Supervision Essentials for AEDP Natasha C. N. Prenn and Diana Fosha (from the APA’s Clinical Supervision Essentials series) Chapter Two: Essential Skills- Vol 7
This chapter outlines the skills we use to translate theory into clinical practice. We start with the role of the relationship and the stance of the supervisor in the relationship. Then we guide you through what we teach and how we teach it—including the essential skills of accelerated experiential dynamic psychotherapy (AEDP) and the language of interventions—highlighting experiential techniques imported directly into supervision from AEDP.
THE ROLE OF THE RELATIONSHIP IS CENTRAL
Although it has been widely acknowledged that the relationship is crucial to supervision (Angus & Kagan, 2007; Budge& Wampold, 2015; Ellis & Ladany, 1997; Watkins, 2012; Watkins, Budge, & Callahan, 2015; Watkins & Milne, 2014), what is unique to AEDP therapy and supervision is how we work with relational experience. We make the experience of therelationship and relatedness explicit, and then we work with that experience both experientially (i.e., proceduralknowledge) and reflectively (i.e., declarative knowledge; Binder, 1993; Watkins, 2012). The use of the relationship is a particular skill set that we explicitly teach (Levenson, 1995). “What is your reaction to me right now?” “How are youexperiencing me now?” “What is your sense of me right now?” These are interventions that work well. One of AEDP’smajor contributions to psychotherapy is unpacking the different ways in which we explicitly use the therapist’s— or thesupervisor’s—self and experience.
Copyright © 2017 American Psychological Association. Reproduced with permission. Supervision Essentials for Accelerated Experiential Dynamic Psychotherapy, by N.C.N. Prenn and D. Fosha.[Full bibliographic citation.] The book is available for purchase at http://www.apa.org/pubs/books/4317435.aspx.
Theoretically, the relationship is a vehicle for change (Lipton & Fosha, 2011); experientially, we as supervisors use thein vivo lived history of our supervisor–supervisee real relationship to facilitate change. The relationship is layered: supervisor and supervisee, therapist and client, and then, also through the work, the relationship that develops between supervisor and client. In supervision that is going well, all three individuals—client, therapist, and supervisor—are in relationship, and through that relationship are learning and changing, and are in transition. As a senior clinician new to AEDP said,
All my training up until now was about how to take myself out of the room and out of the relationship. And nowneuroscience and attachment theory is saying it is the relationship that is central to healing. I know that is right, Iwant to do it, and I don’t know how to do it.
How to Be: I Interact; Therefore, I Am (Tronick, 1998)
The supervisor’s drive to connect, his or her ability to be responsive to need in each moment, and the supervisor’sfund of AEDP knowledge, expertise, and experience combine to make him or her a good enough supervisor(channeling Winnicott’s, 1960, good enough mother for her supervisee). When supervisor and supervisee show up authentically, and the supervisee takes the risk to ask for something he or she needs and the supervisor responds tothat need—responsiveness to need in the moment—we describe this as true self–true other relating (Fosha, 2000b, 2005). The supervisor is a true other to the true self of the supervisee, who, in turn, is a true other to the true self of his orher client (Prenn & Slatus, 2014; see Figure 2.1 concept by Jessica Slatus).
These experiences of true self–true other relating that are lived through together by supervisee and supervisor arecocreated; they increase safety and security, and result in further exploration and risk-taking. The attachment relationship, the secure base (Bowlby, 1988), is continually checked in on and renewed through lived-together moments in which we show up and try to be of help again and again. If we were to translate into words the felt sense of security that emerges in this relationship, they might be:
I can be emotionally real with my supervisor and she will help me. She will understand me and normalize my struggles, and together we will track what I do and what needs to be done. She will point out what is going well and add some of her own ideas, as well, so I can expand my sense of self as a therapist.
AEDP therapy aims to be a transformational therapy. AEDP supervision, being first and foremost experiential, aimsto be a transformational supervision. Eileen Russell (2015) has referenced the work of[Role of the supervisor as true other–true self. Copyright © 2016 by Viktor Koen. Reprinted with permission.]
psychoanalyst Christopher Bollas (1987), who talked about the mother’s being a transformational other to the baby’stransforming self or self-in-transition. Russell, channeling Bollas, talked about the therapist as transformational otherto the client’s self-in-transition. Here, we are extending that terminology to the supervisory process: The supervisor is transformational other to the supervisee’s transitional self in the context of the supervision he or she is conducting in which the supervisee, in turn, is transformational other to the client’s self-in-transition. Thus, in AEDP, we have the triadof the transformational other (i.e., supervisor) to self-in-transition/transformational other (i.e., supervisee/therapist) to self-in-transition (i.e., client).
