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The Clinical Supervisior

ISSN: 0732-5223 (Print) 1545-231X (Online) Journal homepage: https://www.tandfonline.com/loi/wcsu20

When Values Collide
Field Instructors’ Experiences of Providing Feedback and Evaluating
Competence

Marion Bogo MSW, Adv. Dip. SW , Cheryl Regehr PhD , Roxanne Power MSW
& Glenn Regehr PhD

To cite this article: Marion Bogo MSW, Adv. Dip. SW , Cheryl Regehr PhD , Roxanne Power MSW
& Glenn Regehr PhD (2007) When Values Collide, The Clinical Supervisior, 26:1-2, 99-117, DOI:
10.1300/J001v26n01_08

To link to this article: https://doi.org/10.1300/J001v26n01_08

Published online: 08 Sep 2008.

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When Values Collide:
Field Instructors’ Experiences

of Providing Feedback
and Evaluating Competence

Marion Bogo
Cheryl Regehr
Roxanne Power
Glenn Regehr

ABSTRACT. This paper reports on an analysis of qualitative data ac-
crued across four research studies that addressed the experiences of field
instructors in evaluating students and providing corrective feedback when
necessary. Findings suggest that while tools for field evaluation are in-
creasingly attempting to provide standardized, objective, and “impartial”
measures of performance, these evaluations nevertheless occur within a
professional and relational context that may undermine their value. As
social workers, field instructors are guided by the professional values of
respecting diversity, focusing on strengths and empowerment, advocating

Marion Bogo, MSW, Adv. Dip. SW, is Professor, Faculty of Social Work, University
of Toronto, 246 Bloor Street West, Toronto, Ontario, Canada, M5S 1A1 (E-mail: marion.
[email protected]).

Cheryl Regehr, PhD, is Professor, Sandra Rotman Chair, Faculty of Social Work,
University of Toronto.

Roxanne Power, MSW, is Senior Lecturer, Faculty of Social Work, University of
Toronto.

Glenn Regehr, PhD, is Professor, Richard and Elizabeth Currie Chair in Health Pro-
fessions Education Research, Faculty of Medicine, University of Toronto.

Glenn Regehr, PhD, is supported as the Richard and Elizabeth Currie Chair in
Health Professions Education Research.

This study was funded by a grant from the Social Sciences and Humanities Research
Council of Canada.

The Clinical Supervisor, Vol. 26(1/2) 2007
Available online at http://cs.haworthpress.com

© 2007 by The Haworth Press, Inc. All rights reserved.
doi:10.1300/J001v26n01_08 99

for vulnerable individuals, and valuing relationships as avenues for growth
and change. By placing field instructors in a gatekeeping role, the univer-
sity requires them to advocate for particular normative standards of pro-
fessional behavior and to record a negative evaluation for a student who
fails to achieve or adhere to these normative standards. Such activities
can be in direct conflict with social workers’ personal and professional
values, thereby creating a disquieting paradox for the field instructor.
Models of student evaluation must consider the influence of this conflict
on the field instructor’s ability to fulfill the role of professional gatekeeper
and must find new ways of addressing the problematic student. doi:10.1300/
J001v26n01_08 [Article copies available for a fee from The Haworth Document
Delivery Service: 1-800-HAWORTH. E-mail address: <[email protected]
com> Website: <http://www.HaworthPress.com> © 2007 by The Haworth Press,
Inc. All rights reserved.]

KEYWORDS. Field instruction, educational assessment, evaluation, su-
pervision

The accurate assessment of competence is of vital concern to all the
professional disciplines. The ability to reliably and validly differentiate
between those students who possess the knowledge, skills, and judg-
ment necessary for safe and effective practice and those who do not is
central to the critical role that is expected of university-based profes-
sional programs as gatekeepers of their respective professions. Social
work educational programs delegate a major portion of the responsibil-
ity for evaluating students’ practice competence to field instructors in
the practicum. While faculty field liaisons are involved to a greater or
lesser extent in this process (Bennett & Coe, 1998), the primary respon-
sibility for providing corrective feedback and for assessing students’
practice competence rests largely with community-based social work-
ers in their role as field instructors. When students have strong social
work skills, or when students are active and open learners who quickly
integrate corrective feedback in a positive manner, the process of provid-
ing feedback can be rewarding for field instructors as they participate in
the generative activity of teaching and preparing the next generation
of social workers (Bogo & Power, 1992; Globerman & Bogo, 2003). But
what happens when the student is not able to develop the skills and
competencies necessary to be a competent practitioner and displays
many deficits? How does a field instructor respond to situations in which
the pleasure of generativity is transformed into the responsibility for
gatekeeping?

100 THE CLINICAL SUPERVISOR

In an attempt to better understand the factors that contribute to field
instructors’ ability to communicate with students about their level of
performance, this article examines dynamics and issues in instruction
and evaluation. The data for this analysis were drawn from a series of
studies on conceptualizing and assessing student competence where the
topics of working with students who present problematic behaviors,
providing corrective feedback, and generating summative evaluations
of students were explored directly or arose spontaneously.

PREVIOUS RESEARCH

Students’ presenting with attitudes and behaviors inconsistent with
social work has frequently been raised as a concern for educators. In one
line of inquiry addressing this issue, researchers have attempted to de-
termine whether it is possible to identify students who may not possess
characteristics required to attain competence in social work prior to ad-
mission. Pelech, Stalker, Regehr, and Jacobs (1999), for example, exam-
ined the predictive validity of admission criteria in identifying potentially
unsuitable students. Analyzing quantitative data from admission files,
they determined that students who were later identified as problematic
were on average older than other students, were more likely to be male,
had lower grade point averages, and had more social service experience.
These findings were consistent with some earlier findings regarding the
value of age and gender as predictors of difficulty in student social
workers (Cunningham, 1982; Duder & Aronson, 1978; Pfouts & Henley,
1977). However, these demographically-based findings were considered
to be of limited use to admissions decision makers in establishing screen-
ing criteria, and therefore a further content analysis was conducted of
personal statements prepared at the candidacy stage. When compared to
other students, issues identified in the statements of students later rec-
ognized as problematic included a focus on personal histories of abuse,
injustice, or neglect, and plans to work with others with similar experi-
ences (Regehr, Stalker, Jacobs, & Pelech, 2001). To the extent that these
predictive markers manifest as professional challenges for the student
when entering the practicum setting, they are likely to be difficult issues for
field instructors to address with students.

Other research has focused on the evaluation of students and identifi-
cation of those with inadequate skill levels or those who do not possess
the characteristics that would render them suitable for social work. Social
work educators have sought to articulate outcome objectives and related

Bogo et al. 101

criteria for assessing student field learning and practice competence
and to develop reliable and valid measures of field performance (Bogo,
Regehr, Hughes, Power, & Globerman, 2002; Dore, Morrison, Epstein, &
Herrerias, 1992; Koroloff, & Rhyne, 1989; O’Hare, & Collins, 1997;
Reid, Bailey-Dempsey, & Viggiana, 1996; Vourlekis, Bembry, Hall, &
Rosenblum, 1996). Despite the movement to increasingly standardized
measures, clinical performance evaluation remains a complex process
that is further complicated by the social and relational issues involved
in a mentoring relationship (Lazar & Mosek, 1993). Yet, in all these ef-
forts to “improve the scales,” researchers and developers have left the re-
sponsibility for both evaluation and communicating negative evaluations
primarily to the field instructor.

