Parallel Process in Clinical Supervision

Critical Analysis

The parallel process is concerned with the psychoanalytic conceptions of transference and countertransference. The process of transference originates when the counselor is responsible to the presentation as well as emotional issues of the therapeutic relationship under the supervisory clinical authority. Countertransference takes place when the supervisory authority responds to the counselor in the similar way that the counselor responds to the clients (Sumerel, Marie B., 1994). In this way, the clinical supervision is replayed or parallelized with the counseling interface which can be identified by an acute awareness and discreet receptiveness of one’s individualistic issues or events which generate such problematic issues or circumstances (Sumerel, Marie B., 1994). As this definition demonstrates, “Parallel process originally referred to a phenomenon in which therapists unconsciously replicate the problems and dynamics of their clients during supervision (Parallel Process, 2008).

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In Concurrent Loss: A Challenge in Supervision, Joan Beder points out how the Concurrent Loss may occurs major issues for the supervisor as well as supervisee of medical or non-medical fields where the worker has to experience problematic issues due to the lack of harmony and responsibility of both counseling clients and supervisors to tackle the fundamental issues (Beder, 1998). The feelings of loss may be evaluated symbolically or physically, having different forms of loss e.g. sequential loss, truant loss, multiple loss, concurrent loss etc. when a counseling client and worker or supervisor experience such forms of loss coincidently, it is known as concurrent loss.

The feeling of loss or grief due to death of loved one causes the reactionary and complex issues on the behalf of the workers who have to experience the confrontation with the impotence of a counselor in the distinct ways. Resultantly, the worker has to face stressful situations due to the frustration and anger, creating a concurrent loss as the clients or counselor may have to recognize his issues painfully (Beder, 1998). When counselor and client are struggling with the similar kinds of fears or losses, it would be major impediment to develop effective counseling. When a counselor is constantly under the stress of death, fear, personal vulnerability and sense of morality, the worker may entangle with the emotional crippling and discomfort which would inhibit the effectiveness of counseling.

It is argued in Concurrent Loss: A Challenge in Supervision, the emotional burden of anger, depression and despair may create complex kind of feelings in the worker and client which may be prominent in the situation of concurrent loss. There is a need of self-monitoring or self-controlling such reactionary emotions which may enhance the effective supervision (Beder, 1998). The problematic issues of concurrent loss between supervisor and supervises can be tackled by restructuring the agency or organization. There should be encouragement of exposure of grief and latent concurrent loss by the organizational supervisor. It is necessary to discuss and acknowledge concurrent loss by the staff of the agency or organization to find out better solution (Beder, 1998).

In Implications of Intersubjectivity for Supervisory Practice, Cheryl-Anne Cait elaborates how intersubjectivity plays significant role to have detailed study of the emotional history of the patients and psychological analysis. The therapists can’t treat their patients objectively while exchanging therapeutic dialogs to understand the internal psyche of the patients (Cait, 2006). The application of intersubjectivity on the therapeutic process develops awareness about the significant role of interaction of two subjectivities and dynamics that may be emerged when two people try to recognize the independent self-inherent in each other (Cait, 2006). Kron and Yerushalmi (2000) explain arguably how different factors of our selves are affected through our interaction and communication with other individuals of our social setups. What is the significant role of intersubjectivity in the supervisory process?

Firstly we need to analyze critically what aspects of the supervisee have been identified by the supervisor? Secondly we need to evaluate what aspects of the supervisor’s innerself are exposed candidly via direct communication with the supervisee? Thirdly, we need to consider how to implement all such dynamic features by merging subjectivities influence discussion of the patient and course of therapy. Lastly, what aspects of selves direct the supervisee to the therapeutic and how the patients are influenced by the dynamics in this process of therapeutic (Cait, 2006). Several trained counselors play role models by following different theoretical approaches. These approaches are the reflective measures to get knowledge psychological difficulties. The basic objective of counseling strategies should encourage the clients to step ahead from environmental support to self-support, assisting him or her to develop self-awareness (Charalambous and Cyprus, 2003).

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In Beyond Parallel Process: Relational Perspectives On Field Instruction, Ganzer and Ornstein (1999) elucidate the implications of the contemporary relative perspectives for the improvement of our understanding about the conceptual parallel process in supervisory relationship in the workplace. The concept of parallel process, put forward by Harold Searles has been instrumental for the training and supervision of psychotherapists which is also known as “the reflective process” to develop the critical relationship of supervisor-supervisee (Ganzer and Ornstein, 1999). The supervisor is responsible to monitor his reactions and conflicts to supervise and treat the clients or patients as objective counselor rather than subjective one. The feelings, issues and reactions of the supervisors plays role as a diagnostic indicator, recognizing the supervisee’s self-motivated and self-reactionary issues (Ganzer and Ornstein, 1999).

