Supervision Essentials for Existential–Humanistic Therapy [1 ed.] 1433822814, 9781433822810

Table of contents :
Contents
Foreword to the Clinical Supervision Essentials Series
Introduction
Chapter 1
Essential Dimensions of Supervision, Consultation, and Training in Existential–Humanistic Therapy
Chapter 2
Teaching Models, Methods, and Techniques in Existential–Humanistic Therapy
Chapter 3
Case Illustrations: Excerpts From a Transcript of Two Supervisory Sessions
Chapter 4 Handling Common Training/Consultation Issues
Chapter 5
Supervisory Development and Self-Care
Chapter 6
Research and Support for the Existential–Humanistic Training Approach
Chapter 7
Future Directions
Suggested Readings
Appendix A: EHI Certificate Program Pre-Program Questionnaire for the Foundations Certificate
Appendix B: EHI Certificate Program Post-Program Questionnaire
Appendix C: Summary Case Notes
Appendix D: Working With Dreams From an Existential–Humanistic Perspective
References
Index
About the Authors

Citation preview

Supervision Essentials for

Existential– Humanistic Therapy

Clinical Supervision Essentials Series Supervision Essentials for Psychodynamic Psychotherapies Joan E. Sarnat Supervision Essentials for the Integrative Developmental Model Brian W. McNeill and Cal D. Stoltenberg Supervision Essentials for the Feminist Psychotherapy Model of Supervision Laura S. Brown Supervision Essentials for a Systems Approach to Supervision Elizabeth L. Holloway Supervision Essentials for the Critical Events in Psychotherapy Supervision Model Nicholas Ladany, Myrna L. Friedlander, and Mary Lee Nelson Supervision Essentials for Existential–Humanistic Therapy Orah T. Krug and Kirk J. Schneider Supervision Essentials for Cognitive–Behavioral Therapy Cory F. Newman and Danielle A. Kaplan

Clinical Supervision Essentials HANNA LEVENSON and ARPANA G. INMAN, Series Editors

Supervision Essentials for

Existential– Humanistic Therapy

Orah T. Krug and Kirk J. Schneider

American Psychological Association • Washington, DC

Copyright © 2016 by the American Psychological Association. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, including, but not limited to, the process of scanning and digitization, or stored in a database or retrieval system, without the prior written permission of the publisher. Published by American Psychological Association 750 First Street, NE Washington, DC 20002 www.apa.org

To order APA Order Department P.O. Box 92984 Washington, DC 20090-2984 Tel: (800) 374-2721; Direct: (202) 336-5510 Fax: (202) 336-5502; TDD/TTY: (202) 336-6123 Online: www.apa.org/pubs/books E-mail: [email protected]

In the U.K., Europe, Africa, and the Middle East, copies may be ordered from American Psychological Association 3 Henrietta Street Covent Garden, London WC2E 8LU England Typeset in Minion by Circle Graphics, Inc., Columbia, MD Printer: United Book Press, Inc., Baltimore, MD Cover Designer: Mercury Publishing Services, Inc., Rockville, MD The opinions and statements published are the responsibility of the authors, and such opinions and statements do not necessarily represent the policies of the American Psychological Association. Library of Congress Cataloging-in-Publication Data Names: Krug, Orah T., author. | Schneider, Kirk J., author. Title: Supervision essentials for existential–humanistic therapy / Orah T. Krug and Kirk J. Schneider. Description: Washington, DC : American Psychological Association, [2016] | Series: Clinical supervision essentials | Includes bibliographical references and index. Identifiers: LCCN 2016006237 | ISBN 9781433822810 | ISBN 1433822814 Subjects: LCSH: Existential psychotherapy—Study and teaching. | Counseling—Study and teaching. Classification: LCC RC489.E93 K78 2016 | DDC 616.89/140076—dc23 LC record available at http://lccn.loc.gov/2016006237 British Library Cataloguing-in-Publication Data A CIP record is available from the British Library. Printed in the United States of America First Edition http://dx.doi.org/10.1037/14951-000

Contents

Foreword to the Clinical Supervision Essentials Series

vii

Introduction 3 Chapter 1. Essential Dimensions of Supervision, Consultation, and Training in Existential–Humanistic Therapy

25

Chapter 2. Teaching Models, Methods, and Techniques in Existential–Humanistic Therapy

39

Chapter 3. Case Illustrations: Excerpts From a Transcript of Two Supervisory Sessions

71

Chapter 4. Handling Common Training/Consultation Issues

99

Chapter 5. Supervisory Development and Self-Care

111

Chapter 6. Research and Support for the Existential–Humanistic Training Approach

123

Chapter 7. Future Directions

129

Suggested Readings

135

Appendix A: EHI Certificate Program Pre-Program Questionnaire for the Foundations Certificate

139

Appendix B: EHI Certificate Program Post-Program Questionnaire 143 v

Contents

Appendix C: Summary Case Notes

145

Appendix D: Working With Dreams From an Existential–Humanistic Perspective

147

References 149 Index 157 About the Authors

167

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Foreword to the Clinical Supervision Essentials Series

W

e are both clinical supervisors. We teach courses on supervision of students who are in training to become therapists. We give workshops on supervision and consult with supervisors about their supervision practices. We write and do research on the topic. To say we eat and breathe supervision might be a little exaggerated, but only slightly. We are fully invested in the field and in helping supervisors provide the most informed and helpful guidance to those learning the profession. We also are committed to helping supervisees/consultees/trainees become better collaborators in the supervisory endeavor by understanding their responsibilities in the supervisory process. What is supervision? Supervision is critical to the practice of therapy. As stated by Edward Watkins1 in the Handbook of Psychotherapy Super­ vision, “Without the enterprise of psychotherapy supervision, . . . the practice of psychotherapy would become highly suspect and would or should cease to exist” (p. 603). Supervision has been defined as an intervention provided by a more senior member of a profession to a more junior colleague or colleagues who typically (but not always) are members of that same profession. This relationship 77 is evaluative and hierarchical, 77 extends over time, and

1

Watkins, C. E., Jr. (Ed.). (1997). Handbook of psychotherapy supervision. New York, NY: Wiley.

