my teacher skills build every day when I come to the
lab. I see patience in all the teachers and also in me. When I have to convince
the children to make good choices, solve problems, and deal with challenging
behaviors. As a teacher, I’m a role model and a friend to the children. When I set
up an activity, I think about how I can challenge the children to do things that I
think they will learn from that activity. For example, I want the children to do math
patterns, balance with one leg, or walk on the beam without helping hands. The
children need to practice and build on their knowledge, and they learn the skills
through all the activities that they are engaged in in the class.
As a teaching team member, communication is the most important thing.
Teachers need to keep track of the ratio throughout the day. They must
communicate with other teachers in the room when they take the children to the
restroom. Announcing the change in the routine to ensure the children know what
will happen differently that day and let coworkers expect what to do. Never let
down your guard when you are with the children.
What did you learn most about planning emergent curriculum for young
children?
I learned that an emergent curriculum is a program that plans lessons based on
the children's interests. Planning needs a lot of experience, and teachers must
decide what is important for the children to learn. The activity setup layout needs
to be welcoming, and the color and materials must be related. The material and
objects need to stand out to catch the children’s eyes. I need to support diversity,
math, or literacy in the activity. The teacher creates intentional teaching material
that encourages the children to build on what they already know.
What did you find challenging and rewarding about your lead days?
The lead day sounded scary to me in the middle of the semester. Lead day
practice takes place over two days, and these two days are helpful for me in
learning the routine and keeping track of time. It is important to be flexible about
what is happening in the environment and make sure to make the transition at
the right time. When I ask other teachers to do something, I find myself being
weird, especially if they are the teachers and already know what needs to be
done. The lead days taught me how important communication is with team
members.
STIGMATIZATION AND SELF-ESTEEM OF PERSONS IN RECOVERY
FROM MENTAL ILLNESS: THE ROLE OF PEER SUPPORT
MIEKE VERHAEGHE, PIET BRACKE & KEVIN BRUYNOOGHE
ABSTRACT
Background: Persons with mental health problems often experience stigmat-
ization, which can have detrimental consequences for their objective and subjective
quality of life. Previous research seeking for elements buffering this negative
association focused on coping strategies and revealed that no.
Reflective Practice in Nursing Communication Sample Essay.docxwrite22
Reflective practice in nursing involves reflecting on experiences to improve nursing skills and knowledge. Various models of reflection are discussed, including those developed by Dewey, Schön, and Gibbs. Reflective practice benefits communication skills by allowing nurses to reflect on interactions, consider how they can improve, and incorporate lessons learned into future practices. Regular reflection aids continuous professional development and can help address issues or "critical incidents" to enhance patient care.
Health Psychology: Clinical Supervision Course 3 Part Series Michael Changaris
This document provides the syllabus for a doctoral health psychology clinical supervision rotation course. The course consists of three seminars over the 2019-2020 academic year covering key domains of clinical supervision. Interns will develop skills in individual, group, and direct supervision methods. They will explore legal and ethical issues, cultural factors, developing effective supervisory relationships, and recognizing limitations and boundaries as supervisors in training. During the rotation, interns will gain experience providing group supervision under licensed supervision. The seminars aim to develop competencies for supervision in integrated health care settings.
Successful Aging Theory Review Discussion.pdfsdfghj21
1) The theory proposes that aging is a process of adapting to changes through increasingly complex coping processes. A person's choices influence whether their aging is successful.
2) Key aspects of successful aging according to the theory are physical and mental health, meaningful activities, relationships, spirituality, creativity, and a sense of control.
3) The theory was influenced by Roy's adaptation model and aims to help nurses support older adults' transition to later life.
An Interpretive Account Of Counsellor DevelopmentJackie Taylor
The author interviewed 8 counselors-in-training to understand how they develop and make sense of their experiences. Their accounts were integrated into a single narrative divided into four phases: foreshadowings, opening chapters, denouement, and conclusions. The narrative captures the counselors' experiences and how they derive meaning from their counselor education. Implications for counselor education practice are also discussed.
Abstract:
It is difficult to find in Spanish a word that can translate the meaning of Counselling and encompassing all those elements and nuances that you are your own. The translations more frequently used are "assisted advice" and/or "aid relationship" and/or advice, it also includes all the skills that are necessary to establish that interpersonal relationship.
Although the communication skills, and in particular communication of bad news and the relationship with users are currently not part of the university education within the degree in Medicine, Nursing, Physiotherapy or Psychology if it has been of concern on the part of practitioners in these areas present sufficient levels of training in this core competency. In fact, we presented/displayed a communication where the little information received in the own hospital on the part of parents with children with Syndrome of Down is reflected in particular on this genetic alteration before making decisions referred to the birth from the boy. Thus, just as the curative art is learned can be learned the abilities of communication referred the unexpected news, which will help to diminish the psychological cost for the professional and the own patient.
Similar to The Shift from "Ordinary" to "Extraordinary" Experience in Psychodynamic Supervision (20)
Launching a Private Practice: Strategies for Clinical Psychologists and Menta...James Tobin, Ph.D.
In this presentation, Dr. Tobin provides a set of attitudinal and pragmatic recommendations for beginning a private practice in the mental healthcare professions. The central elements of private practice including ethical, legal, marketing, financial, and supervisory factors are introduced. Beyond this, Dr. Tobin suggests that the transition from "trainee" to "entrepreneur" is often fraught with conflict centering on archaic dispositional tendencies residing in many psychologists and psychotherapists. Reviewing Alice Miller's characterization of the "gifted child," Dr. Tobin suggests that many early-career practitioners suppress self-concerned drives and aspirations including financial reward. Yet, establishing a successful clinical practice is a gradual and complex process, one that necessitates a personal resolution of two fundamentally opposed value systems: adherence to the needs of the other vs. the needs of one's self. Professional development is portrayed as the negotiation of these opposing forces across one's career.
Improving Writing and Critical Thinking Competence in Psychology: A Primer a...James Tobin, Ph.D.
