Sissel Reichelt

Nondisclosure in psychotherapy group supervision: The supervisee perspective

The aim of this study was to investigate aspects of nondisclosure in a sample of 55 student therapists, working within a group format of supervision. The study constituted one part of a larger study, with the other, parallel part addressing nondisclosure in supervisors. The participants were recruited from seven university-based training clinics in Norway and Denmark. The supervisees answered a questionnaire comprising 11 items about nondisclosure in supervision. The items were answered in a yes/no format, and the respondents were invited to provide examples and justifications for their answers to each item. The examples and justifications provided were analysed in accordance with Hill’s guidelines for consensual qualitative research. The study confirmed significant nondisclosure by supervisees in a number of important areas. A high percentage found it difficult to talk about topics related to the supervisory relationship, fearing that they would hurt their supervisor or be met with criticism or interpretation. They were also reluctant to talk to their supervisors about professional matters, particularly related to the perceived incompetence of their supervisors and their expectancy of non-constructive criticism. They felt that their supervisors withheld feedback on their work, as well as advise on what to do, and would like more of this. Several of them thought of the lack of feedback as a conscious strategy helping the students to find out for themselves. A rather striking finding was that a high number of students experienced that the groups became more closed throughout the supervision, and blamed their supervisors for inadequate handling of the group process. This is an issue that needs further exploration.Supervisee non-disclosure in psychotherapy group supervision: The supervisee perspective

Refugee families in therapy: from referrals to therapeutic conversations

Refugee families referred for therapy present a wide array of problems and expectations, not always in accordance with what therapy may offer. Major differences between referring professionals, families and therapists regarding problem definitions and solutions may complicate collaboration. Interventions that may overcome these barriers and move initial interviews into a therapeutic context are described. Three patterns regarding referral process, problem presentation and expectations (here called referral contexts) are outlined: ‘the relational’, where families ask for psychological and interpersonal assistance, ‘the unfocused’, where families are referred to therapy without expressing any wish for it, and ‘the fixed solution’, where families seek support for solutions that are not of a therapeutic nature. The interventions described form part of a negotiation where motives and interest for therapy are explored and agreements regarding further therapy are outlined.

What Constitutes a Good Working Alliance in Therapy with Children That May Have Been Sexually Abused

The use of qualitative methods in a case by case study of fifteen psychotherapies with children allowed for inquiries into how the working alliance can be established when children are involved. Therapy hours were recorded, and the children’s, their caregivers’ and the therapists’ views about what happened during therapy were collected at the end of therapy and at one year follow-up. The referral to psychotherapy was a suspicion of sexual abuse. The results show how the working alliance is related to not only the child’s, but also the caregiver’s understanding of the therapeutic process. This includes sharing an understanding of the therapeutic goals and tasks, the emotional bond, and how the caregivers become involved and support their children’s participation in therapy. An expanded understanding of Bordin’s concept of the working alliance along two dimensions is suggested: the first one is from an adult to a child deduced understanding of the therapeutic process that bears in mind the child’s capacity for understanding complex change processes, and the second is from a dyadic to a systemic understanding of the alliance.

Supervision of Inexperienced Therapists

Abstract This paper is based on a qualitative study of supervision of inexperienced trainees. Eighteen supervisor-student dyads were interviewed listening to the same sequences of a tape from a supervisory session. They were also given a semi-structured interview relating to general aspects of supervision. The purpose of the study was to provide understanding of supervision that questionnaires may not make apparent, and to explore them in relation to supervision issues. It appeared that most supervisors had an ideal of a symmetrical position and tried to refrain from being didactic or instructive. This position was mostly appreciated by the trainees. The findings are discussed in relation to the emphasis on didactic training for inexperienced trainees in supervision literature, particularly with regard to possible contextual variables influencing how the trainee perceives and reacts to supervision.

