Journal of Family Thera#y (1980) 2 : 379-387

Live supervision without a one-way screen

Donna Smith* and Philip Kingstont

This is an account of supervision of family therapy taking place at the same time, and in the same room, as the work with the family. We attempted this method of supervision because we did not have the facility of a one-way screen, yet we both had experienced the benefits which could be derived from that. However, what started off as a second-best method of super- vision has become, decisively, a very fruitful way of working. It has a num- ber of advantages over both supervision from behind a one-way screen, and co-therapy.

I n order to distinguish the two r6les involved we will use the word ‘therapist’ to describe the person working directly with the family, and ‘supervisor’ to describe the person who sits back from the family-plus- therapist system, and whose task is to enable the therapist to help the family. We alternate between these rdes with different families but will assume for easy usage, within this article, that the therapist is male and the supervisor is female.

A typical first meeting with a family

The seating is arranged so that the supervisor can sit back a short distance from the family-plus-therapist circle. We normally use an audio tape- recorder and this is placed on a desk in a position which makes it visible to the family.

The meeting begins with both therapist and supervisor attempting to join with the family members in the normal social ways. The therapist acknowledges in a matter-of-fact way that families are complex situations and that we find we can best help them if one of us sits back and then con- tributes whenever she can. The supervisor might then confirm that she will come in when she has something which may help. The therapist also explains that he and his colleague will take ‘time-out’ at some point if they

* Formerly at Hartcliffe Child and Family Guidance Clinic, Bristol. Bristol University, and the Family Institute, Cardiff.

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0163 +4445/80/040379+ 10 $02.00/0 0 1980 The Association for Family Therapy

380 D. Smith and P . Kingston

think they can be most useful to the family by thinking together for a while. The therapist tells the family that we would like to record the meeting because it is likely to enable us all to understand their situation better. He adds that we will be asking them to sign a form at the end of the meeting which gives their consent to this, and that we also will sign it in order to guarantee them about its use.

Work with the family then continues with the therapist working in his normal way. The supervisor’s position allows her to obtain a clearer view of the processes which are occurring, both within the family and between the family and therapist. In addition, she has the psychological space and time to identify the issues which the family are presenting ; thus she can inter- vene to clarify processes and issues and give a sense of direction to the therapist. We find that the number of interventions made by the supervisor varies considerably, depending upon the family involved and the styles and experience of the people occupying the therapist and supervisor rijles; for us, two to five interventions would be normal in the first three quarters of a one hour meeting.

The therapist and supervisor then leave the room for 5 to 10 min for a consultation during which the family have been asked to work at a par- ticular task. The purpose of the consultation is to share perceptions of the processes and issues and, in particular, to think out an intervention which will help to change dysfunctional processes (usually involving some kind of tasks for the family to do between meetings). Both return to the room and one of them (usually the therapist) shares with the family their ideas and recommendations.

Distinguishing the r6les of the therapist and supervisor

I t is essential to clarify the purpose of the two rbles so that collaboration on behalf of the therapy can more easily occur. I t seems to us that the presence of the supervisor enables the therapist to focus upon obtaining information and on empathizing with family members in order to, in Minuchin’s terms, know the family experientially (Minuchin, 1978). He can risk both creating stress by probing, and becoming lost in the family’s content, because he can normally expect the supervisor to make an inter- vention which will enable him to regain a therapeutic position. The super- visor, on the other hand, can, because of her relative detachment, more clearly perceive processes and issues and can begin to think out change interventions.

The distinctions between the rijles are not hard and fast and both people, to a degree, take all aspects of both rijles ; but the emphasis as we experience it, is that the therapist is primarily concerned with joining with the family

Live supervision 381

members and obtaining relevant information, whilst the supervisor is con- cerned primarily with the recognition of processes, with helping the thera- pist to stay in rBle and with beginning to think out possible ways of enabling change to occur.

We think that the supervisor r d e requires, for most of us, the develop- ment of a new range of skills. It necessitates working with the family and the therapist at the same time, and occasionally pointing to the problems in the family or to the therapist’s loss of rBle, without ‘putting down’ either the family or the therapist. I t also requires the ability to retain some detach- ment without either being rude or creating paranoid feelings in the family. In fact, we think that one of the major skills is that of joining with the family from a relatively detached position. This joining can, in our experience, be done by self-disclosure and by careful use of praise, support and encourage- ment of family members.

Whilst clarity of rBles is an obvious aid to joint work, it does not mean that no discomforts and conflicts will arise. As in all shared work, discus- sions of the experience of taking these r6les is essential if a working relationship is to be developed and kept on a course which is therapeutic for the families concerned. Many writers have illustrated this in recent years, mainly in relation to co-therapy (Bannister and Pincus, 1965 ; Sonne and Lincoln, 1965 ; Rubinstein and Weiner, 1967 ; Skynner, 1976). Whilst tensions and conflicts will always occur, some of these can be avoided if the therapist and supervisor agree on some basic ground rules by which the live supervision will be regulated. Hare-Mustin (1976) recommends that the supervisor should intervene infrequently and she and Haley (1976) both think that the interventions should be concise and have a clearly delimited focus. There seems general agreement that there should be clarity about whether the therapist is to treat the supervisor’s interventions as demands or suggestions (Montalvo, 1973 ; Birchler, 1975 ; Haley, 1976).

