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Attachment and supervision - giving difficult feedback

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1 Attachment and supervision - giving difficult feedback
Nadja Krohnert

2 This 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 relationship children learn to modulate affect, soothe themselves and relate to others. Attachment is the base from which they explore. Their early attachments form their concepts of self, others and the world” (Bowlby, 1951)

4 What 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 safety Universal phenomenon Based on biological instinct Relevant across the lifespan

5 The Dance of Attachment
Babies indicate their needs using ‘attachment behaviours’ (crying, smiling, clinging etc) to ensure protection, comfort, survival Caregivers respond in different ways Babies find behaviours that increase positive and decrease negative responses in caregivers Based on these attachment-caregiver interactions, babies develops an ‘internal working model’ of self / others / the world

6 Example where there is attunement ..
Baby has needs Baby cries Needs met by caregiver Trust develops

7 Group exercise: Internal Working Models and Supervision
If an infant’s carer responds: by consistently rejecting the child by consistently and sensitively, meeting the child’s need Inconsistently abusively What 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 so How might this look in supervision? What feelings might this elicit in a supervisor?

8 ‘Attachment styles’ Parent/Carer Infant Adult A Rejecting Avoidant
Dismissive B Sensitive Secure C Inconsistent Ambivalent Preoccupied D Chaotic / abusive Disorganised Fearful

9 Secure (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)


11 Compulsivity – 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’ needs Compulsive self-reliance (A) Extreme form of avoidant attachment characterised by excessive self- sufficiency, distancing, mistrust and fear of dependency on others Compulsive care-seeking (C) Excessive care seeking and undue reliance on attachment figures for care and assistance (Bowlby, / Pistole & Watkins, 1995)

12 Attachment and Clinical Psychology
Broadly when measures of ‘attachment styles’ are used the patterns of clinical psychologists are comparable to the wider population In 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)

13 In 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)

14 Supervision aims ….. To provide a professionally secure and reliable base from which individual trainees can explore and develop their professional identity and skills In doing so, to provide a model on which trainees can base the provision of a secure environment for their clients Pistole & Watkins (1995)


16 But - 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 functioning of the junior member(s), monitoring the quality of professional services to the clients that he, she or they see, and serving as a gatekeeper for those who are to enter the particular profession’ (Bernard and Goodyear, 1998)

17 ‘The secure trainee’ Connections have been shown between secure attachment and: Self–reflection Meta-cognitive processing Empathy Recognising the inherent subjectivity of perceptions Connections have also been shown between the ability to empathise and to think critically Bennett & Deal (2009)

18 Surprise: supervision is a dyadic process!
Relationship-specific attachment is a stronger predictor of supervisory alliance than general attachment style For example The Supervisee may generally use ‘secure’ strategies but becomes distant with a supervisor who is perceived as unsupportive The 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 other Bennett (2008)

19 The 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 styles Adapt our supervisor style to help meet the needs of the trainee.

20 For trainees employing an ‘A strategy’ -rejecting  avoidant dismissive - Compulsive self-reliance
Expressed needs Hidden needs Autonomy Keeping the supervisor at arm’s length Avoid thinking about their own feelings / experience ‘I know better than you’ Supervisee as caregiver Praise Reassurance Permission / encouragement to explore anxiety Permission / encouragement to accept support Start to integrate feelings into primarily cognitive narrative Compulsive self-reliance (A) Extreme form of avoidant attachment characterised by excessive self- sufficiency, distancing, mistrust and fear of dependency on others Compulsive care-seeking (C

21 For trainees employing an ‘C strategy’ inconsistent ambivalent  preoccupied Compulsive care-seeking Expressed needs Hidden needs Reassurance Praise Rescue – supervisor being there whenever needed Support to explore and regulate feelings Structure Encouraging autonomy and problem solving Celebrating independence / achievement of specific goals Support to introduce cognition / coherence into predominantly affective narrative

22 Exercise 1 – supervisor giving feedback
Observe dvd and reflect on: How the clip makes you feel How you think the supervisee is feeling How you think the supervisor is feeling

23 Points 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).

24 In Summary: Overarching goals for supervision...
Create a secure base from which to explore Provide a ‘safe haven’ and allow the trainee the experience of emotional attunement Remain open and curious - attempt to respond to both expressed and hidden needs Use our own supervision to reflect on what is happening for us in terms of attachment

25 Discussion and What are you taking away from this session?

26 References Bennett, 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

27 References 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.

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