If a student is identified as potentially unsuitable for the profession,
the issue of termination takes precedence. Research by several authors
in this area has identified the absence of policies and procedures in
schools of social work for terminating students for reasons such as pro-
fessional unsuitability (Cobb & Jordan, 1989; Koerin & Miller, 1995),
and others have addressed the legal issues associated with such termina-
tion including the framework provided by the Americans with Disabili-
ties Act (Cole & Lewis, 1993; Gillis & Lewis, 2004). From this work, it is
clear that whether one is finding mechanisms to avoid termination of
a student by correcting problematic behavior or whether one is prepar-
ing the way for termination, feedback must be provided to the student
regarding performance deficits, and explicit expectations for change
must be enunciated. Again, given the fact that problematic behavior is
most likely to be manifested and detected in the field placement, it be-
comes the challenging responsibility of the field instructor to enact many
of these underspecified and ill-supported, but legally necessary correc-
tive actions.

Even for students who are not in potential difficulty, however, the
importance of providing meaningful corrective feedback has been a
consistent theme in social work education literature. Munson (2002), for
example, cautioned against giving only positive feedback observing that
in general, social workers (not unlike others perhaps) dislike giving or
receiving criticism. Freeman (1985) provided guidelines for giving bal-
anced feedback that is systematic, timely, clear, and invites dialogue.
Kadushin (1992) offered similar guidelines and observed that workers’
and students’ performance failures need attention from their supervi-
sors. Noting that despite social workers’ valuing of feedback they find it
difficult to give when it is more negative in nature, Abbott and Lyter
(1998) surveyed students and field instructors about their perceptions of

102 THE CLINICAL SUPERVISOR

giving and receiving criticism. They found that criticism was experi-
enced as helpful when part of a positive trusting student and field in-
structor relationship. Criticism was seen as harmful when delivered in
a demeaning or harsh manner. More than a quarter of the respondents
opposed criticism that was also not balanced with positive comments,
and some highlighted the importance of the student being prepared for
receiving criticism. Without such preparation, criticism was thought to
be responsible for damaging self-esteem and self-confidence, decreasing
motivation for learning social work practice, and impeding growth.

While there has been little empirical investigation of field instructors’
experience of their role as evaluators, anecdotal evidence from field
coordinators note that field instructors find this aspect of their role as
“most worrisome” (Pease, 1988, p. 35). Gitterman and Gitterman (1979)
found that field instructors experienced defining criteria, writing the for-
mal document, assessing student practice, and engaging the student in the
evaluation process as stressful. In a study on the supervision of workers,
Kadushin (1985) found that supervisors disliked evaluation as it rein-
forced the power differential with supervisees, and that a negative evalua-
tion evoked anger and upset the balance in the relationship.

Similar concerns about evaluation and gatekeeping are expressed by
supervisors in related human service fields. In the field of clinical psy-
chology, researchers have acknowledged the presence of conceptual ar-
ticles regarding the evaluation of competence and the responsibilities of
internship supervisors for gatekeeping, but they have also noted that
there is little empirical work related to these concepts (Gizara & Forrest,
2004). Problematic student behaviors and trainee impairment have been
studied in incidence studies and in surveys that document the percep-
tions of training directors’ regarding the scope of the problem and ways
of addressing it (Vacha-Haase, Davenport, & Kerewsky, 2004). Gizara
and Forrest (2004) studied the experiences of 12 supervisors who had
worked with students with serious competence problems, and, argued
that further qualitative studies of this type would provide information
that could be helpful to other supervisors. They found that supervisors
perceived the process of evaluation, especially when trainees were not
achieving expected levels of competence, as complex, challenging, and
difficult. Issues that affected supervisors’ experience included lack
of adequate preparation in their own training for the evaluation role in
supervision, the degree of support they received from colleagues in
their agencies, and the negative personal and emotional impact on the
supervisor.

Bogo et al. 103

In a study of clinical supervisors in medicine and surgery, Dudek,
Marks, and Regehr (2005) explored supervisors’ perspectives about evalu-
ating poorly performing medical students and/or residents. They found
that these supervisors felt they were able to identify poor performance but
were often reluctant to report it for a number of reasons. Factors included
their lack of previously documenting poor performance and their lack of
clarity about what to document as supporting evidence for their judg-
ment. Concerns about the potential of an appeal, its impact on their own
credibility with their colleagues, and whether there would be faculty
support for their decision also had an impact. In addition, the perceived
lack of remediation opportunities for the trainee affected their decisions.

In summary, across the human services professions, studies about
gatekeeping at the admissions level have provided some data regarding
potential difficulty that some students might experience in field practice
with populations with similar experiences to the students. In addition,
studies on termination have described the processes required to remove
unsuitable students and highlight the need for explicit feedback regard-
ing unacceptable performance. However, these studies have not fully il-
luminated the issues and challenges faced by field instructors in their
day-to-day interactions with students presenting with problematic behav-
iors. Similarly, despite anecdotal reports from field coordinators regard-
ing the central role that field instructors play as educators and evaluators,
and despite the apparent responsibility these roles engender for the field
instructors as the frontline gatekeepers of the profession, there is little
empirical evidence available regarding the issue of how field instructors
enact these crucial gatekeeping roles: how they evaluate students and
provide feedback when performance does not meet expected standards.

METHOD

As part of a program of research on conceptualizing and measuring
students’ practice competence, a number of studies were conducted (see
the following for a complete discussion of methodology of each study:
Bogo et al., 2002, 2004, 2006; Regehr, Bogo, Regehr, & Power, 2007).
A range of research methodologies were used in each study including
scaling student behaviors, sorting vignettes, focus groups, and in-depth
interviews. In an attempt to understand the challenges field instructors
experience when teaching and assessing for competence, the research-
ers pooled qualitative data from these four studies. The data relevant to this

104 THE CLINICAL SUPERVISOR

elaborated reanalysis were elicited when various aspects of evaluation
were specifically investigated or when instructors’ experiences were of-
fered spontaneously during discussions of evaluation scales. These rele-
vant qualitative data from across the four studies were compiled for the
current analysis. The methodologies of the four studies and the resulting
qualitative data sets from which the relevant data were extracted are de-
scribed as follows.

Study 1: In-depth interviews were held with 19 experienced field in-
structors who were asked to provide descriptions of exemplary, average,
and problematic students they had taught in the field practicum (Bogo
et al., 2006). Spontaneous comments made by field instructors during
these interviews about educating and evaluating students with problem-
atic behaviors were subjected to grounded theory data analysis. An iter-
ative process involved the research team in reviewing the open coding
reports, engaging in selective coding and developing a theoretical un-
derstanding, which was grounded in the themes that emerged.

Study 2: From the 57 descriptions of students collected in the study
above, 20 realistic student vignettes were created to represent a range
of student competence. Ten experienced field instructors were asked,
first independently and then in one of two small groups, to divide these
vignettes into as many categories as they felt necessary to reflect vari-
ous levels of student performance. Two recorders (one for each group)
captured the content and process of the groups as members discussed
their rationale for ranking students (Bogo et al., 2004). Spontaneous
comments made by field instructors about what they imagined it would
be like to teach and to evaluate these fictitious students were used for
this analysis.