This manual was composed to support psychology students' ability at the undergraduate and graduate levels to write more effectively in a variety of contexts within academic and applied settings. The primer is not meant to be a comprehensive writing guide, but focuses instead on the core components of scholarly writing, critical thinking, and the formulation and execution of original ideas. The relevance of these competencies for clinical psychology training is emphasized throughout the manual. Exercises are provided to help the instructor and/or student with practice experiences to support the refinement of the ideas and skills presented.
The Child’s Psychological Use of the Parent: A Workshop James Tobin, Ph.D.
This workshop is designed for parents who would like to improve the quality of their relationship with their children. Dr. Tobin provides a roadmap for parents based on a core paradox of the human condition, i.e., the initial need to bond (to form and sustain early life) and the subsequent need to separate/individuate (in order for the child to secure a distinct personal identity unencumbered by unresolved issues with the family of origin). According to Dr. Tobin, both the parent and the developing child simultaneously press for separation/individuation and resist it. This workshop attempts to alert parents to the underlying dynamics that prolong this ambivalence and provides pragmatic suggestions for how parents can be "of use" psychologically so that their child is more successfully primed for the achievement of autonomy.
The Dynamics of Process and Content in Parent-Teen Communication: A Coding Ma...James Tobin, Ph.D.
This coding manual is designed to provide parents with an approach to understanding their communication and relational difficulties with their children. According to Dr. Tobin, the parent-teen relationship is usually conflictual yet parents often do no understand the specific dynamics of their family system that often result in arguing, stonewalling, oppositionality, distance, and withdrawal. Drawing from scientific research of the conflict dynamics of romantic couples, Dr. Tobin has designed an exercise that consists of the audiotaping of a parent-teen discussion of an issue or problem between them. A set of content codes outlined in the manual is then applied to the transcribed audiotaped dialogue. The scoring sheet for the codes is designed to showcase how what is said, when it is said, and by whom it is said contributes to the facilitation or obstruction of the dialogue. In this way, Dr. Tobin contends that the architecture of the parent-teen relationship can be uncovered and ultimately used in parent guidance and family therapy to improve parents' relationships with their children.
A Therapy Hour: Revisiting Winnicott’s Notion of “Object Usage”James Tobin, Ph.D.
In this talk, Dr. Tobin applies the fundamental constructs of D.W. Winnicott's theorizing including "going on being" and the distinction between "object relatedness" and "object usage" to a clinical patient. The therapy hour selected features the therapist's and patient's complex negotiation of and resistance to aspects transitional junctures of the interpersonal space.
E-Therapy: A Critical Review of Practice Characteristics and Ethical StandardsJames Tobin, Ph.D.
A number of consumers turn to the internet to seek relief from mental distress. Research (Fox & Fallows, 2003) has found 21% of internet users search information on depression, anxiety, and other mental health issues. At the same time, a number of clinicians are engaging in the practice of “e-therapy” over the Internet. E-therapy is now used by a range of professionals and applied to a vast array of problems and conditions. Bischoff (2004) believes the interest in online based counseling is growing due to several reasons: technology is becoming increasingly sophisticated, the technology is becoming more affordable, and people are becoming more comfortable using technology as a means of communication. Furthermore, the telecommunications system will continue to increase in quality and affordability, and this will be associated with an increased user comfort. According to co-authors Lana Hunter and James Tobin, this will make it important for professionals in the mental health field to become familiar with the format and application of e-therapy available as a method of mental health treatment and the ethical and legal issues involved in choose technology as a treatment medium.
Utilizing clips from the feature films "Ali" and "Magnolia," Dr. Tobin emphasizes the importance of regret in adult development. When pursued in psychotherapy, regrets a patient experiences serve as a bridge into vital aspects of emotional development, mourning, and self-integration. Further, Dr. Tobin introduces the notions of "otherness" and "non-meaning" and characterizes their relevance for personal and existential experience.
The Dynamics of Unconscious Communication: Projection, Projective Identificat...James Tobin, Ph.D.
According to Dr. Tobin, communication occurs at an unconscious level and is organized largely around psychological processes that re-create historical events. This talk seeks to clarify how projection and projective identification are relevant in all romantic relationship and engineer patterns of relatedness oriented toward re-traumatization.
This talk presents Dr. Tobin’s view that human relationships, especially intimate romantic bonds, revolve around a central dynamic in which one’s internal representation of relational trauma previously experienced in one’s life (metaphorically called a “parasite”) gets “injected” into the other (or in one’s partner). All human relationships are constituted by a “sender” of parasitic material and a “recipient" who is unconsciously recruited to host the parasite. Once the parasitic material nests and proliferates in the identity of the recipient, the recipient is gradually but inevitably transformed into a perpetrator who then inflicts relational trauma back onto the sender. In this way, the sender’s previous relational trauma is re-experienced in the contemporary relationship, confirming the sender’s rigid construction of the world, of others, and of human relatedness. According to Dr. Tobin, this dynamic of parasitic love explains the patterns of self-sabotage and self-destruction so common in people’s romantic lives. However, it also suggests a paradigm for understanding all forms of aggression including envy, racism, and overt acts of violence: not only are we consistently injecting our parasitic material into others, but we are constantly inundated with parasitic injections into us and ultimately altered in insidious ways that perpetuate cycles of injustice and self-hatred.
Romantic love is parasitic. Unconsciously, we seek out partners who can serve as psychological "hosts" we then use to inhabit our previous relationship traumas. And the host, once recruited, chosen, and "injected" into, houses and nurtures our injured past. As the parasites grow inside our lover/host, he/she is altered and becomes the perpetrator who victimizes and does not love.
Each of us must be aware of how we serve as our partner's host, and how, simultaneously, we seek a host into whom we inject our parasitic material. In this talk, I present the story of "recruitment" and discuss how to recognize the nature of the parasitic material you are receiving. I also address the other side of the equation, i.e., how to understand the parasites already growing within you from previous relational experiences and the particular style of your recruitment and injection strategy.
Academic Cheating Among Youths: A Causal Pathway Model James Tobin, Ph.D.