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FOREWORD TO THE CLINICAL SUPERVISION ESSENTIALS SERIES

77 has the simultaneous purposes of enhancing the professional function-

ing of the more junior person(s); monitoring the quality of professional services offered to the clients that she, he, or they see; and serving as a gatekeeper for the particular profession the supervisee seeks to enter. (p. 9)2

It is now widely acknowledged in the literature that supervision is a “distinct activity” in its own right.3 One cannot assume that being an excellent therapist generalizes to being an outstanding supervisor. Nor can one imagine that good supervisors can just be “instructed” in how to supervise through purely academic, didactic means. So how does one become a good supervisor? Supervision is now recognized as a core competency domain for psychologists4,5 and other mental health professionals. Guidelines have been created to facilitate the provision of competent supervision across professional groups and internationally (e.g., American Psychological Association,6 American Association of Marriage and Family Therapy,7 British Psychological Society,8,9 Canadian Psychological Association10).

2

Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision (5th ed.). Boston, MA: Pearson.

3

Bernard, J. M., & Goodyear, R. K. (2014). Fundamentals of clinical supervision (5th ed.). Boston, MA: Pearson.

4

Fouad, N., Grus, C. L., Hatcher, R. L., Kaslow, N. J., Hutchings, P. S., Madson, M. B., . . . Crossman, R. E. (2009). Competency benchmarks: A model for understanding and measuring competence in professional psychology across training levels. Training and Education in Professional Psychology, 3 (4 Suppl.), S5–S26. http://dx.doi.org/10.1037/a0015832

5

Kaslow, N. J., Rubin, N. J., Bebeau, M. J., Leigh, I. W., Lichtenberg, J. W., Nelson, P. D., . . . Smith, I. L. (2007). Guiding principles and recommendations for the assessment of competence. Professional Psychol­ ogy: Research and Practice, 38, 441–51. http://dx.doi.org/10.1037/0735-7028.38.5.441

6

American Psychological Association. (2014). Guidelines for clinical supervision in health service psychology. Retrieved from http://www.apa.org/about/policy/guidelines-supervision.pdf

7

American Association of Marriage and Family Therapy. (2007). AAMFT approved supervisor designa­ tion standards and responsibilities handbook. Retrieved from http://www.aamft.org/imis15/Documents/ Approved_Supervisor_handbook.pdf

8

British Psychological Society. (2003). Policy guidelines on supervision in the practice of clinical psychology. Retrieved from http://www.conatus.co.uk/assets/uploaded/downloads/policy_and_guidelines_on_ supervision.pdf

9

British Psychological Society. (2010). Professional supervision: Guidelines for practice for educational psychol­ ogists. Retrieved from http://www.ucl.ac.uk/educational-psychology/resources/DECP%20Supervision%20 report%20Nov%202010.pdf Canadian Psychological Association. (2009). Ethical guidelines for supervision in psychology: Teach­ ing, research, practice and administration. Retrieved from http://www.cpa.ca/docs/File/Ethics/ EthicalGuidelinesSupervisionPsychologyMar2012.pdf

10

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FOREWORD TO THE CLINICAL SUPERVISION ESSENTIALS SERIES

The Guidelines for Clinical Supervision in Health Service Psychology11 are built on several assumptions, specifically that supervision 77 77 77 77 77 77

77 77 77 77 77 77 77 77 77 77

requires formal education and training; prioritizes the care of the client/patient and the protection of the public; focuses on the acquisition of competence by and the professional development of the supervisee; requires supervisor competence in the foundational and functional competency domains being supervised; is anchored in the current evidence base related to supervision and the competencies being supervised; occurs within a respectful and collaborative supervisory relationship that includes facilitative and evaluative components and is established, maintained, and repaired as necessary; entails responsibilities on the part of the supervisor and supervisee; intentionally infuses and integrates the dimensions of diversity in all aspects of professional practice; is influenced by both professional and personal factors, including values, attitudes, beliefs, and interpersonal biases; is conducted in adherence to ethical and legal standards; uses a developmental and strength-based approach; requires reflective practice and self-assessment by the supervisor and supervisee; incorporates bidirectional feedback between the supervisor and supervisee; includes evaluation of the acquisition of expected competencies by the supervisee; serves a gatekeeping function for the profession; and is distinct from consultation, personal psychotherapy, and mentoring.

The importance of supervision can be attested to by the increase in state laws and regulations that certify supervisors and the required multiple super­v isory practica and internships that graduate students in all professional programs must complete. Furthermore, research has American Psychological Association. (2014). Guidelines for clinical supervision in health service psychology. Retrieved from http://www.apa.org/about/policy/guidelines-supervision.pdf

11

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FOREWORD TO THE CLINICAL SUPERVISION ESSENTIALS SERIES

confirmed12 the high prevalence of supervisory responsibilities among practitioners—specifically that between 85% and 90% of all therapists eventually become clinical supervisors within the first 15 years of practice. So now we see the critical importance of good supervision and its high prevalence. We also have guidelines for its competent practice and an impressive list of objectives. But is this enough to become a good supervisor? Not quite. One of the best ways to learn is from highly regarded supervisors—the experts in the field—those who have the procedural knowledge13 to know what to do, when, and why. Which leads us to our motivation for creating this series. As we looked around for materials that would help us supervise, teach, and research clinical supervision, we were struck by the lack of a coordinated effort to pre­ sent the essential models of supervision in both a didactic and experiential form through the lens of expert supervisors. What seemed to be needed was a forum where the experts in the field—those with the knowledge and the practice—present the basics of their approaches in a readable, accessible, concise fashion and demonstrate what they do in a real supervisory session. The need, in essence, was for a showcase of best practices. This series, then, is an attempt to do just that. We considered the major approaches to supervisory practice—those that are based on theoretical orientation and those that are metatheoretical. We surveyed psychologists, teachers, clinical supervisors, and researchers domestically and inter­ nationally working in the area of supervision. We asked them to identify specific models to include and who they would consider to be experts in this area. We also asked this community of colleagues to identify key issues that typically need to be addressed in supervision sessions. Through this consensus building, we came up with a dream team of 11 supervision experts who not only have developed a working model of supervision but also have been in the trenches as clinical supervisors for years.

Rønnestad, M. H., Orlinsky, D. E., Parks, B. K., & Davis, J. D. (1997). Supervisors of psychotherapy: Mapping experience level and supervisory confidence. European Psychologist, 2, 191–201.

