Dialogical reflexivity in supervision: An experiential

THE CLINICAL SUPERVISOR 2016, VOL. 35, NO. 1, 1–21 http://dx.doi.org/10.1080/07325223.2015.1135840

Dialogical reflexivity in supervision: An experiential learning process for enhancing reflective and relational competencies Fiona L. Calvert, Trevor P. Crowe, and Brin F. S. Grenyer School of Psychology, University of Wollongong, New South Wales, Australia

Downloaded by [101.174.32.186] at 19:37 22 April 2016

ABSTRACT

A competency approach to supervision focuses on knowledge, skill, attitude-value, and relationship competencies. There is a dearth of research regarding the purposeful engagement in the processes of the supervisory relationship to develop therapeutic relationship competencies, including reflective capabilities. We propose that the supervisory relationship may operate as a transformational learning forum to enhance relationship competencies that can be transferred into therapy. A purposeful approach of dialogical reflexivity is proposed, whereby supervisors use the immediacy of relational engagement within supervision to develop supervisee relational competence. The challenges and research directions for using the supervisory relationship for transformational learning are explored.

KEYWORDS Clinical supervisor; supervision; reflective practice; competence; reflexivity

In this article, we outline the process for a proposed supervisory approach, dialogical reflexivity. Dialogical reflexivity involves utilizing the supervisory relationship as a space of experiential learning through a present-centered, relational focus in supervision, created through a direct conversation between the supervisor and supervisee about the supervisory relationship and process itself. We propose that this highly experiential approach to supervisee learning has the potential for the transformative development of relationship and reflective competencies beyond the acquisition of knowledge and skills. In the following sections, we outline the role of supervision in the development of supervisee relational and reflective competencies, advocating for the use of the supervisory interaction as a space of experiential learning in the development of these abilities. We then define and explore the concepts of parallel process and real relationship as important aspects of the proposed supervisory approach, before defining and outlining the aims and applications of dialogical reflexivity. In the final section, we examine the potential challenges and caveats of using dialogical reflexivity in supervision. CONTACT Fiona L. Calvert Australia, 2500. © 2016 Taylor & Francis

[email protected]

Northfields Clinic, Building 22, University of Wollongong, NSW,

2

F. L. CALVERT ET AL.


Relational and reflective competencies in psychology

The recent trend toward criterion-based curriculum design within psychology has resulted in the articulation of competency-based models of clinical supervision (Falender & Shafranske, 2004; Gonsalvez & Calvert, 2014). In other words, a paradigm shift is occurring in which we are beginning to focus training and supervision efforts on the development of specific therapeutic and professional abilities or competencies (Rubin et al., 2007). Within the competency literature, relationship is acknowledged as foundational and fundamental to other competencies in professional psychology (National Council of Schools and Programs in Professional Psychology, 2007) and has been considered “the substratum existing under and supporting other competencies” in psychological practice (Mangione & Nadkarni, 2010, p. 69). Recent research has shown that prioritizing the therapy relationship makes empirical sense, with the therapeutic alliance accounting for 4% to 26% of the variance in therapy outcomes (CritsChristoph, Gibbons, & Hearon, 2006; Hardy, Cahill, & Barkham, 2007). Thus, relational competence in the therapy room is an important target for supervisee development. Rodolfa and colleagues (2005) defined the relationship competency as the foundational capacity “to relate effectively and meaningfully with individuals, groups, and/or communities” (p. 351). The relationship competency implies more than just basic interpersonal and counseling skills. Practitioners of psychology must also develop the ability to tolerate ambiguities in relationships and process relational phenomena with clients. These skills require therapists to maintain attunement to their own moment-to-moment cognitive and affective experiences and to step back to view the relational dynamics at play with clients (Mangione & Nadkarni, 2010). Reflective practice, the engagement in purposeful and critical analysis of one’s knowledge and experience with the aim of accessing deeper meaning and understanding, is therefore central to relational competence (Mann, Gordon, & MacLeod, 2009). Relational and reflective competencies intersect to facilitate a reflective position within relationships in which practitioners step into a cognitive and affective position alongside the momentto-moment relational situation at hand and examine their own biases, reactions, affect, and behavior (Mangione & Nadkarni, 2010; Safran & Muran, 2000). From this awareness comes the ability to respond to interactions with clients in spontaneous, genuine, and authentic ways, and to encourage clients to also articulate and engage with the relational struggles occurring within the interaction (Jenkins, 2010). Schön (1983) distinguished among three forms of reflective practice. First, reflection-on-action involves making sense of an event that has already taken place (for example, reflecting upon a relational event with a client after the session has finished). Reflection-for-action involves the proactive use of these past reflections to inform future action (for instance, considering how new

THE CLINICAL SUPERVISOR

3

learnings from reflection upon an interaction with one’s client might guide our response to future encounters of a similar nature). Finally, reflection-in-action encompasses engagement in reflection as a relational event is unfolding, making decisions and adjustments to our actions in a moment-to-moment fashion. Each of these reflective processes represents an important relational skill, and practitioners should develop the ability to engage in critical awareness of their experiences both during and after therapeutic interventions (Hallett, 1997).


Strategies for developing relational and reflective competencies in supervision

Within the literature, both outside-of-session and in-session supervision interventions have been proposed for enhancing relational and reflective competencies. A number of approaches have been outlined wherein the supervisee engages in independent reflection on a therapeutic dilemma, responding to questions exploring their cognitions, emotions, intentions, theoretical perspectives, and possible responses to the event (Holloway & Carroll, 1999; Neufeldt, 1999). Journaling has also been proposed as a method for enhancing supervisee reflectivity and relational awareness (Orchowski, Evangelista, & Probst, 2010; Osborn, Paez, & Carribean, 2007), and journal entries can then be processed in supervision (Billings & Kowalski, 2006). Interventions for use exclusively within the supervision session have also been proposed for the development of relational and reflective competencies. Supervisors may model relational and reflective skills so that the supervisee has the opportunity to observe and emulate these skills in his or her own practice (Goodyear, 2014). Supervisors might model these competencies through methods such as role-playing, microskills training, active listening practice, and teaching conflict resolution skills (Mangione & Nadkarni, 2010). Interpersonal Process Recall (IPR; Kagan, 1980) is a supervisory strategy aimed at increasing therapist awareness of affective and interpersonal dynamics in the therapeutic relationship. In this method, the supervisor and supervisee view a video recording of a psychotherapy session, pausing it at puzzling or compelling points for review and analysis. The supervisor acts as a facilitator, using questions to prompt exploration of emotions, intentions, perceptions, and expectations (Bernard & Goodyear, 2014). The strategies just discussed represent the development of relational and reflective competencies predominantly utilizing processes of reflection-onaction and reflection-for-action. Although the importance of these forms of reflection cannot be overstated, there is also a need to attend to therapists’ abilities to engage in moment-to-moment reflection and processing of relational dynamics (reflection-in-action). In addressing this need, the supervisory relationship should be considered an essential space of experiential learning.