Academic cheating is a problem more commonly manifested among children and adolescents than one might expect. Researchers estimate that approximately 75% of high school students cheat at some point during their course of academic study (e.g., McCabe, Trevino, & Butterfield, 2001; Whitley, 1998). While cheating appears to be widespread, it has been under-emphasized in the empirical literature and poorly understood as a behavioral phenomenon despite its association with a range of youth risk factors (including low self-esteem and poor academic performance) and its capacity to predict more severe problems in later adolescence and young adulthood. Conducted by co-authors Nicolette de Sumrak, M.A. and James Tobin, Ph.D., this review attempted to organize the current research findings on academic cheating into a comprehensive causal pathway model. Empirical findings were categorized into (1) individual, (2) contextual and (3) moderating factors that interact to increase the likelihood of the onset and maintenance of cheating behavior.
Promoting the Patient's Capacity to Suffer: A Revision of Contemporary Notion...James Tobin, Ph.D.
In this presentation, Dr. Tobin argues that the era of evidence-based treatment has inadvertently placed too much pressure and responsibility on the part of the clinician to "heal" the patient. Symptom reduction and characterologoical transformation are perspectives on therapeutic transformation that oversimplify the clinical situation. According to Dr. Tobin, a principle focus of psychodynamic treatment is increasing the patient's capacity to contact, tolerate, and represent his or her contributions to experience; learning by suffering denotes a psychological competency in which denial, minimization, and other defensive modes of distortion are replaced by more accurate appraisals of reality.
Culture, Norms, and Process in Adult Sex Offender Groups: Getting Reacquaint...James Tobin, Ph.D.
Most clinicians who treat adult sex offenders utilize group therapy. However, facilitation of groups for sex offenders is often highly idiosyncratic, with great variance in the content and process of groups, clinicians’ views of intervention goals, strategies, and technique, and how the cultural fabric of the group is established. Moreover, clinicians who treat sex offenders typically have expertise in the assessment of risk, relapse prevention, and individual factors that impact the nature and magnitude of aberrant sexual beliefs and tendencies, yet have never had or don’t readily recall advanced training in group psychotherapy. To address this issue, this presentation will describe and delineate transtheoretical factors of group psychotherapy, including here-and-now processing, vicarious learning, group-as-a-whole phenomena, and developmental dynamics across the evolution of the group. Attention will be devoted to the relevance of these factors for adult male sex offender groups, with clinical case material used to illustrate significant themes. Additionally, empirically-based measures that assess group process factors showcased in this talk will be introduced. Attendees will leave this presentation with a greater repertoire of intervention strategies from which to draw, and a theoretical framework for understanding the common events and dynamics that emerge in groups for adult male sex offenders.
The Anatomy of Discovery in Psychotherapy: "Something So Familiar, It is Stra...James Tobin, Ph.D.
The document summarizes a presentation given by James Tobin, Ph.D at the Western Psychological Association Annual Convention on April 25, 2014. The presentation discussed the concept of discovery in psychotherapy and argued that true discovery occurs when patients recognize something familiar about themselves that was previously unintegrated or unformulated. The therapist's role is to create an environment that allows patients to self-observe and explore their experiences to promote this recognition, rather than imposing their own interpretations.
Finding the "Subversive" in the Persona of the TherapistJames Tobin, Ph.D.
In this talk, I present my view of the psychotherapeutic process as a shift from the conventions of typical social reality into a therapeutic space oriented toward self-expression and self-experience. This shift is usually a significant challenge both for the patient and therapist, particularly therapists-in-training or early in their careers. The therapeutic couple may collude in an avoidance of deeper levels of the patient's experience and of the therapist's capacity to articulate what he/she observes or feels about the patient. This presentation attempts to conceptualize how the identity of the therapist needs to be altered into a "therapeutic persona" that subverts conventional relational and attachment tendencies in order to liberate the patient's recognition of oneself.
Inducing and Being Induced: How to Recognize Dysfunctional Relationship DynamicsJames Tobin, Ph.D.
As a species, we are socialized from birth to compromise various aspects of one’s true identity in order to appeal to the primary caregiver. Consequently, we learn how to play roles in relationships very early in development. Yet, role-playing continues into adulthood and even across the lifespan. Every human interaction may be conceptualized from the vantage point of roles, as roles organize emotional experience, the hierarchy of power between individual s and groups, and the execution of tasks. Human relationships, therefore, revolve around inhibitions and resistances to authentic intimacy given that roles provide an architecture of human relatedness and fend off psychological fears and anxieties about closeness. In no other aspect of human life is this most apparent than in romantic relationships. We unconsciously coerce or “induce” others to act in accordance with our role preference, and in turn we are coerced or induced to act in accordance with the role preferences of others. These induced roles quickly set into motion a sequence of interactions that constricts a person’s relational freedom, thus straight jacketing the person into a role that, over time, becomes quite rigid and constraining. Understanding these induction processes, as well as the unconscious longings that generate them, are perhaps the most important keys to having fulfilling, surprising, and viable relationships. In this presentation, I will discuss these induction processes, explain why they are so prevalent, and offer my thoughts on how they may be avoided and/or dissolved.
Repeating the Trauma: Unconscious Factors that Determine Contemporary LifeJames Tobin, Ph.D.
Early developmental factors that pre-determine who we are romantically attracted to and with whom we ultimately choose to be. The narcissistic-codependent bond is only one example of a broader, and more insidious, concept: the human mind is programmed to seek out the “familiar,” no matter how unhealthy, across the lifespan. This notion has been widely supported by theorists in evolutionary psychology and the social sciences, but is not often emphasized when considering the problems of contemporary life. In this presentation, I outline why and how we seek to repeat the fundamental circumstances of early life in relationships, friendships, workplace settings, in our finance status, and in how we see and treat ourselves. While most of our early childhoods are relatively healthy, I will argue that a specific, fundamental trauma underlies each of our personalities and largely determines how our lives unfold. I will also share my ideas regarding how liberation from this pattern may occur.
