"Barging in":In-session supervisory consultations
Timothy F. Dwyer
The present article describes a method of in-session supervision consultations I’ve dubbed "barging in" (Note: my full description of "Barging in"can be found in Lee & Emerson (Eds.), 1999). The following is predicated on the condition that the supervisor and supervisee have negotiated a workable supervision contract. It presumes that the supervisor is operating from an ethical stance, from positions of mutual respect, and keen awareness and appreciation of context, power, and what von Bertalanffy called "perspectivism." These ideas are not about supervisor’s hegemony or imposition of will and presence in therapy. Rather, "barging in" is done with explicit agreement and shared understanding with the trainee. It is carefully planned and aimed in partnership with the supervisee.
What follows is an invitation to consider how entering into the therapy session can serve as both an empowering and collaborative teaching model, as well as a constructive stance for a variety of clinical interventions. "Barging in" can entail surprises. I have found that the surprises most often involve the discovery of untapped themes, revelations of commitment, strength, humor, and new meaning for one’s pain and struggle, all which often results in both new resolve and growth. It holds many benefits for clients as well.
Entering into session can be seen as an "invasion" into the on-going process between the therapist and the client/family. As a consultant to an on-going trainee’s therapy session, our invasion may heighten the awareness that someone has been adopted in this therapeutic system. That is, either the family has adopted the therapist or the therapist has adopted the client. Whitaker (1986) aptly noted that consultants in family therapy can intrusively disrupt the power that families have to co-opt therapists by making them members of the family or by excluding them. Furthermore, he notes that "if the therapist can dare to be vulnerable enough to invite a consultant in, they may give the family the idea that they too can be vulnerable without being destroyed" (p. 80-81).
While completing my training at Purdue, two of my colleagues, Rich Bischoff and Jay McKeel, initiated a consultation study in our marriage and family therapy clinic. The idea was a simple one: what if we asked clients and their therapist about their impressions of therapy? Specifically, from their spirit of solution-oriented leanings, they asked "what have you found helpful in therapy, and how could therapy better meet your goals?" I was one of the first trainees to relish this experiment in the early stages because I saw a definite fit within the narrative framework that I was quickly cultivating. I invited Lee Williams, my supervisor, to "barge in" for me during a couple session. This was not planned, in the sense of knowing what direction we (he) would pursue. In a pre-session I expressed feeling stuck with this couple, and I had my doubts about their commitment to therapy. Lee asked if I would be willing to have him come in and interview us all about our thoughts about therapy. He also asked if I was willing to discover how this couple viewed me. Taking a deep breath, I said "sure."
For this couple, it was a pivotal session in their treatment. For me, I felt empowered as a trainee. I learned new ways how to risk asking, "how is therapy going for you?" and to also how to utilize a supervisor’s presence in order to develop new therapeutic conversations. This was my first experience with "barging in." Now, as a therapist, I still request it. As a supervisor, I make offer for and invitation to it. I see it as a way to teach trainees a certain respect for clients’ strengths, to cultivate a method for validating resources (both the clients and the trainees), and open up space for clients themselves to be teachers. Through "barging in" my trainees and I have learned a great deal from clients about their theories of change, how to court their positive experiences of therapy (Duncan, 1997), and how to model for trainees the exploration of client narratives of treatment.
A Brief Theoretical Background
Of course, there are a number of clinical models and theoretical approaches that include inviting "outside" team members or consultants into the therapy session (Andersen, 1991, Boscolo, Checchin, Hoffman, & Penn, 1987; White & Epston, 1991, et. al.). The role and territory of "consultant" were wonderfully mapped out in Wynne, McDaniel, & Weber (1986). They note thesystems consultant takes a comprehensive, "meta" view of the trainee’s concern, and that the distinctive feature of the systems consultation is in the explicit attempt to consider the multiple contexts or systems of a presenting problem. "Barging in" takes a similar frame. The supervisor is ever mindful of their role as a consultant, not therapist. They remain focused on the trainee’s needs and concerns, in the context of therapy with a specific client. Thus it remains supervision. The notion of supervisor as consultant challenges the traditional complementary teaching role in that the consultees (trainee and client) each may perceive and use the information differently. However, "barging in" is not simply consultation, because the information becomes material for further hypothesizing, clarifying direction, strengthening alliance, generating narratives, and formulating interventions. It is ultimately grist for supervision.
Bateson (1972) referred to impasses in family therapy as "double description" in that more than one component is essential to understanding an integral whole. Or in other words, how can we appreciate both sides of a coin at the same time. The process of "barging in" invites all members of the therapeutic system to consider the wider whole. The current discussion presents "barging in" as a specific supervision method which allows trainees to gain a fresh, new window into their therapeutic role and the experience of their clients. Moreover, it offers an opportunity to learn from clients themselves what they do that is helpful.
In "barging in", the trainee (or consultee) has prearranged to have the supervisor (consultant) enter directly into a therapy session in order to engage the therapeutic system in a discussion about therapy. The general aim may be described to clients as a way to help assess how therapy is going, though the overarching purpose of this set of techniques is to create new knowledge about what is taking place in the session, and to open up space for clearer understanding in the client-therapist relationship for the trainee and client. Patterns of expectancies and interactions can be examined, new information developed, goals clarified, successes highlighted, contradictions challenged, and ultimately the work of therapy accelerated.