4



Supervision as a space of experiential and transformational learning

In order to develop supervisees’ capacity to engage in reflection-in-action, the supervisory relationship is best conceptualized as a platform for experiential learning about relational processes and dynamics (Kaslow & Bell, 2008; Orchowski et al., 2010). Kolb (1984) described learning as a process in which knowledge is obtained through the transformation of experience, which is then put into action. Kolb proposed a cycle of learning progression, consisting of four phases, and asserted that experiential learning occurs most effectively when all four phases of the cycle are completed. The first phase is concrete experience, which involves experiencing through our own firsthand personal involvement in a situation. The second mode of learning, reflective observation, involves the use of logical analysis of the learning situation with an emphasis on understanding rather than practical application. The third stage of the cycle, abstract conceptualization, involves making sense of our new experience abstractly through examining ideas from different angles. Finally, active experimentation involves learners applying their new knowledge in real-world situations. This phase emphasizes practical application and the toleration of risk in order to achieve objectives. The use of experiential techniques within supervision corresponds with Kolb’s assertion that learning is not an additive process, but a holistic transformational experience involving the integration of new emotional experiences and cognitive processes with existing knowledge, attitudes, and behaviors. An experiential and transformational approach to supervision moves beyond reflective dialogues about therapeutic events, the viewing of therapy videos, and the use of role-plays to teach skills. Supervision approaches that utilize purely didactic learning and past-focused reflection may create therapists who have sound knowledge and technical skills, but are less able to respond effectively to challenging relational dynamics with their clients (Ensink et al., 2013; Markovitz & Milrod, 2011). Therapists must be able to use skills of reflection-in-action to engage in complex processing of relational phenomenon with clients, responding automatically or intuitively to such dynamics as they occur in the therapy room (Safran & Muran, 2001). It is worth noting that we do not wish to diminish the role of didactic and demonstrative strategies for supervisee skill development. Relationship competence comprises a number of essential components ranging from basic interpersonal, affective, and expressive skills to more complex skills of relational awareness, reflection, and engagement (Fouad et al., 2009). Mangione and Nadkarni (2010) highlighted that supervisee relational competence progresses through a number of developmental stages, beginning with basic relational knowledge, skills, and abilities, such as the ability to listen and show empathy with others; knowledge of elementary relationship skills; expressions of empathy; and active listening. In early developmental stages,



5

didactic strategies such as direct instruction, modeling, and role-playing serve an important purpose in assisting supervisees’ development of therapeutic microskills. As supervisees develop in their mastery of basic interpersonal skills, more advanced relational and reflective capacities become relevant. These include the understanding that relational processes provide useful data as well as the ability to understand and discuss relational dynamics with clients in a moment-to-moment fashion. The skill of reflection-in-action is a particularly important ability in the face of negative relational events occurring in the therapy setting, including alliance ruptures and nondisclosure (Safran & Muran, 1996, 2000). When such relational events occur, therapists are encouraged to address “the elephant in the room” directly using skills of immediacy and meta-communication about the processes occurring between the therapist and the client (Safran, Muran, & Eubanks-Carter, 2011). Importantly, there is theoretical consensus and empirical evidence (Heatherington, Constantino, Friedlander, Angus, & Messer, 2012; Knox, Hess, Hill, Burkard, & Crook-Lyon, 2012) that engaging with, and conversing about, the relational processes occurring in therapy can result in corrective relational experiences for clients. In order for therapists to integrate complex perceptual, affective, and behavioral resources to respond to relational patterns in an authentic and present manner, learning must occur at an experiential level, not just a conceptual one. Just as one cannot learn to play golf or surf just by reading or talking about it, one cannot develop relational and reflective competencies as a therapist by simply talking about relevant concepts and principles. Supervision provides an optimal space for trainee therapists to development their attunement to the range of relational processes occurring in human engagement (Falender & Shafranske, 2010). The supervision relationship offers a potential mirror to treatment that can be used for supervisees to try out reflexive processing of moment-to-moment relationship material—in other words, to “learn to speak elephant.” There exists a rich territory of relational dynamics at play within supervision that might be purposefully engaged with in developing supervisee relational competence. Several studies have demonstrated that supervisees withhold relevant information from their supervisors on intentional and unintentional bases, particularly thoughts and emotions regarding the supervision relationship itself (Ladany, 2004; Ladany, Hill, Corbett, & Nutt, 1996; Pisani, 2005). Researchers (Gray, Ladany, Walker, & Ancis, 2001; Nelson & Friedlander, 2001) have demonstrated that negative relational events occur within the supervision relationship as they do in therapy, and that supervisees wish that their supervisor would create space for an authentic and acknowledging conversation in response. However, supervisees tend not to disclose such feelings to their supervisors, leaving these negative supervisory events unresolved (Gray et al., 2001; Nelson & Friedlander, 2001).

6


Despite identification of the existence of these processes within the supervisory relationship, there is a lack of research into how to engage with and make use of these phenomena constructively for supervisee development. We believe that supervision that incorporates active engagement in purposeful reflexive and relational processing provides the opportunity for supervisees to develop the skills necessary to ensure that the curative and corrective elements of relational engagement within therapy are not lost to a robotic and disconnected coaching of clients. Thus, the function of the supervisory relationship is not simply the transmission of knowledge and skill, but rather the creation of a space for interactional learning to enhance supervisee competencies in relational and reflective processes (Gonsalvez, Oades, & Freestone, 2002; North, 2013).