The parallel process has been an influential tool for therapeutic impasses to identify unconscious patterns in transference or counter-transference transactions. There is a need of understanding the parallel process via investigating the supervisory transactions in the context of the psychoanalytic and psychodynamic supervision (Ganzer and Ornstein, 1999). The psychological approach about self-organization by Kohut is very supportive for the supervisee to explicate all latent emotions. In exposing the supervisee, the supervisor has to validate, acknowledge and understand the supervisee’s inherent trends, reactions and feelings. The parallel process is very assistive to maintain the impartiality of the supervisors to eliminate the fearful experiences of the clients and only effective supervision can be developed when the supervisor is award of her reactions and willing to repose their drawbacks (Ganzer and Ornstein, 1999).

Hope plays vital role to recover seriously ill patients by pointing out the elements of positivism and optimism to encourage in the state of severe despair and distress. If the clinical supervisors treat the patients hopelessly, then they never help the patients to come out of the despondency and uncertainty (Itzhaky and Ethawi, 2004). The patients can’t overcome their feelings of hopelessness and helplessness if the therapists treat them roughly without any encouragement. According to Itzhaky and Ethawi (2004), Supervision is the most significant of social workforce, developing the professional personality with great competency. It is the personal responsibility of the supervisor to evaluate the individualistic issues of the supervisee and respond to them with immediate solutions. The supervisor should be compliant and polite to deal all patients and their family to repose their feelings of greater success easily.

Itzhaky and Ethawi (2004) put forward the best conceptual approaches of positivism and negativitism to tackle the interpersonal issues of the individuals. The supervisor should support the supervisee to develop such preferences among the clients as mechanism for handling the negative approaches via positive strategies of hope. The supervisor may provide their supervisee the definite supervisee or indicator of feelings of hopelessness or despair via practicability of cognitive techniques (Itzhaky and Ethawi, 2004).

For the assimilation of our feelings and emotions, there is a need of effective supervision which identifies such concealed feelings by using such professional practice and fundamental skills. If the supervisors are more care-giving to the clients or patients, it would formulate the perfect model of clinical supervision (Jones, 1997). The supervisor should develop such perceptive power that he may determine and perceive every kind of feelings like compliancy, envy, gratitude or despair or dejection of the ill patients easily. For the perfect clinical supervision, there is much importance of sense of responsibility to enhance the self-recognition, verbal behaviors and understanding of the clients, family and workplace. The clinical supervision is way of supervising the critical interplay between patients and counseling supervision to boost up the relationship of superviser-supervisee via self-direction.

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In Death, Poetry, Psychotherapy and Clinical Supervision (The Contribution Of Psychodynamic Psychotherapy To Palliative Care Nursing, the author suggests that the involvement in a therapeutic relationship with a dying person may assist the work with parallel struggles, disclosing the preliminary feelings which require discreet supervision. Caring for a dying person is a big challenge for the palliative care workers. Clinical supervision helps the supervisors to perceive the feelings of fear of impending death, poverty, fear, helplessness and hopelessness, striving hard to alleviate the pain and suffering. The proper psychotherapy of a person, facing the ultimate death is a proper way to discharge the burden of unnecessary anxiety and fear (Jones, 1997).

With the growing advancement in the contemporary health care department, the responsibility of providing psychological support for the wretched and dying person is shifting from physicians to psychologists, social workers, nurses and counselors. The death cases may provoke more discomfiture in the counselors rather than other problems which they have to encounter as therapists as the suicidal clients vary to evaluate the counselors’ level of experiences (Kirchberg et al, 1991).

One of the most popular but controversial aspect of clinical supervision is the parallel process in which it is assumed that the process between supervisor and supervisee is the transcript of psychotherapist and client. The parallel process is a very old concept with empirical formulas to boost up the further structural study or analysis of the clinical supervision. It is the best way to understand intrapsychically and interpersonally perspectives of supervisor and supervisee’s emotional growth. There is a need of knowing the significance of the most complex interaction between patient, psychotherapist and supervisor which unite them systematically (Mothersole, 1999).

A mental health counselor should have some specific qualities for the successful and effective clinical supervision as all his individualistic traits affect directly MHC students how such personal qualities affect the assessment of supervisors in evaluating the skills, behaviors and knowledge of the students in this supervision (Pearson, 2004). The supervisors have reported the certain qualities of the supervisee which are significant in learning psychotherapy supervision. Such psychological qualities are as followed: psychological-mindedness, interpersonal curiosity, intuitiveness, openness, dependability, professional expertise, introspectiveness, receptivity to feedback, clinical flexibility, personal and theoretical approaches, enthusiastic and motivated spirits, eagerness and interpersonal curiosity etc. Such certain personal traits are demonstrated to expose the behaviors and personal dynamics of participates during the process of therapy and clinical supervision.

The supervisor has to play his roles as teacher, councelor and consultant in motivating the supervisees how to react and behave in the certain troublesome situation. The supervisor or counselor may explore the personal reactions of the supervisee or trainee by self-recognition. For the effective supervision, the qualities of supervisors like availability and approachability are very functional as all supervisees feel comforts in taking assistance and guidance from such supervisors who are available and willing to guide them properly. Careful reflection and preparation of supervisory plans or authoritative encourage the supervisee or clients to be more flexible and dependable as counseling process has main elements of spontaneity, challenging issues and surprises, creativity, frustration or happiness etc. the supervisors’ behaviors can be evaluated to explore their anxiety and conflicts via proactive or reactive responsiveness of the clients or students (Pearson, 2004). In clinical supervision, there is no more significance of counselor anxiety, parallel process, transference or countertransference and it is dependable how the supervisors strives to normalize the anxiety during supervision process. There are some consequent drawbacks including evaluation anxiety, internal conflicts or performance anxiety, deficits in supervisory relationship, fear of negativism (Pearson, 2004).