“The ideal supervisor . . . exhibits high levels of empathy, understanding, unconditional positive regard, flexibility, concern, attention, investment, curiosity, and openness” (Carifio & Hess, 1987, p. 244). Frequently, these seem to be personal characteristics: Supervisors are born and not made. Yet, woven into the theory of AEDP are a stance and relational skills that inform how to “be” and delineate how to “do” all of the above. The AEDP framework supports theclinician’s ability to not only learn skills but cultivate these capacities. We can do specific behaviors to be this way and we can say particular things to express these characteristics.
The AEDP Supervisory Stance
A number of discrete behaviors double as personality traits, yet they are teachable via the AEDP stance and technique (Fosha, 2008). These behaviors include being kind, real, present, and generous (Pizer, 2012); being with; fostering positively toned interactions; and cocreating positive interactions and repairing stressful, negatively toned interactions (Schore, 2001).Teaching them means going beyond mirroring and engaging in dyadic affect regulation (Fosha, 2000b), behaving in oxytocin-engendering ways, making use of and regulating gaze and eye contact, being tender and owning up to lapses insincerity (Ferenczi, 1933), and fostering the client’s sense that he or she exists in your heart and mind (Fosha, 2000b,adapted from Fonagy, Steele, Steele, Moran, & Higgitt, 1991).
The supervisor models the AEDP therapeutic stance by welcoming the supervisee; taking delight in specifics aboutthe supervisee; and affirming, validating, and appreciating everything that the supervisee is doing well already. Just like the AEDP therapist, the AEDP supervisor is welcoming, affirming, validating, self-disclosing, delighting, celebrating,collaborative, vulnerable, open (not defensive), and responsive. Most of all, he or she wants to genuinely relate andhelp.
Some concepts are easily translated into specific techniques or technical skills to teach you what to do and say to be the kind of supervisor that the AEDP supervisor aims to be. Here, we include the language of actual interventions so you can put into practice the skills we are talking about. You also can see how each concept can be broken down into user-friendly techniques that you can easily incorporate into a supervisory session. We divide these skills into five categories: experiential, privileging the positive, relational, affective/emotional, and integrative/reflective.
1. Experiential Skills
Slowing down is the foundational skill in experiential work. Supervisees must slow down to learn to know their internal experience. Phrases to start this process are: “Let’s slow this down,” “let’s take a breath here,” “we have time,”“let’s pause here,” “mmm . . . a lot here,” “let’s go back,” “let’s stay here,” “let’s stay with this,” and “can we . . . ?” Thesupervisor is saying explicitly and implicitly that he or she knows how to help: “I know the pace is too fast” or“let’s slowdown.” The supervisor knows what to do; he or she actively helps and wants to help. Statements often are more effectivethan questions. Nonverbal behaviors work equally well here: We take a breath ourselves and exhale, we slow down ourspeech, and we make a slow-down gesture with our hands or breathe deliberately.
We try to use experiential language with our supervisees and teach them how to use this language with their clients. We useexperiential language when we are working to shift from the top of the triangle, State 1, to the bottom, State 2—fromprefrontal cortical thinking to limbic experience (see Figure 1.2). We have more than one tone of voice in supervision andtherapy: We have our everyday, social, top-of-the-triangle tone of voice and the more dropped-down voice that comes withemotion and emotional state-sharing in session (Schore, 2001, 2009). A part of the experiential use of language is in thetone, pace, pitch, and prosody of our speech: We try to slow down our speech and lower our tone, which tends to come from aninternal relaxation on the part of the supervisor. The use of experiential language is to help clients and supervisees make theshift from left-brain thinking to the right-brain embodied feeling. We try to use short, monosyllabic words, when possible;we try for one intervention at a time; we try to use Germanic everyday words like fall rather than Greco-Roman words likeautumn, belly rather than stomach, and important rather than interesting. Some interventions work better than others tofacilitate and deepen attachment relationships. Monosyllables like huge, wow, and this is big work well. Vagueness on the partof the supervisor to his or her supervisee and, in turn, therapist to client, makes space for their experience: “something’scoming up here” and “a lot here . . .” are multipurpose phrases that work well.
