Supervision: Enhancing Supervisees Clinical Skills

Relationship as a Secure Base in Counseling Supervision
A key assumption of attachment theory is that "the capacity to make intimate emotional bonds with other individuals, sometimes in the careseeking role and sometimes in the caregiving one is regarded as the principle feature of effective personality functioning and mental health" (Bowlby, 1988, p. 121). Attachment relationships established between supervisors and supervisees should, therefore, be considered both normal and productive. A secure foundation provides the supervisee with sufficient safety so that he or she feels confident addressing the supervisor in times of crisis. Consider a supervisee who may be working with his or her first suicidal client. When confronted with this kind of crisis, the individual with a working model of help as unavailable is less likely to seek support (Simpson et al., 1992) and is likely to be more mistrustful (Feeney & Noller, 1990) of others. Because the supervisee may lack confidence that help is forthcoming, he or she may exhibit reluctance in seeking out the supervisor's assistance. During the same stressful circumstances, the securely attached individual holds an internal model of help as available (Mikulincer, 1997) and presents greater levels of trust than his or her less securely attached peer (Simpson et al., 1992). A secure working model enables the individual to be confident in seeking assistance and confident that help will be forthcoming.

In their work with counseling supervisees, Pistole and Watkins (1995) found that the establishment of a secure supervisory alliance "serves to ground or hold the supervisee in a secure fashion" (p. 469). The function of the relationship provides supervisees with security or safety by letting them know (a) "they are not alone in their counseling efforts, (b) their work will be monitored and reviewed across clients, and (c) they have a ready resource or beacon-the supervisor-who will be available in times of need" (p. 469). Similar to Pistole and Watkins's (1995) discussion, the following cases illustrate specific patterns of attachment I have observed when working with counseling supervisees and illustrate how secure supervisor and supervisee attachments were established. The purpose of each of these relationships was to provide supervisees with a stable foundation on which they could base their learning. Although recent studies (Blustein et al., 1995; Feeney & Noller, 1990; Klohnen & Bera, 1998; Lopez, 1996; Simpson et al., 1992) have documented the connection between early childhood and adult attachments, each of these case examples was based on current observable behaviors during a semester-long practicum experience. At no time were the supervisees' early childhood experiences brought into the supervision context. Names and gender have also been changed to protect confidentiality.

Case Example 1: Secure Attachment
A securely attached person, when confronting a stressful circumstance, will be more likely to ask for help than an individual with a working model of "help as unreliable or inaccessible." William exemplified a pattern of secure attachment.

William was enrolled in a practicum course and was assigned to me for supervision. He was active in student organizations, studious, and genuinely interested in his clients. His practicum experience unfolded as a model semester until William was assigned two female clients. I noticed that William, while appearing oblivious of his mannerisms, interacted with these two clients in a condescending manner. We had developed an excellent supervisor-supervisee relationship earlier in the semester, due in a large part to William's genuineness and openness to feedback. For example, William had approached me throughout the semester when unsure of his intervention strategies and counseling style. Our supervision sessions had progressed in an open and productive manner. When confronting William about my concerns regarding his relationship with his female clients, he initially seemed to be hurt; he then asked me to clarify. By reviewing his tapes and previous statements, we were able to pinpoint several instances of gender conflict during his sessions. Some of my feedback was not what William wanted to hear, but he remained open to correcting the problem.

In his following sessions, William addressed gender differences with his female clients, asking them for their impressions of previous meetings. This feedback helped William to rethink how he approached his female clients and to change some of his mannerisms and language to better facilitate the client-counselor relationship. William seemed to have a working model of help as accessible, which allowed him to seek extra supervision when it was needed. Moreover, when changes in his counseling style were warranted, he was open to exploring the changes that were needed and showed confidence in reshaping his role in the therapy room.

Case Example 2: Anxious-Resistant Attachment
An individual with a working model of "others as inconsistent or unreliable" may show anxious-resistant patterns of attachment, including dependency on attachment figures and fear when instructed to resolve crises. Another student, known here as Patty, exhibited some of these characteristics during her practicum experience. Patty was an older student who always seemed to be in competition with her academic colleagues. For example, she was known for directly asking other students what their grades were and frequently interrupted conversations between other students and professors. Her practicum began in crisis with Patty frequently expressing anxiety over her client's presenting problems and her own performance.

