What to do when supervision goes bad? A guide to supervision ruptures and repair
Curt and Katie chat about what to do when there is a loss of trust in supervision. We explore what has already been researched (and the limitations there). We also look at what can make ruptures more likely, different types of ruptures, and how supervisors can mitigate the risk of rupture and then repair when ruptures inevitably happen. This is a continuing education podcourse.
Transcripts for this episode will be available at mtsgpodcast.com!
In this podcast episode we talk about how to address ruptures in clinical supervision
Clinical supervision has the potential for errors and requires management from the supervisor to acknowledge, deal with, and repair from mistakes that could rupture the supervisory alliance. This workshop helps to identify the types of ruptures that can occur and offers a strategy on how to deal with them so that they are no longer a problem.
What is the focus within the research base on clinical supervision?
· Most of the research on supervision is focused on clinical supervision without a consideration of the employment element of the relationship
· There is not a lot of research on supervision, much less ruptures in supervision
· Much of the research has been from the supervisee perspective, but that is shifting
· Without supervisors being involved in research, there is a risk of supervisors dismissing it
What can make ruptures more likely in supervisory relationships?
· Power differential within the clinical supervision relationship may lead to supervisees feeling unable to talk about mistakes that supervisors make
· Expectations of safety and confidentiality that are not discussed or are assumed to be greater than they are, with a lack of transparency
· Supervisors are responsible to address ruptures, but may not know about them
· Supervisors can fall into risk management and punishment or not allowing supervisees to do anything that may challenge their skill level
What can supervisors do to avoid supervisory ruptures?
· Acknowledge the fallibility of both the supervisor and the supervisee
· Supervisors share when they don’t know something and learn what they need to learn to support their supervisee
· Understanding the impact of each perspective on expectations (i.e., supervisors in agencies are also impacted by the expectations that they have on them from their own supervisors)
· Identify confrontation versus avoidance rupture risks
· Being more transparent on the process of supervision and about the supervisor’s competence and emotional responses
· Understanding and assessing for cultural ruptures, microaggressions, etc.
Can supervisory ruptures also happen based on actions of the supervisee?
· Yes!
· Supervisees can misunderstand their role and not complete what is expected of them
· Supervisees can fail to develop as a clinician
· Supervisees may ask peers rather than their supervisor for what to do and do the wrong things
How can supervisors repair the ruptures that happen in clinical supervision?
· Setting the stage for the most positive supervisory experience
· Cultural humility
· Pause, Consider, Reflect, Act (C.E. Watkins, Jr.’s work)
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unit of continuing education for this podcast episode once you've listened to this episode to get se credit you just need to go to moderntherapistcommunity.com register for your free profile purchase this course past the post test and complete the evaluation once that's all completed you'll get a ce certificate in your profile or you can download it for your records for a current list of our ce approvals check out moderntherapistcommunity.com once again hop over to moderntherapistcommunity.com for one ce once you've listened whoo hoo welcome back modern therapists this is the modern therapist revival guide i'm kurt whithom katie vernois and this is the podcast for therapists about the things that happen in our practices the things that happen in our field and this is another one of our continuing education eligible episodes and this one is by request from one of our listeners and friends julie pain wanting us to talk about how do we handle supervision ruptures and most of what i see online in the facebook groups is coming from the pre license end of things and what happens when we don't agree with our supervisor get a lot of these questions from my students in the past as far as well their students so it does come from kind of the student end of things when it's like what happens when there's disagreements and supervisors i have done enough supervisor consultations or consultations on supervision that end up being able to look at some of these ruptures from the supervisory side and we hope to address both of those in this episode looking at it from both sides and what can be done about it but pulling from the research base as continuing education episodes are required for us to do and also make it to where it's not just us talking about our experiences on things we also are going to acknowledge some stuff that the research base is just missing entirely when it comes to what it is that our practical experiences have brought into this so katie when you hear about supervisory ruptures do you get the same experience as me that it's a lot of times from the supervisee end and supervision ruptures i think can happen from both sides but i definitely heard a lot about it from supervisees i definitely felt it as a supervisee and i think that there are ways in which the power dynamic the systems those types of things can push towards some sort of rupture or loss of trust or whatever that is i think the big thing that has not been covered in research based on what we talked about before the episode is the way in which supervision happens frequently now which is also within an employment relationship or or a business relationship i know a lot of the ruptures that i felt from as a supervisee or as a supervisor were based on the systems and to give you an example not being able to be completely transparent about what's happening in the company or the organization having productivity or business requirements or agency requirements overcome the the supervisory relationship and pushing into those and having disagreements or or ruptures based on that and so my hope as as we're going through this is that we can we can speak into the the evidence base and we can talk through what is happening there as well as bring it into the real world where folks are bringing supervisees into their private practices they're working in organizations where not only do they have supervisees but they also have supervisors and infrastructure that impact how they behave because it's it's such a complexity when we look at supervision in the real world that i i hope that we're able to do all of that justice and so i think we're acknowledging from the very beginning that the evidence base on a lot of supervision stuff is still very much in development there have been some researchers for quite some time who have written well about things there's borders is going to come up in a lot of historical writings about supervision free blender is another name that comes up quite a bit so these are people who have been spending decades and decades writing about it but i don't think it's really been until about the last 15 or so years that supervision as its own skill set and own place within therapist development for both the supervisees as well as the supervisors has really taken on a keen place in the research to be a focus of development and because there's not a lot of historical research on this kind of stuff what you're talking about specifically is almost completely avoided or ignored or just even not acknowledged as far as those intertwining roles a lot of supervisory research is based on the idea that supervision is a place for a mentor or a clinically more responsible person to help somebody who is in their training to become more professionally developed more skillful at the skills that they're supposed to be developing for better client care but because