Regression, Self-Disclosure, and the Teach or Treat Dilemma: Implications of a Relational Approach for Social Work Supervision

Abstract

This paper presents a brief review of a relational approach to clinical supervision and argues for its application in social work settings. Although an integral and essential part of practice, clinical supervision is underrepresented in the practice literature. Given this paucity of writings on supervision, the recent book by Mary Gail Frawley-O'Dea and Joan Sarnat, The Supervisory Relationship: A Contemporary Psychodynamic Approach, stands out as a seminal contribution because the authors present a fully developed relational model of supervision that fills a major gap in the development of contemporary relational theory and practice. We selectively review the basic concepts and principles of Frawley-O'Dea and Sarnat's model and apply this supervisory approach to current social work practice. Our focus will be on exploring three controversial and much-debated topics: self-disclosure, regression, and the teach or treat dilemma. Case vignettes from two supervisory experiences will serve to illustrate how a relational approach enhances both the treatment and the supervisory relationship.KEY WORDS: relational supervision; self-disclosure; regression; teach or treat dilemma.For nearly two decades the relational approach to treatment has been gaining a stronghold in the development of contemporary psychodynamic practice. William Borden (2000) recently traced the roots of the relational model from Freud and Ferenczi throughout the history of psychoanalytic practice in an effort to locate the relational

Challenging Endings: First Year MSW Interns’ Experiences with Forced Termination and Discussion Points for Supervisory Guidance

“…This stance fits well with contemporary relational approaches applied to clinical supervision, which further underscore the centrality of the field instructor-intern relationship in the learning process (Frawley-O'Dea & Sarnat, 2001;Ganzer & Ornstein, 1999, 2004Ringel, 2001;Williams, 1997). In contrast to the traditional conceptualization of a hierarchical, didactic relationship where the field instructor is all-knowing and the intern is the novice receiver of information, a relational approach posits a triadic matrix with multiple, reciprocal relationships between field instructor, intern and client (Ganzer & Ornstein, 1999).…”

Transference Enactments in Clinical Supervision

“…In contrast, therapists and supervisors who view supervision and treatment from a more flexible, relational perspective (Bridges, 2005;Ganzer and Ornstein, 2005), recognize that supervisory (as well as therapeutic) action involves the co-construction of new relationships; what I describe here as corrective interpersonal interaction. Listening attentively for transference enactments in supervision enriches supervisory conversations and communicates empathetic interest in the manifest and latent content of what supervisees communicate.…”

“…Often, supervisees experience conflict with their supervisors at a latent level of meaning and express it indirectly. When supervisor's respond helpfully to such conflict, they offer ''working models'' (Feldman, 1982, see also Ganzer & Ornstein, 2005) for supervisees to internalize and subsequently use in addressing the interpersonal conflicts that arise in treating patients. Saari (1989) presents an elegant stage theory of how M.S.W.…”

“…As best I can tell, Doehrman's observations about transference disappeared almost entirely from the supervisory literature until relationally oriented supervisors (Bridges, 2005;Ganzer & Ornstein, 2005) began to discuss, in the context of co-constructed narratives, what earlier theorists would have described as transference-countertransference interactions. Tosone (1997) observes that supervisors enact both subjective and objective countertransference reactions in relating to their supervisees.…”

“…Decades of experience both as a supervisee and supervisor suggest that professional education and personal treatment may modify or disguise supervisory transference enactments, but do not decrease either their frequency or intensity. I have participated in far too many transferentially saturated case discussions involving well-analyzed, highly respected senior clinicians and/or clinical educators, to think that therapists do not regularly enact transference feelings in discussing case material with each other, their supervisors and/ or their consultants (see also, Ganzer & Ornstein, 2005).…”