There is a constructive and prominent difference between the work of clinical psychologists and the wider range of psychological knowledge to activate all professional groups who are involved in rehabilitation of the adults. The effectiveness of healthcare center is optimized when the psychological approaches, underlying interpersonal communication are understandably applied to develop the awareness of people’s basic psychological needs as patients in clinical department.

It is very essential to improve the understanding of interpersonal communication and training in communication skills as main part of curriculum of health professionals e.g. skills of history-taking, discussing treatment options, describing treatment compliance and fundamental counseling in palliative health care center (Rees, Wilcox and Cuddihy, 2002). An awareness of the effects of hospitalization upon the patients’ behavior is very essential for rehabilitation process. The distressful conditions of the patients or clients may be perceived by the supervisors, good or bad impacts are determined by the supervisory staff. A comprehensive ability to know the psychological needs is very helpful in such state of minds of ill patients facing dying situation, the assistance of clinical psychologist colleagues is very valuable to enhance the additional skills of consultancy and communicative powers (Rees, Wilcox and Cuddihy, 2002).

The supervisory relationship may contain complex multi-faceted interpersonal dynamics which may cause some unresolved issues for both supervisor and supervisee. In the perfect relational model, the knowledge and understanding can be developed by supervisor-supervisee reciprocal involvement and collaborative efforts, interpreting the implications of supervisor-supervisee relationship (Ringel, 2001). When a supervisor is monitoring in the context of death or dying fears, existential issues, certainty of one’s life, fear of death and fittest of survival are significant in the supervisory process, complex relationship of transference-countertransference dynamics between supervisor-supervisee. Accordingly, it is determined that the main role of supervisor is to develop self-awareness and constant self-observation and reflection, supporting the student face and examine her feelings or attitudes toward death. It is very significant to facilitate the interpersonal processes between the supervisee and supervisors to enhance closer interactions (Ringel, 2001).

The supervisory process is very complicated; pin pointing out the questions whether supervisors can augment therapeutic effectiveness for supervisees to organize their personality and relational functionality (Schamess, 2006). The clinical supervision should be designed in this way that all educational and therapeutic goals can be achieved easily. The best supervision always enhances the understanding of the supervisees unconsciously, promoting the empathy, clinical skills, and functionality of egoistic spirits via expansion of relational capacity of the individuals (Schamess, 2006). For clinical learning process, cognitive, effective and relational capacity is interlocked to modify the mental approach of others significantly.

This perception proposes that limitations between cognitive and effective learning and those between professional and personal development are assimilated so deeply in the ways of traditional supervisory literature has been ever disinclined to acknowledge (Schamess, 2006). The latest research and reports has shown that the supervisors are familiar with the supervison’s transformative potentiality by developing professional and personal features via symbolic communication which are effective to displace negative traits with the improved positive supervisory relationship (Schamess, 2006). The supervisors and supervisees reproduce the preliminary features of the problematic relational patterns supervisees support the patients. Consequently, the parallel process correspond the important information about the undistinguished problems supervisees have to encounter with the patients, helping the supervisors to understand supervisee-patient impasses (Schamess, 2006).

The supervisees learn more via actual practicability as supervision is not taken as therapy. Essentially, the supervisors are vulnerable to therapeutic relational functioning with their supervisees; ultimately there would be poor model of practicability and lack of good performance (Shulman, 2005). If we analyze clinical supervision through psychodynamic approach, focusing on transference, countertransference, defensiveness and unconscious processes, there would be primary care via reproduction of supervision via parallel process. The supervisors have to face the challenges to grasp the significant influential role within the clinical workplace, creating space for clinical supervision and reflective approaches. The supervisors may understand the utilization of countertransference and multiple transference relationships via intersubjective approaches, clearly visible by counselor-client relationship. The clinical supervision may support the counselors how to manage and organize the disrupted thinking and feelings for the development of counseling paradigm.

The counselors have to make great efforts with dichotomy between clinical supervisory models as well as counseling paradigms. The counselor contributes greatly in developing appropriate health care settings where the main focus is on human nature, the difficulties of patients, having effective communications, reflection and collaborative practice. The counselor helps to develop psychological insight into emotional and somatic complexities, evaluating the complex emotional reactions like managing envy, psychodynamic perspective and dynamics (Stewart, 2004).

The article, ‘Clinical supervision, death, Heidegger and Freud come ‘out of sighs’ ‘, written by Yedich (2000) is well conceived, explaining some phenomenal aspects concerning a topic that’s usually not looked into in the modern era. Yedich explicitly depicts Heidegger’s ontological hermeneutics and Sigmond Freud’s psychoanalyses, two Psychologists whose schools of thoughts are studied till date. Although both their perceptions and schools of thoughts contradict, Yedich has taken some commendable efforts in comparing and contrasting the perceptions about death–both by ontological and the ‘id’—deep unconsciousness one possesses.