The supervisory relationship: A tripartite model

In examining strategies of incorporating experiential learning opportunities through the purposeful relational engagement within the supervisory context, it is necessary to attend to the nature and composition of the supervisory relationship. A great deal of attention has been given to the nature of the supervisory relationship itself within the psychoanalytic literature, with much focus on the supervisory alliance and the transference-countertransference configuration (including parallel process phenomena). More recently, Watkins (2011) proposed a tripartite model of the supervisory relationship, adding the real or personal relationship to current representations of the supervisory bond. These three facets of the supervisory relationship are considered common factors across different supervision approaches, not just those that are psychoanalytically oriented (Watkins, Budge, & Callahan, 2015). Each of these proposed components of the supervisory relationship is important in the use of supervision for experiential and transformational learning and will thus be reviewed in this section of the article. Particular attention will be given to parallel process and real relationship as important constructs in understanding the use of experiential learning within the supervisory relationship. Supervisory working alliance

The supervisory working alliance is often credited as the primary means through which supervisee competence and development is facilitated (Bordin, 1983; Efstation, Patton, & Kardash, 1990; Ladany, Ellis, & Friedlander, 1999). The supervisory working alliance is based on mutual agreement concerning the goals and tasks of supervision, as well as the development of a strong emotional bond between supervisor and supervisee (Bordin, 1994). Research has indicated that a strong supervisory working alliance is linked to increased supervisory satisfaction (Ladany et al., 1999) as well as to increased quality of the supervisory relationship, leading to improvements in supervisee confidence,


7

professional identity, and clinical perception (Goodyear, 2014; Worthen & McNeill, 1996).


Parallel process

In considering the use of experiential learning in supervision to enhance supervisee competence in working with clients, the concept of parallel process offers a theoretical explanation for the translation of material from one relationship setting to another. Parallel process occurs when similar, interactional patterns arise within both the supervisor-therapist and therapist-client relationships. In other words, the transference of the supervisee and the countertransference of the supervisor within the supervisory context appear to mirror processes occurring in the therapy room (Morrissey & Tribe, 2001). For instance, a supervisee’s experience of anxiety in therapy might result in an anxious or dependent presentation within supervision (Haber et al., 2009). Perhaps a therapist working with an especially passive client begins to act in an atypically passive manner during supervision, paralleling the dynamic within their relationship with the client (Page & Wosket, 2014). This concept was originally articulated by Searles (1955) as the reflection process, or the therapist’s reenactment of therapy session material in the supervision space. Ekstein and Wallerstein (1972) subsequently labeled this phenomenon parallel process and it has received considerable attention within the psychoanalytic literature since that time (e.g., Bromberg, 1982; Caligor, 1984; Gediman & Wolkenfeld, 1980; Morrissey & Tribe, 2001). Although originating from psychodynamic thought, parallel process has been acknowledged as an important facet of supervision for all supervisory orientations (Doehrman, 1976; Raichelson, Herron, Primavera, & Ramirez, 1997; Schlessinger, 1966). Relational understandings of parallel process have deviated from traditional psychoanalytical models to posit that relational dynamics are bidirectional. In other words, in addition to moving from therapy to supervision, relationship dynamics are hypothesized to travel downward from supervision to therapy (Doehrman, 1976; Morrissey & Tribe, 2001). Thus, participants in both the therapeutic and supervisory relationships are thought to contribute unconsciously to transference and countertransference occurring across the different contexts. Illustrating this, Williams (2000) studied 44 supervisory dyads and found that the more facilitative the supervisor’s interpersonal style, the less domineering and controlling the therapist was in interactions with clients. More recently, Tracey, Bludworth, and Glidden-Tracey (2012) demonstrated that patterns of dominance and affiliation can move between therapy and supervision contexts in a bidirectional manner, over a series of sessions. Recently, there have been increasing calls for supervisors to incorporate directed parallel processing interventions within supervision to experientially

8


assist the development of supervisee relational and reflective competencies (Crowe, Oades, Deane, Ciarrochi, & Williams, 2011; Tracey et al., 2012). Active efforts to develop the supervisee’s capacity to engage in moment-to-moment reflection within the supervisory relationship may travel “down the line” (Crowe et al., 2011, p. 57), enhancing the supervisee’s understanding of moment-to-moment relational processes within the therapy room. In other words, the purposeful use of parallel process as a supervisory intervention, by inviting the supervisee to directly work with repetitive relational phenomena in the room, may result in more transformational learning.


Real relationship

In examining strategies of incorporating experiential learning opportunities through the immediacy of relational engagement within the supervisory context, it is necessary to attend to the real or personal relationship between supervisor and supervisee. Watkins (2011) posited that the real relationship in supervision is the foundation upon which the supervision relationship is built and is separate from the learning relationship and transferencecountertransference. The real relationship encompasses the genuine interpersonal connection occurring within the supervisory exchange, reflecting that supervision involves the meeting of two people. We propose that the real relationship can also manifest as genuine and open dialogue relating to difficulties, sensitivities, “stuck points,” and other uncomfortable processes within the supervisory relationship. Watkins suggested that the real relationship exerts a substantial influence upon the development of a successful learning alliance within supervision, as well as the utilization of parallel processes in this context. For Watkins, the real relationship is ultimately “the forever silent yet forever loudly present and powerful foundation of change in the supervisory context” (2011, p. 257). The significance of the real relationship in transformational and experiential learning is underlined by Martin Buber’s (1958) assertion that reflective learning must take place in the context of the “I-Thou” relationship, an interaction that is mutual, respectful, and affective. This form of relationship is distinguished from instrumental “I-It” relationships in which the other is related to as an object. According to Buber, when people agree to be mutually authentic with one another in communication, the result is genuine dialogue and rich learning. Buber posited that “the learner is educated by relationships” (1958, p. 90) and that the I-Thou relationship produces optimal experiential learning. Dialogical reflexivity: Definition and aims

The experiential and transformational use of the supervisory relationship in developing reflective and relational competencies might be achieved through



