EMDR Therapy Quarterly

How did the footballing English Lionesses do so well in the recent World Cup? And what has this got to do with EMDR supervision?  

As you may recall from my last column, I have named the three basic functions of supervision (with the older terms in brackets) as follows: 

• Educating (formative) 
• Enabling (restorative) 
• Evaluating (normative) 

The Three E’s as I like to call them. I was planning to talk about the educating function in this month’s column, but the Lionesses have distracted me (!) and I have decided to go straight to the enabling function instead.  An article in The Guardian describes how their coach, Sarina Wiegman, is following the research evidence that “compassion creates the strongest foundation for resilience and sustained performance under pressure whether in sport, the military, healthcare, or business. Compassion taps into our biological hard wiring. Rather than activating our threat system that evolved to help us survive way back, compassion helps us to feel (biologically) safe and protected, leaving us free to learn, connect with others and start exploring what we’re capable of….Far from people getting away with less, you can push them harder if you also give them the support they need to succeed, avoiding mental and physical burnout.” 

Is this ringing any bells for you as an EMDR therapist? Perhaps our one foot in the present with its supportive and nurturing therapeutic relationship makes it even more possible for that other foot to be placed in the past and the challenge imposed by confronting the trauma through EMDR processing. Similarly, in EMDR supervision (or any other supervision for that matter) we need to feel secure and supported by our supervisor in a non-judgemental way. Only then can we become more open about the mistakes we might be making or our uncertainties about our EMDR therapy practice. As Cath Bishop writes, “that connects to Wiegman’s natural response to Lauren James’s red card against Nigeria [when she deliberately stamped on the back of her prone opponent] pointing out how human it is to err, focusing on the learning opportunity and providing the support needed to do that without fear of reproach.”  

It has been well established in the literature on clinical supervision that the supervisory relationship is crucial to effective supervision. In fact, there is a whole book on the topic (Beinart & Clohessy, 2017). This should come as no surprise since the same is true of psychological therapy with well established research evidence to demonstrate that the therapeutic relationship has more impact on outcome than the actual therapy utilised (Baier, Kline, & Feeny, 2020). In a meta-analysis of 40 studies, Watkins (2014) concluded that the supervisory alliance is consistently the crucial component of a successful supervisory relationship. 

How a supervisory relationship will turn out is likely to be affected by the prior experience of both the supervisee and supervisor. Let me consider an early figure of authority in my own life: My own late father (a photo of whom is on my wall just to the left of my computer screen) was not particularly emotionally warm or empathic. However, amongst his many redeeming features were his calmness, assuredness, spirit of curiosity, playfulness, lack of dogma and encouragement of debate. I think that these qualities helped me to accept feedback and criticism during my own supervision and to cultivate an ability to learn and develop without feeling crushed when I got things wrong. Contrast this, for example, with one of my supervisees who was devasted by some feedback that I provided her, later telling me that this was triggering memories of the difficult relationship that she had with her own father who was very critical. More often perhaps, the early authority figure will be a schoolteacher (Berman, 2000). 

Much of what may be difficult for us as supervisees to disclose is our perception that we have made a mistake during therapy. It can be helpful to take what we may perceive as a disaster and reframe it as new information that will help the us to respond to our client in a more therapeutic way. One of my supervisees told me, “I have found it helpful how you talk about your own mistakes, or when things haven’t gone according to plan, as this helps me with feeling able to accept my own mistakes and to not put too much pressure on myself to have to get it right all the time.” 

I was shocked to read, in a study by Ladany et al. (1996) that 97% of supervisees had withheld information from their supervisors and, in 50% of cases, supervisees said they were not disclosing their mistakes due to a poor alliance with the supervisor. This is a serious problem because, as Bernard and Goodyear (2019) point out, supervisees are putting their clients at risk when they fail to disclose relevant information about them and their treatment. Supervisees are also putting limitations on what they can learn in supervision. Derek Farrell (2020) suggests the following reasons why EMDR supervisees may fail to disclose information about their therapy: 

• Belief that the EMDR clinical supervisor would judge the information to be irrelevant
• That they might experience negative feelings, including shame, disapproval and disappointment
• Perceived differences in cultural background and cultural competency
• Source of conflict between therapy approaches
• Concern over clinical mistakes and potential errors of judgment 
• Disclosing vulnerability
• Outcome focused, therefore wishing to ensure positive evaluation (Farrell, 2020, slide 12).