Various unconscious factors that set the stage for the unfolding of relational dynamics that can be distressing, emotionally painful, and highly destructive. The narcissist-codependent bond is a good example of this. I have argued that such dynamics are largely pre-determined and out of our control and awareness, which is why so many people become frustrated at identifying and limiting the negative impact of these dynamics on their lives. Consequently, these dynamics overtake our best efforts at living a healthy, productive life, and tend to cause chronic damage in our romantic lives, careers, friendships, and even in relation to our own self-care and self-esteem. In this talk, I present an approach to identifying and taking better control of these dynamics – so that we do not allow them to unfold in their typical insidious fashion. My perspective on interpersonal transformation involves a systematic analysis of what constitutes how we view others and how others view us. I will suggest that how we view and are viewed consist primarily of fabrications that perpetuate a series of emotional and psychological provocations which, ultimately, restrict how we maneuver through and negotiate the social world. How to identify and alter these fabrications is perhaps the most common question that has come up in our groups so far and that is asked by patients who see me individually for psychotherapy.
Revisiting Oedipus: The Weakened Masculinity of Modern ManJames Tobin, Ph.D.
In my opinion, it is an era of weakened masculinity. Anecdotal evidence and scientific research suggest the presence of a large demographic of men who lack self-esteem, have difficulty forming and maintaining positive relationships, are poor decision-makers, resort to a variety of high-risk and maladaptive behaviors including internet pornography, substance abuse, and sex and work addiction, and harbor a general dissatisfaction with their quality of life. Although Freud is viewed by many to be obsolete at this point in time, for me his perspective on the Oedipus myth provides a compelling psychological explication of the predicament of modern men. In this talk, I will outline my understanding of Freud’s interpretation of Oedipus, its ramifications for male psychological development, and its relevance to the contemporary problems of men. What I have also discovered in my analysis of Oedipus is the emergence of a theory of male sexual addiction which centers on the man’s compulsive attempt to proclaim his identity in the context of it never having existed.
Why We Love Who We Love: A Psychodynamic Perspective on the Loss of Free Will James Tobin, Ph.D.
In this presentation, Dr. Tobin presents a model of romantic love that synthesizes concepts from evolutionary psychology, Freudian thought, interpersonal neurobiology, and intersubjectivity. Notions of free will and conscious decision-making regarding the choice of romantic partners are refuted. Instead, Dr. Tobin presents an unconsciously motivated perspective on romantic love that emphasizes our uncanny tendency to select and induce others to hurt us emotionally iin ways that are familiar and to which we are highly adapted.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
The Shift from "Ordinary" to "Extraordinary" Experience in Psychodynamic Supervision
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
2
3. Introduction
In this presentation, I will describe an approach
to psychodynamic supervision inspired by my
work with a 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 outline its heuristic value.
3
4. Introduction
If we agree, as Ablon and Jones (2005, p. 564-565)
observed in their research 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’
capacity to utilize this medium through the
metaphor of the “extraordinary.”
4
5. Psychotherapy Training: A Fairly Bleak Picture
Numerous 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.
5
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;
6
7. Psychotherapy Training Issues
• Strict adherence to manual-guided
techniques;
• The failure to foster durable improvements in
overall therapeutic effectiveness.
7
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, and that the effectiveness of our
graduate training programs is assumed
largely on faith.
8
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.).
9
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).
10
11. Binder’s Critique
Curricula expose students to theories and
procedures associated with various treatment
models, followed by “an abrupt transition to
‘practicing’ with real patients” (Binder, 2002,
p. 5).
Yet conceptual knowledge is not readily
available to students about how a treatment
is actually conducted.
11
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.
13
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.
14
15. Stylistic Preferences and Rigidity of Roles
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.
The personality of the supervisor tends to
correspond to broad supervisory styles (taskoriented, interpersonally-focused, etc.)
(Freidlander & Ward, 1984; Shanfield & Gil,
1985) that unwittingly shape and determine
the supervision experience.
15
16. Perpetuation of Poor Supervisory Models
Supervisors also tend to repeat the mistakes
made by their own supervisors (Worthington,
1987).
16
17. Something is not working ...
Given all of the issues, something is clearly not
working in how we teach, train and supervise
students and psychotherapists-in-training.
17
18. 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
19. 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
20. But the Good News Is We Are Making Progress!
Despite these training problems and the
corresponding lack of a consensual model for
conceptualizing and implementing
supervision, we are making significant strides!
20
21. 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
22. 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
23. Relational Emphasis
The supervisory relationship (e.g., 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
24. 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
25. The Educational Pyramid
A triadic model (Bernstein, 1982; Seidman &
Rappaport, 1974) in which the interrelationships of the three figures of
psychotherapy training (client, trainee, and
supervisor) has contributed to the design of
empirical research programs that assess
supervision efficacy and the degree to which
it actually predicts trainees’ interventions
and the outcomes of their therapy cases.
25
26. 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
27. Moving from Micro-Skills to Super-ordinate Goals
For example, Binder (2002) defined 4 superordinate 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
28. 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
29. Tuckett’s Three Frames
For example, 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
30. 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
31. 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, clearly evident in the technique of
highly-skilled and experienced therapists.
But the capacity to identify and use selfexperience is 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
32. A Major But Under-emphasized Issue:
“Sterile” Supervision
In my review of the supervision 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 selfexperience results in “sterile” supervision.
32
33. Sterile Supervision
Sterile supervision may be 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
34. 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
35. Sterile Supervision
We have all heard about or experienced supervisory
sessions that seem no different in tone or content
from formal business transactions or professional
engagements!
Although these modes of interaction are, at times,
reasonable and appropriate for the supervisory
relationship, I believe the patterned and
consistent dilution of the supervision experience
represents a more insidious problem.
35
36. 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’
presentations of clinical material are
commonly filtered or distorted.
36
37. 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
38. 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
and in supervision in order to appeal to the
overt and covert preferences of their
supervisors or peers in consultation groups.
38
39. 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
40. Empirical Evidence of Compliance in Supervision
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 controlling and assertive
manner as compared to the more compliant
supervisee.
40
41. Empirical Evidence of Compliance in Supervision
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 traineetherapist to be controlling as well.
41
42. 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 progressively became more and
more narrowed in scope, with content
condensing to the trainee’s requests for
specific instructions from the supervisor and
the articulation of the supervisor’s insights.
