The Need for Safety in Clinical Supervision

Author(s): Robert S. Pepper

Source: Group , Vol. 42, No. 1 (Spring 2018), pp. 55-58
Published by: Eastern Group Psychotherapy Society
Stable URL: https://www.jstor.org/stable/10.13186/group.42.1.0055

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group, Vol. 42, No. 1, Spring 2018

The Need for Safety in Clinical Supervision

Robert S. Pepper1

In preparation for my workshop at the Adelphi Conference on Clinical Supervi-

sion, I decided to focus most of the short session on my research (Pepper, 2014).
This decision was based partly on the fact that I didn’t know beforehand the level of
experience of workshop attendees, what their goals were for our workshop, or even
how many participants had registered. I wanted all of us to be on the same page, so
to speak, and thought that a brief lecture on my findings would be a good place to
begin. My basic thesis is that, at many group training institutes across the country,
there exists a conflict of interest between the organizations’ need to treat and their
need to train. Independent of theoretical orientation, and the personalities of lead-
ers, abuses of power often occur when the boundary is blurred between therapy
and not-therapy. The need to treat is clinical, and the need to teach is educational.
To combine both under the same roof contaminates both. Training institutes can’t
have it both ways, because there are both ethical and clinical consequences to this
blurring of boundaries. While this axiom applies to analytic institutes for individual
psychotherapy as well as to institutes for analytic group therapy, the probability
of treatment contamination is exponentially greater for analytic group institutes
because of the increased likelihood of many different types of combinations and
permutations of blurred boundaries in the group setting.
But when some of the participants were incredulous that such things existed,
finding it difficult to believe that teaching and training actually took place under
one roof at some training institutes, I decided I had to change course and focused
instead on the more general issue of the need for safety in the supervisory relation-
ship. There was a consensus among the attendees that this would be a better place

1 Director of Training, Long Island Institute of Mental Health. Correspondence should be addressed
to Robert S. Pepper, LCSW, CGP, PhD, 110-50 71st Road, #1E, Forest Hills, NY 11375. E-mail:
[email protected].
issn 0362-4021 © 2018 Eastern Group Psychotherapy Society

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56 pepper

to start. While the audience consisted of a mix of clinicians with varying work
experiences and levels of training, all were eager, bright, and inquisitive about the
issue of secure boundaries. Despite their differences, the members were closely
matched in their psychological sophistication. As a result, we were able to make a
smooth conversational segue, since the keynote speaker of the conference’s opening
plenary, Dr. Rebecca Shahmoon-Shanok, emphasized the importance of safety in
the supervisor–supervisee relationship. I believe this a point well taken. I remember
hearing Harville Hendrix say the same thing during a talk on couple therapy. He
said that, more than anything else, couples report that they most value feeling safe
in a relationship (Hendrix, 2013).
Several attendees picked up on this thread and gave examples of instances where
supervisors paid lip service to the need for safety but didn’t abide by it in their
work. I supported this point and said that it never ceases to amaze me how bright,
psychologically minded clinicians miss the obvious when it comes to examining
their own behavior. There seems to be a blind spot in self-awareness. I’ll recount
some excerpts from our workshop where participants shared their experiences with
blurred boundaries in supervision. My role naturally evolved into an organic op-
portunity to link their examples to the eight dangers of blurred boundaries, which
I describe in my book.
For instance, Melinda2 gave an example of her supervisor, who, in the spirit of
openness, shared a story of his own countertransference toward an intrusive patient,
not realizing that he may have been part of the problem, inadvertently perhaps.
Nonetheless, in the process of telling her the story, he may have revealed more about
his dark side than he had consciously intended. The supervisor told Melinda that
his practice was in his posh home, a Fifth Avenue brownstone. Sam, a workshop
participant, said, “It sounds like he was bragging.” Would he have told Melinda
where his home office was had it been in less posh living quarters, like a studio
apartment in Queens? The group didn’t think so. She also told us that the shared
bathroom between the living quarters and the treatment room was next to his
bedroom, one flight above the treatment room. The patient in question had, after
using the bathroom, wandered around and peeked into the bedroom only to find
the bed unmade. Barry, another participant in the workshop, added that the patient’s
imagination might have been sparked by this, wondering 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, the supervisor told Melinda that he was furious with the patient for
snooping. What he didn’t consider was that having a home office blurs a boundary,
most certainly when the treatment room is in the living quarters. It occurred to
Melinda that her supervisor had created an overstimulating environment by having

