The Socratic Team Model of Advanced Clinical Supervision Jan 20 2025 .pptx

ADVANCED METHODS IN
COUNSELING AND PSYCHOTHERAPY
The Socratic Team Model of Advanced Psychotherapy & Clinical Supervision Training ©
Demetrios N. Peratsakis, ACS, LPC, SDSAS, MSEd, Certified Clinical Trauma Professional
Clinical Supervision & Training in Advanced Clinical Methods

I began formal studies with Dr. Robert (Bob) Sherman, who guided my work from 1980 until his retirement and relocation from New York City, in 1992.
Bob, was an AAMFT Clinical Supervisor, author, co-founder of Adlerian Family Therapy, a long-time Fellow at the North American Society of Adlerian
Psychology, and Chair of the Department of Marriage and Family Therapy (MFT) Graduate Programs at Queens College, in Flushing new York, which he
founded, where I degreed in MFT, Guidance, and School Administration, and where I served on faculty in 1986 and 1987.
I was privileged to meet in small group instruction at the Adler Institute of New York with Kurt Adler, MD (1980), Bernard H. Shulman, MD (1980),
Harold Mosak (1980, 1981) and Lawrence Zuckerman (1982, 1983), trial hypnogogic induction with Martin Astor (1980), and assist the Queens
College’s MFT graduate programs in a unique series of live-practice conferences with founding family therapy theorists Robert Sherman (1980),
Maurizio Andolfi (1981), Adaia Shumsky (1982), Carlos Sluski, MD (1983), Murray Bowen, MD (1984), James Framo (1985), Bunny Duhl (1986),
Monica McGoldrick (1987), Carl Whitaker, MD (1988), Jay Haley (1989), Salvador Minuchin, MD (1990 and 1991), Salvador and Patricia Minuchin
(1991), and Peggy Papp (1992). At the Queens College’s 8th Annual MFT Conference in November 17, 1987, I joined Monica McGoldrick, Adaia
Shumsky, and Robert Sherman for a coordinated set of lectures on family life cycle called “Allies for Change”.
In 1990, I joined Dr. Richard Belson, Director of the Strategic Family Therapy Institute of Long Island, in a 2-year, live-supervision practicum treating
chronic, highly intractable problems using a brief, solution-focused approach. Belson, collaborated with Jay Haley and Cloe Madanes at the Family
Therapy Institute of Washington, D.C., from 1980 to 1990, was on faculty at the Adelphi School of Social Work and serving as a senior Fellow on the
editorial board of the Journal of Strategic and Systemic Therapies from 1981 until 1993.
I am indebted to these remarkable clinicians and the indelible mark they have left on our field.
I am especially grateful to Bob, for his training, encouragement, and love.
-Demetrios N. Peratsakis, ACS, LPC, CCTP, SDSAS, MSEd, Clinical Supervisor and Trainer of Psychotherapy & Advanced Clinical Methods
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A Word of Gratitude for My Clinical Supervisors

DISCLAIMER
The purpose of training is to help improve one’s practice
of therapy through a deeper understanding of methods.
This material is intended to augment, not replace, the instruction and practice
expectations of one’s home agency or Community Services Board.
As such, the ideas presented herein are simply those that assist me in my work
and in my understanding of human motivation and pathology.
____________________ . ____________________
Except as noted, Learning and Teaching Therapy: The Socratic Team Model of Advanced Psychotherapy & Clinical Supervision Training ©
and its associated materials is the expressed intellectual property of Demetrios N. Peratsakis and is copyrighted thereto.

Learning and Teaching Therapy
Training in Clinical Supervision and Advanced Methods of Counseling & Psychotherapy
3 Evidence Based Practice Tools + 6 Methods of Modeling
Revised: January 20, 2025

Purpose: the role of training in advanced clinical methods is to further one’s expertise in the clinical supervision of advanced psychotherapy practices.
The Socratic Team Model of Advanced Psychotherapy & Clinical Supervision Training © provides a continuous learning experience in clinical case supervision for skill development
across the three fundamental components of all therapy approaches: Assessment, Treatment Planning, and Intervention Strategy & Technique. It provides experienced psychotherapists the
opportunity to focus on complex case analysis and management, advanced theoretical integration, refining highly nuanced therapeutic skills, addressing intricate ethical dilemmas, and
cultivating competency and clinical expertise within a specific therapeutic modality.
 Integration of Theory: Exploring how to combine different theoretical approaches within a single case, adapting treatment based on the client's unique needs and presenting issues. In
particular, the development of more sophisticated assessment procedures and the formulation of tactics and strategies for change. (Ai)
 Advanced Therapeutic Skills: Understanding assessment, treatment planning, and the mastery of advanced intervention techniques, including how to challenge and redirect the
power and meaning of symptoms, dysfunctions and desires; how to manipulate beliefs, mood, stress, time and space; how to restructure family roles and functions and create new
realities using reframing, sculpting, and imagery; how to prescribe tasks, directives, rituals, and ordeals; and, how to teach, model and coach different theoretic principles, strategies,
and techniques.
 Complex Casework: Deep analysis of challenging cases involving severe or treatment resistant behavioral health disorders, where the therapist needs to navigate complex family or
interagency dynamics, as well as intricate treatment plans and interventions. (Ai)
 Ethical Decision-Making: Thorough exploration of complex ethical situations, including boundary issues, dual relationships, and informed consent considerations. (Ai)
 Self-Awareness and Countertransference: Intensive examination of the therapist's own emotions and reactions to clients, particularly in challenging cases, to ensure effective
therapeutic interventions. Understanding the therapeutic alliance, isomorphism (transference/countertransference), “blind-spots” and “triggers”. (Ai)
 Research and Evidence-Based Practice: Analyzing current research findings and integrating them into clinical practice, including discussions about the benefits and limitations of
evidence-based practices and principles and the rationale behind treatment decisions.
 Practice Treating Complex Syndromes: Special topic focus on chronic intractable problems and conditions, including Complicated Depression, Eating Disorders, Addiction,
Criminality, Paraphilia, and Psychosis.
 Practice in Advanced Methodologies: Specialized training in advanced treatment and training practice methods, including Couple and Family Therapy, Co-therapy, Greek-Chorus,
Open Forum, Multiple-family Therapy and Tag-team configurations.
Advanced Psychotherapy Clinical Supervision Training
5

The Socratic Team Model
of Advanced Psychotherapy & Clinical Supervision Training©
- Demetrios Peratsakis, LPC, ACS © 2016
A Model for Continuous Skill Development through Case Analysis and Clinical Group Supervision

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1. The Socratic Team Model of Clinical Supervision & Clinical Training ©
2. Counselor Training
 Model Overview: counselor training in Assessment, Treatment Planning, and Intervention Technique
 Use of the Genogram (Assessment)
 Use of Group Supervision (Treatment Planning)
 Use of Role Play (Intervention Technique)
3. Clinical Supervisor Training
 Drilling Down & Pushing the Group Overview
o Scaffolding
o Round Robin
 Modeling: Teaching & Training Counselors
 Live Supervision Coaching: Teaching & Training Clinical Supervisors
o Modeling
o Peer Modeling
o Live Supervision Coaching
o Advanced Supervised Live Supervision Coaching
 Getting a New Team Started
 Advanced Practice Methods
o Collaborative Teaching
o Open Forum
o Live Supervision
o Muli-family Therapy
Table of Contents

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3 Evidence Based Practices are combined to foster continuous learning and skill acquisition in
Assessment, Treatment Planning, and Intervention using Genograms, Group Supervision and 6 Methods of Role Play
Clinicians Learn, then Teach others.
A creative, interactive learning experience develops that supports the Counselor’s transition from
Therapist to Clinical Supervisor and the Clinical Supervisor to Master Therapist.
.
Socratic Teams are small groups of counselors and case managers
brainstorming casework and practice objectives for the treatment of
complex syndromes and conditions. They foster
 Complex Problem Solving
 Critical Reasoning
 Creativity and Innovation, and
 Teamwork
These build Self-confidence and promote interdepartmental
cooperation. As each counselor acquires greater mastery in leading and
teaching clinical practice, complementary skills are refined and become
second nature:
 Effective communication, self-assurance, and assuming leadership
responsibilities
 Collaboration with co-workers
 Thinking outside the box and adapting new strategies
 Improvement in organization and time management skills
 Development of a stronger work ethic
 Deepening one’s understanding of human problems and client care
 An increase in one’s Knowledge and Expertise in the Field.

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2. Treatment Planning -use of Group or Team Supervision
Strategizing the Course of Treatment
Broaden conceptualization of work supporting and treating clients & their
relationship systems. Developing an overall approach to treatment,
deterring goals, and formulating the strategies and methods for problem
resolution and work toward achieving desired improvements and growth.
3. Intervention –use of Role Play
Change Strategies, Tactics & Techniques
Getting from point A to point B and implementing and
refining the problem-resolution strategies and tactics
for change, goal achievement, and growth. This
includes selecting the most appropriate interventions,
from the hundreds of techniques available and
ensuring that evidenced based principles and tenets
drive their selection and use.
1. Assessment -use of Genograms
Problem Analysis & Case Conceptualization
Understanding the elements of the case, the reason for
treatment, the client system and the particulars of the
problem and why it emerged now. It includes an analysis of
the life-stage, issues associated with major life tasks, strength
and resiliency factors, and an overall appreciation of the
source of the pain, what needs to change or be resolved, and
who needs to participate or help and how?
# 3
Intervention
#1
Assessment
# 2
Treatment
Planning
Assessment, Treatment Planning, and Intervention are the
3 Core Learning Competencies of the Counseling Process.
They compliment one another and should be in continual
refinement within each counseling session and across the
entire duration of the treatment episode of care.
3 Evidence Based Practices are combined to foster continuous learning and skill acquisition in Assessment, Treatment Planning, and Intervention

Genograms
(Assessment)
2. Treatment Planning: Socratic Teams are supervision groups that meet for case analysis, case simulation, and clinical
practice.
 Group Supervision allows for case analysis, subject matter expert (SME) highlighting, and the use of members to train, learn, and
teach.
 Teamwork fosters mutual support and promotes vicarious learning, brainstorming and critical reasoning (Socratic Method).
 A Team may be the entire Program or a mix of QMHPs, CMs, Peers, DSPs, Resident LEs, and Licensed staff.
 Each Team is led by a Clinical Supervisor and 1-2 Facilitators who guide the process and train on methods, tactics and techniques.
 As the Team gets underway 1 or 2 Members are selected to “apprentice” as future Team Facilitators.
 Teams meet for 2 to 4 hours, once or twice a month, depending on the size of the group. A group of Clinical Supervisor may also meet.
Group
Supervision
(Tx Planning)
1. Assessment: Genograms provide a simple, yet sophisticated method for Assessment and continuous Treatment Planning, &
Intervention.
 They broaden conceptualization of the client & their relationship system, including collective histories, nodal events, relationship. structures,
core values and shared beliefs, major illnesses, vocations, and primary psychosocial conditions and stressors.
 Genograms expose possible traps, triggers, and vulnerabilities for the clinician and the clinical supervisor (Isomorphism).
 Genogram presentations “share the case”, taking the focus off the Presenter and fostering group innovation and cohesion.
 Case Presentations are used to highlight Presenting Problem or Practice topics (Subject Matter Expertise) applicable to similar cases or issues.
 Case sharing paves the way for Socratic Circles and advanced practices such as co-therapy, Greek Chorus, and live supervision.
Role Play
(Intervention)
3. Intervention: 6 Role Play methods are used to highlight casework, promote skill development, and refine practice through
rehearsal.
 Facilitators discuss clinical methods and the mechanics of interventions and techniques, then model and coach their application.
 Members gain confidence through trial-and-error and develop teaching skills for training and supervising others (Modeling).
 Role Play helps the therapist experience the client’s perspective, examine personal “triggers”, and work through “unfinished business”.
 Role Play trains therapists to be more active and directive in session, gaining expertise working in the “Here-and-Now”, in session.
 Six Models: Supervisor Modeling; Peer Modeling; teaching Triads; Supervised Teaching Triads; Live Supervision Coaching; and Supervised
Live Supervision Coaching. - Demetrios Peratsakis, LPC, ACS © 2016
Copy Slide for All Team Members 10
3 Evidence Based Practices are combined to foster continuous learning and skill acquisition in Assessment, Treatment Planning, and Intervention

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Case Presentations provide a remarkable opportunity for a group to learn and refine therapy and clinical supervision skills
1. Genograms: case analysis fosters discussion on how to understand the problem from the therapist's perspective as well as how to strategize the best
approach to treatment. Brainstorming and Socratic Reasoning improve critical thinking making Assessment and Treatment Planning more tailored to
meet the needs of the client.
2. Group Supervision: in addition to sharing and exchanging ideas, case presentations provide teaching opportunities on various clinical and practice
issues and topics. These highlights foster Subject Matter Expertise across the group’s membership. For example, if a case presentation involves the
presenting problem of drug addiction, or even a less frequently encountered problem or condition such as Dissociative Identity Disorder (DID), group
members are able to learn about the disorder and how to structure treatment in a manner that applies to similar casework. In this manner, each case
presentation proffers an opportunity to increase the clinician’s subject matter expertise.
3. Role Play: role play is an extraordinary, interactive tool for, both, for learning and teaching. Skill acquisition is best anchored when provided
opportunity for application and, in turn, rehearsal and refinement. Role Play may also be used in more sophisticate ways by adding complexity and role
differential that trains the therapist to gain experience as a “client”, as well as a “clinical supervisor”. More advanced designs and configurations
include 1) Supervisor Modeling; 2) Peer Modeling; 3) Teaching Triads; 4) Supervised Teaching Triads; 5) Live Supervision Coaching; and
6) Supervised Live Supervision Coaching. These methods of training therapist and clinical supervisors are described, in detail, later on.
Case Presentations as a Learning Tool

1. Swivel chairs with wheels work best! They provide unfettered movement in Role Play and
encourage members to move freely, position and reposition players, and manipulate space
and proximity to modulate intensity. They make the session and training more dynamic and
encourage participants to learn and practice important (spatial metaphor) techniques such as
Proximity, Empty Chair and Sculpting.
2. A sturdy easel with pad and markers provide a ready-made place for hanging Genograms
for the group to study. Ideally, participants bring a pre-drafted Genogram to the training form
their actual casework. Circling around the easel adds a sense of intimacy to the group and
allows members to view the same tool for assessing interpersonal dynamics, nodal events,
and other key factors.
Required Supplies & Equipment for Team Supervision
Required
1. Circle of Chairs with Wheels:
a) Meeting around a table is prohibited; it negates ready use of Role Play exercises and
creates a barrier between group members.
b) Always have extra chairs, preferably on wheels.
c) Chairs of different sizes/shapes, always a plus, for Empty Chair, Sculpting, and other
techniques.
2. White Board/Flip Chart Easel: sturdy easel for Genogram presentations; dry erase
markers; extra “Post It” easel pads
3. Casework Genograms drafted onto easel pad sheets
Optional
 Agenda: 1) Welcome & Introductions! 2) Business & Housekeeping; 3) Clinical
Practice: training, discussion & role play on clinical best practice methods and
professional competencies; 4) Case Presentation (s): case assessment, treatment
planning and modeling/practice of interventive technique.
 Name Tags for Role Plays (ie. Dad, Mom, Sis)
 Wall TV Monitor Screen (with clicker) for subject matter training to the group; mics.
 Food/Snacks: food encourages good fellowship; supervision training is heavy works
and makes you hungry 
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Clinical supervision is an essential component of the education and training of counsellors and psychotherapists.
It is the “signature pedagogy” (Goodyear, 2007, p. 273) across the mental health professions and
the “cornerstone of professional development (Bernard & Goodyear, 2009, p. 218).

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Socratic Teams for Clinical Training
The previous Sections highlighted the use of 3 Evidence Based Practice tools, Genograms, Team/Group Supervision, and Role Play, for training counselors using
case analysis to increase knowledge and skill acquisition. As counselors gain confidence in the use of Role Play, they acquire more practice in teaching the very
skills they have learned. Teaching is refined through the four methods of modeling already described: 1. Supervisor Modeling; 2. Peer Modeling; 3. Teaching
Triads; and 4. Supervised Teaching Triads. Supervised Teaching Triads is an exceptional method for teaching large groups of counselors, who learn through a
rotation of the three main roles of the therapy process, Client, Therapist, and Supervisor.
This next Section, Clinical Supervisor Training, builds on the use of Role Play as a teaching method (5. Live Supervision Coaching and 6) Supervised Live
Supervision Coaching), along with experiences from the Advanced Methods of Practice section, provides a unique learning experience for those working toward a
Master Therapist level of proficiency.
1. Genograms
2. Team Group Supervision
3. Role Play
1. Supervisor Modeling
2. Peer Modeling
3. Teaching Triads
4. Supervised Teaching Triads
5. Live Supervision Coaching
6. Supervised Live Supervision Coaching
By Learning you will Teach,
by Teaching you will Learn.
-Latin Proverb

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Overview of the Socratic Team Case Supervision Method
1. What Is It?
 A group learning experience for training in counseling and psychotherapy.
 Supervision often leaves the presenter overwhelmed with suggestions and feeling as if they might not have faired well with their work. A
more helpful format places responsibility on each of the Team members and generates more possible ways of working.
2.What Are The Learning Targets?
The counseling process has three (3) interconnected parts. Counselors need continuous skill improvement in each:
1) Assessment & Case Conceptualization: What seems to be the problem? Is it a crisis or chronic condition? Who does it effect and how?
What is the social, historical, and cultural context? What are the client’s strengths, coping skills, risks and motivation for change?
2) Treatment Planning and Strategy: What needs to change and how? What are the steps that need to be taken? Is a particular theoretical
orientation or hypothesize about the nature of the problem indicated? How do legal, medical, psychological, or medication issues factor
into planning and the development of goals? Who needs to participate and what practical issues are likely to support or impede
attendance or progress?
3) Interventive Tactics and Techniques: What specific tactics and interventions may help facilitate behavior change and prompt
experimentation in new ways of being? How will work be directed and underlying issues, such as power-struggles, trauma, depression,
and feelings of guilt and shame be remedied?

