Relational Supervision, Poet Leadings, Transcripts, Reshuffling, Anorexia Makes It's Move
Updated: Oct 5, 2021
Girl Reading, Harold Knight, 1932, Harris Museum & Art Gallery
Photographs that compel us never overpower or coerce; they attract us because they are pensive, they think.
- Roland Barthes
Hello Everyone: Thanks for coming back to the Newsletter.
This wee collection of thoughts runs the gambit from tips for choosing a supervisor, a reason for giving away books, a five-step accountability method of relational supervision, poetry, how not to hire the wrong consultant, the four-step method of our Relational Response Teams, and a completely unaltered partial transcript of my highly imperfect Anti-anorexic session work.
I specifically chose an Anti-anorexic transcript to show as the problem has found great haven and delight during the pandemic. Anorexia has exploded like never before onto my nations landscape.
All the information mentioned above is here - but not exactly in the order listed above. It may take some digging.
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A few years back I completed Walter Isaacson’s 2017 book on Leonardo da Vinci. Weighing in at 4 pounds, it took me a while.
Early last week I set about reshuffling my house full of books and came across Leonardo again, standing upright among other hefty hard covers.
The practice of reshuffling books assists me to re-figure which books stay put and which others be released unto the Goodwill store (a store set up by a local charity inviting anyone to donate a wide range of items.)
Since the pandemic, over eight dozen books have made the Goodwill journey, along with 60% of my clothes. Ha! Shortly after the first 6 months of lockdown I came to realize I was only wearing a small slice of my closet so, out they went. I do wonder if others are also going through a pandemic shred, a purge, a spring clean?
I suppose I could build larger bookshelves but when it comes to certain books, I’m good with the ‘in with the new and out with the old’ sharing routine. I never use to be. I hung on. Since the pandemic, I’ve become a bit more community book minded.
For me, there is an art to reshuffling. I tend to take my time and hover over a book’s history. When and where it was purchased, re-visiting what caught my eye to buy it, and so on. Then comes a solid re-reading of what may have been written in the margins of certain books – then re-writing these thoughts into a trusty mole skin I keep these kinds of notes in.
The final act is a ritual of unbending dogeared page creases. Preparing a books final passage and proper presentation for the next unknown reader.
While reshuffling Leonardo, I remember the author writing of his subjects delight in combining diverse passions as the ultimate recipe for creativity. And his apparent ease being a mid-1400’s alternative: illegitimate, gay, vegetarian, left-handed, easily distracted, and at times heretical.
Leonardo da Vinci wrote, “Poor is the pupil who does not surpass his master.” And he for one outstripped his own teacher, Verrocchio, when as a teenager he added a brilliant angel to his elder’s Baptism of Christ. That’s genius. Yet the originality of Leonardo was made possible by a medieval art education.
The book makes an argument that genius cannot be taught but, skills can. And how even the wildest, most visionary of artists relies on techniques, methods, systems of knowledge they were taught. This much is obvious to a narrative therapy informed therapist.
As I placed the book in the take-away box I was reminded of how Leonardo’s life guides us towards the importance of instilling, both in ourselves, colleagues and clients, not just received knowledge but a willingness to question it—to be imaginative and, like talented misfits and rebels in any era and discipline, to think different.
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I always chuckle on how one thing inevitably leads to many other, things. Recently a good friend sent me poems they had written and kindly invited me to read and offer feedback. Their intense complexity, intention and differing structures were justifiably dreamy and interesting and, whet my appetite for more, poetry.
Poetry has forever been a private part of my life. Since the early days of youth, poems have been something I turn to, revel in, seek wisdom from. Not all of the time but some of the time.
I know enough to look for their succour when intimate relationships begin and end and burn to write them sitting before big wild ocean waves. More recently, during the pandemic’s earliest days, I turned to them again. My good friend’s poems have escorted me back onto the track of poetry. Thanks.
Something about my friend’s poems inspired me to look up a favourite Irish poet of mine, Paul Muldoon. A thing leading to other things. I was in the mood to hear him speak and perform, his poems.
