Communication: The Social Matrix of Supervision of Psychotherapy

DISSERTATION PROPOSAL (3 Nov 1993)
Teachers College Columbia University

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Specific focus of dissertation

The communicative interaction between supervisor and supervisee can be a model of the kind of the communication which the therapist needs to cultivate with his client optimally to help the latter function more effectively and rewardingly in life. But the supervisor and supervisee's communicative interaction often neither exemplifies such healthful and healing communication, nor attends to this issue. Not only is an opportunity to reinforce the effectiveness of the of the pedagogical situation thus missed. Even worse, conflict between the content which is manifestly communicated and the way it is communicated can make the supervisory situation be pathogenic. The communicative process in supervision can thus end up interfering with the therapist's ability to promote constructive communication -- in life situations in general, including, most relevant to his effectiveness as a therapist, his work with his patients.

I want to explain this matter in greater detail, explore it with specific situations, and propose how the communicative engagement in psychotherapy supervision can be enhanced to address it.

Overall horizon of concern

I hope the dissertation provides operationalizable instructions how to do this in one small area of life: supervision of psychotherapy[2], which then will spread out to similarly transform other areas of life, both by the direct effects of therapists' work and also by being a model to inspire others to attempt similar changes in areas of life which concern them:

"...a progressive transformation that ultimately draws into its orbit all ideas proper to finitude [i.e., pre-reflective immersion in any given pattern of life] and with them the entire spiritual culture of mankind... [--] a revolutionizing of all culture... that affects man's whole manner of being as a creator of culture.... This takes place in the form of a new kind of practical outlook, a universal critique of all life and of its goals.... whose aim is to elevate mankind through universal... reason... on the basis of... constant reflectiveness... and thus to transform it into a radically new humanity made capable of an absolute responsibility to itself." (Edmund Husserl, Philosophy and the Crisis of Philosophy, pp. 163, 164, 169, 181)

"...as I said, mankind understanding itself as rational, that it is rational in seeking to be rational; that this signifies an infinity of living and striving toward reason; that reason is precisely that which man qua man, in his innermost being, is aiming for, that which alone can satisfy him, make him 'blessed'...." (Edmund Husserl, The Crisis of European Sciences and Transcendental Phenomenology, pp. 340-1)

"For the sake of the life-task that has been taken up [i.e., the foregoing] , in times of danger one must first let these very tasks alone and do what will make a normal life possible again in the future. The effect will generally be such that the total life-situation, and with it the original life-tasks, has been changed or in the end has even become fully without an object. Thus reflection is required in every sense in order to right ourselves." (ibid., p. 392)

A closer look at psychotherapy supervision and its purpose

[Note that there is a substantial literature on a phenomenon which takes place in supervision which looks similar to what I here am talking about. This is the so-called "parallel process", whereby the supervisee unwittingly shows the supervisor certain aspects of a patient's pathology by unconsciously enacting similar (sic: "parallel") behaviors toward the supervisor. For example, a supervisee may exhibit obtuseness toward the supervisor's instruction not because, in general, the supervisee is obtuse, but because one of the supervisee's patients is being especially obtuse in therapy without the supervisee himself recognizing this. Such difficulties get resolved by the supervisee coming to see that they do not really arise from the supervisory relationship. This phenomenon surely has a place in supervision, but my focus here is on unwitting aspects of the supervisory interaction which are eventually resolved by recognizing their origin in the supervisory interaction -- their, so to speak, "iatrogenic" nature.]

In practice, such reflection does sometimes occur, often without being explicitly recognized, and, a fortiori, valued as such. Various authors writing on theory of supervision mention that the best way to address certain difficulties which occasionally arise in the supervisory relationship is for supervisor and student directly to talk out the issues involved. When it is intentionally undertaken, such reflection is seen as something which has to be done in supervision instead of supervision when the learner has problems with supervision which interfere with his benefiting from supervision. Optimally one shouldn't have to engage in such digressions; next best is to attend to and get done with the precipitating problems as quickly as possible, to be able to turn attention back to "real supervision", focused directly on the student's work with his patients outside the supervisory situation.

The upshot of this orientation toward self-reflection on the process of supervision in the process of supervision is that such self-reflection remains stuck at the level of intuitive, largely prethematic and idiosyncratic practice: something people just "do", "naturally", "obviously"... (or, equally "naturally", "obviously"... do not do). It does not constitute itself as science[3]. An intrinsic result of this condition is that the potential of the practice remains largely undisclosed and, due to both lack of knowledge and lack of interest, unexploited. A likely further factual result, in a social world -- e.g., late 20th century America -- in which anything that is not constituted as a formal discipline has ipso facto increased difficulty getting funded and otherwise sustaining itself in the noetic ecosystem, is that the practice may be squeezed out of whatever role it currently has, entailing loss of even the benefits currently accruing from it.