Strategies used by experienced therapists to explore client goals in early sessions of psychotherapy

The purpose of this study was to investigate the strategies used by highly experienced psychotherapists to explore client goals for psychotherapy during the first three sessions in treatments as usual. Transcripts from audio recordings of the initial three sessions of a sample of nine experienced therapists were analyzed using a modified constructivist grounded theory methodology. The transcripts revealed few therapist behaviors directed toward agreeing upon explicitly defined goals. Analysis of the data made it possible to identify two categories of goal-oriented activity: (1) ensuring that what happens in therapy is meaningful for the client and relevant to the attainment of the client’s goals; and (2) being aware of complexity – the client’s ambivalence and resistance to change. It is argued that the client–therapist dialogs examined in this study were characterized by processes regarding hope, motivation, and engagement rather than by explicit goal agreement. Implications for the concept of goal consensus and the working alliance are discussed.

Veiledning av veiledning: Hva er viktig i veilederutdanning?

Reichelt, S. & Skjerve, J. (2004): Supervision of supervision: What is important in supervisor training? Nordisk Psykologi, 56 (2), 107–127 Supervision of supervision is an important part of training programs for supervisors. In this article we take a closer look at how to carry out supervision of supervision. We are describing conditions we consider important for a good learning process, such as significant qualities of the supervisor of supervisors, the format of the supervision and supervisory methods. A main point is that supervisors in training usually are experienced professionals. Appropriate supervisor roles and methods are discussed in relation to this, and in relation to the specific tasks and goals in this setting. It is argued that a group format is particularly suited for supervision of supervision, and an instrument for evaluation of the work in the groups are presented.

Topic-focused analysis of verbal interaction in a case of integrative therapy with a young woman presenting with symptoms of depression

ABSTRACT It is increasingly recognised that single-case analysis makes a valuable contribution to the evidence base for psychotherapy, alongside other methodologies. Such analyses make it possible to investigate the unfolding process of change in therapy, and develop an understanding of change factors that contribute to outcome. One of the key challenges for the psychotherapy research community is to develop methods for descriptive single-case analysis that are simple to apply, and allow comparison across cases collected in different contexts. Topic Change Process Analysis represents a practice-relevant framework that is descriptive, flexible and widely applicable. The present paper presents an analysis of brief integrative/eclectic therapy received by a young woman struggling to come to terms with emotional instability and depressive episodes. Analysis of topic areas, topic shifts, response patterns within topics and changes in perspective makes it possible to identify key processes which resulted in a positive outcome for this client. The implications of these findings for practice, and future research, are discussed.

Topic change processes in psychotherapy: a case study approach

ABSTRACT A method for the analysis of transcripts from individual psychotherapy sessions is presented. The method, Topic Change Process Analysis (TCPA), is a qualitative and exploratory approach focusing on therapist-client interaction, on how such interaction influences topic changes during the therapy, and the possible contribution of the changes to the final therapeutic outcome. The method is descriptive. This makes it possible to explore the therapeutic processes in therapies with different theoretical orientations and to interpret the findings from different theoretical angles. The material from the analysis can be used to construct case stories covering topic changes occurring during a psychotherapy process.

Mutual assumptions and facts about nondisclosure among clinical supervisors and students in group supervision: A comparative analysis

In the two preceding papers in this issue of Nordic Psychology the authors report findings from studies of nondisclosure among student therapists and clinical supervisors. The findings were reported separately for each group. In this article, the two sets of findings are compared, so as to draw a picture of mutual assumptions and facts about nondisclosure among students and supervisors.

Veilederkompetanse: Oppgaver og utfordringer i veilederrollen

Reichelt, S. & Skjerve, J. (2004): Supervisor competence: Tasks and challenges in the supervisor role. Nordisk Psykologi, 56 (2), 75–91. The clinical supervisor is expected to master a very complex role. Participating in the development of training programs, we have missed a specification of the tasks comprised in this role. In this article they are described and analysed, based upon social role models of supervision, empirical studies of the supervisory process and clinical experience. In training programs for supervisors, competent handling of this list of tasks is the goal for the developing supervisor. The supervisor must continually make decisions concerning focus and interventions as part of the process. A main point in the article is that it does not suffice to be skilled in techniques or methods of supervision to contribute to a stimulating and supporting process for the supervisee. The supervisor must be reflective of and engaged in the role to make good decisions.