It never ceases to amaze me how bright, psychologically-minded clinicians miss the obvious when it comes to examining their own work. There seems to be a blind spot in regard to self-awareness. Here is a case in point. Recently, I attended a conference on supervision in psychotherapy. One of the keynote speaker’s main points was the importance of safety in the supervisor-supervisee relationship, a point well taken. I remember hearing Harville Hendrix say the same thing during a talk on couples’ therapy. He said that more than anything else, couples report that they value feeling safe. But several times during the course of her presentation, the keynote speaker made it clear that working with her wasn’t necessarily safe.
First, in the spirit of openness, she told a story of her own countertransference toward an intrusive patient. Dr. X told the assembly of several hundred clinicians that her practice was in her posh home, a 5th Avenue brownstone. Uhmm, I thought to myself–“she’s bragging”. Would she have told us this detail had her office been in less posh living quarters, like a studio apartment in Queens? I don’t think so. But this is not the end of the story. She told us that the shared bathroom was next to her bedroom, one flight above the treatment room. The patient in question, a celebrity (no less) had after using the bathroom, wandered around and peeked into her bedroom only to find her bed was unmade. The patient’s imagination was sparked by this and wondered what the unmade bed said about the emotional state of her psychotherapist. Who knows what it meant. The point is that the patient was placed in a highly charged emotional position, tempting her voyeuristic fantasies. But rather than take responsibility for setting up the scenario, Dr. X was furious with the patient for snooping. What she didn’t consider was that she was part of the problem. Having a home office blurs a boundary, most certainly when the treatment room is in the living quarters. It occurred to me that Dr.X had created an over stimulating environment by having the shared bathroom next to her boudoir and that some patients would find this too enticing to ignore. The treatment was contaminated and hence unsafe.
Second, Dr. X wanted to demonstrate her style of supervision with a volunteer from the audience. Before beginning the demonstration she turned to the audience of several hundred people and said:” We all agree to keep these proceedings confidential”. I almost laughed out loud. Can you imagine?. At the very least, there must have been at least several members of the audience recording her presentation. I think the more authentic disclaimer would have been to turn to the volunteer supervisee and say: ” Be aware that nothing that you say here is confidential”. This was another unsafe moment. But for me the most unsafe moment came next.
The presentation had been scheduled for a morning and afternoon session with a lunch break in between. The talk was running over time and so the demonstration was about to begin too close to the planned break . Instead of putting off the demonstration until after lunch, Dr. X unilaterally decided to extend the morning session when she said:” I hope you’re all not starving but we’ll continue this session for another 40 minutes past the scheduled beginning of the lunch break.” The unspoken message is that her needs trump everyone else’s, hardly a safe place for a patient to be.