42
43. Empirical Evidence of Compliance in Supervision
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
44. Empirical Evidence of Compliance in Supervision
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
45. 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 of
supervisors are perceived by administrators
as indicative of supervisor competence.
45
46. The Supervisor’s Social Desirability
Supervisors also tend to 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 occur
(Fauth et al., 2007).
46
47. Supervisors’ Desire to Protect, Shield and Prevent
Narcissistic Injury
I also believe there is a tendency among many
supervisors who, conscious of trainees’ fears,
naiveté, demoralization and low professional
self-esteem, over-compensate by attempting
to shield supervisees from common realistic
challenges of the therapy situation and selfexperience (e.g., narcissistic injury) often
associated with the growing pains of learning
the complex task of psychotherapy.
47
48. 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 the training clinic where
he work was 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
49. 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
50. The Avoidance of “Touchy Issues”
Similarly, Lizzio et al. (2009, p. 129) observed
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
51. 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
52. Toward a Definition of “Ordinary” Experience
The many factors contributing to sterile
supervision suggest the potential for a
patterned interpersonal dynamic between
supervisee and supervisor restricted to
conventional forms of relatedness.
52
53. Toward a Definition of “Ordinary” Experience
In this conventional relatedness, 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”).
53
54. Toward a Definition of “Ordinary” Experience
Phony or sterile supervision is facilitated by the
supervisor and trainee colluding so as to
reside within a sanctioned safe zone
relegated to a fundamentally ordinary
relatedness to which both parties are wellaccustomed.
54
55. The Press Toward the Ordinary
Unfortunately, many of our training institutions
embody a culture of ordinary relatedness that
fails our students and supervisees in
numerous ways, including not socializing
trainees to the potential power of a true
therapeutic environment unencumbered by
the restrictions of social mores.
55
56. The Press Toward the Ordinary
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 the pursuit of self-experience that
may be controversial or viewed as
inappropriate when conceived of in the
context of typical social discourse.
56
57. The Press Toward the Ordinary
Consequently, activating the trainee’s selfawareness/use of self in the clinical situation is not
really possible because it is not activated in the
process of supervision; self-experience is largely
censored in supervision as supervision becomes
categorically associated with standard social
discourse.
In this way, the trainee is not provided with a
relational experience that adheres to the distinct
self- and self-other relatedness that characterizes
a psychoanalytically-informed model.
57
58. The Press Toward the Ordinary
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).
58
59. The Press Toward the Ordinary
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.
59
60. The Press Toward the Ordinary
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.
60
61. My Central Thesis
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 in supervision, the supervisee’s
subjective experience as therapist,
learner and person
may be ordinarily
thwarted.
61
62. My Central Thesis
Overly-protecting, supporting or instructing the
supervisee can have the unintended
consequence of ultimately invalidating her
self-experience; yet the ability to access and
use self-experience is a crucial therapeutic
competence and serves as both an anchor
and compass for negotiating the challenges
of actual clinical work.
62
63. Being “Supported Away”
Many of the supervisees I encounter are
discouraged or demoralized because their
own views have seldom been inquired about
or allowed to stand as valid sentiments in
supervision (e.g., a supervisee once told me
she felt like most of her concerns as a
therapist-in-training had been “supported
away”).
63
64. Humility: A Rite of Passage in Training
A common issue 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
65. 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
prompted 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
66. Emulation of the Ordinary
Exposure to sterile supervision leaves the
supervisee with a constricted perspective of
therapeutic relatedness.
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
embedded in the supervisory process.
66
67. 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).
67
68. 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
dynamic therapy situation, which, at its core,
revolves around one mind attempting to
make contact with and understand deeply
the mind of another.
68
69. 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).
69
70. The Supervisee’s Self-Experience
The supervisee is seen 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
71. The Supervisee’s Self-Experience
Therefore, in my view, it is the supervisor’s
primary task to explore extensively the
supervisee’s self-experience with relative
abstinence in order to (1) affirm its validity
and (2) model for the supervisee a mode of
“being with” another’s experience.
71
72. The Supervisee’s Self-Experience
As in psychotherapy, this approach assumes that
due to a variety of interpersonal and
intrapsychic factors there will be resistances
to the expression, examination and tolerance
of the supervisee’s uniquely personal
experience.
72
73. My Primary Task As Supervisor
Therefore, I see my primary task as one of
coaxing into expression the supervisee’s selfexperience; 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.
73
74. Supervision Vignette
• A supervisee, in a practicum placement at 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.
74
75. Supervision Vignette
• 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.
75
76. Supervision Vignette
• 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 at other times 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.)
76
77. Supervision Vignette
• 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.
77
78. Supervision Vignette
• 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.
78
79. Supervision Vignette
• I blurt this all out to you now, without really
thinking about it or organizing it. I guess I
am allowing myself to be spontaneous with
you, which is ironic 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.
79
80. Supervision Vignette
• 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.
80
81. Supervision Vignette
• 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.
81
82. Supervision Vignette
• 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.
82
83. Supervision Vignette
• 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 are really
good. And you seem to be able to prod me
along.”
83
84. Evidence of the Supervisee’s Growth: Reduced Fear of
“Expressing the Natural Me”
This supervisee began working with me with a
heightened degree of self-consciousness and
self-criticality, along with a constant worry that
she wasn’t “doing it” right.
84
85. Evidence of the Supervisee’s Growth: Reduced Fear of
“Expressing the Natural Me”
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 (she was, I believe, “fighting back
the natural me” with me). This clearly has
changed!
85
86. Evidence of the Supervisee’s Growth: Reduced Fear of
“Expressing the Natural Me”
She now approaches her own reflections in
supervision without judgment, although fears
of “doing something wrong” with her patient
still remain; but 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.
86
87. Evidence of the Supervisee’s Growth: Awe and
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 and eager to find
meaning in what she allows herself to put
forth.
87
88. Evidence of the Supervisee’s Growth: Increasing
Autonomy and Fewer Preoccupations
Before, she seemed to rely heavily on me and
other prior supervisors for direction.
Now, she is relatively autonomous in a large
portion 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.
