A discussion of mindfulness-based contemplative supervision in psychotherapeutic practice
This fresh approach to contemplative supervision in clinical practice shows the importance of close and attentive observation of our clients, and this is even more important when we are working online.
This article is for psychotherapy and counselling practitioners interested in supervision.
The contemplative supervision model is based on Buddhist psychology and mindfulness practice, though practising this form of supervision does not require any specialist language or knowledge beyond an appreciation of the fundamentals of mindfulness in psychotherapy and counselling.
It is a helpful model to use when the supervisee feels stuck or when something feels overwhelming or confusing in the client’s experience. The contemplative supervision method works well in group supervision, as having further witnesses can amplify its invigorating effects. It is a powerful resource in supervision and counselling training, as it removes the need for the supervisee to be an “expert” or to rely upon interpretation. The discipline of this model requires that when the client’s presenting issues arise, we refrain from any attempt to solve their problems, or to apply our expertise, but we bring our bare awareness and sense of presence.
Surely this model will make no sense to someone who believes that diagnosis and directed treatment are the correct answer! This is a method for training you to get out of the way of your clients, and to be able to be present with who and how they are without judgement. From a mindfulness perspective, when judgements of the client arise (or of your own performance in the sessions!) then presence is lost.
It is your aware, accepting, honouring, respectful, witnessing presence that provides the environment where your client can find themselves, and learn to stabilise and find resilience.
The methods are as follows. The supervisee describes and presents one client, using the schema of body, speech and mind. Only one client is brought. Initially, the discussion is closely restricted to describing the client within these categories. The supervisor or co-supervisees can ask any questions they want to fill in more detail, but the questioning should not be intrusive or directive, merely a support to help the supervisee bring forth more information. This shows the importance of close and attentive observation of our clients, and this is even more important when we are working online when there can be a tendency to be over-focused on talking with our clients.
The aim of this first stage of the contemplative supervision session is to “bring the client into the room” by evoking them through detailed and accurate observation. It is of course essential that names are never used, and that this only takes place within the confines of formal professional supervision with an experienced supervisor.
The intention is to help the supervisee relate to their client in a fuller and deeper way, yet without struggle or effort.
Describe the client’s physical appearance; this includes all aspects of their physicality, and their being in the world as a physical body. This includes their dress and presentation, how they move and come into the room, and how you experience their presence in your space. It is interesting that often supervisees will have noticed some details but not others, such as the colour of the client’s eyes. This can include all kinds of physical aspects of the client’s life such as how they relate to and care for their body, their sexuality, their home environment and their fundamental stance of relationship to the physical world. Use all of your senses to describe the impact the physical presence of the client has on you, and how you feel in your own body now that you imagine being in the room with them. If you only see them online, then use this as a way to practise paying close attention to all the impressions and information that are available to you when you slow down to take them in.
This refers to all aspects of communication and relationship. Begin by describing the way that they talk, and what you have noticed about this. You may want to include their use of social media and communication devices. Explore the typical ways in which they relate to themselves and others, and the quality of their significant relationships. This is where the presenting issues of the client are likely to begin to reveal themselves, such as repeated patterns of relating. Does the client feel interconnected or isolated? What is their everyday experience of relating with others, at home, at work, with their clients, with their children, with their friends and family? What have you noticed about their attachment styles? What are some of the things they frequently say to you? How does their tone of voice affect you?
This category can be harder to define, but it includes the client’s sense of self, their self concept and what they say about themselves; their beliefs, values and assumptions that direct and guide their feelings and behaviour; their feelings and moods; the concepts that define their world. Here we are looking for the connections between their inner and outer world, and the ways in which what they think and believe is demonstrated to be true for them in their daily experience. This may include formative experiences such as trauma, abuse, neglect or separation which have a lasting impact on the client, and which they have not been able to metabolise. In this category it is important to notice your own tendency to want to join with the client in their material or to “make it ok” – just notice the impact this has upon you.
Once these three “diagnostic” categories have been described, the supervisee can go on to explore further how these aspects affect them, and how they feel in the presence of the client. At this time, parallel processing may emerge in the room, whereby the participants become more aware of the nature of the particular impact this client is having on their therapist. This can emerge in a vast variety of surprising ways, such as shared physical symptoms, specific imagery, or projective identification with the supervisor. It can provide a great deal of relief for the supervisee to be met and understood inn what they are struggling with. Often material that was unconscious in the supervisee or in the client-therapist relationship can now become conscious, and available to be worked with more actively. Again, we are not at this time interested in analysing or solving the client’s issues, but in being curious, aware and engaged with them. If this is taking place in group supervision, usually an enriching conversation emerges in which everyone can learn a great deal from what is taking place in the therapeutic relationship. Each person can acknowledge how this material has affected them, and what comes to mind in thinking about and relating to this client as if they were in the room.
Now that the material has emerged, this can often have a big impact on the supervisee – simply from slowing down, paying attention and being able to identify, understand and process the wealth of material that is always available in any therapeutic relationship. We often do not notice most of this rich material, because we can be too preoccupied, or we are eager to get to the main issue and address the urgent problems the client may be experiencing. The supervisor can offer appropriate guidance and support and help the supervisee form a course of action before closing the session. In my experience, this style of supervision has an immediate impact upon the supervisee-client dyad, and the work is freed up to move on to its next phase.
The origins of contemplative supervision in clinical practice
This mindfulness based supervision modality was first developed at the Naropa Institute in Colorado, https://www.naropa.edu/academics/professional-development/index.php and became the central supervision model used at the Karuna Institute, where I have worked with it with students for many years . https://www.karuna-institute.co.uk/core-process-psychotherapy-resources.htm .
If you would like to experience contemplative supervision for your own clinical work, please contact me to discuss.