This one thing did indeed lead to many other, things. One thing of them being an interview including Paul Muldoon, alongside a reading/interview with the early 2000’s American poet laureate Billy Collins.
And this interview and reading with Billy Collins led me to thinking about the kind of narrative therapy we do at VSNT and thoughts on choosing supervisors and consultants and what actually constitutes this thing we call supervision.
Before I share a few thoughts on supervisors, consultants and supervision, it is my pleasure to introduce you to a Billy Collins poem that filled me to the brim and inspired me to think a bit more about supervisors, consultants and supervision.
He calls this poem, Introduction to Poetry.
Introduction to Poetry I ask them to take a poem and hold it up to the light like a color slide or press an ear against its hive. I say drop a mouse into a poem and watch him probe his way out, or walk inside the poem’s room and feel the walls for a light switch. I want them to waterski across the surface of a poem waving at the author’s name on the shore. But all they want to do is tie the poem to a chair with rope and torture a confession out of it. They begin beating it with a hose to find out what it really means.
American Poet Laureate Billy Collins
Portrait of Edmond Duranty, Edgar Degas, 1879, Glasgow Museums Collection
Recently I’ve been rattling on and on in narrative therapy workshops about my new fascination with what I frame as the Relational Ecology of the Receiving Context We Receive Client Stories Into.
A therapists Relational Ecology of the receiving context constitutes an interwoven relational symphony of ideas, beliefs, values, cultural location, history, feelings, structural inequalities, ideologies. To be sure, and to state the obvious, all therapists we know of have a relationship with a relational receiving context they receive client stories into. But sometimes they don’t quite know enough to spark up this relationship, further.
In thinking about receiving structures, I am reminded of the day long ago I first visited Michelangelo's 5.7 meter 'David' at the Academia Gallery in Florence. Can you ever imagine Michelangelo receiving this massive block of marble from the quarry?
Overwhelming to most humans but the structure of understanding into which Michelangelo receives the slab of marble allows him to begin his production. His 18 feet of sculpting work. Chiseling. It took 2 years.
He was under contract to create a David but exactly how and what he created emerged from the structure of the receiving context he received this massive block of marble - into.
For a narrative therapist (or supervisor), what is created from the ecology of a therapists relational receiving context is delivered through a therapeutic question. That is our work. Our chiseling. And this one therapeutic question has a family of origin and be traced back to a relational ecology of the receiving context.
This one little therapeutic question represents an entire production of how the client story was received and responded to. The relational ecology of the receiving context the narrative therapist or supervisor receives client stories into represents two Inter-related productions:
The ideological beliefs/values/experience the client story is received into, and,
How the receiving context produces a single question that is consistent and coherent with the context the story was received into.
The challenge for the narrative therapy informed therapist is, a) there must first be a clear understanding of the relational ecology of the receiving context we receive client stories into and,
b) the therapist’s therapeutic ethos (character) is demonstrated through practices of accountability to produce a clear and coherent representation of this receiving context through the question asked.
Entering into each daily therapy session a narrative therapist must be prepared to articulate a solid understanding of any question asked and - exactly how the receiving context they received the client story into formulated the question.
This forms and frames how we go about supervision at VSNT.
And without this form of relational practice rigor and accountability a therapist and supervisor will necessarily and realistically need to lower their expectations of therapeutic assistance they can offer a client’s relational suffering. And . . . they may wish to inform clients of this beforehand.
Relational Supervision Practice
My long-time training partner, co-supervisor and good friend David Rock Nylund loves to use the following quote to kick off our supervision teaching:
Asking for consultation on a clinical case via notes or memory is like getting an art review by verbally describing your art instead of letting someone see it. If you want to improve your clinical skills, then you have to show your work” (Rousmaniere, 2017)
During a 1994 video interview I conducted with Michael White on the politics and practice of narrative therapy questions I asked him about the politic and practices of narrative training and supervision. Michael stated:
Therapy training and supervision must mirror the practices of
what goes on in the therapy room. Otherwise, I don’t see how therapists can take moral and ethical responsibility for the work they are doing.