12

Schön, D.  A. (1987). Educating the reflective practitioner: Toward a new design for teaching and learning in the professions. San Francisco, CA: Jossey-Bass.

13

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We asked each expert to write a concise book elucidating her or his approach to supervision. This included highlighting the essential dimensions/key principles, methods/techniques, and structure/process involved, the research evidence for the model, and how common supervisory issues are handled. Furthermore, we asked each author to elucidate the supervisory process by devoting a chapter describing a supervisory session in detail, including transcripts of real sessions, so that the readers could see how the model comes to life in the reality of the supervisory encounter. In addition to these books, each expert filmed an actual supervisory session with a supervisee so that her or his approach could be demonstrated in practice. APA Books has produced these videos as a series and they are available as DVDs (http://www.apa.org/pubs/videos). Each of these books and videos can be used together or independently, as part of the series or alone, for the reader aspiring to learn how to supervise, for supervisors wishing to deepen their knowledge, for trainees wanting to be better supervisees, for teachers of courses on supervision, and for researchers investigating this pedagogical process.

ABOUT THIS BOOK In this book, Supervision Essentials for Existential–Humanistic Therapy, Orah T. Krug and Kirk J. Schneider first explain that existential–humanistic (E-H) therapy is designed to answer such questions as How shall we live? How are we living in this moment? What really matters to us? How can we pursue what really matters? They go on to state that to live and not simply exist takes courage. They describe E-H therapy as an experiential therapy that seeks to diminish the natural and self-imposed limits of living so that the individual can embrace more joy, satisfaction, meaning, and purpose. But how does one train to do this type of therapy—therapy that is as much an art as a science? Through transcripts of actual supervision sessions, self-revealing comments by the authors and those who have undergone the training, and a wealth of empirical data supporting the model, Krug and Schneider give voice to how supervisees gain clinical competency and emotional maturity with E-H supervision. xi

FOREWORD TO THE CLINICAL SUPERVISION ESSENTIALS SERIES

The E-H supervisor’s goal is to encourage trainees to cultivate finetuned, experiential skills to guide their clients on a demanding, awe-inspiring journey. The training stance holds that supervisees need to explore their own embodied process of being so they can guide their clients to live fuller lives. In this model, the supervisor pays close attention to how the supervisee is present not only with his or her clients but also within the supervisory session. The supervisor supports his or her trainees as they learn to become more mindful of what they see, sense, and feel as they are with their clients. As an added bonus, readers of this book are also introduced to an amplification of the E-H training model to include a more integrative approach in which traditional E-H principles are bolstered by evidencebased relational skills (e.g., alliance building, empathy, collaboration, authenticity, encouragement of hope). In contrast with today’s emphasis on empirically supported treatments and therapy driven by managed care, this book focuses on a different type of psychotherapy supervision—in the authors’ words, “one that develops the hearts and minds of psychotherapists so they may successfully engage in life-changing psychotherapy with their clients.” We thank you for your interest and hope the books in this series enhance your work in a stimulating and relevant way. Hanna Levenson and Arpana G. Inman

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Supervision Essentials for

Existential– Humanistic Therapy

Introduction

T

his volume is intended to describe the rationale, goals, methods, and modes of supervision in existential–humanistic (E-H) therapy. We will vividly illustrate how E-H supervisors teach supervisees to engage in life-changing depth psychotherapy. This model of supervision is built on the principles and methods of E-H therapy; in other words, it is a psychotherapy-based supervision model. Consequently, the principles and methods of E-H therapy will be summarized in this chapter to give the reader a context for E-H supervision. Becoming an E-H therapist and supervisor is a lifelong commitment to personal and professional development, grounded in an ethic sensitively articulated by James Bugental, one of the founders of E-H therapy, in The Search for Existential Identity (1976): Psychotherapy is an art form. An art form seriously practiced by an artist worthy of that name calls for cultivated sensitivity, trained

http://dx.doi.org/10.1037/14951-001 Supervision Essentials for Existential–Humanistic Therapy, by O. T. Krug and K. J. Schneider Copyright © 2016 by the American Psychological Association. All rights reserved.

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Supervision Essentials for Existential–Humanistic Therapy

skills, disciplined emotion, and total personal investment. . . . Psychotherapy demands discipline from its responsible practitioners above all else. Only after one has mastered the fundamentals, steeped [oneself] in the diversity of human experience, and explored more advanced possibilities can [one] improvise and create meaningfully and responsibly. (pp. 297–298)

The mission at the heart of supervision, training, and education in E-H therapy is to facilitate an actualization of this ethic. A multifaceted approach is required to achieve this mission, and the supervisor of E-H therapy creatively weaves together the philosophy, science, and art of psychotherapy; in doing so, the supervisor becomes a “virtuoso” (Bugental, 1987, p. 264) of E-H therapy. How does the supervisor develop this virtuosity? A supervisor’s kinship with the E-H approach typically begins with an appreciation of such existential philosophers as Kierkegaard, Nietzsche, Sartre, Heidegger, Buber, and Tillich; past practitioners identified as existential and/or humanistic such as Carl Rogers, Clark Moustakas, Rollo May, Victor Frankel, and James Bugental; or current practitioners such as Irvin Yalom and the authors of this book, Kirk Schneider and Orah Krug. Resonance with an existential and/or humanistic perspective helps a new attitude about human nature and existence to take root. Other steps in the development of E-H supervisors are successful graduation from a nationally recognized clinical or counseling psychology or mental health graduate school, receipt of a license to practice psychotherapy, and practice as an E-H therapist for at least 5 to 10 years. Typically, budding E-H supervisors have sought out consultation and training in E-H therapy from acknowledged masters of E-H therapy for those same numbers of years. Of course, this process of philosophical and/or psychological resonance followed by intensive consultation and training in E-H therapy may happen in reverse order, but regardless of the order, with these two pieces in place, the developing supervisor is ready to engage with E-H psychotherapy not only as a science but also as an art. The movement along this path requires a commitment to specialized training and education that focuses on developing the person as much 4

