When Values CollideField Instructors’ Experiencesof Pro

When Values Collide:
Field Instructors’ Experiences
of Providing Feedback
and Evaluating Competence
Marion Bogo
Cheryl Regehr
Roxanne Power
Glenn Regehr
ABSTRACT. This paper reports on an analysis of qualitative
data ac-
crued across four research studies that addressed the
experiences of field
instructors in evaluating students and providing corrective
feedback when
necessary. Findings suggest that while tools for field evaluation
are in-
creasingly attempting to provide standardized, objective, and
“impartial”
measures of performance, these evaluations nevertheless occur
within a
professional and relational context that may undermine their
value. As
social workers, field instructors are guided by the professional
values of
respecting diversity, focusing on strengths and empowerment,
advocating
Marion Bogo, MSW, Adv. Dip. SW, is Professor, Faculty of
Social Work, University

of Toronto, 246 Bloor Street West, Toronto, Ontario, Canada,
M5S 1A1 (E-mail: marion.
[email protected]).
Cheryl Regehr, PhD, is Professor, Sandra Rotman Chair,
Faculty of Social Work,
University of Toronto.
Roxanne Power, MSW, is Senior Lecturer, Faculty of Social
Work, University of
Toronto.
Glenn Regehr, PhD, is Professor, Richard and Elizabeth Currie
Chair in Health Pro-
fessions Education Research, Faculty of Medicine, University of
Toronto.
Glenn Regehr, PhD, is supported as the Richard and Elizabeth
Currie Chair in
Health Professions Education Research.
This study was funded by a grant from the Social Sciences and
Humanities Research
Council of Canada.
The Clinical Supervisor, Vol. 26(1/2) 2007
Available online at http://cs.haworthpress.com
© 2007 by The Haworth Press, Inc. All rights reserved.
doi:10.1300/J001v26n01_08 99
for vulnerable individuals, and valuing relationships as avenues
for growth
and change. By placing field instructors in a gatekeeping role,

the univer-
sity requires them to advocate for particular normative
standards of pro-
fessional behavior and to record a negative evaluation for a
student who
fails to achieve or adhere to these normative standards. Such
activities
can be in direct conflict with social workers’ personal and
professional
values, thereby creating a disquieting paradox for the field
instructor.
Models of student evaluation must consider the influence of this
conflict
on the field instructor’s ability to fulfill the role of professional
gatekeeper
and must find new ways of addressing the problematic student.
doi:10.1300/
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KEYWORDS. Field instruction, educational assessment,
evaluation, su-
pervision
The accurate assessment of competence is of vital concern to all
the
professional disciplines. The ability to reliably and validly
differentiate
between those students who possess the knowledge, skills, and
judg-
ment necessary for safe and effective practice and those who do

not is
central to the critical role that is expected of university-based
profes-
sional programs as gatekeepers of their respective professions.
Social
work educational programs delegate a major portion of the
responsibil-
ity for evaluating students’ practice competence to field
instructors in
the practicum. While faculty field liaisons are involved to a
greater or
lesser extent in this process (Bennett & Coe, 1998), the primary
respon-
sibility for providing corrective feedback and for assessing
students’
practice competence rests largely with community-based social
work-
ers in their role as field instructors. When students have strong
social
work skills, or when students are active and open learners who
quickly
integrate corrective feedback in a positive manner, the process
of provid-
ing feedback can be rewarding for field instructors as they
participate in
the generative activity of teaching and preparing the next
generation
of social workers (Bogo & Power, 1992; Globerman & Bogo,
2003). But
what happens when the student is not able to develop the skills
and
competencies necessary to be a competent practitioner and
displays
many deficits? How does a field instructor respond to situations
in which
the pleasure of generativity is transformed into the

responsibility for
gatekeeping?
100 THE CLINICAL SUPERVISOR
In an attempt to better understand the factors that contribute to
field
instructors’ ability to communicate with students about their
level of
performance, this article examines dynamics and issues in
instruction
and evaluation. The data for this analysis were drawn from a
series of
studies on conceptualizing and assessing student competence
where the
topics of working with students who present problematic
behaviors,
providing corrective feedback, and generating summative
evaluations
of students were explored directly or arose spontaneously.
PREVIOUS RESEARCH
Students’ presenting with attitudes and behaviors inconsistent
with
social work has frequently been raised as a concern for
educators. In one
line of inquiry addressing this issue, researchers have attempted
to de-
termine whether it is possible to identify students who may not
possess
characteristics required to attain competence in social work
prior to ad-
mission. Pelech, Stalker, Regehr, and Jacobs (1999), for

example, exam-
ined the predictive validity of admission criteria in identifying
potentially
unsuitable students. Analyzing quantitative data from admission
files,
they determined that students who were later identified as
problematic
were on average older than other students, were more likely to
be male,
had lower grade point averages, and had more social service
experience.
These findings were consistent with some earlier findings
regarding the
value of age and gender as predictors of difficulty in student
social
workers (Cunningham, 1982; Duder & Aronson, 1978; Pfouts &
Henley,
1977). However, these demographically-based findings were
considered
to be of limited use to admissions decision makers in
establishing screen-
ing criteria, and therefore a further content analysis was
conducted of
personal statements prepared at the candidacy stage. When
compared to
other students, issues identified in the statements of students
later rec-
ognized as problematic included a focus on personal histories of
abuse,
injustice, or neglect, and plans to work with others with similar
experi-
ences (Regehr, Stalker, Jacobs, & Pelech, 2001). To the extent
that these
predictive markers manifest as professional challenges for the
student
when entering the practicum setting, they are likely to be

difficult issues for
field instructors to address with students.
Other research has focused on the evaluation of students and
identifi-
cation of those with inadequate skill levels or those who do not
possess
the characteristics that would render them suitable for social
work. Social
work educators have sought to articulate outcome objectives and
related
Bogo et al. 101
criteria for assessing student field learning and practice
competence
and to develop reliable and valid measures of field performance
(Bogo,
Regehr, Hughes, Power, & Globerman, 2002; Dore, Morrison,
Epstein, &
Herrerias, 1992; Koroloff, & Rhyne, 1989; O’Hare, & Collins,
1997;
Reid, Bailey-Dempsey, & Viggiana, 1996; Vourlekis, Bembry,
Hall, &
Rosenblum, 1996). Despite the movement to increasingly
standardized
measures, clinical performance evaluation remains a complex
process
that is further complicated by the social and relational issues
involved
in a mentoring relationship (Lazar & Mosek, 1993). Yet, in all
these ef-
forts to “improve the scales,” researchers and developers have
left the re-

sponsibility for both evaluation and communicating negative
evaluations
primarily to the field instructor.
If a student is identified as potentially unsuitable for the
profession,
the issue of termination takes precedence. Research by several
authors
in this area has identified the absence of policies and
procedures in
schools of social work for terminating students for reasons such
as pro-
fessional unsuitability (Cobb & Jordan, 1989; Koerin & Miller,
1995),
and others have addressed the legal issues associated with such
termina-
tion including the framework provided by the Americans with
Disabili-
ties Act (Cole & Lewis, 1993; Gillis & Lewis, 2004). From this
work, it is
clear that whether one is finding mechanisms to avoid
termination of
a student by correcting problematic behavior or whether one is
prepar-
ing the way for termination, feedback must be provided to the
student
regarding performance deficits, and explicit expectations for
change
must be enunciated. Again, given the fact that problematic
behavior is
most likely to be manifested and detected in the field
placement, it be-
comes the challenging responsibility of the field instructor to
enact many
of these underspecified and ill-supported, but legally necessary
correc-

tive actions.
Even for students who are not in potential difficulty, however,
the
importance of providing meaningful corrective feedback has
been a
consistent theme in social work education literature. Munson
(2002), for
example, cautioned against giving only positive feedback
observing that
in general, social workers (not unlike others perhaps) dislike
giving or
receiving criticism. Freeman (1985) provided guidelines for
giving bal-
anced feedback that is systematic, timely, clear, and invites
dialogue.
Kadushin (1992) offered similar guidelines and observed that
workers’
and students’ performance failures need attention from their
supervi-
sors. Noting that despite social workers’ valuing of feedback
they find it
difficult to give when it is more negative in nature, Abbott and
Lyter
(1998) surveyed students and field instructors about their
perceptions of
giving and receiving criticism. They found that criticism was
experi-
enced as helpful when part of a positive trusting student and
field in-
structor relationship. Criticism was seen as harmful when