Derek’s last point clearly relates to the evaluating functions of supervision. There is undoubtedly a tension here for the supervisee in terms of balancing learning, which will require disclosure, with their desire to receive a positive evaluation. This tension may, they feel, necessitate keeping information about their therapy sessions under wraps (Hess, 2008). 

The parallel process 

A “parallel process” (Doehrman, 1976) occurs when the supervisory relationship is manifesting similar relationship dynamics to those in the therapeutic relationship. For example, a particular client may be very dependent on me as a therapist which may be reflected in me appearing to be dependent on my supervisor when I am discussing a particular client. Or a client whose negative cognition is “I’m not good enough” may manifest in the parallel process as me feeling “I’m not a good enough therapist.” What happens in the therapy room may be re-enacted in supervision (Bernard & Goodyear, 2019) and, conversely, what happens in supervision may be re-enacted in the therapy room (Frawley-O’Dea & Sarnat, 2001).  

I recall a supervisee, who usually presented their clients to me in a clear and succinct way. She appeared confused and hesitant when presenting a particular client to the point where I myself felt muddled and anchorless. When I reflected this back to my supervisee, it helped her to realise that there were issues in her relationship with her client that she had not previously recognised and that this was getting in the way of her being able to help her client with EMDR therapy. 

It has been pointed out however that the notion of the parallel process creates a risk of creating an assumption that all issues between supervisor and supervisee are a reflection of the therapeutic relationship. Focusing on this too much may lead to avoidance of addressing conflicts in the supervisory relationship itself (Berman, 2000; Scaife, 2019).  

Shame and the power relationship 

The second point on Derek’s list mentions shame and this can be a major issue for us both as supervisees but also for our supervisors. In the background, there always lurks the fear, when I am presenting a case or when I am supervising or teaching, that I may get found out as a fraud and I don’t really understand what this EMDR is all about. Even for me, after practicing EMDR for 25 years, being a senior trainer, running consultant’s trainings and being a former President of the EMDR Association, that fear still lurks. Hahn (2001) addresses the function of shame in the development of attachment to caregivers and how this is projected into the supervisory relationship. When shame is activated, supervisees have three options:  

• They can acknowledge to themselves that they are experiencing shame and silently struggle to maintain their composure  
• They can acknowledge to their supervisor that they feel inadequate and incompetent and share their belief that they will be condemned for their incompetence. Most supervisees will find this impossible to admit  
• They can react to the shame to protect themselves from their overwhelming and disorganising experience.  

The third of these is the most likely outcome. Nathanson (1994) has identified four common reactions to shame which, according to Hahn, are likely protective reactions to occur in the supervision session: 

• Withdrawal 
• Avoidance 
• Attack on self 
• Attack on others 

Hahn says that, irrespective of how shame is triggered and manifested, supervisors should avoid the temptation of confronting shameful reactions or prematurely referring supervisees for personal therapy. “Supervisor self-disclosure and normalization of treatment hurdles can help supervisees feel competent relative to their level of training” (p. 280). 

Coupled with shame is the evaluating aspect of supervision which clearly leads to a significant imbalance of power in the supervisory relationship. If we deny that there is a power differential in supervision, we are deluding ourselves and will make this more of a problem than it needs to be. “The supervisor’s greater power can be problematic if the supervisor is oblivious to it, abuses it, or (more typically) has difficulty using it comfortably” (Bernard & Goodyear, 2019, p. 110).  

Clearly supervisor power can be abused by the supervisor, for example pathologising supervisees and attempting to give them therapy instead of supervision, selectively focusing on their limitations, verbally attacking supervisees, insistence on adherence to the supervisor’s approach or even unwanted sexual advances (Porter & Vasquez, 1997). But power can be used in a positive way to protect the client and enhance the supervisee’s learning (Bernard & Goodyear, 2019). 

So, to finish, let’s go back to the footie. Interviewed about Lauren James’s red card, Weigman said, that in a highly emotional situation, “in a split second, she lost her emotions… it’s a huge lesson for her to learn.” Haven’t we all done something stupid and illogical during the course of our work? Although we have the advantage that it was not watched by millions of viewers worldwide. We learn more from our mistakes than from our successes and, as Bill Gates said, “success is a lousy teacher.” 

Robin Logie is a Clinical Psychologist and EMDR Europe accredited consultant and trainer. He is a Past President of the EMDR Association UK, a current member of its Accreditation Committee and runs EMDR consultants’ trainings on behalf of the Association.