Study 3: A Practice-Based Evaluation Tool, grounded in the concepts
and language used by field instructors during the first two studies, was
created. This tool consisted of six dimensions of competence described in
detail along five levels of student competence. Forty three experienced
field instructors were asked to recall their most recent student and to eval-
uate the student first using the school’s current competency-based tool,
then using the new practice-based evaluation tool (Regehr et al., in re-
view). Following completion of the tools, focus groups of approximately
10 instructors each, were held where participants were asked for their
opinions about the two tools, about giving feedback to students (espe-
cially negative feedback), and about evaluation of student competence
in general. One recorder captured the content in the discussions. Follow-
ing the focus groups the recorder and group facilitator reviewed the writ-
ten notes to check for accuracy and comprehensiveness. These notes

Bogo et al. 105

were subjected to grounded theory analysis following the procedure
described above.

Study 4: The 20 realistic student vignettes, as described in Study 2,
were provided to 28 experienced instructors who were asked to recall
their most recent student and select the vignettes that were “most simi-
lar” to their student. They were then asked to rate the same student using
both the practice-based evaluation tool and the school’s current compe-
tency-based evaluation tool described above (Regehr et al., in review).
Following completion of the evaluations, focus groups ranging from 6 to
10 participants were held where participants’ opinions about the various
evaluation methods were elicited and recorded. As well, participants dis-
cussed their experiences of giving feedback to students, especially nega-
tive feedback, and about evaluation of student competence in general.
Methods of recording, data checking, and analysis were the same as de-
scribed in Study 3.

In summary, 100 field instructors participated in these studies with
19 instructors providing data in individual interviews and 81 instructors
providing data in 9 focus groups of 5 to 10 participants.

The researchers reviewed the relevant data from these four studies
and, in the analysis, used a grounded theory iterative approach building
on the themes emerging from each study. Each successive study pro-
vided an opportunity to challenge the team’s interpretations through en-
gagement with groups of field instructors who had not participated in
the earlier phases of the research program in order to assess transferabil-
ity and confirmability (Cresswell, 1998; Erlandson, Harris, Skipper, &
Allen, 1993).

FINDINGS

Discussions with the field instructors across these four studies re-
vealed six recurrent and interconnected themes. Each of these themes
will be discussed separately in the following sections, and a model of
how these various considerations combine to represent field instructors’
experiences and constructions of giving negative feedback will be offered
in the discussion section.

Posture Towards Evaluation

Evaluating students presents a range of issues for social work field in-
structors. When field instructors in these studies were expected to evaluate

106 THE CLINICAL SUPERVISOR

their students’ performance and rank or categorize it on a continuum,
they reported conflict between the need to determine skill levels and their
deeply held professional values, such as being nonjudgmental, using a
strengths perspective, individualizing the person one is working with,
and understanding behaviors in context. While they acknowledged that as
social workers they must make judgments “in the real world of practice,”
the role of facilitating learning is far more appealing to them than the role
of judging student performance.

Field instructors in this group of studies were asked to provide feed-
back on a series of tools for evaluation. Given their commitment to being
nonjudgmental and focusing on strengths, field instructors were very
sensitive to the language used in various evaluation tools, preferring
what they perceived as the neutral and specific behaviors found on
competency-based inventories. They were critical of tools that used what
they perceived to be value-laden terms (such as unfocused, authoritar-
ian with clients, inflexible regarding intervention planning) or referred
to personal qualities (initiative, warmth, sensitivity) despite their ac-
knowledgment that these factors were often more important dimensions
of practice than some of the concrete behavioral skills. They wanted
to “individualize the student” and preferred tools that provided a frame-
work and a means for them to “describe the attributes and process of
learning and development” of the particular student rather than tools
that required them to grade, rank, categorize, or rate students. They rec-
ognized the time challenge also, with one participant expressing explic-
itly that “Whatever evaluation tool we use we will complain about the
time it takes, even though evaluation is important.”

Student Response to Feedback and Evaluation

Giving feedback is not a problem for instructors when the student re-
sponds in a thoughtful manner or accepts it, works with it, and uses it in
subsequent work with clients. Instructors spoke about their gratification
when they “could see the student using the feedback in the next inter-
view.” Giving feedback becomes difficult, however, when the student
does not accept it. The instructors described a range of student reactions
including arguing, becoming defensive, attacking the instructor’s teaching
style, and becoming silent and avoidant. Three types of circumstances were
identified by instructors as limiting students’ acceptance of feedback:
(1) where students had difficulty understanding the role of social work
and the nature of practice and hence could not accurately assess their
behaviors or skills; (2) where students had worked before entering the

Bogo et al. 107

educational program, believed themselves to be competent and were not
open to a new view of their skill level; and (3) where students’ personality
style was such that problematic behaviors were a pervasive part of their
interactions with clients, colleagues from related professions, or both.

When students did not use the instructors’ feedback productively, the
focus in the practicum changed from developing practice competence
to concerns about the possibility of the student failing. Some students
became fearful and cautious, and their struggles in learning were exacer-
bated. A downward and deteriorating cycle ensued with negative feedback
producing more anxiety and concerns for students, which in turn inter-
fered with their ability to learn and progress.

The Relationship as a Context for Feedback and Evaluation

Social worker field instructors in these studies discussed giving both
positive and negative feedback to students as similar to giving feedback
to clients. They highlighted the importance of the relationship as the
context where feedback and information are provided that could pro-
duce growth, development, or change: “You have to be open and honest
from the beginning and not shy away from correcting behavior and
skills. In establishing an open and honest relationship you earn the right
to give open and honest feedback.” They underscored the importance
of giving feedback in a nonjudgmental way in practice and when work-
ing with students: for example, “I try not to only be critical but ask how
could you have done better?”

Using social work values and adult education principles, the instruc-
tors encourage student participation and collaboration in all aspects of
field education including setting learning objectives and evaluating
learning. When expected to provide a numerical ranking for students on
a rating scale, they reported that students pressure them for rankings at the
high end of the scale. Interpersonal dynamics, differences in interpreting
the meaning of the numbers on the scale, and time constraints left instruc-
tors feeling burdened and pressured to provide higher ratings.

As a consequence of the intensity in the dyadic tutorial model of social
work field instruction, the instructors commented on how giving feed-
back, especially negative feedback, is difficult. Hence as one instructor
stated, while other focus group participants nodded in unison, “giving
negative feedback to the student is so difficult . . . it feels so personal.”
They noted this was especially so when aspects of the student’s personality
or personal style were at issue, for example, relationship abilities or de-
gree of initiative in learning and practice. In these situations, students

108 THE CLINICAL SUPERVISOR

frequently were reported to have difficulty accepting feedback. Field in-
structors reflected that when feedback was not accepted, not only was
learning and change impeded but also an acrimonious process devel-
oped in the relationship with the student. Field instructors used strong
terms to describe the atmosphere in their subsequent sessions and in the
relationship such as “becoming tense,” “very heavy, intense,” “emotional,”
and “like me against the student.”

The Practicum Setting as an Influence
on Feedback and Evaluation

Social work practicum generally takes place in organizations where
students join instructors on multi-professional teams. Instructors reported
being caught between organizational needs and students’ needs. On the
one hand, they needed to preserve longstanding inter-professional relation-
ships and the organization’s positive perceptions about social workers’
contributions. These perceptions were challenged when colleagues were
critical of problematic student behaviors and impatient with the instruc-
tors, perceiving them as inappropriately defending the student. On the
other hand, instructors wanted to be fair and ensure the student had every
opportunity to learn and progress. A time-consuming balancing act en-
sued: “I had to spend inordinate amounts of time managing the fall-out
from the student’s behavior in the setting.”

Similar to the instructors’ concern about individualizing students’
approaches to learning and progress was their perception that evalua-
tion takes place within the context of a particular organizational setting.
They were concerned that dynamics in their setting affected opportu-
nities for student learning. Even though the instructors might rate the
student highly, they were concerned that their rating would be inter-
preted to mean that the student could function in other settings, a predic-
tion they were not comfortable in making.