When any part of life is thematized as a discipline, it changes its place in life, and, consequently, modifies the overall constellation of life in general. (Example: All humans prepare and eat foodstuffs; modern nutritional science changes, in varying gross and subtle ways, not only what people eat, but the activities in which they engage vis-à-vis alimentation, including, for one entirely new phenomenon: that some persons now spend large parts of their lives investigating how to improve nutritional practices and training other persons to do this, thus constituting a new autonomous sphere of life.) By repositioning self-reflection in psychotherapy supervision into scientific (i.e., thematically self-elaborating and self-correcting) discipline, I aim to increase its constructive potential, as well as its actual "visibility" and "influence".

I will argue that, when the supervisory process focuses on the student's therapeutic work per se, without also addressing the meaning of this process for the supervisee as he experiences it, the resulting communicative interaction, untethered from its ground, is vulnerable to teach, largely out of awareness, "things" different than and even in conflict with the objective meaning of the verbal messages it contains. Such communication, by excluding, or, even more perniciously, misrepresenting aspects of itself, produces unconscious(sic) instantiation of unconscious process [the very structure psychotherapy is supposed to undo!]. When, on the other hand, supervisor and supervisee, whatever they are talking about (the student's therapeutic work, the previous night's baseball game...), "also" attend to the dynamics of the supervisory situation in the supervisory situation itself[4], the student gains experience which enables him more effectively and confidently to perceive and respond to the dynamics of the therapy situation (and, indeed, all interpersonal relationships in life), not by acquiring specific "therapeutic" skills but by enriching his general expectations of interpersonal communication and his sensitivity to potential obstacles to the realization thereof. Through the uncovering process of clarifying the supervisory interaction itself (making that particular unconscious material conscious), the student gains [from analogical experience] a lively sense of what is involved in the uncovering process of therapy -- "what it's about", "what some of the difficulties are", "how to make it happen".... This can occur fortuitously when the persons involved are intending something else; it should have better prospects of occurring more, and more effectively if intentionally cultivated.

Psychotherapists aim directly to modify the deep patternings of persons' ways of being-in-the-world. Supervision of psychotherapy shapes the kinds of interventions therapists make. Subsequent to a major change in the process of supervision, therefore, we should be alert to the possibility of even more consequential changes in persons' lives and encompassing social life, than result from many other manipulations and innovations, even such powerful ones as new communication [media] technologies, which operate on less pervasive layers and narrower sectors of persons' orientation in life (of course this is so far only a possibility: direct efforts to change something do not on that account necessarily have greater impact on their target than indirect and even unintended side-effects of more or less unrelated phenomena).

Organization of dissertation

The existential impact of any reading experience will likely fall far short of actually participating in an interaction in life (the interaction in which you, my reader, and I are engaged is one involving this text in its, i.e., our social context). It seems to me that the potentially most "mutative" kind of reading experience is where the reader can imaginatively engage himself with dramatic material in an open-ended way. Reflection on alternative courses of action in a vividly imagined scene seems to me more likely to "affect how one lives" than merely discursive argumentation.

Even if it is dramatic, of course, an example can be adduced to support an argument. My examples can be treated that way. In some ways, however, I feel more committed to my examples than to my arguments: I believe that the examples show something valid and important even if the arguments don't fully succeed in telling what that is and explaining why it is valid and important. (I am aware that all action is theory-dependent.) On the other hand, the relationship between the examples and the argument is not merely paratactic [in the grammatical, not psychoanalytic sense of that word]: I contend that the examples not only provide evidence to an observer for the theory in terms of which I have interpreted them, but also, if lived out, they will contribute to the participants themselves validating, coming to a richer understanding of (or even constructing!) that theory for themselves, in and through their interaction.

Primary sources

Pursuant to seeing this dissertation as extending Ruesch and Bateson's work, I have titled it "Communication: The Social Matrix of Supervision of Psychotherapy". I would like to go further and make communication theory the heart of the entire edifice of psychotherapist training (followed, as second priority, by certain social work or "case management" skills). There are reasons for limiting myself to the supervisory component of that training, in addition to the logistical desideratum of delimiting my dissertation project. Foremost may be the prospects of actually affecting how therapists get trained. Most pedagogical reforms require institutional action, which I take to be beyond my power to effect (if I had power to shape a training program, I wouldn't be writing this dissertation [At the time I wrote this dissertation, 1993-4, I was in such a program, and I did try to shape it, but the upshot was that I got what I believe the Amish call: "shunned", because the faculty deemed it was the program's -- which, in their eyes meant: their own -- role to shape the student rather than the other way around.]). For supervisors and/or students to try out -- and, I hope, reap significant benefits from -- the suggestions I make herein, requires "only" that, as individuals, they attend to what transpires in the supervisory situation(s) in which they are already engaged. By felicitous coincidence, it also seems to me the potential "payoff" of the proposed "simple", no-cost changes for the effectiveness of psychotherapy training (both the process and its outcome, i.e., the quality of therapy to which it leads) may likely exceed that of many kinds of elaborate curriculum reform (etc.).

