EMDR Therapy Quarterly

I am sitting in front of my computer and see six boxes on my Zoom call, each containing another EMDR therapist, one of whom is our supervisor, Gordon. We have just logged in and are doing the usual formalities: “How are you?” and “You’re muted!”

Once we’ve settled in, our supervisor calls us to order and goes round the group, asking each of us what we have brought to supervision today. I did have an idea before the group about a client I am feeling stuck with, but I am wondering whether to discuss this client and thinking about the potential feelings of shame when I reveal how ignorant I am about the standard protocol. But I feel reassured by Gordon, who, I remember, has told us about some of the times that he has ‘messed up’ in EMDR therapy, and I feel that it might be worth taking the risk. So, when it comes to my turn, I ask the following supervision question:

“My client doesn’t seem to be processing, and I am wondering whether I’ve got the right target. Can you help me with my case conceptualisation?”

Then I start to worry about something else: What if the other people in the group have something more pressing and urgent to discuss, and I will be hogging the session with my little problem? But then I remember that Gordon is usually good at making sure that everyone has a fair share of the time and that others can contribute to the discussion about my case and will thus feel involved.

Welcome to the world of EMDR group supervision, where some things aren’t quite the same as they are in individual supervision.

Why group supervision?

Firstly, what is the point of doing supervision in a group? Well, the most obvious reason for providing supervision in a group setting is that of economies of both time and money. Where there exists an insufficient number of EMDR consultants, as is currently the case in the UK, group supervision rather than individual supervision is a better use of their time. In addition, the costs are less for the organisation or for the individual if they are funding the supervision themselves.

However, there are many other advantages to group supervision, and I have summarised the points made by Bernard and Goodyear (2019) below:

• Through group supervision, each supervisee has access to a wider range of practice and will learn about the utilisation of EMDR with many more clients than their own.
• The group format provides a much greater variety of learning experiences, for example, reflecting on the practice of colleagues.
• Each group member will benefit from a greater diversity of perspectives on their clinical work.
• The group format enables the supervisor to obtain a more comprehensive picture of their supervisee as they observe how they interact with other members of the group.
• The supervisee will learn more about how they are seen by others, which can be valuable information.
• The supervisee gains the opportunity to learn supervision skills, especially relevant for supervisees who are training to become consultants themselves.
• Supervisees’ experiences are normalised, finding, for example, that other EMDR therapists have the same doubts and anxieties as their own.

Bernard and Goodyear also outline some disadvantages of group supervision:

• Particular individuals may not get what they need from supervision and the supervisee may have particular issues that the supervisor can only manage in an individual setting.
• There may be concerns about confidentiality relating to both client information and the supervisees’ own issues.
• The form and structure of group supervision does not mirror the practice being supervised, namely individual one-to-one therapy, which is how EMDR is usually delivered.
• Certain group phenomena, such as competitiveness and insensitivity to cultural differences, can impede learning.

On balance, group supervision is generally found to be as effective as individual supervision (Ögren, Boëthius, & Sundin, 2014) and the advantages tend to outweigh the limitations (Bernard & Goodyear, 2019).

Types of groups

EMDR supervision groups can take different forms, as summarised by Proctor and Inskipp (2001). They described four types of groups, the first three being supervisor-led and the fourth described as a peer group.

• Type 1. Authoritative group (supervision in a group)
• Type 2. Participative group (supervision with the group)
• Type 3. Co-operative group (supervision by the group)
• Type 4. Peer group

Type 1. Authoritative group (supervision in a group)

The supervisor provides supervision to each supervisee in turn, whilst the other supervisees are primarily observers and learners during this process. It is, in effect, individual supervision with an audience.

Type 2. Participative group (supervision with the group)

The supervisor still takes prime responsibility for supervising each therapist. However, the supervisor also actively directs group members to co-supervise each other and comment on each other’s presentations.

Type 3. Co-operative group (supervision by the group)

Here, it is the group itself that is providing the supervision. The supervisor’s role is as a facilitator and supervision monitor. In the context of EMDR supervision, the supervisor will still take responsibility for ensuring that comments by members of the group are in accordance with EMDR protocols. In addition, as an evaluator in relation to accreditation, the supervisor will also be assessing the group members in terms of their understanding of the protocol during this process.

Type 4. Peer group

In this type of group, no individual is taking on the responsibility of supervision. Although one individual may act as chair or co-ordinator (a role that might revolve around the group), this person holds no responsibility as a supervisor. Such groups exist in some regions of the UK under the auspices of the EMDR Association. It should be noted that peer group meetings cannot be counted towards accreditation, even if there is an EMDR consultant present at the meeting. To be absolutely clear about this, a decision was made when I was on the board of the Association to describe such groups as ‘peer support groups’ rather than ‘peer supervision groups.’