3. Team Membership; Who Participates?
 As a train-the-trainer model, the Team Supervision experience is intended for group case supervision, training on expert subject material and the apprenticeship and
tutoring of counselors working toward clinical supervisor status. Membership includes seasoned clinical supervisors or group facilitators who serve in a coaching and
proctor role (Lead Clinical Supervisor), counselor supervisees and 1-3 facilitators-in-training working toward a level of confidence and competency to facilitate Team
Supervision groups of their own using the same format.
 Options for Team Member Composition
1. Homogenous Team: Counselors share a comparable level of expertise or role; ie. all LEs, all QMHPs, or all TDT staff
2. Mixed Team: Counselor have varied levels of expertise or roles and are pooled from various programs, such as ES, PSR, OP
4. What is the Team Size and Schedule?
Sessions run for 2-hours, every two weeks or 1 x a month, if a smaller, Clinical Supervisor training group, and a larger, all-clinician, training group are being run in the
same month. In this paradigm, the Clinical Supervisors are trained in Advanced Practice and expected to assist in the training of the general counseling staff.
5. What Tools facilitate the Team Process?
3. Use of the Genogram for a) case conceptualization and b) as a common presentation tool. Cases material provides for instruction on a) process, such as how to
transition parents into couple therapy and b) special topic subjects, such as working with addiction, domestic violence or paraphilia. This provides counselors
variety in types of client profiles and syndromes.
4. Use of the Team’s group members for Cross-training and Brainstorming over treatment goals, strategy and planning.
5. Use of Role-play to actively rehearse and practice tactics and technique and maximize working in the here-and-now in session.
In addition, Clinical Supervisors should provide periodic hand-outs and reading assignments on counseling theory, technique and special topic areas and
schedule all meetings in a comfortable room with easel and markers and adequate space and swivel, wheeled chairs for role-play practice.
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Lead
Clinical
Trainer
Counselors
LCTs-In-
Training Team

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Counselor Preparation for Supervision
Counselor-supervisees are students; as such, they should be prepared with all necessary documentation and client materials, have completed their
assignments and forged a bond with their immediate instructor.
1. They should keep an up-to-date list of Active Clients and a history of session and supervisory meeting dates.
2. Each New Case presented should include, at minimum, the following information:
a) Referral source, date and initial reason. If client initiated, their stated purpose for seeking treatment.
b) Genogram, socio-gram or summary of relational issues or snap-shot of the client system, including individual backgrounds, such as medical
conditions; medications; presentation/hygiene; occupation/education level; and living arrangements; as well as more dynamic artifacts, such as life-
cycle issues; deaths, births and anniversary dates; family roles, rules, myths and legacies; trauma events and cut-offs and sources of support and
distress
c) The Presenting Problem, including the contract for therapy goal(s), participants and expected duration
d) An analysis of who needs to participate and why; what’s the hypothesis on reason from seeking treatment.
e) Number of sessions to date, frequency of treatment and format
4. Active Case presentations should include the information above as well as a summary of treatment to date:
a) Overview of treatment goal (s), number of sessions and progress or change to date
b) Relationship with counselor
c) Details on how the Presenting Problem, Symptom(s) or Pain has changed
d) Plans for Termination date and work
5. Counselors are also expected to
e) Follow directives, study assignments, as appropriate to their level demonstrate a working knowledge of counseling theory, core theoretical
constructs, basic counseling techniques and the major elements inherent in specialty issues
f) Join with the client(s), use oneself in therapy, bond with the client(s)assume risk
g) To be receptive to feedback on clinical work, progress and personal growth, including receptivity to supervision
h) To participate in professional training, conference development, peer supervision, and community-wide presentations

As a Socratic Group or practicum group experience, the facilitator’s role is to create a classroom-like experience that challenges each clinician’s knowledge and
skill level. A main objective of the experience is to make the meetings interactive and “experimental”, safe zones to question, practice and refine technique
through role-play and re-enactment of session dealings. Every member is ‘pushed’ to actively participate and to learn, through teaching.
The facilitator actively
1. Gatekeeps against “Advice-Giving”
Prevents members from “advising” the presenter or others: No direct advice permitted or advice-giving under the guise of asking leading questions, asking for
clarification or wondering and musing out loud
2. Provokes Critical Reasoning through “Socratic Questioning”
Stimulates critical thinking by questioning and challenging group members as to how they would handle some process but of the counseling session or intervention,
then using comments from the current speaker to challenge another, and so on.
3. Trains Skill Refinement through Role-play and Re-enactment
1) Structures role-plays between members so they have an opportunity to practice and refine their skills to enact an intervention or tactic
2) Demonstrates technique by directly modeling its introduction, use and variations
3) Coaches member in “therapist” role by fine-tuning their verbal and behavioral interventions
4. Continuously pushes each Member to Learn through Practice and Teaching
The goal is for each counselor to work toward becoming a Clinical Supervisor, and each Clinical Supervisor to work toward becoming a Master Therapist. While
this many not, in fact, be the interest of some of the group members, the attitudes reflects two known facts: 1) its best to teach toward the higher learner, knowing
that those with less experience we benefit regardless, and 2) many counselors don’t truly know their level of commitment, until they discover their level of interest.
When part of a workforce development initiative, some Members may need to improve their overall conception of the treatment process but have less need
to learn the intricacies of outpatient therapy, proper. While ultimately the Administrator’s decision, nobody should argue that less knowledge is better, although its
application must be accommodated. Alternative Teaching, is a collaborative style of instructional groups that require general, as well as more specialized training
curriculum.
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Role of the Facilitator

Group supervision may leave the presenter overwhelmed with suggestions and feeling as if they might not have handled their case well.
A more helpful format places responsibility on each of the group members on how they might approach the case, how and why.
The supervisor guides and gate-keeps the process:
1.The presenter is asked to draw the case genogram and indicate the following
 The presenting problem and a history of its onset
 Who lives at home/is involved in the presenting problem
 Who has attended session and number of sessions to date
 Their overall treatment strategy
2.The supervisor allows a brief period of information gathering (no case recommendations) by the members
3.The supervisor then challenges the group, “round robin” or through “scaffolding”, on how they might handle the case if it was their own; ie.
 “You just received this case from the current therapist; what is your treatment strategy and how would you proceed?”
 “Assume you have 5 sessions remaining; what would you do within each (session by session) to accomplish the stated goal or
outcome?”
 “Imagine you are asked to consult. You have 1 and only 1 meeting with the current case. What do you wish to accomplish and how?”
4.The supervisor wraps up the “Socratic Questioning” and
 Points to how best to work with issues common to this kind of issue, case or client;
 Cautions about possible “blind spots”
 Points to areas for clinical improvement and professional development
5. Gets group member in Role Play or an “Enactment” scenario to practice some technique or portion of the case
6. Supervisor or seasoned clinician may be asked to provide “Live Supervision Coaching”.
Feedback to the Case Presenter
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Details of the Evidence Based Method of Practice of Advanced Clinical Supervision
The Socratic Team Model of
Advanced Psychotherapy & Clinical Supervision Training©
A Model for Continuous Skill Development through Case Analysis and Clinical Group Supervision

Everyone Works Off a Genogram
Genograms, 3-generational family trees, are used to conceptualize & present casework
1

Genograms
Method
A genogram is a three generational map of the relationship system and family tree. It emphasizes the emotional connection between its
members and the nodal events, milestones, psychosocial conditions, values, core belief structures, and attributes, characteristics and
atmosphere that hallmark its history and its members.
Genograms are a remarkably powerful tool for clinical assessment and case conceptualization. They promote innovation in strategy, tactics
and treatment intervention and provide an invaluable context that benefits the therapist and supervisor as well as the client system.
Genograms presentations are required.
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1

1. Genograms provide a common assessment tool for case studies and supervision
2. Members learn from each other’s casework, including assessment, treatment planning, methods of intervention and special topic areas, such
as depression, paraphilia or work with couples.
3. Genograms place the client(s) in a relational context and promotes thinking in systemic terms
4. Genograms take the focus off the Presenter and makes the supervision process collaborative
5. Genograms point to client foundation beliefs about roles, rules, gender, loyalties, myths, mistaken beliefs, familial trends and characteristics
6. It reveals the medical, behavioral health, educational, occupational, and social history of its members
7. It reveals core assumptions and beliefs about race, gender, religion, roles, and responsibilities
8. It reveals family dynamics and helps the therapist make better assessments
9. It documents key dates and illuminates the individual and familial landmarks, including rites of passage, graduations, marriages, deaths,
births, birth order, and other ceremonies or social events and that help define those experiences
10. It reveals the etiology of mistaken beliefs, attitudes and fictional ideals and intergenerational legacies, loyalties, and myths
11. It speaks to membership affiliations of who is in and out, close and distance and includes markers for intimacy, estrangement, conflict, and
emotional cut-off
12. It speaks to issues of power and authority and provides insight as to how members interpret and express love, anger, and joy
13. It provides information as to intergenerational transmission including of key biopsychosocial issues such as trauma, depression, and anxiety,
and points to ways that pain is expressed including gambling, addiction, paraphilia, neurosis and psychosis.
14. Genograms may also be used directly with clients. It makes the therapeutic process more collaborative and helps remove blame and shame
from the client’s experience of their family and the development of their problem.
Benefits of Using Genograms
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1

Genogram Presentation Format
White Board or Easel Pad
1. Presenting Problem & Nodal Events
a) Case Outline: the Presenting Problem, including nodal events
surrounding its recent onset, who participates and how (denotes
purpose of problem). The sequence of behaviors surrounding
the presenting problem (who does what when?) denotes who
participates in maintaining the problem or symptom.
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2. Family Constellation: Display family membership and nodal events for at least three generations
 the client’s name, age, gender , occupation, spouse/partner, children, parents and siblings
 the wider family such as grandparents, uncles, aunties, and their pairings and children (include names, birth dates, ages, gender, occupation ,
highest level of education, dates of marriage, divorce, death, etc..)
 how persons are related and the relationship between family members (adoptions, marriages, sources of stress/support, alliances/collusions,
etc..)
 clinical and health issues such as child/partner abuse, drug and alcohol dependency, anxiety, depression, heart conditions, cancers, diabetes, etc...
 ethnic and cultural history of the family
 socioeconomic status of the family
 major nodal events and recent trigger issues, such as pregnancies, illnesses, relocations, or separations
3. Family Atmosphere: Track and Interpret family beliefs and relationship patterns, conflicts, etc...
 post the client’s symptoms/concerns and trace similar patterns across member relationships
 look at roles and rules that may have bearing on the presenting problem (s); post myths, legends and value statements
 look at life-cycle, nodal events and triggers for timing surrounding the presenting problem(s)
 demarcate, by dotted inclusion lines, members who participates/in the presenting problem
 client(s) and therapist (s) share observations and interpretations from the genogram
b) Treatment Overview: including previous therapy
experiences and their outcomes, frequency and number
of sessions to date, attendance pattern, regular
participants and members refusing to attend or excluded.
c) Challenges and Quagmires: “sticky” places and
“triggers”. Known and possible pitfalls and areas of risk.
Note:
The more detailed the
information, both factual
and anecdotal, the better. It
may be collected from
several sources including
the referring agent, the
client (s), the assessment,
session work, neighbors,
family members and
friends.
A common practice is to
return to a particular
genogram to add
information, as well as to
mark and gauge treatment
progress.
1

25
Sample Genogram Case Presentation for Group Supervision
STEP 1: The Genogram (background on the client and their relationship system)
1. Draw a 3-generation Genogram of the client and their relationship system. Males are squares; females,
circles; transgender or fluid are represented with a circle inside a square and description.
2. Add pertinent soci-demographic data next to each person and relationship, including ages; deaths;
marriages/divorces/remarriages; etc.
3. Indicate major primary and behavioral health conditions.
4. Indicate who lives with who by a dotted circle.
5. Indicate the condition or quality of the relationship (ie. stormy; abusive; co-dependent)
6. Mark the primary symptom bearer or Identified Patient with an asterisk or star
1

26
STEP 2: The Presenting Problem (the pain, its source, and the desired outcome of therapy)
1. Presenting Problem (PP): reason for the referral or for seeking therapy, including prior history of treatment
2. History of the PP: nodal events, stressors, conflicts, milestones of significance surrounding the Presenting Problem
and its onset
3. Who Participates and How? (interactions and transaction patterns that maintain the Presenting Problem)
STEP 3: Reason for Presenting the Case (case analysis and alternative treatment options)
4. “Here’s how/where/why I’m feeling stuck  ______________________________”
5. “If I could start anew, here’s what I would do ________________________”
6. “If I could waive a magic wand and everything in this case would be as a I wished it, here’s who I would
want in session and here is what I would want to see happen _______________”
1

27
Standard Genogram Symbols
1

Genograms Reveal Relationship Structures & Emotional Boundaries
Boundary Mapping
Defining the Emotional Reactivity Between Individuals and Systems
Example: parents disengaged from one another; mother enmeshed with son
M F
...........
S
Sample Genogram
 mapped as
Boundaries represent the emotional integration of the relationship between individuals and subsystems. When overly reactive or co-dependent
(enmeshed) they foster difficulties with individuation, a primary process of independence, maturation and adulting. When overly detached (diffuse)
emotional responsiveness is lacking and renders the members toward isolation and feeling inadequately supported. These extremes, often
intergenerational social responsiveness styles, are exacerbated at times of distress or due to prolonged trauma, conflict and periods of despair.
Mapping of boundaries,
hierarchies and subsystems
was developed as a short-
hand method of relationship
description by the Structural
school of family therapy.
1

SFT Family Mapping: adding family dynamics to Genograms
Structural Family Therapy uses a Genogram or visual interpretation of the family’s dynamics,
roles and relationships, to uncover and describe family patterns, hierarchies, and borders.
1

Advantages of using structural family therapy maps
1. Visual representation: SFTMaps allows families to see and understand the patterns and structures within their relationships. By creating a visual
representation, such as a genogram or a family map, it becomes easier to identify the roles, hierarchies, and boundaries within the family system. This
visual aid can help family members gain new insights and promote a shared understanding of their dynamics.
2. Systemic perspective: This approach considers the family as a whole system, rather than focusing solely on individual members. SFTMaps helps
identify how each family member contributes to the overall functioning of the system. By examining the interactions and connections between family
members, therapists can uncover underlying issues and work towards creating healthier patterns of interaction.
3. Problem identification: The diagraming techniques can effectively highlight problematic patterns or structures within the family system. By visualizing
these dynamics, therapists can pinpoint areas that need attention or change. This can help families identify and understand the root causes of their issues,
allowing them to work towards resolving conflicts and improving communication.
4. Targeted interventions: With a clear understanding of the family structure and dynamics, therapists can develop targeted interventions that address
specific issues within the system. By focusing on changing interactions and restructuring relationships, SFTMAps can help families develop healthier
patterns of communication and behavior. This targeted approach can lead to more effective therapy and positive changes in family dynamics.
5. Empowerment and collaboration: SFTMaps encourages collaboration and active participation from all family members. By involving the entire family
in the creating process, it empowers them to take ownership of their roles and responsibilities within the system. This collaborative approach promotes a
sense of shared responsibility and encourages family members to work together towards positive change.
6. Long-lasting results: By addressing the underlying structures and patterns within the family system, SFTMaps can lead to long-lasting results. By
identifying and resolving dysfunctional dynamics, families can build stronger relationships, improve communication, and develop healthier coping
mechanisms. This can contribute to improved overall family functioning and lasting positive changes.
Structural Family Maps
1

Everyone Meets as a Team for Group Supervision
Group Supervision & the Socratic Method of Case Exploration require specialized skill training
2

‘Socratic Team’ Method of Group Case Supervision
Socratic Teams are Small Group “Practicum” Experiences for Group Supervision.
Method
Group supervision provides a superior method for case analysis and clinical skill acquisition. The Socratic Team Method encourages Members to openly brainstorm and
problem-solve clinical case solutions, with casework serving as an impetus for clinical discussion, instruction on special topics, and training new skills through modeling,
coaching and role-play practice. This generates new perspectives for the Presenter, promotes critical thinking, and encourages group learning and peer cohesion.
Members are actively discouraged from advising one another or the Presenter. Instead, Members are challenged as to how they would handle the particular case or some
portion of it, real or imagined. The facilitator asks provocative, Socratic-style questions to the team, either in random or round-robin fashion: “If this was your case, tell us
how you would handle this?” “Let’s say your client tell you they are relocating and has 5 more sessions. Tell us what you might do, session by session”. “If you could get
anyone to participate who would that be and Why?”. “If you could change anything with this case, what would it be and how would you do it?”
“What if…?”
“Why not try…?”
“What do you think about this?”
32
2

1. More economical use of time, costs and expertise.
2. Skill improvement through vicarious learning, as supervisees observe peers conceptualizing and intervening with clients.
3. Group supervision enables supervisees to be exposed to a broader range of clients and syndromes than any one person’s caseload
4. The normalization of supervisees’ experiences
5. Supervisee feedback of greater quantity, quality and diversity; other supervisees can offer perspectives that are broader and more
diverse than a single supervisor
6. Quality increases as novice supervisees are likely to employ language that is more readily understood by other novices
7. The group format enriches the ways a supervisor is able to observe and monitor a supervisee
Benefits of the Socratic Team Approach to Group Case Supervision
33
2

Supervision may leave the presenter overwhelmed with suggestions and feeling as if they might not have faired well with their work.
A more helpful format places responsibility on each of the Team members and generates more possible ways of working.
1.Draw Genogram: The presenter is asked to draw the case genogram and indicate the following
 The presenting problem and a history of its onset
 Who lives at home/is involved in the presenting problem
 Who has attended session and number of sessions to date
 Their overall treatment strategy
2. Collect Info: The supervisor allows a period for information gathering (no case recommendations) by the members
1) Presenting Problem & Nodal Events
a) Case Outline: the Presenting Problem, including nodal events surrounding its recent onset, who participates and how (denotes
purpose of problem). The sequence of behaviors surrounding the presenting problem (who does what when?) denotes who
participates in maintaining the problem or symptom.
b) Treatment Overview: including previous therapy experiences and their outcomes, frequency and number of sessions to date,
attendance pattern, regular participants and members refusing to attend or excluded.
c) Challenges and Quagmires: “sticky” places and “triggers”
2) Family Constellation (structures and sociodemographic profile data)
3) Family Atmosphere (dynamics within the relationship systems)
Steps in The Team Case Supervision Process
34
2

3. Challenge Presumptions: The supervisor challenges the group, “round-robin” fashion, on how they would handle the case:
1) “You just inherited this case from the current counselor. Tell us, specifically, what you would do and how you would proceed?” or
“You only had 5 sessions left to get to the goal of therapy; explain what you would do each session, session by session?”
2) “You’ve been asked to come into session as a consultant. What’s the 1 thing you would try to accomplish in 1 session and how?”
3) “Using the other members in a role-play, show us how you would make that (move, tactic, technique) happen.”
General Questions to the Team
 Why is the client/family seeking treatment at this particular time? Why this particular problem? What has changed? What if the Presenting
problem was NOT the true problem but masked an underlying issue. What would it be? (purpose of symptom)
 What would you do if a member critical to resolving the problem refused to attend or the client refused to have them attend?
 Who has the power to bring the client(s) back?
 How might they defeat the therapist or how might the therapist be most likely to fail?
 If a co-therapist or consultant was brought in, how would you structure their role? What would wish for them to accomplish?
 If you were supervising this case what direction/instruction would you give the therapist?
 If you were to work from a different theoretical premise, what would you try and how would you approach the case?
 What specific intervention would you wish to try or employ in the next session?
4. Button-Up: The supervisor wraps up the “feedback” and
 Points to how best to work with issues common to this kind of issue, case or client;
 Cautions about possible “blind spots”
 Points to areas for clinical improvement and professional development
35
2

36
“Drilling Down” & “Pushing” the Group
Case analysis is used to prompt brainstorming in Assessment, Treatment Planning and Intervention Technique.
The facilitating Clinical Supervisor uses Socratic Questioning to challenge the group members to think out-side the box
2