Conceptualizing supervisor interventions

We find that interventions by the supervisor fall within the following conceptual scheme :

pointing to processes not recognized by the therapist (e.g. a child behaving as though he is a parent to his brother) ; pointing to problems not recognized by the therapist (e.g. the difficulties which were arising for a mother who had to cope with children while her husband was working away from home) ;

(c) encouraging the therapist to take a more flexible approach by suggesting alternatives ;

382 D. Smith and P . Kingston

(d) asking the therapist to seek information which may clarify the processes within the family. This is usually done by asking the therapist to follow up a specific situation (e.g. the reactions of parents to the discovery that their daughter was not attending school) ;

(e) asking the therapist to return to a focus which he has lost (e.g. when parents had moved to a general criticism of their child’s behaviour, the therapist was asked to return to the specific example) ;

(f) making a statement about the family structure (e.g. to suggest that a girl who was living with her parents and grandparents needed to be clear as to what their respective areas of authority were) ;

(g) intervening as an expert so as (i) to normalize a situation which is creating dysfunctional anxiety (e.g. where parents believed that a child who was unwanted during pregnancy would inevitably be damaged emotionally) ; or (ii) to create concern in people who are letting a situation drift (e.g. pointing to the problems which could be expected in future if a 13-year old was not controlled) ;

(h) delivering a message following consultation outside the room where it is believed that a message will have more impact if delivered by the supervisor, as ‘expert’, or because of some personal attribute such as sex alignment (e.g. the male supervisor explaining to a father the normality of masturbation in adults and children, and giving a task to relieve the amount of anxiety and attention focused on the child) ;

(i) checking whether the family members have agreed with something when the therapist has not noticed that there may be disagreement (e.g. a father agreeing to a goal whilst the mother remained silent) ;

(j) generally joining with the family by way of encouragement and understanding (e.g. by acknowledging how difficult it is to come to an agency for help, or by praising people who have negotiated a successful outcome to a conflict). These joining statements are, however, nearly always allied to one of the other supervisor inter- ventions listed above.

Live supervision in the room compared with (a) Supervision from behind a screen and (b) Co-therapy

Although we will refer to advantages and disadvantages when making these comparisons we realise that the relative assessments of these will vary with

Live supervision 383

different therapists. Given experience and skill, most disadvantages can be turned to advantages ; given inexperience and unawareness, most advantages can be lost. The following comments should be seen in this light.

(a) Comparison with supervision from behind a screen

There is a small but growing literature about live supervision via a one-way screen (e.g. Montalvo, 1973; Birchler, 1975; Haley, 1976; Hare-Mustin, 1976 ; Meyerstein, 1977 ; Papp, 1977 ; Walters, 1977 ; Gershenson and Cohen, 1978 ; Palazzoli et al., 1978). This form of supervision has obvious advantages over the retrospective self-report which has been the traditional basis of supervision in the helping professions. I n particular, it protects clients by providing a situation in which the mistakes of the therapist can be reduced by the prudent interventions of the supervisor, or when they occur can often be rectified during the session. The learning gains are enormous with the instant feedback providing an opportunity for rapid development in knowledge and, more importantly, in skill.

Haley regards live supervision via a one-way screen as the most effective method of supervision but thinks that to have the supervisor in the room would involve her ‘in the therapy and prevent private collaboration and strategy planning between therapist and supervisor’ (p. 192). We think he raises difficulties which are potentially real but which, in our experience, can largely be overcome. For example, families quickly recognize that their interactions with the supervisor are different from those which they experi- ence with the therapist and they accept this r61e differentiation. However, we have experienced situations where the supervisor has been drawn into making impulsive interventions which, with a little more reflection, might have been made more constructively. Obviously, a one-way screen places more controls on impulsive or over-intrusive responses by the supervisor ; at the same time it removes an opportunity to learn to cope with the internal and external pressures which led to those responses.

With regard to collaboration and strategy planning, we find that ‘time- out’ during a session is an effective way of meeting this need. We both have experience of using one-way screens at the Cardiff Family Institute where there are telephone links between supervisor and therapist. The telephone enables the kind of concise interventions which are advocated by Haley and Hare-Mustin to take place, but does not allow for more detailed sharing of ideas. For that to occur, ‘time-out’ is normally necessary. However, as with any kind of continuing shared work, the supervisor and therapist are likely to develop an understanding of each other’s work without full discussion being necessary.

384 D . Smith and P . Kingston

The supervisor’s interventions have their impact because they come from outside the system of therapist-plus-family. When using a screen, moving in to make an intervention or moving out again is accomplished simply by using the connecting door or the telephone at the moments of optimum therapeutic advantage. With ‘in the room’ supervision, we find that the supervisor needs to introduce many interventions through the therapist, e.g. ‘Phil, Mrs M. seems not to be hearing her husband’. Avoiding direct interaction cannot be carried to absurdity and at times, this is needed either to join, as stated before, or to produce lightness or intensity, but the supervisor can then withdraw from the central arena of interaction through the therapist.