Introduction

as developing mastery of a particular skill set. Research on the effectiveness of E-H training programs (Pierson, Krug, Sharp, & Piwowarski, 2015) underscores the vital role this specialized training plays in participants’ develop­ment as E-H therapists and supervisors. The education is perceived to strengthen professional identity and stimulate participants’ capacity for experiential freedom—the freedom to profoundly feel, sense, and think—the lifeblood of artistic expression. There is a critical distinction between “knowing about” an E-H perspective from a theoretical standpoint and knowing the perspective from an embodied level because it has been repeatedly modeled and personally experienced, not only in one’s therapeutic work but also in one’s way of being. Consequently, the curriculum emphasizes learning experientially the principles of E-H practice, such as the capacity to be present, congruent, and empathic, and not simply using them as “tools.” The education follows a dictum from Frieda Fromm Reichman that “patients need experiences not explanations” (cited in Ehrenwald, 1991, p. 392). The same, we believe, holds true for therapists in training and supervisors in training; they need more experiences with E-H principles and fewer explanations about them. Presence, congruence, and empathy are ways of being; they cannot be taught, but they can be modeled and valued. Within a contemporary psychotherapy climate heavily influenced by the managed care industry and the medical model, we believe today, perhaps more than ever, there is a need for a different type of psychotherapeutic training and supervision: one that focuses not only on the science but also on the art of psychotherapy and supervision and one that develops the hearts and minds of psychotherapists and supervisors so they may successfully engage in life-changing psychotherapy with their clients and successfully teach life-changing psychotherapy. Students who participate in training and supervisory programs with an E-H orientation are more likely to receive this type of multifaceted and comprehensive education. E-H therapists and supervisors are opposed to “standardization” of therapy or supervision because standardization, as Irvin Yalom suggests, “renders the therapy [and supervision] less real and less effective” 5

Supervision Essentials for Existential–Humanistic Therapy

(2002, p. 34). Increasingly, even the science backs our opposition to standardization and our emphasis on the art of psychotherapy. In a comprehensive overview of the effectiveness of humanistic principles of practice, Angus, Watson, Elliott, Schneider, and Timulak (2015) found that for the majority of problems typically addressed in therapy, humanistic principles of practice, such as an emphasis on the relational and experiential aspects of the work, are on par with—and in some cases superior to— more programmatic principles of practice, such as those of cognitive– behavioral therapy. Leading researchers such as Bruce Wampold and John Norcross have been espousing similar positions for the past several years (Wampold, 2007, 2008; Norcross & Lambert, 2011). A description of this specialized training and supervision in E-H therapy is the focus of this text. In subsequent chapters, crucial aspects of the educational and supervisory process will be examined, illustrated with vivid case examples, and liberally sprinkled with students’ reflections about their supervisory and training experiences. The authors of the text understand the term supervision broadly to include the traditional one-on-one and group supervision/consultation learning format but also such educational formats as immersive, experiential trainings. The terms supervisor, consultant, and teacher and the matching terms of supervisee, consultee, and student and trainee will be used interchangeably throughout the text, although it is understood that the legal and ethical responsibilities of each designation can and do vary. Our focus is on the teaching and learning dynamics of these relationships, not on the legal or ethical dynamics, although these dynamics will be discussed in a later chapter.

DESCRIPTION OF EXISTENTIAL– HUMANISTIC THERAPY Before addressing how E-H supervisors teach E-H therapy, a brief description and explanation of the basic tenets of E-H therapy is offered. To provide additional context, a brief historical perspective of E-H therapy is included. 6

Introduction

When an E-H therapist encounters a new client, he or she may silently wonder and observe: How does my client want to live? How is he or she living in this moment? What really matters to my client? How can he or she pursue what really matters? These questions focus E-H therapists not only on the explicit or content dimension of the encounter (i.e., the client’s story) but also and more importantly on the implicit, process dimension (i.e., the attitudes or feelings underlying the client’s story). By attuning to the process dimension, E-H therapists enter their clients’ world to experience how their clients may be blocking themselves from attaining what matters. To live and not simply exist takes courage. An assumption of E-H therapists is that clients, and people in general, often turn away from what overwhelms or frightens them, constructing protections that keep them safe but also constrict their living. E-H therapy is an experiential therapy, which assumes that if life-limiting protections are diminished, more joy, satisfaction, meaning, and purpose can emerge. Awareness of our existence requires an inward courage to face life—not avoid it. Through experiential reflection and enactment, E-H therapy aims to help clients see “close up” how they miss a fuller life by constricting or blocking their capacity to live. Consciousness, personal freedom, and responsibility take root in this reflective process, supporting the reoccupation of previously abandoned ways of being. A reclaiming of one’s life is the ultimate goal, but this cannot be achieved until one knows what has been disowned. This type of change is not primarily concerned with symptom removal, although symptom removal often occurs. Rather, this type of change is in the core of one’s being: it is “whole-bodied” and transformative. What is meant by existential–humanistic therapy? Existentialism is concerned with the living experience of becoming and originates from the Latin root ex-sistere, which literally means to stand forth or to become. Humanism comes from the Greek tradition of “knowing thyself ” (Schneider & Krug, 2010). Thus, existential–humanism, although a seemingly static term, actually refers to the dynamic process of becoming and knowing oneself. 7

Supervision Essentials for Existential–Humanistic Therapy

HISTORICAL PERSPECTIVE OF EXISTENTIAL– HUMANISTIC THERAPY Existential–analytic therapy, the “grandfather” of E-H therapy, arose in Europe, spearheaded by Ludwig Binswanger (1958) and Medard Boss (1963), as a rebellious response to the reigning psychological movements of the 20th century: behaviorism and psychoanalysis. Binswanger and Boss contended that neither behaviorism, led by B. F. Skinner (1971), nor psychoanalysis, developed by Freud (in Gay, 1989), provided a theory of human functioning that truly reflected a person as he or she really was—in fact these theories obfuscated the real, living persons whose worlds are unique and concrete. To help clients, they argued, therapists must truly know them, which means therapists must find ways to enter into and exist in their clients’ experiential worlds—not merely project onto them various theoretical notions of human functioning. Thus was born the phenomenological method, which began with Kierkegaard’s (1944) philosophical musings and came to fruition with Husserl (1962) and Heidegger (1962). The phenomenological method challenges the assumption that humans can be adequately understood in terms of some theory, whether it is a mechanistic, biological, or psychological one. (For an expanded explanation see Krug [2016] and Schneider and Krug [2010].) Rollo May, who had studied with Alfred Adler and Paul Tillich, brought the European existential perspective to the United States with the publi­ cation of the book Existence (May, Angel, & Ellenberger, 1958). This book arrived at a time when humanistic psychology, founded by Abraham Maslow and Carl Rogers, was gaining popularity by challenging the more prevalent therapeutic approaches of behaviorism and psychoanalysis. The book’s themes expanded the focus of American humanistic psychology by introducing “gloomier” existential concerns, such as death, limited freedom, and uncertainty, into the “sunnier” humanistic landscape, flush with possibilities and potentialities. Perhaps of even more significance was the authors’ introduction of the phenomenological method illustrated in case studies by May, Binswanger, and Boss. These therapists emphasized an intimate and “whole-bodied” way of understanding and working with 8