2 All names have been changed.

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The Need for Safety in Clinical Supervision 57

the shared bathroom next to his bedroom and that some patients might find this too
enticing to ignore. The treatment was contaminated and hence unsafe. This was an
example of one of the eight dangers that I call overstimulation, which occurs when
the clinician’s transparency is too arousing for patients. It often occurs when treat-
ment takes place in the home office setting, where too much of the therapist’s real
life is on display and largely out of the therapist’s control and conscious awareness.
Interestingly, Melinda shared with us that she didn’t confront her supervisor with
her view of what had happened. When someone asked why not, she said that she
feared that the supervisor would become defensive and not be open to looking at
the scenario from another point of view. In fact, she feared the worst. She believed
that the unspoken message of the supervisor’s attempt at openness was in reality
“Don’t cross me, even if I’m out of line.” She told us that she had felt inhibited. I
pointed out that her inhibition was an example of another one of the eight dangers
of blurred boundaries, the one that I call the conspiracy of silence.
Another attendee, Marty, recalled having seen a senior clinician at his analytic
institute do a demonstration supervisory session with an audience volunteer at a
training conference. He reported that he had to laugh because, prior to beginning
the demonstration, she turned to the audience of several hundred people and said,
“We all agree to keep these proceedings confidential.” “Can you imagine?” Marty
said. “At the very least, there must have been at least several members of the audi-
ence recording the proceedings.” I said that a 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 instance of an unsafe environment
and an example of another danger of blurred boundaries that I call breaches of
confidentiality. I then told the group about an article (Pepper, 2015) that I recently
wrote about the illusion of confidentiality in any group setting. One finding was
that, from a legal perspective, any communication between more than two people
is not protected by laws of confidentiality. As a final example, Lois told us a story of
having attended a supervision training seminar where the presenter broke another
type of boundary that left her feeling unsafe.
The presentation had been scheduled for a morning and afternoon session, with
a lunch break in between. The talk was running overtime as the speaker was about
to begin the next section of his talk, which was now too close to the planned lunch
break, but instead of putting it off until after lunch, the presenter unilaterally decided
to extend the morning session when he said, “I hope you’re all not too starving, but
we’ll continue this morning session for another 35 minutes.” While others may have
seen this as no big deal, it was a big deal to Lois. It meant that she was not being
consulted in a plan change that affected her. It felt like a control issue—the speaker
was pulling rank on the audience. Lois felt insulted and unsafe but said nothing, and
neither did anyone in the audience of more than a hundred clinicians. Barry said
that he had been at the same conference and was shocked by his own passivity and
that of the audience. He asked himself, “Why didn’t I speak up and at least question

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58 pepper

the speaker’s decision to change the group contract without any discussion?” Lois
said that she read the speaker’s unspoken message to be that his needs trumped
everyone else’s, hardly a safe place for a supervisee—or a patient, for that matter—to
be. Here was another example of one of the eight dangers that I call the emperor’s
new clothes effect. In this case, no one confronted the speaker’s fait accompli and
thereby colluded with him against themselves and protected his narcissism.
As our workshop drew to a close, I asked the group for any final comments.
Rachel said that she thoroughly enjoyed the discussion. She said that it was thought
provoking. Michelle said that she hadn’t realized how complicated boundary issues
could be. Harry lamented that the meeting was ending while there was so much
more to discuss. The group agreed that they would be most interested in continu-
ing our discussion at a future conference. I was very pleased with the intensity and
insightfulness of the group interaction. It reaffirmed my belief that the subject of
boundaries is an often overlooked but nonetheless necessary topic for all clinicians
to consider.

REFERENCES

Hendrix, H. (2013). Making marriage simple: Ten truths for changing the relationship you
have into the one you want. New York: Harmony Books.
Pepper, R. S. (2014). Emotional incest in group psychotherapy: A conspiracy of silence.
Lanham, MD: Rowman and Littlefield.
Pepper, R. S. (2015). Is group therapy inherently unethical? GROUP, 39(2), 159–160.

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