The following, line of questioning works very well:
“Tell us what you would do?”
“And then what would you do?”
“And then what?”
“And then what might you do?”
“And then?”
“And how would you go about doing that?”
“And then what would you do?”
“And then what?”
“And then……….?”
37
a) Socratic Method of “Drilling Down” to What Happens Next (“And Then What?”)
This is a simple, but very powerful method by which to brainstorm and encourage new possibilities by pushing the line of thinking “further down the road”.
Think of it as a train ride and have the individual (s) imagine what’s at the very next stop. And then the next one. And the one after that. And then so on.
Facilitator singles-out team members,
Round-Robin or At-Random,
to answer hypothetical questions based on
another team member’s response.
The “facilitators” foster an atmosphere of
experimentation and encourage
–or direct members actively participate.
(see section on Prescribing Directives, Disengaging
& Redirecting Power Plays; slide 174)
2

b) Socratic Brainstorming: “What Ifs?” and “Thinking Outside the Box”
1. About Assessment
 What/who has brought this client to therapy?
 What are some of the main stressors at this time?
 Why do you think the problem emerged now and not 6
months ago? What has changed?
 Is this a psychological or neurobiomedical problem?
What makes you say so? What about___?
 Who actively participates in the problem?
 Who else does the problem effect and how?
 What stage of the life-cycle is the client in? What are
the normative processes & tasks involved?
 What is likeable about the client? Not likeable?
 How is anger handled? Intimacy?
 Why this symptom? Why not some other symptom?
2. About Treatment Planning & Strategy
 What’s best, individual, couple or family therapy?
 What model or approach would work well here?
 If the Presenting Problem wasn’t the problem, what –or
who, do you imagine might be?
 Prior history of treatment? Successes? Failures?
 Who has the power to bring this client back?
 Who should attend session and why?
 After joining, what’s the first thing you would try? And
then what? And then? What next?
 How many sessions will the PP take to remedy?
 What should be the therapist’s main concern?
 How can the life tasks be better adapted to?
General Challenge Questions (continued)
 Why do you think she asked that question?
 What does ___ mean?
 How does ___ apply to everyday life?
 What do we already know about this?
 How does this relate to what we have been talking
about? What makes if different?
 How could you verify/ disapprove that?
 Can you give me an example?
 Are you saying ______ or ______ ?
 Do you agree or disagree with _______?
 Why is that happening?
 Show me how_____ ?
 What do you think causes _______ ?
 Why is __________ happening?
 What alternative ways of looking at this are there?
 Who benefits from this?
 What are the strengths and weaknesses of ______?
 How are _____ and _____ similar? Different?
 How could you look another way at this?
 What should we do next? And then?
 Name some possible unintended the consequences?
 How does ______ fit with what we learned before?
 Why is _______ important?
 What does the symptom do for the client?
 What other information do we need?
 What’s your reasoning for that conclusion?
 How might therapy fail? What could you do/not do to
help ensure it doesn’t? What else?
 If we flipped a switch and everything was as it should
be, what would things look like?
 What does this teach you about yourself?
38
About Interventions
 If this was your case, what would you do next session?
 How does the client respond to your directives?
 What would you try if the client was open to it?
 What have you tried elsewhere that might work here?
 What might you try even if you were unsure of the client's
reaction? How might you obtain permission?
 The client’s attendance has been/becomes spotty. What can
you do to address it? What if it continued?
 You discover the client won’t share a secret. How might you
handle it? What if it risks harm?
 Explain how you might introduce a particularly off-putting
suggestion or very tricky intervention?
 Who needs to get aligned with whom? How?
 How might you disengage these powerplays?
 How does ___ affect ___?
 How does ___ tie in with what we learned before?
5. General Challenge Questions
 What is another way to look at it?
 How would another therapist handle this?
 Would you explain why it is necessary or beneficial, and who
benefits? Why is ____ best?
 What are the strengths and weaknesses of ____?
 How are _____ and _____ similar?
 Can you rephrase that, please?
 Please explain why/how ________ ?
 What would happen if ________ ?
 What could be done different?
 What would you try again, with another case?
 How has therapy been succeeding? Failing?
 If you were supervising someone else’s handling of this case,
what would you have them do and why?
“Client” refers to individual, couple or family system
Exploring Hypotheticals and New Possibilities : Sample Socratic Brainstorming Questions
2

Engaging group members in a dialogue that helps them imagine new possibilities fosters impromptu clinical strength.
The Facilitator challenges members, at random or “round-robin”, to explore how they might approach the presenter’s case
1. Why is therapy being sought at this particular time? Why not a month ago or 6 months ago? What has changed? And, why this particular problem? Ask
yourself, if the Presenting Problem was NOT the actual problem, what else -or who else, might be?
2. Who can identify a specific intervention they would wish to try with this case? Using group members for role-play show us how you might go about trying
that.
3. Suppose you just got assigned this case. What would you do first? And then what? And then? And after, that what would you do?
4. Suppose you were trained in a different counseling style. How might you approach this case differently if it was Functional Family Therapy (FFT)?
Emotionally Focused Therapy (EFT)? What about Dialectical Behavior Therapy (DBT) or Brief Strategic Therapy?
6. Someone critical to the case refuses to attend session or is excluded from participating. How would you get them in?
7. If this case was to trigger your past or pose serious pitfalls or sand traps, what would they be? Who would make you feel that way?
8. You just received this case from the current therapist. The client is due in tomorrow. What is your treatment strategy and how would you proceed?”
9. The client is re-locating and you have 5 sessions remaining. What would you do, each session, session by session, to accomplish the stated goal or outcome?
5. Imagine you are asked to consult. You have 1 and only 1 meeting with the client and therapist. What do you wish to accomplish and how?”
6. What do you do when, during a one-on-one, the client drops the following “bomb” and ask you not to disclose it to anyone:
a) “I have been seriously considering ending my life, have a specific plan, and don’t want to be talked out of it. I simply came to say Good-Bye!”
b) “I’ve been cheating on my partner for several months, and I’m unsure if I want to remain with them or separate.”
c) “ I was drinking and committed a serious crime (murder, arson, Medicaid fraud). Nobody knows, but it would definitely get me sent to jail?”
d) “I’ve been having some disturbing, invasive thoughts about you, as my therapist. They’re very sexual in nature”.
39
Sample Socratic “Stump the Therapist” Starters
2

6. Someone critical to the case refuses to attend session or is excluded from participating. How would you get them in?
7. You find out from another client that your client has been harboring secrets that make a huge difference in your case. How would you broach the issue?
8. Your client wants help with his depression but refuses to address his substance abuse. You suspect he’s coming to session high. What do you do and how?
9. Your client continually flirts with you and has gotten more sexually explicit. What do you do?
10. You find out from another client that your client has been harboring secrets that make a huge difference in your case. How would you broach the issue?
11. Your client wants help with his depression but refuses to address his substance abuse. You suspect he’s coming to session high. What do you do and how?
12. Your client continually flirts with you and has gotten more sexually explicit. What do you?
13. One of the partners in your couple session announces they want to separate. What do you do?
14. The teenage daughter gets so enraged You just received this case from the current therapist. The client is due in tomorrow. What is your treatment
strategy and how would you proceed?”
15. The client’s mother keeps calling you to complain that she’s not getting any better and has, in fact, gotten worse since working with you. How would you
handle this?
16. The clients continually expresses a strong desire to work in therapy and resolve their pain, yet they continually cancel and “no show”. What would you
do?
17. The parents describe their son as having been a problem “since he was born” and believe it may be neurobiomedical. What do you do?
18. The client continually forgets his homework assignments. What do you do?
19. Your 28 yo client arrives clearly impaired from drinking and wants to meet. What do you do?
20. You are assigned the following client syndromes. Explain your understanding of the conditions and choice of treatment you would use:
a) Addiction: Alcohol? Heroin? Gambling?
b) Psychosis
c) Depression: Simple? Complicated? Depressive Life-Style?
d) Eating Disorder: Anorexia Nervosum? Bulimia? Obesity?
e) Paraphilia: Fetichism? Child Molestation?
40
2

Everyone Practices Role Plays
Role Play, an evidence-based method of skill development, is used to coach & rehearse clinical practice
3

Role Play: Model, Coach, Practice
Role Play helps members learn and refine clinical practice through Modeling & Guided Practice (Coaching)
1. Role Play is used to instruct, model and coach team members on the mechanics of clinical intervention and technique.
2. Modeling (teaching and demonstrating) by more experienced counselors provides “learning by observing”; coaching, provides fine-
tuning and rehearsal of verbal and behavioral interventions
3. Role-play provides members opportunities to try out, smooth and rehearse new techniques (behavior rehearsal and refinement). “Do-
overs” and “Let’s try this or in this way” fosters experimentation, creativity, and nimbleness.
4. As confidence grows, the group may elect to participate in more Advanced Practice formats including Co-therapy, Team therapy,
Multiple Family Group Therapy, Open Forums and Live Supervision
5. As confidence grows, Team members take turns facilitating the group and later establish their own Supervisory Teams
3 42

43
Benefits of Modeling & Role Play
Modeling (teaching) technique & Role-Playing (behavior rehearsal) provide more effective method of instruction and skill refinement
“What I hear, I forget. What I see, I remember. What I do, I understand.”
-Xunzi (340 - 245 BC)
 Modeling
 Role Play
Best way to teach
AND learn new skills.
Supervisors must
encourage modeling.
3

44
Role Play is a Superior Medium for Skill Acquisition
”Students are directly active during the role play, so it is more effective in “embedding concepts” into
their long-term memory. The excitement of the role play, the interaction and stimulation to visual,
auditory and kinesthetic styles of learning helps a broad range of learners” - Yasmeen Rafaq
Role play is an educational
technique that allows a
group to explore realistic
situations by interacting
with one another in a
managed way. They gain
experience, trial different
strategies in a supported
environment, and may
analyze the enactment with
the help of other role
players and observers.
3
Role play is “real play”,
every member fills the
role with their own,
unfinished business.

Evidence Based Practices are combined to foster continuous learning and skill acquisition in Assessment, Treatment Planning, and Intervention
Modeling for Advanced Clinical Practice

46
Clinical Supervision is a life-long learning process that is intended to benefit the field of Counseling as well as to improve one’s own clinical acumen. Just as the goal for each Counselor should be
to acquire the skills and certification necessary to qualify as a Clinical Supervisor so, too, must be the goal for each Clinical Supervisor to further one’s expertise in the clinical supervision of
advanced psychotherapy practices. Our goal, as Clinical Supervisors, should be to teach and work toward a level of proficiency termed Master Therapist. A Master Therapist must posses the
following knowledge, skills and abilities:
1. Integration of Theory: Exploring how to combine different theoretical approaches within a single case, adapting treatment based on the client's unique needs and presenting issues. In particular,
the development of more sophisticated assessment procedures and the formulation of tactics and strategies for change.
2. Advanced Therapeutic Skills: Understanding assessment, treatment planning, and the mastery of advanced intervention techniques, including how to challenge and redirect the power and
meaning of symptoms, dysfunctions and desires; how to manipulate beliefs, mood, stress, time and space; how to restructure family roles and functions and create new realities using reframing,
sculpting, and imagery; how to prescribe tasks, directives, rituals, and ordeals; and, how to teach, model and coach different theoretic principles, strategies, and techniques.
3. Complex Casework: Deep analysis of challenging cases involving severe or treatment resistant behavioral health disorders, where the therapist needs to navigate complex family or interagency
dynamics, as well as intricate treatment plans and interventions.
4. Ethical Decision-Making: Thorough exploration of complex ethical situations, including boundary issues, dual relationships, and informed consent considerations.
5. Self-Awareness and Countertransference: Intensive examination of the therapist's own emotions and reactions to clients, particularly in challenging cases, to ensure effective therapeutic
interventions. Understanding the therapeutic alliance, isomorphism (transference/countertransference), “blind-spots” and “triggers”.
6. Research and Evidence-Based Practice: Analyzing current research findings and integrating them into clinical practice, including discussions about the benefits and limitations of evidence-based
practices and principles and the rationale behind treatment decisions.
7. Practice Treating Complex Syndromes: Special topic focus on chronic intractable problems and conditions, including Depression, Eating Disorders, Addiction, Paraphilia, and Psychosis.
8. Practice in Advanced Methodologies: Specialized training in advanced treatment and training practice methods, including Couple and Family Therapy, Co-therapy, Greek-Chorus, Open Forum,
Multiple-family Therapy and Tag-team configurations.
Note: Please note that some of the material from prior slides has been copied to this Section to help with context. A Section marked “Background” is included for those working toward Clinical
Supervisor status who may not have already taken coursework specific to counselor requirements and the supervision of counselors.
While many resources exist, SAMHSA provides free, delivered to your place of preference book on Clinical supervision. While labeled for Substance Abuse Counselors, the material is, in essence,
the same and applicable to all clinical supervision experience: TIP 52: Clinical Supervision and Professional Development of the Substance Abuse Counselor
Available at: https://store.samhsa.gov/product/tip-52-clinical-supervision-and-professional-development-substance-abuse-counselor/sma14

47
Socratic Teams for Clinical Training
The previous Sections highlighted the use of 3 Evidence Based Practice tools, Genograms, Team/Group Supervision, and Role Play, for training
counselors using case analysis to increase knowledge and skill acquisition. As counselors gain confidence in the use of Role Play, they acquire more
practice in teaching the very skills they have learned. Teaching is refined through the six methods of modeling: 1. Supervisor Modeling; 2. Peer
Modeling; 3. Teaching Triads; and 4. Supervised Teaching Triads; 5. Live Supervision Coaching; and 6) Supervised Live Supervision
Coaching.
These are exceptional methods of instruction that helps counselors and clinical supervisors refine their skill through a rotation of the three main roles of
the therapy process, Client, Therapist, and Supervisor. Methods 4, 5, and 6, are specifically geared toward assisting the Clinical Supervisor to train,
along with experiences from the Advanced Methods of Practice section, toward a level of proficiency commensurate with a Master Therapists.
1. Genograms
2. Team Group Supervision
3. Role Play
2. Peer Modeling
3. Teaching Triads
By Learning you will Teach,
by Teaching you will Learn.
-Latin Proverb

48
Our brains are developed to learn through observation. Mirror neurons give us the ability to watch someone perform a task and repeat, or mirror, it back. Modeling not only taps into
how our brain learns, but it strengthens mirror neurons to help group members become better learners over time. Modeling is achieved through demonstrations and narrations. The
facilitator demonstrates an activity or narrates their actions to provide insights into the type of thought processes that go into completing an interventive technique. Group members
are to physically see and take part in the activity being completed which gives them a better understanding of how to do it themselves.
The facilitating Supervisor creates an interactive experience by engaging the entire group in the experience of making active observations, noticing cause-and-effect, and asking and
answering questions. The Facilitator may narrate some of their internal thinking, but instead of pointing out what group members should be looking for or doing at each step. They
ask the group questions such as “What did you notice?” “What just happened?” “How might you do this same thing?” “How can you get to the same place using another approach?”
“What do you imagine the client’s experience is like?” “If you were modeling this who can show us how they would do it?”
This Section covers Role Play Modeling methods 1-6. Methods 1-3 are ideal for training therapists and provide the added bonus of developing leadership and supervisory skills in
the facilitating Clinical Supervisor. The next four methods (4, 5, 6), along with variations for number 6, cover advanced modeling called Live Supervision Coaching and Supervised
Live Supervision Coaching. Live Supervision Coaching provides a remarkable opportunity for the Clinical Supervisor to provide ‘real time’ feedback to the practicing therapist. It is
based on a long-standing tradition in our filed that relies on observer feedback to augment and refine clinical skill development. Similar formats have included video taped or audio
recorded session, the 2-way mirror, Greek Chorus and even co-therapy or tag-team therapy configuration.
The Live Supervision Coaching method of modeling clinical input was developed from work undertaken with Richard Belson of the Family Therapy institute of Long Island in
1990. Dr. Belson sponsored a 30-session externship for practicing professionals designed around a live therapy supervisory model. This, in itself, reflected the tradition of family
therapy conferences of the 70’s, 80’s and 90’s, where a renown founding therapist met with a live case before an audience and explained the nature of their work. This, in turn,
reflects the Open Forum method of therapy first popularized by Alfred Adler and modeled for me by Robert Sherman. As few things are truly “new”, the Open Forum and Live
Supervision formats are, themselves, fashioned after the Greek Chorus configurations of the drama plays of theater from ancient Greece. These are highlighted in the section marked
Advanced Practice Methods. A shout out should also go to Moreno (Psychodrama), Perls (Gestalt), and Satyr (Conjoint Therapy) who made interactive treatment a commonplace
occurrence.
-Demetrios Peratsakis
Notes on the Six Methods of Modeling Using Role Play

Six Modeling Methods for Teaching & Training
Clinical Supervisors Using Role Play to Teach, Guide & Refine Counselor Therapy Skills

50
1. Clinical Supervisor Modeling
2. Peer Modeling
3. Teaching Triad (Supervisor/Therapist/Client)
Modeling: 6 Methods of Role Play Training
Modeling for Therapist & Clinical Supervisor Training Modeling for Advanced Clinical Practice
4. Supervised Teaching Triad(s)
The Socratic Team Model of Advanced Psychotherapy & Clinical Supervision Training © employs Role Play for continuous improvement
in the Clinical Supervisor and Therapist’s Assessment, Treating Planning and Intervention Strategy & Technique knowledge, skills, and abilities.

Supervisor models
technique to
Counselor
Counselor rehearses
with Supervisor, then
models it back.
a) Clinical Supervisor Models It! -the “trainer” or supervisor describes the technique, tactic or strategy and explains its history and use, then models it
with a group member, counseloror “trainee” in a role play. For more complicated techniques, describe the technique and its purpose, proffer some background
information or examples, and demonstrate it, including how it may be introduced and details that may qualify it, such as tone of voice, clarity of instruction, seating
proximity, degree of immediacy and detail, etc.
b) Counselor Models IT Back! –the trainer and trainee rehearse it, then the trainee demonstrates a working knowledge of the technique by modeling it,
in turn, with the trainer.
 Give Positive Feedback: evaluate the group member’s progress and offer immediate, constructive feedback and encouragement.
 Practice, Practice, Practice!: new skill acquisition requires practice and should include change-ups and “do-overs”. Clinical Supervisors encourage active
rehearsal and creative use of alternative approaches to the technique. Make it fun and experimental!
51
Modeling, Practicing & Re-teaching New Skill Acquisition: 6 Methods

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2. Peer Modeling - supervisor train counselor, counselor trains peer; peers then rehearse taking turns acting as “therapist” and “client”
Peer Modeling invites group members to model what they have learned. A facilitator first teaches or demonstrates a skill or technique, then selects a group member
(supervisee) to replicate that demonstration for their classmates, allowing for both active learning and peer-to-peer instruction. Facilitators can prompt group members to
make observations and ask questions, exactly as if the facilitator was modeling the skill.
Benefits of Peer Modeling:
 Increased engagement: group members are more likely to be engaged when watching a peer perform a task.
 Differentiated learning: allows for tailored support as the facilitator can select supervisees to model based on their individual understanding.
 Builds confidence: supervisees who are chosen to model can gain confidence in their abilities by teaching others.
How to implement Peer Modeling:
 Choose a clear task: Select a skill or concept that can be easily demonstrated and observed.
 Model thoroughly: Explain each step clearly while demonstrating the task.
 Select a student to model: Choose a student who understands the concept well and is comfortable presenting to the class.
 Provide feedback: Offer constructive feedback to the student modeling before they present to their peers.
Peer Modeling
Supervisor models
technique to Counselor
Counselor rehearses
with Supervisor, then
models it back
Counselor then models
technique with a peer or
another counselor

3. Teaching Triads - allows group members the opportunity to train both as therapists and as clinical supervisors.
Facilitators may design a “Teaching Triad” to have Peer Modeling operate more independently. A Teaching Triad uses three group members, each working from a specific role:
4. “clinical supervisor” or “coach”: learning the facilitator role requires practice in teaching concepts and demonstrating technical skills;
5. “therapist”: while supervisees or group members are, in fact, therapists, this role allows direct observation of the facilitator’s approach to modeling which they may revise;
and
6. “client”: while the role of the client may appear passive, it is in fact a critical practice element as group members improve their ability to act, as well as experience the
effects of the modeled technique.
Once the three roles are assigned, they can be made interchangeable so that each member has an opportunity to serve as “coach” (supervisor), “therapist” (supervisee) and
“client” (peer supervisee). A more systematic design for Teaching Triads is presented under the Advanced Methods section.
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Facilitator (Clinical Supervisor) demonstrates the
skill to a supervisee/group member, while
engaging the entire group in the process. The
supervisee, in turn, mirrors the skills back to the
facilitator who provides feedback and remedial
guidance. The facilitator then selects a second
group member/supervisee to join the triad. The
first supervisee is then directed to demonstrate
the skill they rehearsed to their peer.
Once this process is well versed, the facilitator may
substitute the first group member in their stead and
allow three group members to function as a rotating
triad while they (the Facilitator/Clinical Supervisor)
observe and provide feedback and guidance.
Once the Facilitator has trained the dyad, she adds a third member (triad), replaces herself as the Role Play
Clinical Supervisor, and then proctors the process from outside the trio. Others are encouraged to replicate the
process.
-see details on next slide
Demetrios Peratsakis © 2017

