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Original Articles

The Role of Supervision in Managing Intense Affect and Constructing Boundaries in Therapeutic Relationships

Pages 218-225 | Published online: 21 Jan 2015
 

Abstract

Clinicians frequently encounter intense and startling feelings in therapeutic relationships. Managing and formulating intense feeling states in treatment relationships is central to the psychodynamic management of boundaries. Absence of supervisory attention to these issues leaves clinicians exposed to the risk of engaging in destructive behavioral enactments or developing practice styles that abandon the patient and stifle the psychotherapeutic process. This article proposes a model of individual supervision that focuses on trainees' psychodynamic understanding and management of intense feelings and the construction of clinically useful and ethically sound treatment boundaries. Consideration is given to how the supervisor sets the frame, formulates learning goals, and introduces and manages the emergence of personal feelings. Helpful processes include attention to trainees' safety and comfort, assuming an educational rather than a therapeutic stance, focus on skill development and acquisition, and providing students with a cognitive framework for understanding affect. Shame and self-consciousness may be diminished through the supervisor's willingness to assume a self-revelatory stance, including sharing personal mistakes and making the process transparent. Ethical supervision is embedded in a clearly articulated supervisor-student relationship that monitors misuse of power and boundary crossings, yet is capable of deeply personal discourse.

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