88
89. Evidence of the Supervisee’s Growth: Recognition of
the Patient’s Character Structure and Relational
Dynamics
While the supervisee previously seemed to
objectify her patient (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.
89
90. Evidence of the Supervisee’s Growth: Recognition of
the Patient’s Character Structure and Relational
Dynamics
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.”
90
91. Evidence of the Supervisee’s Growth: Emergence of a
Therapeutic Identity
Previously, the supervisee seemed to lack a
professional-therapeutic identity; her
interventions were frequently impulsive
and raw or, conversely, had the quality of
mimicking what she thought a therapist
should do/say.
91
92. Evidence of the Supervisee’s Growth: Emergence of a
Therapeutic Identity
Now, her progress is striking: she is clearly
formulating a more substantive therapeutic
identity (manifested in her naming of and
reckoning with it) and is devoting attention to
issues and drawbacks re: integrating her
personal and therapeutic proclivities and
attitudes.
92
93. Evidence of the Supervisee’s Growth: A Shift Out of
the Ordinary
In the emergence of her therapeutic identity, she is
beginning to recognize moments when she
fears expressing something to her patient
(often represented in the guise of what the
patient is believed not to be able to tolerate).
In my view, this represents a crucial progression:
she is essentially acknowledging for the first
time the possible adherence to “ordinary”
relatedness that is infiltrating her burgeoning
therapeutic identity
93
94. Evidence of the Supervisee’s Growth: A Shift Out of
the Ordinary
It is an interesting paradox (not just for this
supervisee, but for many others) that in one of
the most intimate of all settings -- the
therapeutic situation, the expression of the
natural me (or “me-me”) is often inhibited,
perhaps due to various conscious and
unconscious assumptions about therapy and
about the therapist’s role that reflect the
censorship of standard decorum.
94
95. Evidence of the Supervisee’s Growth: A Shift Out of
the Ordinary
My supervisee, though, is clearly in transition on
this, which represents movement out of the
ordinary.
She is beginning to realize the potential for a
greater degree of intimacy with her client in
the clinical situation, as well as its risks.
This likely reflects a greater degree of freedom
and intimacy she felt toward me in
supervision.
95
96. Evidence of the Supervisee’s Growth: A Shift Out of
the Ordinary
She now appears invested in creating an
ambience with patients and within herself
that is “extraordinary,” i.e., it is
fundamentally different from how she
typically is in her “real life.”
96
97. Evidence of the Supervisee’s Growth: A Shift Out of
the Ordinary
More specifically, this ambience consists of the
supervisee’s newly conscious awareness of
the desire to relate and express, as well as
the willingness to be related to and reflect on
this relatedness.
97
98. Evidence of the Supervisee’s Growth: A Shift Out of
the Ordinary
Further, she is newly cautious about introducing
her own personhood too impulsively into the
clinical situation.
At the same time, she also is attending to
reasons why elements of her spontaneity
(her “natural me”) do not yet comfortably
carry over into her relationship with her
patient (e.g., Renik, 1996, 1999).
98
99. Evidence of the Supervisee’s Growth: A Shift Out of
the Ordinary
This suggests the need in ongoing supervision to
examine lingering reservations and fears of
deeper, more intimate contact with patients
unencumbered by social convention in which
she can be more “real” (Renik, 1999).
99
100. 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 that has informed
my approach.
100
101. Techniques and Guiding Principles:
(1.) Limit Convention and Compliance/Social
Desirability
Fundamentally, I attempt to create an
atmosphere in supervision relatively devoid
of aspects of social convention that obstruct
the supervisee’s exposure to an alternative
form of relatedness consisting of freedom of
self-expression and a reduced focus on
appealing to the other.
101
102. Techniques and Guiding Principles:
(1.) Limit Convention and Compliance/Social
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.
102
103. Techniques and Guiding Principles:
(1.) Limit Convention and Compliance/Social
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-intraining often cue their patients (and their
supervisors) with head nods.
103
104. Techniques and Guiding Principles:
(1.) Limit Convention and Compliance/Social
Desirability
I work hard to sensitize the supervisee to this
social convention and how it, like many other
conventional behaviors, generally promotes
restricted (“ordinary”) relational experience
that inhibits the more expansive, wideranging and uncensored quality of the
distinctive therapeutic experience we are
seeking to potentiate.
104
105. Techniques and Guiding Principles:
(1.) Limit Convention and Compliance/Social
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
important discussions in supervision of
traditional analytic notions of abstinence and
neutrality and their continued relevance.
105
106. Techniques and Guiding Principles:
(1.) Limit Convention and Compliance/Social
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, rigid unconditional positive
regard, etc.) that may represent adherences to
social convention and a loyalty to ordinary
personas within the trainee as well as her
patient.
106
107. Techniques and Guiding Principles:
(1.) Limit Convention and Compliance/Social
Desirability
As supervision proceeds, I hope to continue to
engender in the supervisee a relinquishment
of her “ordinary persona” which may be
characterized by an array of previously
unexamined attitudes and tendencies.
Simultaneously, I aim to cultivate an alternative
therapeutic persona.
107
108. Techniques and Guiding Principles:
(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).
108
109. Techniques and Guiding Principles:
(2.) “Don’t just do something, sit there!”
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 usually all
that concerned with reactivity or action “of
an automatic, habitual pattern” (i.e., that
often constitutes “ordinary” experience).
109
110. Techniques and Guiding Principles:
(2.) “Don’t just do something, sit there!”
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.
110
111. Techniques and Guiding Principles:
(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 metacognitive 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).
111
112. Techniques and Guiding Principles:
(3.) Promote Mindfulness Via the Extraordinary
“... 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).
112
113. Techniques and Guiding Principles:
(3.) Promote Mindfulness Via the Extraordinary
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).
113
114. Techniques and Guiding Principles:
(3.) Promote Mindfulness Via the Extraordinary
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 supervision merely being a mandatory
appointment in which therapy sessions are
reviewed and evaluated).
114
115. Techniques and Guiding Principles:
(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.
115
116. Techniques and Guiding Principles:
(4.) Attend to Shame
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.
