Download XVII WORLD CONGRESS OF SEXOLOGY MONTREAL 2005

CLINICAL SUPERVISORS’ HANDLING OF SEXUAL ATTRACTION IN THE
WORK OF THERAPISTS THEY SUPERVISE
DR MARIA LUCA, SENIOR RESEARCH FELLOW, [email protected]
and
DR DESA MARKOVIC, PROGRAMME DIRECTOR PSYCHOTHERAPY AND COUNSELLING
[email protected]
UKCP 18 July 2015, Luca & Markovic
1
CONTEXT AND AIMS
Reflections Research Centre RUL: Maria Luca, Desa Markovic&
Palacky University Czech Republic: Martin Lecbych, Marek Kolarik
Examine how supervisors handle sexual attraction as a
phenomenon within the domain of therapy
Ways of managing the situation, dilemmas, questions, strategies
Develop analysis of this complex phenomenon, patterns in
conceptualising, and handling in supervision
Implications for clinical practice, training and supervision
UKCP 18 July 2015, Luca & Markovic
BACKGROUND TO THE TOPIC
Psychoanalytic literature on erotic and eroticised transference and
countertransference in therapy (e.g. Blum, 1973, 1994; Bolognini,
1994; Bollas, 1994; Bonasia, 2001; Covington, 2000; Gorgin, 1985;
Gould, 1994; Guttman, 1984; Kumin, 1985; Lester, 1985; Luca,
2003; Mann, 1997; Orbach, 1999; Parsons, 2000; Person, 1985;
Rappaport, 1956; Silverman, 1998).
Luca, M. (Ed) (2014): from the psychoanalytic model of pathology to
normalising the phenomenon.
Supervisors’ handling of sexual attraction in their work?
UKCP 18 July 2015, Luca & Markovic
RESEARCH METHOD
GROUNDED THEORY:
A set of systematic inductive methods for conducting qualitative
research aimed toward theory development (Charmaz, 2003)
Comprehensive explanation of a process or a particular
phenomenon
‘Construct oriented’ approach (e.g., creating categories that describe
patterns in the data)
Useful common language that researchers can work from as they
build a body of knowledge and seek to impact practices (Corbin &
Strauss, 2008)
UKCP 18 July 2015, Luca & Markovic
This diagram explains how a
researcher chooses a type of GT
29/10/2014 Dr M Luca
Distinctive features of grounded theory
Grounded theory has certain distinctive features that
distinguish it from other forms of qualitative analysis (see
Wertz et al. 2011). What are the distinctive features of
grounded theory? This method:
• Provides explicit tools for studying processes
• Promotes an openness to all possible theoretical
understandings
• Fosters developing tentative interpretations
about the data through coding and categorising
• Builds systematic checks and refinements of the
researcher’s major theoretical categories.
Kathy Charmaz (2012) ‘The Power and Potential of Grounded Theory’. A Journal of the BSA MedSoc Group The
Power and Potential of Grounded Theory Medical Sociology online 4 Volume 6 | Issue 3 | October 2012
29/10/2014 Dr M Luca
Charmaz asks the following questions
to help the coding process:
What is going on?
What are people doing?
What is the person saying?
What do these actions and
statements take for granted?
How do structure and context serve to
support, maintain, impede or change
these actions and statements?
29/10/2014 Dr M Luca
nitial or open Coding
Remain open
Stay close to the data
Keep your codes simple
nd
precise
Construct short codes
Preserve actions
Compare data with data
Move quickly through the
ata
Code or Label words and
phrases found in the
transcript or text.
pen coding is the initial step of
eoretical analysis, developing
odes from the data. This form of
Selective or Focused
Coding
Axial coding
Directed, Selective
and Conceptual
• Which of the initial
codes make the most
analytic sense to
categorize your data
incisively and
completely?
• Not entirely a linear
process
Axial coding
consists of
identifying
relationships
among the ope
codes. What ar
the connection
among the cod
•
Create Themes
Categories by
grouping codes
labels given to
RESEARCH PROCESS
Semi-structured individual interviews
Research question: What are the ways of clinical supervisors’
handling of issues of sexual attraction in the work of therapists they
supervise?
Discuss situations; Strategy to manage? Any specific issues? Do
therapists find it easy / difficult to talk about it? What influences this?