this is written in this fantasy worlds where there's all of this time that it's just a supervisor having these long walks on nature trails with supervisees where they spend hours and hours talking about every single case there's a little bit of reading supervision research that's just kind of fantasy it's almost you could go from like lord of the rings and just your supervision and here's this here's Gandalf coming in every so often just being and here's some words of wisdom yes for sure so it's not to say that there isn't a lot of research out there it's just that it's still very much in its infancy or early childhood when it comes to what we have to pull from on this because there's not a lot we're going to start with the dictionary as our first place on this so we're going to start by defining rupture we're going to start by defining rupture and i think that this is actually a not just a time filler piece of this episode this is something that actually has a little bit of a purpose here because we have to look at rupture as both a noun and a verb and in this whole aspect of what we're going to dive into in this episode is that the rupture the noun comes from a different Latin word than rupture the verb does and i'm not going to spend a ton of time looking at me on this but i just i just slowly blink to my eyes going what are you doing we're talking about the Latin we are you're not stopping me now i'll go for it all right i'll i'll dig in here we go so rupture the noun comes from rupture which means to break or uh to corrupt rupture the verb comes from Latin ruptus which also means to break or but more in the concept of to burst but it's the ongoing effect specifically more towards medicine as it was adopted by doctors throughout the middle ages so looking at this is both a noun and a verb allows us to look at there are the specific acts that can be addressed that is the noun action of it and the verb is oftentimes the lingering effects that go along with it so there are instances within supervision that we're going to talk about where there's rupture the noun where it's a specific act that is to be pointed out versus rupture the verb where it's the ongoing handling of the situation that i think a lot of these complaints end up really being able to continue on and continue to end up being something that makes supervision less than a satisfactory experience okay that sounds good one of the things that i came across in preparing for this episode is there's not just one but there are two freed lenders who have done quite a bit of the supervisory research one that i was quite familiar with and have referenced a lot in many of the supervision workshops that i've done is carol freed lender and she has done a lot of work around making supervision good just working on supervisory alliance kinds of stuff the one that i came across for this episode is mirna freed lender and continuing into the supervision areas this is somebody who has done a good job of looking at alliance ruptures in the supervisory process and even as recently as 2015 i recognize that that's nearly 10 years ago at this point but mirna freed lender had pointed out that all of the research on supervisory ruptures up until that point seemed to focus solely on the supervisees perspective about what has happened in supervision now i can posit a couple of theories about this number one is that it seems to be people who are more likely to complain about supervision not going well or the people who have greater numbers in supervision that and those people are more likely on their way to licensure or to becoming psychologists who will later go into doing their own research around things that did not go well for them and this is not to say that supervisors are completely unaware of supervisory ruptures from their end of things but are probably also much more established in the things that they're already doing and not moving into research themselves so it's kind of up until that point a little bit of a perspective that these are the people who are more likely going to write and research about the things that they know and that they've experienced and what it has really done though in some of the supervision groups that i've been in in the past of supervisors kind of looking at the research being able to adopt it into the agencies or the practices that they had is that a lot of the research on supervisory ruptures pre-2015 kind of got accepted by a lot of supervisors as these kids they're just complaining about a lot of things kids these days they just they'll grow up and they'll see that things are different and it's felt very dismissive especially when I was early on in my supervision experience of wanting to learn a lot more to have kind of some of these conversations going on and I can specifically remember some conversations particularly around the perceived things like microaggressions that might end up happening in supervisory discussions that supervisees would be interviewed for some of these research articles and they would say my supervisor is using outdated language about a particular minority or oppressed group of people and that's something that either affects me or it affects the sibling that my you know family ends up being affected by and my supervisor does not feel like a safe person that I can really be able to address and call them out on that was some of the beginning things of here are microaggressions as a cause of supervisory rupture so I'm glad to see that there continues to end up being more research from both ends of this and specifically some of the focus on aspects from what can be done and what are some of the responsibilities from the supervisor because we inherently have to start this conversation with acknowledging the power difference between a supervisor and supervisee. There's the inherent power differential based on kind of mentor, mentee, those types of things. There's also the power differential you know going back to what I was talking about before that comes from employing someone or having a evaluative responsibility over someone and so to me I'm guessing that the research that we're talking about would come from more the mentor mentee modality but I think that it makes sense to make sure that we're also acknowledging that in the world today people are not just in mentorships and in traineeships that they don't need to make any money they don't need to have employment and so it's this pure supervisory relationship. When we're talking about the power differential I'm curious if there are ways in which how that power differential that risk can be mitigated whether there can be more of that open space because if folks are feeling uncomfortable talking about some sort of rupture or those types of things they don't see their supervisor as a safe place. Is there space to be able to bring this up and for supervisors to open that space to bring it up? I think there is but I just was curious if that's going to be part of what we get to later. I think this episode is inherently going to focus on rupture stuff and while we will talk about being able to fix or do things well I want to make sure that we're staying kind of on topic through a lot of this episode. Yes I agree and good supervisors not only say but they also do things that make sure that supervision can be a place to be respectful and brave. Now I'm shying away from the word safe here a little bit because safe is kind of a nebulous word when it comes to the definition of what's one person safety versus another because good supervisors and I'm now specifically referring to especially group supervision have a lot more dynamics that they need to handle and you can't guarantee as a supervisor what one supervisor is going to say that is going to end up being perceived or actually offending another supervisor within the group. And so there's a lot of being able to handle and manage what is happening in the dynamics of a supervision group in that kind of scenario that's quite a bit different than one-on-one supervision that ends up happening and we have an example it'll come from