The Responsibility of the School of Social Work

A general theme emerged that can best be labeled “Where is the
school?” While faculty field liaisons were praised on an individual basis
as supportive and involved, instructors voiced concern about the school
supporting their judgments. Instructors working with difficult students
felt isolated in their role: “[I felt] lonely, alone and out there to do the
hard work of giving feedback about problematic behaviors.” Critical
comments related to the structure of social work education that relegates

Bogo et al. 109

primary responsibility to the field practicum for developing and evalu-
ating students’ self-awareness, professional use of self, ability to self-
assess, and level of practice competence. Instructors questioned criteria
used in the admissions process that resulted in enrolling students who
appeared to lack interpersonal skills or the ability to learn. They were
critical of the primacy given to outcomes such as grades on written
papers in academic courses rather than to assessments that provide an
indication of professional competence. Finally, they resented what they
perceived as the burden placed on them to evaluate student practice per-
formance and serve as gatekeepers for the profession.

The Field Instructor’s Sense of Self

Conscientious about their teaching role, field instructors reported
“second guessing” their judgments and seeking out the opinions of
other social workers and colleagues in the setting to determine whether
their assessment of the student was fair, accurate, or too harsh. They
tried to sort out “how much is me and how much is the student?” They
spoke about questioning themselves and their ability to deal with the sit-
uation: “Could I do this differently or better?” Sharing their impressions
and experiences with other field instructors or colleagues resulted in
feeling less isolated.

Giving negative feedback and continuing to teach in a deteriorating
and tense relationship with the student was highly stressful, and instruc-
tors described their experience as “tedious, the repetition in teaching the
same thing again and again with no change in the student’s behavior
was draining.” In the end it had a profound impact on the instructors:
“[I felt] horrible, depleted . . . I had to take a break from taking students
for a few years after that experience,” and “three days feels very emo-
tionally draining.” The time involved in working with a student display-
ing problematic behaviors, who did not join the instructor to change and
develop, was a pervasive theme. In an era of demands from employers for
increased productivity, students who need a considerable investment of
time created an added burden and stress for these social workers.

Valuing a strengths focus in their practice and in their teaching, these
field instructors expressed regret and a concern that they had in some
way failed to make progress with these students. Generally they tried to
provide explanations and rationalizations for the lack of change and
attributed problems to a lack of fit with the setting or the developmental
stage in the student’s life. The experience of judging student behaviors
as problematic created dissonance and discomfort for these social workers

110 THE CLINICAL SUPERVISOR

who were motivated to provide student education as a generative and
energizing professional activity.

DISCUSSION

Evaluation of students in the field is viewed by field instructors to be
one of the most challenging and stressful aspects of practicum teaching.
When the skills and characteristics of the student do not meet expected
standards for a professional social worker, the evaluation role becomes
even more difficult and dreaded. From the findings of these four studies,
we conclude that the evaluation of student competence and the provi-
sion of feedback in field education are complicated by a number of in-
terconnected factors. The tools of evaluation, the student response to
evaluation, the relationship in which the evaluation occurs, and the orga-
nizational context in which the evaluation occurs all present challenges.
These challenges are exacerbated by the professional values these field
instructors embrace as social workers. While in the field instruction role,
these social workers continue to draw on the professional values that in-
form and guide all aspects of their practice. When social work values
come into conflict, field instructors experience dissonance and stress as
evaluators and gatekeepers.

Several values come into conflict when field instructors are faced
with the task of evaluating students and providing corrective feedback.
The first conflict relates to the responsibility to ensure professional stan-
dards of competence are upheld while simultaneously being committed
to the belief in individuals’ abilities to build on strengths and develop
greater capacities. On the one hand, social workers expect their colleagues
to be competent, and they believe that clients need to be protected from
incompetent social workers. In their roles as field instructors, they judge
negatively students who display problematic behaviors when working
with clients and colleagues. When students are not able to change and learn
competent practice, instructors expect such students will not proceed to
become practitioners. On the other hand, these social workers are com-
mitted in their practice to empowerment of individuals with challenging
and difficult behaviors and interpersonal styles. Social workers strive to
engage such individuals, understand the life situations that have contrib-
uted to these difficulties, and work collaboratively towards helping clients
develop more adaptive behaviors. Empowerment practice includes fo-
cusing on individuals’ strengths and avoiding judgmental, deficit-focused,

Bogo et al. 111

and problem-saturated perspectives. When the social work field instructors
in our studies were confronted with students who displayed negative be-
haviors or attitudes they experienced conflict about their responsibility
to identify and label incompetent practices, in language they experienced
as pejorative or negative, and their convictions about a “strengths” perspec-
tive. While the field instructors in our studies (Bogo et al., 2004, 2006) and
others (LaFrance, Gray, & Herbert, 2004) clearly identified that students
who are most suitable for the profession possess qualities of maturity,
honesty and integrity, the ability to form relationships with colleagues
and clients, self-awareness, receptiveness to feedback, and personal con-
gruence with social work values, there was marked discomfort in address-
ing deficits in these areas. Such reluctance is undoubtedly accentuated in
light of previous findings that problematic students are more likely to re-
port histories of abuse, injustice, and neglect (Regehr et al., 2001). Field
instructors may perceive such students as already disadvantaged and vul-
nerable and are understandably averse to adding to these students’ negative
interpersonal experiences. Critical feedback can reinforce a student’s neg-
ative self-image, and damage self-esteem and self-confidence (Abbot &
Lyter, 1998). To communicate that particular behaviors or attitudes do
not meet expectations of competence can be experienced by field instruc-
tors as conflicting with the value of acceptance of individual difference
and commitment to enhance each individual’s unique skills and abilities.
Hence providing direct and concrete feedback to students can represent
a challenge to field instructors’ professional self-image as caring and
accepting. A similar theme emerged in a recent study of supervisors of
psychology interns (Gizara & Forrest, 2004). Trained as therapists to be
nonjudgmental, empathic, and accepting of individual differences, super-
visors in their study found it difficult to provide critical feedback experi-
encing themselves as judgmental, confrontational, and uncomfortable with
the power and responsibility in their role.

The second value conflict involves the primacy social workers’ place
on maintaining positive relationships as the context for practice and also
the context for learning. They recognize that negative feedback can lead
to deterioration in a relationship such that progress is impeded. Numer-
ous studies identified the crucial nature of student and field instructor
relationships in promoting student learning and satisfaction in field edu-
cation (Alperin, 1998; Fortune, McCarthy, & Abramson, 2001; Knight,
2001; Raskin, 1989). The intense dyadic tutorial model is also valued by
field instructors as they experience their mentoring as contributing
to the next generation of social workers (Globerman & Bogo, 2003).
However, when negative feedback and evaluation become a regular part

112 THE CLINICAL SUPERVISOR

of supervision, a disjuncture in relationships between students and their
instructors can occur and often cannot be repaired (Bogo, 1993). This is
especially so when students do not agree with the instructors’ assessment
of their behavior or competence. Students may experience their instructors
as demanding, “too negative,” or unfair, and they may react negatively
in supervision. Field liaisons are frequently involved and a process of set-
ting learning goals and reviewing progress established. The relationship
does not end abruptly with the negative feedback but continues with in-
tensity for sometime. Field instructors who appreciate the potential of
relationships to bring about growth and change are then continuously
confronted with frayed relationships and the challenge of maintaining
a productive interpersonal climate in the face of potential conflict or
avoidance. The focus moves increasingly towards following policies
and procedures required for supporting a failing grade (Cobb & Jordan,
1989; Keorin & Miller, 1995).