Role-Play sample:
Use of
visualization
technique
1. Client (s)
Therapist
rehearses technique.
Tries “Do-overs”
and variations.
2. Therapist
 Coach guides practice
 Gives feedback/Adjusts
 Directs “re-dos”
 Signals starts/stops
3. Coach
The Lead Clinical Supervisor(s) models the tactic or technique and then circulates among the Triads, each led by a “coach” working with a “client”-”therapist" pairing.
As each member assumes one of the three disparate “roles” they gain perspective and an understanding of the dynamic of change and the therapeutic process.
1. Lead Clinician or Facilitator divides the
Team Members into Triads with 3
distinct roles: Client; Therapist; Coach
2. Lead Clinician/Facilitator introduces,
explains, and demonstrates (models)
selected technique
3. Lead Clinician/Facilitator sets the
task, keeps time, and directs action,
pacing and change-ups
Lead
Clinical
Trainer
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Detail: Teaching Triads Cycle for a 3 Step Model, Mirror, Coach Role Play
Working through an actual case presentation is the best method for acclimating the Team to the Socratic Method.
Modeling and Role Play modify each Member’s experience of supervision and of the clinical skill development process.
Ask for 3 volunteers, assigning one to play the role of the “client”, one the “therapist”, and one the supervisor or “coach”. Demonstrate a technique, then ask the “coach” to help
instruct the “therapist” on how to introduce it to the “client”. Once this has been trialed, break the remainder of the full Team into “Teaching Triads”. Have then walk through
the same technique, alternating roles. Then move to a variation of the technique. Review experiences and newly crafted versions.
Teaching Triad: Rotating Roles (Client, Therapist, Coach) for the Practice and Rehearsal of Technique

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1. Models Technique
Sandy, mirrors the technique back to
the coach, smoothing it our with practice
2. Sandy, playing the part of the therapist, models the
technique with a peer serving in the role of a “client”.
Sandy’s “coach” supervises, corrects and remodels
Sandy’s use of the technique, as needed.
1. The “coach”, or Clinical Supervisor, models the
technique with Sandy acting in the role of the “client”
3. Sandy, now serving as the “coach”, oversees the
modeling of the technique with yet another peer.
“Client”
“Therapist” “Client”
“Coach”
Sandy
We did Good!
Sandy
Sandy
“Coach”
Team Members Work in Triads!
Models Technique
Back to “Coach”
Detail: Teaching Triads Cycle Illustrated for a 3 Step Model, Mirror, Coach Role Play
3

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Teaching Triads comprised of 3 Peers or Counselors practice rotating “Therapist”, Counselor” and “Supervisor” roles to refine modeling of new skill. A Clinical Supervisor
may be added to circles the triad(s) providing feedback and guidance to each player, acting in their respective roles. This fourth role Play Model is termed a “Supervised
Teaching Triad” and works extremely well with very large groups. Counselors are assigned a number (1 = Client; 2 = Therapist, 3 = Supervisor) then directed to gather as
groups of three, begin role play and upon cue, switch roles. The facilitating Clinical Supervisor circulates among the triads and provides feedback.
A 4th
Role Play configuration can be created by adding a second
Clinical Supervisor to the mix. Their job is to monitor the
teaching triad and provide guidance and feedback to the Triad.
Teaching Triad
Teaching Triad
Teaching Triad
Teaching Triad

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5. Live Supervision Coaching - allows Clinical Supervisors the opportunity to train therapists in “live” practice.
Role Play Client
By sitting immediately behind the therapist’s chair and peeking over their shoulder, the clinical supervisor, or facilitating coach, is able to remain outside
the emotional sphere of the client-therapist dyad and offer “live supervision” suggestions and advice by whispering comments in the therapist’s ear.
In this manner the “coach” observes the “therapist’s” work with the “client” and helps to refine it by providing guidance on interventions, offering
alternative perspectives on client behavior, identifying potential pitfalls, traps or concerns, suggesting new techniques to address specific issues, and
helping the therapist navigate challenging moments in real-time.
A key task of the “Clinical Supervisor” is to point to out whenever the client or the therapist is avoiding “hot” topics or not working:
The general rule is “NEVER interrupt when work is being done; ALWAYS interrupt when work is NOT being done!”
Clinical Supervisor or
Facilitator as Live Supervision Coach
Role Play
Therapist
Client-Therapist-Live Supervision Coach Triad for Refining 1) Therapist & 2) Clinical Supervisor
Technique

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Live Supervision Coaching Overview
In this exercise, a more experienced practitioner or clinical supervisor sits immediately behind the “therapist” working
with the “client” in a Role Play simulation, and provides direct, real-time, supervisory oversight, feedback and suggestions.
This is of enormous benefit to the clinician who continually refines their line of intervention.
Similarly, the clinical supervisor has the opportunity to see the impact of their suggestions and continue to refine their input as they watch the “therapist” and “client”
interact.
- the set up is showcased on the following slides
“Live Supervision Coaching” is a two-tiered method for simultaneously refining the skills of the Clinical Supervisor AND the Therapist.
“Pssst! Ask her if
she’s still
planning to leave
him…”
While Modeling is an important instructional method for counselors, its variation, Live Supervision Coaching,
is specifically designed for refining the supervisory skills of the Clinical Supervisor.

Detail: Live Supervision Coaching Target Skills for Live Supervision Coaching
Live Supervision Coaching is a variation on the Role Play configuration and specific to the Socratic Team Model of Advanced Psychotherapy & Clinical Supervision Training ©.
It involves having a clinical supervisor, facilitator or seasoned therapist serving a “coach” sit directly behind and over the shoulder of the role play “therapist” as they work with
the role play “client(s)”. The coach, redirects and refocuses the therapist’s line of intervention by whispering suggestions or instructions in the therapist’s ear. A prearranged
cue, such as tapping on the therapist’s shoulder may help alert them that they may need to switch or augment their approach. Tap, means a suggestion is coming.
Active clinical supervision with an in-session consultant, per this design, is a superior method of training for the Clinical Supervisor, as well as the Therapist. In this manner, both
continuously refine their skills in Assessment, Treatment Planning and Intervention. The Clinical Supervisor should be mindful to not overwhelm the therapist, but to bail them
out.
Essentials for the Clinical Supervisor to train for deepening the Therapeutic Alliance as a more supportive and often more intimate relationship evolves.
1. ACTIVE LISTENING: Be on Alert for Guilt, Anger and Shame (GASh)!
a) Challenge Guilt (guilt feelings are means of negating the need to change or make sacrifice, filled with a sense of nobility)
b) Uncover Shame, then tap into the Anger (Shame ALWAYS is accompanied by anger, resentment or rage)
c) Tap Into Anger & Give It Voice! (unresolved, anger will emerge openly as Aggression or covertly as Passive Aggressive maneuvers)
2. GIVING DIRECTIVES: Creating Safety Zones or Embedded Sessions
d) “Experiment” (suspending the world to try something different; enter the experiment chamber, then “leave the experience behind”)
e) Hand Signals/Sign Language
f) Buttoning Up & Temperature Checks
3. POWER STRUGGLES: Harnessing Power Plays to Deepen the Therapeutic Alliance
g) Fear vs Passive Aggression
h) Disengage & Redirect Power Struggle
i) Temperature Check & (Paradoxical) Prediction of Separating from Treatment
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1. Challenging the World View
The most sophisticated part of the therapist’s work is the systematic modification of the meaning, purpose, and power of the client’s belief system. It begins by
questioning and challenging the client’s world view, their interpretation of self, others, and especially of the symptom or presenting problem. These grow progressively
more rigid and less flexible under duress and worsen in response to trauma as the individual seeks to regain security and obtain a sense of control. The result is a see-
saw struggle between fear and ambivalence and the imperative to change. This dynamic continually emerges in treatment, calling for and periodic review of the goal
and motivation for change. The therapist must, therefore, be ever vigilant to the need to rework problematic viewpoints and the core beliefs, emotions, and behaviors
that reaffirm them. The process is on ‘restructuring”, a defined set of interventions that introduce doubt and confusion (cognitive dissonance) so that alternative
solutions may be suggested and explored:
2. Challenge the Meaning, Purpose or Power of the Presenting Problem (PP) or Symptom. Force the client(s) to elaborate on exactly what makes the problem a
problem, what would change if it were reconciled, what unintended consequences might occur, who would benefit/suffer the most, and what would be the problem
if this wasn’t?
3. Create a new symptom (ie. “I am also concerned about ________; when did you first start noticing it?”) or move to a more manageable one (ie. chores vs
attitude)
4. I.P. another family member (create a new symptom-bearer or sub-group; ie. “the kids”, “the boys”)
5. I.P. a relationship (“the relationship makes her depressed”)
6. “Spitting in the Soup” –make the covert intent, overt
7. Restructure Behavior: the sequence of behaviors and interactions maintain the Presenting Problem or Symptom. Role Play or Enact it, in session, then
restructure/modify some aspect of it, for example: add, remove or reverse the order of the steps; remove or add a new member to the loop; change the duration,
frequency or rate of the symptom or pattern; add (at least) one new element to the pattern; perform the symptom without the pattern (short-circuiting).
Clinical Supervisor Note: push therapist to challenge the symptom by continually narrowing or broadening perspective: “And then what would happen…?”
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Detail: Live Supervision Coaching Target Skills for Live Supervision Coaching
As preciously noted, the Clinical Supervisor must continually train on the importance of the therapeutic alliance. The are also several important areas that should be targeted
for continuous skill acquisition. Working off the specifics of the case and its presenting information provides the most natural and immediate opportunity for input. As a
general rule, however, the following target areas should also be a center of focus. They also provide a means of fine-tuning the therapist’s attention to specific, required skills:

2. Interrupting Counter-productivity: The Coach interrupts the Therapist-Client dyad whenever work is not being done or the work is counter-productive or counter-
therapeutic. Client avoidance, ambivalence and fear tend to derail efforts by the therapist to hone-in on more underlying issues. Addressing the intermittent ambivalence
fear or disruption to the therapeutic alliance is important to ensure work continues in a smooth and unabated manner. Therapy sessions are prone to impasses, which could
be forms of passive aggression or a power struggle with the therapist. Stopping or freezing the session to point it out and returning the power to the client (what would
you like us to do?) is a method of disengaging and redirecting it.
Clinical Supervisor Note: ALWAYS interrupt session when work is NOT being done; NEVER interrupt when work is being done!
3. Focus on Emotions: The expression of volatile emotions such as rage or unremitting sorrow or fear in session can be frightful for the client as well as the therapist. It’s
for this reason that it is often avoided, at times by a silent collusion between the two. Yet. Tapping in to the pain the client is experiencing typically poses this very risk. In
fact, for some healing, the goal of therapy is to surface the underlying emotions and give them voice. A good example is depression. Depression is more than
disappointment, sadness or sorrow. It is sadness mixed with anger and typically expresses as sullenness because the anger is deemed too toxic, to uncontrollable. So the
individual and their relationship system collude to have its more socially acceptable side, the sadness, take center stage. Sadness, after all is more socially acceptable and
brings people together; anger, is the and does the opposite. Helping the therapist help the client tap into underlying emotions is a critical skill for the Clinical Supervisor.
Both, in fact, need to master the skill. It begins by identifying and validating the underlying emotion (listening with a “Third Ear”), generalizing and normalizing it to the
occasion, and then beginning to inquire as to its frequency and magnitude, as if its existence was a given. The therapists should assume that if they would feel afraid, sad
or angry, then in all likelihood the client would.
The Clinical Supervisor listens for the emotional content underlying the narrative and pushes the therapist to validate it and move into a more explicit emotional
regulation exercise. Most therapists spend too much time talking about feelings, instead of getting to them. Challenge distraction and the underlying
emotions will become more surface; validate and normalize them and the opportunity for an emotional regulation exercise will occur (see embedded session).
Clinical Supervisor Note: with key emotions, prompt the therapist to ‘land the plan’, whenever there is too much ‘circling of the runway’ (avoidance)
4. Shaming: despite our best efforts we all use language that may be experienced as demeaning or shaming, even when such was not our intent. It may be a consequence of
our abruptness or personality style, or even our attempt to hone-in and get the client to work. Regardless, we often times don’t “hear ourselves talk” and therefore don’t
have the opportunity to self correct. The Clinical Supervisor should prompt the therapist to “slow down’ or “take it easy” or “you’re being too rough”, whenever they
observe undue harshness or shaming.
Clinical Supervisor Note: as a second set of eyes and ears, prompt the therapist whenever you hear/observe something amiss in their language or tone.
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5. Power Struggles -see Background Material Slides for How to Disengage & Redirect
Power Struggles are an inevitable part of the therapeutic process. Since a part of the therapist’s job is to guide, nudge or otherwise control
the process, challenge, and steer attention toward potentially unwelcome thoughts and feelings, it’s a natural process that
emerges. The therapist must therefore be ever alert for it and work through it in a reasonable fashion. This is more difficult when a power struggle
emerges, especially when passive aggressive. The therapist may be caught off guard or find them selves getting progressively
frustrated or angry. This is counterproductive and may, at times, be the very intent of the client’s posturing.
The Clinical Supervisor must stay vigilant for power struggles and helps the therapist to disengage and redirect its energy and intent. The first step is
demarcating fear from passive aggression. Fear is a natural reaction to the dread that accompanies recalling unhappy events or reconciling painful
experiences. In these instances, the therapist needs to slow down, recognize and validate the angst and reapproach it slowly and in smaller bites.
Exploring the power surrounding the dreaded memory or topic is often more valuable than a frontal attack: “What’s the worst thing that would happen
if……?”
When clear that it isn’t a simple matter of fear or discomfort but outright opposition, then a different strategy is required. Power Struggles express
themselves in various forms: 1- 16, courtesy of Ofer Zur, Ph.D.; 17-33, courtesy of D. Peratsakis. These are detailed in Section marked “Background”.
6. Not talking
7. Not following advice or suggestions
8. Non-disclosure [Selective disclosure] or not answering questions
9. Taking notes or recording sessions
10. Coming late or leaving sessions early
11. Non-payment or refusal to agree to terms of service
12. Stalking
13. Change seating or other office arrangements
14. Provocative or threatening clothing
15. Use of violent, vulgar, threatening or provocative language

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5. Power Struggles (continued) -see Background Material Slides for How to Disengage & Redirect
11. Use of anger, aggression or rage
12. Dominating the conversation
13. Inappropriate touch
14. Inappropriate gifts
15. Offering incentives
16. Acting coy or seductively
17. Not improving or regressing
18. Motivation for treatment drops or drags
19. Shot-gunning or “carpet-bombing”: too many Presenting Problems and Identified Patients
20. Presenting Problem or Symptoms keep changing
21. Confusion or ambivalence over selecting a Goal or Presenting Problem
22. Client sets appointment, cancels or no-shows; sets appointment, cancels or no-shows again
23. Spokesperson, referral agent, spouse or partner sets appointment, client refuses to attend
For Couples:
24. One sets appointment, then sabotages their partner’s participation
25. Both attend, one sees a problem, one does not
26. Both attend, both agree that one partner is the problem (identified patient/I.P.)
27. Both attend, agenda moves to Individual Counseling (I/C) or child focus (F/C)
28. Both attend, one begins to No-show (leaving therapist with partner/spouse)
29. Both attend, one drops a “bomb” (ie. sexual affair, drug abuse, major illness)
30. Both attend, one discloses their desire to separate or divorce
31. Both attend, one or both unclear on commitment (separate or remaining together)
32. Both attend, one or both continually triangulate the therapist
33. Both attend, the agenda and goal of therapy continually changes or vacillates

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5. Power Struggles (continued) -represent direct challenges to the therapeutic alliance and should be confronted right away.
As previously stated, push-back is due to one of two factors:
6. Fear, Anxiety or Angst, or Morbid Dread:
-comfort the fear and encourage them back to task: “This is very hard”; “Let’s slow down and try again”
-if the task cannot be completed, focus on the fear: “What is the worse that would happen?”; “What’s happening now?” “If you could
do it…”
2. Power-play:
7. The simplest method is to discuss the power-play as a barrier to the requested help; that it appears to be a “mixed message” : “I want counseling, but I don’t
want to change!”
8. Stop the process and ask directly about the issue.
 Point to the ambivalence: “I’m getting some mixed messages. Should we move forward or not; is this worth trying to change?”
 “I think I may have stepped on your toes a bit, are we going to be okay?……..”
 Take a 1-down: “I’m not sure where we are; how should we proceed?”; “I’m a bit lost, where should we go from here?”
3. The client is then encouraged to make a choice and decide how, if at all, they wish to proceed. This validates the client’s power.
4. The therapist also has a choice. They ultimately control what they do or do not do, beginning with whether they hold session or not. The therapist must
ALWAYS agree to the terms necessary for c hange to occur. The ideal (“Going for the Gold”) while preferred ius not always necessary. At times, the
therapist must settle for the “Silver” or the “Bronze” Medal, but should NEVR proceed if they are out of contention. They owe it to the client to ensure that
therapy succeeds, even if the facts poit to the reality that this may NOT be a good time to engage in treatment. While therapy can be failure prone it is
imperative that the client never be led to believe that therapy is not a potentially beneficial experience.
5. Often it is important to repair the therapeutic alliance by a) reframing the client’s behavior (“This is very common and natural…”; “I’m glad that you still
have some feistiness left in you –wink,wink!”) and b) address the inherent resentment and anger at the therapist.
6. Seek permission to power-play: “My role is to push you in ways that will be uncomfortable. That may be more than you bargained for but otherwise we may
waste a lot of time and not get as much done”. “What would you prefer we do?”
Clinical Supper Note: Never allow therapy to proceed until an existing powerplay has been satisfactorily reconciled.

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6. Deepening the Therapeutic Alliance The most powerful intervention for helping clients transcend their suffering, is the Therapeutic Alliance.
The acceptance, trust, and intimacy that can be achieved in the relationship with a therapist is restorative and curative; it provides the support and encouragement necessary to
explore one’s pain, face one’s fears, and take the necessary risks to change.
Ironically, much like therapy, itself, Role Play can engender strong emotional content and is, therefore, an inevitable context for experiencing triggers from past trauma, as well as
transference and countertransference. It is important to note that these experiences are natural to the therapy process and provide the therapist the continuous opportunity for self-
reflection and growth: “Therapy allows for the continuous possibility of a genuine, human-to-human encounter. As the counselor develops greater “therapeutic relational
competence” their power as an agent for change matures and grows (Watchel, 2008). In this manner, both therapist and client grow through authentic encounter with each other”.
(Connell et al.,1999; Napiers & Whitaker, 1978).
Temperature Check and Pacing
For change to occur, the therapist must continually encourage experimentation in new ways of thinking, feeling and interacting. This can be difficult when working through painful
events where there is a natural reluctance to revisit and explore the hurt. Most often, these are the very areas that requires attention, making encouragement and confrontation or
challenge (“pushing”) by the therapist necessary. This can lead to resentment or anger at the therapist which, unchecked, will degrade the therapeutic alliance and risk the client
exiting from therapy. To offset this, the therapist must continuously “temperature check” the relationship in a manner that allows the client to retain control while accepting support
in working through the pain, not merely to re-experience it. A simple, yet clear understanding must be established early on in treatment that this is a necessary part of the clinical
experience. In truth, there would be little need to seek therapy if the client could achieve this work on their own. Simple statements that continually reaffirm the purpose of treatment
as “work”, and the therapist job to encourage, but at times to “push”, work best. For example, “How are we doing? Did I push you too hard or step on your toes, just now?” “Most
folks get a bit upset when I push too hard. How upset with me are you for pushing you today?” “Sometimes when I push too hard, the person doesn’t feel it right away, but will
sometime get angry after they’ve left. That’s perfectly normal. If that happens, do you think you would be too upset with me to come back -even for just one more session?”; “Do
you need us to take it slower and not push so hard or work so fast?”
1. Depending on session difficulty, several temperature checks might need to be taken. Simpler phrases, such as “Are we still okay” or “Are you okay if we work -and I push, a
little bit harder/more?” can be added periodically to augment the work.
2. An important addition to the Temperature Check technique is to add a symbol that allows the client to control the pace or intensity of session work, such as holding one’s arm
up, palm out, in a “stop” gesture to indicate “that’s far enough right now” or “you’re pushing too hard”. An easy way to set this up is to associate “pushing too hard” with
“invading your space” or proximity to the client. One can practice this with the client by asking them to hold up their hand (in the gesture to “stop”) -when “I get too far into
your space”, then slowly inch your chair forward until the client announces, by gesture, that it is too close and they need you to back off. Repeat this and then return to a safe
distance. The marking gesture has now been incorporated as a routine signal in session.
3. A more complete temperature check should always be completed at the end of the session.
Clinical Supervisor Note: if the therapist is unable/unwilling to deepen intimacy with the client, it may signal a strong counter-transference for immediate remedy.