delivered in
a demeaning or harsh manner. More than a quarter of the
respondents
opposed criticism that was also not balanced with positive
comments,
and some highlighted the importance of the student being
prepared for
receiving criticism. Without such preparation, criticism was
thought to
be responsible for damaging self-esteem and self-confidence,
decreasing
motivation for learning social work practice, and impeding
growth.
While there has been little empirical investigation of field
instructors’
experience of their role as evaluators, anecdotal evidence from
field
coordinators note that field instructors find this aspect of their
role as
“most worrisome” (Pease, 1988, p. 35). Gitterman and
Gitterman (1979)
found that field instructors experienced defining criteria,
writing the for-
mal document, assessing student practice, and engaging the
student in the
evaluation process as stressful. In a study on the supervision of
workers,
Kadushin (1985) found that supervisors disliked evaluation as it
rein-
forced the power differential with supervisees, and that a
negative evalua-
tion evoked anger and upset the balance in the relationship.
Similar concerns about evaluation and gatekeeping are
expressed by

supervisors in related human service fields. In the field of
clinical psy-
chology, researchers have acknowledged the presence of
conceptual ar-
ticles regarding the evaluation of competence and the
responsibilities of
internship supervisors for gatekeeping, but they have also noted
that
there is little empirical work related to these concepts (Gizara &
Forrest,
2004). Problematic student behaviors and trainee impairment
have been
studied in incidence studies and in surveys that document the
percep-
tions of training directors’ regarding the scope of the problem
and ways
of addressing it (Vacha-Haase, Davenport, & Kerewsky, 2004).
Gizara
and Forrest (2004) studied the experiences of 12 supervisors
who had
worked with students with serious competence problems, and,
argued
that further qualitative studies of this type would provide
information
that could be helpful to other supervisors. They found that
supervisors
perceived the process of evaluation, especially when trainees
were not
achieving expected levels of competence, as complex,
challenging, and
difficult. Issues that affected supervisors’ experience included
lack
of adequate preparation in their own training for the evaluation
role in
supervision, the degree of support they received from
colleagues in

their agencies, and the negative personal and emotional impact
on the
supervisor.
Bogo et al. 103
In a study of clinical supervisors in medicine and surgery,
Dudek,
Marks, and Regehr (2005) explored supervisors’ perspectives
about evalu-
ating poorly performing medical students and/or residents. They
found
that these supervisors felt they were able to identify poor
performance but
were often reluctant to report it for a number of reasons. Factors
included
their lack of previously documenting poor performance and
their lack of
clarity about what to document as supporting evidence for their
judg-
ment. Concerns about the potential of an appeal, its impact on
their own
credibility with their colleagues, and whether there would be
faculty
support for their decision also had an impact. In addition, the
perceived
lack of remediation opportunities for the trainee affected their
decisions.
In summary, across the human services professions, studies
about
gatekeeping at the admissions level have provided some data
regarding
potential difficulty that some students might experience in field

practice
with populations with similar experiences to the students. In
addition,
studies on termination have described the processes required to
remove
unsuitable students and highlight the need for explicit feedback
regard-
ing unacceptable performance. However, these studies have not
fully il-
luminated the issues and challenges faced by field instructors in
their
day-to-day interactions with students presenting with
problematic behav-
iors. Similarly, despite anecdotal reports from field
coordinators regard-
ing the central role that field instructors play as educators and
evaluators,
and despite the apparent responsibility these roles engender for
the field
instructors as the frontline gatekeepers of the profession, there
is little
empirical evidence available regarding the issue of how field
instructors
enact these crucial gatekeeping roles: how they evaluate
students and
provide feedback when performance does not meet expected
standards.
METHOD
As part of a program of research on conceptualizing and
measuring
students’ practice competence, a number of studies were
conducted (see
the following for a complete discussion of methodology of each
study:

Bogo et al., 2002, 2004, 2006; Regehr, Bogo, Regehr, & Power,
2007).
A range of research methodologies were used in each study
including
scaling student behaviors, sorting vignettes, focus groups, and
in-depth
interviews. In an attempt to understand the challenges field
instructors
experience when teaching and assessing for competence, the
research-
ers pooled qualitative data from these four studies. The data
relevant to this
elaborated reanalysis were elicited when various aspects of
evaluation
were specifically investigated or when instructors’ experiences
were of-
fered spontaneously during discussions of evaluation scales.
These rele-
vant qualitative data from across the four studies were compiled
for the
current analysis. The methodologies of the four studies and the
resulting
qualitative data sets from which the relevant data were extracted
are de-
scribed as follows.
Study 1: In-depth interviews were held with 19 experienced
field in-
structors who were asked to provide descriptions of exemplary,
average,
and problematic students they had taught in the field practicum

(Bogo
et al., 2006). Spontaneous comments made by field instructors
during
these interviews about educating and evaluating students with
problem-
atic behaviors were subjected to grounded theory data analysis.
An iter-
ative process involved the research team in reviewing the open
coding
reports, engaging in selective coding and developing a
theoretical un-
derstanding, which was grounded in the themes that emerged.
Study 2: From the 57 descriptions of students collected in the
study
above, 20 realistic student vignettes were created to represent a
range
of student competence. Ten experienced field instructors were
asked,
first independently and then in one of two small groups, to
divide these
vignettes into as many categories as they felt necessary to
reflect vari-
ous levels of student performance. Two recorders (one for each
group)
captured the content and process of the groups as members
discussed
their rationale for ranking students (Bogo et al., 2004).
Spontaneous
comments made by field instructors about what they imagined it
would
be like to teach and to evaluate these fictitious students were
used for
this analysis.
Study 3: A Practice-Based Evaluation Tool, grounded in the

concepts
and language used by field instructors during the first two
studies, was
created. This tool consisted of six dimensions of competence
described in
detail along five levels of student competence. Forty three
experienced
field instructors were asked to recall their most recent student
and to eval-
uate the student first using the school’s current competency-
based tool,
then using the new practice-based evaluation tool (Regehr et al.,
in re-
view). Following completion of the tools, focus groups of
approximately
10 instructors each, were held where participants were asked for
their
opinions about the two tools, about giving feedback to students
(espe-
cially negative feedback), and about evaluation of student
competence
in general. One recorder captured the content in the discussions.
Follow-
ing the focus groups the recorder and group facilitator reviewed
the writ-
ten notes to check for accuracy and comprehensiveness. These
notes
Bogo et al. 105
were subjected to grounded theory analysis following the
procedure
described above.

Study 4: The 20 realistic student vignettes, as described in
Study 2,
were provided to 28 experienced instructors who were asked to
recall
their most recent student and select the vignettes that were
“most simi-
lar” to their student. They were then asked to rate the same
student using
both the practice-based evaluation tool and the school’s current
compe-
tency-based evaluation tool described above (Regehr et al., in
review).
Following completion of the evaluations, focus groups ranging
from 6 to
10 participants were held where participants’ opinions about the
various
evaluation methods were elicited and recorded. As well,
participants dis-
cussed their experiences of giving feedback to students,
especially nega-
tive feedback, and about evaluation of student competence in
general.
Methods of recording, data checking, and analysis were the
same as de-
scribed in Study 3.
In summary, 100 field instructors participated in these studies
with
19 instructors providing data in individual interviews and 81
instructors
providing data in 9 focus groups of 5 to 10 participants.
The researchers reviewed the relevant data from these four
studies
and, in the analysis, used a grounded theory iterative approach
building

on the themes emerging from each study. Each successive study
pro-
vided an opportunity to challenge the team’s interpretations
through en-
gagement with groups of field instructors who had not
participated in
the earlier phases of the research program in order to assess
transferabil-
ity and confirmability (Cresswell, 1998; Erlandson, Harris,
Skipper, &
Allen, 1993).
FINDINGS
Discussions with the field instructors across these four studies
re-
vealed six recurrent and interconnected themes. Each of these
themes
will be discussed separately in the following sections, and a
model of
how these various considerations combine to represent field
instructors’
experiences and constructions of giving negative feedback will
be offered
in the discussion section.
Posture Towards Evaluation
Evaluating students presents a range of issues for social work
field in-
structors. When field instructors in these studies were expected
to evaluate

their students’ performance and rank or categorize it on a
continuum,
they reported conflict between the need to determine skill levels
and their
deeply held professional values, such as being nonjudgmental,
using a
strengths perspective, individualizing the person one is working
with,
and understanding behaviors in context. While they
acknowledged that as
social workers they must make judgments “in the real world of
practice,”
the role of facilitating learning is far more appealing to them
than the role
of judging student performance.
Field instructors in this group of studies were asked to provide
feed-
back on a series of tools for evaluation. Given their commitment
to being
nonjudgmental and focusing on strengths, field instructors were
very
sensitive to the language used in various evaluation tools,
preferring
what they perceived as the neutral and specific behaviors found
on
competency-based inventories. They were critical of tools that
used what
they perceived to be value-laden terms (such as unfocused,
authoritar-
ian with clients, inflexible regarding intervention planning) or
referred
to personal qualities (initiative, warmth, sensitivity) despite
their ac-
knowledgment that these factors were often more important

