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Ongoing Clinical Supervision recognized the limitations of his professional involvement and more clearly understood what could realistically be achieved with this couple during a brief inpatient stay. Authority and dependency issues are frequently at the root of parallel processes (Grey & Fiscalini, 1987). If the clinical supervisor and clinician don’t explore motivations for engaging in this process, they may get stuck in a series of transferencecountertransference interactions. Grey and Fiscalini (1987) state that this is avoided if the clinical supervisor empathizes with the clinician, but does not get stuck in the empathic process. The clinical supervisor is able to see the client and clinician’s perspectives, and differentiate them from his or her own. The supervisor is then able to clarify the transference-countertransference interplay occurring. However, if the clinical supervisor does get caught up in a parallel process, he or she can use his or her own emotional response to explain the anxiety in the clinician-client dyad and, additionally, the anxiety in the supervisor-clinician dyad. Exploring transference, countertransference and parallel process as they emerge within the supervisory relationship and clinician-client dyad ultimately illuminates a deeper, more meaningful understanding of the client. Conclusion Individual clinical supervision, when conducted in the context of a supportive, trusting relationship, is a vital process that contributes significantly to quality client care. As the clinician’s capacity to engage in reflective practice grows, so too does his or her ability to establish therapeutic relationships with clients. The supervisory process is a journey that clinical supervisor and clinician embark on together. It is a journey that in so many ways models the clinician-client relationship by introducing experientially concepts critical to the development of healthy and therapeutic relationships with clients such as empowerment, empathy, trust and boundaries. The supervisory process and the client are better understood through discussions of transference, countertransference and parallel process as they emerge along the way. While taking time out of one’s busy schedule to participate in or conduct clinical supervision may at times seem challenging, this is time well spent, particularly when one sees the positive outcomes for clients, the therapeutic impasses that are overcome, and the boundary transgressions that are avoided. 63
Clinical Supervision Handbook A CASE PRESENTATION MODEL FOR CLINICAL SUPERVISION Presenting a case to a supervisor and / or colleagues helps clinicians organize information about treatment into coherent themes and concepts. It also gives the clinical supervisor a chance to evaluate which areas of practice and client management the clinican has mastered and which could be improved or enhanced (Ask & Roche, 2005) There are many ways that case presentations can be structured. The following section describes the approach used by one camh program. Using the Core Conflictual Relationship Theme The clients of a camh program that provides inpatient and outpatient transitional care treatment for women with a mood disorder associated with a history of interpersonal trauma (childhood and/or adulthood physical, emotional and/or sexual abuse often experience the consequences of trauma including substance abuse, selfharm behaviour and dysfunctional interpersonal relationship patterns. Because they experience these problems within their relationships, the Core Conflictual Relationship Theme (ccrt) and the consideration of feminist themes are used as frameworks to enhance clinicians’ understanding of the client’s dynamics. Luborsky (1997) believed that the ccrt was a valuable approach to setting treatment goals in short-term hospital settings. It provides a way of both clinicians and clients increasing their understanding of the client’s relationship difficulties and ways of overcoming them. The ccrt method is based on the principle that redundancy across relationship narratives is a good basis for assessing the central relationship pattern. A relationship pattern consists of: • the person’s wish in relationships • what they experience as the reaction of others (RO) to them • how they respond to these reactions (the reaction of self (RS). People generally approach relationships with a wish for something particular from the other person (e.g., the wish to be loved, validated or generally cared for). They experience others responding to them in particular ways (e.g., loving, abusive, silencing) and they react in kind (e.g., withdraw, push the other person away in anger). Through describing different relationships, the clinician and client can see patterns emerge. 64
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A Pan American Health Organization
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