The case study employed in this article for comparison, was unique in a sense that a dying patient has to counsel herself, coupled with the fact that she has to also counsel her young child and her depressed husband. It explains as to how ‘strong’ Lindsey has to be and face the situation, and not face the fear of death. She loses hope in herself and faces anxiety, and eventually plans to seek the support of the nurse. However, time runs against her, and she dies.

Many aspects of Heiddegger and Freud were looked into; many angles were studied, which made the study even more authentic. Yedich also compared Schutz, Jones, and Husserl’s perception about death, and their theories, and these diverse aspects added essence to his article.

Yedich has dug deep in explaining how ones ego is so strongly governed by his sub or unconsciousness within. He has compared this psychological aspect with the contradicting views proposed by Heidegger, that one’s anxiety or fear of death is in the intellectual thought process—it’s the thought that governs everything.

This beautiful comparison of two entirely different perceptions about death ultimately yield the same result, i.e. silence, and this silence too is elegantly compared. Yedich then digs deep in explaining Heideggers limitations of thinking- ‘Being is unknowable’ against Sigmond Freud’s perception that the ‘unknown is unspeakable’. This galvanizes the perception about death by the different schools.

Although many horizontal angles were evaluated, the author failed to take a three dimensional approach in this particular case study. There was potential of a ‘vertical’ analysis of the two psychologists, the study was mostly superficial. In particular, the immense amounts of research and schools proposed by Sigmond Freud were not discussed, and there was a slight inclination towards Heideggers perceptions.

Yedich could have compared and contrasted some other aspects about death, as proposed by other psychologists like Watson, whose studies on intuition were immense, and whose sample tests for anxiety are used till date. A comparative study by Watson and Freud about death would have been an interesting one.

Clinical supervision should not have been touched on so much in detail, as a nurse must handle such cases. However, transference could have been explained is it exists; which would have been another case study altogether, not to be mixed up with Lindsey’s fear of death. There was a lack of coherence, clinical supervision, and perceptions of a nurse differ from the fear and anxiety faced by a patient. Another comparative analysis on this aspect by Yedich will be interesting.

Overall, this was a good study, depicting one of the challenges that each of us will have to face each day. The case study was elegantly explained in detail, and the overall beauty of the article was the way Yedich so tactfully couples and compares different perceptions about a hard reality, ultimately resorting to a common conclusion.

Wells and her co-workers (Wells, Trad, and Alves 2003) have conducted a significant study on Parallel Processes of supervising and training supervisors simultaneously with trauma therapists. Wells has made use of the ‘top-down’ process of supervision. Her studies depict the relationships and emotions depicted from both conditions i.e. top-down and bottom-up, simultaneously, thus studying a thorough flow of emotions, which further helps in the therapeutic process.

Wells tries to make the therapies for trauma driven clients much more efficient by first, training the therapist and second, by training the supervisor of the therapist, and she wants to do this simultaneously. To make her study more significant, she makes use of ‘freshmen’ i.e. both, the therapist and the supervisor in training are new and inexperienced. She then employs several methods, and suggests ways as to how the supervisor and therapist can perform efficiently.

The article is well written and is explicitly explained. Wells has used several models of studies for comparison, and has tried to convince the readers that this parallel process of supervision is more effective. She has tried to establish a mutual level of trust and authority in the 2-way flow of emotions and feelings. Her suggestions regarding use of metaphors, and depicting the ‘butterfly’ example are well conceived, and worth mentioning.

Wells has touched on the sensitive issue of ‘shame’, and how the client is to overcome this, and likewise, how the therapist has to overcome this issue—this is a very good example of ‘parallel process’ therapy. Likewise, several other matters, like, a level of trust, or how and when to avoid, and counter transference are discussed in detail, and suggestions are proposed for improvements. The most significant issue prevailing among trauma driven clients is a sense of ‘believe’—the therapist must always believe in the client, and never make him feel as though he was lying. This can cause irreversible damage. Wells explains in detail, how this sense of trust can be developed in the client and likewise also in the therapist himself, and how not to break or shake the clients confidence, especially in sexual abuse cases, which is very sensitive issue. Already the victim wants to hide and not discuss this issue, and Wells goes deep in explaining how not to further damage the victims confidence.

However, the article has its shortcomings as well. There is alot of redundancy in facts. The matter of transference is discussed repeatedly. Likewise, the matter of the therapist or the supervisor in training having ‘authority’ and getting used to this newly attained position is over-emphasized. Likewise, I feel that the actual content into consideration, i.e. therapy of the traumatized patient is not discussed in detail. Wells could have proposed some tests or group lessons of both the therapist and supervisor, instead, she tried to train two people individually but simultaneously.

The efforts made by Wells and her co-authors are commendable, as the parallel approach proposed by her can be executed in almost all hierarchies – be it psycho-counseling, an academic organization, or an entrepreneurship. Her model of parallel processes can be employed in almost any employment scheme.

