An Extensive Outcome of a New Approach to Supervision

AN EXTENSIVE OUTCOME OF A NEW APPROACH TO SUPERVISION:

A RESEARCH STUDY DERIVED FROM SUPERVISION PROTOCOLS' OF STUDENTS' PSYCHOTHERAPEUTIC AND PSYCHOMETRIC ACTIVITIES

I.K. Tsegos, V. Karayanni, N. Karapostoli, E. Morarou

Open Psychotherapy Centre, Institute of Group Analysis (Athens)

ABSTRACT : The «Greek Model of Supervision» developed by the Institute of Group Analysis (Athens). In the first phase (Analysis) the "students-supervisors" along with the "trainer-observer" write down on the supervision protocol their emotions-feelings, fantasies and perceived topics during the presentation of a therapy session by another student. The network of interactions promotes the emergence of multiple mirror phenomena, the exploration of which during the discussion phase (Synthesis) promotes greatly the formation of the students' identity as group psychotherapists and the working through of many therapeutic difficulties. This model has been used quite extensively for 22 years in supervising several kinds of groups. The second part of the presentation provides the preliminary results of an ongoing research study, based on the quantitative and qualitative analysis of 225 Supervision Protocols of multiple supervised activities (ie.group-analytic, sociotherapeutic, dyadic meetings,family-couple therapy, psychological assessment).

Introduction

In every psychotherapy training the importance of supervision is indisputable, as it constitutes a main source of knowledge, especially for the new trainees who are confronted during their clinical experience with a plethora of theoretical and experiential stimuli which increase their anxiety, confusion and fear. So, it seems rather strange the fact that there is a lack of research evidence concerning the different models of supervision (dyadic/groupal) or the ways through which a better combination between theory and practice would be succeeded for the trainees.

The present research concerns an original model, the Greek Model of Supervision or the Group Analytic Model, as it is constructed by the first author and is applied in the Institute of Group Analysis (Athens) since 1983, and the three Training Institutes of the Open Psychotherapy Centre. The corresponding training programs include personal therapy, theory, clinical practice, communal activities and supervision. The whole supervisory process takes place as following (Tsegos, 1995, 2002).

The Supervising Group: it is a group in its own right, with a fixed time and place of meeting. It meets for 2 hours, once a week, during the year and is conducted by one of the students, while a trainer is present only as an experienced observer.

The supervisory process

During the Presentation stage, a therapeutic activity is presented, with the student reading out his or her notes and marking group exchanges on the blackboard. The supervising group sits in a semi-circle infront of the blackboard and is expected to take an active part in the second stage of supervision. This is the Analysis, which follows the Presentation Stage. During the Analysis each of the supervisor-students, follows the presentation procedure and records on a special format, the Supervision Protocol, the following:

• His or her emotions-feelings during or after the Presentation,
• His or her fantasies (images that passed through the mind during the presentation),
• What are perceived as the main themes or topics of the presented group.

After the presentation, each of the students reads out his/her notes. All this material is written out on the blackboard.

The final stage is the Synthesis in which participate all the group members, including the experienced observer and they try to connect the material presented with that produced in the supervising group, as now seen on the blackboard. After all this, there may be some suggestions concerning the technique or the way that the therapist or therapists made their interventions. The whole procedure can be clarified further by examining the Supervision Protocol itself.

Methodology

The lack of relevant studies concerning group supervision in the existing bibliography, obliged us to formulate a methodology which was designed on the basis of using our data in the most valid way.

1. Record of the data, derives from the archives of the supervision protocols of all supervised activities, dyadic or groupal, of the last decade (1992-2002), as the model had been established and the participants had been familiarised with the process. During this extended period there was a variety of supervisory groups as there was a different synthesis of trainees and observers and the sample which was recorded was the following:

2. Sample of the Study

The total number of the Supervision Protocols was 225, corresponding to 1027 different entries of supervising students .

• 44 protocols of Group-Analytic Groups
• 44 protocols of the Therapeutic Communities Groups (activity/sociotherapy groups, i.e. art therapy, play therapy, dance therapy e.t.c.)
• 18 protocols of Group-Analytic Psychodrama Groups
• 25 protocols of Couple Therapy Sessions
• 17 protocols of Counselling Sessions for Parents
• 14 protocols of Family Therapy Sessions
• 20 protocols of Psychological Assessment (stages of the psychological assessment: record of the individual's personal data, history, information and clarification regarding the procedure, responses to the tests, M.M.P.I., Rorchach, T.A.T., Rotter, e.t.c.)
• 12 protocols of Dyadic Psychotherapy
• 31 protocols of the Informative Dyadic Meetings before entering the Therapeutic Community as a member

3. Categorization of the Data

The entry and analysis of the data was divided in three categories: the first one was concerning Emotions-Feelings, the second Fantasies and the third one Themes and Topics.

