Presentation on theme: "Attachment and supervision - giving difficult feedback"— Presentation transcript:
1Attachment and supervision - giving difficult feedback Nadja Krohnert
2This presentation draws on the presentation given at the Group of Trainers in Clinical Psychology conference in 2013 called ‘Challenges to the supervisory relationship: What is our role as trainers?’ by Jenny Davies, Clinical Tutor, Lancaster & Ruth Butterworth, Academic Tutor, Birmingham
3“Through a positive reciprocal relationship What is Attachment?“Through a positive reciprocal relationshipchildren learn to modulate affect, soothe themselves and relate to others. Attachment is the basefrom which they explore. Their early attachments form their concepts of self, others and the world”(Bowlby, 1951)
4What is Attachment?Bowlby asserts that people have evolved a predispositions to form and maintain strong bonds with individuals on whom they can rely on for protection and a sense of security in times of need, and that attachment experiences continue from ‘the cradle to the grave’ ,(Bowlby, 1977, p203)Tie based on need for safetyUniversal phenomenonBased on biological instinctRelevant across the lifespan
5The Dance of Attachment Babies indicate their needs using ‘attachment behaviours’ (crying, smiling, clinging etc) to ensure protection, comfort, survivalCaregivers respond in different waysBabies find behaviours that increase positive and decrease negative responses in caregiversBased on these attachment-caregiver interactions, babies develops an ‘internal working model’ of self / others / the world
6Example where there is attunement .. Baby has needsBaby criesNeeds met by caregiverTrust develops
7Group exercise: Internal Working Models and Supervision If an infant’s carer responds:by consistently rejecting the childby consistently and sensitively, meeting the child’s needInconsistentlyabusivelyWhat beliefs will they develop about themselves?What beliefs will they develop about other people and the world?What will they learn to do (behaviour)?Forward 25 years or soHow might this look in supervision?What feelings might this elicit in a supervisor?
9Secure (B) Dismissive (A) Fearful (D) Preoccupied (C) It is easy for me to become emotionally close to others. I am comfortable depending on others and having others depend on me. I don't worry about being alone or having others not accept me.(sensitive secure ….)Dismissive (A)I am comfortable without close emotional relationships. It is very important to me to feel independent and self-sufficient, and I prefer not to depend on others or have others depend on me.(rejecting avoidant ….)Preoccupied (C)I want to be completely emotionally intimate with others, but I often find that others are reluctant to get as close as I would like. I am uncomfortable being without close relationships, but I sometimes worry that others don't value me as much as I value them.(inconsistent ambivalent ….)Fearful (D)I am uncomfortable getting close to others. I want emotionally close relationships, but I find it difficult to trust others completely, or to depend on them. I worry that I will be hurt if I allow myself to become too close to others.(chaotic / abusive fearful ….)Bartholomew & Horowitz (1991)
11Compulsivity – common patterns Compulsive care-giving (commonly an ‘A’ strategy)Unwillingness to accept help from others, while simultaneously taking on a care-giving role and prioritising others’ needsCompulsive self-reliance (A)Extreme form of avoidant attachment characterised by excessive self- sufficiency, distancing, mistrust and fear of dependency on othersCompulsive care-seeking (C)Excessive care seeking and undue reliance on attachment figures for care and assistance(Bowlby, / Pistole & Watkins, 1995)
12Attachment and Clinical Psychology Broadly when measures of ‘attachment styles’ are used the patterns of clinical psychologists are comparable to the wider populationIn a study trainees self-identified themselves - 53% secure, 28% preocupied, 10% fearful, 3% dismissive (Dickson et al, 2010)Compulsive care-giving is the most common ‘compulsive’ strategy and is unrelated to ‘attachment styles’ (Leiper & Casares, 2000)Compulsive self-reliance is the strategy most strongly associated with a poor working alliance in supervisory alliances (Dickson et al, 2010)
13In context: Attachment and supervision Human beings have an evolved predisposition to form and maintain strong affectional bonds with individuals on whom they can rely for protection and a sense of security in times of need (Bowlby, 1977)The challenges of the supervisory (and training) process may activate the attachment system for a new supervisee, who may in turn seek the closeness and safe haven of the supervisor for support and guidance (Bennett, 2008)
14Supervision aims …..To provide a professionally secure and reliable base from which individual trainees can explore and develop their professional identity and skillsIn doing so, to provide a model on which trainees can base the provision of a secure environment for their clientsPistole & Watkins (1995)
16But - there’s an alternative definition ….. ‘An intervention that is provided by a senior member of the profession to a junior member or members of that same profession. This relationship is evaluative, extends over time, and has the simultaneous purposes of enhancing the professional functioningof the junior member(s), monitoring thequality of professional services to theclients that he, she or they see, andserving as a gatekeeper for those whoare to enter the particular profession’(Bernard and Goodyear, 1998)
17‘The secure trainee’Connections have been shown between secure attachment and:Self–reflectionMeta-cognitive processingEmpathyRecognising the inherent subjectivity of perceptionsConnections have also been shown between the ability to empathise and to think criticallyBennett & Deal (2009)
18Surprise: supervision is a dyadic process! Relationship-specific attachment is a stronger predictor of supervisory alliance than general attachment styleFor exampleThe Supervisee may generally use ‘secure’ strategies but becomes distant with a supervisor who is perceived as unsupportiveThe Supervisor may not offer a high level of support due to their general attachment ‘style’ (e.g. ‘dismissive’), or because of interactive or wider systemic factors (e.g. pressured by the time of service issues)If one partner in the relationship is generally secure, they may be better able to tolerate the insecurity of the otherBennett (2008)
19The supervisory challenge … If the idea of attunement and consistency is key to healthy attachment styles – how can we …..Start noticing our own and our trainees stylesAdapt our supervisor style to help meet the needs of the trainee.
