Supervision for Professionals

Dr. Pitta is available for supervision for mental health professionals.  She has been supervising psychologists, social workers and licensed mental health professionals for the past twenty years.  Dr. Pitta created “Integrative Healing Family Therapy” which integrates Systems, Psychodynamic, Behavioral, Cognitive Behavioral, Communication as well as the Mind- Body Connection theories.  Dr. Pitta has published extensively within the field of psychology and family therapy.  She is available for individual and group consultation.

An Integrated Supervisory Model

Published in Family Psychologist, l995, APA Publications

The supervisory experience is one that enables a supervisee to explore his/her processes of treatment, recognize and deal with personal limitations and expand strengths and understandings of individual and family interactions.  In a successful supervision one learns to: establish clear and realistic goals, appreciate boundaries, and help the supervisee to develop greater respect for contextual variables and relationship difficulties while evaluating patients' issues and conflicts realistically.  By familiarizing the supervisees with processes of differentiation, de-triangulation, and setting healthier boundaries, they can learn to enable others to resolve conflicts.  Through a heightened awareness of perceptions and feelings, individual achievements can be extended, and shifts
can be made to deal more effectively with situations in a broader context.

Having been in the field for 20 years, I have come to realize that working from a single therapeutic ideology is too limiting and narrow in perspective.  Training in a variety of approaches makes for a therapist whose conceptual and technical skills are more developed than one who has been trained in one approach (Mikesell, Lusterman & Mc Daniel, l995; Pitta, l995).  Therefore, an integrative theory that utilizes an "ecosystemic approach" which includes Bowenian, Psychodynamic, Objects Relations, Comprehensive Family Therapy, and Communication theories enables supervisor and supervisee to be more effective and efficient (Lusterman, l985).

When working with a supervisee I want to understand his or her functioning as part of a larger whole. I want to know about family interactions (3 generations preferably).  This is accomplished by obtaining a genogram (Pendagast and Sherman, l984; Kaslow,l995). When the supervisee presents the genogram, I use the systemic philosophy of Bowen (l985), Kerr and Bowen (l988), Guerin (l984), Guerin, Burden, and Fay (l987), and Fogarty (l984).   I become familiarized with the levels of anxiety, fusion, triangulation, differentiation, conflict, and cut-offs within the supervisee and the family system they come from.  I identify triggers and countertransferential issues that present difficulties (stuckness); for example, a male supervisee overfunctioned in his family of origin.  The question I posited was, "Is this a process that goes on in the therapy setting with clients?"  While the supervisee presents the genogram, I look for contextual variables (Walters, Scrafford, Cunningham, Leitch & Levner,l992; Leitch, l992)) such as gender, race, ethnicity, marital status, family position, geographic location, and socio-economic factors (table #2).  I identify patterns and issues in the case, looking at transmission process and repetition of behaviors within the supervisee's life, (Bowen, l985) and how this may translate in the supervisee's style, messages within, and/or perceptions; for example, a supervisee was working with a family that demonstrated a projection process of blaming others for their lack of progress. The supervisee was willing to accept such blame from this family, thus maintaining stuckness in treatment.  We referred to her role in her family of origin where she took responsibility for family problems. In identifying this pattern, she was able to alter her own perceptions as a therapist and identify for her clients their projection process.  This enabled therapy to become unstuck.                                             
Throughout the supervisory process, the following concepts are referred to and discussed to assist the supervisee to enable the patient or family to develop in a more orderly and integrated manner: pursuit and distance (Fogarty, l984), triangulation (Fogarty, l984),fusion, anxiety level, transmission
processes (Bowen,l985), introjection, identification, and relationship to self functioning (Freud, l959), splitting(Scharff & Scharff, l99l, l992), reparenting skills(Kirschner & Kirschner, l986), and communication and negotiating skills(Guerney,l977). This theoretical framework is presented at the beginning of supervision.  At this time I also present a Theoretical Flow Chart describing these theoretical orientations (Table 1). I also present a flow chart of Contextual Variables (Table 2) which enables the supervisee to identify in what context this patient or family functions and how these variables influence life choices and actions.  We also discuss supervisee's triggers or countertransferential issues at the beginning of supervision and throughout the supervision (Table 3). These flow charts provide road maps which are often referred to when supervisees attempt to work through "stuckness" with sessions or cases (stuckness defined as: supervisee cannot help patient's progress as a result of lack of knowledge of theories,  application of theories or techniques, or  experience and interference of countertransferential issues).  Supervisory Techniques and Outcomes are also discussed during the session (Tables4,5).  Also we refer to the Supervisory Checklist(Table 6) at the end of the session to evaluate and define what processes and issues were discussed and utilized in the session.   Fogarty(l984) has noted that we can take clients as far as we have gone in our own development.  We repeat patterns of behavior whether within the self, nuclear family, extended family, or society in general. Who we are in our family of origin is who we are in our office. 

Following is a case example and presentation which demonstrates the use of the model:

Case Example:
The supervisee, a 33 year old, white, Jewish male (contextual variable) was a psychologist who requested my supervision of his cases on a fee for service basis.  When beginning the supervision, the supervisee presented a genogram of his family including 3 generations. He had an intact marriage of 8 years and was in a close, somewhat enmeshed relationship with his aging parents for whom he was responsible. He is the eldest son in a family of three male siblings. His father was a passive- aggressive man who was ineffective as a husband and father but was a good provider. The supervisee was a caretaker and the overresponsible one in his family of origin, as was his mother in her family of origin (generational transmission process)  He worked( through his own therapy) for years on making that relationship more manageable and this enabled him to differentiate and individuate himself.  As a child and teenager, he colluded with his mother about his father's cruelty and insensitivity. This put him in an overclose relationship with his mother and at the same time he experienced a distant and angry relationship with father (enmeshment).  This collusion left him feeling guilty, angry, and passive, and his male identity in terms of role assertion was confused.  His marriage was an intact one, but could be described as a rescue marriage (Wallerstein & Blakeslee, l995). Initially, he was primarily in the rescuer mode,  but the marriage was growing, becoming one of more equality and mutual nuturance.  His wife was a dependent, passive, and angry woman who was also working on separating from her family of origin. The relationship with his two children was fraught with the usual struggles of raising children.  His inability to be assertive and to deal effectively with their manipulation was repetition of the family transmission process of his family of origin and extended family (theoritical explanation).  