VSNT Position on Relational Supervisory Accountability
Supervision discussions that do not involve the use of live sessions, up close review of video and/or unaltered transcripts of the session can always be helpful. However, they must also be viewed as fictional accounts of the therapist/client relationship and can be supporting of:
Erasure of client knowledge, experience and representation,
Inequalities of story-telling rights acting in support of dominant hierarchies of knowledge,
A pretense and pretending that one knows exactly what is going on in the client's relational story and through deductive reasoning they can translate what the truth of the client story is,
I’ll bring you back to a bit of Billy Collins:
I say drop a mouse into a poem and watch him probe his way out, or walk inside the poem’s room and feel the walls for a light switch. I want them to waterski across the surface of a poem waving at the author’s name on the shore. But all they want to do is tie the poem to a chair with rope and torture a confession out of it. They begin beating it with a hose to find out what it really means.
Best Tips for Choosing a Relational Supervisor
*Advice for students, therapists and agencies:
Before you choose a supervisor ask them to first show you their therapy work through 3 mediums: Live session, video, and unaltered transcripts.
Instituting these 3 transparent practices allows for joint actions of vulnerability and risk and allows one to witness the supervisor actually doing what they promise to supervise you on,
Insist on regular supervision through Live session interviewing, video + unaltered transcripts,
Insist the supervisor regularly shows you their recent and ongoing therapy practice, and invites you to supervise this work,
Insist on theoretical discussions mediated through narrative readings and/or the use of VSNT.live - that you read/watch together,
Resist any supervision accounts based only in case reviews and old war stories to avoid exaggerations, fictions, fantasy and expert knowledge regimes and practices.
What is an Unaltered Transcript?
I’m often asked by students and therapists and agencies what constitutes an unaltered transcript. An unaltered transcript is exactly that – it is completely unaltered from the tape it was recorded from. It is not shined up to look better and, under no circumstances, is the conversational language of the therapist or client altered – in any way.
Agency and independent therapists as well students undertaking supervision and consultation with VSNT must first agree to submit regular unaltered transcripts.
Below is a part way through portion of one of my anti-anorexic unaltered conversational transcripts for you to review:
SM: Yeah... Looking back is that a strategy that’s familiar for you to isolate you, have anorexia isolate you. Why does anorexia have a desire to isolate you from your husband, from your sister, from your friends?
Annie: Cause all the things like not eating and exercising I can only do alone. I can’t do that with other people.
Annie: Well it isolates me so, if I’m with other people, well it wins if it isolates me. Then I can go off and exercise and I don’t have to eat and stuff if I’m alone. If I’m with people it doesn’t win as much.
SM: Why is that? What’s happening to you relationally that anorexia is a lot less powerful when you’re in the company in relationship with others.
Annie: (long pause) Well cause when I’m with, you know, its just not as strong when I’m with others.
SM: Any hunches as to why anorexia loses its grip on you when you’re in the presence of other people you love?
Annie: (long pause) Well partly I don’t feel so alone and I mean I think it thrives on it when I’m alone. Like it takes, when I’m with other people they become more part of my head than it, right? Like I’m with other people, it gets me out of my head. You know?
SM: What is it about your relationship with other people - and I ask you this because I know that you are able and very skilled at establishing very close relationships in your life - what is it about being in the company of others in those relationships that is so unsupportive of anorexia and it’s goals for you?
Annie: Well I think I just feel part of something other than it and of myself, right. And like, I mean, for me my relationships have always been that thing that have helped pull me out of it, right. Like I am a very social person and I like being around people, I do, right, so it just doesn't have the strength when I’m with other people cause I feel - I guess that’s when I feel more joy, I feel, you know I don’t, in spite of losing my close friend I’ve actually made some really nice connections in the co-op this summer.
SM: Some new ones?
Annie: Yeah, really nice connections. And I think I am working hard to foster those more like in the last month or so.
SM: How so?