Introduction

people in distress, challenging the prevailing, objectified “ways of knowing” human beings. As a result of Existence (May et al., 1958), E-H therapy developed as an amalgam of American and European perspectives, uniting existential accents on limited freedom with humanistic accents on potentiality. Added to this distinctly American mix was a radical method of understanding human beings, not through a lens of abstract theories but through a direct encounter with their experiential worlds. Consequently, E-H therapy emphasizes (a) attunement to one’s subjective and relational lived experiences and ways of being, (b) experiential reflection on one’s personal meanings about being and becoming, (c) freedom to become within one’s given limitations, and (d) responsibility to respond to what one becomes.

NOTABLE CONTRIBUTORS TO EXISTENTIAL– HUMANISTIC THERAPEUTIC THEORY An E-H understanding of healthy functioning rests on the aforementioned interdependent dimensions. Although E-H theorists almost invariably highlight all four of these dimensions, they do so in unique and varied ways. For example, Rollo May (1981) gives primary attention to freedom and that which he terms “destiny.” By freedom, May means the capacity to choose within the natural and self-imposed (e.g., cultural) limits of living. Freedom also implies responsibility, for if we are conferred the power to choose, do we not have the responsibility to exercise that power? James Bugental (1999), a brilliant practitioner as well as a theorist, gives primary attention to the client’s subjective lived experience. He understands people as essentially a matter of process, yet they are physically embodied, separate but related to the world. The person who comes to therapy is usually self-alienated because of a psychological split that he or she experiences as an internal battle between a part of self that is attempting to emerge and another endeavoring to block that part. The result is a constricted and self-alienated person. This characterization is akin to the overly constricted person, described by Kierkegaard (1944) and Nietzsche (1982), who objectifies himself or herself and is bound by 9

Supervision Essentials for Existential–Humanistic Therapy

excessive rules. Bugental (1999) aims for internal wholeness and authenticity by recovering the person’s lost sense of being. This reclaiming of self occurs by heightening the client’s immediate subjective awareness—an awareness that implies freedom, choice, and responsibility. Irvin Yalom, a colleague and close friend of Rollo May, is probably the most famous existential psychiatrist practicing today. In his widely read “teaching novels” (e.g., When Nietzsche Wept, 1992), academic textbooks (e.g., Existential Psychotherapy, 1980), and intriguing case studies (e.g., Love’s Executioner, 1989), existential theory and practice become not only understandable but also intuitive. A gifted storyteller, Yalom breathes life into the existential givens and the relational dimension of psychotherapy with a conversational and transparent style that engages and resonates easily with people from all walks of life. Early in Yalom’s career at Stanford University, he wrote the lengthy Existential Psychotherapy (1980), in which he outlined, using vivid case histories to illustrate, his existential therapeutic perspective. He described four “givens” of human existence: death, freedom, isolation, and meaninglessness. The extent to which we are able to confront these givens will determine the extent of the dynamic conflict. If we need, for example, to deny the reality of death, we may cope by developing overexpanded, extreme risk-taking behavior, or we may cope with overconstricted, excessive rulebound behavior. But if we are able to face these givens sufficiently, our lives will be more balanced, free, honest, and congruent. Thus, the central aim of therapy is to “de-repress” (Yalom, 1980) and reacquaint the individual with something she or he has known all along. In doing so, the individual learns to face and accept the givens, thus supporting the development of a life with greater balance, honesty, and freedom.

THE EMERGENCE OF CONTEMPORARY EXISTENTIAL–HUMANISTIC THERAPY Kirk Schneider was fortunate to be mentored by Rollo May and James Bugental. In his previous writings, he has elaborated on a constrictive/ expansive continuum of conscious and subconscious personality func10

Introduction

tioning. This existential–integrative perspective echoes that of Nietzsche, Kierkegaard, Tillich, and May in its emphasis on the paradoxical nature of human functioning. This constrictive/expansive continuum of personality functioning has a capacity that is both freeing and limiting. It is the interplay among constrictive and expansive capacities that constitutes personal and interpersonal richness and health—or what Schneider has more recently termed “awe-based” consciousness (Schneider, 1999, 2008, 2013). Orah Krug had the good fortune to be mentored by two brilliant existential practitioners: James Bugental and Irvin Yalom. Her long associations with Bugental and Yalom influenced her to integrate the two diverse foci of her mentors and redefine E-H therapy as a therapy with both a subjective and relational focus (Krug, 2009). This type of integrated presence gives E-H therapists a wider lens from which to see and illuminate varied patterns of being, be they intrapsychic or interpersonal. In addition to her research on the effectiveness of the Existential–Humanistic Institute’s training programs, Dr. Krug has been enthusiastically investigating how existential meaning making is at the heart of therapeutic change. Her focus on the meaning-making process has brought new attention to the influence of personal context on perception, contact, and change (Krug, 2010, 2016). In 1997, we, along with our colleagues Nader Shabahangi and Sonja Saltman, founded the Existential–Humanistic Institute (EHI) in San Francisco, California. Inspired by our mentor, James Bugental, and with his support, we envisioned EHI primarily as a teaching institute with a mission to educate the next generation of therapists interested in practicing from an E-H perspective. The curriculum, developed by the coauthors, emphasizes what its founders came to value: competency in the principles of E-H practice and the personal development of the student therapist. EHI offers certification and training programs that include 4-day experiential training retreats, online courses, and various consultation formats, such as online group consultations. One certificate program is in part­ nership with Saybrook University. In 2016, Division 32 of the American Psychological Association awarded to the EHI the Charlotte and Karl Buhler Award for outstanding organizational contributions to humanistic psychology in recognition of its educational and training programs. 11