There was a great difficulty in categorising EMOTIONS-FEELINGS and their qualitative classification, due to:

• entries which purely describe an emotional state (i.e. anger, pleasure, sorrow)
• entries which describe the perception of an event in the supervised activity, on behalf of the participants (i.e. relief, tension)
• entries which describe a somatic reaction of the participants (i.e. headache, exhaustion)
• entries which describe an event by interpreting it (instead of writing about a fight, the student mentions it as a competition)
• entries which describe a condition (i.e. perplexity, interest)

Given the great number and variety of emotions-feelings, we decided to apply the following categorisation:

1) Positive Emotions-Feelings (i.e pleasure, familiarity, joy e.t.c.)

2) Negative Emotions-Feelings (i.e. agony, anxiety, sorrow e.t.c.)

3) Indeterminable Emotions-Feelings (i.e. surprise, query, astonishment e.t.c.)

The second category which concerned FANTASIES (i.e. images that passed through the mind during the presentation), was classified according to:

• Positive Fantasies (i.e. children playing happily in the school yard), Negative (i.e. a monster is threatening a young couple), Indeterminable ( a small boat sailing in the winter)
• eleven subcategories are related with the content of the fantasy ( people relating, people alone, art, animals e.t.c.).

The third category which was MAIN THEMES AND TOPICS ( i.e. the specific themes and topics which are presented and discussed in the activity) was classified according to:

• the number of entries for each protocol
• the number of resembling entries for each protocol

In order to make the correlation, we have recorded all the collected data per each session's protocol (N=225). Each protocol contains the data (emotions-feelings, fantasies and themes/topics) which are completed by ALL the participants, trainees and observer, who were present in the supervision group (n=1027). (S.P.S.S. 11)

RESULTS

1: Mean of Emotions-Feelings according to each Type of the Supervised Therapeutic Activity (N=225)

The mean of Emotions-Feelings according to the type of the supervised activity fluctuates between 18,9 and 29,2. The higher score is observed in the protocols of Therapeutic Communities Groups (29,2) and the lower in the protocols of Counselling for Parents (18,9).

2: Mean of Fantasies according to each Type of the Supervised Therapeutic Activity (N=225)

The mean of Fantasies according to the type of the supervised activity fluctuates between 4,9 and 6,9. The higher score is observed in the protocols of Psychological Assessment (6,9) and the lower score in the protocols of Counselling for Parents (4,9).

3: Mean of Main Themes and Topics according to each Type of the Supervised Therapeutic Activity (N=225)

The mean number of Themes and Topics according to the type of the supervised activity fluctuates between 11,9 and 15,6. The higher score is observed in the protocols of Family Therapy (15,6) and the lower in the protocols of Counselling for Parents and the Infromative Dyadic Meetings for the T.C.(11,9).

4: Μean of the Positive / Negative / Indeterminable Emotions-Feelings according to each Type of the Supervised Therapeutic Activity (N=225)

Positive Emotions-Feelings: The higher score is observed in the protocols of Therapeutic Communities Groups (14,2) and Group-Analytic Psychodrama (13,3) and the lower score in the protocols of Family Therapy (5,8) and Couple Therapy (6,8).

Negative Emotions-Feelings: The higher score is observed in the protocols of Family Therap (14,5), Psychological Assessment (13,8) and Dyadic Psychotherapy (12,4) and the lower in the protocols of Group Analysis (8,5), Counselling for Parents (8,1), Group-Analytic Psychodrama (7,9) and the Informative Dyadic Meetings for the T.C. (7).

Indeterminable Emotions-Feelings: there is not any significant deviation and the score fluctuates between 2,7 and 5 for all supervised activities.

5: Μean of the Positive / Negative / Indeterminable Fantasies according to each Type of the Supervised Therapeutic Activity (N=225)

Positive Fantasies: The higher score is observed in the protocols of Therapeutic Communities Groups (2,3) and Group-Analytic Psychodrama (2,3) and the lower in the Protocols of Family Therapy (0,5) and Dyadic Psychotherapy (0,6).

Negative Fantasies: The higher score is observed in the protocols of Family Therapy (4,8) and Psychological Assessment (4,3) and the lower in the protocols of Group Analysis (2) and the Informative Dyadic Meetings for the T.C. (1,7).

Indeterminable Fantasies: there is not any significant deviation and the score fluctuates between 1,4 and 2,1 for all supervised activities.

DISCUSSION

Though the supervising population is mixed as the participating students (supervisors) derive from all four Institutes (i.e. Group Analysis, Diagnostic Psychology, Psychodrama-Sociotherapy, Family Therapy), the findings indicate considerable differences in each thepapeutic activity per se. It seems that the supervising group echoes and mirrors each therapeutic activity correspondingly.