one of the research articles here a little bit later that talks about how that might come up and how it might be handled but inherently returning back to a place of respect and safety is the ultimate goal in being able to handle this and that does start with the idea that supervision has to have kind of a general expectation that is set up from good supervisors and supervisees that they agree that what they're moving into is a space that is respectful and it is a space to be able to learn but there's not inherently a guaranteed safety in supervisory discussions because of what we're going to end up talking about later. Yeah I think there's there's this other element and I'll move on after this this other piece but if if a supervisor doesn't create the space to bring up ruptures they're potentially not going to know that the ruptures exist. I think the other thing is that within a organization especially the ability to be safe or even confidential within supervision is not necessarily present because if I am supervising you and I have a supervisor I may be required or encouraged or need to bring up what we you and I have talked about to my supervisor and so I think that when we look at breaches of trust based in that power differential I think and we'll talk about this later I think the transparency of how that communication happens and how you and I could create the space to fix a rupture needs to be a communication or a conversation between the two of us versus something that either of us assumes that we know how to do. And I think that there's a couple of things that you're also talking about here that we need to address is that one of the things is developmentally there's something much different about supervising somebody who's in the first stages of their practicum while they're in grad school versus the much more advanced nearly licensed supervises where some of that inherent trust over the long-term supervision relationships may be explicitly spelled out it may be something that is just kind of naturally gotten there that also has to be a contextual factor that supervisors have to be responsible for. The other thing that you're bringing up here is about the transparency about what this supervision relationship is. Unlike therapeutic relationships there is not a legal responsibility for supervision to remain confidential. Now there's plenty of stuff in our ethics codes that talks about supervisors responsibilities to maintain the trust about what supervisees bring up in supervision. Client confidentiality still needs to be maintained but as you're pointing out in especially like agencies where administrative supervisors and clinical supervisors may be different people there may be treatment teams or maybe employment review kinds of things. Good healthy supervision transparency is this is how this information is communicated about your employment about your clinical progress. If it's grad students in schools here's how evaluations are shared back and forth between the school and the clinical site so yes good supervision is going to structure that from the very beginning of supervision as far as here's what your expectations are and it is a place where some of the supervisory ruptures can be kind of brushed past it or set up to be something that happens later. So to kind of summarize that a bit I think we want to set up good supervision we want to make sure that there's a transparency in how this operates a creation of if not a safe space a brave space a place that that these conversations can happen not an assumption that as a supervisor you're going to understand what you know how confidentiality works and supervision those types of things. So really trying to mitigate some of those really basic ruptures that can happen when a supervisor does not understand how supervision works. Correct. I think getting into some of the more common, harder to avoid supervisory ruptures I think is probably where we should go next. So I just want to finish talking about the the power differential here is this might be the thing that spoils the entire episode for everybody here but the the power differential comes from the clinical experience the career experience the knowledge of agency or practice rules that makes most of what we're talking about the supervisor's responsibility to ultimately address and it's to ultimately be respectful and recognize that in particular for where supervisors are at developmentally that there's reasons to be able to mentor and educate about where people are in their field of why they might be responding in certain ways and it's a much slower process and especially in very busy agencies where I hear a lot of these supervisee compliances the time isn't taken to be transparent about how things all fit together for many trainee students their education in classes is here's theoretically how you would work with clients here are interventions here are steps that you may end up doing that the trainee then goes into that workplace they try to attempt to do these things but it doesn't fit within the model of how the agency may be operating so it might be somebody who's being trained in something like substance abuse and coming from like a strong 12 step kind of you know lesson plan out of a couple of weeks that goes into a very trauma-informed agency so they're walking in with hey I've got how 12 steps fits within these meetings and this is how this can end up you know helping a client that is completely at odds with an agency that is trying to commit things from a very trauma-informed sort of place that may not see a 12 step approach as being part of the client's recovery so in these cases it's the supervisor who has to be able to recognize and respond to those situations in a way that is transparent and delicate but more often than not what we see is potentials for ruptures because there's more of a risk management or a quick push to discipline rather than kind of taking the time to begin off in the trail in the forest for everybody to kind of get on the same page I think you're talking about being able to see the supervisor as someone who is trying their best and explore their understanding of it and fill the gaps I think when you were talking there was a part of me that's like oh yeah I remember how supervision felt like sometimes parenting a teenager it's like I do know more than you and I am I'm not perfect so there's going to be stuff I tell you that may not be great but give me a little bit of respect and trust as the person who is set to be your Gandalf just for the moment right and I think that's the hard part is that when we get to a place as a supervisor especially if we're overwhelmed and we're burdened with lots of paperwork or too many supervisees or whatever it is I think we can get to this place of if you are imperfect you are messing up my job there's so much risk and I don't have time for you so I'm going to just try to tell you what to do or I'm going to try to you know like you said get very disciplinary with you to get you in line versus actually taking the time to understand your perspective and make sure that I recognize where you are developmentally and what that means with your fallible I'm fallible this is a process right I think it can be so scary especially for new supervisors thinking this is my license this person is doing crazy stuff I don't like it it's there's so much that happens there right and so I think the the piece of of being able to sit in that we are both humans in this space tapping into our differential experience to help train you and and create a better product so to speak of therapy I think can be really challenging in either burnt out or brand new supervisors. 