Attachment in Supervision

Report
Attachment and supervision - giving
difficult feedback
Nadja Krohnert
This presentation draws on the presentation given at the Group of
Trainers in Clinical Psychology conference in 2013 called
‘Challenges to the supervisory relationship: What is our role as
trainers?’ by Jenny Davies, Clinical Tutor, Lancaster & Ruth
Butterworth, Academic Tutor, Birmingham
What is Attachment?
“Through a positive reciprocal relationship
children learn to modulate affect, soothe
themselves and relate to others. Attachment is the base
from which they explore. Their early attachments form their
concepts of self, others and the world”
(Bowlby, 1951)
What is Attachment?
Bowlby asserts that people have evolved a
predispositions to form and maintain strong bonds with
individuals on whom they can rely on for protection and a
sense of security in times of need, and that attachment
experiences continue from ‘the cradle to the grave’ ,
(Bowlby, 1977, p203)
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Tie based on need for safety
Universal phenomenon
Based on biological instinct
Relevant across the lifespan
The Dance of Attachment
Babies indicate their needs using ‘attachment
behaviours’ (crying, smiling, clinging etc) to ensure
protection, comfort, survival
Caregivers respond in different ways
Babies find behaviours that increase positive and
decrease negative responses in caregivers
Based on these attachment-caregiver interactions,
babies develops an ‘internal working model’ of self /
others / the world
Example where there is attunement ..
Baby has
needs
Trust
develops
Baby
cries
Needs
met by
caregiver
Group exercise: Internal Working Models
and Supervision
If an infant’s carer responds:
a. by consistently rejecting the child
b. by consistently and sensitively, meeting the child’s need
c. Inconsistently
d. abusively
What beliefs will they develop about themselves?
What beliefs will they develop about other people and the
world?
What will they learn to do (behaviour)?
Forward 25 years or so
How might this look in supervision?
What feelings might this elicit in a supervisor?
‘Attachment styles’
Parent/Carer
Infant
Adult
A
Rejecting
Avoidant
Dismissive
B
Sensitive
Secure
Secure
C
Inconsistent
Ambivalent
Preoccupied
D
Chaotic / abusive
Disorganised
Fearful
Dismissive (A)
Secure (B)
I am comfortable without close
emotional relationships. It is very
important to me to feel independent
and self-sufficient, and I prefer not
to depend on others or have others
depend on me.
(rejecting  avoidant ….)
It is easy for me to become
emotionally close to others. I am
comfortable depending on others
and having others depend on me. I
don't worry about being alone or
having others not accept me.
(sensitive  secure ….)
Preoccupied (C)
Fearful (D)
I want to be completely emotionally
intimate with others, but I often find that
others are reluctant to get as close as I
would like. I am uncomfortable being
without close relationships, but I
sometimes worry that others don't value
me as much as I value them.
(inconsistent  ambivalent ….)
I am uncomfortable getting close
to others. I want emotionally close
relationships, but I find it difficult to
trust others completely, or to
depend on them. I worry that I will
be hurt if I allow myself to become
too close to others.
(chaotic / abusive  fearful ….)
Bartholomew & Horowitz (1991)
Compulsivity – common patterns
Compulsive care-giving (commonly an ‘A’ strategy)
• Unwillingness to accept help from others, while
simultaneously taking on a care-giving role and
prioritising others’ needs
Compulsive self-reliance (A)
• Extreme form of avoidant attachment characterised by
excessive self- sufficiency, distancing, mistrust and fear
of dependency on others
Compulsive care-seeking (C)
• Excessive care seeking and undue reliance on
attachment figures for care and assistance
(Bowlby, 1977 / Pistole & Watkins, 1995)
Attachment and Clinical Psychology
Broadly when measures of ‘attachment styles’ are used the
patterns of clinical psychologists are comparable to the wider
population
In a study trainees self-identified themselves - 53% secure,
28% preocupied, 10% fearful, 3% dismissive (Dickson et al, 2010)
Compulsive care-giving is the most common ‘compulsive’
strategy and is unrelated to ‘attachment styles’ (Leiper &
Casares, 2000)
Compulsive self-reliance is the strategy most strongly
associated with a poor working alliance in supervisory
alliances (Dickson et al, 2010)
In context: Attachment and supervision
Human beings have an evolved predisposition to
form and maintain strong affectional bonds
with individuals on whom they can rely for
protection and a sense of security in times of
need (Bowlby, 1977)
The challenges of the supervisory (and training)
process may activate the attachment system for a
new supervisee, who may in turn seek the
closeness and safe haven of the supervisor for
support and guidance (Bennett, 2008)
Supervision aims …..
To provide a professionally secure and
reliable base from which individual trainees
can explore and develop their professional
identity and skills
In doing so, to provide a model on which
trainees can base the provision of a secure
environment for their clients
Pistole & Watkins (1995)
But - there’s an alternative definition …..