Supervision Essentials for Existential–Humanistic Therapy

The current leaders of E-H therapy have also encouraged its evolution as an integrative methodology. With the advent of existential–integrative (EI) therapy, Schneider and May (1995; Schneider, 2008) developed a framework for engaging various therapeutic modalities within an overall existential or experiential context. The coauthors’ textbook Existential–Humanistic Therapy (Schneider & Krug, 2010) expanded on this innovative perspective: by offering a phenomenological method for understanding human beings, not through a lens of abstract theory but through a direct encounter with their experiential worlds. With this method, E-H therapy could serve as an effective foundation for a strikingly wide range of client populations and therapeutic modalities. As a result, today’s E-H therapy has become for many an increasingly integrative therapy by being a bridge to both mainstream and existentially oriented therapies. (See leading psychotherapy researcher Bruce Wampold’s support of this view [Wampold, 2008].)

KEY CONCEPTS OF EXISTENTIAL–HUMANISTIC THERAPY RELEVANT TO TRAINING AND SUPERVISION Human Beings Construct Subjective Meaning From Experiences in the External World In Existence (1958, p. 11), Rollo May and colleagues defined existentialism as the “endeavor to understand man by cutting below the cleavage between subject and object which has bedeviled Western thought and science since shortly after the Renaissance.” What did May mean by “cutting below the cleavage between subject and object”? And how was this a new understanding of the structure of human existence? Existential theory challenges the Cartesian notion of a world made up of objects, and subjects who perceive those objects. Individuals, according to existential theory, do more than simply perceive and experience reality; they in fact participate in constituting their realities by constructing meanings of their perceptions and experiences as they relate to the external world. Thus, they are not simply aware, they are conscious—aware of being the ones who construct meanings from 12

Introduction

experiences. This is a core concept across all existential, humanistic, and other experiential therapies. Within this definition of existence lies (a) agency: we are centered in our being and create meanings about our world and ourselves; (b) freedom: we choose how we define our perceptions and experiences; (c) responsibility: we are responsible for the choices we make; and (d) change: we have agency to create new meanings about our world and ourselves. This core concept invites an appreciation of personal agency, with the freedom and capacity to create new meanings about self and others. It underscores the need for both supervisors and therapists to sensitively attune to and explore the personal meanings and associated feelings of clients and supervisees, over and above dispensing a particular treatment or technique. Specific examples of what this looks like and means are provided in subsequent sections. The Meaning-Making Process Results in the Creation of Self and World Constructs Existential–humanistic therapy and supervision assumes that the subjective process of constructing meanings from experiences in the external world forms one’s self and world construct system. Rollo May (1975) called this meaning-making process passion for form that results in an “I am” experience: that is, an experience of one’s being. As May posits, I can shape feelings, sensibilities, enjoyments, and hopes into a pattern that makes me aware of myself as a man or woman. But I cannot shape them into a pattern as a purely subjective act. I can do it only as I am related to the immediate objective world in which I live. (May, 1975, p. 135)

May’s (1975) concept, although clearly informed by the existential philosophers, was also informed by process philosophy’s great thinker Alfred N. Whitehead (1978). Whitehead’s understanding of human beings as part of nature and therefore a matter of process was helpful to May’s formulations about human beings. (For an expanded explanation, see Schneider & Krug [2010]). 13

Supervision Essentials for Existential–Humanistic Therapy

The meanings made from lived experiences create a set of self-world constructs that allow individuals to explain their nature and their experiential (personal) world. For example, a core belief about self could be “I am damaged beyond repair,” and a core decision related to that could be “I must hide this from others by controlling how others perceive me.” These constructs are both protective and constrictive—Jim Bugental likened them to wearing spacesuits in outer space: they allow us to survive and function, but they don’t give us the freedom to scratch our noses! Selfworld constructs are the foundation of one’s personal context that varies, influenced by the cultural, historical, and cosmological experiences of each individual. Supervisors create various exercises to help supervisees understand both theoretically and personally the process of meaning making that results in self and world constructs. Examples of such exercises are provided in later chapters. Awareness of self and world constructs helps supervisees hone in on their clients’ unique perspectives about their nature and relational world, as well as hone in on their clients’ protective patterns that constrict and support survival. It also focuses the student therapist on his or her own context (i.e., self-world constructs and protective patterns) that may impede therapeutic effectiveness. These concepts help the supervisor normalize supervisees’ impediments to therapeutic effectiveness in that they imply a “fellow traveler” attitude of: “We all have perspectives on others, the world and ourselves that may enhance or constrict our functioning. What matters is that we become aware of them as much as possible!” This attitude may support and encourage supervisees’ personal introspection without triggering shameful feelings. Human Beings Are Both Free and Determined A corollary to the dialectical process of identity formation is the assumption that human beings are both free and determined: a paradoxical premise with roots tracing back to the Greek philosopher Heraclitus. The idea is that humans are free because they make meanings from their experiences, and they are determined because these meanings are limited by natural and self-imposed limitations. In other words, our subjective freedom— 14

Introduction

that is, our freedom to form attitudes, meanings, and emotions about an experience—is limited by the objective facts of the experience, the givens of existence, and our personal, cultural, and historical context. An awareness of the impact of natural and self-imposed limitations on one’s personal freedom helps the student therapist appreciate the challenges inherent in effecting healing and change: the constancy of personhood is a powerful counterweight to freedom and change. The tension between constancy (of old, familiar patterns) and change (to new, unfamiliar patterns) often results in internal battles that clients struggle to resolve in therapy. For E-H supervisors, this concept is critical as they cultivate increased awareness of their supervisees’ protective patterns, such as a rescuing or judgmental pattern of relating to clients. E-H supervisors typically illuminate supervisees’ internal battles: their protective pattern or life stances (e.g., their rescuing or judging stances) that may be battling with the more constructive parts that are trying to emerge. Personal Context Influences Perception and Contact An individual’s context acts as a lens from which one sees and makes sense of one’s world and oneself. For example, one person may see himself as loveable and perceive his world as kind and accepting, whereas another may see herself as unworthy and perceive her world as judgmental and critical. The present, external world is continually influencing the individual’s context—simultaneously one’s context is continually influencing one’s perceptions and experiences of the external world. Consequently, perception and experience are always contextualized. In other words, as much as we strive to brush away our biases and be deeply present, our personal context inevitably limits this intention. For the E-H supervisor and therapist, this is obviously crucial to understand—that one’s personal context is always influencing one’s interpersonal contact. The Past Is Alive in the Present Moment In each moment, the past, all of the meanings constructed about self and others, flows into the present. Thus self and world constructs manifest 15