Finally, the context in which the students’ behavior occurs is impor-
tant as it reflects social workers’ value on understanding individual be-
havior in relation to systemic forces. Field instructors are not neutral
when viewing social work in the host organization. Social work stu-
dents are representative of the profession of social work–particularly in
settings where social work is a secondary service (Globerman & Bogo,
2003). Students’ behavior can be experienced as a reflection of the pro-
fession and also as an extension of their field instructors. As a result,
students’ problematic behaviors may be experienced by field instruc-
tors as a source of professional and personal humiliation on the team.
Field instructors as social workers, however, are also committed to social
justice and advocacy for those who are oppressed by systemic factors.
They may be influenced by the felt responsibility to support students
and ensure that the setting itself was not the cause of or a contributor
to students’ issues. The school of social work in this study may have had
a structure that further exacerbated the sense of difficulty and conflict.
While individuals in the role of faculty field liaison provided support to
field instructors on a case by case basis, the structure of the academic
program and the priorities of the program were not seen to be consistent
with or supportive of ensuring competence in the field. There were no
school-based final over-arching assessment processes that included direct
observation and evaluation of students’ practice competence. The only
evaluation of students’ actual abilities to practice was conducted in their
particular field settings.

Bogo et al. 113

CONCLUSIONS

Schools of social work are committed to ensuring that the graduates
of their programs become professionals who are able to provide ethical,
competent, high quality service to the public. Much of the attention of
academic programs within the schools focuses on ensuring that students
understand and embrace social work values which dictate respect and
valuing of differences between individuals, focus on strengths and em-
powerment of vulnerable individuals, direct advocacy for the rights of
individuals against organizational and societal constraints, and focus
on the therapeutic alliance or relationship as a conduit for support and
change. Field evaluation processes in social work attempt to define
competency for practice, identify the observable skills and behaviors
that exemplify competency, and establish means to determine whether
students demonstrate competencies in their practice. In this context,
field instructors are expected to be impartial evaluators. What is missing
from this model of evaluation is that field instructors are committed
to the same social work values taught to students in the classroom not
only for services directed at clients, but also in relation to their students
who are in subordinate and vulnerable positions. A paradox is then
created in which the skills and behaviors required to be a good evaluator
may be at odds with the deeply held values of the social worker.

Students presenting with attitudes and behaviors inconsistent with
social work are an ongoing concern for educators. While the problems
of these students may be exhibited in a variety of contexts, it is frequently
the field practicum in which they are most evident. Field instructors are
therefore placed in the position of being gatekeepers for the profession
by providing corrective feedback to the student, providing negative
evaluations as required and failing students who are not suitable for the
profession. This role is not necessarily what field instructors envisioned
when they volunteered to provide a practicum.

This study illuminated the challenges experienced by field instruc-
tors in providing corrective feedback related to their own professional
values, the nature of the student supervisor relationship and the context
in which the instructor and student both work. Given the findings it is
imperative that schools of social work provide mechanisms for training
and support of field instructors that address these central issues in the
evaluation process. The emphasis on defining outcome criteria and de-
veloping reliable and valid standardized tools, while commendable, does
not address these crucial process issues which will ultimately limit the
value of any formal evaluation instrument (Regehr et al., 2007). Assisting

114 THE CLINICAL SUPERVISOR

field instructors in their evaluation role provides some immediate assis-
tance but does not address the overarching issue of the responsibility of
schools of social work to ensure their graduates are competent to practice.
Educational outcomes are assessed in classroom courses largely through
written products while the assessment of actual practice competence is
relegated to the field. It is essential that schools of social work take back
the responsibility for evaluation and gatekeeping that currently falls on
field instructors. New models of evaluation are needed and social work
educators might examine approaches used in related fields. For example,
assessment of educational outcomes in a range of health professions such
as nurses, pharmacists, and physiotherapists use a range of evaluation ap-
proaches beyond sole reliance on clinical instructors’ reports. The need for
new approaches to field education and the preparation of students for
practice has recently received renewed attention (Lager & Robbins, 2004;
Wayne, Bogo, & Raskin, 2006). The findings from these studies and the
challenges presented in our current gatekeeping practices reinforce the
need for change.

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Bogo et al. 117

O R I G I N A L P A P E R

Teaching the Use of Self Through the Process of Clinical
Supervision

John P. McTighe

Published online: 29 September 2010

� Springer Science+Business Media, LLC 2010

Abstract In their efforts to learn the skills involved in the

use of self, clinical social work supervisees are faced with

the daunting task of integrating information coming not

only from the patient but also from their own complex set

of responses. The clinical supervisor serves a key role in

guiding the trainee through this process. Grounded in

contemporary psychodynamic theory, this paper discusses

an approach to helping the supervisor model the use of self

in the context of the supervisory relationship. A supervi-

sory case example is used to illustrate.

Keywords Use of self � Clinical supervision �
Countertransference � Psychodynamic theory

Among the greatest challenges for the novice clinical social

worker is the process of learning to incorporate and make

sense of the myriad information that is communicated and

received throughout the course of even a single psycho-

therapy session. At a time in training when the student’s

emerging sense of professional identity is often quite

fragile (Gill 2001), the task of sorting out the internal

responses evoked by the patient from those emerging from

one’s own history, all while attempting to conceptualize

case material through the lens of one’s increasing font of

academic knowledge, can seem insurmountable. Beginning

therapists are learning to sort out the complex implications

of issues such as race, gender, and perceived socio-eco-

nomic status (both of the clinician and the patient). They

are dealing with their responses to the material that the

patient is presenting, especially when this material is

experienced as taboo or otherwise provocative (e.g. issues

of abuse). At the same time, they are learning to attend to

the many levels of conscious and unconscious communi-

cation that are occurring throughout the treatment. Making

therapeutic use of this material by means of well-conceived

and well-crafted interventions can thus seem a Herculean

task well beyond the grasp of the trainee. It falls in large

measure to the clinical supervisor to accompany the neo-

phyte therapist in the process of growth, discovery, and

integration.

Grounded in contemporary psychodynamic theory, this

paper will explore processes by which the supervisor can

assist social work supervisees in incorporating the use of

self into their practice. In addition to surveying briefly the

history of the concepts of countertransference and use of

self as well as their perceived role in therapeutic treatment

since the time of Freud, it will consider the skills that we

seek to develop in supervisees, and the role of the super-

visor as teacher and model of use of self. In particular, it

will consider ways in which the supervisor can model a

stance of non-judgmental, reflective attention to one’s

internal responses in the clinical situation, and make use of

these as a tool for understanding and intervening with

patients. Existing models for educating trainees about the

use of self will be reviewed. A detailed supervisory case

example will be used to illustrate.

Historical Perspectives on Countertransference

and the Use of Self

Beginning with Freud, much attention has been paid to the

phenomenon of countertransference and its impact on the

J. P. McTighe (&)
Department of Counseling, Health & Wellness, William

Paterson University of New Jersey, 300 Pompton Road,

Wayne, NJ 07470, USA

e-mail: [email protected]

123

Clin Soc Work J (2011) 39:301–307

DOI 10.1007/s10615-010-0304-3

clinical situation. Freud (1910) first described counter-

transference as ‘‘a result of the patient’s influence on his

[i.e. the analyst’s] unconscious feelings’’ (p. 144). Later,

Freud (1912) used the image of the telephone to describe

the nature of communication between the analyst and

analysand, encouraging the analyst to be receptive to the

patient’s transmittal of unconscious material. Thus, it fell

to the analyst to do all in his or her power to eliminate

interference with this process. The classical tradition, then,

encouraged awareness of the complex set of personal

reactions and responses to the patient known as counter-

transference with a view to decreasing its influence in the

therapeutic situation and facilitating the neutral stance of

the therapist (Edwards and Bess 1998; Jacobs 1991; Racker

1988/1957; Thompson 1988/1956).