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7. Rescuing & Enabling are common expressions of the therapist desire to be liked and to helpful, natural tendencies for counselors in the helping
profession. It may also point to a more personal difficulty, based on own family of origin. This may be a preferred role based on a history of codependent or
parentified relationships. The Clinical Supervisor should recognize this pattern and address it with the therapist directly. Enabling stems form an inherent problem with
self-esteem and the need to be needed Lifeguard inflate it. Unfortunately, it robs the client of the opportunity to do their own work and, thereby, prosper by the value of
treatment. Most therapist are self-correcting and only require a gentle reminder or nudge when they are overstepping this boundary.
Clinical Supervisor Note: nudge the therapist and remind them: “Their therapy, not yours!” OR “No Life-Guard ON Duty!”
8. Relationship Focus is made difficult by the nature of the session (individual therapy) and the customary way we have been trained to view our own
personhood. We continually make the mistake of believing that our sense of independence extends to some true and autonomy form others. Remember,
“Individuals leave their families, but their families never leave them!”
Systemic Therapy is about perspective, NOT about how many people are in the room and Presenting Problems are by-products of the client’s RELATIONSHIPS!
While Socratic Model of Case Supervision requires use of the Genogram, counselors should be trained in Structural Mapping, and excellent tool for assessing family
dynamics related to power (Hierarchy) and boundaries (emotional content). These provide therapists with a more holistic appreciation of the client and the sources of
support and duress they experience. Therapists should also be trained to continually employ relationship-oriented questions. For example:
 Who else is affected by this and how? What does your mom/dad/brother/sister/spouse/kids say?
 Does this get better or worse when you’re around certain people? What about mom/dad/spouse?
 Who else gets sad/mad the way you do? Who are you most like when you get angry/depressed/anxious?
Clinical Supervisor Note: continually prompt the therapist to focus on absent members of the family of origin and current family configuration
9. Homework should be very carefully assigned. It poses potential, unwarranted risks for clients unless carefully attended to by the clinician. and when does
so follow up with how it went, then asks for it to be re-enacted in session. The greatest risk should be undertaken by the client in session under the supervision of the
therapist. While Homework can echo, extend or reinforce change practiced in session, it should be free-floating and should NOT be the first experience
outside of session. It is most beneficial for the therapist to predict difficulties and caution the client against doing more than is comfortable. If the therapist suspects
sabotage or failure, then, if appropriate, that should be predicted and accounted for, otherwise the task should not go forward. Once assigned, Homework is therapy work
and must be expected to be complied with, same as in sessions tasks; otherwise, it must be regarded as an unwieldy assignment by the therapist or else an act of defiance
by the client.
Clinical Supervisor Note: short-circuit any assignment that is too risky or hasn’t first been trialed by the therapist in session.

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6. Supervised Live Supervision Coaching -Clinical Supervisor training through Role Play
The sixth method of modeling technique through Role Play adds a second or facilitating Clinical Supervisor to the mix. Their role is to assist the Live Supervision Coach refine
their input and focus on the treatment experience of the therapist, as well as the client. As they push the Clinical Supervisor to push the therapist, skill development
becomes more focused, with greater attention to the process of conducting therapy over the particulars of a given case.
A seasoned Clinical Supervisor monitors the guidance provided by the Live
Supervisor Coach and provides feedback and redirection, as needed.
Clinical Supervisor Check List
1. Joining/Client Experience
2. Therapist Challenges P.P./Symptom
3. Interrupt Avoidance/Distraction
4. Therapist focus on Emotions (listen for Guilt,
Anger, Shame (GASh)
5. Encouragement/No Shaming
6. Therapist successfully negotiates Power
Struggles: Disengages & Redirects
7. Gives Directives effectively
8. Experiments/Embedded Sessions
9. No Rescuing or Enabling
10. Therapist focus on Relationships
11. Homework: safety/ “doom” to success
Clinical Supervisor Target Skills
Help Therapist Deepen Therapeutic Alliance
1. Active Listening:
a) Challenge Guilt
b) Uncover Shame
c) Tap Into Anger & Give It Voice!
2. Giving Directives:
d) “Experiment”
e) Hand Signals/Sign Language
f) Buttoning Up & Temperature Checks
3. Reconciling Power Struggles
a) Fear vs Passive Aggression
b) Disengage & Redirect Power Struggle
c) Temperature Check & (Paradoxical) Prediction
of Separating from Treatment
Wheels allow members to move freely, manipulate space and proximity to modulate intensity.

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Greek Chorus
Once the Live Supervision Coach configuration has been mastered, a seasoned
Clinical Supervisor may be added to observe and proffer guidance. Once that has
been mastered a second grouping of live supervising coaches, or a Greek Chorus,
may be added for added complexity and advanced methods training. The Greek
Chorus may simply provide advice or play a specialized role, as antagonists.
–Demetrios Peratsakis
Advanced Supervised Live Supervision Coaching manipulates the advisor component.
It may be yet another clinical supervisor or group, a Greek Chorus, or some other feedback directive, especially for problems that pose continuous reluctance to change.
6 A. Advanced Supervised Live Supervision Coaching (Variation) - Clinical Supervisor training through Role Play
The sixth method of modeling technique, Supervised Live Supervision Coaching, can be further enhanced using a variety of different consultation designs. This may simply be the
addition of yet another Clinical Supervisor or a more planned design focused on specific components of the therapy process. A similar paradigm was popularized by the Greek Chorus
and Phone In methods of Family Therapy and illustrate its creative use: “A consultation group acting as a Greek chorus underlines the therapist's interventions and comments on the
consequences of systemic change. This group is also sometimes used to form a therapeutic triangle among the family, therapist and group, with the therapist and group debating over
the family's ability to change.” –Peggy Papp, ACSW.

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6 B. Advanced Supervised Live Supervision Coaching (The “Dueling Live Supervision Coaches” Variation; AKA “Hot Seat”!)
- Clinical Supervisor training through Role Play
The sixth method of modeling technique, Supervised Live Supervision Coaching, can be further enhanced using a variety of different consultation designs. This may simply be the addition of
yet another Clinical Supervisor or a more planned design focused on specific components of the therapy process. One variation places the Clinical Supervisor in the “Hot Seat” and the
Therapist as the Live Supervision Coach, counseling the Client on their presentation. Therapist and Client, portrayed by another Therapist, the opportunity to see how the Clinical Supervisor
might handle continually shifting narratives. In essence, both the Client and the Clinical Supervisor/Therapist each get a Live Supervision Coach.
Advanced Supervised Live Supervision Coaching manipulates the advisor component. It may be yet another clinical supervisor or group, a Greek Chorus, or some other
feedback directive, especially for problems that pose continuous reluctance to change. It may include a Live Supervision Coach for the Clinical Supervisor, Therapist, Client, or
all three.
“Client” Clinical Supervisor
Live Supervision Coach Live Supervision Coach

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Finding a Balance: Input versus Overload
Although Clinical Supervision requires that the supervisee obtain instruction and guidance from their supervisor, it is important to find a balance so that directives given by the “Coach” are
not overwhelming or overly intrusive. As suggested, hand signals, taps on the shoulder or back and so on can help minimize confusion and alert the supervisee when guidance is
forthcoming. The search for the right balance is, in itself, one of the most nuanced skills a Clinical Supervisor must develop, often taking years on continued practice.
Things that readily effect the amount of instruction that should be given, even in Role Play, include:
1. The experience level of the clinician: more seasoned therapists require and should receive less guidance.
2. The immediacy of the Presenting Problem: some issues pose greater degrees of danger for the client. For example, while Anorexia Nervosum and Obesity are both eating disorders,
starvation poses a much higher and more immediate lethality risk . Similarly, depression, while disconcerting, has a higher level of immediacy when active suicide ideation or drinking
and drugging are present. The Clinical Supervisor must prioritize the client and the therapist’s safety above all else.
3. Ethics: more obvious risks such as ethical concerns, bodily harm, or the risk of a client abandoning treatment may also increase the need for more directive action by the Clinical
Supervisor.
4. Crossroads: at times the entire course of treatment may turn or need to be turned rather abruptly. These crossroad moments rely on very skilled maneuvers and may include such varied
issues as a) the need to seek a psychological, contact to the police or other major stakeholder; b) the need to convert individual therapy to couple or family; c) the need to invite or
remove a significant player from the mix; d) the benefit of introducing a co-therapist, consultant, Greek Chorus or other major therapeutic modification; and so on.
5. A Bad Therapist: some individuals may make poor therapists, regardless of the amount of training they receive. In particular, individuals who are a) overly co-dependednt with severe
boundary issues; b) those who struggle with a lack of empathy and appear unable to project genuine warmth and caring; or c) those who remain so autocratic and moralizing that they
appear unduly judgmental and unaccepting of differences.

Advanced Methods of Practice
There are several formats that augment training in advanced methods of clinical practice.
Four are highlighted in the following slides:
Collaborative Teaching; The “Open Forum”; “Live Supervision Therapy”; and Multiple Family Therapy.

1. Collaborative Teaching
6 Models for Reconfiguring the Group Experience to Augment the Learning Experience
- popular teacher/trainer group configurations for mixed groups of student or trainees

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Group Members have the opportunity to learn
from Facilitators who may have different
teaching styles, ideas, perspectives, and
experience. It also makes it easier to
implement differentiated instruction and
personalized learning:
 Creates effective, fun learning
 Teachers can use their knowledge
effectively together
 Keeps co-teacher involved in class
 Allows for shared ideas including
enrichment and differentiation
 Breaks up the monotony of one person
doing all instruction
 Creates many spontaneous teachable
moments
Therapists at all experience levels benefit from alternative assignments and greater facilitator attention in group and sub-group activities that co-leading makes possible. It allows for
more intense and individualized instruction, increasing access to the general curriculum as well as to specialized instruction and demonstration. and respect for students with special
needs. Group Members have a greater opportunity for continuity of instruction, benefit from the professional support and exchange of shared practices, work collaboratively, and share
objectives with mutual ownership, pooled resources and joint accountability. (Friend & Cook 2016). - Six Approaches to Co-Teaching are outlined on the next two slides
1. Advanced Method of Practice: Collaborative Teaching

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Lead-Support (“One Teach, One Support”): this is the customary set up for training new or apprentice facilitators, who first serve as
“Assistants” in support of the Lead. One facilitator leads the case analysis or the main instruction while the other observes and provides support.
The support comes in the form of serving as helping to set up role plays, time management, taking notes for future planning, crafting a genogram
or notes on the white board.
Team Teaching: this is the customary set up for the Socratic Team Model. Two or more facilitators lead the group in its analysis of the case.
Sometimes referred to as “tag teaming”, facilitators may echo instructions, highlight different components of the group’s analysis, model
technique using each other as responders, and share Subject Matter Expertise instruction. This is a great way for students to benefit from the
different perspectives of the two educators. One of the advantages is that more detailed observation of members engaged in the learning process
can occur. In a second approach, one facilitator would keep primary responsibility for questioning while other facilitator circulated through the
room providing unobtrusive assistance to members as needed. Co-facilitators should decide their roles in advance, but if they wish to swap roles,
they should develop signals and work to remain with a given role and not bounce from role to role, which can add unwarranted confusion to the
group. Both facilitators should be fairly experienced in group dynamics and the Socratic Method of co-facilitation and coaching.
Parallel Teaching: this is the customary set up for larger groups or “co-horts”. They meet as an entire group for Subject Matter Expert
instruction and then break into small the groups (“break out sessions”) for case analysis of more specialize lessons. Each group may cover the
same genogram or SME instruction or simply the same process, ie. Genogram + SME instruction. The smaller groupings facilitate tighter group
interactions. The small groups may then be re-grouped for de-briefing, sharing lessons learned or follow up SME instruction.
Collaborative Teaching

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Station Teaching: the group, often larger, is divided into different stations, each led by a facilitator who covers different aspects of the
instruction or Subject Matter Expertise lesson plan. Therapists rotate among stations or, at minimum, two facilitators who teach different
things or highlight different issues. This works well when each facilitator has specialty in specific SME information or is adept at teaching
a specific intervention or technique. A simple example is small groups moving to an office set up where one facilitator is training on the
empty chair technique and another on imagery, and yet another on EMDR. If appropriate, a “Peer Station” could give students an
opportunity to work independently.
Circuit Teaching: The last and most collaborative form of co-teaching is Circuit Training. This is when students are (ideally) in
heterogeneous study groups and working collaboratively together. Clinical supervisors rotate between the different groups to focus on
different things, different materials, or teach similar concepts and skills at different levels.
Alternative Teaching: in most supervision groups, occasions arise in which several participants need specialized attention. In
alternative teaching, one teacher takes responsibility for the large group while the other works with a smaller group. Group members are
separated into two groups, one larger, one smaller. One facilitator leads the large group while the other works with a smaller group that
needs specialized instruction or helping them access or relearn the content by reinforcing a concept or providing additional technical
support. This format works well when new, less experienced members have joined an established, more seasoned group and “catch-up”
may be helpful.
Collaborative Teaching

2. The Open Forum
Adlerian Psychotherapy Live Community Therapy Sessions pioneered by Alfred Adler
- modeled by Dr. Robert Sherman, Queens College Graduate Programs in Marriage & Family Therapy (1980);
- adopted by Demetrios Peratsakis and Mark Armiento, ASPECTS Family Counseling Center (1980s)

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2. Advanced Method of Practice: “The Open Forum”
Alfred Adler pioneered the “Open Forum”, a venue for inviting volunteers to engage in one-session problem-solving therapy in front of a live audience.
Audience members are invited to step onto the stage to discuss their situation and obtain help from the therapist and others.
The format was heavily replicated by talk show hosts beginning in the 1980’s.
- modeled by Dr. Robert Sherman, Author, Senior Fellow at the Adler Institute of NYC, and Chair of the Queens College Graduate Programs in Marriage & Family Therapy.

3. Live Supervision with Clients
Strategic Therapy 30-session live demonstration group training externship for Clinical Supervisors
- modeled by Dr. Richard Belson, Director of the Family Therapy Institute of Long Island (1990) ;
- adopted by Demetrios Peratsakis, Strategic Impact Family Therapy Consultation (1992 – 1995)

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3. Advanced Method of Practice: “Live Supervision Therapy”
Lead Therapist (s)
Client (s)
Th
Th
Th
Th
Th
The advanced Live Supervision format invites seasoned clinicians to join willing clients in the therapy process under the auspices of a Lead Practitioner.
The Lead Practitioner structures session so as to draw on participating members individually or as a group (“Greek Chorus”).
The format encourages broad experimentation across gender, age, racial and cultural lines, “tag team therapy”, and structured realignments, coalitions, and collusions.
- modeled by Dr. Richard Belson, Director of the Family Therapy Institute of Long Island and long-time collaborator with Jay Haley.
Greek Chorus:
May be Active or
Silent observers;
Lead Therapist may
defer to Greek Chorus
members as a sounding
board, for opposing
opinions, for emphasis,
or to echo disparate
voices. Members may
also be called to step-
in as Co-therapists or
provide “Tag Team”
therapy support.
Unlike a 2-Way Mirror
Therapy Room the
Treatment Team, Lead
Clinician(s) and
Client(s) are all in the
same room, sitting
audience-style.
The session may be
highly choreographed
or free-floating
depending on its
purpose, the approach,
and the interests of the
client(s).
Group members may
be invited to assist the
therapist or interact directly
with the client, as determined
by the Lead (see next slide)

 In Live Supervision, you are in charge and responsible for the outcome of therapy/treatment
 Ensure everyone’s welfare, protecting the rights of the client as well as their safety
 Ensure an agreed upon format and have everyone follow the same model of treatment
 Decide, in advance, the extent of disclosure with clients of the team’s strategies and techniques
 Be prepared to redirect, block, reframe, or side-line directives by non-lead counselors
 Formats may include Supervisor/Counselor(s) alternating, Lead, Tag-team, Good Cop/Bad Cop
 Require that all participants practice before the group
 Require that supervisee is fully prepared to present their case
 Do not permit mocking, horse-play or ridicule of clients or other counselors (either side of mirror)
 Follow 1 or 2 cases from first session to termination, whether the supervisee sees a concern or not
 Demonstrate: how to effectively interview (therapy is competent interviewing; J. Haley)
 Demonstrate: how to move into the client’s emotional sphere, and then keep inching forward
 Demonstrate: how to introduce in-session tasks and force work by remaining undistracted/on-task
 Demonstrate how to introduce and reach agreement on the need to bring in critical participants
 Demonstrate: how to push for the pain, -the worry, the guilt and shame, the anger, the sorrow
 Demonstrate: how to button-up after each hard push and then at the end of a session
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Live Supervision and Tasks Common to the Lead Supervisor

4. Multiple Family Group Therapy
Pioneered by H. Peter Laqueur working with Mental Health families (1964)
-popularized by Addiction and Substance Dependence Residential Treatment programs beginning in the 1970s

Multiple Family Therapy (Multi-family Therapy/Multi-Family Group Therapy) brings several families together,
usually four to seven, who are struggling with a similar problem, condition or pathology such as Addiction, Eating Disorders, or Psychosis.
Families work together and as separate units along, and across, generational, gender, and subsystem lines (see next slide).
- first pioneered by H. Peter Laqueur, MD, at Creedmoor State Hospital, in NYC, in the early 1950’s.
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4. Advanced Method of Practice: Multiple Family Therapy

Several families
(3-6) meet as one
large group
F1
F2
F3
F4
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Multi-family Therapy Configuration Examples
Parents
Teens
Younger
Children
Parents
Teens
Younger
Children
Task 1
Task 2
Task 3
Group Task
Pa
re
nts
Teens
Children
Te
en
s
Children
Parents
Male Female
The “Clans”
Process Circle
Subsystems
Gender, Age, Political Beliefs, etc.
Role Reversal
Task Assignments

Background Materials for Clinical Supervisors

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1. Supervision is based on mutual trust and respect.
2. Supervisees are offered a choice of supervisor to secure a good
match on a personal level, an expertise match and to meet
cultural needs.
3. Both supervisors and supervisees have a shared understanding
of the purpose of the supervisory sessions.
4. Supervision focuses on sharing and enhancing knowledge and
skills to support professional development and improving
service delivery.
5. Supervision is regular and based on the needs of the individual,
and ad hoc supervision is provided in cases of need.
6. Supervisory models are based on the needs of the individual,
such as one-to-one, group, internal or external or distance.
7. The employer creates protected time, supervisor training and
private space to facilitate the supervisory session.
8. Training and feedback is provided for supervisors.
9. Supervision is delivered using a flexible timetable, to ensure all
staff have access to sessions, regardless of working patterns.
10. Different types of supervision, including practice, professional
and managerial supervision is delivered by different
supervisors, or by those who are trained to manage the
overlapping responsibility as both line manager and
supervisor.
Courtesy of the Health and Care Professions Council (HCPC)