‘An intervention that is provided by a senior
member of the profession to a junior member
or members of that same profession. This
relationship is evaluative, extends over time,
and has the simultaneous purposes of
enhancing the professional functioning
of the junior member(s), monitoring the
quality of professional services to the
clients that he, she or they see, and
serving as a gatekeeper for those who
are to enter the particular profession’
(Bernard and Goodyear, 1998)
‘The secure trainee’
Connections have been shown between
secure attachment and:
• Self–reflection
• Meta-cognitive processing
• Empathy
• Recognising the inherent subjectivity of
perceptions
Connections have also been shown between
the ability to empathise and to think critically
Bennett & Deal (2009)
Surprise: supervision is a dyadic process!
Relationship-specific attachment is a stronger predictor of
supervisory alliance than general attachment style
For example
• The Supervisee may generally use ‘secure’ strategies but
becomes distant with a supervisor who is perceived as
unsupportive
• The Supervisor may not offer a high level of support due
to their general attachment ‘style’ (e.g. ‘dismissive’), or
because of interactive or wider systemic factors (e.g.
pressured by the time of service issues)
If one partner in the relationship is generally secure, they
may be better able to tolerate the insecurity of the other
Bennett (2008)
The supervisory challenge …
If the idea of attunement and
consistency is key to healthy attachment
styles – how can we …..
• Start noticing our own and our trainees
styles
• Adapt our supervisor style to help
meet the needs of the trainee.
For trainees employing an ‘A strategy’
-rejecting  avoidant dismissive
- Compulsive self-reliance
Expressed needs
Hidden needs
• Autonomy
• Keeping the supervisor at
arm’s length
• Avoid thinking about their
own feelings / experience
• ‘I know better than you’
Supervisee as caregiver
• Praise
• Reassurance
• Permission / encouragement
to explore anxiety
• Permission / encouragement
to accept support
• Start to integrate feelings
into primarily cognitive
narrative
For trainees employing an ‘C strategy’
inconsistent ambivalent  preoccupied
Compulsive care-seeking
Expressed needs
Hidden needs
• Reassurance
• Praise
• Rescue – supervisor being
there whenever needed
• Support to explore and
regulate feelings
• Structure
• Encouraging autonomy and
problem solving
• Celebrating independence /
achievement of specific
goals
• Support to introduce
cognition / coherence into
predominantly affective
narrative
Exercise 1 – supervisor giving feedback
Observe dvd and reflect on:
• How the clip makes you feel
• How you think the supervisee is feeling
• How you think the supervisor is feeling
Points following discussion of dvd…..
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•
•
•
Dan Hugh’s work can provide a helpful framework for
thinking about the attachment framework as something
nurturing while also needing to set boundaries.
Beginning supervision with a helpful check in ‘How am
I: how are you: how are we’ can help keep reflection on
the quality of the supervisory relationship core to the
task. It also help to level power imbalances.
Does the literature on ‘delivering bad news’ have
anything to tell us about difficult feedback?
(unfortunately we ran out of time …. It was generally
acknowledged that lots more ideas could have been
explored).
In Summary: Overarching goals for
supervision...
• Create a secure base from which to
explore
• Provide a ‘safe haven’ and allow the
trainee the experience of emotional
attunement
• Remain open and curious - attempt to
respond to both expressed and hidden
needs
• Use our own supervision to reflect on what
is happening for us in terms of attachment
Discussion
and
What are you taking away
from this session?
References
• Bennett, C.S. (2008). Attachment-informed supervision for social work field
education. Clinical Social Work Journal, 36, 97-107
• Bennett, S. & Deal, K.H. (2009). Beginnings and endings in social work
supervision: The interaction between attachment and developmental
processes. Journal of Teaching in Social Work, 29, 101-117.
• Bowlby, J. (1977a). The making and breaking of affectional bonds I. Aetiology
and psychopathology in the light of attachment theory. British Journal of
Psychiatry, 130, 201-210.
• Dickson, J.M., Moberley, N.J., Marshall, Y. & Reilly, J. (2010). Attachment style
and its relationship to working alliance in the supervision of British Clinical
Psychology trainees. Clinical Psychology and Psychotherapy, DOI:
10/1002/cpp.715
References continued ..
• Leiper, R. & Casares, P. (2000). An investigation of the attachment
organization of clinical psyhcologists and its relationship to clinical practice.
British Journal of Medical Psychology, 73, 449-464.
• Pistole, M.C. & Watkins, C.E. (1995). Attachment theory, counseling process,
and supervision. The Counselling Psychologist, 23(3), 457- 478.
• Slade, A.(2008). The Implications of Attachment Theory and Research for
Adult Psychotherapy. . In Cassidy, J. & Shaver, P. (Eds) Handbook of
attachment: Theory, research, and clinical applications. New York: Guilford
Press.
• Thompson, R. (2008). Early attachment and later development: Familiar
questions, new answers. In Cassidy, J. & Shaver, P. (Eds) Handbook of
attachment: Theory, research, and clinical applications. New York: Guilford
Press.

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