Annie: Well there was one day in the summer I totally didn’t, I mean - if I can explain it to you. We went on a camping trip, but we took a ferry with two kids, went one night, packed up and left and took a ferry home. And people were like ‘what? What are you doing?’ But I literally went because there’s like these three families that we have - our kids are similar ages right - and I have been working hard to make connections with them, I’m like because these are the families we’re going with. And I’m like ‘do I wanna go one night on a ferry?’ no but we did and it was a lot of fun, it was a lot of fun. So you know just doing things to sort of, yeah, make more connections with.
SM: So what effect does it have on anorexia the more you foster these relationships and are in the company of others?
Annie: When I’m with them I actually don’t feel it present as much, I don’t. You know like even the morning, for instance this was back in the summer, but it was totally, you know, Philipa a lady in my building, she was like “oh we went up to the farmers market before you guys got here Annie I bought you a gluten free muffin.” And right away my whole body was like, ‘I don’t wanna eat that’, but then everybody just started eating all this stuff and I did, I was like, ‘ok I’m just gonna be normal here, I’m just gonna eat it, right?’ but I never would have done that alone.
SM: Can you see why I’m curious as to how that’s possible? I mean it is possible, but what conclusions do you have that allowed that to be possible that seems when you’re on your own is impossible?
Annie: I don't know, there’s many instances where I think, so if I look back, whatever, if you wanna look back 15 years ago, I would never have, doesn't matter how many people I was around, would I have? No, I would not have eaten the muffin, there’s many things that are different now.
SM: Well was that a case of you being so terribly isolated?
Annie: Well yeah, but I think now that - and I’m saying this cause I only realize it right now - like when I, you know for the past three months I just felt like I was spiraling worse and worse and worse downhill, like almost back, I just felt like everything was getting worse and worse, I felt like I was eating less everyday but, you know I have to, if I look at moments, like the other night my sister in law made dinner and dessert, she’s like ‘Annie you just ate your dessert and your kids dessert cause they didn’t like it’, and I just felt like it was fine, but I never would have done that.
SM: Well, hold on...
Annie: So I don’t think its, if I bring myself out of it, its probably not as, I mean its not great but there’s moments where I have, where I don’t... you know?
SM: Can you see why I might be fascinated with these moments?
Annie: I’m only realizing them now, which I don’t think I even know they exist sometimes. Not until this moment did I even think of things, right now I’m just...
SM: Do you think that’s a tactic of anorexia helping you remember to forget anything that goes against your relationship with it and it with you?
If any of you are looking for a way to feel more comfortable with Live Supervision, Live Public Feedback and Creating Live Unaltered Questions in a super laid back and fun learning environment you may want to think about our November 12-14, 2021 course: Applied Skills of Narrative Practice (The Live supervision course with Rock, Todd and myself).
Man Reading, Janet McShain, 2018, McShain Studio Gallery
Best Tips for Choosing an Agency Supervisor
Common sense will instruct the agency to choose a supervisor who holds a practice history matching the agencies therapeutic context and culture.
Equally important, the chosen supervisor needs to hold a therapeutic practice history that matches what the agency wants the supervision conducted through, i.e. CBT inspired supervisors do not often do well in narrative therapy based agencies.
And, the chosen supervisor must find a fit within an agencies preferred ideological, political, cultural, gendered, racial and sexualities context and this is 100% decided by the agency staff, directors, board etc..
So . . . it goes without saying that if you are choosing a supervisor to supervise workers on an impatient adult eating disorder ward you will want a person who has a history of highly skilled work with persons, families, cultures and communities struggling with anorexia and bulimia, who works from a particular method the hospital is interested in exploring, fits the hiring profile and – who has (ideally) spent time working in an eating disorder hospital setting.
Best Tips for an Agency Choosing a Consultant
Consultant presentations at agencies fall into two categories: the therapy specific, and the non-therapy specific consultation.
The therapy specific consultation will usually address a particular agency focus within a particular therapeutic practice method and topic like, understanding the theory and practices of youth engaged in relationships to self-harm or, narrative therapy with gender violence, or with parents and children etc.