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One of the things that I love about doing these continuing education episodes is diving into new research and finding new researchers that are my favorite at least my favorites of the month kind of things and for this particular episode my favorite researcher at least of the month or the one that I'm relying on just very heavily for a lot of the more recent research for this episode is C Edward Watkins jr who has done quite a bit of research both solo and with some colleagues especially around supervisory ruptures there's a 2024 article in the clinical supervisor that is a solo article by C Edward Watkins jr when supervise these rupture supervisor rupture reactions and repair further stops and steps along the way and this article starts with the line fallibility provides the context within which this paper is situated so speaking exactly to what you were just talking about lines of exactly with where I was prepared to go with this episode next which is excellent supervisors have to acknowledge that fallibility is going to be present whether it be within themselves whether it be within the supervisee that there are mistakes that are going to be made and part of the supervisory theoretical models that are especially based on developmental tasks fully acknowledge that there are mistakes that are going to be made and unfortunately a lot of the way that that looks in practice as supervisors get to this place of like you're not allowed to see clients with this complexity yet it comes from this very much preservation safety sort of thing that is we shall not allow mistakes to be made rather than being able to look at this might be a challenging case for you and here's support that you might need good supervisors who are out there who are listening to this and who are already doing that good job i'm not talking about you but there are supervisors who get into this place where they'll have associates or interns kind of those postgraduate people that they just don't feel are ready for any of the clients yet that are kind of all right you're being assigned case manager roles rather than being allowed to actually see anybody and so there's already an inherent mistrust that is being communicated to the supervisee that i am so worried about you messing up that i'm making you mess up even by not allowing you to do anything and this starts to be wrote away at that supervisory alliance because supervisees are coming in week after week being like i'm ready for clients i'm ready for clients and supervisors are putting them into that great gen z catch 22 which is you don't have any experience so you can't see these clients and you can't see these clients because you don't have any experience so there ends up becoming this kind of place where if we acknowledge that supervisees are going to make mistakes and that becomes part of the supervisory process and the mentorship process that we're looking for people to eventually learn how to evaluate for themselves i am approaching clients that are very much overwhelming to me i might not feel like i have the skill set that supervisors tell and show that they're responsible to the supervisee as well that they're able to help guide them along the path rather than just being some arbiter of this is way above your pay grade here i think that there is gatekeeping and i've heard more around gatekeeping with supervisors who are in private practice nerves about you know complexity of cases or higher fee clients or those types of things so i i have heard gatekeeping and i think that does like you said transmit a i don't trust you to do good work on the flip side i think that there's this other element with a lot of agencies that i've worked with or or talked you know talked to people who have worked in where there's absolutely no gatekeeping it's here is your caseload of 25 clients that are excruciatingly complex and there's so much risk and i don't have the time to even talk to you about all of those cases and so in that way i don't know if you can do good work or not i that's not even being addressed there it's you can't fail and i've not set you up for success and so it it becomes this thing of if i don't figure it out if i don't take care of these clients then i am failing i'm going to get some sort of discipline or some sort of negative thing that happens in my employment and i don't have the skill sets to to do this work and so to me i feel like it can it can happen from both sides of it where you're not given any work or you're giving so much work that you can't even learn how to do that work and and you're bridging into the next part of this conversation is supervisors who don't recognize that they can be fallible as well and making mistakes like the one that you just described and this is the piece that i probably hear most complaints from most trainees and most associates are interns depending on your jurisdiction where supervises bring up something new they bring up a theory that might be being taught in grad school that the supervisor depending on how long they've practiced haven't had experience with that is just met by the supervisor is no that's not correct it just becomes dismissed because it's outside of the supervisor's familiarity with things hold that in contrast to most supervisees or licensed people who hear talk fondly about their supervisors most will talk about good supervisors will have some sort of response around hey i'm not familiar with that let me look into that more or some sort of response that kind of boils down to hey i don't know everything and i'll be the first to make mistakes or i'll be the first to admit when i make mistakes that really does show that we don't have to have this perfection or this prescribed perfection that we need to have in the field and i do hear a lot of complaints from supervisees around just there's no explanation there's no transparency as to why something might be wrong there ends up becoming kind of this doubling down from the supervisory end that takes the rupture now into a ruptured verb where it just creates that ongoing mistrust about how supervision can end up being see that that discussion around the dictionary did end up coming back it was important yes of course yes i think the the piece that i found myself responding to which was very interesting it was so visceral so i want to go back to how you first responded to me say supervisors might give way too many clients and not set them up for success your response was this was a supervisory mistake and supervisors won't necessarily admit it in my mind i'm thinking that's not a mistake and i want to explain why i went there because in an agency it may be something where this caseload is coming from above me and so i am trying to navigate manage that and i have to make sure that all the clients have therapists and all of the things happen and so it feels like a result of a higher level mistake so it's not my mistake right and so i started thinking about it and i was trying to pay attention and think at the same time so there might be some points we have to go back to but i was thinking about how in agencies especially supervisors are caught in the middle with this where they're afraid to make mistakes because it's their job and so they're rated on are your supervisees meaning productivity or do we have too much of a wait list is this going on is their risk and so it becomes this you know kind of shit runs downhill but i think there's that element of supervisors may not feel able to correct mistakes because of the system or admit them because of their own supervisors and so going back to this complexity of oh my goodness fallibility across agencies should be acceptable and understood and that's the only way we move away from these systems where supervisees are not getting taken care of supervisors are chickens with their heads cut off and managers are just trying to sort through how do i survive and so it it's really interesting how these ruptures can be perceived from each angle because my first reaction was a mistake and then i was like oh yeah that is a mistake if you don't set your supervising it for success that is a mistake and it didn't feel like the supervisor had control over it obviously in private practice she would say that's a whole other conversation but it's just interesting where my my head went when you said that that was a supervisory mistake it was so visceral totally not something that i was going to talk