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Counselor Preparation for Supervision
Counselor-supervisees are students; as such, they should be prepared with all necessary documentation and client materials, have completed their
assignments and forged a bond with their immediate instructor.
1. They should keep an up-to-date list of Active Clients and a history of session and supervisory meeting dates.
2. Each New Case presented should include, at minimum, the following information:
a) Referral source, date and initial reason. If client initiated, their stated purpose for seeking treatment.
b) Genogram, socio-gram or summary of relational issues or snap-shot of the client system, including individual backgrounds, such as medical
conditions; medications; presentation/hygiene; occupation/education level; and living arrangements; as well as more dynamic artifacts, such as life-
cycle issues; deaths, births and anniversary dates; family roles, rules, myths and legacies; trauma events and cut-offs and sources of support and
distress
c) The Presenting Problem, including the contract for therapy goal(s), participants and expected duration
d) An analysis of who needs to participate and why; what’s the hypothesis on reason from seeking treatment.
e) Number of sessions to date, frequency of treatment and format
4. Active Case presentations should include the information above as well as a summary of treatment to date:
a) Overview of treatment goal (s), number of sessions and progress or change to date
b) Relationship with counselor
c) Details on how the Presenting Problem, Symptom(s) or Pain has changed
d) Plans for Termination date and work
5. Counselors are also expected to
e) Follow directives, study assignments, as appropriate to their level demonstrate a working knowledge of counseling theory, core theoretical
constructs, basic counseling techniques and the major elements inherent in specialty issues
f) Join with the client(s), use oneself in therapy, bond with the client(s)assume risk
g) To be receptive to feedback on clinical work, progress and personal growth, including receptivity to supervision
h) To participate in professional training, conference development, peer supervision, and community-wide presentations

There are times when problems arise in the supervisory process which could be an indication of
 Conflict or boredom with the supervisor;
 Ambivalence about the field or frustration with one’s own personal abilities;
 Problems at work or of a personal nature;
 Conflicting directives from peers and others; or
 Unidentified resonance or “blind spots” resulting from Parallel Process and Isomorphism
Concerns that may indicate the Counselor is experiencing difficulties:
 Recent change in supervisee behavior, especially withdrawal, aloofness, or avoidance.
 Decreased participation in meetings, quality of interaction becoming poor or guarded.
 Change in overall style of interaction, such as combativeness or sullenness.
 Over-compliance with supervisor suggestions.
 Supervisee appearing preoccupied, seeming distant or annoyed, seeming stressed or nervous.
 Supervisee confusion or passive-aggressive responses to directives and recommendations.
The supervisor should raise their concerns and be open to the need to modify their own style of teaching as
well as the need to re-evaluate the growth of the counselor and target their training more appropriately.
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Common Issues in Supervision

1. Isomorphism/Parallel process resonance : unresolved personal conflict or trauma activated by the treatment (counselor-client) or
supervisory relationship (supervisee-supervisor) that goes unrecognized or unaddressed, resulting in “blind spots”, transference/counter-
transference and the replication of intergenerational patterns, rules, and roles.
2. Skewed power dynamics of the relationship (one-up, one-down as norm, especially for beginning practitioners)
1. Supervisee continually feeling over-powered; high reactivity to limit-setting and rule and role enforcement by the supervisor
2. Misuse of power by the supervisor; fostering feelings of inadequacy, inferiority or shame (abuse)
3. Putting the supervisor on a pedestal: idealization of the supervisor or continual need for acceptance or approval
4. Supervisor having a continual need to be seen as knowledgeable and competent
5. Personal dislike or disdain for the client, supervisee or supervisor
6. Sexual or romantic attraction by to the client, supervisee or supervisor
7. Cultural bias (over-identification or under-sensitivity) between the counselor and client or counselor and supervisee due to age, gender,
religion, political viewpoints, sexual orientation or personal beliefs
8. Shame: feeling ashamed or guilty that one is unable to treat or guide successfully
9. Using one’s own personal philosophy or our world-view as the default perspective in treatment
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Common Problems in Supervision

10. Disagreeing with supervisory directives or receiving conflicting feedback from other supervisors, peers or
reading materials. While this may broaden insight it may also create confusion or timidity in session
a) Paralysis often occurs because of the fear of doing, the desire to please, or anxiety about being wrong
b) Supervisees are responsible for following the directive of their assigned primary supervisor
c) Peer observation may have as much (or more) validity and should not be discounted
d) There is rarely only one way of interceding; alternatives provide flexibility & spontaneity in session
e) Counselors, as well as supervisors, should pay attention to the suggestions they like the least
f) Counselors must accommodate feedback to their own language, tempo, and way of working
g) Counselors should avoid selecting a method simply because it “feels safer” or is more “comfortable”
h) If there are several ways of moving and one is truly “stuck” as to how to proceed, ask the client
i) Learning to “trust one’s gut instincts” is the beginning of independence in counseling
j) While Counseling is only as good as the counselor, Supervision is only as good as the supervisor
k) Counselors should be coached on responsible spontaneity; if one is clear on the plan for the session, one is
free take whatever step fits
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Common Problems in Supervision (continued)

Member roles and participation issues
 Dominating; oversharing
 Under-sharing or mute but listening
 “Expert” group members
 Echoing the leader
 Inattentive/disengaged
 Defiance or passive aggressive
Feedback issues
 Overly critical or harsh
 Lack of constructive criticism
 “Deaf” participants (not receptive to feedback)
 Subgrouping (ganging up)
 Challenging the leader
Casework issues
 Button pushing (hitting on personal issues)
 Time-wasting on irrelevant issues
 Collusion with the client
 Presenting insufficient information
 Ethical impropriety/placing consumer at risk
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Common Team Problems
Teams are groups of individuals whose behavior influences the group and in return are
influenced by the group. Groups change depending on the membership, as well as the tasks
and the roles they shape.
As with all groups, power is expressed in a myriad of ways, as are power-struggles, places
where each member’s efforts to control and influence are in conflict.
While normal, the Facilitator must guard against collusions and alliances and other group
tactics that detract from the purpose of the Team.
These but a few of the categories that are common to all group processes and must be
reconciled in a manner that reflects the therapeutic milieu of the group. Unlike most
groups, Socratic Teams are trained on group dynamics and should readily recognize –and
self-correct, the dynamic when indicated.
This is the advantage of each Facilitator, Group Leader or Program Manager participating
in some fashion of ongoing clinical supervision for guidance.

Contracting is an exceedingly sophisticated, yet poorly understood component of the treatment process. The basics include an
investigation of the presenting problem, completing an assessment, and crafting an individualized service plan. It should also include a
continuous refinement of the goal of therapy and an increasing trust and confidence in one’s treating clinician. This latter part, the
therapeutic alliance, is of the utmost importance. When strong, the client experiences hope and acceptance and finds the courage to
assume the very risks necessary to experiment with a new way of being.
From a technical standpoint, contracting is the continual reevaluation of the purpose and value of change; it is a process by which
reluctance to change is continuously challenged and reconciled. At first, this might seem a bit counterintuitive. “Doesn’t the client
seek therapy in order to change and isn’t the therapist dedicated to helping with this?” While the obvious answer is “yes”, there are two,
naturally occurring processes within the client-therapist relationship that unwittingly frustrate the process of change:
1. One, is a poor understanding of ambivalence and the purpose it may serve in decision-making and matters of change.
2. The other, is collusive resistance, a form of collusion (transference/countertransference) whereby the therapist inadvertently joins
with the client to avoid uncovering painful issues or contending with toxic emotions.
Of the two, ambivalence is a more complicated issue. It may arise as the natural indecision experienced while making complex or
difficult choices or it might be a useful and purposeful ploy that quells concerns and controls or perhaps even punishes others.
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Contracting for Therapy and Reluctance to Change

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Ambivalence
Although indecisiveness can accompany any major decision, ambivalence is a longer, more protracted period of ambiguity resulting from a
fear of the potential for blame. Often, its purpose is to delay in order to encourage others to decide or else in the hope that the situation will
change. Those who habitually rely on this form of avoiding responsibility for choice, garner the resentment of others and lose the opportunity
to experience success. Missing the chance to make decisions that include risk may seem advantageous, but it reduces the capacity to build
resiliency and self-worth. Nobody wants to make a mistake, but mistakes are important lessons that help us to grow and mature.
There are several factors that may detract from engagement in therapy:
 Pain is a primary motivator for change. Once the symptom, pain or discomfort begins to subside, the motivation to work toward
enduring change will diminish. For this reason, the clinician must continuously monitor for the influence that symptom relief has on
motivation for treatment. It will result from such key changes as the end of a crisis, the onset of medication or specialty interventions
such as hypnosis or EMDR, and any significant change in the presenting problem or its membership. Often, relief from the immediacy
of a symptom may be all that is necessary and is best illustrated by the following axion: change the symptom and the system will
change; change the system and the symptom will change.
 Change often entails modification to one’s long-held beliefs and opinions. This may engender identity changes as well as loyalty issues
with family and friends. Legacies, myths, rules, roles, biases and shared imaginings all tend to be intergenerational belief structures.
 For many, therapy may be seen like an admission of failure, a statement of one’s inadequacy or inability to effectively cope. It may be
especially disconcerting to ask for help from someone who is younger or of a different gender, ethnic, racial or socio-economic
background.
 Suffering, carries an inherent sense of nobility; it garners sympathy and compassion from others. Surrendering the pain, may have
untenable consequences.

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Ambivalence (continued)
 Problems and symptoms tend to relinquish one from the responsibility to change. We blame the addiction, the gambling or the
depression, thereby deflecting the full bulk of the blame. Moreover, the problem can serve as a rationale for not attending to the
necessary task of life. As terrible as this may seem, it may be preferable to becoming fully accountable. The clinician should what is
done and what is said and monitor either that implies one ‘cannot’ (“I can’t”). It is important to aggressively demarcate “I won’t” from
“I can’t”.
 Symptoms can serve as highly effective strategies for controlling or punishing others. While very passive-aggressive, they may add to
one’s sense of superiority and defiance -as others struggle in vain to vanquish their problem. The symptom organizes the interactions of
the relationship system and provides each with a respective role or function. Consider the roles we ascribe to families with addiction:
the Dependent; the Enabler; the Hero; the Scapegoat; the Lost Child; and the Mascot. Might these not be said of any family contending
with a long-standing clinical syndrome?
 Many find excitation in the subversion or social revulsion of their symptom. Some, such as drug use and crime, provide exciting
alternatives to the day-to-day doldrums of life. The subgroup provides cohesion and important alliances as well as pleasure in a life-
style of rogue attitudes, rebelliousness and “second or permanent adolescence”. Even socially vilified behavior has purpose. A
pedophile, for example, not only finds excitement in the secrecy and lawlessness of their acts, they are also assured of the moral
indignation of others. The primary goal of their perversion is aptly rewarded: active avoidance of the true possibility of a meaningful,
intimate relationship with another adult.
 Symptom and problems serve as stop-gap measures, legitimate entanglements that prevent one from striving forward, moving on and
facing potentially greater ills or disappointments or fears. If I wallow in my despair over a love held and lost, it may prevent me from
starting over and re-risking hurt.

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Ambivalence (continued)
In practice, we work on ambivalence through some form of motivational interviewing, a process by which we discuss the difficulty of making
choices, along with the client’s specific reasons and motivations for wanting to change. Motivational Interviewing (MI) was first developed as a
structured intervention by William R. Miller and Stephen Rollnick, although it builds on the collaborative, person-centered and non-directive
approach popularized by Carl Rogers. It closely examines the potential benefits of the status quo and the reasons the client has been reluctant to
change. What does work about the existing problem and what are the negative consequences to its change? This is important, for if behavior has
purpose, so too must symptoms and the pattern of interactions that maintain them, the complex ways that they structure daily activity including
the lives and roles of others. As these have acquired purpose, meaning and power over time, these will necessarily be change as well.
Miller and Rollnick outline 8 steps of MI that help encourage the process of change:
1. Establishing rapport
2. Setting the agenda
3. Assessing readiness to change
4. Sharpening the focus
5. Shifting the focus
6. Identifying ambivalence
7. Eliciting self-motivating statements
8. Handling resistance

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Power and People
It is very instructive to examine the basis of motivational interviewing and what makes it effective in reconciling power. It is
predicated on the recognition that an underlying power-struggle exists whenever two relatively equal, but opposing concerns
emerge. The two concerns compete for control, a process we refer to as conflict, a normal consequence of human interaction and
our collective effort to express our interests and desires. It will intensify as the power dimension becomes stabilized and
progressively moves toward a greater balance. As power-struggles solidify they result in stale-mates characterized by tension and
distress.
To a great extent, this is how many complex syndromes develop. Individuals in a relationship system adopt polar positions, one
toward the impetus to change and one toward maintaining the current situation. Typically, the power-struggle or tug-of-war has the
identified patient (IP) on one end and concerned, well-meaning family members and friends on the other. As the roles and
behaviors rigidify the pattern of interaction becomes entrenched and reduces the participants’ capacity to more effectively adapt to
developmental change. This premise was first stated by Murry Bowen in 1978: “When anxiety increases and remains chronic for a
certain period, the organism develops tension, either within itself or in the relationship system, and the tension results in symptoms
or dysfunction or sickness. The tension may result in physiological symptoms or physical illness, in emotional dysfunction, in
social illness characterized by impulsiveness or withdrawal, or by social misbehavior.”-Family Therapy in Clinical Practice; p.
361.
Assessing the power structure begins with a history of the Presenting Problem and the specific circumstances that led to its onset.
Why now? What has changed to bring the client(s) into session at this particular time? Who has the overt power in the system and
can bring the client(s) back to session? Who helps to maintain the problem or is most affected by it? What is the exact pattern of
behaviors among the individuals that customarily participate in its reoccurrence? The “who, does what, when?” underscores the
unique pattern of reinforcers provides significant insight as to the consequence of change and to the prospective role that therapy
may play. To gain great insight as to the meaning of the symptom and its underlying purpose, the clinician must answer the
following question: “If the Presenting Problem was NOT the problem, what or who would be?”

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Power and People (continued)
Lastly, it should be noted that ambivalence often masks an outright unwillingness or refusal to change. This is
common in relationship systems characterized by severe power inequities. The individual feels progressively more
pressured, reluctance turns to opposition and then hardens into defiance. The more that others demand change, the
more power they cede to the individual to refuse. This fuels an escalating power-struggle that results in acts of
withholding, a very powerful method of neutralizing others. It may express itself as procrastination, hesitancy,
ambivalence, failure, or outright avoidance. Over time, the power-struggle will stabilize into a stalemate, with the
Identified Patient (IP) and their symptom on one end and those petitioning for change on the other.
Typically, the IP will experience remorse and despair for the burden they place upon others. It’s interesting to note
that while their guilt and their shame may be genuine it appears to serve an important function: it blunts the anger
of others, while echoing the individual’s reported helplessness to change. This mixed messaging poses an obvious
quandary the clinician: one’s words say “I can’t, but I wish that I could!” while one’s actions say that “I won’t, and
no one can make me!”. Despite what might be said, the smarter clinician should believe what one does, or does not
do. In essence, one’s behaviors and actions “speak louder than words” and are a better determinant of intent.

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The Treatment Process
Therapy involves an endless string of directives, “Tell me about it…”; “Let’s try this…”; “I’d like you to…” and so on. Tasks, interventions and
homework assignments are even more prescriptive and are geared toward prodding or pressuring change. In response, the client expresses some
degree of push-back, a power struggle that is normal and to be expected. It should not be misinterpreted as a lack of desire to change or as some
harbinger of adversarial intent. It is a natural and routine part of the therapy process that the therapist will recognize by the degree of frustration
or resentment they experience at the client.
There are three possible reactions to each and every one of the clinician’s directives:
1. The client complies with the task and is open to the exploration;
2. The client experiences legitimate confusion over the task or its instructions;
3. The client becomes defiant and reluctant to acquiesce to the therapist’s directive (power-play)
The first requires no comment and while the second does occur, more often than not it is reluctance or refusal disguised as a question. The third
is a direct challenge to the authority and level of trust of the clinician and must be addressed without delay. Whenever a client does not complete
a directive or task it will be for one of two reasons: 1) fear; or 2) defiance. Either requires a pause in the treatment process while the cause of the
reluctance is examined and reviewed. Fear is a natural concern and should be addressed in a patient and encouraging manner. A strategic prompt
might be something like “Most people are nervous about trying something that is new like this; tell me, if you could do it, what would that be
like?” or “Many find this difficult and a bit scary. If you were able to do it, what’s the worse that might happen? Could you live with that?” An
outright refusal, on the other hand, is a direct challenge to the authority of the clinician and the process of change that therapy represents. The
therapist must not continue until the conflict has been successfully resolved, the power-play disengaged and re-directed to the work at hand
(Robert Sherman). How to do so, without escalating the conflict is a matter of better understanding power-plays and their expression.

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The Treatment Process (continued)
Clinicians that achieve mastery over handling issues of power, whether between individuals in the client’s relationship system or
within the therapist-client relationship, gain enormous skill in producing change and fostering transformation.
Power, the ability to influence outcome, is an expression of one’s will, of intent, and is a fundamental element of the life force of all
living creatures. It is inextricable to all human interaction. Good stuff I learned from Bob Sherman:
 Power is the expression of will and intent; the ability to influence outcome
 Power is at the core of every social interaction; it is influence and control within the relationship system
 Conflict is always about power; it occurs around issues of money, work, sex, children, chores, and in-laws
 Power determines the style of communication and how love, caring, anger, and other emotions are expressed and understood
 Power determines the style of decision-making and problem-solving
 Power defines the level of trust for meeting or not meeting needs
 Power establishes the rules for interdependence, independence and for distance and closeness between members
(attachment/mutual accommodation; affection/expressing and experiencing love)
 Power defines the rules around positions and roles; these are usually reciprocal, interactive patterns of behavior found
primarily in the Family of Origin. The rules are taken or assigned to individual in the family unit and are expected to be
maintained; they are relatively enduring (permanent) and acquire “moral character” and “status” which results in one’s
placement in the family's power hierarchy, often replicated outside the family at work and with others
 Since interaction entails the expression of power between individuals, power-struggles are a natural by-product of most social
interactions. These are resolved in a myriad of ways, most so subtly they aren’t hardly noticed. When they become magnified
and remain chronic we identify them as power-plays or stale-mates. These can acquire a lot of energy as they become win-
lose scenarios for their participants. While the ensuing tension may be toxic, it is the manner in which the impasse is broken
that can have severe and long-standing impact. More often than not, the impasse is broken by acts of collusion with others
(adding to one’s power), domination (over-powering) or betrayal (hurting or victimizing in order to weaken).

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Treatment Process (continued)
Ofer Zur, Ph.D. described the following expressions of power by the client within the therapeutic alliance (# 1-16):
1) Not talking: Some clients may choose to stay completely silent during therapy or an evaluation session. For some clients, keeping
silent is a way to maintain control and power over the situation. Adolescents, young adults, inmates, those who were detained in
psych. wards, and certain clients with character disorders have been reported to be selectively mute or use the 'silent treatment'
against their therapists, especially if they were coerced or were mandated to enter therapy against their will.
2) Not following advice or suggestions: Some clients may maintain autonomy and control by not following the therapists' ideas,
suggestions or homework.
3) Non-disclosure [Selective disclosure] or not answering questions: An obvious way for clients to maintain control over what the
therapists know about them is by disclosing very strategically and discriminately. By limiting their self-disclosure, clients limit
therapists' knowledge-base power. Non-disclosure is more overt and is apparent as when clients do not answer therapists' questions
and inquiries or can be more passive and covert when clients do not disclose important or relevant information.
4) Taking notes or recording sessions: Some clients take notes during therapy or insist on recording sessions as a way to gain more
power or, at least, match therapists' power.
5) Coming late or leaving sessions early: One of the many ways that clients may control the beginning or end of sessions is by either
coming late to sessions or leaving early. While leaving early is more likely to be a more overt way to gain power over the time and
length of session, arriving at appointments late is a more passive way of such time control.
6) Non-payment: One of the more common ways for clients to assert control over their therapy and their therapists is by deliberately
withholding agreed upon payments or fees. Like non-disclosure and timing, clients may choose to withhold payment more
passively by making up excuses or more overtly by stating their intention of withholding payments.
7) Stalking: Clients who successfully stalk their therapists are likely to gain a lot of information about the therapists, which may
translate to a power position. Therapists who are stalked are often frightened for their own safety and the safety of their family or
pets. Therapists are often hesitant to report criminal stalking to the authorities because they either are (needlessly) concerned with
confidentiality issues or are afraid to aggravate their clients. This is especially true with psychopathic, violent, and Borderline
Personality Disordered clients. Stalking clients are often intimidating and therefore often command significant power in the
relationships with their therapists. Cyber-stalking, which was discussed above, can be performed without a therapist's knowledge
and can also yield vast amounts of personal information about the therapist, which can give the client significant knowledge power.