Non--therapy specific consultations are usually one-off enterprises. I’ve known of clowns brought in to ease stressful working conditions, people to teach meditation, offer financial advice, or give an update on government policies affecting social workers and counselors.
For years I have taken the position that whomever an agency hires for either a therapy specific or non-therapy specific consultation they should first audition the presenter. Yes audition.
Because there is absolutely nothing worse for agency moral than a worker in the agency making an independent decision to hire a consultation presenter for the whole agency - who ends up leaving the clinical staff disappointed, disconnected, upset, bored to tears, and possibly outraged.
There is also nothing worse for agency moral than workers being given time away from their daily work with clients only to experience this time off with the consultant - a complete waste of time.
I advocate to agencies that before they go about hiring a consultant, choose selected members of the agency team and give them the responsibility to interview, interrogate and audition a prospect consultant, well beforehand. Selected staff will only need to set up the interviews content based on what the majority of their co-workers desire, regarding exactly what they feel their agency needs, most.
Trondheim Norway Our 5-Step Relational Supervisory Commitment Framework
I have had the luxury of consulting with 2 combined family therapy teams working with High Conflict Couple Relationships for about 4 years.
Together we constructed our unique 5-Step Relational Supervisory Commitment Framework. It works for us
. . . have a look.
Step One: Supervision of unaltered transcripts: Each month two therapists produce a 7-10 minute unaltered transcript. of their narrative therapy informed Relational Interviewing couple co-therapy session.
Therapists translate the transcript (from Norwegian to English) and send this unaltered session to me one week ahead of time.
My job as supervisor is to interrogate and question the grammar, politic, direction, temporality, and relational receiving context of the co-therapists’ narrative therapy informed Relational Interviewing questions, offer up a series of alternative questions, situate these questions into the ecology of my receiving context, and review different cultural meanings of the questions and phrases: once they are translated.
A quick example. Two members of the team submit a transcript after writing the separated co-parenting couple’s relationship a therapeutic letter after the third session. They include the first letter and a transcript (10 minutes). After one of the couple reads their letter from the relationship addressed to the couple the following comment was stated and question was asked:
Client: It was" my assignment "(laughs). Now I wrote a lot, but this is the way I wrote it after the last meeting. Yes, I don't know if it was completely wrong, or?
Therapist : How was it for you to write this? It was after the last meeting, and you have written a lot ...
Alternative Questions to consider:
Were there any ideas the relationship was able to express that had not been expressed by you as a couple before?
Was there any point in particular the relationships perspective highlighted (brought into view/brought out into the open) that you most appreciated?
If you were to guess, what point in the relationships letter would you guess XX most enjoyed hearing?
What were the major feelings you experienced when you found yourself writing the letter from the relationship’s perspective?
Can you explain these feeling you experienced to us?
Moving further along into the interview and after having long discussions with the co-therapists and team members on locating the ecology of support, situating purpose, direction etc., and questioning sets of the co-therapists (in this case spectacular) questions, I paused and moved on to some ideas I’d written the week prior to the Team meeting directly into the transcript:
Team please Remember: Go slow. Hover. Because I feel there is so much of an opening XX has given you to explore.
For example: When you look out and onto the relationship from your relationships perspective are there specific values it might encourage you to move towards?
Do you feel these values are something the relationship would like to have back?
If the relationship was to re-find (re-collect) these values what direction might they allow the relationship to step towards?
You might notice that these questions above afford the couple time to speculate/imagine and provide a guide for possible movements and a preference of direction.
When you look back upon your therapy questions (or are inventing questions in the session) it is helpful to feel the movement in them.
These questions afford the relationship to state a preference/preferred direction. These questions are designed to (hopefully) create a movement in the couple relationship as to what they moved away from and what they would like to move towards.
The questions allow the relationship to realize that relationships are always in movement = they are not static/stuck in one place. In fact, the relationship can occupy many different landscapes at one and the same time.