9

an approach we term dialogical reflexivity. In line with the existential use of the term, dialogical is here used to denote a focus on the real experience of relational processes. Distinguished from reflectivity, the term reflexivity is used in this instance to describe a responsive, moment-to-moment engagement with an “other” and is aimed at working toward relational change. Thus, dialogical reflexivity refers to a present-centered, relational focus in supervision, created through a direct conversation between the supervisor and supervisee and a narrative about the supervision relationship and process itself. This involves engaging in dialogue about unseen or neglected aspects of supervision, prioritizing reflective focus on the experience of supervision for both supervisee and supervisor, and engaging in direct and forthright discussion about the processes occurring within the supervisory relationship. Dialogical reflexivity incorporates the construct of the real relationship to emphasize an approach to supervision that focuses on transformative relational learning. It extends from standard reflective practice strategies in that it encompasses more than just the acknowledgment of relational processes in supervision; it involves choosing to engage in these relational processes in the moment and process the relational phenomena that traverse supervision and clinical contexts. Furthermore, this approach to the development of relational and reflective competencies involves more than just being present to the relational dynamics in supervision and bringing attention to here-and-now phenomena. It also involves an openness to I-Thou (Buber, 1958) relating with another and a purposeful inclusion of the self in the interaction with the other. This encompasses a willingness to be self-reflective and genuine in communicating with the other member of the supervisory dyad. Therefore, the supervisor needs to be prepared to lead the way in bringing more of her or his genuine experience of self into the room. Dialogical reflexivity emphasizes real relationship engagement in the moment and emotional presence, rather than meta-relational processes (i.e., merely requesting feedback about the relationship). In this sense, dialogical reflexivity represents a unique supervisory stance to be used in addition to other established practices for developing supervisee reflective and relational competencies. Dialogical reflexivity also acknowledges and makes use of the transferencecountertransference configuration in supervision. This approach of utilizing the immediacy of relational engagement within the supervisory context may allow therapists to broaden their ability to process here-and-now phenomena with clients. Utilizing dialogical reflexivity within supervision may enhance the therapist’s ability to process relational dynamics in a moment-to-moment fashion and to tolerate the uncertainty and uniqueness of each interaction. In other words, using the supervisory relationship as a platform for real-time interactional learning may help therapists learn to be more open to what truly exists within their interactions with clients and to suspend the temptation of imposing “structure” and conceptual constructs upon the moment.


10


To date, only a few researchers have investigated the process of reflecting upon the relational material occurring within the supervisory exchange. James, Allen, and Collerton (2004) conducted a single-subject study in which a psychology trainee reviewed videos of her supervision and provided a commentary on her emotional reactions within the sessions. The trainee reflected on her experience of a range of emotions in the supervisory exchange and identified emotional triggers within the supervision relationship. In a study conducted by North (2013), 15 supervisees individually reviewed audiotapes of their supervision and were then interviewed about this process. Participants reported that this procedure had positively impacted their learning and understanding of self, and also felt that the intervention would lead to enhanced supervisory alliance. However, these protocols for utilizing the supervision relationship in developing reflective capacity correspond with current individually based strategies for supervisee development of reflectionon-action. A recent study conducted by Hill, Crowe, and Gonsalvez (2015) extended these protocols by investigating the use of videos of supervision to initiate collaborative, reflective dialogue between supervisors and supervisees. In contrast to individual reflection by supervisees, seven supervisory dyads participated in a reflective practice protocol together. This involved viewing a video of their most recent supervision session and engaging in collaborative reflection about the supervisory processes and dynamics observed on the video. Thematic analysis of participants’ individual reflections regarding the protocol resulted in several dominant themes: increased discussion in supervision of the supervisee’s anxiety and themes of autonomy and dependence; intentions to change roles and practices in supervision as a result of engaging in the protocol; identification and consideration of parallel process; and a range of perceived impacts of participating in the protocol, including improved supervisory alliance. Although Hill and colleagues (2015) extended on current protocols for utilizing the supervisory relationship as a source of reflective and relational learning, the protocol evaluated within the research again involved the skill of reflection-on-action. Thus, while these studies highlight the importance of reflection upon supervisory relationship dynamics, they fail to examine the depth and transformative power of this relationship in developing supervisee skills of reflection-in-action. Dialogical reflexivity calls for attention to and engagement with the relational events unfolding within the supervision exchange in a here-now, I-Thou manner. A case illustration of dialogical reflexivity

The following case example illustrates dialogical reflexivity in action during a supervision session, distinguishing this from reflection-on-action and reflection-for-action. The supervisor (S) and the supervisee/therapist (T)


11

discuss the supervisee’s experiences with a client who has been engaging in impulsive risk-taking behaviors between therapy sessions. The case example (based on an actual video-recorded supervisory exchange) begins with reflection-on-action, discussing the supervisee’s experiences and actions within the therapy room. The conversation progresses to the use of dialogical reflexivity in which supervisor and supervisee discuss what is unfolding relationally within supervision. Finally, the supervisory dyad engage in reflection-for-action, discussing the application of learning to alternative ways of approaching this client.

Reflection-on-action


S: T:

S:

You said you feel frustrated with this client. Is there anything else that you’re feeling when you’re in the room with him? Yes, anxious. Really anxious. Frustration is one layer to it, but the anxiety is the strongest thing I feel with him. I also get a bit helpless as well. Like no matter what I try, it just doesn’t work. He just keeps doing these really risky things outside of sessions and I don’t know what else to try with him. What have you tried with him so far in therapy to address these issues?

[Supervisor and supervisee discuss treatment approaches employed with client] S: T:

S: T:

S: T:

So what happens with your frustration when you feel it in the session? I think the problem is that I don’t ever convey that to him. I hold it back and sit on it, but then it starts to eat away at me. But in that last session, I was more open with him about it. I think that was a good thing, but I found it really hard. It had to happen sooner or later though. In saying that you were more open with the client, what form did that take? Well, I addressed the feelings I’ve been having with him. I needed to set some limits around these behaviors and I sort of shared with him that I’m not saying these things to be punishing or because I’m disappointed in him. It’s just that when he walks out the door, I feel worried about him. What prompted you to do something different like this? To talk with him about these feelings? It wasn’t really by choice actually. I wrote a letter to his doctor about these behaviors and how I’m concerned. I wanted to keep the doctor in the loop about that and what I was going to try and put in place to manage the risk stuff.1 I specifically wrote in the letter that I didn’t want the doctor to share this with the client until we

12

S:


T:

S: T:

S: T:


talked about it and I said that I hadn’t raised it with the client yet. Unfortunately, the doctor did share the contents of the letter with him. Right. So then that was something you felt you had to talk through with the client? Yep. The client sent me a message through the practice e-mail and titled it “Ashamed.” He said he knew I probably didn’t want to continue therapy with him. There wasn’t anything in that letter that he was offended by or anything. It was just the idea that I was raising these things as concerning with his doctor and he felt badly about that. He is prone to being easily shamed, so at first he was feeling worried that I was disappointed with him or would be punitive with him. But I know I had to talk with him about the issues because it was impairing my ability to work with him. How has it been impairing your ability? Because I get caught up in my own anxiety. It’s just hard to hear what he is saying sometimes because I keep second-guessing myself about whether it’s enough. Where’s the line of knowing that I’ve done everything I can? If something were to happen to him, I can see my work being pulled apart, like “you failed him.” By who? Who would pull it apart? I’m not even sure . . . . Probably mostly myself. I feel like I’m letting him down and letting his family down . . . and his doctor too. I often just feel like I should send all my clients on to someone who can help them better than I can. Like maybe there is someone who can help him better and I’m depriving him of that.