about on this episode so we're going to keep this pretty short here and some of my longer supervision workshops i start with the idea it's the seven-eyed model of supervision and it really does put into context a lot of the different ways that relationships can work out and maybe we'll do an episode just on the seven-eyed model of supervision i know i've talked about it a little bit before but a lot of supervisory research even going back to at least the 60s talks about the parallel process that can happen between clients and supervisees that ends up showing up in supervision between supervisees and supervisors what you're referring to is ripe for needing a new invented name for what happens between supervision and then between the supervisor and the agency kind of a hyper parallel process or ultra parallel process i'm pointing both at this point just to keep my options open in the future but there we go but i'm glad to hear you you pause and consider and reflect on this is how it fits within fallibility before we get back into fixing things i do want to talk about the ways that ruptures can happen and this again comes out of a lot of research from seanwood wackens junior at all and a couple of different new favorite researcher new favorite researcher i am always open to listeners who may know the people that we reference if you make introductions and we become best friends i will at least you know cite you as far as this is the start of our friendship and we can interview them directly which is always fun we can there's a couple of different ways that supervisor ruptures can show up and they fall into two categories one is confrontation rupture reactions these are things that outwardly happen they are direct things that end up coming up they might end up being expressed directly to the supervisee they might be things that are happening within an agency that our talk to to whether it be the clinic director the administrative supervisor that are not as direct to the supervisee that contributes to some of the toxic work environment kinds of things we'll link to that episode in our show notes some examples of this are for example just complaining about the supervisee yeah i think that that can happen both to the supervisee when folks don't have the spoons to be appropriate with instructive feedback but it can also be something where it comes back to the supervisee that the clinical supervisor has been complaining to the administrative supervisor or to another clinician that something's going on with the supervisee i think it can be ah it can feel like high school it can feel like bad parenting like there's just so many ways that this can happen and it feels like a no-brainer but i don't know about you but i i got so much of this in the agency work where i would hear from supervisees that they're like my supervisor is saying not so nice things about me and it's coming back to me and i'm like oh that just seems like professionalism like it seems like a normal thing to do yeah the next one on the list is rejecting supervisee interventions either by dismissing or by pushing back and this can happen quite a bit in especially newer superviser situations where there's kind of this like push to get the client fixed push to get the client through the interventions push to get them through the treatment plan that's more telling the supervisee what to do rather than how to think or be able to evaluate how their ideas might end up playing out with with the clients and so a supervisee might be showing up in in supervision saying hey i have a client who's suffering panic attacks and i'd like to teach them mindfulness in order to be able to be more aware of just kind of their internal state and the supervisor being like well that's not what the evidence base says the evidence base says that you need to do x y and z and just kind of pushing back that's dismissive in nature i've also heard this based on cultural differences especially with supervisees who are culturally similar to their clients and the supervisor is not and so i think the piece that i think we talked about this with Adriana so i'll link to her episode in the show notes over at mtsgpodcast.com but it's something where lived experience or knowing of the supervisee is dismissed as well there's also supervisors who have let's just say old school knowledge and there's information that may be coming from the grad school program or other types of training that the supervisee is trying to bring in and and i think you talked about this earlier where there's this disconnect between what the supervisees training has said and what the supervisor or agency or whatever typically does and there's not a discussion and so i think i think we also talked about this in millennials as therapists i think the the piece that can get hard here is what is perceived as a rejection of an intervention potentially as a rejection of the intervention it could also be the responsibility that supervisors have to make sure that supervisees are not doing things that they should not be doing because there's a lot of especially social media information and those kinds of things that may be totally appropriate coming from lived experience or they might be harmful and supervisors have the responsibility to push back when a supervisee is trying to do something that is either ethically or clinically unsound there's a even more specific version of this that is when supervisors complain or express dissatisfaction or discomfort or disagreement with specific tasks of supervision like role plays or in session tasks or homework assignments that and again this is something that i can see from supervisors who maybe over expect especially student and newly graduated clinicians to have more knowledge or more expertise or more of a skill set than what a fresh graduate might end up having that can come across is well all you're doing is giving clients homework or all you're doing is doing role plays and sessions with the client that well as a supervisee that that's what i know how to do please teach me more yeah i think that the challenge there is for a lot of new supervisors they potentially became supervisors because they were good at being therapists and that could be they were good at the job of therapy meaning they got good productivity they got their documentation and on time those kinds of things or it could be that they're strong clinically and there's this element of not knowing how to teach someone to do good work but only knowing how to teach someone to do things the way that you would do them and so when you were talking about complaints about the supervisee activities i thought about when i was a new supervisor and i had this tendency to want my supervisees to write their notes the way that i wrote wrote my notes i would want them to put their schedule together the way i would put together my schedule i feel like i quickly got out of that and i was able to look more at where is their knowledge what do they need to learn and how do i teach them to be therapists or have a therapist job in a way that's strongest for them and i know that there are still times when anyone who is asking for my feedback and it's i have to go to the place of is this good enough or is this just not the way i would do it and if it's good enough and it's just not the way i would do it fine if it's not good enough then i can give feedback and i have to figure out how to give that feedback in a way that's that's teaching and that is acknowledges the person's skill set and knowledge who is in front of me but it's it's so hard especially for new supervisors because they may not have been trained on how to be a supervisor they're just supposed to teach people to duplicate them and that's not really realistic and this is another emphasis on the point that supervision is a different skill set it is one that is very much different than just do things the way that i do them i do want to give credit for this list that i'm going through this is in the chapter repairing alliance ruptures by castran you bangs j christopher mirin and jeremy saffron