Beginning in the 1940s a shift was noticed in the way in

which countertransference was viewed (Thompson 1988/

1956). This shift involved a reconsideration of the nature

and therapeutic value of countertransference. Increasingly,

these internal responses came to be seen as a potentially

valuable tool that the clinician might use to advance the

clinical work with the patient. In his writing, for example,

Tauber (1988/1954)) notes that an analyst may be so

concerned with avoiding the possible impingement of

countertransference that he or she may not be able to attend

fully to the contents of the material that the patient is

presenting. To remedy this, Tauber encourages the con-

servative and responsible use of the countertransference

material as long as the analyst is willing to take responsi-

bility for the effects of doing so in the treatment and not to

react with defensiveness. In this way, he suggests, issues of

resistance may be more easily worked through.

For her part, Thompson (1988/1956) adds that the ana-

lyst should be open to the patient pointing out what may be

blind spots in the analyst’s personality, and calls upon the

analyst to respond in a non-defensive manner, thus

encouraging the analyst’s naturalness and spontaneity. She

draws attention to the notion that the whole person of the

analyst and the whole person of the patient exert a mutual

influence upon each other.

In decades since, the emergence of the relational,

interpersonal, and self-psychological traditions has con-

tributed further to our understanding of the meaning and

role of countertransference in psychotherapy. In these

views, the internal experience of the therapist is seen less

as a hindrance and more as an integral part of the thera-

peutic process. This inner dynamic serves not only to help

the therapist understand the unconscious communication of

the patient, but also to craft interventions that utilize and

build upon the therapeutic relationship. It is this relation-

ship and the interface of the subjectivities of therapist and

patient that is seen as central to the helping, healing process

(Brown and Miller 2002). The whole self thus becomes the

instrument or tool of the therapist (Thompson 1988/1956).

In this view, not only is it undesirable to eliminate the

impact of the clinician’s subjectivity from treatment, it is

downright impossible (Lewis 1991). This has important

implications for the supervisory relationship as a key place

where beginning clinicians learn to make use of their self in

their work.

Cultivating the Supervisee’s Use of Self Through

Supervision

Various methods have been proposed for teaching the use

of self to students of psychotherapy. Edwards and Bess

(1998) focus their attention on the central importance of

self-awareness on the part of the therapist as a way of

integrating personal and professional selves (Reupert 2007,

2008). To this end they advocate a three-pronged approach

to the exploration of the self. First, they suggest, the

therapist must make an inventory of the self. This includes

a self-examination of personality traits that contribute to

her identity as a therapist. They encourage reflection on

questions such as what one enjoys about being a therapist

and a consideration of the role that this plays in the ther-

apeutic work. Secondly, they call for the development of

self-knowledge. This especially concerns beliefs and atti-

tudes on the part of the therapist about the nature of life’s

problems and how they are best solved. Finally, the authors

point to the need for an acceptance of risks to the self. That

is to say, therapists must remain open to self-discovery

with all the challenges that accompany it. Only in this way,

they suggest, can therapists hope to understand their

patients better.

For his part, Lewis (1991) has developed a modular

training program for therapists that includes one section

devoted the development of use of self. This module

contains various elements. Lewis begins with the consid-

eration of the impact the therapist makes upon a patient by

virtue of factors such as appearance, size, movement,

posture, office setting, among others. Furthermore, he

suggests that students will benefit from as much insight as

possible into their interpersonal style and how this impacts

others. Thirdly, growth in the use of self demands attention

to the therapist’s developing feelings (including sexual

feelings) about the patient. Finally, Lewis utilizes an

exercise in which trainees discuss and elaborate fantasies

about themselves and their patient as a way of uncovering

underlying countertransference.

Glickauf-Hughes (1997) describes a model of supervi-

sion in which supervisees are taught in both didactic and

experiential ways how to manage patients’ use of primitive

defenses such as splitting, projection and projective iden-

tification and their impact on the clinical situation. Citing

302 Clin Soc Work J (2011) 39:301–307

123

the work of Bion (1962) on containment, Glickauf-Hughes

notes that therapy provides a new opportunity for patients

to have their difficult feelings and behaviors effectively

contained thereby allowing for the possibility of an inter-

personal dynamic with the therapist that is different from

the one to which they have become accustomed. In order

for this kind of containment to occur, therapists must be

able to acknowledge, sit with, and wonder about their

experience of a range of affective states that are often

difficult to tolerate, particularly in the clinical context.

Examples of such states might include anger, shame,

incompetence, boredom, and sexual arousal.

These considerations highlight in a particular way the

issue of personal psychotherapy as an element of training

in clinical practice. Personal psychotherapy has long been

considered to be of great benefit to the developing psy-

chotherapist, not only to prevent unresolved personal issues

from adversely affecting the treatment as discussed previ-

ously, but in fact to free up areas of the therapist’s per-

sonality for greater use in the therapeutic relationship

(Thompson 1988/1956; Wolstein 1988/1959). Edwards and

Bess (1998) suggest that personal psychotherapy affords

the student the opportunity to have a therapist who may be

a model for practice, provides a first-hand understanding of

the therapeutic process, and facilitates the integration of

one’s personality with one’s professional learning. In

keeping with the perspective presented here, personal

psychotherapy can provide new clinicians with a safe space

in which to grow in comfort with the exploration of a wide

range of emotional experiences as they deepen their self-

awareness.

Still, the narcissistic vulnerability to which new thera-

pists are subject can make the practice of attending to the

many internal and external aspects of treatment seem

extremely daunting. Psychotherapy trainees of any disci-

pline who are trying on an unfamiliar role are commonly

preoccupied with issues of competence such as following

the rules, doing things correctly and well, understanding

the patient’s presenting problem, and using effective

techniques and interventions. Thus, they may find it quite

difficult to listen deeply to their internal responses in the

ways that have been suggested. An example serves to

illustrate.

Ms. K was a second year social work student placed in

an outpatient mental health clinic. Eager to learn, she

nonetheless expressed normal doubts about her ability

since she had never before conducted individual psycho-

therapy with patients. She felt full of questions on issues

ranging from the initial orchestration of the formalities of a

session to the complex work of assessment, diagnosis, and

intervention. Her supervisor, while providing needed

answers to her task-oriented questions, reassured her that

he would be there to support her, and encouraged her to be

patient with herself and to allow the process to unfold. In

this way he attempted to shore up her vulnerable sense of

self as a student and emerging professional.

As Ms. K began treating her first patients, her supervisor

noted that her process recordings were peppered with self-

recriminations about the ‘‘badness’’ of her reactions to her

patients. Statements such as, ‘‘I’m feeling like I want to

take care of the patient, and I know that is really bad,’’

were common. The supervisor asked her what she believed

was bad about her feelings. Ms. K. stated that she believed

she had to maintain a neutral and distant stance in order to

help her patients. The supervisor clarified that this belief

was grounded in a particular theoretical system and sug-

gested that her countertransference might in fact be helpful

in her work. He encouraged Ms. K to suspend judgment of

her reactions and suggested an observation of the material

that emerged both from the patient and herself, taking all of

this as information that would help her to understand her

patient better. This would serve as a framework for the

interpretation of future countertransference reactions.