Reflection-in-action (DR)

S: T: S: T: S: T: S: T:

What’s it like for you to say this in here with me? It doesn’t feel good. It’s making me upset. I feel this way with a lot of my clients. Also with my colleagues—this sense of just always letting people down. So you know this about yourself, but it’s a hard pattern to break. Yeah, exactly. Always this fear that I’m not living up to expectations and I’m just majorly stuffing it up. I’m wondering if that ever goes on here, this feeling. Or even if this is happening here, between us right now? [Pause] Well, I feel like I’m really stupid because I cry a lot. Like right now, I’m starting to get all teary and I just feel like an idiot. You feel like an idiot when you get emotional here? Yeah . . . . Like you’re sitting here thinking that you agreed to supervise me because I seem strong and capable and you’re figuring out that I’m


S: T:


S:

T: S: T:

S:

T: S:

T:

13

actually not. That actually I’m weak. I feel sorry for you because it’s like I’ve let you down. I’ve got to tell you, that thought has never entered my mind about you. I actually have tremendous respect for you. Well, I think I look like I’m capable and very together, but it doesn’t take much for someone to unpick me. If you start to scratch the surface, my emotions will unravel because I hold it together so tightly. And then I think, “Oh no” . . . . Like you are seeing the real me and it’s pretty bad. Well, actually as you are talking, I am thinking about how competent you are and how dedicated you are to doing whatever is asked of you. The fact that you get emotional has never entered my mind as being too sensitive or too emotional. To me it’s a strength that you allow yourself to feel things in my presence. I don’t want to be that supervisee though, that just comes in and has a meltdown. I think professionally, there often isn’t room for being too sensitive. You just look like a joke. What is worrying you most about talking with me about this now? I’m worried that you might go and tell other people that I’m weak. Then it’s about the embarrassment that I would feel if people knew that. It feels like it’s shameful . . . to just come here and end up crying. First, I want to bring you back to one of our first conversations when we started supervision. This space we have here in supervision is confidential. Just like your confidentiality with clients, I would only break this if I were worried about you or a client being at risk of harm. I want you to feel safe to talk about these important issues here with me, knowing that I wouldn’t talk about this with others unless there was a real need to do so. Thanks. I do know that our supervision sessions are private in that way. I suppose it’s that feeling of shamefulness really . . . and being worried about how you see me or how I’m handling the client. Yes, I can really hear that this idea plays on your mind here. I want to emphasize to you that I really like that you are able to talk about this with me in supervision and I’m not feeling critical or judgmental towards you in the slightest. I can really sense how important your work with this client is to you . . . . It occurred to me when you were talking about shame and embarrassment here with me, that you got an e-mail from your client titled “Ashamed.” Like he was worried that he had let you down . . . and from what I hear you saying, you worry about something similar here. Yeah, that’s true . . . and I’m worried about letting the client down too.

14


Reflection-for-action


S:

I’m wondering if, within that, there might be a pathway for a way ahead with clients experiencing these struggles. If shame and embarrassment were less of a concern for you, I wonder how you might be different with him in your work together.

Within this excerpt, the supervisor and supervisee begin with a discussion about supervisee experiences of frustration and anxiety in working with a particular client. They discuss the supervisee’s therapeutic work with this client as well as her own emotional experiences of this work (reflection-on-action). As the supervisee comes into contact with her anxiety in the supervision session, dialogical reflexivity is utilized to identify, explore, and engage with the relational processes occurring in the here-and-now. A parallel is identified between the supervisee’s perception of her client’s experiences in therapy and her own experiences within her supervision relationship. This process creates an opportunity for corrective emotional learning to occur within the supervisory relationship (through the supervisor sharing her own reflections in that moment). Furthermore, the supervisee has the opportunity for real-time, transformational learning of relational competence through the experience of having her concerns about confidentiality directly acknowledged and addressed by her supervisor. This process lays the foundation for opening discussion around possible pathways ahead in working with this client (reflection-for-action). Challenges and promises in the use of dialogical reflexivity

Among the promises of transformational learning and powerful down-the-line translation of skills, experiential supervision is not without challenges. Boundary considerations

One such challenge in attending to the relational dynamics in supervision in a moment-to-moment fashion is that it may carry with it the risk of blurring the boundaries between supervision and therapy. For instance, in discussing relational experiences within supervision, a supervisee may feel that the conversation strays too closely to issues that might be more appropriately explored within a therapeutic relationship. It is essential that use of dialogical reflexivity as a supervision process is preceded by clear explanation of the approach at the outset of the supervisory exchange. Glickauf-Hughes and Campbell (1991) asserted that the risk of blurred boundaries can be effectively managed in the supervisory context if supervisors and supervisees clarify upfront the demarcation between experiential supervision and psychotherapy, as well as the guidelines for the use of therapeutic processes in supervision. Glickauf-Hughes and Campbell also suggested that any supervisee “excursion



15

into the self” (p. 633) in supervision ought to be followed by a cognitive examination of the experience and linked to his or her work with clients. If the supervisor observes a blurring of boundaries, it is recommended that this is openly discussed and the possibility of the supervisee seeking psychotherapy from someone within the community is explored. In this way, the open, genuine, and reflective processes of dialogical reflexivity may in fact offer a way to disentangle already blurred boundaries and engaged attachment patterns. Numerous writers have also attended to the difficult task of balancing the dual role often faced by the clinical supervisor. On the one hand, supervisors fulfill a restorative and formative purpose, and there is consensus within the literature that providing the supervisee with support and encouragement is an essential function of the supervisory relationship (Bambling, King, Raue, Schweitzer, & Lambert, 2006). However, it is common for supervision to also operate as an opportunity to evaluate supervisee competence to practice (Bogo, Regehr, Power, & Regehr, 2007; Gizara & Forrest, 2004). The tensions associated with balancing these functions are relevant in deciding the appropriateness of different supervisory activities. For instance, if a supervisee is anxious about the supervisor’s evaluations of his or her clinical aptitude, disclosure of this experience may be avoided due to concern that the supervisor will negatively evaluate the supervisee’s aptitude based on this anxiety (O’Donovan, Halford, & Walters, 2011). The consideration of boundary-blurring and related tensions in the supervisory relationship is essential in the creation of a safe emotional climate for relational process-focused approaches in supervision. Safety considerations