dimensions
of practice than some of the concrete behavioral skills. They
wanted
to “individualize the student” and preferred tools that provided
a frame-
work and a means for them to “describe the attributes and
process of
learning and development” of the particular student rather than
tools
that required them to grade, rank, categorize, or rate students.
They rec-
ognized the time challenge also, with one participant expressing
explic-
itly that “Whatever evaluation tool we use we will complain
about the
time it takes, even though evaluation is important.”
Student Response to Feedback and Evaluation
Giving feedback is not a problem for instructors when the
student re-
sponds in a thoughtful manner or accepts it, works with it, and
uses it in
subsequent work with clients. Instructors spoke about their
gratification
when they “could see the student using the feedback in the next
inter-
view.” Giving feedback becomes difficult, however, when the
student
does not accept it. The instructors described a range of student
reactions
including arguing, becoming defensive, attacking the
instructor’s teaching
style, and becoming silent and avoidant. Three types of
circumstances were
identified by instructors as limiting students’ acceptance of

feedback:
(1) where students had difficulty understanding the role of
social work
and the nature of practice and hence could not accurately assess
their
behaviors or skills; (2) where students had worked before
entering the
Bogo et al. 107
educational program, believed themselves to be competent and
were not
open to a new view of their skill level; and (3) where students’
personality
style was such that problematic behaviors were a pervasive part
of their
interactions with clients, colleagues from related professions, or
both.
When students did not use the instructors’ feedback
productively, the
focus in the practicum changed from developing practice
competence
to concerns about the possibility of the student failing. Some
students
became fearful and cautious, and their struggles in learning
were exacer-
bated. A downward and deteriorating cycle ensued with
negative feedback
producing more anxiety and concerns for students, which in turn
inter-
fered with their ability to learn and progress.
The Relationship as a Context for Feedback and Evaluation

Social worker field instructors in these studies discussed giving
both
positive and negative feedback to students as similar to giving
feedback
to clients. They highlighted the importance of the relationship
as the
context where feedback and information are provided that could
pro-
duce growth, development, or change: “You have to be open and
honest
from the beginning and not shy away from correcting behavior
and
skills. In establishing an open and honest relationship you earn
the right
to give open and honest feedback.” They underscored the
importance
of giving feedback in a nonjudgmental way in practice and when
work-
ing with students: for example, “I try not to only be critical but
ask how
could you have done better?”
Using social work values and adult education principles, the
instruc-
tors encourage student participation and collaboration in all
aspects of
field education including setting learning objectives and
evaluating
learning. When expected to provide a numerical ranking for
students on
a rating scale, they reported that students pressure them for
rankings at the
high end of the scale. Interpersonal dynamics, differences in
interpreting
the meaning of the numbers on the scale, and time constraints

left instruc-
tors feeling burdened and pressured to provide higher ratings.
As a consequence of the intensity in the dyadic tutorial model
of social
work field instruction, the instructors commented on how giving
feed-
back, especially negative feedback, is difficult. Hence as one
instructor
stated, while other focus group participants nodded in unison,
“giving
negative feedback to the student is so difficult . . . it feels so
personal.”
They noted this was especially so when aspects of the student’s
personality
or personal style were at issue, for example, relationship
abilities or de-
gree of initiative in learning and practice. In these situations,
students
frequently were reported to have difficulty accepting feedback.
Field in-
structors reflected that when feedback was not accepted, not
only was
learning and change impeded but also an acrimonious process
devel-
oped in the relationship with the student. Field instructors used
strong
terms to describe the atmosphere in their subsequent sessions
and in the
relationship such as “becoming tense,” “very heavy, intense,”
“emotional,”

and “like me against the student.”
The Practicum Setting as an Influence
on Feedback and Evaluation
Social work practicum generally takes place in organizations
where
students join instructors on multi-professional teams.
Instructors reported
being caught between organizational needs and students’ needs.
On the
one hand, they needed to preserve longstanding inter-
professional relation-
ships and the organization’s positive perceptions about social
workers’
contributions. These perceptions were challenged when
colleagues were
critical of problematic student behaviors and impatient with the
instruc-
tors, perceiving them as inappropriately defending the student.
On the
other hand, instructors wanted to be fair and ensure the student
had every
opportunity to learn and progress. A time-consuming balancing
act en-
sued: “I had to spend inordinate amounts of time managing the
fall-out
from the student’s behavior in the setting.”
Similar to the instructors’ concern about individualizing
students’
approaches to learning and progress was their perception that
evalua-
tion takes place within the context of a particular organizational
setting.
They were concerned that dynamics in their setting affected

opportu-
nities for student learning. Even though the instructors might
rate the
student highly, they were concerned that their rating would be
inter-
preted to mean that the student could function in other settings,
a predic-
tion they were not comfortable in making.
The Responsibility of the School of Social Work
A general theme emerged that can best be labeled “Where is the
school?” While faculty field liaisons were praised on an
individual basis
as supportive and involved, instructors voiced concern about the
school
supporting their judgments. Instructors working with difficult
students
felt isolated in their role: “[I felt] lonely, alone and out there to
do the
hard work of giving feedback about problematic behaviors.”
Critical
comments related to the structure of social work education that
relegates
Bogo et al. 109
primary responsibility to the field practicum for developing and
evalu-
ating students’ self-awareness, professional use of self, ability
to self-
assess, and level of practice competence. Instructors questioned
criteria
used in the admissions process that resulted in enrolling

students who
appeared to lack interpersonal skills or the ability to learn. They
were
critical of the primacy given to outcomes such as grades on
written
papers in academic courses rather than to assessments that
provide an
indication of professional competence. Finally, they resented
what they
perceived as the burden placed on them to evaluate student
practice per-
formance and serve as gatekeepers for the profession.
The Field Instructor’s Sense of Self
Conscientious about their teaching role, field instructors
reported
“second guessing” their judgments and seeking out the opinions
of
other social workers and colleagues in the setting to determine
whether
their assessment of the student was fair, accurate, or too harsh.
They
tried to sort out “how much is me and how much is the
student?” They
spoke about questioning themselves and their ability to deal
with the sit-
uation: “Could I do this differently or better?” Sharing their
impressions
and experiences with other field instructors or colleagues
resulted in
feeling less isolated.
Giving negative feedback and continuing to teach in a
deteriorating
and tense relationship with the student was highly stressful, and

instruc-
tors described their experience as “tedious, the repetition in
teaching the
same thing again and again with no change in the student’s
behavior
was draining.” In the end it had a profound impact on the
instructors:
“[I felt] horrible, depleted . . . I had to take a break from taking
students
for a few years after that experience,” and “three days feels
very emo-
tionally draining.” The time involved in working with a student
display-
ing problematic behaviors, who did not join the instructor to
change and
develop, was a pervasive theme. In an era of demands from
employers for
increased productivity, students who need a considerable
investment of
time created an added burden and stress for these social
workers.
Valuing a strengths focus in their practice and in their teaching,
these
field instructors expressed regret and a concern that they had in
some
way failed to make progress with these students. Generally they
tried to
provide explanations and rationalizations for the lack of change
and
attributed problems to a lack of fit with the setting or the
developmental
stage in the student’s life. The experience of judging student
behaviors
as problematic created dissonance and discomfort for these
social workers

who were motivated to provide student education as a
generative and
energizing professional activity.
DISCUSSION
Evaluation of students in the field is viewed by field instructors
to be
one of the most challenging and stressful aspects of practicum
teaching.
When the skills and characteristics of the student do not meet
expected
standards for a professional social worker, the evaluation role
becomes
even more difficult and dreaded. From the findings of these four
studies,
we conclude that the evaluation of student competence and the
provi-
sion of feedback in field education are complicated by a number
of in-
terconnected factors. The tools of evaluation, the student
response to
evaluation, the relationship in which the evaluation occurs, and
the orga-
nizational context in which the evaluation occurs all present
challenges.
These challenges are exacerbated by the professional values
these field
instructors embrace as social workers. While in the field
instruction role,
these social workers continue to draw on the professional values

that in-
form and guide all aspects of their practice. When social work
values
come into conflict, field instructors experience dissonance and
stress as
evaluators and gatekeepers.
Several values come into conflict when field instructors are
faced
with the task of evaluating students and providing corrective
feedback.
The first conflict relates to the responsibility to ensure
professional stan-
dards of competence are upheld while simultaneously being
committed
to the belief in individuals’ abilities to build on strengths and
develop
greater capacities. On the one hand, social workers expect their
colleagues
to be competent, and they believe that clients need to be
protected from
incompetent social workers. In their roles as field instructors,
they judge
negatively students who display problematic behaviors when
working
with clients and colleagues. When students are not able to
change and learn
competent practice, instructors expect such students will not
proceed to
become practitioners. On the other hand, these social workers
are com-
mitted in their practice to empowerment of individuals with
challenging
and difficult behaviors and interpersonal styles. Social workers
strive to
engage such individuals, understand the life situations that have

