The network that helps the therapist: the importance of supervision in a psychotherapy case
When we tell patients that we must learn to be with suffering and accept that we cannot always be effective, we must remember that this also applies to us.
Advertising message Here we are, the time has finally come to really get involved! I have been practicing for years, studying, preparing for this day, for this moment, and now we are there! Finally the first patient arrives! What an emotion…
Of course, it’s not the first time I’ve ever followed a patient. During the formative years, during the internship, I have seen them cooked and raw, but the context was completely different. Behind me there has always been the tutor, ready to help me in times of difficulty and to remedy my mistakes. But now it is time to leave your comfort zone and experience yourself in a different context. And so, a little by chance, a little luckily, I was contacted by the first patient to be followed in private.
I felt like when, as a child, I cycled for the first time without the wheels. I felt “great” and, at the same time, very frightened. While pedaling I looked for my father, hoping that he was ready to catch me, but slowly the awareness that it was now a bit too far away and, if I fell, the only thing ready to welcome me would have been the asphalt . Of course, not pleasant, but as they say in my part, “you don’t go further down the ground”, and therefore I took courage and threw myself into this new venture.
When Laura, my invented name, rang the bell in my studio, my heart was beating faster and I could hardly keep my hands from shaking. Then we sat down, started talking and all the tension was gone. I dropped into the role of psychotherapist and completed the first interview.
Laura is about my age, but that’s not the only thing we have in common. We both do the same job, and I’m not talking about psychology. During the years of specialization, to make ends meet in some way, I worked as an educator at a social cooperative. And Laura is also an educator. The cooperative is not the same, but the dynamics are practically identical, also because we live in two villages very close to each other and, for this reason, very similar.
I immediately realized how many things we have in common. To be honest, I thought they helped us build a good therapeutic relationship. And maybe it was. Of course, I admit that sometimes some of the situations you recounted triggered me more than I wanted, but initially I managed to keep in mind which pieces were of the patient and which were mine.
But then life events got in the way. I will not go into detail, but suffice it to say that during one of the various services that I carry out for the cooperative I suffered an injury and for me it was a rather tiring moment. Maybe I should have taken a break, but obstinate and stubborn I thought, wrongly, that I would be able to manage everything. Damn Wonder Woman Syndrome!
The moment of the weekly session with Laura arrives and we start talking. Even for her this is a difficult moment and an important role is played by her job. We do the ABCs and, going down in laddering, I realize that much of his dysfunctional thoughts were mine too. And how do I dispute thoughts that I myself cannot question? I was trying to be rational, but I could not find the words to convince her, but above all myself, that those thoughts only made us struggle and that, to continue to brood in that way, would not have helped us at all.
And it is at that moment that I realize how similar we were actually, even physically. Both rather tall, rather thin, with a very similar hairstyle, we also dress in a similar way. Cabbages … how many chances were the first patient, the one to get out of the comfort zone, really my duplicate? We also like the same TV series!
Realizing this sent me extremely confused. Everything went through my mind … “She too will suffer my own injury”, “will I really be attuning to the patient or what I actually feel is a piece of mine and not hers?”, “I really should have stopped, I was so worried by the idea of giving her a hole and being yet another person who does not listen to her and does not see her that I risk making a mess “, and so on, down in judgments, self-insults, anger, sadness, guilt, ruminations ( exactly as you do, I want to underline it).
In a phase of life in which I was overwhelmed by events, being in front of one’s duplication equally overwhelmed for similar reasons made me feel strongly inadequate. What kind of therapist is the one who is unable to manage and help the patient? Sure, every patient activates something in the staff therapist, but I wasn’t prepared for all this. In my short experience as a budding psychologist I made some mess, but in the context of the internship I felt safe and in some way I had always managed to remedy, thanks also to the help of the tutor. I was prepared for the possibility of not being effective, but not so early and not with a case that I feel so close to.
And yes, because in all this we must add that Laura really feels very close to me and I care a lot about her. She is an ideal patient, she follows you and has great introspective abilities. Although he is going through a difficult moment, he does not lose heart and does everything he can to try to get out of it, even too much … not for nothing, brooding, brooding, brooding, brooding … From the first session I realized that it was not a simple panic attack disorder. Laura has a varied personality, a tiring past and a strength and a will that she herself does not recognize.
With that narcissistic side mixed with the cross-red spirit that we all psychologists have, I thought I could really be of help. Unfortunately, however, my assurances were starting to falter.
Should I have sent it?
We have to say it all. In reality I was not prepared for the possibility of having to send Laura to another psychotherapist. I realized that I had entered the alarm cycle with all my shoes and that I had taken some methodologically wrong steps, and for this reason I asked the teachers for help in understanding how to move.
How do you see the experience! A glance was enough that they immediately told me to stop and reflect on what I was doing and that, of course, I would have had to work on myself first to overcome my difficult moment. Of course, now I say of course, at that very obvious moment it was not … To put it in LIBET terms: I activated my beautiful immunizing plan and I started to not hear (say redundant, exactly like Laura does!).
This beautiful truth, slapped in front of the eyes, was like a frozen shower. I wasn’t ready to stop, I didn’t want to hear it. Too busy with my work dramas, I did not realize that I was writing the real drama by myself in the profession for which I invested so much and to which I care very much.
“Ok Elena – I said to myself – we have to face reality. What are you doing?”.
I have always been very grateful to my teachers, but in this moment more than in others. I understood that the first and most important thing to do was to ask for supervision. An external eye, much more experienced than me, could have helped me clarify my ideas.
Not so much about the patient herself, I had it very clear in my mind, and equally clear I had the various techniques and protocols that we could have used. But all this is useless if we do not first exit the alarm cycle and do not stop using the act not to hear. But if I myself don’t believe in my disputes, how can the patient believe it?
Advertising message When we tell patients that we must learn to stay with suffering and accept that we cannot always be effective, we must remember that this also applies to us. Thanks to the process-oriented supervision, that is the one directed to ask “how am I with the patient”, “what am I doing problematic?”, “What is the discomfort I had during the sessions”, I realized that when I am particularly emotionally activated and when it comes to issues that are so close to me (and painful), it is not easy to question oneself. How much do I accept that I am told that that clinical act, those emotions with that patient, are the result of a painful story of mine, right in the area that this patient touches? Well,
I had to sleep on it before I realized that those words were more than sensible and that I should have done something about it.
I was reminded of a professor at the university, who said that in order to enter the patient, we must always have a safety net ready to pull us out, otherwise we risk remaining in the belly of the whale. And the safety net is precisely the colleagues and supervisors. We don’t understand the meaning of these words until we go into the whale’s belly, until we feel a little Jonah, alone and in the dark, inside something that we don’t know and that scares us a little. It was clear to me that the whale represented pain, but that the pain was as much to the patient as ours, I had not fully understood.
Supervision is fundamental to understand the patient, to understand if we missed something, if we made technical errors, of course, but supervision is even more important to get us out of the whale and make us see clearly that in the end that is an immense animal , majestic but almost harmless, which feeds on plankton and which does not attack man. Only an external gaze can help us understand this, because sometimes, when we have our heads under water, we do not notice how deep we are. Feeling suffocated, we do not realize that it would be enough to rest your feet and raise your head to be able to breathe again.
Currently Laura’s therapy is continuing. We took time to “not do” and to be with our painful emotions. Our similarities have become strengths in the therapeutic alliance and together we are taking some steps forward. And all this was only possible thanks to the supervision and support of colleagues.
One thing is certain … I will not give up my safety net!