In the last section, we discussed three key ethical issues involved in the supervision of a therapist: proper knowledge and skill; avoiding dual relationships; and fair and balanced assessment evaluations.
In this section, we will present methods to help improve your supervisee's therapist-client relationships.
In my experience as a supervisor, I prefer to review the basics of a client session initially with a supervisee in four steps to make sure we're on the same page. The four parts I use are preparation; beginning; exploration; and creating contracts. Of course, you will have your own system, but I feel it's important not to assume that your supervisee is aware of some therapy basics, so I state, "Let's make sure we're on the same page."
4-Step Review of a Client Session
♦ Step #1 - Preparation
The first step in therapist-client relationships that I believe a supervisee should keep in mind to improve the therapist-client relationship is preparation. Before actually setting foot into a room with the client, it would be beneficial for the supervisee to prepare him or herself as much as possible.
In these cases, the supervisee would obviously review the client's history, whether there had been:
1. Cases of abuse or other trauma issues in the past,
2. Whether the client is susceptible to suicide or other bodily harm, or
3. Whether their history is entirely lacking in mental disorder.
On the supervisee's part, I feel it would be useful to consult you, the supervisor, to identify any objectives that should be considered before the first session. However, as you are aware, as the supervisee's experience increases, the need for a preparatory consultation with a supervisor will decrease. In readying a supervisee's empathy, I ask him or her to consider what types of emotions a certain client will most likely bring to a session based on their preparatory review and exploration. Preparatory empathy could also include taking into account the client's cultural aspects.
♦ Technique: Empathic Exercise
Because preparatory empathy I feel is one of the more key preparation tasks, I ask some of my supervisees to undergo an "Empathic Exercise" technique prior to working with their first client. In this technique, I relate to the supervisee a scenario and ask him or her to write down their emphatic emotions.
One of my scenarios is the following: "Assume that you are a therapist in a general hospital. This morning, a physician contacts you and asks that you accompany her while she informs the mother and father of a 16-year-old boy that their son has AIDS. The physician wants you to provide support to the family after she informs them of the diagnosis and prognosis." Many times, the supervisee states: grief, anger, maybe resentment. Also an occasional sense of loss and failure as parents. I also ask them to take into account the potential sexuality question, whether or not the client is homosexual and if the parents are aware of this.
♦ Step # 2 - Beginning
The second phase in covering therapist-client relationships with your supervisee is the actual beginning of the first session with a client.
Two Parts to Beginning the First Session with a Client
As you know, this stage formally begins when a supervisee, in the role of a therapist, and the client encounter one another. First impressions are vital, so it's necessary to review proper introduction etiquette. Here are the basics that bear repeating. They are so basic, I find that many supervisors overlook them and assume their supervisee has learned this in grad school.
The supervisee usually starts by identifying him or herself by full name and profession, and by agency or departmental association. For example, a supervisee might say, "Hello Mr. and Mrs. Doe" and at this point the supervisee would offer a hand to shake and continue, "I'm Dr. Colby. I'm a therapist here at the family service agency. I specialize in helping people who are dealing with family issues of one kind or another."
The next step in the beginning phase would be describing initial purpose for the visitation. The supervisee would state clearly and succinctly, "During our meeting today, I'd like to explore in detail with you the nature of your marriage, its history, and how it developed to this point. As we both gain a better understanding of the circumstances, we can decide together what to do next."
As you can see, though the therapist clearly stated the purpose of the meeting, he left it open for the client to outline his or her own role. Also remember to explain to your supervisee the importance of discussing ethical and policy factors to the client such as confidentiality, reporting laws, or any other such legality matters.
♦ Step # 3 - Exploration
In addition to preparation and beginning, the third phase in therapist-client relationships when covering the basics is exploration in which the supervisee engages the client in a mutual exploration of the person, issue, or situation.
7 Exploration Skills
As you know, the skills most applicable to the exploration phase are:
1. Asking questions that led to the situation in which the client now finds him or herself.
2. Seeking clarification on statements that may seem unclear.
3. Reflecting content in communicating your understanding of the factual or informational part of the message.
4. Reflecting feelings in communicating your understanding of the feelings expressed by the client.
5. Reflecting feeling and meaning by using the format "You feel this emotion because of this situation."
6. Partializing is used to break down several aspects and dimensions of the person-issue-situation into more manageable units to address them more easily.
7. Going beyond what is said to extend slightly what the client has actually said according the supervisee's empathic understanding of the client.
By emphasizing these skills to your supervisee, you can help them more efficiently explore the dimensions of a client's situation.
♦ Step # 4 - Creating Contracts
In addition to preparation, beginning and exploration, a fourth phase in the basics of therapist-client relationships that I cover with my supervisee is creating contracts. Creating contracts involves reflecting an issue, clarifying issues for work, and establishing goals.
Two Steps to Creating a Contract
A. Reflect an Issue
To reflect an issue, I ask my supervisees to try the following format: "As you see it, one of the issues you'd like to address in our work together is_____." As you can see, the supervisee, through this format, can demonstrate to clients that he or she understands their views of an identified topic of concern.
B. Clarify Issues
To clarify issues for work, I ask my supervisees to extract these issues from those the client has identified, those the supervisee has contributed, or some negotiated combination of the two.
To facilitate relationship with clients, I ask supervisees just starting out in a session to try the following format: "I think we agree about the primary issues that we will address in our work together, Let's review them and I'll write them down so that we can refer to them as we go along. First there is the issue of _____. Second, the issue of _____. Third, _______. What do you think? Is this an accurate list of the issues that we'll address together?" Notice that the supervisee is always including the client's opinions on a course of action.
In this section, we discussed methods to help improve your supervisee's therapist-client relationships by relating the basic method of an interview session with a client in four steps: preparation; beginning; exploration; and creating contracts.
In the next section, we will examine ways to evaluate and identify problems in the supervisor-therapist relationship and in the therapist-client relationship: identifying avoidance of conflict; and the "Interview Session Checklist".
Peer-Reviewed Journal Article References:
Borelli, J. L., Sohn, L., Wang, B. A., Hong, K., DeCoste, C., & Suchman, N. E. (2019). Therapist–client language matching: Initial promise as a measure of therapist–client relationship quality. Psychoanalytic Psychology, 36(1), 9–18.
DePue, M. K., Liu, R., Lambie, G. W., & Gonzalez, J. (2020). Examining the effects of the supervisory relationship and therapeutic alliance on client outcomes in novice therapists. Training and Education in Professional Psychology. Advance online publication.
Vandenberghe, L., & Silveira, J. M. d. (2012). The trouble with the short-term therapist-client relationship and what can be done about it. International Journal of Behavioral Consultation and Therapy, 7(2-3), 159–166.
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