We have said that we want to make the attachment relationship explicit, and so we need to adjust the experientialattachment language with closeness and relatedness, according to the comfort level of our supervisees. For some supervisees, the language of we is initially too intimate. Notice the difference between the abstract and less personal“this is moving” to the more personal “I feel moved by you.” When we take the first and second person pronouns youand I and we and us out of our interventions, we lower the heat of the relational thermostat. When we put them in, we up the relational ante, making it more explicit and more experiential. How we language our interventions is critical. Again, notice the difference between the explicit attachment language in “we are working on this together” or “let’swork on this together” and the more distancing “these are the stated goals of this supervision.”
This is a multifaceted skill. It is the microtracking, the zoom-in-tight focus into the here-and-now experience of thesupervisee with supervisor. What kinds of things are we tracking? Posture, movement, tension, relaxation, facialexpression, shifts in eye contact, speech, tone, volume, pace, coherence, breathing, and so forth. AEDP’s skill-building involves the sequencing of interventions and breaking down AEDP into one achievable skill at a time. A beginning AEDP therapist who has been taught to pay attention to the words, figure things out, and interpret may well be dauntedby the idea of using what is called moment-to-moment tracking. So we break it down and suggest that, for 1 week, thebeginning therapist will track body movement only. When we divide a learning task into component pieces, it becomes more manageable. “How about you try once or twice in every session to notice the hands, arms, legs, and feet of yourclient; notice shifts, movement. Let’s practice your observational, perceptive skills this week. Just that.” This becomes“homework” for our supervisees to practice week to week.
Next, we build the skill of how to intervene through expressive skills.
The supervisor tells the supervisee,
Let’s try to notice in words how to express to your client what we see. Let’s start with statements and notquestions. For example,“your foot is telling a story”; “your foot had a reaction to that”; “your foot is moving”;“wow, your foot and now my foot—a lot of energy as we are talking.”
Learning to pepper a session with moment-to-moment tracking statements is a good way to get started in experientialbody-based psychotherapy. It is a way of quietly and unobtrusively saying, “I notice.” It is an indirect self-disclosure: I am the kind of person who notices. We notice nonverbal behaviors. For example, “you made a fist”; “your hands are talking”; “expressive hands today” (the supervisor might make the same movements);“I am moving around a lot, too, I notice”;and“hmm . . . I wonder what your hands are saying.” And then we are off to the relationship races: “How is it to know Inotice, to get a sense of my gently noticing you?” Whenever possible, we use the two-step intervention: a “noticing” andits metaprocessing.
Next, we teach questions that ask more of a client because they ask for a response: “What is your foot saying?” “Don’tstop: It is talking! It is helping us.” “If we held a microphone to your foot (and you didn’t think) and you just spoke, I wonderwhat the first words from your foot would be?” These are ways to build skills in supervision.
Most supervisees will come in week after week having tried out a specific skill, and if they have been successful, we build on that success and keep adding skills. If they have noticed that they are unable to practice a skill, we get curious together about what happens for them. We practice in the here-and-now of the supervision session with our supervisees. We unobtrusively moment-to-moment track their nonverbal communication and we make what we notice explicit: “Yousmile! You brighten.” “Your brow is furrowing . . . something there.” In this way, during a session, we can give the superviseean experience of being on the receiving end of a skill.
Making the Implicit Explicit and Specific, and the Explicit Experiential
When we make the implicit explicit, we shine a light on what is happening specifically and in detail experientially. We do not let the procedural hum of all of this live in the background of our work: We bring it to the foreground. It is thismaking the implicit explicit that brings the work into the here-and-now and allows for the possibility of a new experience. We want to notice our supervisee’s patterns of relating to him- or herself and to us, and by bringing our focusto what it is like together in this moment, we model the workings of AEDP therapy. We ask for details from our supervisees and teach them to ask for details from their clients. It is in the specific example and the details of anexperience that the procedural ways of interacting come to the fore.