Step 2. Live Therapy Demonstrations with Response Team:
Pre-Covid I travelled to supervise the teams in Trondheim Norway either twice or three times throughout the year.
During the on-site supervisory and consultation visits family therapist high conflict team members provide conflicted couple relationships for me to interview in Live Therapy (sessions conducted in English). The selection process regarding which particular couples the high conflict team wants interviewed always offers us with a wide and complex learning surface.
Family Therapist High Conflict Team members (and twice Family Court Judges the teams work with have been present) sit behind the one-way screen and form the role of the ‘Relational Response Team”.
All RI couple therapy sessions are video-taped and I place them in our supervisory RI learning archive.
Part way through the pandemic we began seeing couples Live on Zoom and use the 4 step Relational Response Team live session format. We feel it is important the supervisor continue to show these Live demonstrations of their own practice during Supervision.
4-Step Relational Response Team Interviewing
I created the Relational Response Team interview method during my MFT Doctoral Studies based on Norwegian psychiatrist Tom Andersons Reflecting Team model. I went to visit him and spoke with him about his model. I then re-constructed a different version to fit with narrative therapy practice. I then developed a 4th stage of reflection, response and transparency (originally written about in my dissertation.)
Our Relational Response Team format takes approximately 1.5 hours and consists of four distinct and related sections:
Stage 1) Interview: Performative Supervisor Therapist interviews couple relationship with the team listening an taking notes behind the mirror, 45 minutes,
Stage 2) Response to Interview: Each team member responds to the session specific to their personal experience and where the conversation personally transported them. The therapist and couple relationship present in the same room is listening on, and taking notes, 15 minutes +,
Stage 3) Response to Response: Therapist invites the couple relationship to respond back to the team’s personal responses, with the team present and listening on, 15 minutes,
Stage 4) Supervision: Team and couple join together to ask ‘supervisory’ questions of the therapist about why they asked the questions they asked in the RI couple therapy session, 15 minutes +.
Step 3. Reflections on Questions and Letters:
The team initially began with members submitting and distributing two Relational Interviewing questions from their couple sessions to be shared and discussed at their team meetings (building up an RI question archive).
*More recently team members have been submitting session questions to me (each question written out in Norwegian and English) and then as a team we investigate the ecology of the receiving context the questions were inspired by. We have investigated relational letters through this same process.
Step 4. Additional Rough Notes for Supervision
As the Team supervisor I am responsible for providing the content for ongoing discussions. This includes keeping the Team updated on any new developments in the practice of narrative therapy, and all new ideas on the practice of Relational Interviewing with conflicted couple relationships.
Step 5. VSNT.live Membership
Added to the Trondheim supervision VSNT offer’s each Team supervision member full access to their narrative therapy online learning platform VSNT.live.
Supervisory Team commits to scheduling out team meeting times to come together to watch and discuss specific narrative theory and practice demonstrations on VSNT.live.
During May 2021, I taught in VSNT’s faculty Advanced Practice 5-day accredited course on Relational Supervision alongside two of the Trondheim Teams senior members Elin Bjøru and Stein-Roger Brønseth.
As part of her discussion Elin relayed to the veteran international Advanced Narrative Practice learning audience her: Recent Survey of the Couple Conflict Team Supervision Experience. Her questions included:
What significance has the supervision with Stephen and the team had for you and for your professional and therapeutic development?
A) What significance has the supervision with Stephen and the team had for you and for your professional and therapeutic development?
B) Has the supervision been different from other guidance you have had - and if so, in what way?
Thanks to you Elin, the team's leader Stein Roger, and all our wonderful colleagues on the Trondheim high conflict family therapy teams for adding a new form of participatory feedback and a further method of relational accountability for our supervision.
Hoping to see all of you soon.
Thanks to all of you narrative therapy readers who managed to read all the way down to the bottom.
Please let your friends know they can read this and all past newsletters here.
If you’d like, contact me directly.
I look forward to the coming days where I can see many of you, again.
Until such time I wish all of you all of the best.
A Young Woman Studying, Stephan Ussing,1898, Private Collection