So, which is the best sort of group? The answer is, ‘It all depends…’ If those in the group have not yet completed their basic seven-to-eight-day training in EMDR or have only recently completed it, an authoritative group might be the most effective format. This is because trainees will still be learning basic EMDR protocols and would be floundering if they were expected to comment upon each other’s cases. However, in my experience, even with such groups, an element of a participative group can often be valuable, and I would not preclude other members of the group from commenting when one of their colleagues is presenting a case. Generally speaking, however, the more experienced the group members are, the more appropriate it will be to have a participative or co-operative group. In particular, if the group consists mainly of consultants or consultants-in-training, a co-operative group will assist them in learning and practising the skills of supervision.

It may be that a particular group will oscillate between being authoritative and co-operative. For example, a group that normally works co-operatively, may, on occasion, have a many more cases to discuss, and there may simply not be sufficient time to involve the whole group in discussing each case. So, the group may need to resort to becoming an authoritative one for that meeting.

How many in the group?

The ‘Goldilocks’ range – not too large, not too small – for a supervision group appears to be four to six members. Boalt Boëthius and Ögren (2001) suggest that a group of just three individuals may become too competitive, whereas a group of four can relate to each other in dyads. However, as the group size increases, more reticent members may fail to contribute, and some members may begin to dominate.

Additionally, the guidelines regarding frequency and quantity of EMDR supervision by the EMDR Association UK (2019), the first version of which was drafted by me, specifies a recommended group size of no more than six.

Homogenous versus heterogenous

There are a number of ways that individual members of a group may differ in terms of, say, age, gender, race, nationality, professional training and experience. In general, a more heterogenous group functions better (Ögren, Boëthius & Sundin, 2014). However, I am concerned here in thinking about the individual’s level of development as an EMDR therapist.

What are the pros and cons of having more heterogeneity in a supervision group in terms of the EMDR development of its members? The advantage of a homogenous group is that everyone is working at a similar level, and any teaching relating to the EMDR protocol is likely to be relevant to all the members of the group. If it is an advanced group of consultants-in-training, the group can also address issues regarding supervision that would not be relevant to those who are not yet accredited practitioners. I have run such homogenous groups, one for recently trained EMDR therapists working towards practitioner accreditation and one for those working towards consultant accreditation, and both worked well.  

However, I also ran a very mixed group that included consultants-in-training and those who had not yet completed their basic EMDR training. This group also worked very well, and, in fact, the consultants-in-training were able to practise and demonstrate their group supervision skills whilst I was observing them in the form of live supervision-of-supervision, which worked well for everyone.

Organisation and structuring of groups

One of the things you will notice if you move from individual supervision to group supervision is how the session needs to be organised. For individual supervision, the supervisee usually sets the agenda, decides what they want to discuss and how much time to spend on each supervision question.
 
In a group context, however, the agenda needs to be set by the supervisor, who will need to start by finding out what everyone has brought to supervision to formulate a group agenda. Alongside this, the supervisor needs to ensure everyone’s supervision needs are met and that supervisees feel safe enough to share their vulnerability about their struggles in working with particular clients.

Shame. It’s never far away!

As EMDR therapists, we are aware that before we can start processing a trauma, our client needs to be in a place of security and have sufficient resources in situ. Without that firm ‘foot in the present,’ they will not be ready to put their ‘foot in the past.’ Similarly, with group supervision, before we, as supervisees, feel comfortable in sharing our vulnerabilities regarding our clinical work, we must feel safe and secure in the group and with our supervisor.

The experience of being in a supervision group and sharing our mistakes and vulnerabilities as therapists can engender a sense of shame. It is important for our supervisor to foster a climate in which we can be open about our vulnerabilities without feeling judged by members of the group. Whilst remaining strong and dependable as a group leader, a supervisor who shares some of their own vulnerabilities and examples of when they themselves have ‘messed up’ should help to create the right culture in the group. Group members need to feel a sense of security and know that they can trust other group members as well as the supervisor (Ögren, Apelman, & Klawitter, 2002).

In conclusion, group supervision can be scary and daunting. But, with the right group culture, it can be one of the most rewarding, stimulating and energising experiences.

Postscript

I have now decided to finish my regular columns in ETQ on the topic of EMDR supervision – principally because I have run out of things to say! I was initially invited to write this column in 2021 by Omar Sattaur, a former editor of ETQ, and was delighted to start this process.

This is my 11th column, and, after a total of 23,086 words, I think you will have heard enough from me! Also, I will be retiring later this year, although I will be popping back to run Consultants Trainings for a couple more years. I have thoroughly enjoyed writing this column, and I hope that it has been of help to my readers.