116
117. Techniques and Guiding Principles:
(4.) Attend to Shame
Winnicott’s (1969, 1975) distinction between
object “usage” vs. “relatedness” is relevant
here.
117
118. Techniques and Guiding Principles:
(4.) Attend to Shame
The supervisor gradually begins to realize that
she is not acting on the patient so much as
being acted upon by the patient (via the
specific quality of object-relatedness the
patient needs to enact).
The same could be said for supervision: the
supervisor is acted upon by the trainee and
must accept this fate!
118
119. Techniques and Guiding Principles:
(4.) Attend to Shame
The supervisee often struggles with the fact that
patients will not necessarily “use” them in
the ways she would typically like (“ordinary”
relatendess).
What’s more, the supervisee faces the
additional challenge of accepting Winnicott’s
vital observation that the patient needs to
destroy the object before it can be used.
119
120. Techniques and Guiding Principles:
(4.) Attend to Shame
Thus, shame is a predominant affective
response as the supervisee acknowledges
these emerging dilemmas and becomes more
aware of her reluctance, and corresponding
attitudinal and behavioral responses, to
being related to (not used) by the patient.
120
121. Techniques and Guiding Principles:
(5.) Dispel Expectations of Progress and Social
Comparison
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.
121
122. Techniques and Guiding Principles:
(5.) Dispel Expectations of Progress and Social
Comparison
My attempt here is to socialize the supervisee
into a view of herself and her 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.
122
123. Techniques and Guiding Principles:
(5.) Dispel Expectations of Progress and Social
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.
123
124. Techniques and Guiding Principles:
(6.) Promote Acceptance of Unconscious Relational
Forces
I attempt to downplay standard views of and
conventional opinions on therapeutic course
and action; instead, I emphasize an
acceptance of what is occurring in the clinical
process as reported by the supervisee,
especially its thorny and unclear nature, and
the ongoing evaluation of its many potential
meanings.
124
125. Techniques and Guiding Principles:
(6.) Promote Acceptance of Unconscious Relational
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.
125
126. Techniques and Guiding Principles:
(5.) Promote Acceptance of Unconscious Relational
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.
126
127. Techniques and Guiding Principles:
(5.) Promote Acceptance of Unconscious Relational
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.
127
128. Techniques and Guiding Principles:
(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 “professional me”
and the “natural me” in their clinical work.
128
129. Techniques and Guiding Principles:
(6.) Pursue “Professional Me”/“Natural Me” Tensions
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.
129
130. Techniques and Guiding Principles:
(6.) Pursue “Professional Me”/“Natural Me” Tensions
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.
130
131. Techniques and Guiding Principles:
(6.) Pursue “Professional Me”/“Natural Me” Tensions
Finally, a consideration of these tensions
hopefully stimulates and encourages the
trainee’s career-long analysis of the ways in
which her professional role actually mobilizes
(does not obstruct) profoundly intimate
contact with patients unattainable in any
other social realm.
131
132. 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 nontransferrable and often disadvantageous for
psychoanalytically-informed psychotherapy.
132
133. 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., the restrictions of 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.
133
134. Summary
For the many reasons I have described, both
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.
134
135. Summary
My supervisory approach argues 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, will support the supervisee's ultimate
therapeutic potential.
135
136. 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
136
137. References
Ablon, S., & Jones, E. (2005). On analytic process. Journal of the American
Psychoanalytic Association, 53, 541-568.
Alonso, A., & Rutan, J.S. (1988). The experience of shame and the restoration
of self-respect in group therapy. International Journal of Group
Psychotherapy, 38, 3-14.
Alonso, A., & Rutan, J.S. (1996). Activity/nonactivity and the group therapist:
“Don’t just do something, sit there!” Group, 20, 43-55.
Alpher, V.S. (1991). Interdependence and parallel processes: A case study of
structural analysis of social behavior in supervision and short-term
dynamic psychotherapy. Psychotherapy, 28, 218-231.
Aron, L. (1991). The patient’s experience of the analyst’s subjectivity.
Psychoanalytic Dialogues, 1, 29-51.
Bernstein, G.S. (1982). Training behaviour change agents. Behaviour Therapy,
13, 1-23.
Binder, J.L. (1993). Is it time to improve psychotherapy training? Clinical
Psychology Review, 13, 301-318.
137
138. References
Binder, J.L. (2002, August). What we know about psychotherapy
training. Paper presented at the eighteenth World Congress of
Psychotherapy, Trondheim, Norway.
Binder, J.L. (2004). Key competencies in brief dynamic psychotherapy: Clinical
practice beyond the manual. New York: Guilford.
Bishop, S.R., Lau, M., Shapiro, S., Carlson, L., Anderson, N.D., Carmody, J., et
al. (2004). Mindfulness: A proposed operational definition. Clinical
Psychology: Science and Practice, 11, 230-241.
Bordin, E.S. (1983). A working alliance –based model of supervision. The
Counseling Psychologist, 24, 3-21.
Ekstein, R., & Wallerstein, R.S. (1972). The teaching and learning of
psychotherapy. New York: Basic.
Fauth, J., Gates, S., Vinca, M.A., Boles, S., & Hayes, J.A. (2007). Big ideas for
psychotherapy training. Psychotherapy: Theory, Research, Practice,
Training, 44, 384-391.
138
139. References
Frawley-O’Dea, M.G., & Sarnat, J. (2008). The supervisory relationship: A
contemporary psychodynamic approach. New York, NY: Guilford Press.
Freidlander, M.L., & Ward, L.G. (1984). Development and validation of the
Supervisors Styles Inventory. Journal of Counseling Psychology, 31, 541557.
Gabbard, G.O. (2010). Long-term psychodynamic psychotherapy. A basic
text. Washington, D.C. American Psychiatric Publishing, Inc.
Galante, M. (1998). Trainees’ and supervisors’ perceptions of effective and
ineffective supervisory relationships. Dissertations Abstracts
International: 49: 933B.
Gans, J.S., & Weber, R.L. (2000). The detection of shame in group
psychotherapy: Uncovering the hidden emotion. International Journal of
Group Psychotherapy, 50, 381-396.