contrib-
uted to these difficulties, and work collaboratively towards
helping clients
develop more adaptive behaviors. Empowerment practice
includes fo-
cusing on individuals’ strengths and avoiding judgmental,
deficit-focused,
Bogo et al. 111
and problem-saturated perspectives. When the social work field
instructors
in our studies were confronted with students who displayed
negative be-
haviors or attitudes they experienced conflict about their
responsibility
to identify and label incompetent practices, in language they
experienced
as pejorative or negative, and their convictions about a
“strengths” perspec-
tive. While the field instructors in our studies (Bogo et al.,
2004, 2006) and
others (LaFrance, Gray, & Herbert, 2004) clearly identified that
students
who are most suitable for the profession possess qualities of
maturity,
honesty and integrity, the ability to form relationships with
colleagues
and clients, self-awareness, receptiveness to feedback, and
personal con-
gruence with social work values, there was marked discomfort
in address-
ing deficits in these areas. Such reluctance is undoubtedly
accentuated in

light of previous findings that problematic students are more
likely to re-
port histories of abuse, injustice, and neglect (Regehr et al.,
2001). Field
instructors may perceive such students as already disadvantaged
and vul-
nerable and are understandably averse to adding to these
students’ negative
interpersonal experiences. Critical feedback can reinforce a
student’s neg-
ative self-image, and damage self-esteem and self-confidence
(Abbot &
Lyter, 1998). To communicate that particular behaviors or
attitudes do
not meet expectations of competence can be experienced by
field instruc-
tors as conflicting with the value of acceptance of individual
difference
and commitment to enhance each individual’s unique skills and
abilities.
Hence providing direct and concrete feedback to students can
represent
a challenge to field instructors’ professional self-image as
caring and
accepting. A similar theme emerged in a recent study of
supervisors of
psychology interns (Gizara & Forrest, 2004). Trained as
therapists to be
nonjudgmental, empathic, and accepting of individual
differences, super-
visors in their study found it difficult to provide critical
feedback experi-
encing themselves as judgmental, confrontational, and
uncomfortable with
the power and responsibility in their role.

The second value conflict involves the primacy social workers’
place
on maintaining positive relationships as the context for practice
and also
the context for learning. They recognize that negative feedback
can lead
to deterioration in a relationship such that progress is impeded.
Numer-
ous studies identified the crucial nature of student and field
instructor
relationships in promoting student learning and satisfaction in
field edu-
cation (Alperin, 1998; Fortune, McCarthy, & Abramson, 2001;
Knight,
2001; Raskin, 1989). The intense dyadic tutorial model is also
valued by
field instructors as they experience their mentoring as
contributing
to the next generation of social workers (Globerman & Bogo,
2003).
However, when negative feedback and evaluation become a
regular part
of supervision, a disjuncture in relationships between students
and their
instructors can occur and often cannot be repaired (Bogo, 1993).
This is
especially so when students do not agree with the instructors’
assessment
of their behavior or competence. Students may experience their
instructors
as demanding, “too negative,” or unfair, and they may react

negatively
in supervision. Field liaisons are frequently involved and a
process of set-
ting learning goals and reviewing progress established. The
relationship
does not end abruptly with the negative feedback but continues
with in-
tensity for sometime. Field instructors who appreciate the
potential of
relationships to bring about growth and change are then
continuously
confronted with frayed relationships and the challenge of
maintaining
a productive interpersonal climate in the face of potential
conflict or
avoidance. The focus moves increasingly towards following
policies
and procedures required for supporting a failing grade (Cobb &
Jordan,
1989; Keorin & Miller, 1995).
Finally, the context in which the students’ behavior occurs is
impor-
tant as it reflects social workers’ value on understanding
individual be-
havior in relation to systemic forces. Field instructors are not
neutral
when viewing social work in the host organization. Social work
stu-
dents are representative of the profession of social work–
particularly in
settings where social work is a secondary service (Globerman &
Bogo,
2003). Students’ behavior can be experienced as a reflection of
the pro-
fession and also as an extension of their field instructors. As a

result,
students’ problematic behaviors may be experienced by field
instruc-
tors as a source of professional and personal humiliation on the
team.
Field instructors as social workers, however, are also committed
to social
justice and advocacy for those who are oppressed by systemic
factors.
They may be influenced by the felt responsibility to support
students
and ensure that the setting itself was not the cause of or a
contributor
to students’ issues. The school of social work in this study may
have had
a structure that further exacerbated the sense of difficulty and
conflict.
While individuals in the role of faculty field liaison provided
support to
field instructors on a case by case basis, the structure of the
academic
program and the priorities of the program were not seen to be
consistent
with or supportive of ensuring competence in the field. There
were no
school-based final over-arching assessment processes that
included direct
observation and evaluation of students’ practice competence.
The only
evaluation of students’ actual abilities to practice was
conducted in their
particular field settings.
Bogo et al. 113

CONCLUSIONS
Schools of social work are committed to ensuring that the
graduates
of their programs become professionals who are able to provide
ethical,
competent, high quality service to the public. Much of the
attention of
academic programs within the schools focuses on ensuring that
students
understand and embrace social work values which dictate
respect and
valuing of differences between individuals, focus on strengths
and em-
powerment of vulnerable individuals, direct advocacy for the
rights of
individuals against organizational and societal constraints, and
focus
on the therapeutic alliance or relationship as a conduit for
support and
change. Field evaluation processes in social work attempt to
define
competency for practice, identify the observable skills and
behaviors
that exemplify competency, and establish means to determine
whether
students demonstrate competencies in their practice. In this
context,
field instructors are expected to be impartial evaluators. What is
missing
from this model of evaluation is that field instructors are
committed
to the same social work values taught to students in the
classroom not
only for services directed at clients, but also in relation to their

students
who are in subordinate and vulnerable positions. A paradox is
then
created in which the skills and behaviors required to be a good
evaluator
may be at odds with the deeply held values of the social worker.
Students presenting with attitudes and behaviors inconsistent
with
social work are an ongoing concern for educators. While the
problems
of these students may be exhibited in a variety of contexts, it is
frequently
the field practicum in which they are most evident. Field
instructors are
therefore placed in the position of being gatekeepers for the
profession
by providing corrective feedback to the student, providing
negative
evaluations as required and failing students who are not suitable
for the
profession. This role is not necessarily what field instructors
envisioned
when they volunteered to provide a practicum.
This study illuminated the challenges experienced by field
instruc-
tors in providing corrective feedback related to their own
professional
values, the nature of the student supervisor relationship and the
context
in which the instructor and student both work. Given the
findings it is
imperative that schools of social work provide mechanisms for
training
and support of field instructors that address these central issues

in the
evaluation process. The emphasis on defining outcome criteria
and de-
veloping reliable and valid standardized tools, while
commendable, does
not address these crucial process issues which will ultimately
limit the
value of any formal evaluation instrument (Regehr et al., 2007).
Assisting
field instructors in their evaluation role provides some
immediate assis-
tance but does not address the overarching issue of the
responsibility of
schools of social work to ensure their graduates are competent
to practice.
Educational outcomes are assessed in classroom courses largely
through
written products while the assessment of actual practice
competence is
relegated to the field. It is essential that schools of social work
take back
the responsibility for evaluation and gatekeeping that currently
falls on
field instructors. New models of evaluation are needed and
social work
educators might examine approaches used in related fields. For
example,
assessment of educational outcomes in a range of health
professions such
as nurses, pharmacists, and physiotherapists use a range of
evaluation ap-

proaches beyond sole reliance on clinical instructors’ reports.
The need for
new approaches to field education and the preparation of
students for
practice has recently received renewed attention (Lager &
Robbins, 2004;
Wayne, Bogo, & Raskin, 2006). The findings from these studies
and the
challenges presented in our current gatekeeping practices
reinforce the
need for change.
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doi:10.1300/J001v26n01_08
Bogo et al. 117
O R I G I N A L P A P E R
Teaching the Use of Self Through the Process of Clinical
Supervision
John P. McTighe
Published online: 29 September 2010
� Springer Science+Business Media, LLC 2010
Abstract In their efforts to learn the skills involved in the

use of self, clinical social work supervisees are faced with
the daunting task of integrating information coming not
only from the patient but also from their own complex set
of responses. The clinical supervisor serves a key role in
guiding the trainee through this process. Grounded in
contemporary psychodynamic theory, this paper discusses
an approach to helping the supervisor model the use of self
in the context of the supervisory relationship. A supervi-
sory case example is used to illustrate.
Keywords Use of self � Clinical supervision �
Countertransference � Psychodynamic theory
Among the greatest challenges for the novice clinical social
worker is the process of learning to incorporate and make
sense of the myriad information that is communicated and
received throughout the course of even a single psycho-
therapy session. At a time in training when the student’s
emerging sense of professional identity is often quite
fragile (Gill 2001), the task of sorting out the internal