Main themes

Searles (1955) theorizes the parallel processes which display the patient and therapist, reflecting affinity or close relationship between therapist and supervisor. The supervisor reacts unconsciously to the emotions of the counseling agent, and the counselor respond similarly to the client, developing the parallel process. The counselor displays discomfort in the therapeutic relational functioning and working with the client (Sumerel and Marie, 1994). The parallel process takes place when the counselor shows the impatience, realized by the supervisor in the therapeutic relationship with the client. Ekstein & Wallerstein (1972) believes that the supervisory techniques are helpful for the counselors to learn how to implement themselves in the counselor-client relationship. The parallel process in clinical supervision creates self-awareness how oneself is engaged in the therapeutic and supervisory relationship (Sumerel and Marie, 1994).

In Concurrent Loss: A Challenge in Supervision, the author demonstrates how the concurrent loss takes place when the supervisors and counselors are exposing similar feelings of their losses simultaneously. The workers entangles with the burden of their losses, the supervisors play instrumental role in managing their receptiveness to the clients and their emotions (Beder, 1998). Beder (1998) asserts how the worker has to experience concurrent loss, related with the clients, supervisor and patients. The problematic issues of oneself are emerged from the complicated feelings of the supervisor-supervisees. The author tries to explore how the supervisor has to face challenges working with the supervisee, facing the concurrent loss (Beder, 1998). Beder (1998) categories the various kinds of feelings of loss including concurrent loss, sequential loss, truant loss, multiple loss, and secondary loss. The personal experience of the client loss through death of intimate ones perplexes the workers with the certain reactionary spirits. The counselor has to overcome his drawbacks in the most distressed state of mind which is directly affected by the supervisor-supervisee relationship (Beder, 1998).

The counselor shows the existential fear and anxiety of his death fear, self-recognition of morality and vulnerability. The professional experience helps the client to use his practical feelings of loss or greif to go ahead. Such intrarole conflict takes place when the workers applies their personal feelings and experiences in same situation of their own family, using their professional knowledge and awareness for identifying the clients’ suppressed feelings of loss, fear, frustration, despair and anger (Beder, 1998). There is a need of regression the personal feelings of loss, grief and fear when a counselor or clinical supervisory advisor is working with the client or patients who have same feelings and emotions. If the supervisor applies his own personal experiences and feelings of loss to the situation of the clients’ life, there would never be development of effective clinical supervision.

The basic theme of Implications of Intersubjectivity for Supervisory Practice is to enumerate the factors which affect the therapeutic work on the particular patient. According to the psychoanalytical theory, one-person psychology has main focus on the intrapsychic state of the patients. Psychoanalytic theory plays vitalr role to enhance the significance of countertransference in therapeutic encounter how the confrontation of client-patient feelings occurs consciously or unconsciously (Cait, 2006). There is a need of organize the most autonomous and distinct selves by entire negation, relating with others’ objects. It is very significant to value the self of the therapist by monitoring therapist-patient relationship. Discreet supervisor can mirror the inherent traits of the therapist which allows him to work with the patient objectively. The therapist’s experience of self influences his working with the client who struggle with such inner conflicts directly when he communicates with his client (Cait, 2006). It is very essential to organize the chaotic emotional state of mind of the counselors and clinical supervisors to enhance the effectiveness of clinical supervision. When all selves of the counselors are controlled organizationally, he would be capable of working with the client impartially without any interface of his personal experiences.

The author of Reflective Practice, Reflective Practice as a facilitator for learning, reflection is very important for clinical practice, developing critical ability to think, evaluate and move forward intelligently. By reflective measures, the medical practitioners are empowered to transform the contradictory issues which they encounter while clinical supervisory process. Reflective practice is very supportive to enhance the intellectual capabilities by exploring the inner-selves of the supervisors-supervisees (Charalambous and Cyprus, 2003). The reflective practice is very helpful for the clinical supervisors to tackle all kinds of the challenging issues. The clinical practice is a continual process to recognize the inner conflicts of their selves as well as their clients via process of self-awareness or psychoanalysis (Charalambous and Cyprus, 2003).

In any social workplace, particularly in medical health care center, there is a great significance of contemporary relational perspectives for the transformation of our sense of comprehensibility and supervisory counseling via parallel process (Ganzer and Ornstein, 1999). The concept of parallel process has direct relational perspectives with the psychodynamics supervision and critique of social work literature in paradigmatic and constructive way. The value of parallel process in clinical supervision is acknowledged by all psychologists and medical practitioners for organization of psychodynamic supervision where the interactive process is continuously going on between client and patient or supervisor and supervisee (Ganzer and Ornstein, 1999).

In Hope As A Strategy In Supervising Social Workers Of Terminally Ill Pateints, Itzhaky and Ethawi (2004) argues emphatically that hopeful behavior of the supervisors with their supervisees is very effective to produce productive results of clinical supervision. If the clinical supervisor creates hopelessness and helplessness among the seriously ill pateitns who are facing the dying situation, influenced by their personal feelings of loss or fear of death, there would never be effective supervision (Itzhaky and Ethawi, 2004). The pateints should be dealt leniently by the clinical supervision so that they may maintain their moral strength to struggle with their painful mental conditions, dying state of the pateitns.

