My Experience as a Neuropsychoanalytic Psychotherapy Consultant/Supervisor ( Part III)

The beginning phase of neuropsychoanalytic  psychotherapy consultation/supervision is similar to but different from the beginning phase of neuropsychoanalytic psychotherapy. It is similar in that the primary goal of the beginning sessions is all about forming a relationship with the student/clinician. In psychotherapy we call this the forming of a therapeutic relationship or a therapeutic alliance. In consultation/supervision we call it forming a supervisory relationship or a learning alliance. The relationship building part of the beginning phase requires the same skills of the supervisor as it does of the therapist. And from the student side, it requires the same amount of trust that forming a relationship with their therapist requires.

The major difference is the goal and purpose of consultation/supervision verses therapy. Supervision is not a therapeutic experience. It is a learning experience. It is not a therapist to patient relationship. It is a teacher to student relationship. We call this the "teach versus treat" goal. It is very important that the supervisor and the supervisee know the difference in the two forms of encounter.

Now what is unique about psychotherapy consultation/supervision, unlike other teacher/student relationships, is there is an element of therapy in the teaching. Because the teacher is also a therapist, they use their understandings and skills to help the supervisee see some things about themselves that would be off base to share in any other teacher/student dyad. For instance, if the supervisee makes a huge mistake in treating one of their patients, and the therapist believes it is because the supervisee's own personal issues got in the way, then they will tactifully point that out to the student. But they will not go into depth about the student's personal issues as if it were a therapy session. Instead they will say something like, "If this personal issue continues to get in your way then you might want to bring it up with your therapist." This is why it is so important that the supervisee also have a therapist as well as a supervisor. In addition to forming a learning alliance with the student/clinician, the supervisor will also want to learn as much about the student's history of learning psychotherapy as possible. So the supervisor asks all about how the student became interested in therapy, what types of therapy have they themselves been in, what courses have they taken, where do they feel are the gaps in their knowledge, how much therapy have they actually conducted and what types, etc? During this time of history gathering the student/clinician may tell the teacher many personal and private things about themselves as well. The teacher listens empathically to the student as if these were therapy sessions, but the teacher does not dwell on these more personal experiences. The focus remains educational and not therapeutic. When does the beginning phase of supervision end? When the supervisor and supervisee feel they are quite comfortable with each other, and their relationship is no longer something they are focused on.

The beginning phase ends when both participants are caught up in the treatment of the supervisee's patients and the patient becomes the major focus of the sessions. Then the dyad has moved into the middle phase. The middle phase in psychotherapy is called the "working through phase." I would call the middle phase in consultation/supervision the "working on" phase, meaning the student and the teacher are both now working on the student's provision of therapy for the patient. The student/clinician  is "working on doing it." The teacher is "working on teaching it." Learning is taking place. The supervisee is learning how to do neuropsychoanalytic psychotherapy. It is during this middle phase that the major problems of consultation/supervision come up. The student's personality sometimes helps the therapy process and sometimes gets in the way of it. It is the same with the supervisor. Their personality sometimes enhances their teaching and sometimes hinders it. These learning difficulties, problems, conflicts, and misunderstandings have to be worked on in the consultation/supervision, just as they have to be worked through in psychotherapy. It may be that both teacher and student have to consult a third party to clear up some problems in the supervisory work together. Sometimes the consultation/supervision problems cannot be worked out and the supervision ends before completion. Hopefully that does not occur and the supervisory dyad moves into the third and final phase of consultation/supervision, the ending or termination phase.

The termination phase is marked by the time in consultation/supervision when both the supervisor and the supervisee believe that the supervisee has learned all they can learn from the supervisor, and they are now feeling that they can function independently of the supervisor as a colleague or beginning neuropsychoanalytic  therapist. Sometimes this ending is determined by a set number of supervision sessions required for licensure. At other times it is a free decision between the supervisor and the student/clinician. No matter how the ending is determinded, ending consultation/supervision is not unlike ending therapy. It is all about wrapping things up, summarizing gains, celebrating victories, accepting failures, and ending the supervisory relationship. Like in therapy this ending needs not to be rushed. I would say it takes three months to successfully end several years of consultation/supervision. A major part of supervision termination, like in therapy termination, is grief. Both the student/clinician and the teacher will hopefully grieve the loss of the relationship, and this grief needs to be acknowledged and talked about. Of course both members of the dyad will also be celebrating as the student comes to "graduate" from supervision and becomes an independent therapist. For the supervisor it is not unlike having a teenager transition from young adulthood to mature adulthood. The student/clinician  may indeed feel the same type of growth process and outcome. It should be a happy day when the former consultant/supervisor and the former student/clinician celebrate together the former student's readiness to practice neuropsychoanalytic  psychotherapy on their own!