and this appears in the book by jc norcross and mj lambert psychotherapy relationships that work volume one evidence-based therapist contributions and continuing through this list of other confrontation markers supervisees expressing concerns about the parameters of supervision schedule or agreement supervisors that are one example is what you pointed out earlier about not being transparent about how supervision communications may be shared with other people in the agency it might be supervisors who are constantly shifting when supervision is or how it might show up without really being flexible or respectful in that process supervisee complaints about the progress in supervision or that can be made in supervision and this is oftentimes coming across as not enough time being allowed for being able to explore things and this is particularly problematic in like group supervision where one supervisee might be allowed to really dominate a lot of time especially those that are maybe more comfortable in speaking up first and then all of a sudden half of supervision is gone and seven other people need to share the remaining half so there's just a few minutes left to get to everybody else another one is supervisee defends the self against the supervisor this is needing to defend thoughts actions feelings against what is perceived to be the supervisor's criticism or judgment again another one that boils down to not feeling a sense of respect or safety and the last one on this list is the supervisee trying to pressure the supervisor supervisee's pressure the supervisor to fix supervisee and therapy problems or issues quickly or attempt to control the supervisor or the supervision session again i think this one is more prime for like group supervision kinds of things where there emerges to be somebody who's kind of challenging the supervisor and there becomes almost kind of this power struggle that can develop there it's interesting when you talk about some of these things i think about it from another angle i think about especially in agency work that's where a lot of the supervision that i'm familiar with happened so that's where my examples come from where whether it's group supervision or individual supervision supervisors will have a responsibility to set the agenda and i think we did an episode on how to set up supervision so i'll link to all of our supervision episodes in the show notes over at mtsgpodcast.com but when i think about supervisors that push deeply into administrative problems or documentation and take all of supervision time for that and supervisees don't have the ability to get their cases through and they don't feel like they're getting the clinical support that they need that can be another type of rupture that happens while super bills can be helpful for your private pay clients they don't help clients access therapy today when clients see you weekly or bi-weekly they may be out hundreds of dollars before they receive reimbursements four to six weeks later which can be financially straining on them. the risers mission is to help clients access therapy today by working to get them instantly reimbursed for out-of-network sessions. first you can help your prospects instantly verify their 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five hundred dollars in payments. the other category that ruptures can fall under are withdrawal rupture reactions now these might not be as prevalent or as easy to identify because they're not outward complaints they're not things that are more in that noun version of rupture they're more in that verb version of rupture that can kind of linger and pull back they may be a result of some of those noun ruptures but this is where we'll see like supervisors or supervisees disengaging and pulling back and not really having the confidence to be able to talk more to do anything more other than just kind of check the boxes it can show up as just kind of appeasement or only sharing what is absolutely necessary in a supervisory discussion about clients or about professional development or skill development it seems like a protective mechanism and it can be protective on both sides i remember supervisory relationships where either the supervisor or the supervisor would come late they would reschedule supervision or keep rescheduling and it wouldn't happen and i know that that becomes different if folks are gathering hours or needing to have the supervision signed off on but especially in in agencies where people would have supervision passed when they were they were earning hours you would start seeing folks not showing up coming late rescheduling all of those things and then really the conversations would not really go anywhere i think i've said this on the podcast before but one of the supervisors i had really early on was i think fairly burned out and just i think a little bit interesting and how he took things on but he would come into group supervision especially and he would say i don't want to talk about psychology what's the latest movie that we've seen and would really make it about personal stuff and it would be a quarter or a half of the way through supervision before we actually got to clinical material now i'm way beyond getting licensed so i don't have any concerns that they i won't be able to count those supervision hours so i feel perfectly free to say those things but it was interesting that he would he would start supervision trying not to do supervision and i think it was part of it he was burned out and he was also i think tired of all of these pre-licensed folks coming in and not knowing stuff and having to teach them so oh in the list of examples here you're hitting on a couple of them one is avoidant topic shifting just talking about anything else another one is just denial that it's happening one is minimal response to stuff okay you've talked good you're not gonna you're not going to mess up a client and just move on kind of things yeah another example is abstract communication where it's just kind of talking at like this really like not in the weeds at all the exact opposite like space shuttle level like all right in the scheme of things and humanity and this kind of stuff that's just not particular to the client whatsoever what are the ones that i think really shows up and this is for supervisors to pay attention to and this has some caveats to it but deferential and appeasing supervisees who have just kind of given up and are in the all right i i will just do whatever you say all of the time now i say this one has some caveats to it because this is also getting to know where your supervisees have been in their previous jobs in their previous life but one of the things that's happened in my practice and i'm very open about my learning process with this not only with my supervisee but also now everybody who listens to this podcast but for the first time i have been supervising a military veteran and some of the aspects that come up in this relationship is how much i'm encouraging independent thinking and the ability to make decisions and be adaptable which is the complete opposite out of chain of command kinds of things that this particular supervisee had experienced being in the military of waiting for approval to do the next steps and i'm glad that we're able to talk about this because without paying attention to this it would look just very deferential like why are you only ever doing the things that i tell you exactly what to do yeah and so as a supervisor part of this is being able to address it being able to address it in healthy ways another way that withdrawal ruptures can happen or can show up in supervision is in particularly self-criticism and this can happen again from both the supervisor side or the supervisee side supervisee side can really be like well i'm just not ready for things yet or i'm not good enough or i'm not prepared enough but this can also happen from the supervisor end of things and i have heard supervisees complain before where supervisors have said things like well if you're just not getting it maybe i'm not a good enough