139
140. References
Germer, C.K. (2005). Mindfulness: What is it? What does it matter? In C.K.
Germer, R.D. Siegel, & P.R. Fulton (Eds.), Mindfulness and psychotherapy
(pp. 3-27). New York: Guilford.
Gill, S. (Ed.) (2001). The supervisory alliance: Facilitating the psychotherapist’s
learning experience. Northwale, N.J.: Aronson.
Gitterman, A. (1972). Comparison of educational models and their influence
on supervision. In F. Kaslow (Ed.), Issues in human services (pp. 18-38).
San Francisco: Jossey-Bass.
Hedges, L.E. (in press). Relationship. The essence of psychotherapy and
supervision. International Psychotherapy Institute.
Heppner, P.P. & Roehlke, H.J. (1984). Differences among supervisees at
different levels of training: Implications for a developmental model of
supervision. Journal of Counseling Psychology, 31, 76-90.
Hoffman, I. Z. (1983). The patient as interpreter of the analyst’s experience.
Contemporary Psychoanalysis, 19, 389-422.
140
141. References
Ladany, N.C. (2004). Psychotherapy supervision: What lies beneath.
Psychotherapy Research, 14, 1-19.
Ladany, N.C. (2007). Does psychotherapy training matter? Maybe not.
Psychotherapy: Theory, Research, Practice, Training, 44, 392-396.
Lizzio, A., Stokes, L., & Wilson, K. (2005). Approaches to learning in
professional supervision: Supervisee perceptions of processes and
outcomes. Studies in Continuing Education, 27, 239-256.
Lizzio, A., Wilson, K., & Que, J. (2009). Relationship dimensions in the
professional supervision of psychology graduates: supervisee perceptions
of process and outcome. Studies in Continuing Education, 31, 127-140.
Martin, J.S., Goodyear, R.K., & Newton, F.B. (1987). Clinical supervision: An
intensive case study. Professional Psychology: Research and Practice, 18,
225-235.
Miller, A. (2008). The drama of the gifted child: The search for the true self.
New York, NY: Basic Books.
Milne, D.L., & James, I.A. (2002). The observed impact of training on
competence in clinical supervision. British Journal of Clinical Psychology,
41, 55-72.
141
142. References
Nathanson, D.L. (Ed.) (1987). The many faces of shame. New York: Guilford
Press.
Norcross, J.C. (Ed.) (2002). Psychotherapy relationships that work: Therapist
contributions and responsiveness to patient needs. New York: Oxford
University Press.
Orlinsky, D., Grawe, K., & Parks, B. (1994). Process and outcome in
psychotherapy. In A.E. Bergin & S.L. Garfield (Eds.), Handbook of
psychotherapy and behavior change (pp. 270-376). New York: Wiley.
Ramos-Sanchez, L.R., Esnil, E., Goodwin, A., Riggs, S., Touster, L.O., Wright,
L.K., Ratanasiripong, P., & Rodolfa, E. (2002). Negative supervisory events:
Effects on supervision satisfaction and supervisory alliance. Professional
Psychology: Research and Practice, 33, 197-202.
142
143. References
Recihelt, S., & Skjerva, J. (2002). Correspondence between supervisors and
trainees in their perceptions of supervision events. Journal of Clinical
Psychology, 58, 759-772.
Renik, O. (1996). The perils of neutrality. Psychoanalytic Quarterly, 65, 495517.
Renik, O. (1999). Getting real in analysis. Journal of Analytical Psychology, 44,
167-187.
Ronnesttad, M.H., & Skovholy, T.M. (1993). Supervision of beginning and
advanced graduate students of counselling and psychotherapy. Journal of
Counseling and Development, 71, 396-405.
Russell, R.K., & Petrie, T. (1994). Issues in training effective supervisors.
Applied and Preventive Psychology, 3, 27-42.
Safran, J.D., & Muran, J.C. (2000). Negotiating the therapeutic alliance: A
relational treatment guide. New York: Guilford Press.
143
144. References
Safran, J.D., & Muran, J.C. (2001). A relational approach to training and
supervision in cognitive psychotherapy. Journal of Cognitive
Psychotherapy: An International Quarterly, 15, 3-15.
Sarnat, J. (2010). Key competencies of the psychodynamic psychotherapist
and how to teach them in supervision. Psychotherapy: Theory, Research,
Practice, Training, 47, 20-27.
Seidman, E., & Rappaport, J. (1974). The educational pyramid: A paradigm for
training, research, and manpower utilization in community psychology.
American Journal of Community Psychology, 2, 119-130.
Shanfield, S.B., & Gil, D. (1985). Styles of psychotherapy supervision. Journal
of Psychiatric Education, 9, 225-232.
Stoltenberg, C.D., & Delworth, U. (1987). Supervising counselors and
therapists. San Francisco: Jossey-Bass.
Stoltenberg, C.D., & Delworth, U. (1988). Developmental models of
supervision: Is it development—Response to Holloway. Professional
Psychology: Research and Practice, 19, 134-137.
144
145. References
Tuckett, D. (2005). Does anything go? Toward a framework for the more
transparent assessment of psychoanalytic competence. International
Journal of Psychoanalysis, 86, 31-49.
Watkins, Jr., C.E. (1997). Defining psychotherapy supervision and
understanding supervisor functioning. In C.E. Watkins, Jr. (Ed.), Handbook
of psychotherapy supervision (pp. 3-10). New York: Wiley.
Watkins, Jr., C.E. (2011). The real relationship in psychotherapy supervision.
American Journal of Psychotherapy, 65, 99-116.
Winnicott, D.W. (1969). The use of an object. International Journal of PsychoAnalysis, 50, 711-716.
Winnicott, D.W. (1975). Through paediatrics to psycho-analysis. New York:
Basic Books.
Worthen, V., & McNeil, B.W. (1996). A phenomenological investigation of
“good” supervision events. Journal of Counseling Psychology, 43, 25-34.
145
146. References
Worthington, E.L. (1987). Changes in supervision as counselors and
supervisors gain experience: A review. Professional Psychology: Research
and Practice, 18, 189-208.
146
147. 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.
147
148. 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.
148