Supervisors must consider temporal and frame issues as well as supervisee development in the implementation of such an approach. It is vital that a trusting relationship and safe emotional environment are established before experiential learning and relational processing takes place in supervision, and there is increasing acknowledgment within the literature that the supervisory relationship has to create a “safe enough” environment for supervisees to disclose and explore their thoughts and feelings regarding the supervision process (Bernard & Goodyear, 2014). Watkins (1995) and Pistole and Watkins (1995) proposed that the supervisory relationship is an adult-adult relationship with many similarities to parent-child relationships. They suggested that it may therefore be useful to think of supervision as an attachment process. More recently, Watkins and Riggs (2012) suggested that the supervisory relationship involves an affective component that evokes attachment dynamics. For instance, a supervisee with an anxious attachment style may be dependent and even “clingy” within the relationship, and compulsively self-reliant supervisees may be likely to refuse, resist, or even resent supervisors’ attempts to assist them. It is therefore important to consider the attachment dynamic and safety

16


within supervision before utilizing the supervisory relationship for open and genuine disclosure.


Alliance considerations

On a related note, the use of dialogical reflexivity in supervision may also pose a risk to the supervisory relationship if used ineffectively. To venture into processing relational processes within supervision too soon or in an insensitive manner may result in alliance ruptures. The supervisor must be equipped to sensitively manage the experiential phenomenon occurring within such methods and adequately address ruptures in the supervisory alliance. Interestingly, the suggested methods for addressing alliance rupture within the literature are in line with the principles of dialogical reflexivity. In other words, rupture resolution strategies such as interpersonal reflection, awareness of own feelings, and acceptance of responsibility (Safran & Muran, 1996, 2000) are consistent with the process of dialogical reflexivity. Safran and colleagues (2011) highlighted the importance of meta-communicating about processes occurring between the therapist and client, using the skill of immediacy to address ruptures. Bernard and Goodyear (2014) stated that this form of direct intervention for relationship ruptures has the advantage of modeling relational skills that supervisees will inevitably use with their clients. Therefore, we posit that, while dialogical reflexivity may contribute to alliance ruptures if used without supervisee readiness sensitivity, the process of dialogical reflexivity can also be used to remedy such ruptures and potentially deepen the alliance. It is worth noting, however, that we believe the potential benefits of dialogical reflexivity proposed in this article are greater than the task of addressing relationship ruptures, and a rupture does not need to be present in supervision for dialogical reflexivity to be utilized. Although dialogical reflexivity has a broader function than rupture resolution (i.e., supporting the development of the relational self of the therapist and associated relationship competencies), this relationalfocused method might be used to enhance the supervisee’s awareness of his or her own reactions within the supervision space and ability to begin a metacommunication dialogue about relational processes occurring within the room. Research to explore dialogical reflexivity

Research is required to enhance understanding of current reflective practices being utilized in supervision and to explore how dialogical reflexivity compares with these currently used methods. It is also worth investigating supervisor and supervisee willingness/readiness to utilize experiential approaches like dialogical reflexivity, as well as the concerns and barriers to using such an approach. Furthermore, it would be useful to explore how dialogical reflexivity compares with other practices designed to enhance reflective practice and


17

relational competencies, such as journaling (Billings & Kowalski, 2006) and independently reviewing supervision videos (James et al., 2004; North, 2013). Supervisory dyads might be trained in a dialogical reflexivity approach to supervision which involves purposeful attendance to the relational dynamics at hand when discussing clients. Similar to the process involved in IPR, supervisory dyads may be encouraged to “press pause” during the supervision session to make contact with the relational processes unfolding in the here-andnow. It would be useful to explore whether the experience of such a dialogical approach within supervision enhances supervisee willingness to have “elephant in the room” conversations with clients.


Conclusion

The supervision context offers an important opportunity for experiential and interactional learning to develop trainee reflective and relational competencies. The purposeful process of dialogical reflexivity represents an experiential supervision method for developing relational and reflective metacompetence. This approach follows from reflective practice into behavioral engagement with the immediate relational processes within the supervisory context to develop supervisee relational and reflective competence. The development of reflective and relational competencies through the supervisory engagement is at present an under-researched area. Exploration of methods to facilitate transformational and experiential learning in supervision has the potential to improve trainee competence beyond the acquisition of knowledge and skills.

Note 1. Please note: Client consent was obtained for therapist to contact referring doctor.

References Bambling, M., King, R., Raue, P., Schweitzer, R., & Lambert, W. (2006). Clinical supervision: Its influence on client-rated working alliance and client symptom reduction in the brief treatment of major depression. Psychotherapy Research, 16, 317 – 331. Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision (5th ed.). London, UK: Pearson Education Limited. Billings, D., & Kowalski, K. (2006). Journaling: A strategy for developing reflective practitioners. The Journal of Continuing Education in Nursing, 37, 104– 105. Bogo, M., Regehr, C., Power, R., & Regehr, G. (2007). When values collide: Field instructors’ experiences of providing feedback an devaluating competence. The Clinical Supervisor, 26, 99–117. Bordin, E. S. (1983). A working alliance model of supervision. The Counseling Psychologist, 11, 35– 42. Bordin, E. S. (1994). Theory and research in the therapeutic working alliance: New directions. In A. O. Horvath & L. S. Greenberg (Eds.), The working alliance: Theory, research and practice (pp. 13– 37). New York, NY: Wiley.