How often does the issue arise? How does it help to bring it up? Can
talking about this complicate the situation? What factors can hinder
a discussion? Gender differences in the readiness to present? Any
ethical dilemmas?
UKCP 18 July 2015, Luca & Markovic
RESEARCH PARTICIPANTS
Twelve experienced psychotherapists & supervisors
More than ten years supervision experience
Academic lecturers and training supervisors, researchers and
authors
Psychotherapy orientation: existential, psychodynamic, systemic,
integrative, humanistic
Four had specialisation in psychosexual therapy
Varied background: gender, age (40-75), culture, sexual orientation,
professional affiliations
UKCP 18 July 2015, Luca & Markovic
DATA ANALYSIS
Transcripts analysis: developing concepts and conceptual
categories through a systematic coding
Constant comparative analysis.
Induction, deduction, abductive reasoning and verification to
develop theory
Researchers develop hypotheses, ideas, insights and questions that
drive further data analysis and refinement of the theory.
Conditions, context, action / interactional strategies and
consequences of the researched phenomenon (Strauss & Corbin,
1990).
UKCP 18 July 2015, Luca & Markovic
UKCP 18 July 2015, Luca & Markovic
SUPERVISORY ALLIANCE
Supervisees have to trust and feel safe that they can
bring something and it’s going to be taken seriously
Talking about SA enhances supervisory alliance
Not just talking about it, but to create a safe environment
where you’re not being judged
Supervisors’ sensitivity to power imbalance is crucial
UKCP 18 July 2015, Luca & Markovic
CONTAINING AND SUPPORTING
Talking about erotic interplay can feel containing
Affirming what’s been done well and reassuring
Checking it gives permission to talk about it. Supervisees
may feel threatened / need to support
Gentle encouragement
Allow explicitness
Need to take it seriously
UKCP 18 July 2015, Luca & Markovic
NORMALISING
Acceptance of the difficulty to talk about it
Naming what’s going on can break the taboo
Encouraging supervisee to acknowledge her
attractiveness
Being open that it happens to all of us
There has to be normalisation before supervisor can
help
UKCP 18 July 2015, Luca & Markovic
CREATING A CONTEMPLATIVE, OPEN
ATMOSPHERE
Supervisory space is where the taboo of SA needs to be
broken
Supervisors must be more ready to open such a difficult
issue up
We create together a space where we can think and
think about the meaning
Creating a relaxed attitude
UKCP 18 July 2015, Luca & Markovic
CONSTRUCTIVELY CHALLENGING
Constructive challenge of the supervisee
Asking direct questions of supervisees’ feelings &
conveying the importance of not blocking feelings
UKCP 18 July 2015, Luca & Markovic
DISCUSSION
SEXUAL ATTRACTION AS A TABOO
Infrequently brought to supervision (‘infrequent’;
‘oblique’; ‘rarely’)
Brought up ‘indirectly’
Attached to shame
‘Transference’ can close down conversations
Supervisors’ responsibility: ‘I should do more probing’
UKCP 18 July 2015, Luca & Markovic
IMPLICATIONS FOR PRACTICE
WHY IS IT IMPORTANT?
Shame and embarrassment: unhelpful impact on therapeutic
relationship
‘If therapists are not prepared this might happen, they fall into all
sorts of traps with it.’
‘It’s dangerous not to talk about is because it may be very disturbing
for the supervisee and may contaminate the work.’
‘Probably it is at the root of a lot of abuse of clients by therapists.’
UKCP 18 July 2015, Luca & Markovic
IMPLICATIONS FOR TRAINING
Essential
Existing training inadequate
Not covered at all
‘Sex, sexual relationships and sexual attraction in therapeutic
relationship should be mandatory’
‘It is not only about sexual development and issues of sexual
orientation. We have to include functions of sex, how people have
sex, how sexual attraction works…’
UKCP 18 July 2015, Luca & Markovic
CONCLUDING REFLECTIONS
Taboo
Highly relevant to discuss in supervision
Supervisors’ responsibility
Conditions for effective handling: Encouraging, facilitative and nonjudgmental handling
Supervisory alliance, Containing & Supportive, Normalisation,
Contemplative and Open Atmosphere, Constructive Challenge
Need for more research, inclusion in training
UKCP 18 July 2015, Luca & Markovic