Case Presentation:
The supervisee presented a genogram of the family at initial sessions and updated the genogram as more information was obtained.  This family was an intact family where the wife was the overresponsible one and the husband was a depressed escape artist. They had two teenage children.  The presenting problem was the 17-year-old son who was found with drugs (marijuana and ecstacy) and was demonstrating poor school performance, arrogant attitude, and non co-operation in the household.  Upon presentation, the supervisee became anxious and threatened by the symptomatology of this family.  It set off the old records of people asking for help for something he did not know how to handle (drugs). Throughout his life his mother had asked for assistance with her emotional life which he did not understand and which overwhelmed with. (countertransference).  The supervisee had no experience working with drug involvement and understanding the theoretical underpinnings of working with families with drug issues. I advised him to send the teenager for a drug evaluation to a local hospital (referral to other specialist). I suggested he read about addictions and treatment in the family (knowledge and theoritical enhancement).  He worked with the parents who had real difficulty in being assertive and insisting that their son go for such an evaluation.  The supervisee was not insistent at first because of his fear of losing the case and also the repetition of his role in his family of origin to side with the underdog (countertransference issues). As a result of our conversation, the supervisee identified, processed, and dealt with his countertransference issues (his passivity and fears).  At that point, he was able to challenge, teach and support the parents to become more assertive and to take responsibility for their enabling their son to act out.  

The supervisee became unstuck and empowered in confronting his passivity and enabled his patients to do the same.

When working with many theories in an integrated manner and being sensitive to contextual variables and countertransferential triggers, we enable our supervisees to get in touch with their limitations and enhance their strengths, which enables them to help their patients in a more effective and efficient manner.  The use of flow charts is a means of presenting the model, setting a systems of checks and balances to evaluate the progress of both the supervisee and his or her patients; and promoting more effective growth and competency based supervision.

Bowen, M. (l985). Family Therapy in Clinical Practice. New York, Jason Aronson.

Fogarty, T. (l984). Operating Principles. The Best of The Family l978-l983, Compendium II, 25-40.

Fogarty, T. (l984). The Distancer and the Pursuer. The Best of The Family l978-l983, Compendium, 45-51.                            

Fogarty, T. (l984). The Family Organization. The Best of The  Family l978-l983, II, 51-59.

Fogarty, T. (l984). The Therapy of Hopelessness. The Best of the Family l978-l983, II, 59-65.

Fogarty, T. (l984). The Individual and the Family. The Best of The Family, II, 71-77.

Freud, S. (l959) Collected Papers. Volumes 1-5. New York, Basic Books.

Guerin, P., Burden, S., Fay, L. (l987). The Evaluation and Treatment of Marital Conflict. New York, Basic Books.

Guerin, P. (l984). Theory and Art of Family Therapy.  The Best of The Family l978-l983, II, 3-8.

Guerin, P. & Chabot, D. (l984-l992). History of Psychotherapy- A Century of Change. Ed. Donald K. Freedheim, American Psychological Association Washington, D.C., l992.  The Best of The Family,III, 3-23.

Guerney, B. (l977) Relationship Enhancement. San Francisco, Jossey-Bass.

Kaslow, F. (l995) Projective Genogramming. Florida, Professional Resource Press. 

Kerr, M. & Bowen, M. (l988). Family Evaluation, New York, W.W. Norton & Company.

Kirshner, D. & Kirschner, S. (l986). Comprehensive Family Therapy. New York, Brunner/Mazel.

Leitch,L. (l992) Explicity Recognizing Contextual Influence Broadens Our Scope of Inquiry. The Supervision Bulletin, Vol.V.

Lusterman, D. (l985) An Ecosystemic Approach To Family School Problems. The American Journal of Family Therapy,Vol.13, No.1.

Mikesell,R., Lusterman,D.& McDaniel,S. (l995) Integrating Family Therapy: Handbook of Family Psychology and Systems Theory; Washington, D.C., APA.

Pendagast, E. & Sherman R. (l973-l978). Guide to a Genogram. The Best of The Family , I, 101-112.

Pitta, P. (l985). Adolescent-Centered Family Integrated Philosophy and Treatment. Psychotherapy, Spring, Vol.3. No.1. 

Scharff, J. & Scharff, D. (l992). Scharff Notes: A Primer of Object Relations Therapy. New York, Jason Aronson.

Scharff, D. & Scharff, J. (l991). Object Relations Couple Therapy. New York, Jason Aronson.

Wallerstein, J. & Blakeslee, S. (l995). The Good Marriage. New York, Houghton Mifflin Company.

Walters, M.,Scrafford D.,Cunningham, D., Leitch, L., Levner, L. (l992). The Process of Contextual Supervision. AAMFT 50th Conference.

Whitaker, C. & Abrams, G. (l974) New Approaches to Residency Training in Psychiatry. In G. Farwell, N. Gamsky, & P. Mathier-Couoglan (Eds.), The Counseler's Handbook. New York: Intext