We find that there are two clear gains from the supervisor being in the room rather than behind a screen. One is that being present in the room is more insistent in engaging the supervior’s attention. The processes and issues in the family appear to be much more immediate and alive and the supervisor’s concentration and commitment is enhanced. The second is that the proximity of the family and therapist offers the possibility of appro- priately rapid intervention by the supervisor. There is less likelihood that the moment to intervene will be lost.

(h) Comparison with co-therapy

The advantages and disadvantages of co-therapy have been much dis- cussed (e.g. Birchler, 1975; Holt and Greiner, 1976; Walrond-Skinner, 1976; Dowling, 1979). Many beginning family therapists prefer it because of the sense of security which they experience. Some experienced therapists often use it as a preferred method of treatment (Boszormenyi-Nagy and Spark, 1973).

The staff of the Institute of Marital Studies normally work in pairs with a couple, although they often each work separately with one partner of the marriage (Bannister and Pincus, 1965). A part of the theory upon which the work of the Institute is based is that the therapist’s emotions and behaviours begin to mirror the emotions and behaviours of the couple, and the former are able to use their awareness of this mirroring in their interventions. However, what we know of the work of many experienced family therapists is that they prefer to be alone in the room with the family (though often having live supervision from behind a screen or having their interview videotaped for subsequent supervision and review).

We have experienced co-therapy and live supervision in the room with a number of different therapists and find that live supervision gives the following advantages :

Live supervision 385 (i) The clear distinctions between the rbles in live supervision help

to cope with the competitiveness and to avoid the muddle which sometimes arises in co-therapy . The supervisor appears more likely to add to, rather than diminish, the therapist’s effectiveness.

(ii) The fact that the supervisor will almost certainly perceive pro- cesses more clearly than the therapist, enables her to make inter- ventions with considerable energy and conviction. This applies both to interventions during the session and to those which occur after a ‘time-out’ consultation. As one family member remarked when reviewing this method of working, ‘she doesn’t say much, but when she speaks you really hear her’. This process is no doubt aided by the family’s attribution of expertise to the supervisor.

(iii) The fact that the two workers can often alternate their rbles with different families means that they can experience the problems and strengths inherent in each rble. Compared with co-therapy they are less likely to become trapped in a continuing comple- mentary rble.

(iv) The focus and direction which result from live supervision appear to enable rapid change to occur in the family.

Dowling (1979) has listed three functions of the co-therapy team, namely modelling, division of labour, and mirroring families’ behaviour. I n our view, the value of modelling functional behaviour for the family is not lost in the form of supervision we are describing. In fact, for those who are attempting structural family therapy (Minuchin, 1974) it may provide a particularly apt model. But, whatever the theoretical base there are some important aspects of family relationships which the supervisor and therapist can demonstrate. These include the expression of differences, clear com- munication and the acceptance of individuality within a shared task. The second of Dowling’s functions, the division of labour, is clearly present in live supervision. The third, that of mirroring the family’s behaviour, is much less possible in live supervision than it is in co-therapy.

Beginning live supervision Our experience of live supervision in the room has been more with col- leagues than with family therapy trainees. The following comments reflect this. Because the supervisor is likely to perceive processes and issues more clearly than the therapist, she is more likely than he to produce therapeutic leverage. We, therefore, think that when people begin working in this way it is more successful if the experienced member of the pair initially takes the supervisor rble. A less experienced person taking a supervisor r81e in

386 D. Smith and P . Kingston

relation to a more experienced one tends to become involved in a study of style rather than in observing the process of the session. However, once a person has developed some ability to recognize processes and issues rather than become immersed in the details of content, then he or she can, from within the supervisor rble, offer a perspective which the therapist however competent cannot have.

Each rble exposes some different aspects of our work with families. If two people experience each other only in the one rble, fantasies will develop about the extent of their ability in the other r81e. Both therapist and super- visor may, for example, wonder whether the supervisor could actually cope well with the therapist rble.

These fantasies often exist where there are organizational rble differences between the workers (as for example, when they are in a trainer/trainee or a senior/subordinate relationship), or if there are differences in professional rble. If the need to maintain organizational or professional status differ- ences inhibits them from risking personal parity, then the formal rbles may be maintained at the cost of therapeutic effectiveness. Joy and David Rice have written an important article about this in relation to co-therapy (Rice and Rice, 1975) which has direct relevance to live supervision. They have noted, for example, that the achieved status of doctor and the ascribed status of male, may in family work, subvert a model of sharing. In our experience switching rbles within the therapy increases openness, sharing and com- petence, without necessarily removing distinctions which are functionally necessary for the organization. These distinctions are maintained whilst the professional equality and personal openness which are needed for joint work with the family are enhanced.

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