In A ‘bonding between strangers’: a palliative model of clinical supervision Jones (1997) has presented perfect palliative model of clinical supervision to enhance the effectiveness of the supervisory authority. There is a strong bond among the families, nurses, medical practitioners and clinical supervisors to enhance the palliative impacts upon the clients via effective supervision (Jones, 1997). There is a complex interaction among all these supervisor-supervisees and counseling clients or patients for the development of palliative health care center. The parallel process of clinical supervision is very essential to enhance the clinical supervision for the development of professional practice (Jones, 1997).

Jones (1997) points out the main factors which are instrumental for the growth of supervisory effectiveness by having critical psychoanalytic influences upon the relationship of supervisor-supervisee through parallel process. The elementary aspects of clinical supervison is illustrated in this article, Death, Poetry, Psychotherapy and Clinical Supervision (The Contribution Of Psychodynamic Psychotherapy To Palliative Care Nursing. The supervisor suggests the therapeutic affinity with a dying person who works with a parallel struggle, manifesting the preliminary emotions of the supervisees (Jones, 1997).

The current health care center is responsible for the psychological support of the psychologists, social workers, physicians and counselors who may encourage the distressed persons to discharge their fear of death and anxiety via proper psychotherapy. If the counseling psycho-therapists can’t able to overcome his weaknesses and drawbacks, he can’t be able to handle all problematic issues of oneself (Kirchberg et al, 1991). In Parallel Process: A Review, The Clinical Supervisor, the main features of parallel process are reviewed by the authors to enhance the relational functioning of the professionals. The supervisors have to experience a variety of supervisory relationship in the broader spectrum for the emotional exposure with the assistance of the therapist (Mothersole, 1999). The parallel process and supervisory role in clinical supervision has been interwined with each others to enhance the functionality of the supervisory machinery in the health care center.

In Getting the Most Out of Clinical Supervision: Strategies for Mental Health, clinical supervision has been organized by the counseling and psychotherapeutic elements which are required by the clinicians. Clinical supervision is one of the challenging and adventurous enterprises to mitigate the influences of variable qualities of supervision (Pearson, 2004). For having the effective supervision, there should be some basic features of supervisors including psychological-mindedeness, desirability, motivation, enthusiastic and impatient aptitudes, dependability, interpersonal sense of curiosity, intellectual measurement, empathy, readiness to risk, enhancement of professional knowledge, introspective and receptive aptitudes, clinical flexibility and defensiveness (Pearson, 2004). Pearson (2004) stresses upon the proper training of the instructors or supervisors who may face the challenges with great competencies. The supervision should be effective if the learners are trained how to behave and move forward by establishing supervisor-supervisee relationship (Pearson, 2004).

Clinical supervision is referred as individualistic learning plans for supervisees who are working with the clients within the particular social set up where the useful strategic methods are applied systematically. The parallel process of supervision is determined by the psychodynamic or behavioral client-centered therapy which is assistive in building the structure of different supervision models including developmental models, integrated models and orientation-specific models (Pearson, 2004). The main objective of effective clinical supervision is to develop strengthen and maximize the typical characteristics of supervisory agents who work with the clients to enhance their efficiency. The latest research and studies have reviewed the developmental approach of the supervision models and other patterns to ensure the high-quality clinical supervision in the correspondence with the parallel process (Pearson, 2004). The professional expertise may overlap with the other categories, functionalized by the professional advisors who want to uplift the standards of the professional as well as ethical behaviors. The supervisors initiate or respond to enhance the supervisory influences positively upon the clients and MHC students who are under the training process (Pearson, 2004).

MHC students have to consider following things including evaluation anxiety, performance anxiety, individualistic or internal conflicts, inefficient supervisory relationship, and fear of negative consequences via counseling interventions. It is very flexible to explore the feelings of anger, defensiveness, disinterestedness and reactionary temperament of the individuals (Pearson, 2004). In Psychology in rehabilitation of older adults, it is discussed arguably how to recuperate the confidence of the older adults via proper psycho-analytical therapy. When a patient suffers from the chronic illness, there is a need of psychological support for the encashment of fortitude of the patients via the proper training of the supervisory influences. The role of supervisors as clinical psychologists is very functional to create the optimistic attitude of the individuals who are struggling with the inner conflicts and physical illness. If the patients are treated by using the strategies methods of rehabilitations, they would be recovered soon by overcoming their state of hopelessness or helplessness via the positive approach of the clinical supervision. (Rees, Wilcox and Cuddihy, 2002).

Ringle refers In the Shadow of Death: Relational Paradigms in Clinical Supervision, how the supervisory authority would develop the relational functionality or relational paradigms. The process of clinical supervision is very complicated procedure where numerous factors or characterstic approaches of supervisory dyad, social or ecological influences and developmental valuation through parallel process. The evaluation of transference and countertransference paradigms is very proper to give a shape to the parallel process in the effective manner (Ringel, 2001). the supervisory relationship comprises manifold complex aspects of interpersonal dynamics which may create unresolved issues for both supervisor and supervisees. The relational model of the clinical supervision is very assistive to produce the influential impacts upon the supervisory relationship by developing knowledgeable understanding (Ringel, 2001). A safe supervisory relationship, task-oriented structural framework, methodological and organizational supervisory roles and communicative skills of the supervisors are very productive to grow, develop and transform what you want in the process of clinical supervision.