When we slow down and moment-to-moment track, we make use of what we are tracking to find places to enter, tointervene. We call these entry points. When we notice a shift or a glimmer of something affective or relational emerginginternally or between us, it is a moment we want to notice and seize (Frederick, 2005), and so we stop the supervisee. It is important to seize it, to identify it, mark it, discuss it, imprint it. The supervisee did something and it really worked. It is an important moment because it is a moment when a change involving a state shift has occurred. We want to notice, seize,stay, and understand what happened and why, and help make it happen many more times. At such moments, it is importantto stop the action to process and metaprocess.
It is a general rule of experiential therapies to ask open-ended questions and avoid questions that invite a simple yes or no answer. This is true in AEDP except when we use the most crucial intervention: asking permission. “Is it okay withyou?” “Can we . . . together?” “Would it be all right if we stay with this/if we look at this together?” We want to emphasize this intervention is critical to promote safety, and that we want a strong, “Yes” or head nod indicating “Yes!”before we proceed. Probably the biggest mistake we see in therapists new to AEDP is not asking permission frequently enough. A way to invite a “No” and give permission to say “No” is to follow up with the words, “Would you feelcomfortable enough with me to say, ‘No!’” or “You can say ‘No’—you know.”
Using Phenomenology: The Schemas of AEDP Anchor the Work
We use the phenomenology of experience to guide us. The triangle of experience and the four states of the transformationalprocess (see Figures 1.1 and 1.2) are the central schematics of all our work. What skills accompany them in supervision?Together with our supervisees, we draw triangles to map their clients’ defenses, anxiety, and feelings, and we use the fourstates to describe what we are seeing. We ask our supervisees, “Where are we on the triangle? What state is your client in?”The aim is almost always to be moving down through the four states, from the top of the triangle, State 1; to the bottom, State 2;to the transformational affects, State 3; until we reach the integrative consolidation of State 4.
The Interruption. In AEDP, we announce our subjectivity by saying, “I am thinking,” “I am feeling,” “This is whatoccurs to me,” and so forth. We announce our ability to play with supervisory interventions by starting to say somethingand course-correcting as we speak:
This is what I am seeing and feeling as I watch your client . . . Wait . . . Let me check in with myself. That doesn’tseem quite right. Would it be okay if I paused for a moment? As I am saying this, I notice I am having another reaction inside of me.
The course correction spoken out loud of our internal experience—“As I say this, this doesn’t seem quite right”—is atechnique we call the interruption. Interrupting yourself as a supervisor is useful both because it allows you to think aloudand to model that it’s important not to be too wed to any one idea. In addition, this technique is useful in therapy when we start to say something and realize it doesn’t seem quite right (Bollas, 1987), or a client is showing signs of emotion that need attending to in the moment.
The Completion, a.k.a. “Finish That . . .” Finish the sentence. When emotion, vulnerability, anxiety is present, we aremore likely to cognitively disrupt: Supervisees and clients start a sentence and stop. This is a moment to use the completion.We ask the supervisee or client to finish the sentence; for example, “I am afraid . . .,” “Finish that . . .,” “I am afraid she isgoing to be angry with me,” and “Tell me more.”
Contain With a Time Limit. When we ask permission, we often use a time limit to give a structure and to contain a pieceof work. “Would it be okay if we stayed with this together for 5 minutes?”
2. Privileging the Positive
Explore, Expand, and Harness Excitement, Enjoyment, and Success
Under the umbrella of privileging the positive is AEDP’s aim to explore, expand, and explicitly enjoy positively attunedand positively valenced interactions. When we have disruptions or negatively valenced interactions, we seek to repairimmediately and assiduously until we reestablish a synchronized state that feels good. Learning a new way of working isdifficult, but we head into what is hard together and focus on the positive affects of curiosity, excitement, and success that emerge. We know that we need to harness these positive affects, know how to harness them, and know their function in improved memory, flexibility, and creativity (Fosha, 2007, 2009a; Russell, 2015, p. 100, pp. 265–270; Russell& Fosha, 2008).
Welcoming, Affirming, Validating, Delighting, Celebrating
Above all else, affirming and supporting explicitly and specifically all that a supervisee is clearly doing well translates into confidence building in supervision. It says, “You are already doing this—keep doing it and do more of it!”
Michael Glavin, the trainee whose supervision session is documented in the American Psychological Association DVDAccelerated Experiential Dynamic Psychotherapy (AEDP) Supervision (Fosha, 2016; see https:// www.apa.org/pubs/videos/4310958.aspx), said that his previous, non-AEDP experience of supervision had been much more focused on things that he was doing wrong. A supervisor who is experienced and has much clinical wisdom toimpart can unwittingly shame a supervisee who is, by his or her very position, less experienced and seeking help and guidance (Sarnat, 2016).