Although Patty regularly asked for feedback about her sessions, she often became tearful or despondent. She sought out, at inopportune times, any and all previous instructors, repeatedly asking the same questions that she had posed earlier in supervision. I focused on establishing a supportive relationship with Patty. This included developing clear boundaries regarding appropriate disclosure in and out of supervision, what constituted an emergency, and my own time limitations. Initially, Patty expressed anxiety and frustration with these guidelines. For 2 months, I continued to provide her with our regularly scheduled supervision and also remained accessible throughout the week if she believe had a real emergency. I noticed that as the weeks passed, Patty began to realize that my office hours remained stable and that she could easily reach me by telephone or e-mail. She also began to relax and focus more on her clients, ceasing to badger student colleagues and instructors with minor concerns.

Although I might have categorized Patty as a high-maintenance practicum student, eventually she was able to develop confidence in her own abilities and to be open to constructive feedback. Moreover, whereas Patty may have held a working model of "help as inconsistent," it is possible that the development of a stable relationship provided her with a foundation on which she could develop confidence in her supervisor and in herself as a professional. This hypothesis is consistent with the literature (Collins & Read, 1990; Kenny & Rice, 1995; Lopez, 1996) discussing the potential for modifying an adult's working model of self and others.

Case Example 3: Anxious-Avoidant Attachment
An anxious-avoidant pattern of attachment is based on an individual's belief that no assistance will be forthcoming in times of crisis. Whether or not he or she has the necessary skills and knowledge, an individual with this kind of working model may attempt to solve problems alone. One such person, known here as Helen, was a student who presented characteristics of this pattern during her practicum experience. Helen seemed to have few friends or academic colleagues. She rarely engaged in peer supervision except to state her opinion as the "right" way to proceed. Establishing a productive supervisor-supervisee relationship with Helen was a slow and painstaking process. She seemed closed to feedback of any kind, at one point snatching corrected progress notes from my hands, saying that I had "ruined" them. I let the incident pass, realizing that addressing her behavior would be useless until she learned to trust me. During the next few weeks, I refrained from constructive feedback regarding her use of empathy in the therapy room, choosing instead to observe her sessions closely and to focus supervision on Helen's comfort level with the practicum itself. Gradually, Helen began to open up to me. One month after she had snatched the progress notes from my hand, she apologized for her behavior. By the end of the semester, Helen actively sought constructive feedback and worked outside of practicum hours to develop her empathy skills. She also began to take a genuine interest in listening to peer feedback. Although Helen was able to begin developing a productive supervisor-supervisee relationship, at the end of the semester she remained somewhat aloof from her student colleagues and seemed to be defensive when she received feedback from any supervisor other than me. It seemed to me that Helen held a working model of "help as inaccessible," which influenced her motivation to seek out the support she needed to develop her counseling skills.
- Neswald-McCalip, Rhonda, Development of the Secure Counselor: Case Examples Supporting Pistole & Watkins (1995) Discussion of Attachment Theory in Counseling Supervision, Counselor Education & Supervision, Sep 2001, Vol. 41, Issue 1.

Personal Reflection Exercise #10
The preceding section contained information about the attachment theory in counseling supervision. Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Bedford, S., Repa, L., & Renouf, A. (2020). Supervision in interprofessional education: Benefits, challenges, and lessons learned. Journal of Psychotherapy Integration, 30(1), 16–24.

Danzi, B. A., Tawfik, S. H., Mora Ringle, V. A., & Saez-Flores, E. (2020). Enhancing profession-wide competencies in supervision and assessment: An evaluation of a peer mentorship approach. Training and Education in Professional Psychology, 14(3), 176–184.

Falender, C. A. (2018). Clinical supervision—the missing ingredient. American Psychologist, 73(9), 1240–1250.

Online Continuing Education QUESTION 17
Upon what belief is an anxious-avoidant pattern of attachment in clinical supervision based? Record the letter of the correct answer the CEU Test