18


Bromberg, P. M. (1982). The supervisory process and parallel process in psychoanalysis. Contemporary Psychoanalysis, 18, 92– 110. Buber, M. (1958). I and thou (2nd ed.). New York, NY: Scribner. Caligor, L. (1984). Parallel and reciprocal processes in psychoanalytic supervision. In L. Caligor, P. M. Bromberg, & J. D. Meltzer (Eds.), Clinical perspectives on the supervision of psychoanalysis and psychotherapy (pp. 1– 28). New York, NY: Plenum. Crits-Christoph, P., Gibbons, M. B. C., & Hearon, B. (2006). Does the alliance cause good outcome? Recommendations for future research on the alliance. Psychotherapy: Theory, Research, Practice, Training, 43, 280– 285. Crowe, T. P., Oades, L. G., Deane, F. P., Ciarrochi, J., & Williams, V. (2011). Parallel processes in clinical supervision: Implications for coaching mental health practitioners. International Journal of Evidence Based Coaching and Mentoring, 9, 56– 66. Doehrman, M. J. (1976). Parallel processes in supervision and psychotherapy. Bulletin of the Menninger Clinic, 40, 9 – 104. Efstation, J. F., Patton, M. J., & Kardash, C. M. (1990). Measuring the working alliance in counselor supervision. Journal of Counseling Psychology, 37, 322 – 329. Ekstein, R., & Wallerstein, R. S. (1972). The teaching and learning of psychotherapy (2nd ed.). New York, NY: International Universities Press. Ensink, K., Maheux, J., Normandin, L., Sabourn, S., Diguer, L., Berthelot, N., & Parent, K. (2013). The impact of mentalization training on the reflective function of novice therapists: A randomized controlled trial. Psychotherapy Research, 23, 526 – 538. Falender, C. A., & Shafranske, E. P. (2004). Clinical supervision: A competency-based approach. Washington, DC: American Psychological Association. Falender, C. A., & Shafranske, E. P. (2010). Psychotherapy-based supervision models in an emerging competency-based era: A commentary. Psychotherapy Theory, Research, Practice, Training, 47, 45– 50. Fouad, N. A., Grus, C. L., Hatcher, R. L., Kaslow, N. J., Hutchings, P. S., Madson, M. B., . . . Crossman, R. E. (2009). Competency benchmarks: A model for understanding and measuring competence in professional psychology across training levels. Training and Education in Professional Psychology, 3(4), S5 – S26. Gediman, H. K., & Wolkenfeld, F. (1980). The parallelism phenomenon in psychoanalysis and supervision: Its reconsideration as triadic system. Psychoanalytic Quarterly, XLIX, 234– 255. Gizara, S. S., & Forrest, L. (2004). Supervisors’ experiences of trainee impairment and incompetence at APA accredited internship sites. Professional Psychology: Research and Practice, 35, 131 – 140. Glickauf-Hughes, C., & Campbell, L. F. (1991). Experiential supervision: Applied techniques for a case presentation approach. Psychotherapy, 28, 625– 635. Gonsalvez, C. J., & Calvert, F. L. (2014). Competency-based models of supervision: Principles and applications, promises and challenges. Australian Psychologist, 49, 200 – 208. Gonsalvez, C. J., Oades, L. G., & Freestone, J. (2002). The objectives approach to clinical supervision: Towards integration and empirical evaluation. Australian Psychologist, 37, 68 – 77. Goodyear, R. K. (2014). Supervision as a pedagogy: Attending to its essential instructional and learning processes. The Clinical Supervisor, 33, 82 – 99. Gray, L. A., Ladany, N., Walker, J. A., & Ancis, J. R. (2001). Psychotherapy trainees’ experience of counterproductive events in supervision. Journal of Counseling Psychology, 48, 371 – 383. Haber, R., Marshall, D., Cowan, K., Vanlandingham, A., Gerson, M., & Fitch, J. C. (2009). “Live” supervision of supervision: “Perpendicular” interventions in parallel processes. The Clinical Supervisor, 28, 72– 90. Hallett, C. E. (1997). Learning through reflection in the community: The relevance of Schön’s theories of coaching to nursing education. International Journal of Nursing Studies, 34, 103–110. Hardy, G., Cahill, J., & Barkham, M. (2007). Active ingredients of the therapeutic relationship that promote client change: A research perspective. In P. Gilbert & R. Leahy (Eds.), The therapeutic relationship in the cognitive behavioural psychotherapies (pp. 24 – 42). London, UK: Routledge.



19

Heatherington, L., Constantino, M. J., Friedlander, M. L., Angus, L. E., & Messer, S. B. (2012). Clients’ perspectives on corrective experiences in psychotherapy. In L. G. Castonguay & C. E. Hill (Eds.), Transformation in psychotherapy: Corrective experiences across cognitive behavioral, humanistic, and psychodynamic approaches (pp. 161 – 190). Washington, DC: American Psychological Association. Hill, H. R., Crowe, T. P., & Gonsalvez, C. J. (2015). Reflective dialogue in clinical supervision: A pilot study involving collaborative review of supervision videos. Psychotherapy Research, Advance online publication. doi:10.1080/10503307.2014.996795 Holloway, E. L., & Carroll, M. (1999). Training counselling supervisors. London, UK: Sage. James, I. A., Allen, K., & Collerton, D. (2004). A post-hoc analysis of emotions in supervision: A new methodology for examining process features. Behavioural and Cognitive Psychotherapy, 32, 507 – 513. Jenkins, S. (2010). Relationships. In J. C. Thomas & M. Hersen (Eds.), The handbook of clinical psychology competencies (pp. 123– 152). New York, NY: Springer. Kagan, N. (1980). Influencing human interaction- eighteen years with IPR. In A. K. Hess (Ed.), Psychotherapy supervision: Theory, research & practice (pp. 262 – 286). New York, NY: Wiley. Kaslow, N. J., & Bell, K. D. (2008). A competency-based approach to supervision. In C. A. Falender & E. P. Shafranske (Eds.), Casebook for clinical supervision: A competencybased approach (pp. 39– 56). Washington, DC: American Psychological Association. Knox, S., Hess, S. A., Hill, C. E., Burkard, A. W., & Crook-Lyon, R. (2012). Corrective relational experiences in psychotherapy. In L. G. Castonguay & C. E. Hill (Eds.), Transformation in psychotherapy: Corrective experiences across cognitive, behavioral, humanistic, and psychodynamic approaches (pp. 191 –213). Washington, DC: American Psychological Association. Kolb, D. A. (1984). Experiential learning: Experience as a source of learning and development. Englewood Cliffs, NJ: Prentice Hall. Ladany, N. (2004). Psychotherapy supervision: What lies beneath. Psychotherapy Research, 14, 1–19. Ladany, N., Ellis, M. V., & Friedlander, M. L. (1999). The supervisory working alliance, trainee self-efficacy, and satisfaction. Journal of Counseling and Development, 77, 447 –455. Ladany, N., Hill, C. E., Corbett, M. M., & Nutt, E. A. (1996). Nature, extent, and importance of what psychotherapy trainees do not disclose to their supervisors. Journal of Counseling Psychology, 43, 10– 24. Mangione, L., & Nadkarni, L. (2010). The relationship competency: Broadening and deepening. In M. B. Kenkel & R. L. Peterson (Eds.), Competency-based education for professional psychology (pp. 69– 86). Washington, DC: American Psychological Association. Mann, K., Gordon, J., & MacLeod, A. (2009). Reflection and reflective practice in health professions education: A systematic review. Advances in Health Sciences Education, 14, 595–621. Markovitz, J. C., & Milrod, B. L. (2011). The importance of responding to negative affect in psychotherapies. American Journal of Psychiatry, 168, 124 – 128. Morrissey, J., & Tribe, R. (2001). Parallel process in supervision. Counselling Psychology Quarterly, 14, 103 –110. National Council of Schools and Programs in Professional Psychology. (2007). Competency developmental achievement levels (DALs) of the National Council of Schools and Programs in Professional Psychology. Retrieved from http://www.thencspp.com/DALof%20NCSPP%20921-07.pdf Nelson, M. L., & Friedlander, M. L. (2001). A close look at the conflictual supervisory relationships: The trainee’s perspective. Journal of Counseling Psychology, 48, 384– 395. doi:10.1037/0022-167.48.384 Neufeldt, S. A. (1999). Training in reflective processes in supervision. In M. Carroll & E. L. Holloway (Eds.), Education of clinical supervisors (pp. 92 – 105). London, UK: Sage. North, G. J. (2013). Recording supervision: Educational, therapeutic, and enhances the supervisory working alliance? Counselling and Psychotherapy Research, 13, 61– 70. O’Donovan, A., Halford, W. K., & Walters, B. (2011). Towards best practice supervision of clinical psychology trainees. Australian Psychologist, 46, 101– 112.