Bion (1970) exhorted the analyst to come to the session

without memory, desire, or understanding. Trained in east-

ern traditions of philosophy, Bion believed that such a stance

created the condition for the possibility of openness on the

part of the therapist. If the supervisee can be encouraged to

begin from a stance of non-judgment, both of the patient and

of herself, the kind of observation and active wondering that

the use of self demands may be facilitated. Having thus

cleared away much of the static that can result from

expectable initial self-consciousness and doubt, the student

can be guided to consider and make use of her self experience

in a more integrated way with the patient and to translate this

experience into effective interventions.

The Supervisor as a Model of the Use of Self

As already noted, the task of guiding the beginning clinical

social worker in the development of the use of self falls

largely to the clinical supervisor. What, then, are the attitudes

and tasks that this requires of the supervisor? Like the novice

or experienced therapist, the supervisor may be encouraged

to follow the advice of Bion (1970) by approaching the work

of supervision without memory, desire, or understanding.

Thus, while the supervisee is being encouraged to attend not

only to the accuracy of assessment, understandings, inter-

pretations and other interventions, but also to the role of

countertransference in the weaving of the therapeutic rela-

tionship, so too must the supervisor attend not only to the

work of teaching (i.e. the transmittal of information)

and skill development, but to the impact of counter-

transference reactions on the supervisory relationship itself

(Kindler 1998).

Clin Soc Work J (2011) 39:301–307 303

123

Furthermore, several authors discuss the mutual interac-

tion or influence of the supervisor, the supervisee, and the

patient in the context of supervision. Here too, the supervisor

serves as a model for the use of self. Strean (2000), for

example, notes that attention to one’s own countertransfer-

ence with the supervisee can be useful in working through

difficulties in the student’s clinical work inasmuch as these

difficulties often get unconsciously enacted in the supervi-

sory relationship. He recommends judicious suspension of

the anonymity of the supervisor so as to facilitate the

student’s work. The student is likewise assisted in the

development of the use of self when the supervisor acts as a

model in this way. For example, Knox et al. (2008) found that

supervisors’ self-disclosure of their reactions to supervisees’

patients helped normalize supervisees’ feelings, served as a

teaching tool, and strengthened the alliance between super-

visor and supervisee.

In her method of teaching students to deal with patients’

use of primitive defenses, Glickauf-Hughes (1997) notes

that due to their primitive nature and the complexity of

dealing with them, such defenses may be enacted by

students in the supervisory relationship. This may serve as

an unconscious way of communicating to the supervisor

what is happening in the treatment (Bromberg 1982).

Furthermore, this parallel process offers the supervisee the

opportunity to experience the containment of these difficult

dynamics by the supervisor. Other examples of students’

manifestation of their efforts to manage patient’s primitive

defenses might include rejecting the supervisor’s attempts

to help, feeling dejected because of a patient’s devaluation

of them, expressing intense anger towards the patient, and

wishing to terminate the therapy precipitously. Glickauf-

Hughes recommends a variety of techniques for dealing

with this including various combinations of teaching,

clarification, modeling, and role playing.

Kindler (1998) discusses supervision from a self-psy-

chological perspective. Borrowing from Fosshage’s (1995)

thinking regarding the analyst’s experience of listening

from a variety of positions, Kindler applies this construct to

the supervisory relationship. In addition to her stance as

supervisor, she may also take the position of the supervisee

as well as the patient. Furthermore, the supervisor may

listen from the perspective of empathy (e.g. from the

patient’s perspective) or from an other-centered perspec-

tive (e.g. as someone in relationship to the patient). By

taking this stance, the supervisor may more effectively

listen and understand not only the patient’s internal pro-

cess, but the dynamic process between the supervisee and

the patient. This facilitates not only the treatment but the

development of the supervisee as well. Confirmation of this

development may be seen in the supervisee’s increased

capacity for self-righting, the expansion of self-awareness,

and symbolic reorganization.

Kindler goes on to emphasize the importance of the

supervisor’s empathic listening to the supervisee, even if

this seems to preempt the discussion of patient material.

This activity is viewed as not only modeling the process of

self-psychologically-oriented treatment, but also serving

self-cohesion and vitality functions for the supervisee thus

enabling her to focus more adeptly on the subjectivity of

the patient. Likewise, consistent with a self-psychological

orientation, he recommends a close and non-defensive

attention to the supervisee’s experience of the supervisor to

promote feelings of safety and the growth of the supervi-

sory relationship.

From a related school of thought, Brown and Miller

(2002) add an intersubjective nuance to the discussion by

viewing the supervisory process as a triadic intersubjective

matrix. While akin to Fosshage’s (1995) notion of multiple

perspectives, Brown and Miller see the supervisory rela-

tionship as the ‘‘point of interaction’’ (p. 814) of three

unconscious processes. By viewing the supervisory expe-

rience as a ‘‘space for listening’’ the authors seek to attend

to the unconscious communication between supervisor,

supervisee, and patient. Such a perspective does not come

without its perils, according to the authors. Attending to the

confluence of unconscious processes in this way runs the

risk of blurring the line between supervision and the

supervisee’s personal treatment—a hazard not uncom-

monly encountered in the supervisory relationship. Like-

wise, supervision in this vein depends upon the willingness

of both supervisor and supervisee to foster an atmosphere

of self-disclosure in which material such as dreams as well

as their personal reactions in the process are laid bare. The

authors acknowledge that this may be difficult especially

for the beginning student who is in a more vulnerable

position.

Calling upon Mitchell’s (1998) notion of the relational

matrix, Ganzer (2007) applies a relational perspective to

the structure of supervision. She states that a relationally

oriented supervision is built not on the hierarchical stance

of the supervisor vis a vis the supervisee, but on the mutual

influence of the supervisor, the supervisee and the patient.

This relational matrix, she suggests, is constructed from the

intrapsychic, interpersonal, environmental, and organiza-

tional characteristics of all those involved.

Clinical Example

Ms. K brought the case of Victoria to supervision. Ms. K

had begun treatment with Victoria approximately 4 weeks

earlier. A single woman in her early twenties, Victoria was

accompanied to the clinic by her mother and the two began

to describe issues of poor self-esteem, a history of learning

difficulties, social awkwardness, irritability, and loneliness.

304 Clin Soc Work J (2011) 39:301–307

123

Her mother reported frustration with Victoria, stating that

she just wanted her to get married, and stop being such a

problem. Significantly overweight, Victoria reported a

great deal of self-consciousness about her appearance and

detailed her envy of her reportedly beautiful and popular

sisters. She had never been in a romantic relationship, and

though she longed for this experience she stated that she

did not know how she would ever find a man who would

love her. She stated that she felt verbally abused by her

father and brother who called her names and related trau-

matic incidents of verbal abuse by teachers when she was

in grade school. She noted that these experiences continued

to disturb her.