There can be several different approaches to barging in, depending on the learning needs and goals of the trainee, clinical needs of clients, and/or the context of the clinical training setting. As supervisors, there are a few ground rules you should adhere to when barging in. You are advised to discuss and negotiate these and other points with your trainees, and to clarify for each case what the goals and needs are for the session. First of all, you are not out to correct or change anything. You are like an anthropologist, trying to understand the culture of the session. If new thoughts, ideas, or interventions are revealed, the trainee should refrain from responding to those - and should not discuss those with you - until after the "barging in" session. A second and equally important point is to not allow barging in to become a gripe session. That is, the primary task of the supervisor is to facilitate the conversation so that it remains safe, non-blaming, and informative. Acknowledging that the trainee is put in a rather vulnerable position, every effort should be maintained to not only recognize that risk, but to direct the conversation in a way that protects the trainee when necessary.
A variety of approaches and defined purposes for barging can be planned. One very useful approach is what I call "taking stock." It offers a way to introduce this method to clients. I encourage a certain anticipation about the conversation, though this cannot always occur. At the outset of therapy, and as a socializing aspect to the treatment context, trainees should inform their clients of the possibility that a consultant may be invited in to sit in on a session.
The simplest, more straightforward purpose and approach for barging in, is "taking stock." This can occur after about the 3rd or 4th session to simply determine how things seem to be going, whether the therapist and client are "on the same page" with regard to understanding the problem and goals. This is a good time to clarify if the clients feel like they are being heard and understood. The outcome of this sort of consultation is that it can strengthen the therapeutic alliance. It is recommended to use the presence of an outside person to keep the session from slipping back into "therapy." In fact, through barging in, both trainees and clients may get a different experience of themselves (and each other) which can liberate the therapy to proceed with greater openness and trust.
Prior to ‘taking stock’ the trainee assigns a homework task inviting the clients to consider how therapy is going. Specifically, the trainee could ask them to think about what seems to be going well for them; how therapy is or isn’t giving them hope that their problem can be resolved; what, if anything, do we think should be done differently in therapy? The trainee should let the client know thatthey plan to invite their supervisor into the next session.
By asking the clients to give some thought as to how therapy is going, we may punctuate a difference between doing therapy, and talking about therapy. It helps to make the point by saying, "we’re going to step back from therapy, and take a look at how it’s going for everyone." Taking stock is explicitly framed as a conversation. The presence of the supervisor is to help guide and facilitate that conversation. Sometimes clients think that this is some kind of evaluation for their therapist, and they want to make a good impression. Thus, it’s important to note that this "taking stock" is not being conducted to assess how the therapist is doing, but more generally how therapy is going. It’s helpful to note that "we encourage this sort of ‘taking stock’ in all important endeavors of life: work, marriage, parenting, or rituals and routines such as holidays, mealtimes, and events such as vacations."
Specific questions you may want to ask clients in "taking stock" include:
• What are your impressions of therapy so far?
• What has been most helpful about therapy?
• What has your therapist done or said that has been most helpful?
• How could therapy be changed in some way to better meet your needs?
• If you could change one thing about therapy to better meet your needs, what would it be?
Questions to the trainee/therapist you may consider asking may invite the trainee to identify particular client strengths, to simply reflect in a candid and genuine way how the trainee experiences the clients, or to voice some question they have had about the direction, content, or process of therapy. These questions may take the form of the following:
• What are your impressions of therapy with this client(s)?
• What are some things you have been particularly impressed with about this client(s)?
• What do you find enjoyable/challenging about working with this client(s)?
• What thoughts or images do you think about when you are preparing for a session with this client(s)?
It is important to give permission for the clients to disagree, and to feel free to voice their different experience. Therefore, asking them, "do you feel comfortable saying if you disagree with a suggestion from your therapist? What would you do if you did not like a suggestion from your therapist?" Similarly, you could clarify with the trainee, "how do you know if this client does not agree with you, or does not like your suggestions?" Wrapping up a "taking stock" session can be as simple as asking, "is there anything else about therapy you would like to mention before I leave?" The session can be as brief as 10-15 minutes, or it can take longer, depending on the number of family members in the session, and the openness of all members to disclose.
Again, the task of the supervisor is to keep the session from slipping into therapy, to keep it safe, non-blaming, and to facilitate a meta-dialogue about therapy. Other goals and tasks can be embedded in the questions posed, and should be discussed with the trainee in a pre-session.
This frame of "taking stock" should be present for each barging in session, though the goals and questions will obviously differ. Other goals and purposes of barging in include: reviewing goals, clarifying communication, offering split messages - or playing "good cop/bad cop", and simply building bridges to a stronger therapeutic alliance.
The advantage of inviting a supervisor to barge in is sometimes to have them say what trainees would like to say, when they - or you - may not see it as prudent. Supervisors can and should offer themselves as messengers for therapeutic messages that perhaps need to come from an "outside" source. Stepping back from therapy to discuss the process and reflect on the moments which have been successful, or tension filled, awkward or humorous, confusing or irritating can serve to strengthen the alliance in therapy and create more solid bridges of trust.
Whether conducting a sort of self-consultation with your own clients, or barging in with your trainees permission, hosting conversations and modeling reflective dialogue in a therapeutic context has "trust building" written all over it. The process of talking about therapy in a therapy setting underscores the humanity of all participants and validates the risk that everyone takes in therapy. As a training technique, it can provide the trainee with a new experience of you, their supervisor, their clients, and themselves in relation to the therapeutic system. Not only can new information be gleaned from the conversation, but relationships can be enriched. The barging in method and techniques can effectively demonstrate a capacity for trust and care that will further open up space for growth in the supervisory relationship. It can also expand the trainee’s ability to think flexibly in relation to the messages they send and receive, and consider novel and creative ways to utilize live supervision.
Timothy F. Dwyer, PhD, is Assistant Professor of Marriage and Family Counseling and Director of the Counseling and Training Center, Our Lady of Holy Cross College, New Orleans, LA. He is also an AAMFT Clinical Member and Approved Supervisor.