3. Relational Skills
Attachment: The “We-ness” of Attachment
Under the umbrella term of attachment are specific relational techniques to translate attachment theory into clinical practice, including undoing aloneness, which is a key AEDP concept and an actionable behavior. Typical statementsand questions used in these interventions include: “Can we look at this together?” “I am here and listening . . . Tell me more. . .,” “Would it be okay if we paused here/rewound the tape here?” “Where are we right now, you and I?” and “This is sucha difficult moment.” Meanwhile, body language makes our presence implicit and explicit by nodding and leaning forward tomake obvious that we are concentrating.
The notion of existing in each other’s heart and mind can be turned into an actionable behavior by rememberingthe supervisee’s history and clients, and making this explicit. You might say to your supervisee, “I remember yourclient: I have seen Martha [or Jimmy or Rob] before. Of course, I remember.” Or, “I remember what you werepracticing last week. Did you practice the interventions? How did that go with Linda? Let’s take a look at Jack thisweek, and do tell me in three sentences how the interventions with Linda went!”
The supervisee is strongly encouraged to articulate what he or she is experiencing in the supervisory session andhow it makes him or her feel. The supervisee’s experience of the supervisor and that person’s supervising are an essential part of constructing a two-way relationship in which both parties feel seen, heard, and felt. The supervisee must feelhelped and supported in the relationship. Invitations from the supervisor to compare views are crucial: “This is how I seeit,” you might say, “but what’s your take on this?” (Fosha & Slowiaczek, 1997, p. 239).
Self-disclosure often makes therapists nervous, whether in therapy or supervision. The idea that there is a correct,“neutral” way of working looms large. It is helpful to define and be clear about what we mean by self-disclosure and how and why we use it.
There are two main kinds of self-disclosure. The first, self-experiencing
self-disclosure, happens when the supervisor describes his or her own affect and process as it unfolds in the session and fromsession to session. In many ways, our interactions reveal us: When we notice sadness, for instance, we reveal that we are the kind of person who notices and feels comfortable noticing and talking about sadness. If we are silent when difficultfeelings come up, we are revealing just as much, but different, information, “for absence has presence” (Wachtel, 1997,p. 245). Consider a technique that Greenberg and Watson (2005) called “saying all of it” (p. 128): It is not enough to say we feel angry, delighted, or distanced by a supervisee; we need to say all of it and tell the supervisee the specifics,what the content is, and what our process is. We thereby make the implicit explicit and specific. Interventions thatdemonstrate this idea include language like “I feel you . . . move away, relax, come forward, shift, tense up” and “I felt that . .. something shifted.”
The quickest way to deepen experience between two people is when one of them says something personal,particularly something affect laden (Prenn, 2009). Self-revealing self-disclosure happens when the supervisor describes actual life experiences, triumphs, vulnerabilities, uncertainties, and dilemmas. Self-disclosure is a secure attachment-creating intervention. The intervention typically begins with language like “I have felt that too . . .”; “I know thatpersonally . . .”; or “our histories are different, and I, too, know how it feels to feel disappointed/scared/humiliated. . . .” The supervisor might self-disclose about the supervisee’s effect on him or her, by saying, “I thought about you this week: I got stuck in a similar place with a similar client, and my conversation with you the week before helped me getunstuck more quickly.” In working with the client, the supervisee might say, “I am moved by your . . .,” “I appreciate,wow, I am touched by how you . . .”
Revealing vulnerability is key. Say a supervisee is lamenting that a client is leaving her practice. She is wondering why he might have left. A supervisor might lean in and say that she, too, has had a client leave after two sessions and addthat she really doesn’t know why. The supervisor says, “I have lots of ideas and, ultimately, I don’t know why he left.”Then she might ask, “How is this to hear that I know this, too—clients sometimes leave after one, two, or 10 sessions andwe don’t always know why? What is that like to know?” We are in rich, mutative territory when the supervisor communicates that she is imperfect, she makes mistakes, she doesn’t know things, and she is vulnerable. She doesn’t workperfectly with every client who walks through her door.