Shulman (2005) throws light in his article, The Clinical Supervisor-Practitioner Working Alliance: A Parallel Process, how to develop core dynamics and expertise of the supervisor-practitioner working relationship, reliance and alliance of the supervisors and supervisees. The parallel process influences the performance of the supervisor via perfect presentation of counseling and psychoanalytic therapy. In Therapeutic Processes In Clinical Supervision, transference process play important role in the clinical supervision despite of the conscious or unconscious efforts of the supervisors or supervisees develop professional expertise and individualistic growth (Schamess, 2006). The supervisors are so professionally expert and discreet to recognize that the clinical supervision has therapeutic potentiality which may address their problems which are interrupted by the supervisees’ therapeutic and individualistic functionality (Schamess, 2006).

In Supervising the primary care counsellor within the psychodynamic frame, Stewart (2004) explores the unconscious processes which are manifested by organizational dynamics, transference and countertransference relationships between supervisor-supervisees. He discusses in details how an effective clinical supervision can be created via parallel process where the challenging issues, supervisor has to encounter due to his psychoanalytic impotence while working with his clients (Stewart, 2004). In nutshell, the parallel process and supervisory role of the clinical supervisor are complementary elements to enhance the effectiveness of the clinical supervision which is the very essential to develop more comforts for the hospitalized patients in the health care center. The supervisors must discard away their introspective attitude towards their clients or patients, if they want to get productive results from the clinical supervisory counseling.

Parallel Process and The Supervisory Role In Clinical Supervision

The research carried out for “Parallel Process and the Supervisory Role in Clinical Supervision” contains some strengths and limitations that need to be addressed. Most of the research done on clinical supervision is based on theoretical rather than practical themes. There is ample amount of theories given in the articles, which are not convincing for supervision, as practicability of things is of utmost significance today.

The articles ought to have some sort of survey conduction, which is an important aspect of researching. Some form of authentic research tools and surveys undertaken, to provide realistic results on a well-defined hypothesis. In the articles given, only previous studies and their results have been continuously stated, thus paving way for further research to be done on the subject of clinical supervision.

Further research needs to be carried out on the role of the supervisor in clinical supervision. There are no studies mentioned which have been carried out by the authors themselves, with any investigations or findings of their own. However, a lot of literature has been provided, citing a variety of authors who have previously written on this subject.

There are many ways to carry out researches, which include activities such as following up the participants, offering them incentives, and getting acquainted with a diversity of people. With the acknowledgement of a variety of responses, the researchers themselves may learn many new things, and increase their depth of knowledge.

The article by Itzhaky focuses solely on hope and how disease can be countered with a feeling of high hopes embedded into oneself. This was a good opportunity for a proper survey to be conducted, with questioning participants, and carrying out observations. Itzhaky just gave suggestions on how to incorporate and enhance the element of hope into patients, to counter disease. One positive aspect of his article is the addition of a supervisory model, which contains goals, means and techniques for those who deal with patients. This is a good piece of information for readers, and is a strong point of the article.

Ganzer has provided a brief outline of the history of the parallel process, with comparisons of the previous and current status of psychodynamic supervision. In one way, it is a good provision of information regarding the relationship between the supervisor and supervisee, and how the parallel process is effective in interaction.

The article by Charalambous has provided plenty of literature regarding theory implementation in the field of nursing, but also claims that whatever has been researched till date is insufficient, and there is a large scope of further research on parallel process in supervision. The article compiled by Beder is different, and speaks of the losses faced by the supervisor himself, while handling the client’s losses simultaneously. The limitation of this article is that it pertains to ‘losses’ specifically, and not supervisory roles in general.

This study examines the major factors influencing the co-relationship among the workers, supervisors, supervisees, clients and patients. Several research works has been going on the clinical supervision more than 25 years which is reviewed and contrasted with the practicability of supervision, infrastructure of supervision, variables which influence supervisor-supervisee relationship and enactment of parallel process. The main focus of the research work should be on the core dynamics and skills of the supervisor-supervisee working relationship, use of certain communication, relationship and problem-solving skills by the supervisor may affect the development of a positive working alliance with the supervisee and it is best way to influence such kind of working relationship. The supervisor and supervisee play vital role in this parallel process of clinical supervision by self-contribution to this enactment of process.

A great research work has been carrying on the concept of the “Parallel Process” and it is evaluated that the role of supervisor and basic objectives of clinical supervision are entirely different from counseling and therapeutic dynamic relationship. According to the researcher, the clinical supervision is taken as the process of professional learning and development which is practice-oriented theoretically. A wider range of research has shown how the clinical supervision process was conducted in the last decades. The most of the studies and research is descriptive and exploratory with limited range of knowledge about the parallel process and role of supervisory authority and there is a need of broaden the scope of clinical supervision versus parallel process.