20For trainees employing an ‘A strategy’ -rejecting avoidant dismissive - Compulsive self-reliance Expressed needsHidden needsAutonomyKeeping the supervisor at arm’s lengthAvoid thinking about their own feelings / experience‘I know better than you’ Supervisee as caregiverPraiseReassurancePermission / encouragement to explore anxietyPermission / encouragement to accept supportStart to integrate feelings into primarily cognitive narrativeCompulsive self-reliance (A)Extreme form of avoidant attachment characterised by excessive self- sufficiency, distancing, mistrust and fear of dependency on othersCompulsive care-seeking (C
21For trainees employing an ‘C strategy’ inconsistent ambivalent preoccupied Compulsive care-seekingExpressed needsHidden needsReassurancePraiseRescue – supervisor being there whenever neededSupport to explore and regulate feelingsStructureEncouraging autonomy and problem solvingCelebrating independence / achievement of specific goalsSupport to introduce cognition / coherence into predominantly affective narrative
22Exercise 1 – supervisor giving feedback Observe dvd and reflect on:How the clip makes you feelHow you think the supervisee is feelingHow you think the supervisor is feeling
23Points following discussion of dvd….. Dan Hugh’s work can provide a helpful framework for thinking about the attachment framework as something nurturing while also needing to set boundaries.Beginning supervision with a helpful check in ‘How am I: how are you: how are we’ can help keep reflection on the quality of the supervisory relationship core to the task. It also help to level power imbalances.Does the literature on ‘delivering bad news’ have anything to tell us about difficult feedback?(unfortunately we ran out of time …. It was generally acknowledged that lots more ideas could have been explored).
24In Summary: Overarching goals for supervision... Create a secure base from which to exploreProvide a ‘safe haven’ and allow the trainee the experience of emotional attunementRemain open and curious - attempt to respond to both expressed and hidden needsUse our own supervision to reflect on what is happening for us in terms of attachment
25Discussion and What are you taking away from this session?
26ReferencesBennett, C.S. (2008). Attachment-informed supervision for social work field education. Clinical Social Work Journal, 36,Bennett, S. & Deal, K.H. (2009). Beginnings and endings in social work supervision: The interaction between attachment and developmental processes. Journal of Teaching in Social Work, 29,Bowlby, J. (1977a). The making and breaking of affectional bonds I. Aetiology and psychopathology in the light of attachment theory. British Journal of Psychiatry, 130,Dickson, J.M., Moberley, N.J., Marshall, Y. & Reilly, J. (2010). Attachment style and its relationship to working alliance in the supervision of British Clinical Psychology trainees. Clinical Psychology and Psychotherapy, DOI: 10/1002/cpp.715
27References continued ..Leiper, R. & Casares, P. (2000). An investigation of the attachment organization of clinical psyhcologists and its relationship to clinical practice. British Journal of Medical Psychology, 73,Pistole, M.C. & Watkins, C.E. (1995). Attachment theory, counseling process, and supervision. The Counselling Psychologist, 23(3),Slade, A.(2008). The Implications of Attachment Theory and Research for Adult Psychotherapy. . In Cassidy, J. & Shaver, P. (Eds) Handbook of attachment: Theory, research, and clinical applications. New York: Guilford Press.Thompson, R. (2008). Early attachment and later development: Familiar questions, new answers. In Cassidy, J. & Shaver, P. (Eds) Handbook of attachment: Theory, research, and clinical applications. New York: Guilford Press.