supervisor for anybody that is something where it can happen on both sides of things so all of these are signs of withdrawal rupture reactions the self-criticism one on the supervisor side is pretty interesting too because i feel like there is a balance between self-criticism or humility or those types of things and pretending that you're infallible so some of these things are kind of a yes and or nuanced and so i just wanted to acknowledge that one place that does seem to come up quite a bit in the supervisory rupture stuff is around cultural ruptures and this can happen with as you mentioned earlier either supervisees from a different cultural or identified background than from what their supervisor is it can happen in the process between when a supervisor comes from a different background then where a client is coming from there may be an alliance as you mentioned like with Adriana's episode where clients in supervisee might share there might be some of this that might show up between where the supervisor and the supervisor might share a different background than where the client is coming from where microaggressions or spaces to grow and exhibit cultural humility would really be rife for this we've had plenty of episodes talking about cultural humility i don't want to get into the the specifics of that aspect here so we'll include some of those other episodes in our show notes for this where i want to focus this part of this episode just so we can talk about how to respond to rupture within the rest of our time here as well as talking about supervisee ruptures a little bit more specifically is cultural ruptures that can happen when other group members in group supervision are the ones who are saying it and supervisees who come into supervision with the expectation that supervision is a safe place calling back to the beginning of the episode where i was previewing this part of it that sometimes supervision is going to have either other group members who are making microaggressions either intentionally or not or where it's likely to come up most often which is not necessarily with bad intention but it's directly quoting clients who are saying things that can be microaggressions or even aggressive actions towards any oppressed group of people when we're talking about microaggressions i i want to acknowledge that there are a few other ways that that can show up and it's the responsibility of the supervisor to take care of that and i know you you're going to get to that but i i want to also express that in a lot of organizations they're potentially serving typically minoritized marginalized oppressed communities and the way in which therapists talk about their clients not necessarily quoting clients i think that's also a place that that can come up but in the way that therapists talk about clients especially when some of the supervisors in the group are of the same or share identities those types of things i think it can be difficult to always spot especially when we get into kind of the hero complex or kind of the patronizing tone that can happen even in when there's not cultural differences but disability differences or other types of demographic differences there can be an inherent way that we discuss clients that can feel unsafe to folks in the room either because they share those identities or because they recognize that it's just not okay and so to me i feel like there's there's a lot to discuss here on this and and like you said we don't have the space to talk about it here but i want to acknowledge that even when we're talking from a place of wanting to help our clients and all those things if we put them in a one down position that can feel in some ways like microaggressions or just it's it can be bad clinically but it's it's something where recognizing how you're looking at your clients and how you're talking about your clients can be an element of these things and it's something that the supervisor should pay attention to so i want to point to an article this is from 2022 it is titled extending multicultural orientation to the group supervision of psychotherapy practical applications by see Edward Watkins jr at all your favorite and in this article there's a couple of things that i really love one is an example of dealing with rupturing microaggressions in group supervision and in this particular case it was a supervisor who was directly quoting a client who had used a slur about the lgbtq community that a client had said and was repeating it in supervision as far as how to manage it another supervisor in the group comes from a family where they had a sibling who identified as part of that group and the discussion ended up turning around to feelings of safety feelings of how to address it and in this particular article the authors do go about highlighting a way for supervisors to be able to handle those ruptures well supervisors who don't address what is happening in the room there is a process that happens in those group dynamics that does need to be attended to rather than it just being individual supervision with eight different people and kind of this spoken wheel kind of supervisory process that a lot of us have suffered through that also needs to focus on being able to handle the expectations of what happens in group supervision how things are going to be communicated and this is one that i will really encourage that people go back through and read kind of how the supervisor in this situation handles this this article also recommends that there be group supervision adapted ground rules based on cultural humility and i'm not going to go through all ten of them but again this is going to be in our show notes over at mtsgpodcast.com and it has things like i will enter into each group supervision experience with an open mind and possess an attitude willing to explore new concepts i will enter each group supervision meeting with a flexible and humble attitude and not allow my ego to impede the learning experience i will support my supervision team members as we engage in discussions and learning just as three examples out of the ten that i think helps to address this specifically within a multicultural orientation as it comes to group supervision i think we might need a whole episode on group supervision but that's just me i think so too so we have talked about supervise e ruptures as well i want to point out a couple of other ones that might show up and this is a couple i want to point out a couple of other ones one is misunderstanding aspects of the role of working in an agency and then acting on those misunderstandings a lot of this comes in those agency type settings where supervisees enter in with the idea of i'm going to be a therapist and i'm going to do therapist things and not recognize that they're also entering into a workplace that has extra work tasks that aren't necessarily clinical hours towards licensure or supervision or documentation it might be things like staff trainings it might be things like team building kinds of aspects that don't end up directly working that are part of a job description but aren't kind of the i'm here to be a therapist aspects another thing that can be a supervisee rupture is just kind of not developing as a supervisee and staying within the safety of only doing very task oriented directives with their clients and not moving into more of the broader picture kinds of abilities to look at things that go with kind of the ongoing lived experience that we have a supervisor as therapists as being oh here's the broader aspects of things beyond the questionnaire the follow-up questions that can be asked that might help validate clients more the types of supervisee ruptures that i think i saw a lot of from kind of managing supervisors where i would hear about these things later on or from the supervisors were when especially newer clinicians to the organization would come in and they would talk to their peers about what to do and they would ask questions from their peers on what to do and would get into some pretty you know kind of gnarly situations and would be asking