responses evoked by the patient from those emerging from
one’s own history, all while attempting to conceptualize
case material through the lens of one’s increasing font of
academic knowledge, can seem insurmountable. Beginning
therapists are learning to sort out the complex implications
of issues such as race, gender, and perceived socio-eco-
nomic status (both of the clinician and the patient). They
are dealing with their responses to the material that the
patient is presenting, especially when this material is
experienced as taboo or otherwise provocative (e.g. issues
of abuse). At the same time, they are learning to attend to
the many levels of conscious and unconscious communi-
cation that are occurring throughout the treatment. Making
therapeutic use of this material by means of well-conceived
and well-crafted interventions can thus seem a Herculean
task well beyond the grasp of the trainee. It falls in large
measure to the clinical supervisor to accompany the neo-
phyte therapist in the process of growth, discovery, and

integration.
Grounded in contemporary psychodynamic theory, this
paper will explore processes by which the supervisor can
assist social work supervisees in incorporating the use of
self into their practice. In addition to surveying briefly the
history of the concepts of countertransference and use of
self as well as their perceived role in therapeutic treatment
since the time of Freud, it will consider the skills that we
seek to develop in supervisees, and the role of the super-
visor as teacher and model of use of self. In particular, it
will consider ways in which the supervisor can model a
stance of non-judgmental, reflective attention to one’s
internal responses in the clinical situation, and make use of
these as a tool for understanding and intervening with
patients. Existing models for educating trainees about the
use of self will be reviewed. A detailed supervisory case
example will be used to illustrate.
Historical Perspectives on Countertransference

and the Use of Self
Beginning with Freud, much attention has been paid to the
phenomenon of countertransference and its impact on the
J. P. McTighe (&)
Department of Counseling, Health & Wellness, William
Paterson University of New Jersey, 300 Pompton Road,
Wayne, NJ 07470, USA
e-mail: [email protected]
123
Clin Soc Work J (2011) 39:301–307
DOI 10.1007/s10615-010-0304-3
clinical situation. Freud (1910) first described counter-
transference as ‘‘a result of the patient’s influence on his
[i.e. the analyst’s] unconscious feelings’’ (p. 144). Later,
Freud (1912) used the image of the telephone to describe
the nature of communication between the analyst and
analysand, encouraging the analyst to be receptive to the
patient’s transmittal of unconscious material. Thus, it fell

to the analyst to do all in his or her power to eliminate
interference with this process. The classical tradition, then,
encouraged awareness of the complex set of personal
reactions and responses to the patient known as counter-
transference with a view to decreasing its influence in the
therapeutic situation and facilitating the neutral stance of
the therapist (Edwards and Bess 1998; Jacobs 1991; Racker
1988/1957; Thompson 1988/1956).
Beginning in the 1940s a shift was noticed in the way in
which countertransference was viewed (Thompson 1988/
1956). This shift involved a reconsideration of the nature
and therapeutic value of countertransference. Increasingly,
these internal responses came to be seen as a potentially
valuable tool that the clinician might use to advance the
clinical work with the patient. In his writing, for example,
Tauber (1988/1954)) notes that an analyst may be so
concerned with avoiding the possible impingement of
countertransference that he or she may not be able to attend

fully to the contents of the material that the patient is
presenting. To remedy this, Tauber encourages the con-
servative and responsible use of the countertransference
material as long as the analyst is willing to take responsi-
bility for the effects of doing so in the treatment and not to
react with defensiveness. In this way, he suggests, issues of
resistance may be more easily worked through.
For her part, Thompson (1988/1956) adds that the ana-
lyst should be open to the patient pointing out what may be
blind spots in the analyst’s personality, and calls upon the
analyst to respond in a non-defensive manner, thus
encouraging the analyst’s naturalness and spontaneity. She
draws attention to the notion that the whole person of the
analyst and the whole person of the patient exert a mutual
influence upon each other.
In decades since, the emergence of the relational,
interpersonal, and self-psychological traditions has con-
tributed further to our understanding of the meaning and

role of countertransference in psychotherapy. In these
views, the internal experience of the therapist is seen less
as a hindrance and more as an integral part of the thera-
peutic process. This inner dynamic serves not only to help
the therapist understand the unconscious communication of
the patient, but also to craft interventions that utilize and
build upon the therapeutic relationship. It is this relation-
ship and the interface of the subjectivities of therapist and
patient that is seen as central to the helping, healing process
(Brown and Miller 2002). The whole self thus becomes the
instrument or tool of the therapist (Thompson 1988/1956).
In this view, not only is it undesirable to eliminate the
impact of the clinician’s subjectivity from treatment, it is
downright impossible (Lewis 1991). This has important
implications for the supervisory relationship as a key place
where beginning clinicians learn to make use of their self in
their work.
Cultivating the Supervisee’s Use of Self Through

Supervision
Various methods have been proposed for teaching the use
of self to students of psychotherapy. Edwards and Bess
(1998) focus their attention on the central importance of
self-awareness on the part of the therapist as a way of
integrating personal and professional selves (Reupert 2007,
2008). To this end they advocate a three-pronged approach
to the exploration of the self. First, they suggest, the
therapist must make an inventory of the self. This includes
a self-examination of personality traits that contribute to
her identity as a therapist. They encourage reflection on
questions such as what one enjoys about being a therapist
and a consideration of the role that this plays in the ther-
apeutic work. Secondly, they call for the development of
self-knowledge. This especially concerns beliefs and atti-
tudes on the part of the therapist about the nature of life’s
problems and how they are best solved. Finally, the authors
point to the need for an acceptance of risks to the self. That

is to say, therapists must remain open to self-discovery
with all the challenges that accompany it. Only in this way,
they suggest, can therapists hope to understand their
patients better.
For his part, Lewis (1991) has developed a modular
training program for therapists that includes one section
devoted the development of use of self. This module
contains various elements. Lewis begins with the consid-
eration of the impact the therapist makes upon a patient by
virtue of factors such as appearance, size, movement,
posture, office setting, among others. Furthermore, he
suggests that students will benefit from as much insight as
possible into their interpersonal style and how this impacts
others. Thirdly, growth in the use of self demands attention
to the therapist’s developing feelings (including sexual
feelings) about the patient. Finally, Lewis utilizes an
exercise in which trainees discuss and elaborate fantasies
about themselves and their patient as a way of uncovering

underlying countertransference.
Glickauf-Hughes (1997) describes a model of supervi-
sion in which supervisees are taught in both didactic and
experiential ways how to manage patients’ use of primitive
defenses such as splitting, projection and projective iden-
tification and their impact on the clinical situation. Citing
302 Clin Soc Work J (2011) 39:301–307
123
the work of Bion (1962) on containment, Glickauf-Hughes
notes that therapy provides a new opportunity for patients
to have their difficult feelings and behaviors effectively
contained thereby allowing for the possibility of an inter-
personal dynamic with the therapist that is different from
the one to which they have become accustomed. In order
for this kind of containment to occur, therapists must be
able to acknowledge, sit with, and wonder about their
experience of a range of affective states that are often

difficult to tolerate, particularly in the clinical context.
Examples of such states might include anger, shame,
incompetence, boredom, and sexual arousal.
These considerations highlight in a particular way the
issue of personal psychotherapy as an element of training
in clinical practice. Personal psychotherapy has long been
considered to be of great benefit to the developing psy-
chotherapist, not only to prevent unresolved personal issues
from adversely affecting the treatment as discussed previ-
ously, but in fact to free up areas of the therapist’s per-
sonality for greater use in the therapeutic relationship
(Thompson 1988/1956; Wolstein 1988/1959). Edwards and
Bess (1998) suggest that personal psychotherapy affords
the student the opportunity to have a therapist who may be
a model for practice, provides a first-hand understanding of
the therapeutic process, and facilitates the integration of
one’s personality with one’s professional learning. In
keeping with the perspective presented here, personal

psychotherapy can provide new clinicians with a safe space
in which to grow in comfort with the exploration of a wide
range of emotional experiences as they deepen their self-
awareness.
Still, the narcissistic vulnerability to which new thera-
pists are subject can make the practice of attending to the
many internal and external aspects of treatment seem
extremely daunting. Psychotherapy trainees of any disci-
pline who are trying on an unfamiliar role are commonly
preoccupied with issues of competence such as following
the rules, doing things correctly and well, understanding
the patient’s presenting problem, and using effective
techniques and interventions. Thus, they may find it quite
difficult to listen deeply to their internal responses in the
ways that have been suggested. An example serves to
illustrate.
Ms. K was a second year social work student placed in
an outpatient mental health clinic. Eager to learn, she

