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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