Ryle, A., 2005. Long Distance Supervision. Reformulation, Autumn, pp.4-5.
Over the 13 years since my retirement from NHS work, during which I have been abroad half of the time, I have been reluctant to end my contact with clinical issues and have continued to be involved with CAT supervision and teaching. I have therefore accumulated a considerable experience of phone/Fax/email supervision. I have not formally evaluated this, but I thought it might be useful to give some impressions of its effectiveness and its limits.
I have supervised geographically remote trainees, initially with people I had worked with previously face to face, but latterly with a number of people whom I have never met. I have combined Fax or email supervision with weekly phone conversations in some cases, but not in others. I was one of the supervisors of the Melbourne Group, where we used email, email voice recordings of parts of sessions and collective phone ins, thus getting some of the advantages of group supervision. I have mostly supervised therapists with some CAT training but also a few others in faraway places who were experienced therapists but had met CAT only through books. With these, I have combined supervision with some teaching and directed reading. As I am a slow typist, I warn therapists that terse and seemingly directive comments are not to be taken as gospel.
My main impression is that these various ways often work well. Written reports of sessions are often clearer than verbal ones, having been reflected on (but hopefully not edited). Supervisory comments can be similarly thoughtful and having a record of them enables the supervisor to remember and hence repeat or revise earlier comments. Technical CAT procedures can be reinforced and, perhaps more surprisingly, after a time with a particular trainee, countertransference issues can be picked up and discussed – diagrams are particularly helpful here.
I develop a strong sense of the individuality of many supervisees whom I have never met and this makes it easy to take up problems in non-punishing ways. But maybe I am protected from negative feelings in the supervisory relationship and there are limitations. In order to explore these I sent a draft of the above to a small number of people who had received long distance supervison from me; I am very grateful for their observations. Some had received distance supervision as their only source, some I had initially supervised face-to-face. On the positive side, one reported how the work of the ‘internal supervisor’ was mobilised by the preparation of the session reports and confirmed that, as long as the reports of sessions had been carefully read, the supervisor’s comments were valuable and could illuminate the therapy relationship. Another observed that ‘supervision has been on a deeper level than I would have predicted could be possible from e-mails’. Several felt that preparing the reports involved more time, and more thought, than was normally the case in live supervision and welcomed the fact that the supervisor’s comments could be re-read a number of times, and even discussed with colleagues. Some had gone on to offer distance supervision themselves, in some cases combining a refresher course of being supervised for their own work with support for their supervisory role. This can be on demand rather than a regular event ; one commented that taking on the supervisory role with the knowledge that supervision was available if needed’ was like having money in the bank, ‘you do not necessarily spend it but you know it is there’.
The main limits of long range supervision which were identified were the restrictions on unstructured explorations, especially where there had been no previous contact. For supervisees with little previous experience disclosing negative aspects of countertransference and technical failures was particularly difficult and might be impossible; it was always important that, when these were reported, the supervisor’s comments were framed in a supportive way. Even where adequate telephone links could be established, working together on the development of diagrams and making use of group processes were problematic. People varied in their attitude, however; some saying they would never supervise long distance except where they had already worked face-to-face while one therapist, who had experience of providing as well as receiving long distance telephone supervision, felt that attention to voice tone and silences could convey the emotional tone of the relationship, even though it was impossible to provide the small gestures which can convey support and understanding of supervisees as they report difficult aspects of their work.
A map of the world tracing the history of the spread of CAT would show an initial radiation of lines from London and, after a short time, the creation of new centres of training and supervision in various parts of the UK and Ireland and later in more faraway places. Distance learning played some part in this spread although many trainees endured heroic amounts of travel to get personal contact. The wider spread to other parts of the world relies to a greater extent on distance learning and geography remains the main indication for it. In less remote places it can still make training less expensive of time and money by restricting travel; in such cases it can be part of a programme involving direct meetings at intervals. As regards the methods, while some supervisors find fax or e -mail alone to be satisfactory, others will only offer distance supervision if it can be combined with the use of the telephone or if it follows face-to-face working.
It must be accepted that not everybody can provide or use long distance methods; I have had the experience that some supervisees are unable to convey the feeling or meaning of their sessions through writing. Supervisors taking on trainees where no direct contact had been possible would be well advised, before accepting them, to ensure that they have read basic CAT texts and should get some idea of their style and readiness by asking initially for a case summary and a provisional CAT reformulation of one of their current therapies. Supervisory comments on this also give the potential supervisee a sample of what to expect. If this goes well, the first case treated with cat will provide a clear experience to both of the adequacy of long distance supervision.
Long-distance Supervision and the Melbourne Project
Burns Lundgren, E., 2002. Long-distance Supervision and the Melbourne Project. Reformulation, Spring, p.8.
CAT and the Cultural Formation of a Case of Anorexia Nervosa: An Italian Case Study
Cristina Fiorani and Marisa Poggioli, 2005. CAT and the Cultural Formation of a Case of Anorexia Nervosa: An Italian Case Study. Reformulation, Autumn, pp.13-17.
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