nonetheless expressed normal doubts about her ability
since she had never before conducted individual psycho-
therapy with patients. She felt full of questions on issues
ranging from the initial orchestration of the formalities of a
session to the complex work of assessment, diagnosis, and
intervention. Her supervisor, while providing needed
answers to her task-oriented questions, reassured her that
he would be there to support her, and encouraged her to be
patient with herself and to allow the process to unfold. In
this way he attempted to shore up her vulnerable sense of
self as a student and emerging professional.
As Ms. K began treating her first patients, her supervisor
noted that her process recordings were peppered with self-
recriminations about the ‘‘badness’’ of her reactions to her
patients. Statements such as, ‘‘I’m feeling like I want to
take care of the patient, and I know that is really bad,’’
were common. The supervisor asked her what she believed
was bad about her feelings. Ms. K. stated that she believed

she had to maintain a neutral and distant stance in order to
help her patients. The supervisor clarified that this belief
was grounded in a particular theoretical system and sug-
gested that her countertransference might in fact be helpful
in her work. He encouraged Ms. K to suspend judgment of
her reactions and suggested an observation of the material
that emerged both from the patient and herself, taking all of
this as information that would help her to understand her
patient better. This would serve as a framework for the
interpretation of future countertransference reactions.
Bion (1970) exhorted the analyst to come to the session
without memory, desire, or understanding. Trained in east-
ern traditions of philosophy, Bion believed that such a stance
created the condition for the possibility of openness on the
part of the therapist. If the supervisee can be encouraged to
begin from a stance of non-judgment, both of the patient and
of herself, the kind of observation and active wondering that
the use of self demands may be facilitated. Having thus

cleared away much of the static that can result from
expectable initial self-consciousness and doubt, the student
can be guided to consider and make use of her self experience
in a more integrated way with the patient and to translate this
experience into effective interventions.
The Supervisor as a Model of the Use of Self
As already noted, the task of guiding the beginning clinical
social worker in the development of the use of self falls
largely to the clinical supervisor. What, then, are the attitudes
and tasks that this requires of the supervisor? Like the novice
or experienced therapist, the supervisor may be encouraged
to follow the advice of Bion (1970) by approaching the work
of supervision without memory, desire, or understanding.
Thus, while the supervisee is being encouraged to attend not
only to the accuracy of assessment, understandings, inter-
pretations and other interventions, but also to the role of
countertransference in the weaving of the therapeutic rela-
tionship, so too must the supervisor attend not only to the

work of teaching (i.e. the transmittal of information)
and skill development, but to the impact of counter-
transference reactions on the supervisory relationship itself
(Kindler 1998).
Clin Soc Work J (2011) 39:301–307 303
123
Furthermore, several authors discuss the mutual interac-
tion or influence of the supervisor, the supervisee, and the
patient in the context of supervision. Here too, the supervisor
serves as a model for the use of self. Strean (2000), for
example, notes that attention to one’s own countertransfer-
ence with the supervisee can be useful in working through
difficulties in the student’s clinical work inasmuch as these
difficulties often get unconsciously enacted in the supervi-
sory relationship. He recommends judicious suspension of
the anonymity of the supervisor so as to facilitate the
student’s work. The student is likewise assisted in the

development of the use of self when the supervisor acts as a
model in this way. For example, Knox et al. (2008) found that
supervisors’ self-disclosure of their reactions to supervisees’
patients helped normalize supervisees’ feelings, served as a
teaching tool, and strengthened the alliance between super-
visor and supervisee.
In her method of teaching students to deal with patients’
use of primitive defenses, Glickauf-Hughes (1997) notes
that due to their primitive nature and the complexity of
dealing with them, such defenses may be enacted by
students in the supervisory relationship. This may serve as
an unconscious way of communicating to the supervisor
what is happening in the treatment (Bromberg 1982).
Furthermore, this parallel process offers the supervisee the
opportunity to experience the containment of these difficult
dynamics by the supervisor. Other examples of students’
manifestation of their efforts to manage patient’s primitive
defenses might include rejecting the supervisor’s attempts

to help, feeling dejected because of a patient’s devaluation
of them, expressing intense anger towards the patient, and
wishing to terminate the therapy precipitously. Glickauf-
Hughes recommends a variety of techniques for dealing
with this including various combinations of teaching,
clarification, modeling, and role playing.
Kindler (1998) discusses supervision from a self-psy-
chological perspective. Borrowing from Fosshage’s (1995)
thinking regarding the analyst’s experience of listening
from a variety of positions, Kindler applies this construct to
the supervisory relationship. In addition to her stance as
supervisor, she may also take the position of the supervisee
as well as the patient. Furthermore, the supervisor may
listen from the perspective of empathy (e.g. from the
patient’s perspective) or from an other-centered perspec-
tive (e.g. as someone in relationship to the patient). By
taking this stance, the supervisor may more effectively
listen and understand not only the patient’s internal pro-

cess, but the dynamic process between the supervisee and
the patient. This facilitates not only the treatment but the
development of the supervisee as well. Confirmation of this
development may be seen in the supervisee’s increased
capacity for self-righting, the expansion of self-awareness,
and symbolic reorganization.
Kindler goes on to emphasize the importance of the
supervisor’s empathic listening to the supervisee, even if
this seems to preempt the discussion of patient material.
This activity is viewed as not only modeling the process of
self-psychologically-oriented treatment, but also serving
self-cohesion and vitality functions for the supervisee thus
enabling her to focus more adeptly on the subjectivity of
the patient. Likewise, consistent with a self-psychological
orientation, he recommends a close and non-defensive
attention to the supervisee’s experience of the supervisor to
promote feelings of safety and the growth of the supervi-
sory relationship.

From a related school of thought, Brown and Miller
(2002) add an intersubjective nuance to the discussion by
viewing the supervisory process as a triadic intersubjective
matrix. While akin to Fosshage’s (1995) notion of multiple
perspectives, Brown and Miller see the supervisory rela-
tionship as the ‘‘point of interaction’’ (p. 814) of three
unconscious processes. By viewing the supervisory expe-
rience as a ‘‘space for listening’’ the authors seek to attend
to the unconscious communication between supervisor,
supervisee, and patient. Such a perspective does not come
without its perils, according to the authors. Attending to the
confluence of unconscious processes in this way runs the
risk of blurring the line between supervision and the
supervisee’s personal treatment—a hazard not uncom-
monly encountered in the supervisory relationship. Like-
wise, supervision in this vein depends upon the willingness
of both supervisor and supervisee to foster an atmosphere
of self-disclosure in which material such as dreams as well

as their personal reactions in the process are laid bare. The
authors acknowledge that this may be difficult especially
for the beginning student who is in a more vulnerable
position.
Calling upon Mitchell’s (1998) notion of the relational
matrix, Ganzer (2007) applies a relational perspective to
the structure of supervision. She states that a relationally
oriented supervision is built not on the hierarchical stance
of the supervisor vis a vis the supervisee, but on the mutual
influence of the supervisor, the supervisee and the patient.
This relational matrix, she suggests, is constructed from the
intrapsychic, interpersonal, environmental, and organiza-
tional characteristics of all those involved.
Clinical Example
Ms. K brought the case of Victoria to supervision. Ms. K
had begun treatment with Victoria approximately 4 weeks
earlier. A single woman in her early twenties, Victoria was
accompanied to the clinic by her mother and the two began

to describe issues of poor self-esteem, a history of learning
difficulties, social awkwardness, irritability, and loneliness.
304 Clin Soc Work J (2011) 39:301–307
123
Her mother reported frustration with Victoria, stating that
she just wanted her to get married, and stop being such a
problem. Significantly overweight, Victoria reported a
great deal of self-consciousness about her appearance and
detailed her envy of her reportedly beautiful and popular
sisters. She had never been in a romantic relationship, and
though she longed for this experience she stated that she
did not know how she would ever find a man who would
love her. She stated that she felt verbally abused by her
father and brother who called her names and related trau-
matic incidents of verbal abuse by teachers when she was
in grade school. She noted that these experiences continued
to disturb her.