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8) Change seating or other office arrangements: Some clients, in a 'power move', sit in places that were not assigned by the therapists or
even sit in the therapists' chair themselves. Similarly, a client may turn the clock in the office so it faces him or her and faces away from
the therapist. Another client may move his/her chair closer or further from the therapist or turn it in away from the therapist. In a fit of
irage, some hostile, psychopathic, and Borderline Personality Disordered clients were reported to reorganize the office furniture.
9) Provocative or threatening clothing: Clients may gain power by dressing in certain ways that may be sexually or otherwise
provocative, seductive, or intimidating. Sexually revealing clothing or garments that bear gang insignias or symbols like swastikas may
be intimidating and so are certain violent, sexist, or racist tattoos. Depending on the gender, ethnicity, age, culture, race, or class of the
therapists and the clients, clients can dress in ways that can give them power.
10) Use of language: Violent, vulgar, or threatening language can definitely affect the power relationships between therapists and clients.
Therapists may be intimidated, frightened or simply distressed by the use of certain expressions and intonations by certain clients.
Borderline clients have been reported to throw tantrums or fits and use language that intimidates and threatens their therapists.
11) Rage: Rage-filled clients can be highly intimidating to therapists who may feel frightened and powerless in the face of raging patients.
This s especially true in a private practice setting when therapists are isolated and often are not trained to deal with clients who are
extremely hostile or violent. Gutheil has written about Borderline rage:
Borderline rage is an affect that appears to threaten or intimidate even experienced clinicians to the point that they feel or act as
though they were literally coerced -moved through fear- by the patient's demands; they dare not deny the patient's wishes. Such
pressure may deter therapists from setting limits and holding firm to boundaries for fear of the patient's volcanic response to being
thwarted or confronted. . . Patients with borderline personality disorder who are dysfunctional in many areas of life may still
preserve intact powerful interpersonal manipulative skills. They may still be capable of getting even experienced professionals to
do what they should know better than to do or -all too commonly- what they do know better than to do. (Gutheil, 1989, p. 598)

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12) Dominating the conversation: Another way that clients may gain the 'upper hand' is by dominating the
conversation, talking excessively and incessantly, or simply taking all the airtime.
13) Inappropriate touch: The professional literature has described several situations where clients surprised their
therapists with a kiss on the cheek or lips, sexual embrace, or even reached out and touched the therapists'
genitals. Needless to say, any of these actions, when they catch the therapists by surprise or unprepared, can
cause a power shift in the relationships.
14) Inappropriate gifts: Clients may give very expensive gifts (i.e., season tickets, a car) or symbolically
inappropriate gifts (e.g., sex toys, a dozen roses, weapons) in a power move over their therapists.
15) Offering incentives: Clients may offer their therapists a promising business contact, lucrative business deals,
investment tips or promise to give them referrals as a way to level the playing field or even to gain the upper
hand.
16) Acting seductively: Clients can act seductively in many ways. It can be the content of their dreams, description
of their private behavior and, of course, the way they talk, move, or dress. Clients can gain significant power if
they get the sense that their therapist is attracted to them and their seductiveness.

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Treatment process (continued)
Similarly, there are some very common ways that power is expressed surrounding the contracting context or therapy process, especially during
couple and family therapy. While legitimate obstacles to appointment setting and engagement arise, the ones listed below are in regards to power-
struggles whose main intent is motivated out of fear and ambiguity or else an outright attempt to dissuade or derail the onset of treatment (#1-8
Peratsakis):
1) Shot-gunning/Carpet-bombing: Unloading a laundry list of Presenting Problems or Identified Patients overwhelms the clinician and
confuses the starting point of treatment. This often mirrors the client’s life, where a cornucopia or various problems, each fighting for
prominence, helps ensure that little can be resolved. Many things contribute to a chaotic life-style, the single-most common being an
underlying need for the chaos. The client should be informed that while all problems are solvable, they cannot be all tackled at the exact same
time. The work involves continually addressing the deviations or lack of commitment to a specific choice. This is difficult when a crisis or
new matter of urgency arises, as is likely to happen. The clinician should decide on the importance of temporarily pausing the work to
address it. For those who relish drama, the consistent deviations provide the evidence for addressing the purpose that such inconsistency
provides.
2) Client sets appointment, cancels or no-shows; sets appointment, cancels or no-shows: Simply, “No start, no finish”. The best course of
action is to inform the client that they are not ready to change as of yet, and arrange for a simple way to be re-contacted. Pushing out
typically results in some recoil and greater persistence in attending. Should the client insist on attending, then an overt message should be
ascribed to any potential cancellation: “I am not convinced it’s a good time, but I’m willing to set another appointment so long as we agree
that if you are unable to keep it, the I will understand that as your way of letting me know that this is NOT a good time”.

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Treatment process (continued)
3) Key member or partner sets appointment, other key member or partner refuses to attend
It is common for one person to be more motivated to attend treatment than others. While beginning with one member and then
broadening the work to include others is an acceptable strategy, there are problems that must be reconciled for therapy to succeed.
 the partner or family members may not share the same beliefs about the value of treatment or cultural morays about seeking
help
 refusing to attend may be a way to punish or hold someone hostage
 worry that a bob will be dropped or some secret revealed
 there may be fear of being attacked at session
 viewing the therapist as the another’s/partner’s choice or advocate
 the invitation to attend was poorly given
 appropriate concerns and barriers such as child-care, loss of work, etc.
4) One sets appointment, then sabotages another’s participation
Common reasons include a fear that a secret or bomb-shell will be exposed and some hidden desire to escape the relationship and
wanting the therapist’s support
5) One sees a problem, others do not
Therein, lays a significant problem. The therapist must be careful to not take sides. It is important to indicate that the lack of consensus,
and therefore of mutual support is, itself, a significant problem. Let them struggle with how to proceed; do not rescue or enable. If all
else fails suggest that the problem or situation may need to worsen before they can achieve some consensus on whether to proceed or not.
6) All agree that one person is the problem or “Identified Patient” (IP)
This is an acceptable starting point. The therapist should begin with the Presenting Problem and start to indicate the relational
components as they arise, then broaden the issue and tie-in the other participants. For example, mother describes the problem as her
daughter’s depression. The daughter agrees. The therapist begins by exploring the depression, being mindful to point out the added
burdens the mother endures in her effort to help. The problem has now been shifted slightly to the relationship, which must, in some
ways, reinforce the depression through a particular interactional pattern. This takes some of the pressure off the daughter for carrying the
full weight of the dysfunction and enables an exploration as to her concerns for her mother or the way in which she views the relationship

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7) Couple or Family attend, agenda moves to Individual Counseling (I/C) or child focus (F/C)
While the move toward individual work may be appropriate, more often it is a sign that the therapist has failed to engage certain
members, driven certain off, strayed to afield of the Presenting Problem, or failed to successfully demonstrate the importance of the other
member participation toward resolution of the problem.
8) Someone drops a “bomb” (ie. sexual affair, drug abuse, desire to divorce or separate, major illness). This transforms a regular
session into a crisis one, with the need to stabilized matters first. Others may feel ambushed and betrayed by the news. The news may also
be given in session as a means of buffering its impact or declaring some intent to abandon the relationship, leaving them with the therapist
to heal.
When the therapist suspects that the power-play is directed at them, they should walk through a simple -and honest, appraisal of its intent
and then move to address it directly with an appeal to a more meaningful course of work:
 Is the client angry or upset with the therapist?
 Is the client second-guessing the utility or effectiveness of treatment?
 Has the therapist behaved in a manner that is suspect or that has damaged the trust?
 Does the therapist misuse their power, belittle, shame, or induce guilt in the client, especially by moralizing, lecturing or assuming a
haughty or “parental” attitude?
 Is the client frightened?
 Is the client reacting to anger or counter-transference material from the therapist?
 Is the therapist moving too fast or stripping the client of places to hide?
 Is the client responding to an internalized objection of the therapist’s terms or style? Clients have a legitimate right to object to
therapeutic initiatives that they fail to understand or accept. Rennie’s (1994) qualitative analysis on client-centered perspectives of
therapy characterizes various forms of opposition, including:
a. Resistance to the therapist’s general approach to therapy (e.g., involving discrepancies in general expectancies and/or
objectives for treatment)
b. Resistance to specific in-session techniques (e.g., session structure, particular interventions, etc.) and
c. Resistance to words or phrases used by the therapist

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While unsettling, these should be viewed as critical components to treatment and not merely as bumps in the road that must be overcome.
Chances are strong that the therapist may be in error or that they likely experiencing the particular manner in which control is expressed by
the client with others. This latter discovery is important as it helps to explain how the individual may connects in more intimate relations or
those in which they perceive a clear power differential.
It is simplest to openly discuss the relationship and inquire as to the value and utility of the process. In doing so, one must be genuine and
open to constructive criticism. Open-ended ice-breakers, such as “What’s going on, I feel like we’re not on the same page…” or “I have a
sense that I may have stepped on your toes or upset you by something I said or did, can we talk about it?”, work especially well. Using terms
that are more neutral, “upset” versus “angered”, or more commonplace, “ticked you off”/ “stepped on your toes” versus “angered you” start
the discussion better. Likewise, taking ownership is important: “I did something to upset you” is markedly different than “you are upset” or
“you seem angry by what I did”. Ideally, one introduces and substitutes the more toxic term in a deliberate manner: “I have a sense that I may
have stepped on your toes or upset you by something I said or did. People often tell me I may them angry when I do that”. Anger, which can
be very toxic becomes somewhat neutralized and more important, normalized. The clinician should routinely check the “temperature” within
the relationship and, depending on the work at hand, may need to do so several time within the session. Simple checks, such as “Are we still
okay?” work best so long as some ground work has already been laid down: “Most people get angry when I push them to work this hard,
which happens a lot in therapy. Do I need to back off or slow down a bit?” the continual reference to “work” and “pushing” validates the
inherent power-struggle that defines the process of therapy and therapeutic alliance: the client seeks help to remedy the very matter they wish
to avoid.
Because of the importance that trust holds, the therapist should never proceed until the relationship has been mended and the therapeutic
alliance restored. There are some special circumstances that negate this rule, but those usually surround more esoteric tactics associated with
paradoxical intention or highly prescriptive ordeals scripted to obtain oppositional recoil. In those strategies the therapist is seeking to use
some defiance by the client to accomplish some outright rebellion as a means of effecting change.

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Lastly, two companion issues of concern should be noted:
1. Removal of a symptom or problem could threaten the individual and the system. Several outcomes are possible:
 a worsening of the existing symptom or problem (rebound);
 the creation of a new symptom, symptom-bearer or problem (deflection);
 the development of physical or psychiatric illness (conversion); or
 the abandonment of treatment (escape)
2. Treatment failure or failure to change will be used to justify
 the severity of the symptom and the struggle
 the inadequacy of the member to change
 the inadequacy of the therapist to accomplish change
Three rather simple techniques can help the therapist to remain focused:
2. Continuous Feedback:
a. Barometer Checks: How are we doing? Is this worse than you thought it would be? (scaling). How badly did I upset you? It’s natural to get upset when the therapist
“pushes” work in session, how will you show me that you’re getting upset with me or that I’m stepping on your toes?
b. Outside Insight: Use a chair, ghost or the client themselves to comment on treatment progress: what would your dad say is going on? If so-and-so was here what would
they say about our work? If you were the counselor what would you say needs to happen in therapy?
3. Shrinking Treatment: Imagine you have 5 sessions left, the last of which will necessarily include buttoning up, exploring relapse and saying good-bye. How will you
get to the intended goal in the remaining sessions? What will you do, specifically, each session until your last? What if you had 1 session or were asked to come into
session as a consultant, what would you do? A simple method for improving one’s skill level is to limit the initial contract with the client. Contracting for a defined
number of sessions, say 6,8 or 12, from the get-go with the option to re-contract brings enormous focus to the work and pressures a level of deliberateness to each
session.
4. Donate Your Case: Carl Whitaker once remarked that when he was “stuck’ and wanted help with how to proceed he would describe the case to any layperson he
happened upon and sought their advice. The very idea that normative problems had commonsensical solutions was profound. In similar fashion, one can “donate” their
case to another and ask them to describe how they would proceed. This is also an effective method for enhancing critical reasoning skills among a group of supervisees.
When a case is presented, instead of asking the group to comment on what the presenter should do the supervisor challenges each member as to their course of action.
The process can be amplified by having each supervisee in the group present their line of intervention, round-robin, from the comments of the counselor preceding
them.

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Collusive Resistance
As previously mentioned there is a second process unique to the therapeutic alliance that can frustrate and even sabotage change. Sometimes
referred to as a form of parallel progression (transference/countertransference) collusive resistance is a process whereby the therapist
inadvertently joins with the client to avoid confronting painful issues (Raymond Fox, Ph.D., and Lois A. Carey, Ph.D.). For example, should
the client have difficulty expressing anger and the therapist is, likewise, very sensitive or uncomfortable with its expression, the two may
tacitly agree to avoid confrontation or minimize situations that are likely to raise the potential for its expression. So, too, entire areas of
important experiences, so-called “blind spots”, may be diffused or marginalized out of fear of triggering toxic thoughts and emotions.
Although the experience is familiar to both clinician and supervisor, the most common -and somewhat inaccurate, term used to describe it is
transference/countertransference. Transference/Countertransference more accurately refers to the processes by which the client (transference)
and therapist (countertransference) project onto the other, characteristics and relationship elements that originate from their respective family
of origin. These concepts have shifted slightly over the years as the relationship between client and therapist has become more egalitarian and
humanistic. A similar dynamic, termed parallel process, is mirrored in the therapist’s relationship with their supervisor: it is “a phenomenon
noted between therapist and supervisor, whereby the therapist recreates, or parallels, the client's problems by way of relating to the
supervisor. The client's transference and the therapist's countertransference thus re-appear in the mirror of the therapist/supervisor
relationship.” (Wikipedia). When the “blind spot” is mirrored between client, therapist and clinical supervisor, the process is termed
isomorphism. While isomorphism is more specific to the re-creation of interactional patterns, it’s reference to this three-way form of
avoidance or resistance has merit. The overriding phenomenon is one of collusion to avoid uncomfortable memories or toxic emotions and
interactions. Since one would serve as a trigger to the other, the opportunity is suppressed, glossed-over or otherwise minimized.

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Collusive Resistance (continued)
The natural challenge -for all three members of the supervisory triad (client, therapist supervisor), is how best to recognize “blind spots” that are, by definition,
relatively unseen and unknown?
1) Genogram: the simplest and most straightforward method is to have one’s genogram examined for a more open and thorough review of one’s Family of Origin
and Intergenerational Issues. Exploring one’s history in this particular manner allows for an open discovery of self in a more neutral and blameless manner.
2) Similarly, a comprehensive Adlerian Life-Style Assessment or similar self-assessment inventory, is an excellent means of understanding the influences that
shape one’s primary schema and manner of interpreting events and the world that surrounds us. As with the Genogram, it places one’s identity in a context that
is shared and intergenerational.
3) Supervision and psychotherapy are opportunities for self-discovery. While one is focused on casework and the other on personal development, they both
require that one explore their motivations, the purpose of their behavior and intent of our strivings. Each, underscores the manner of our interactions and the
roles that we adopt in the company of others. The client and therapist, as well as the therapist and supervisor, should openly discuss their experience of the
relationship; this provides feedback as to how they are experienced by the other.
4) Getting Stuck in therapy and becoming confused as to where to go or what to do is often a signal that one is circling a blind-spot. A similar experience is
called the Carousel or Merry-go-round effect, whereby one has the sense that they are on the move, and yet continue to end up in the exact same place. Getting
stuck may also be identified by a lack of focus or pace in therapy; an ambivalence as to the progress of treatment.
5) Sticking to Theory. Despite efforts to standardizing practice, the field has several hundred different approaches to counseling
6) Introspection: As a final note, it is important to recognize that the best form of protection from blind-spots or collusion is introspection, the examination or
observation of one's own mental and emotional processes. One is reminded of the quote by Carl Jung: “Everything that irritates us about others can lead us to
an understanding of ourselves.” In most instances our annoyance is a tell-tale signal of a blind-spot, for that which we do not wish to hear or see, we should.
We become annoyed because we are reminded of some truth that we had half-hoped would never have been retold.