Other sources in communication theory from which I draw include Birdwhistell, Boulding, Goffman, Habermas, McLuhan, Ong, Scheflen, and my "oral" communications with Professor Emeritus Forsdale (I wish I had more such living sources to draw upon: sources whose meanings I could clarify and elaborate by a real process of conversation!). Other disciplines on which I draw include phenomenological philosophy (Husserl, Alfred Schutz, etc.), hermeneutics (esp. Gadamer), certain strands of psychoanalytic theory (Ferenczi, Winnicott, Sullivan, etc.), and other texts which have mattered to me, such as Hannah Arendt's The Human Condition, and Hermann Broch's novel The Sleepwalkers, some films, such as Alain Resnais' "Mon Oncle d'Amerique"....

It may be noted that most of these sources are somewhat "old" -- work of persons who have died or who, if still alive, are no longer young. Is it just that I am too far away from "where it's happening" to be aware of more advances being made by "contemporaries" which would appeal to me? Many things are worth doing, and our society is still rich enough to do many things, but we can't do everything and some alternatives may not even get a chance. Might we do better to devote more resources to studying metacommunication and less to telecommunication, more to studying the structures of the Lifeworld and less to virtual reality, more to deutero-learning and less to multimedia, less to affirming cultural diversity and more to elaborating Universal culture, more to reconstruction and less to deconstruction...? But it's not just an [empirical] issue of redeploying person-hours from group-A to group-B tasks; it is more consequentially a[n ontological] decision whether to consciously situate the one group of activities in the context of the other. Insofar as in fact they are so situated even if we don't think (know) they are, then the transformation I am urging is that where anonymous process was (and, alas, still is...), there responsible action shall be.[7]

May this dissertation be a worthy example which will inspire increased efforts to "Prove all things; hold fast that which is good" (1 Thes. v. 21; the text of William Ellery Channing's "Baltimore Sermon" (1819), defining American Unitarianism -- and which, if understood deeply and radically, summarizes my thesis).

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Footnotes

[1] See, e.g., the Preface to Peter Eisenman et al, Five Architects, 1972 -- now [1993] 21 years old. [I quote from this reference in my Postmodernism background material webpage.]

[2] I have selected this particular object of study on account of its value in itself (the role of psychotherapy in social life), and also because the kinds of communicative interaction which occur in supervision of psychotherapy are exceptionally rich, in ways which make it a "privileged" domain to study to learn about communication in general.

[3] I am using the term "science" here in Edmund Husserl's sense of self-reflective, self-critical, self-elaborating inquiry, for which the so-called "exact sciences" (such as physics) are not a paradigm but only equivocal examples, since their self-reflection does not extend to their situation in the encompassing horizon of life (what Husserl called the "Lifeworld"). Alternatively, the word "science" can here be understood to include any self-elaborating social endeavor vis-à-vis an object domain, including physics, experimental psychology, p[hr]enology and perhaps even astrology. The criterion is then sociological, not epistemological, i.e., that it is a certain kind of activity, not that a certain kind of validities result from the activity.

[4] A psychoanalytic term which may describe this process is: "observing ego function".

[5] In all, the dissertation will consist of four parts:

1. Theoretical exposition of selected communication theory. [Chapter 1.]
2. Description of the supervisory component of psychotherapy training. [Chapter 2.]
3. My proposed changes to the supervisory process (applying #1 to #2 via in-depth study of the example set). [Chapter 3. I came to call this kind of in-depth study of particular communicative interactions, and then proposing what the participants could have said to make their interaction better, i.e., where I put my words in their mouths: "rescripting". Preferably these new words should be "monosyllables", to make it as easy as possible for the reader to "get the point".]
4. Broader implications and directions for further work. [Conclusions.]

[6] One reason for using examples from the literature is to avoid confidentiality issues without resorting to "made up" and therefore less credible stories.

[7] "Wo Es war, soll ich werden" (Sigmund Freud, New Introductory Lectures on Psychoanalysis, end of lecture #31)

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http://www.cloud9.net/~bradmcc/dProp.html Copyright © 1998 Brad McCormick, Ed.D. bradmcc@cloud9.net 16 March 2006 [22 June 2002] v01.15