their peers and not their supervisor and so then the supervisor would come back and say why are you doing that and it would be because of the feedback they got from their peers and and the fact that they did not necessarily feel comfortable to talk to their supervisor about it because either the supervisor didn't create the space for that or the supervisee's history suggested they could not trust the supervisor or they could not make mistakes and so they didn't want to show the supervisor they didn't know what they were doing and so to me that time that type of rupture could be a supervisor rupture but i think there are times when it is definitely a supervisee rupture where they find information about what they're supposed to be doing for their job and they do not verify it with their supervisor. Well the last part of the episode i want to cover what do we do with repair and yes yeah how do we repair these ruptures? Getting getting to this so according to Lidani et al this is from 2005 rupture repair the goal is to ideally resolve the rupture by both parties expressing an understanding of the impassee in a way that indicates they no longer experience the feelings aroused by the conflict dealing particularly with the verb aspect of rupture and the recommended process for this comes from C. Edward Watkins' tutor. Oh your favorite we got to interview this guy if anybody knows him. So recommends a process for supervisors that comes down to PCRA. Pause, consider, reflect, act and Katie in her own way did this earlier when she was talking about her visceral response to the very tough situation that clinical supervisors and agencies find themselves sometimes in that she took a pause she considered some different aspects around it she reflected on where is this feeling coming from and if she was a supervisor would then choose a course of action to be able to communicate that hopefully to the supervisors as far as hey here's the broader context when we're considering what everybody's roles are within the agency. This in action looks like within the context of the rupture the supervisor clarifies a misunderstanding. Now a lot of this is going to come back to the supervisors responsibility to be able to handle this because of that inherent power differential that we talked about at the beginning of the episode. However I think it is important to recognize that if a supervisor does not bring anything up and does a lot of that kind of withdrawal it can be hard for a supervisor to know and so yes it is the supervisor's responsibility but supervisees you need to bring things up. Yes within the context of the rupture the supervisor can consider changing the tasks or the goals. Now this may show up as different ways that approaches are brought into supervision whether it be how case presentations are handled it could be other work assignments as it deals with working things through with clients but being able to take that pause consider reflect on are there tasks or goals that can and should be changed in order to help both the client and the supervisor the supervisor. Within the context of the rupture the supervisor also provides a rationale for supervision and this is kind of that being more transparent pulling the curtain back here's where I'm coming from that is more than just kind of that confrontational rupture that can end up doubling down on itself we'll do it because I said so. Next is the supervisor invites the supervisor to discuss their thoughts or feelings in a respectful manner so this is respectfully is your supervisor I want to hear you out on where you're coming from on this. Within the context of the rupture the supervisor acknowledges their possible contribution to the rupture. Hey own it own it I'm I'm feeling pressure from my boss to get everybody up to productivity the kinds of things yes this came across in a way that affected you. And within the context of the rupture the supervisor discloses their internal experience of the supervisor supervisor interaction supervisors have feelings too and sometimes the way that things are challenged or brought up within a supervision and I see most of these examples in my consultations and my experience before as having happened particularly in group situations particularly where a member of a group supervision is somebody who's distracting or kind of viewing things off topic or the mood ends up becoming very disruptive to the other supervisor members. The supervisor responds to the rupture through validating the supervisor in any way I see where you're coming from I hear you like these are things that if you do it in a non-genuine way would be very patronizing so you have to as a supervisor get to a way where you can validate where somebody is being able to bring this stuff up and last but not least the supervisor responds to the rupture by redirecting or refocusing the supervisor and this is stepping in and being able to ask a supervisor to step back consider the broader picture of things engage in their own pause consider reflect act actions that sometimes as supervisors we can develop really good skills of being able to pause ourselves step back look at the broader picture of things that when we look at the fallibility ideas that sometimes earlier career clinicians might be very excited about things might be very focused on things might lose the forest for the tree so being able to pause consider reflect and act is really the way to handle ruptures when it comes to supervision. All right so just to close up here to give a practical example as a supervisor and a manager actually there were times when there were huge numbers of clients who needed to be seen and there were times we were short staffed there were times when there were program responsibilities that required us to take clients as an agency or as a program and so what I ended up doing is I would acknowledge especially for newer clinicians who felt completely overwhelmed hey I messed up I put too much on your plate I took my ownership there and then I went through and and this is this is what I did a lot of and so I don't know that this is always possible for folks but I brought the team together so it was a particular program or whatever it is and I brought the team together and I said okay here's actually what we're facing this is this is the structure that we're facing there's this many clients that we have to see this is what we're doing this is what this looks like what ideas do people have how do we who has the capacity to take on some extra cases or what do we need to do and I worked on it as a team and took ownership of the problem as a team and recognizing it was my responsibility figured out and came up with more ideas so it goes to that critical thinking that you were talking about where you know at some point some folks were like well can we see these clients in groups if we can see them in groups it's a more manageable caseload we already are doing groups we know how to do groups this is a skill set we have maybe this helps us from having 40 clients a week or whatever craziness that had happened at that point and so when folks were in it and they were able to say hey I'm overwhelmed this is this is not where my skill set is or this is not what I was expecting bringing it back to the group or back to individual supervision and and problem-solving together I think was the way in which I was able to do a little bit better not always perfect but a little bit better at trying to live with the system while also trying to support my supervisees so it's imperfect but that's what I ended up doing it was like hey this is what it is this is a context and I want to respect your knowledge and learn from you and you're you're in the trenches doing this stuff what can I do to help support us given that these are the requirements that we have placed on us you can find our show notes over at mtsgpodcast.com listen at the beginning in the end of the episode for information on how to get continuing education and until next time I'm Kurt Whitham with Katie vernois. 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