All these research-oriented articles are reviewed in the light of thematic conception, trends and implications of practical training of supervisor, role of supervisor, impacts of parallel process on supervisor-supervisees relationship and practice of clinical supervision. There is a need of qualitative study for the improvement of working relationship of counseling client and patient or supervisor-supervisees, exploring the multiple issues and challenges and research initiatives within community-based clinical supervisory settings which affect directly the process of clinical supervision (Manser et al, 2004). The clinical challenges can be identified by applying all research-oreinted methodology within the existing supervisory model at any health care center. Generally these issues or limitations are discovered as follows:

  • All kinds of supervisory relationships were not well-developed
  • There is loss of autonomous agency
  • Lack of flexibility, sense of responsibility and intimacy
  • Inner conflicts between the supervisor and supervisee
  • Issues of intervention dependability

All above discussions and identification of these limitations and strengths recommends the planners and implementers to enhance the scope of perceptive evidence-based involvement in clinical supervision. The researchers and clinical planners should continue such valuable research works which enhance the efficiency of clinical staff under the effective supervision of the supervisor.

References

Beder, 1998, DSW, is Assistant Professor, Wurzweiler School of Social Work, Yeshiva University, 2495 Amsterdam Avenue, New York, NY 10033. The Clinical Supervisor, Vol. 17(2) E by The Haworth Press, Concurrent Loss: A Challenge in Supervision.

Cait, 2006, Implications Of Intersubjectivity For Supervisory Practice, Cheryl-Anne Cait, Ph.D., Faculty of Social Work, Wilfrid Laurier University, Clinical Social Work Journal, Vol. 34, No. 3.

Charalambous and Cyprus, 2003, Reflective Practice, Reflective Practice as a facilitator for learning, ICUS NURS Web J │ Issue 13│(Nursing.Gr).

Ganzer and Ornstein, 1999, Beyond Parallel Process: Relational Perspectives On Field Instruction, Clinical Social Work Journal, Vol. 27.

Itzhaky and Ethawi, 2004, Hope As A Strategy In Supervising Social Workers Of Terminally Ill Pateints.

Jones, A ‘bonding between strangers’: a palliative model of clinical supervision, Journal of Advanced Nursing, 1997, 26, 1028–1035 Alun Jones RMN RGN DipPsych CPN Cert PGDE MA, Lecturer in Nursing, School of Nursing Studies, University of Manchester, Coupland III, Building, Oxford Road, Manchester M13 9PL.

Jones, 1997, Death, Poetry, Psychotherapy and Clinical Supervision (The Contribution Of Psychodynamic Psychotherapy To Palliative Care Nursing, JONES A. Journal of Advanced Nursing 25, 238–244.

Kirchberg et al, 1991, Reactions of Beginning Counselors to Situations Involving Death and Dying, Kirchberg, Thomas M. and Neimeyer, Robert A. ‘Reactions of beginning counselors to situations involving, death and dying’, Death Studies,15:6,603 — 610. To link to this Article: DOI: 10.1080/07481189108252548.

Manser et al, 2004, Clinical Supervision Issues in the Implementation of Randomized Clinical Trials, Manser ST, Guydish J, Tajima B, Jessup M; AcademyHealth. Meeting (San Diego, Calif.). University of California, San Francisco, Institute of Health Policy Studies, 3333 California Street, Suite 265, Box 0936, San Francisco. Web.

Mothersole, 1999, Parallel Process: A Review, The Clinical Supervisor, Vol. 18(2).

Parallel Process,2008, Parallel Process, Web.

Pearson, 2004, Getting the Most Out of Clinical Supervision: Strategies for Mental Health, Journal of Mental Health Counseling, Volume 26/Number 4/Pages 361-373.

Rees, Wilcox and Cuddihy, 2002, Psychology in rehabilitation of older adults, Reviews in Clinical Gerontology 12; 343–356 ©  Cambridge University Press Printed in the United Kingdom DOI:10.1017/S0959259802012467.

Ringel, 2001, In The Shadow Of Death: Relational Paradigms In Clinical Supervision, Clinical Social Work Journal, Vol. 29, No. 2.

Schamess, 2006, Therapeutic Processes In Clinical Supervision, Clinical Social Work Journal, Vol. 34, No. 4.

Shulman, 2005, The Clinical Supervisor-Practitioner Working Alliance: A Parallel Process, Shulman, Lawrence. Co-published simultaneously in The Clinical Supervisor (The Haworth Press,Inc.) Vol. 24, No. 1/2, pp. 23-47.

Stewart, 2004, Supervising the primary care counsellor within the psychodynamic frame, Online Publication Date: To link to this Article.

Sumerel, Marie B.,1994, ERIC Identifier: ED372347, Source: ERIC Clearinghouse on Counseling and Student Services Greensboro NC. Web.

The Clinical Supervisor, ISSN: 0732-5223), Volume: 24 Issue: ½, Publication Date: 2006. Web.

Wells, M., Trad, A., Alves, M. (2003) Training Beginning Supervisors Working with New Trauma Therapists: A Relational Model of Supervision. Journal of College Student Psychotherapy, Vol. 17(3).

Yedich, T. Clinical supervision, death, Heidegger and Freud come ‘out of the sighs’. fournal of Advanced Nursing, 2000, 31(4), 953-961.

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