Though Victoria stated that she wanted therapy, Ms. K

reported that she experienced her as apathetic and com-

plaining during the sessions and wondered what to make of

this. Ms. K went on to explore further with her supervisor

an incident with Victoria that had occurred the day before

supervision. Victoria had arrived for her session over two

hours late. When Ms. K was informed by the receptionist

that Victoria had arrived she was surprised, having sup-

posed that Victoria would not come at all. She informed the

secretary that she would be down shortly to speak with

Victoria. Ms. K came to the supervisor’s office for advice

on how to proceed. While she had availability in her

schedule she did not know if she should see Victoria. She

stated that she had learned in Social Work Practice class to

reinforce the importance of coming on time to session, and

she was concerned about the possibility of encouraging the

behavior of arriving late. While acknowledging this,

the supervisor reminded Ms. K that it was still unclear

why Victoria had come late. Together they decided that,

when she went to speak with Victoria, Ms. K would inquire

about the reason for the lateness and assess whether or not

Victoria was in any kind of crisis. If Victoria was in crisis,

she would be seen. If she simply had not come on time,

Ms. K would reschedule the session.

Ms. K told the supervisor that when she went down-

stairs, she greeted Victoria in a friendly manner. She noted

that Victoria did not appear to be in any distress. Ms. K

called Victoria to the side and quietly noted that she was

two hours late for her appointment. Ms. K asked Victoria if

she was alright and assessed her for any sign of crisis.

When Victoria stated that everything was fine Ms. K told

her that they would need to reschedule the appointment. At

that, Victoria began to yell loudly at Ms. K, asking her why

she hadn’t said so in the first place. Ms. K felt confused and

asked what Victoria meant. Victoria responded in the same

loud tone that Ms. K should have just told the secretary that

she was not going to see her instead of making her sit there

and wait. When Ms. K replied that she wanted to come

down and speak with Victoria personally, Victoria yelled

that all Ms. K was doing was wasting Victoria’s time. With

that she stormed out of the clinic as other patients looked

on from a nearby waiting area. No follow up appointment

was made. Ms. K stated that she was unsure what to do

next.

When the supervisor asked Ms. K how she felt about what

had transpired she reported confusion and anger. The con-

fusion, she said, related to her sense that Victoria’s outburst

had come out of nowhere. The anger related to her embar-

rassment at having been yelled at in view of the receptionist

and patients in the waiting room. Furthermore, she admitted

that, in her anger, she felt ‘‘turned off’’ to the idea of working

with Victoria and somewhat pleased at the prospect of not

seeing her again. The supervisor validated Ms. K’s reactions

both verbally and non-verbally, empathizing with both how

confusing and embarrassing it must have been for her. He

then asked Ms. K if she felt able to sit with those feelings and

her memory of the interaction. Perhaps she and the super-

visor could wonder about this together. What else did she

think and feel about her exchange with Victoria? What else

might have been going on?

As she processed her experience with the supervisor,

Ms. K stated that it seemed like Victoria was telling her she

was a bad therapist and was therefore rejecting her by

storming out of the clinic. She spoke about feeling

embarrassed and thought that she had perhaps not handled

the situation well. Maybe this was why Victoria was

leaving treatment. For his part, the supervisor was aware of

having another feeling about the interaction between Ms. K

and Victoria. He shared with Ms. K his sense of irritation.

Victoria seemed not to have taken into account the value of

Ms. K’s time, he said, but then proceeded to accuse Ms. K

of wasting her time. This led Ms. K to identify more with

her own sense of irritation, which she had initially named

but then abandoned to focus on her sense of embarrassment

and inadequacy. The supervisor interpreted these latter

feelings as understandable and likely related to her inse-

curity as a beginner, and added that they may in fact cloud

some of her deeper reactions. The supervisor further noted

that, if properly contained and dealt with, difficult count-

ertransferential reactions, like irritation, can sometimes be

a great source of insight and can open new pathways for

therapeutic progress.

As they continued the supervisory session, the supervi-

sor encouraged Ms. K to sit with and be curious about her

own sense of irritation or annoyance. This led Ms. K to

make a number of associations to Victoria’s mother and to

descriptions of the dynamics between the two as well as

to Victoria’s home life in general. The supervisor asked

Ms. K to describe these. What emerged was a pattern of

unstable, shifting affects in Victoria’s relationships that

evoked in her the very sense of emptiness and inadequacy

she sought to remedy through therapy. As the supervisory

dialogue continued, and the supervisor further modeled a

Clin Soc Work J (2011) 39:301–307 305

123

wondering stance, Ms. K grew more comfortable articu-

lating and exploring her feelings and associations to what

transpired with Victoria the day before. Having shared his

sense of irritation, the supervisor facilitated Ms. K’s

identification and acceptance of her own anger, as well as

her desire to end her therapeutic relationship with Victo-

ria—not an easy thing for a new supervisee to admit to her

supervisor.

However, this in turn helped Ms. K identify on an

experiential as well as intellectual level a pattern whereby

Victoria thwarted the development of healthy relationships.

The supervisor encouraged Ms. K to think more deeply

about the origins and implications of this pattern. Ms. K

began to see that this aspect of Victoria’s interpersonal

behavior was born of repeated experiences of traumatic

rejection that led to a narcissistically depleted self. In a

self-protective but interpersonally frustrating way, Victoria

evoked the very rejection she feared. However, she did so

in such a manner as to walk away with some sense of

control. At this point Ms. K said she was aware of expe-

riencing even more empathy for Victoria and felt free to

reach out genuinely to Victoria while allowing her the

freedom to leave treatment if she chose to. With a mini-

mum of effort, Ms. K was able to reconnect with Victoria

and her treatment continued. Ms. K’s increased under-

standing of and empathy for Victoria helped her not only to

facilitate the repair of their relationship but to form a strong

working alliance with her. Together, they began to examine

the dynamics of Victoria’s relationships and how they

could be improved.

This clinical and supervisory experience helped Ms. K

to grow in a number of ways. On a procedural level, she

gained a clearer understanding of the way in which patient

lateness was handled in the mental health clinic to which

she was assigned. Furthermore, she benefitted from the

experience of working through a conflictual encounter with

her patient. Perhaps most significantly, however, she grew

in her ability to explore her affective response to her

patient and to wonder about the nature and meaning of that

response. Further development of this skill will contribute

to her growing confidence and effectiveness as a clinician.

Conclusion

The development of the use of self demands cooperative

effort on the part of both the social work supervisee and the

clinical supervisor. For the supervisee, this means the fos-

tering of self-awareness with its attendant risks, the will-

ingness to explore countertransferential experiences on all

levels, the capacity for insight, and the ability to tolerate

uncertainty and to suspend judgment both of the self and the

patient in order to listen with evenly suspended attention. For

the supervisor, this means the ability to model self-awareness

and the vulnerability that comes with the appropriate sharing

of one’s feelings and thoughts, and the ability to listen

carefully and non-judgmentally not only to one’s own

countertransference, but to the experiences of the patient and

supervisee alike. Having assisted the supervisee in the

identification and exploration of his or her experience of the

patient, the supervisor is then able to help the supervisee

translate that insight into clinically useful interventions that

will advance the treatment. In this way, the supervisor is in a

unique position to assist in the integration of the new clini-

cian’s personal and professional identities, and the honing of

the finest of therapeutic instruments—the supervisee’s very

self.

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Author Biography

John P. McTighe is Associate Director of Counseling, Health &
Wellness at William Paterson University. He holds a M.S.W. and

Ph.D. in Clinical Social Work from New York University. He is an

adjunct assistant professor of Pastoral Counseling at Fordham

University and maintains a private practice in northern New Jersey.

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  • c.10615_2010_Article_304.pdf
    • Teaching the Use of Self Through the Process of Clinical Supervision
      • Abstract
      • Historical Perspectives on Countertransference and the Use of Self
      • Cultivating the Supervisee’s Use of Self Through Supervision
      • The Supervisor as a Model of the Use of Self
      • Clinical Example
      • Conclusion
      • References