Supervision Essentials for Existential–Humanistic Therapy

concretely as ways of being, in vocal tones, affect, body postures, language, dreams, and relational behavior patterns. We do not construct meanings as dry abstractions but rather as embodied memories richly laden with emotions and opinions about self and others. These constructs are often actual but out of awareness. The E-H supervisor consequently teaches her supervisees how to cultivate presence to the unfolding process, illuminating attitudes and behaviors that are actual but out of awareness. The following example1 illustrates this idea. The first author (Orah Krug) was sitting with a new client, who was relating her sad story of being left by her boyfriend. Soon, she began to cry, taking a tissue from the tissue box beside her. As she proceeded with her story, Dr. Krug became curious about the fact that even though the tissue the client was using was torn and tattered, she declined to take another. With her years of experience Dr. Krug has come to trust her intuition, so she gently commented, at an appropriate time, on the client’s refusal to take another tissue. The client’s eyes welled up with more tears as she realized this behavior was a familiar way of being, and she said, “I always just make do with what I have.” Illustrated in this therapeutic moment is a part of the client’s sense of self: she “always just makes do with what she has.” One can hear in this statement her particular life stance or attitude toward herself and others, a stance that both protects and constricts her. When Dr. Krug “tagged” her behavior with the shredded tissue, the therapist and client were equally surprised that the client’s refusal to take another concretely revealed a lifelong stance. As their therapy progressed, both began to understand how the client’s “tissue behavior” in therapy reflected how she related to herself and others outside the therapy room. The incident illustrates Dr. Krug’s trust that sensitive presence will reveal core ways of being that are real but often out of awareness. The E-H supervisor helps her supervisees to understand that the underlying nature of a problem may be different than the surface content. 1

All case material in this volume is disguised. In most instances, case material entails a composite, drawn from our respective practices.

16

Introduction

For example, whereas the content of a client’s report (e.g., “my boyfriend left me”) may seem exclusively relational in nature, the process or implicit aspects may reveal features of a more personal nature. The client’s stance of “I always make do” is in part responsible for her difficulty in sustaining interpersonal relationships. Thus, the E-H assessment is predicated not only on a client’s presenting problem (or complaint) but also on the entire atmosphere of a client’s predicament. Supervisors help supervisees become sensitive to all aspects of their clients’ ways of being with self and with others, as in the client’s “tissue behavior.” Supervisors also bring this sensitivity to the supervisory process. If, for example, a supervisee repeatedly relates to the supervisor in an overly compliant manner, the supervisor will tag concrete manifestations of the compliant behavior, thus bringing supervisee awareness to this way of being. Everything and anything is open to investigation within the E-H framework, from the initial manner in which the client or supervisee greets the therapist or supervisor to the position of the client’s or supervisee’s hands while elaborating her concern. Put another way, every E-H assessment is holographic. Every moment is believed to be a microcosm and in some sense dovetails with every other moment, and no moment stands in isolation.

Objective and Subjective Awareness Form a Challenging Paradoxical Unity We have the capacity to be aware of ourselves objectively, for example: “I have a cold with the symptom of a stuffy nose.” Conversely we can experience ourselves subjectively: “My head feels like it’s full of cotton, and I feel rotten.” Objective awareness pertains to measurable facts; subjective awareness pertains to feelings and experiences. They are not in opposition; rather, they form a paradoxical unity of human experience. Human beings, unlike most organisms, have the remarkable capacity to construct meaning and create an experiential world that is unique and personal, a world that includes both subjective and objective awareness.

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Supervision Essentials for Existential–Humanistic Therapy

This paradox of human experience should not be resolved because choosing to emphasize one pole to the exclusion of the other can result in behavior that is either too expanded or too limited. This perspective can be found in the thoughts of Kierkegaard, Nietzsche, May, and other existential thinkers. Supervisors help supervisees attune to (within themselves and with regard to their clients) potential overemphasis of one pole, such as the emotionally repressed, objectively focused intellectual (too limited), or the pleasure seeking, subjectively focused risk-taker (too expanded). E-H therapists and supervisors foster in their clients and supervisees a way of being that supports the development of both objective and subjective awareness and balanced behavior. The ability to move between the subjective and the objective pole is the source of human creativity and energy, but it is also deeply challenging. The Internal Battle: Holding the Paradoxical Unity In The Courage to Be (1952), Tillich marvelously articulates this fundamental challenge—to face the reality of our “finite freedom,” without avoidance, denial, or repression. It takes courage to be fully present in life, to face the “givens” of life and of one’s personal experiences and limitations. The choices we make determine who we become. Often an internal battle develops between those parts seeking consciousness and one’s protective life stance, created to block those parts from consciousness. This psychological split often results in self-alienation or estrangement. Illuminating and holding the client’s internal battle is a major focus for E-H therapists. Similarly, holding and illuminating the supervisee’s internal battle is a major focus for E-H supervisors. For example, a supervisee may want to take herself seriously and value her competency, but she’s afraid to do so because of past shaming experiences. In supervision, her battle manifests as an incongruent laugh when she’s discussing a serious issue related to herself or her client. The supervisor may first simply tag the laugh, but if it occurs repeatedly, the supervisor may invite the supervisee to engage in a deeper exploration of its meaning. 18