Supervisors can use metaprocessing to inquire into many facets of our supervisees’ experience regarding self-disclosure. Some of these interventions can be characterized as metacognitive: “What is it like to think that thought?” “How is it for you to think: ‘I did self-disclose and metaprocess with my client?’” “What is it like to go from thinking youcan’t do AEDP to noticing all the ways you are already doing AEDP!” Other interventions are meta-affective: “What isit like to feel the gratitude you just described?” “How is this feeling of self-compassion sitting with you?” “What is it like to feel sad for your client when you said you felt numb before?” Still other interventions are metasomatic: “What is itlike to sit taller in your seat?” “What is it like to sense the strength in your arms?” “How is it for you to sense these changes inside right now?” And others are metatherapeutic: “How does taking in my care and support sit with you?” “How is it for you to sense our connection?” “What is it like to have done this work with me today?” We can also describethese inquiries as “What’s it like?” questions, “What are you noticing?” questions, and “How is it going for us?”questions (Lipton, 2013).
4. Affective/Emotion-Focused Techniques
Shifting From Reflective Listening to Experiential Exploring
Experiential–dynamic work is a way of working that makes a shift from reflective listening and response to experientialexploration. A first skill we teach in AEDP is noticing an affect-laden word or an emotion-rich word and exploring itsinternal experience. An affect-laden word is one that is alive with emotion, such as sad, disappointed, remorseful,heartbroken, or frustrated. For instance, in the supervision session that is on the DVD (Fosha, 2016) accompanying thisbook and is discussed in detail in Chapter 3, the supervisor notices and seizes “squirmy” as the affect-laden word that becomes the entry point to a rich and productive exploration. Any word that describes an experience and has oomph orenergy, or a notable lack thereof, becomes a focus of our exploration. The most obvious way of intervening—which therapists trained in other treatment modalities use and that is learned in graduate school—is reflective responding and explaining instead of exploring. In AEDP, we believe that clients will be helped most by knowing what they are experiencing and how they are experiencing it. This essential skill is the shift from reflective responding to experientialworking.
Compare these two short examples. First:
Client: I feel so sad.
Supervisee: It sounds like you feel sad.
Client: Yes I do. It seems hopeless.
Supervisee: It seems hopeless right now.
We call this kind of back-and-forth ping-pong: We give the emotion back to the client or supervisee.
On the other hand, consider this example (see Figure 2.2):
Client: I feel so sad.
Therapist: What is that like—that sadness?
Client: Ugh. It seems hopeless.
Therapist: And that hopeless feeling . . . What is that like?
Ping-pong reflective responding, mirroring, and reframing. Copyright © 2016 by Viktor Koen. Reprinted with permission.
Notice and seize an affect-laden word. Copyright © 2016 by Viktor Koen. Reprinted with permission.
Client: It feels like a weight.
Therapist: That is great you notice that. Where is that weight inside your body? (See Figure 2.3.)
When we teach this skill, we tell the supervisee about it: For every affect-laden word you notice, try to notice and seizethe word, and explore what it is like. The supervisor might model this skill first and give the practicing of the skill forunofficial homework so that the supervisee has the experience of the skill and the didactic learning, too.
Modeling the Intervention Supervisor: How does it feel to imagine doing this? Supervisee: It feels a little daunting.
Supervisor: And that daunting feeling—What is that like inside of you? Is it okay to ask?
Supervisee: Yes, it’s okay to ask. Ya . . . I can feel myself shrink inside.
Supervisor: Is it okay to stay with that? What is the shrinking like inside?
Supervisee: A fluttery sensation inside my chest—right here [puts her hand to her collarbone] and the thought comesthat I won’t be able to. And then the fear that I won’t be any good at AEDP, and you won’t like me.
Supervisor: Right, okay. And how is it to let me know that?
Supervisee: It feels vulnerable.
Supervisor: And how is that for you to feel vulnerable with me?
A portrayal is a specific technique used to build emotional and expressive capacities, and to mine the dynamics of a particularrelationship in AEDP therapy and supervision. Portrayals can be real or imagined scenes from the past, present, or future inwhich the client or supervisee is invited to have a reparative, or a feared, avoided, or a wished-for experience through thevehicle of imagination. The more vivid and specific the imagery, the more connections there are to dynamic and affectiveexperiencing. The imagery and metaphor of portrayals activate almost as many areas of the brain as actual livedexperience (Pally, 2000, pp. 33, 132). Portrayal experiences in session assist in the processing of dynamic material and canhelp to bring countertransference issues to light. The language of portrayals expands the supervisee’s experiential,emotional repertoire. As supervisees gradually face—intrapsychically—people, affects, and situations they previouslyavoided because of their painful/frightening/longed-for content, they improve their ability to connect with their clients intheir therapy sessions. Portrayals open up possibilities for supervisees to become more assertive, confident, and emotionallyconnected, and to engage in adaptive actions on behalf of themselves (Prenn, 2010).