20


Orchowski, L., Evangelista, N. M., & Probst, D. R. (2010). Enhancing supervisee reflectivity in clinical supervision. Psychotherapy Theory, Research, Practice, Training, 47, 51– 67. Osborn, C. J., Paez, S. B., & Carribean, C. L. (2007). Reflections on shared practices in supervisory lineage. The Clinical Supervisor, 26, 119– 139. Page, S., & Wosket, V. (2014). Supervising the counsellor and psychotherapist (3rd ed.). New York, NY: Routledge. Pisani, A. (2005). Talk to me: Supervisee disclosure in supervision. Smith College Studies in Social Work, 75, 29– 47. Pistole, M. C., & Watkins, C. E. (1995). Attachment theory, counselling process, and supervision. The Counselling Psychologist, 23, 457 – 478. Raichelson, S. H., Herron, W. G., Primavera, L. H., & Ramirez, S. M. (1997). Incidence and effects of parallel process in psychotherapy supervision. Clinical Supervisor, 15, 37 – 48. Rodolfa, E. R., Bent, R. J., Eisman, E., Nelson, P. D., Rehm, L., & Ritchie, P. (2005). A cube model for competency development: Implications for psychology educators and regulators. Professional Psychology: Research and Practice, 36, 347 – 354. Rubin, N. J., Bebeau, M., Leigh, I. W., Lichtenberg, J. W., Nelson, P. D., Portnoy, S., & Kaslow, N. J. (2007). The competency movement within psychology: An historical perspective. Professional Psychology: Research and Practice, 38, 452 – 462. doi:10.1037/0735-7028.38.5.452 Safran, J. D., & Muran, J. C. (1996). The resolution of ruptures in the therapeutic alliance. Journal of Consulting and Clinical Psychology, 64, 447– 458. Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance: A relational treatment guide. New York, NY: Guilford Press. Safran, J. D., & Muran, J. C. (2001). A relational approach to training and supervision in cognitive psychotherapy. Journal of Cognitive Psychotherapy, 15, 3 – 15. Safran, J. D., Muran, J. C., & Eubanks-Carter, C. (2011). Repairing alliance ruptures. Psychotherapy, 48, 80– 87. Schlessinger, N. (1966). Supervision of psychotherapy: A critical review of the literature. Archives of General Psychiatry, 15, 129 – 134. Schön, D. A. (1983). The reflective practitioner: How professionals think in action. New York, NY: Basic Books. Searles, H. F. (1955). The informational value of the supervisor’s emotional experiences. Psychiatry, 18, 135 – 146. Tracey, T. J. G., Bludworth, J., & Glidden-Tracey, C. E. (2012). Are there parallel processes in psychotherapy supervision? An empirical examination. Psychotherapy, 49, 330– 343. Watkins, C. E., Jr. (1995). Pathological attachment styles in psychotherapy supervision. Psychotherapy, 32, 333– 340. Watkins, C. E., Jr. (2011). Toward a tripartite vision of supervision for psychoanalysis and psychoanalytic psychotherapies: Alliance, transference-countertransference configuration, and real relationship. Psychoanalytic Review, 98, 557 –590. Watkins, C. E., Jr., Budge, S. L., & Callahan, J. L. (2015). Common and specific factors converging in psychotherapy supervision: A supervisory extrapolation of the Wampold/ Budge psychotherapy relationship model. Journal of Psychotherapy Integration, 25, 214 – 235. Watkins, C. E., Jr., & Riggs, S. A. (2012). Psychotherapy supervision and attachment theory: Review, reflections, and recommendations. The Clinical Supervisor, 31, 256– 289. Williams, A. B. (2000). Contribution of supervisors’ covert communication to the parallel process. Dissertation Abstracts International Section A: Humanities & Social Sciences, 61, 1165. Worthen, V., & McNeill, B. W. (1996). A phenomenological investigation of “good” supervision events. Journal of Counseling Psychology, 43, 25– 34. Fiona L. Calvert is a Doctor of Philosophy (Psychology) student at the University of Wollongong, Australia. She is a practicing psychologist and holds a Bachelor of Psychology (Honours) and a Master of Clinical Psychology, both from the University of Wollongong.


21

Dr. Trevor P. Crowe is a Senior Lecturer and Coordinator of the Master of Professional Psychology program at the University of Wollongong, Australia. He holds a Bachelor of Science (Hons1) and PhD (Psychology). Dr. Crowe has held a full-time research position at the Illawarra Institute for Mental Health, Australia, and teaching positions with the School of Psychology at the University of Wollongong since 2003. He has 15 years experience as a clinical supervisor.


Prof. Brin F. S. Grenyer (BA[Hons], MSc, PhD) is a professor of psychology at the University of Wollongong Australia. He provides clinical, consulting, and research services across NSW Health and to the non-government mental health and drug and alcohol sector. Professor Grenyer coordinates a research program focused on the treatment of chronic and complex psychological problems, including personality disorders, chronic depression, aggression and violence, early attachment relationships, chronic lifestyle diseases, and substance dependence. Over the past fifteen years he has led psychotherapy clinics both for personality disorder and depression, with over 1000 patients enrolled in treatment and research.