Clients present in a myriad of configurations with varied histories and breadths of concerns. By its nature, working together often fosters missteps and
confusion, as well as collaboration and growth. Shared emotionality triggers each member of the client system, including the therapist and supervisor. The
following General Rules of Therapy provide some guideposts fr helping to navigate these periods of uncertainty and vagueness.
 Psychotherapy is the art of encouraging practice in new ways of being.
 The difference between counseling and psychotherapy is the degree to which one is willing to accept personal responsibility for change.
 When you begin to view each of your actions as either therapeutic -or counter-therapeutic, your work becomes nothing short of remarkable.
 Clients come to therapy not because they desire change, but because they failed to accommodate to change.
 Teach = Learn
 SA = MH (addiction is a form of self-medication; poor self-esteem/self-worth)
 Sad = Mad (sadness is almost always accompanied by anger, though sdaness is more socially acceptable)
 Guilt = false sense of nobility, moral superiority, and contrition. Price for getting on’e way on something they know is wrong.
 Depression = Guilt + Anger + Shame (+ Fear + Sorrow) = GASh
 Shame = Rage
 The more bizarre and antisocial the behavior, the more safe-guarding or self-protective it is. The greater the antisocialism, the poorer the self-esteem/self-
worth. The more bizarre and antisocial the behavior, the more rigid and inflexible the individual and their relationship system.
 If you would feel it (sorrow, fear, anger) the client or therapist would, as well. If they don’t, they should!
 If the therapist is getting frustrated with the client or pissed, then they are embroiled in a passive aggressive ploy. Same for the Clinical Supervisor and
Therapist.
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General Rules & Guideposts

 Trauma, is the psychological injury to one’s feelings of self-worth, an estimation of personal value inextricably tied to others. It results in depression and
anxiety, which are fueled by Guilt, Anger and Shame (GASh).
 Symptoms can serve as an effective means of avoiding responsibility for change.
 Never interrupt when work is being done; always interrupt when work is not being done.
 Assigning homework can pose unintended risk; if the problem could be safely handled outside of session, there’d be little need to discussing it inside of
session! Assign homework within a safe, highly stylized context. Advise client to not make it a “test” and to discontinue if helpful.
 Nothing impedes therapy more than the therapist’s own fears. “ …if the therapist doesn’t change, then the patient doesn’t, either” -Carl Jung
 Contracting is the most sophisticated portion of the therapy process. It requires continuous refinement of the goal of therapy and a continual re-
evaluation of one’s investment for change.
 You can only control what you agree to do or not do. That is the source of power.
 Therapists fail by agreeing to conditions that reduce their effectiveness to help:
o Never accept secrets
o Never parent children -unless you are planning to adopt them
o Never ask permission -unless you are willing to accept a “No”
o Never exclude members necessary for change
o Never work harder than your client
o Never proceed until conditions are acceptable (to do so, is to give up control and power)
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 Despite what is said, believe what one does (and does not do). Help match words with behavior and both with intent.
 Make the covert, overt, especially when behavior is passive-aggressive.
 Misery conceals its true goal of “nobility”. As does “Guilt”.
 Depression can be a highly effective form of coercion; suicide, an even greater one.
 A problem is the result of a power-play, real or symbolic, between the individual and others, the individual and society, the individual and
themselves. The role of psychotherapy is to disengage and redirect the power-play (Robert Sherman)
 All problems are relational, as is their cure.
 The single greatest agent of change, is the “therapeutic alliance”.
 When possible, sit within arm’s reach of the client.
 How therapy ends is more important than how it begins.
 If you are not actively discouraging, you are passively encouraging.
 Every client is a forced referral.
 Symptoms are highly effective strategies for avoiding change. To change the symptom, challenge its power; to challenge its power, change its
reality.
 Ghosts need to be exorcised. The dead, can be especially demanding.
 Change the symptom to change the structure; change the structure to change the symptom. Change both, and you change the system.
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 Betrayal, demands revenge. Punishment and restitution are the salve that reconcile the path toward forgiveness and redemption.
 Make the covert, overt, especially when behavior is passive-aggressive.
 Psychotherapy is an isomorphic process; the clinician, client and supervisor are each transformed as therapy triggers the pain of their respective lives.
 The client’s behavior is intended to suppress their pain; challenge the distracting behaviors and the pain will emerge for healing.
 True intimacy provides a mirror onto one’s Self; this is the reason that those who feel unworthy, fear it.
 The response to our behavior by others is intentional; it allows others to reaffirm our own beliefs about ourselves and how we are to behave. These
“shared imaginings” are the root of our social identity and the reason we retain such preferred ways of interacting.
 The best clinicians are willing to immerse themselves in the pain, rage, or insanity of another.
 When all else fails
a. prescribe the symptom
b. invite a consultant or co-therapist to session
c. add or subtract a member to session
d. convert the client to a therapist
e. pronounce the client cured
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Socratic Teams = “Complex Case Staffing”
(use of casework presentations for clinical supervision & training)
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The Socratic Team Model of Advanced Psychotherapy & Clinical Supervision Training ©
Goal: to create a classroom-like experience for continuous knowledge and skill acquisition.
Objectives:
a) to foster critical reasoning, brainstorming, and collaborative problem-solving; and
b) to practice and refine clinical methods through role-play and re-enactment

Welcome & Housekeeping
1. Business Updates
 News from the Field
 Plans for training the Managers, Counselors or Other Trainees/Supervisees
 Other
2. Case Presentation Section
1. Case Presentation (s): Socratic Method of case assessment, treatment planning and
interventive technique (Clinical Supervisor)
2. Case SME Highlights
3. Case Role Play: Socratic Modeling and Coaching (Clinical Supervisor Group Members)
3. Professional Competencies: lecture highlight of an SME issue or topic of interest
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Clinical Supervisor Training Meeting Agenda

Like all groups, Socratic Teams will follow certain predictable phases of growth and development.
As team members gain confidence, they take on more responsibility for “pushing” the team to explore more advanced material and practice.
 Review the Agenda (see section 1-3, in prior slides) and summarize the Ground Rules for the Case Presentation:
 Facilitators direct Case Presenters to post Genogram with background information & reason for presenting the case;
 Facilitators allow Team Members to gather additional information about the case (5-10 minutes)
 Facilitators actively “gatekeep” members from advising and direct or “push” members to express their viewpoints. Similar to the
counseling or clinical supervision process, the role of the facilitator is to “Challenge assumptions” and “explore” out of the box
thinking and new possibilities!
These three steps should continually be followed:
1. Brainstorming: exploring hypotheticals, the “What Ifs?” or “Suppose this…” or “What might happen if….?”
2. Drilling Down: exploring the very next step of the process and then keep pushing, step after step: “And then what would happen?”
“And then….?”
3. Role Play: Show me! Skill acquisition requires practice through modeling, rehearsal, and coaching. The facilitator must get the
Team member up and moving, out of their comfort zone. The following slides showcases an easy way of using the Socratic
Reasoning method to “Brainstorm” and “Drill Down” a scenario. Once the team has a sense of the format, a case should be
presented as a means of acclimating the group to the process. Active interventions, such as role play using the Empty Chair and
Family Sculpting techniques are ideal for accommodating work to the ‘Here-and-Now’ and encouraging the Team to be more
directive and more experimental as therapists. Games like “Stump the Therapist” are excellent for Socratic Reasoning!
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Getting a New Team Started

The Socratic Team Model is very intentional in its approach to fostering speculation and innovative thinking among the group supervision
members. It fosters brainstorming, pushing member through Socratic questioning and then moves its participants to action through Role Play. The
Facilitator(s) use group members to model (teach), coach, and rehearse technique, encouraging do-overs and ‘What If’s?’
Case Staffing Procedure & Role of the Facilitator(s)
1. Facilitators direct Case Presenter to post Genogram, Background Information & Reason for Presentation
2. Facilitators encourage Team Members to gather additional information about the case (5-10 minutes)
3. Facilitators Gatekeep & Direct Team Members:
 Prohibit Team Members from Giving Advice - either directly or under the guise of asking leading questions, asking for clarification or
wondering and musing out loud 
 Use of Socratic Questioning to foster Critical Reasoning
Group members are challenged, through questioning, as to how they would handle the case or some particular aspect of it. The facilitator
challenges other participants in the same manner, at times building on the response(s) of the prior speaker(s).
1) Brainstorming! “What do you think might happen if….”; “What if we tried this_______?”
2) Drilling Down! Pushing for next and new steps: “What would you do? And, then what would you do? And then what?”
Scaffolding: adding on, building upon the group member’s responses, pushing her/him further
Round Robin: bouncing from group member to group member to ensure participation and quick thinking
3) Practice! Get Team Members up and moving in Role Play -“Show us how you would do or say that!”
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Two common teaching methods for “drilling down” or unlayering deeper, alternative possibilities is “Scaffolding” and “Round Robbin”. Scaffolding relies on building
upon prior knowledge and is used with the individual clinician as well as the group. Round Robbin is the process of jumping from one member to another as a means
of keeping the entire group alert and engaged. As different group members are engaged, the facilitators questions may scaffold responses for a deeper dive. -see next
slides
1. Drilling Down & “Pushing” the Group

1. Brainstorm - conjecture & hypotheses; “What if’s?”
Suppose you’re working with a couple when one of them suddenly
announces that they are having an affair with the partner’s best friend.
“What would you do?!” (“volun-told” a Socratic Team member)
2. Drilling-down - exploring next steps
“…and then what would you do?”
“And suppose that didn’t’ work, what would you try next?.............. And then?”
3. Role Play - modeling & role play; “Let’s try something…!” “Show me!”
“Who can show us?!”
Pick some folks to help you out!
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Drilling Down & “Pushing” the Group: “Scaffolding”
The Facilitator begins by directing a question to one of the group members, then continues a line of Socratic Questioning, “pushing” the member to
think more deeply and more creatively about the session work. They may build on the member’s previous response or go off on a different vector.

1. Brainstorm:
Your 40 y.o. client’s mom continually calls to provide you updates and advice on how to
handle her son. He complains that it makes him feel like a baby.
“What would you do?!” (team member 1); “What about you?!” (team member 2)
2. Drilling-down:
“…and then what would you do?” (team member 3)
“Suppose that didn’t work what would you try next?.............. And then?” (team member 4)
3. Role Play:
“Show us how you would do it?!” (team member 5)
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Drilling Down & “Pushing” the Group: “Round-Robin”
The Facilitator begins by directing a question to one of the group members, then engages another member and directs them to pick
up where the previous member left off. The Facilitator bounces around the group, working to keep all members engaged.

Empty Chair and Sculpting
are powerful techniques, each
with several variations.
They attune focus and allow
for immediate modulation of
intensity and force.
Once a new Team or Group has been instructed on the “rules”, format, and how to construct and craft a Genogram, its best to get them mobilized and
out of their usual “comfort zone”, preferably by asking for volunteers and having them walk through a demonstration and role-play. “Empty Chair” and
“Sculpting” are two, excellent techniques for energizing the new Socratic Team and helping them to experience the power of Modeling and Role-Play.
These techniques have the added benefit that they promote team spirit, group cohesion and team-work.
1. Members become energized and interactive; the process communicates that therapy can be playful and fun, a learning, instructive
experience and an opportunity to try something different, to be imaginative and think and behave in a different way.
2. Members learn to assume a position of authority gaining confidence over leading session and how to command or direct session work.
3. Members learn to think and work in relational terms, to see human interaction and conditions in temporal and spatial terms.
4. Members learn to think and work in the here-and-now, to adapt, to be innovative, nimble and responsive in fostering change.
5. Members learn how to make covert processes overt and to simplify complex operations into manageable steps.
120
Getting the New Team Started
Sculpting
Popularized by Jacob
Moreno (Psychodrama)
and Fritz Perls (Gestalt)
Popularized by Virginia
Satir (Conjoint Therapy or
Satir Transformational
Systemic Therapy (STST)

Chairs may be used to illustrate relational issues and dynamics or to heighten and lower confrontation among members.
As such, they make the covert, overt and allow rehearsal in new forms of alignment and communication.
The Empty Chair Technique
A projective technique popularized by the Gestalt therapy group, “empty chair” is an effective medium through which one may remedy unfinished business,
including such noxious issues as anger, guilt and shame.
 Unfinished Business
The relevance of unfinished business to self-worth cannot be overstated. It is a source of continuous grief and duress, a constant reminder that one has failed to
achieve or remedy some important task or piece of business. One cannot feel entirely whole or at peace and will judge themselves wanting until closure has
occurred. Lack of closure thwarts progress in moving forward.
 Detail Makes It Real
The greater the detail and specificity attached to the imagery or recollection (protagonist, symptom, role, rule, disturbing event, etc) the more likely it is that
underlying feelings will surface; the visage will become more concrete and the reaction to it more genuine. The power and immediacy of the technique can by
increased by moving the task from mere reference (“If your dad was here, what would you say to him?”) to an explicit, detailed image of the individual including
their clothing, body language, facial expressions and vocal intonations. For example, “Your father is sitting here in this chair wearing his tattered green t-shirt
and coveralls with the torn patch on his right knee; he’s got that familiar scowl and cold-eyed stare of disgust on his face and a two-day stubble of beard,
wringing his hands and beginning to slowly, deliberately nod his head back and forth in disapproval when he says….”.
 Concrete Reminder
The “chair” serves as a “concrete reminder” and therefore should be pulled out and put away as often as is helpful for the process. Its symbolic intensity can be
altered by its proximity; the closer the chair is moved to the client the more intense the experience tends to be. Similarly, a frontal positioning of the chair is the
most intense, representing a more confrontational situation. The emotional intensity can be reduced by turning the chair sideways or entirely around so that the
client is facing its back. Once “contaminated” the chair should never be used in session with the same client for any other purpose as it is now imbued with
symbolic content and power.
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SAMPLE Technique: Use of Chairs in Therapy

1. Placeholder: empty seat representing an important member, living or dead, not in session
2. Open Forum/Hot Seat: place empty chair in the middle of the room and ask “Who wants to work?” Extra chair can be brought forward for
client to call forward another member
3. Decision Making: place two chairs facing each other, representing either side of debate/dilemma. Have the client takes turns sitting in each
until they’ve decided how they wish to proceed
4. Controlled Confrontation/Abating Volatile Material: Set two chairs back-to-back (not touching). Angry/volatile clients are encouraged to
begin a dialogue. Later, reposition chairs
5. Co-therapist: Use an empty chair to represent the client.
a) Open: invite the client to be your co-therapist and advise you as to how to help the “client” to change.
b) Directive: “Chris, tell me what “Chrissy” needs to do to become the new-Chris, “Christina”?
6. Symptom Vacation: chair as a repository for the client’s symptom, their depression or illness, providing a temporary “vacation” from their
problem that they retrieve before they leave session.
7. Greek Chorus: empty chair off to the side as a contrarian “Greek Chorus” meta-message of refusal to change.
8. Sculpting: Use empty chairs to illustrate proximity, collusions and alliances
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Variations on the Empty Chair
I’m staying!!!
I’m leaving!!!

8. Exorcism: Advanced technique requiring a relaxation directive.
Working through unfinished business: refer to the person, rule, behavior, illness, or symptom as a “ghost” that will continue to “haunt” the client until
exorcised. Have the client confront them as the source of their misery or pain.
 Make an estranged or cut-off member “visible”
Ghosts are family legacies, myths, and legends as well as dead and estranged members whose persona have presence and meaning to the individual
or group. They may be “good” ghosts or “bad” ghosts, and may be as simple as a family or personal rule or value or a more complex, over-riding
philosophy or vantage point on how to behave, interact and even think.
“Good” ghosts can provide support and nurturance; “bad” ghosts can be inexorable in their demands and ruthless in their punishments.
 “Ghosts” often ‘haunt’ due to guilt, shame, retribution or vengeance. Anger and rage can be elixirs.
 Make covert issues and rules, overt: (ie. “Temper” = adversary that one can battle)
 Work through what makes the ghost more/less restless…what issue needs to be put to rest?
 Write a letter, epitaph or will to the Ghost, emphasize disparities and similarities; develop a new legend or myth; make a “voodoo-doll”; create a ritual for taming the ghost
 Reconnect to estranged partners and members
 Hold a séance or conduct an exorcism
 Prescribe the phantom
 Make a volatile emotion such as Rage or Shame “controllable”
This is an excellent technique for acquiring greater mastery of something heretofore experienced as not under one’s control, such as emotional (ie. rage, sadness) or physical pain
 Picture the “feeling” that you’re having
 What color is it? What is its shape? It’s size? What texture does it have? What’s its temperature?
 Can you change its shape….it’s color….it’s temperature…..it’s texture…. Now, make it larger/smaller; hotter/cooler; more rough/smoother; less red/more red; taller/shorter. For homework, sit and relax and practice changing the one thing we have agreed
to (always move to less toxic)
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Variations on the Empty Chair

What it is: putting family or group members in physical positions that represent how a “sculptor” sees each person’s role in the family.
How it works
 Each family member given opportunity to sculpt family as they see it.
 Gives nonverbal, symbolic depiction of family process from each person’s perspective.
o Nonverbal confrontation that bypasses cognitive defenses.
o Able to literally see how he or she is contributing to problematic family process.
 Best to let each person sculpt before allowing discussion of sculptures.
 Encourage family members to respect the subjective experience and deepen understanding of one another.
Benefits
 Makes the covert, overt. Provides insight into each other’s perspective and experience of relationship
 Creates a set time-line of “Now” and “Future”; “How do we get from where we are to there?”
 Shows disparities in perspective and roles; “How do we get these “pictures” to match-up better?
 Makes session fun and provides a continuous frame of reference for session
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SAMPLE Technique: Sculpting or Spatial Metaphor

What it is: putting family or group members in physical positions that represent how a “sculptor” sees each person’s role in the family.
How it works
 Each family member given opportunity to sculpt family as they see it.
 Gives nonverbal, symbolic depiction of family process from each person’s perspective.
o Nonverbal confrontation that bypasses cognitive defenses.
o Able to literally see how he or she is contributing to problematic family process.
 Best to let each person sculpt before allowing discussion of sculptures.
 Encourage family members to respect the subjective experience and deepen understanding of one another.
Benefits
 Makes the covert, overt. Provides insight into each other’s perspective and experience of relationship
 Creates a set time-line of “Now” and “Future”; “How do we get from where we are to there?”
 Shows disparities in perspective and roles; “How do we get these “pictures” to match-up better?
 Makes session fun and provides a continuous frame of reference for session
Type of 3-dimensional projective technique or psychodrama used in group and family counseling to portray the relationship system between members, focusing on boundaries,
intimacy, power and alignments. The traditional Sculpting technique (“snap-shots”) relies on depictions that represent the perspective of each member on their or the group’s
process. One may vary this basic technique in several ways:
 Snap Shots: Show me how it is. Show me how you would wish it to be. How do we get there?
 Drama Mama: sculpt the conflict; without speaking, show me how you would resolve it
 Symptom Sculpture : sculpt your symptom
 Therapist’s Sculpture: as a supervision and treatment planning tool, the therapist sculpts their client(s) and how they wish to mobilize them (courtesy of Natalia Tague,
LPC)
 Psychodynamics: sculpture of any part of the family process
1. The therapist (or clients) sculpts the underlying processes that sustains the stalemate or power-struggle (ie. Individuation) and “freezes” the snap-shot
2. The therapist then whispers specific instructions to each member that will exaggerate, breach or spoil the stalemate; members are told to act with all their fervor when
commanded to “Go!”
3. Therapist directs the group to “Go!”
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SAMPLE Technique: Sculpting or Spatial Metaphor

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3 Evidence Based Practices combine to foster continuous learning and skill acquisition in Assessment, Treatment Planning, and Intervention

References
1. Adler, A., Understanding Human Nature, translated by W. Beran Wolfe, MD, 1927; published Faucett Premier, New York, 1957
2. Adler, A., The Individual Psychology of Alfred Adler, H. L. Ansbacher and R. R. Ansbacher (Eds.) (Harper Torchbooks, NY 1956
3. Adler, A., The Practice and Theory of Individual Psychology, translated by P. Radin (Routledge & Kegan Paul, London 1925; revised edition 1929, & reprints
4. Ansbacher, Rowena R. (Editor), Ansbacher, Heinz Ludwig (Editor); Superiority and Social Interest: A Collection of Later Writings by Alfred Adler
5. Bowen, M. , Family Therapy in Clinical Practice, Aronson New York. 1976.
6. Carlson, J. and Slavik, S, editors, Techniques in Adlerian Psychology, Routledge, Ztaylor& Francis Group, New York, London, 1997
7. Cognitive Restructuring: Gladding, Samuel. Counseling: A Comprehensive Review. 6th. Columbus: Pearson Education Inc., 2009.
8. Conte, Christian. Advanced Techniques for Counseling and Psychotherapy, Springer Publishng Company, New York
9. Dinkmeyer, D., Pew, W. and Dinkmeyer, D. Jr. 1979. Adlerian Counseling and Psychotherapy, Monterey, CA: Brooks/Cole.
10. Dreikurs, R., Gould, S. and Corsini, R. 1974. Family Council, Chicago: Henry Regnery.
11. Erford, Bradley T., 2015, 2010. Forty Techniques Every Therapist Should Know, 2nd
edition, Merrill Counseling Series, Pearson
12. Haley, Jay, Strategies of Psychotherapy, 1963, Grune and Stratton.
13. Hope D.A.; Burns J.A.; Hyes S.A.; Herbert J.D.; Warner M.D. (2010). "Automatic thoughts and cognitive restructuring in cognitive behavioral group therapy for
social anxiety disorder". Cognitive Therapy Research. 34: 1–12.
14. Mosak, Harold H., Maniacci, Michael P., Tactics in Counseling and Psychotherapy, F.E. Peacock Publishers, Inc.
15. Sherman, R., Oresky, P., Rountree, Y. 1991. Solving Problems in Couples and Family Therapy, Brunner/Mazel. New York
16. Sherman, R., Fredman, N., 1986. Handbook of Structured Techniques in Marriage & Family Therapy, Brunner/Mazel, NY
17. Sherman, R., Dinkmeyer, D.,1987. Adlerian Family Therapy, Brunner/Mazel, New York
127

For additional information or assistance contact:
Demetrios N. Peratsakis, ACS, LPC, SDSAS, MSEd, Certified Clinical Trauma Professional
Clinical Supervision & Training in Advanced Clinical Methods
dperatsakis@gmail.com Cell: (757) 377-2397
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