Though Victoria stated that she wanted therapy, Ms. K
reported that she experienced her as apathetic and com-
plaining during the sessions and wondered what to make of
this. Ms. K went on to explore further with her supervisor
an incident with Victoria that had occurred the day before
supervision. Victoria had arrived for her session over two
hours late. When Ms. K was informed by the receptionist
that Victoria had arrived she was surprised, having sup-
posed that Victoria would not come at all. She informed the
secretary that she would be down shortly to speak with
Victoria. Ms. K came to the supervisor’s office for advice
on how to proceed. While she had availability in her
schedule she did not know if she should see Victoria. She
stated that she had learned in Social Work Practice class to
reinforce the importance of coming on time to session, and
she was concerned about the possibility of encouraging the
behavior of arriving late. While acknowledging this,
the supervisor reminded Ms. K that it was still unclear

why Victoria had come late. Together they decided that,
when she went to speak with Victoria, Ms. K would inquire
about the reason for the lateness and assess whether or not
Victoria was in any kind of crisis. If Victoria was in crisis,
she would be seen. If she simply had not come on time,
Ms. K would reschedule the session.
Ms. K told the supervisor that when she went down-
stairs, she greeted Victoria in a friendly manner. She noted
that Victoria did not appear to be in any distress. Ms. K
called Victoria to the side and quietly noted that she was
two hours late for her appointment. Ms. K asked Victoria if
she was alright and assessed her for any sign of crisis.
When Victoria stated that everything was fine Ms. K told
her that they would need to reschedule the appointment. At
that, Victoria began to yell loudly at Ms. K, asking her why
she hadn’t said so in the first place. Ms. K felt confused and
asked what Victoria meant. Victoria responded in the same
loud tone that Ms. K should have just told the secretary that

she was not going to see her instead of making her sit there
and wait. When Ms. K replied that she wanted to come
down and speak with Victoria personally, Victoria yelled
that all Ms. K was doing was wasting Victoria’s time. With
that she stormed out of the clinic as other patients looked
on from a nearby waiting area. No follow up appointment
was made. Ms. K stated that she was unsure what to do
next.
When the supervisor asked Ms. K how she felt about what
had transpired she reported confusion and anger. The con-
fusion, she said, related to her sense that Victoria’s outburst
had come out of nowhere. The anger related to her embar-
rassment at having been yelled at in view of the receptionist
and patients in the waiting room. Furthermore, she admitted
that, in her anger, she felt ‘‘turned off’’ to the idea of working
with Victoria and somewhat pleased at the prospect of not
seeing her again. The supervisor validated Ms. K’s reactions
both verbally and non-verbally, empathizing with both how

confusing and embarrassing it must have been for her. He
then asked Ms. K if she felt able to sit with those feelings and
her memory of the interaction. Perhaps she and the super-
visor could wonder about this together. What else did she
think and feel about her exchange with Victoria? What else
might have been going on?
As she processed her experience with the supervisor,
Ms. K stated that it seemed like Victoria was telling her she
was a bad therapist and was therefore rejecting her by
storming out of the clinic. She spoke about feeling
embarrassed and thought that she had perhaps not handled
the situation well. Maybe this was why Victoria was
leaving treatment. For his part, the supervisor was aware of
having another feeling about the interaction between Ms. K
and Victoria. He shared with Ms. K his sense of irritation.
Victoria seemed not to have taken into account the value of
Ms. K’s time, he said, but then proceeded to accuse Ms. K
of wasting her time. This led Ms. K to identify more with

her own sense of irritation, which she had initially named
but then abandoned to focus on her sense of embarrassment
and inadequacy. The supervisor interpreted these latter
feelings as understandable and likely related to her inse-
curity as a beginner, and added that they may in fact cloud
some of her deeper reactions. The supervisor further noted
that, if properly contained and dealt with, difficult count-
ertransferential reactions, like irritation, can sometimes be
a great source of insight and can open new pathways for
therapeutic progress.
As they continued the supervisory session, the supervi-
sor encouraged Ms. K to sit with and be curious about her
own sense of irritation or annoyance. This led Ms. K to
make a number of associations to Victoria’s mother and to
descriptions of the dynamics between the two as well as
to Victoria’s home life in general. The supervisor asked
Ms. K to describe these. What emerged was a pattern of
unstable, shifting affects in Victoria’s relationships that

evoked in her the very sense of emptiness and inadequacy
she sought to remedy through therapy. As the supervisory
dialogue continued, and the supervisor further modeled a
Clin Soc Work J (2011) 39:301–307 305
123
wondering stance, Ms. K grew more comfortable articu-
lating and exploring her feelings and associations to what
transpired with Victoria the day before. Having shared his
sense of irritation, the supervisor facilitated Ms. K’s
identification and acceptance of her own anger, as well as
her desire to end her therapeutic relationship with Victo-
ria—not an easy thing for a new supervisee to admit to her
supervisor.
However, this in turn helped Ms. K identify on an
experiential as well as intellectual level a pattern whereby
Victoria thwarted the development of healthy relationships.
The supervisor encouraged Ms. K to think more deeply

about the origins and implications of this pattern. Ms. K
began to see that this aspect of Victoria’s interpersonal
behavior was born of repeated experiences of traumatic
rejection that led to a narcissistically depleted self. In a
self-protective but interpersonally frustrating way, Victoria
evoked the very rejection she feared. However, she did so
in such a manner as to walk away with some sense of
control. At this point Ms. K said she was aware of expe-
riencing even more empathy for Victoria and felt free to
reach out genuinely to Victoria while allowing her the
freedom to leave treatment if she chose to. With a mini-
mum of effort, Ms. K was able to reconnect with Victoria
and her treatment continued. Ms. K’s increased under-
standing of and empathy for Victoria helped her not only to
facilitate the repair of their relationship but to form a strong
working alliance with her. Together, they began to examine
the dynamics of Victoria’s relationships and how they
could be improved.

This clinical and supervisory experience helped Ms. K
to grow in a number of ways. On a procedural level, she
gained a clearer understanding of the way in which patient
lateness was handled in the mental health clinic to which
she was assigned. Furthermore, she benefitted from the
experience of working through a conflictual encounter with
her patient. Perhaps most significantly, however, she grew
in her ability to explore her affective response to her
patient and to wonder about the nature and meaning of that
response. Further development of this skill will contribute
to her growing confidence and effectiveness as a clinician.
Conclusion
The development of the use of self demands cooperative
effort on the part of both the social work supervisee and the
clinical supervisor. For the supervisee, this means the fos-
tering of self-awareness with its attendant risks, the will-
ingness to explore countertransferential experiences on all
levels, the capacity for insight, and the ability to tolerate

uncertainty and to suspend judgment both of the self and the
patient in order to listen with evenly suspended attention. For
the supervisor, this means the ability to model self-awareness
and the vulnerability that comes with the appropriate sharing
of one’s feelings and thoughts, and the ability to listen
carefully and non-judgmentally not only to one’s own
countertransference, but to the experiences of the patient and
supervisee alike. Having assisted the supervisee in the
identification and exploration of his or her experience of the
patient, the supervisor is then able to help the supervisee
translate that insight into clinically useful interventions that
will advance the treatment. In this way, the supervisor is in a
unique position to assist in the integration of the new clini-
cian’s personal and professional identities, and the honing of
the finest of therapeutic instruments—the supervisee’s very
self.
References
Bion, W. (1962). Learning from experience. London:
Heinemann.

Bion, W. (1970). Attention and interpretation. London:
Tavistock.
Bromberg, P. M. (1982). The supervisory process and parallel
process.
Contemporary Psychoanalysis, 18(1), 92–111.
Brown, L. J., & Miller, M. (2002). The triadic intersubjective
matrix
in supervision: The use of disclosure through painful affects.
International Journal of Psychoanalysis, 83(4), 811–823.
Edwards, J. K., & Bess, J. M. (1998). Developing effectiveness
in the
therapeutic use of self. Clinical Social Work Journal, 26(1),
89–105.
Fosshage, J. (1995). Countertransference as the analyst’s
experience
of the analysand: Influence of listening perspectives. Psychoan-
alytic Psychology, 12(3), 375–391.
Freud, S. (1910). The future prospects of psycho-analytic
therapy S.E.
(Vol. 11, pp. 139–151). London: Hogarth.
Freud, S. (1912). Recommendations to physicians practising
psycho-
analysis S.E. (Vol. 12, pp. 109–120). London: Hogarth.
Ganzer, C. (2007). The Use of self from a relational
perspective.
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Gill, S. (2001). Narcissistic vulnerability in supervisees: Ego
ideals,
self-exposure and narcissistic character defenses. In S. Gill
(Ed.),
The supervisory alliance: Facilitating the psychotherapist’s
learning experience (pp. 19–34). Lanham, MD: Jason Aronson.
Glickauf-Hughes, C. (1997). Teaching students about primitive
defenses in supervision. The Clinical Supervisor, 15(2), 105–
113.
Jacobs, T. (1991). The use of self: Countertransference and
commu-
nication in the analytic situation. Madison, CT: International
Universities Press.
Kindler, A. R. (1998). Optimal responsiveness and
psychoanalytic
supervision. In H. A. Bacal (Ed.), Optimal responsiveness: How
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Inc.
Knox, S., Burkard, A. W., Edwards, L. M., Smith, J. J., &
Schlosser,
L. Z. (2008). Supervisor’s reports of the effects of supervisor
self-disclosure on supervisees. Psychotherapy Research, 18(5),
543–559.
Lewis, J. M. (1991). Thirty years of teaching psychotherapy
skills.