In summary the main findings are:

• The highest mean of positive Emotions-Feelings occurs in:

- Therapeutic Communities Groups

- Group Analytic Psychodrama

- Informative Dyadic Meeting for the T.C.

• The highest mean of positive Fantasies occurs in:

- Group Analytic Psychodrama

- Therapeutic Communities Groups

• The highest mean of negative Emotions-Feelings occurs in:

- Family Therapy

- Psychological Assessment

- Couples' Therapy

- Dyadic Psychotherapy

• The highest mean of negative Fantasies occurs in:

- Family Therapy

- Psychological Assessment

- Dyadic Psychotherapy

- Couples’ Therapy

• It seems that while most groupal activities present the highest mean of positive Emotions-Feelings and Fantasies, on the other hand the
• Dyadic activities such as Psychological Assessment, Dyadic Psychotherapy and also Family Therapy and Couples' Therapy (though the last two ones are somehow groupal), present the highest mean of negative Emotions-Feelings and also negative Fantasies.
• The most frequent Emotion-Feeling for all the supervised activities is interest.
• All the supervised activities present almost the same mean of Themes and Topics, with a small deviation.

In conclusion, the tendencies which appear in the supervisory protocols of the different therapeutic activities, both quantitative and qualitative, are common. Since this occurs regardless of the synthesis of the supervising group, we presume that the group reactions are mainly related with the supervised activity. Therefore, any critical observations regarding group supervision (i.e. development of group phenomena that prevent or distort the supervisory process), do not seem to stand valid as concerns the group-analytic model of supervision.

Of course, we do not ignore the existence of other dynamic factors which are related with the developed relationships among the participants of the supervisory group and they may influence the supervisory process. And because these factors may prevent and complicate the supervisory group process the "safety valve" of the group-analytic model for such phenomena is to "close the circle", that is to leave for the moment its supervising task and being occupied with issues relating to itself and to the relations among its members.

Though the above findings are important in relation to the study of the specific model of supervision, however it is necessary to clarify that they are not connected with any therapeutic outcome. The fact that certain therapeutic activities cause more positive or negative reactions to the supervising group, does not mean that they are more or less therapeutic. On the contrary, it is the different character of these activities which is distinguised, a fact which may constitute the motive for future interesting research studies.

REFERENCES

Abercrombie, M.L.J. 1983. "The Application of Some Principles of Group Analytic Psychotherapy to Higher Education". In M. Pines (ed.), The Evolution of Group Analysis. London: Routledge and Kegan Paul.

Foulkes, S.H. 1975. Group Analytic Psychotherapy. Method and Principles. London: Gordon and Breach. Reprinted London: Karnac, 1986.

Grotjahn, M. 1987. My Favourite Patient: The Memoirs of a Psychoanalyst. Frankfurt: Peter Lang, p. 129.

Kakouri, A. and Tsegos, I.K. 1993. "Boundaries and Barriers in Peer Supervision". Proceedings of the 9th European Symposium in Group Analysis, Heidelberg.

Kouneli, E., Tsegos, I.K. and Karaolidou, M. 1992. "The Group-Analytic Supervision: the Significance of the Peer Group in the Supervision of Psychotherapy Trainees". Paper presented at the 4th Panhellenic Conference in Psychogy, Athens, 16-19 April.

Tsegos, I.K. 1993. "Strength, Power and Group Analysis". Group Analysis, Vol. 26 (2), pp. 131-137.

Tsegos, I.K. 1995. "A Greek Model of Supervision. The Matrix as Supervisor-A Version of Peer Supervision Developed at I.G.A. (Athens)". In M. Sharpe (ed.), The Third Eye: Supervision of Analytic Groups, pp. 117-129. London: Routledge.

Tsegos, I.K. 2002. The Disguises of the Psychotherapist. Athens: Stigmi.

I.K. Tsegos, M.D. Psychiatrist, Group Analyst, Director of the Training and Research Department of the Open Psychotherapy Centre.

V. Karayanni, Psychologist, Group Analyst.

N. Karapostoli, Occupational Therapist, Sociotherapist-Psychodramatist, Family Therapist.

E. Morarou, P.S.W., Group Analyst, Sociotherapist-Psychodramatist, Family Therapist.

Address: Open Psychotherapy Centre, Training & Research Department, Haralambi 1 & Mavromihali, 114 72 Athens, Greece. 

Τὸ ἀνωτέρω κείμενο ἀποτελεῖ ἀνατύπωση (χωρὶς τοὺς πίνακες) τοῦ ἄρθρου  :

Tsegos, I.K., Karayanni, V., Karapostoli, N., Morarou, E., 2004. " An Extensive Outcome of a New Research to Supervision: A research Study Derived from Supervision Protocols of Students' Psychotherapeutic and Psychometric Activities". The European Journal of Psychiatry, Vol.18, p.61-70.