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Book Reviews   |    
Dimensions of Psychotherapy Supervision: Maps and Means • The Supervisory Encounter: A Guide for Teachers of Psychodynamic Psychotherapy and Psychoanalysis
Reviewed by Jane Thorbeck, Ed.D.
Psychiatric Services 1998; doi:
View Author and Article Information

by Russell Haber, Ph.D. ; New York City, W. W. Norton, 1996, 237 pages, $29 • by Daniel Jacobs, M.D., Paul David, M.D., Donald Jay Meyer, M.D. ; New Haven, Connecticut, Yale University Press, 1995, 285 pages, $28.50

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Haber leads off with the lofty proposition that "this book presents a model that integrates the relational, contextual, theoretical, and technical dimensions of supervision." However, the author provides no comprehensive model. He simply puts forward an interesting metaphor—that supervision is like a house containing "the ecosystems of both the supervisor and the supervisee." Supervisors and supervisees are advised to explore the bottom floor ("self of the therapist"), middle floor ("work context"), top floor ("ideology"), and attic ("culture"). As an exercise, such an exploration has allure. As a model or method for supervision, it is neither quite comprehensible nor particularly useful.

The author does not work from a coherent theory of the mind, and his book suffers from it. For example, within two pages early on, he refers to "systems theory," "parallel process," "transgenerational therapists," "transference problems," "the equation of the professional and clients' houses," "the self of the supervisor," "the isomorphism perspective," "the perpendicular intervention," and "a supervision-of-supervision group." This kind of scattered thinking keeps the book on the surface, giving the reader little to dive into.

Haber is a psychologist, an experienced clinician, and a lively and talented teacher. He is at his best when actually describing supervisory situations, innovative treatments, and supervisory techniques. His detailed descriptions about how to use the one-way mirror during psychotherapy, the telephone intervention during live supervision, videotapes with a supervisee, and the empty-chair and role-playing techniques are provocative and helpful. The section on three types of "live supervision" in which the supervisor is directly involved with the clients and the supervisee—live supervision, live consultation, and apprentice cotherapy—is the best the book has to offer. It is detailed, applicable, unpretentious, and down to earth.

The author is also skilled in considering the contextual variables influencing the therapeutic situation. His discussion of special populations such as physically disabled people or alcoholics is informative. His review of the impact of important variables such as race, gender, age, culture, and clinical setting (in both the supervisory and the treatment situation) is thought provoking and in tune with the realities of a multicultural world.

Although Haber implies that the book will be useful to those supervising treatment of patients in any modality, the author's clinical foundations, and his heart, are in family and couples therapy. He makes frequent references to his mentors from the original family therapy movement: Whitaker, Satir, and Pesso. Yet even when he seems to be hitting his family systems stride, the reader is often astonished by what he suggests. For example, he spontaneously advised a supervisee to tell the separated parents of a 12-year-old enuretic son to "have the boy sleep in their beds in their respective homes." This suggestion may have the ring of a family therapy intervention, but it lacks a grasp of what the meaning or unconscious implication of this action is to the child.

Haber is writing for a specific, if limited, audience. This book may be useful for those who supervise, or want to learn to supervise, family and couples therapy. The vignettes on individual psychotherapy do not reflect understanding of depth psychology and the unconscious workings of the mind. Psychodynamically orientated supervisors will find this book too focused on technique and without supporting theory.

The Supervisory Encounter is a vastly different book for a vastly different audience. Jacobs, David, and Meyer, all experienced psychiatrists and teachers, have written a sophisticated yet highly readable book on supervision for clinicians who are interested in depth psychology and who supervise work primarily with individual patients. What the authors value most highly is the depth of the supervisory discourse. And so they fashion their book in every way to achieve this end. Although the authors synthesize the work of others, they are innovative in their own right. Their book is full of new ideas.

The authors assume readers have a basic understanding of the central psychoanalytic concepts of transference, countertransference, defense, and resistance. Some sections of the book are a reach for the beginning supervisor, as it is dense in places, necessitating rereading. The effort, however, is well worth making. For the experienced supervisor, the authors raise consciousness by putting into words and concepts much that is assumed or unarticulated in the supervisory experience. In so doing, they open the way for an increased supervisory repertoire and responsiveness.

Throughout the book the authors focus primarily on the supervisor-supervisee dyad. Running through the text are two vitally important and timely threads that are not stated as main topics of the book. First is the authors' emphasis on supervision as a collaborative experience—in sharp contrast to the dated psychoanalytic tradition of "received wisdom." This emphasis reflects advances in psychoanalytic theory and technique in which the therapeutic relationship is now regarded as a collaboration, co-constructed and relational.

A second and related theme is the clinical need to attend to the supervisee's potential experience of shame. The authors describe that experience as rooted in the "inescapable conflict between curiosity, exploration, and the search to deepen understanding on the one hand and the narcissistic vulnerability of the supervisee on the other."

This emphasis also parallels theoretical advances in our understanding of the importance of shame in the psychotherapeutic process. The likelihood of shame in the supervisor-supervisee relationship may be increased by the vertical nature of the relationship and the supervisee's inevitable comparison of oneself with a more advanced or idealized supervisor. Because in supervision, as in treatment, anxiety brings material into the process, and shame keeps it out, it is difficult to overestimate the importance of the supervisor's awareness of shame in the learning process.

An atmosphere of collaboration and sensitivity to narcissistic vulnerability and shame allows for differences and disagreements in the supervisor-supervisee relationship. The authors emphasize that open and debated differences are a healthy development that deepens the supervisory discourse and helps the supervisee understand and develop his or her own style. When the book fostered thinking and prompted disagreement on my part, which it did frequently, I felt it was alive, like a successful supervisory session.

The book is well organized, with innovative chapters on identifying and fostering four modes of thought that are essential to the development of the supervisee: inductive, associative, creative, and self-reflective. The chapter entitled "How Personal Should Supervision Be?" deals with the tension between the supervisor, who is "the professionally trained intruder," and trainees, who commonly feel vulnerable about opening themselves up too much. The chapter on "Supervisory Interventions" offers fine examples of confrontation and clarification, modeling, didactic instruction, Socratic questioning, encouragement and permission, and "the riskiest form of supervisory intervention," interpretation. The final chapter, "Termination," is rich with novel ideas about a topic almost unmentioned in the supervisory literature.

The authors succeed in their stated goal of encouraging readers to better formulate their ideas on the supervisory encounter. For the psychodynamic clinician, this is the most thoughtful, engaging and useful book on supervision to come out in many years. It serves up old wisdom in a thoughtful and synthesizing manner and advances theory and technique to a new level.

Dr. Thorbeck is affiliated with the department of psychiatry at Massachusetts General Hospital in Boston and is an instructor in the department of psychiatry (psychology) at Harvard Medical School.

Dr. Thorbeck is affiliated with the department of psychiatry at Massachusetts General Hospital in Boston and is an instructor in the department of psychiatry (psychology) at Harvard Medical School.




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