International Journal of Group Psychotherapy, 41(4), 419–432.
Mitchell, S. (1998). Relational concepts in psychoanalysis: An
integration. Cambridge, MA: Harvard University Press.
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countertransfer-
ence. In B. Wolstein (Ed.), Essential papers on countertrans-
ference (pp. 158–201). New York: New York University Press.
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Reupert, A. (2007). Social workers’ use of self. Clinical Social
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Journal, 35(2), 107–116.
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self.
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369–383.
Strean, H. S. (2000). Resolving therapeutic impasses by using
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supervisor’s countertransference. Clinical Social Work Journal,
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Author Biography
John P. McTighe is Associate Director of Counseling, Health &
Wellness at William Paterson University. He holds a M.S.W.
and
Ph.D. in Clinical Social Work from New York University. He is
an
adjunct assistant professor of Pastoral Counseling at Fordham
University and maintains a private practice in northern New
Jersey.
Clin Soc Work J (2011) 39:301–307 307
123

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Case Study: Working With Groups: Latino Patients Living
WithHIV/AIDS
The support group discussed here was created to address the
unique needs of a vulnerable population receiving services at an
outpatient interdisciplinary comprehensive care center. The
center’s mission was to provide medical and psychosocial
services to adult patients living with HIV/AIDS (PLWH). Both
patients and providers at the center expressed a need for a group
to address the needs of the center’s Latino population. At the
time the group was created, 36% of the center’s population
identified as Latino, and 25% of this cohort identified Spanish
as their primary language. The purpose of the group was
twofold: 1) to reduce the social isolation felt by Latino patients
at the center and 2) to create a culturally sensitive environment
where Latino patients could explore common medical and
psychosocial issues faced by PLWH within a cultural context.
Planning for the group consisted of 1) defining a format for the
group, 2) recruiting appropriate members, and 3) building an
appropriate group composition. When considering the format of
the group, I thought about structure, time, place, and language.
The group was designated a closed group in that new patients
were not admitted once the initial membership was determined.
The group was held in the center’s conference room, which was
furnished with comfortable seating around a large conference
table so that members were visible to each other during group
sessions. The group met once a week for 90-minute sessions

during which 60 minutes were spent on open discussion and the
last 30 minutes were spent on having lunch. Given the
importance of food in the Latino culture, I thought members
would appreciate the opportunity to share a meal with their
peers. I decided to designate the group as Spanish-speaking so
that all sessions were held in Spanish. This offered members not
only a sense of comfort and an opportunity to explore issues in
their native tongue, but it also addressed the language barrier
that often isolates Latino PLWH.
I used several strategies to recruit members. I hung flyers
throughout the center, and I informed my colleagues about the
group during interdisciplinary staff meetings. Referrals
ultimately came from physicians, social workers, and even
administrative staff who had developed relationships with
patients at the center. When considering group composition, I
focused on creating balance in group size and the characteristics
of individual members. I worked to create a group with enough
members so that discussions would be fruitful and differing
opinions could be presented, but at the same time, individual
members would have an opportunity to discuss their unique
feelings, thoughts, and opinions. When it came to member
characteristics, I strove to create a balance between
homogeneity and heterogeneity across such domains as age, sex,
sexual orientation, socioeconomic status, etc. The goal was to
create a group where no member felt isolated by uniqueness
while simultaneously promoting diversity between members.
Prior to being admitted to the group, potential members were
interviewed/screened in person or by phone. The focus of these
interviews was to 1) assess the patient’s ability to communicate
in Spanish, 2) describe the purpose of the group, 3) discuss
individual expectations for the group, and 4) answer questions
about group process and function. A total of 15 patients were
referred. Four declined to participate before the group started
and two did not show up after the first session. Of the remaining
nine members, three were women and six were men. All of the
men had a significant history of intravenous drug use (IVDU).

Two of the men identified as gay, one identified as bisexual,
and three considered themselves to be heterosexual. All of the
women were heterosexual, identified a risk factor of
unprotected heterosexual sex, and denied a history of IVDU.
Members’ ages ranged from 36 to 60.
The group ran successfully for 18 months. Throughout the life
of the group, several recurrent themes were discussed, including
1) stigma of HIV and homosexuality, 2) disclosure of HIV
status, 3) safer sex practices, 4) adherence to HIV treatment,
and 5) the doctor–patient relationship. Each of these themes was
discussed within a cultural context giving light to issues such as
familialism, collectivism, simpatia, machismo (gender roles),
and Latino culture’s tendency to rely on a folk model of
medicine.
As in most groups, certain members adopted roles within the
group. For example, Anna, a 46-year-old female member,
adopted the role of the “silent member.” She repeatedly came to
sessions and sat in silence, only responding when she was
prompted by direct questions from me or other members. The
challenge with Anna was that as this behavior continued, other
members tended to ignore her and leave her out of the
discussion. In turn, it became my role to try to engage Anna as
much as possible and draw her into the discussion. Another
example is Diego, a 60-year-old male, who adopted the role of
the “help-rejecting complainer.” Throughout group sessions,
Diego repeatedly presented a problem or issue and engaged the
entire group by asking for help. When members responded with
suggestions or solutions, he came up with a myriad of excuses
why none of them would work. I will admit I was not successful
at altering Diego’s behavior in any way. I attempted to point out
the pattern, and I tried to ask other members how it felt to
constantly have their input rejected, but nothing seemed to
work. Group members did express frustration and boredom with
Diego. This was manifested in their body language and during
group sessions when Diego was not present. When members
spoke about Diego in his absence, I always encouraged them to

bring these issues to his attention when he was present, but
members were not able to do this because they were fearful of
hurting his feelings.
Ultimately, the group served as an arena for mutual support and
commonality. Group members forged relationships with peers
with whom they would not have had contact in the absence of
the group. They also had the opportunity to reflect on their
illness and personal experiences within a safe and culturally
sensitive environment. While a scientific evaluation of the
group was not performed, I witnessed and members reported
positive outcomes from the experience.
Discussion 1:
Policy Process and Public Opinion
Managing public opinion and understanding the balance
between its influence and your advocacy goals is a delicate
matter. It is a task fraught with uncertainty because, as a policy
advocate, you must navigate through the territory of politicians,
bureaucrats, and lobbyists whose primary goals are to appease
and please their constituents.
In this Discussion, you select a social problem that is of interest
to you and identify how public opinion influences the process
and political approaches involved in addressing that social
problem.
Children stuck in the foster care system is the topic.
Post a description of the importance of public opinion in
addressing the social problem you have selected. How does
public opinion influence political approaches to the problem?
Explain. What policy advocacy approaches and skills can you
use to address the problem with political leaders? What are the
social justice implications of your approach?
Should be at least 100 words and contain at least 2 references

and 2 in text citations in APA format. References should be
from 2013-2018.Discussion 2: Confidentiality
One of the most important concepts in clinical practice and
group work is confidentiality. All members of the group sign an
informed consent form in order to address the rules and
parameters of the group sessions. The rules regarding
confidentiality are stated in one section of the form. Although
every member must sign this agreement, ensuring that all
information shared in the group remains confidential can be
difficult. As the group leader, the clinical social worker is
responsible for developing strategies so that all members feel
safe to share.
For this Discussion, review the “Working With Groups: Latino
Patients Living With HIV/AIDS” case study (in attachments).
Post strategies you might prefer to use to ensure confidentiality
in a treatment group for individuals living with HIV/AIDS.
Describe how informed consent addresses confidentiality in a
group setting. How does confidentiality in a group differ from
confidentiality in individual counseling? Also, discuss how you
would address a breach of confidentiality in the group.
Should be at least 100 words and contain at least 2 references
and 2 in text citations in APA format. References should be
from 2013-2018.
Discussion 3: Week 4 Blog
Refer to the topics covered in this week's resources and
incorporate them into your blog.As you engage in social work
practice, your professional identity will emerge. Field
instructors will have different leadership styles, and
determining where you fit within their leadership structure may
affect the extent to which you acquire your social work practice
skills. To facilitate the development of sound social work
practice skills, the relationship between you and your field
instructor will be important.

Post a blog post that includes:
· An explanation of the role of supervision in your field
education experience – Supervision assigns me work, verifies
the quality of my work, and provides me feedback.
· A description of your field instructor's leadership style and an
explanation of whether the leadership style will promote your
agency learning agreement during your field education
experience – Field instructor is hands on, she likes to makes
sure she is supportive, and she is encouraging.
· Incorporate three references and in text citations to this weeks
reading resources. This weeks reading resources are listed
below.
Bogo, M., Regehr, C., Power, R., & Regehr, G. (2007). When
values collide: Field instructors' experiences of providing
feedback and evaluating competence. The Clinical Supervisor,
26(1–2), 99–117. (in attachments)
Mctighe, J. P. (2011). Teaching the use of self through the
process of clinical supervision. Clinical Social Work Journal,
39(3),301–307. (in attachments)
Should be at least 150 words.

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