In AEDP supervision, we use this tool to expand the possibilities of what a supervisee might say to a client. It is a way to start to formulate a response or a prompt; to put it into language; and to build new, expressive neural networks.The standard intervention is: “What would you want to say or do to let your client know how you feel about this if youcould say or do anything at all without censoring?” It is a way to ask them to imagine— and thus experience—alternative ways of dealing with the client or ways to solve whatever dilemma the supervisee presents with. An even simplerintervention is: “What might you say?”
In the following vignette, notice the following skills in action: affirmation, modeling (supervisor models theintervention, describes possible interventions first), asking permission, and using imagination.
Supervisor: What might you say to Suzanna, your client? [starting and modeling the use of portrayal]
Supervisee: I don’t know. I am having so much trouble with this client. She dodges my every intervention, she nods,sounds emotional. I think we are connecting and getting traction around something . . . and then she dismisses me with awave of her hand, or a“yes, but!” And she moves right away from her emotions and me. I like her so much and understand how she came by her dismissive ways honestly, and yet I feel so shut out by her and so deskilled. I want to help her, and Ijust feel so pushed away by her!
Supervisor: I love what you just said. [expressing delight in the supervisee] I think you just said it! What could you say to her about all of this? [affirming all supervisee is already doing]
Supervisee: I don’t know.
Supervisor: Well, you just so beautifully told me how you experience her. Could you imagine telling her? [stretching thesupervisee to just imagine]
Supervisee: Telling her?
Supervisor: Yes, telling her . . . Tell her. If she was here right now, what would you say—what do you call her?Suzanna? Suzy? [the standard way to start a portrayal with the immediacy of saying the client’s name]
Supervisee: I call her Suzy.
Supervisor: So you’d say, “Suzy, I like you so much and I feel shut out by you.” What else would you say to her? [Start theportrayal to actively help.]
Supervisee: You dismiss me.
Supervisor: That’s right. Keep going, tell her directly. [affirm, offer encouragement]
Supervisee: Suzy, you dismiss me. You nod and say, yes, and then, with a wave of your hand, you wipe me out. I feelinvisible with you. I feel so small and like you don’t see me.
Supervisor: That’s right. How do you feel towards her?
Supervisee: I feel so whiplashed by you, like we are together and I am safe, and then off you go dismissing me, and Ifeel so abandoned in these moments with you [looks a little surprised]. Oh, I know this feeling—oh, I know where thiscomes from . . . huh. Okay.
Supervisor: What are you getting? What are you realizing? Is that okay to ask?
Supervisee: This is my stuff; my history. I know that this is coming from my childhood. I can tell you I know exactlywhere this comes from.
Supervisor: You can if you want, and for our purposes here, that isn’t necessary.
Here, the supervisor encourages her supervisee to get deeper into her experience with her client to unpack thecountertransference or the dynamics. Without her supervisor knowing the details from her past, the supervisee neverthelesssees the dynamics at play with her client, Suzy.
5. Integrative/Reflective Skills
This skill highlights what has felt good and has promoted growth in the session and in our work session-to-session. The explicit exploration together of the experience, skills, new learning, and answer to the supervisee’s questions helpsboth supervisor and supervisee know and remember what has happened in their time together. Supervisors metaprocess throughout the supervision session and at the end of each session.
After an interpersonal moment in which a supervisee has broken eye contact, the supervisor inquires gently about the shift:“What just happened?” and the supervisee lets the supervisor know that what the supervisor had said was not helpful, andwhy. The supervisor takes a moment to platform, or sum up or recap, what happened so that once it’s out there and shared, itcan launch the next exploration:
I noticed your breaking eye contact with me. It was a notice-and-seize moment. You let me know that what Iwas saying wasn’t helpful to you and why and how that felt physically, and then we both noticed together wefelt more relaxed and connected, and we metaprocessed how it was: “It was better . . . it was good,” you said,and we both laughed about it. You told me what you needed; we both got color back in our cheeks! And now this is a bit of a teaching point: What did I do and how was it for you? And how are we now?
This platforming allows a right-brain experience to be interpreted by left-brain reflection and language, as described in Chapter 1.
Narrating/Thinking Out Loud/Voicing the Therapist
Conceiçäo, Iwakabe, Edlin, et al. (2016) describe how supervisors share their thinking about video recorded therapy sessions according to the experience level of the supervisee. With a beginning clinician, we might model this thinking aloud first and then ask the supervisee to join in and share his or her take. For a more seasoned clinician, we might askthat person to think aloud first, and then we might say, “Would it be okay if I added some of what I was noticing andthinking, and perhaps other ways of working?” Again, notice that asking permission is almost always a part of AEDP’s supervisory offerings.
Eliciting Specific Feedback From the Supervisee
One of the most common challenges we all face is bringing up negative feedback, yet eliciting negative feedback from a supervisee is essential. Remember to ask, “How are we doing? How did we do today? What was helpful? What was not helpful?” AEDP does privilege the positive, but we also recognize the necessity of expanding a supervisee’s ability tometa-process all aspects of a therapy session. In eliciting negative feedback, we use kindness; directness offered with tact; and “I” statements, rather than third-person deliveries of authoritative knowledge; and we always metaprocess the experience. As a part of this process, the supervisor should also check in about how the inquiry or intervention has landed. “You are having a reaction to my bringing it up?” Notice that we try to describe what is happening with curiosity, without judgment. It is likely that anxiety is driving the process, so we want to regulate that before we do anything else.
We elicit negative feedback in three different ways. First, we ask for specificity: “What specifically did not feel goodfor you about what I said?” “How did it affect you?” “You say you are not feeling heard. Can you give me an example?” We pursue concrete, practical examples, seeking to apply what was discussed in the supervisory hour.
Sometimes, in response to our requests for negative feedback, a supervisee or client will explain why we are not the supervisor or therapist for him or her, and this is useful information. We are not for everybody; we can try to be, and wecan adapt and be creative, but sometimes there is too much of a mismatch. In response, the supervisor might say, “This issomething I have heard before and know about myself.” This is stating directly: “It is not your fault.” This is a starting pointand not an endpoint: We always try to metaprocess. These authentic moments feel good; they are real, not defended, andare open and engaged.
The second way we elicit negative feedback is by modeling the cycle of attunement, disruption, and repair (Safran &Muran, 2000; Tronick, 1998). We show that mistakes can be made and misattunement can occur. When we are not attuned (e.g.,we intervene in a way that unintentionally shames or injures), we seek to repair. And because we metaprocess, we know it is happening and we can repair. This process models the cycle of disruption and repair, and also lets the supervisor know what isnot helpful.
A third way we elicit negative feedback is through the use and understanding of nonverbal communication. Asupervisee who shrugs her shoulders, twiddles her pen, or closes her computer may be having a reaction. This is a place to use our moment-to-moment tracking skill: “You are saying, ‘Yes,’ and you are also shrugging as you speak—what might your shoulders say if you let them?” or “I notice, and, correct me if I am wrong, some hesitancy as you say,‘Yes, I will try that.’”
The platforming intervention also may be particularly helpful here, as you might say, “Yes, this is helpful, and I seeyou get quiet and shrug your shoulder. [Supervisor shrugs, too.] I wonder what your body is saying.” Or, “I notice that we spend a lot of time talking at the beginning of our sessions so that we don’t always have enough time to watch the tape ofyour session with the client.”
In this chapter—intended as a primer of essential skills—we highlighted the key elements of the AEDP supervisorystance and the skill set necessary for positive supervisory experiences. We expanded the theoretical idea of the true self and true other to describe the AEDP supervisor as a transformation other to the supervisee’s transitional self. Wetranslated AEDP theory into five kinds of user-friendly interventions and provided examples of actual interventions: (a) experiential skills, (b) privileging the positive skills, (c) relational skills, (d) affective/emotion-focused techniques, and
(e) integrative/reflective skills. We encourage you to practice some of these skills in your supervisory sessions, if that feelsright.
In the next chapter, you will see how the concepts and skills fit together as we examine, with annotated commentary, thetranscript of a supervision session from beginning to end.