Introduction

THE PROCESS OF CHANGE FROM AN EXISTENTIAL– HUMANISTIC PERSPECTIVE IN THERAPY AND SUPERVISION The Phenomenological Method—A Way to Enter One’s Experiential World The basic principles of E-H therapy do not lend themselves easily to conventional empirical study, yet the phenomenological method is intuitively understandable to all therapists. To understand the inner world of their clients and supervisees, therapists and supervisors need to encounter their clients and supervisees without standardized instruments or preconceived notions: understanding clients’ symptoms and supervisees’ limitations not as problems to eliminate but rather as methods for maintaining selfhood by shutting out disavowed feelings or experiences. As Yalom (1980) suggests, “So far as possible one must ‘bracket’ (or set aside) one’s own world perspective and enter the experiential world of the other” (p. 25). There is nothing esoteric or highbrow about this method. All good therapists and supervisors engage in this way of being with their clients and supervisees—it simply means being present, accepting, empathic, and attuned to the meanings clients and supervisees have made about themselves and their experiences. Supervisors help supervisees understand that the intention of the phenomenological method is to treat every client and supervisee as an individual and not as a diagnosis or classification. Presence and curiosity cannot be cultivated when abstract models of human behavior or clinical diagnoses are projected onto clients or supervisees. Attitudes of being with and being for clients and supervisees are desirable—treating or doing to clients or supervisees are undesirable. The phenomenological method or the cultivation of presence promotes a real encounter between two individuals; it is not a hierarchical meeting in which one is a shadowy figure holding all the knowledge and power. On the contrary, as May (1983) suggests, “encounter [is] a way of participating in the feelings and world of the patient” (p. 66). Yalom (2002) describes it as a meeting of two “fellow travelers” on life’s journey together. 19

Supervision Essentials for Existential–Humanistic Therapy

Understanding the therapeutic and supervisory meeting or encounter in this way promotes attitudes of being with and being for clients and supervisees and germinates safe and close therapeutic and supervisory relationships, which form the foundation upon which other, more challenging work relies. Specific examples of how supervisors embody being for and being with supervisees are provided throughout the text. Cultivate a Presence to Process More Than Content As mentioned, although E-H therapists and supervisors value the content (or explicit features) of clients’ and supervisees’ experiences, they are acutely and simultaneously attuned to the process or implicit aspects of those experiences. Thus, E-H therapists and supervisors carefully cultivate presence to the personal and interpersonal ways of expressing content more than to the literal content of the story. They wonder, “How is my client or supervisee telling me his story?” “Is his voice flat and unemotional or filled with trembling emotion?” “Does he look at me or does he turn away as he tells me his story?” Process refers to clients’ and supervisees’ implicit attitudes and ways of relating to themselves and others. To the extent that clients and supervisees are desirous and capable of deeper work, E-H therapists and supervisors focus on the here and now, assuming that the therapeutic and supervisory relationships are microcosms of the client’s and supervisee’s personal and relational worlds. Therefore, E-H therapists and supervisors appropriately reflect back implicit personal and relational ways of being that are evident but unnoticed. They are attuned to what is most alive in the moment: for example, Krug’s focus on the client’s shredded tissue. They take note of self-critical or indecisive behavior. How does the client or supervisee relate to the therapist or supervisor—in an engaged, open manner or in a detached, aloof manner? How does the client or supervisee occupy personal space—with confidence and ease or with hesitation and constraint? Why do E-H therapists and supervisors focus their attention in this way? Because they assume that not only are their clients and supervisees before them, but so are their lives: their wish to live and their awareness of death, their yearnings for connection and their fear of rejection, 20

Introduction

their desire for change and their fear of the unknown. E-H therapists and supervisors know they don’t have to go on a treasure hunt to understand the client’s or supervisee’s past—it’s right in front of them! If therapists and supervisors bring a full and genuine presence to the encounter, they can bracket their own world perspective sufficiently to see a person as he or she really lives and understand his or her unique meanings made from past experiences. Illuminate the Actual but Unnoticed Protective Patterns Healing and change happen as protective patterns are mirrored back to clients and supervisees, allowing them to experience how their patterns are embodied and enacted within the therapeutic and supervisory relationships. Through this process clients and supervisees are more willing and able to reclaim disowned or undeveloped aspects of self in the future. Put another way: the path to greater freedom is paradoxically found through an encounter with the ways in which one is bound. Clients and supervisees begin to have a capacity to reflect on their ways of being instead of being unaware them: “Oh there I go, just making do again,” or “There I go again, rescuing my client instead of allowing her to become aware of a protective pattern.” Reflection on ways of being requires a pause, a slowing down of the process. We invite clients and supervisees to attend to what’s happening in their bodies. We invite images and associations about meanings and past experiences to become more conscious. “Just go slow and see what’s there” is something we might suggest to shift clients and supervisees from a doing mode to a being mode. Cultivating personal and relational presence in this way often allows clients and supervisees to feel the pain of a wound, no longer numbed by the protective pattern. The belief about self finds expression: “I’ve never felt worthy of being cared for—I’m damaged, that’s why I don’t reach out to you.” Or “I’m afraid if I don’t rescue my client, she won’t like me or she’ll discover I’m not enough.” To the extent appropriate, meanings made about self, others, and the world and the associated hurt and pain are felt and worked through at an embodied, not cognitive, level in the safety of the therapeutic and supervisory relationship. When supervisors support clients and supervisees to 21

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experientially embody their restrictive patterns, clients and supervisees can face and accept the givens of existence and their core decisions and wounds that may have been avoided, denied, or repressed. Together past relational patterns can be dissolved and new ones developed. Awareness, responsibility, and choice now become a part of the exploratory, reiterative process: “Oh, there I go again, just making do! Is that what I want to keep doing? Maybe not.” Or “There I go again, rescuing my client. Maybe I can pause and help her cultivate more presence about her way of protecting herself?” Jim Bugental likened a person’s protective pattern to a mask on one’s face, and as therapy and supervision progress and awareness about it increases, the client and supervisee slowly pull the mask away, bringing it into ever-greater focus. Responsibility is assumed for constructing the protective pattern and along with it a newfound sense of agency and choice. The process of healing and change is by no means linear; it also is not primarily cognitive. The deepest roots of trauma cannot be talked about or explained away; they must be discovered, felt, and lived through.

Emergence of New Meanings and New Behaviors Responsibility assumption is not sufficient—it is simply preparatory for substantive change evidenced when clients and supervisees first make new meanings about themselves (e.g., “I don’t have to just make do, I can lean on others because I am worthy and loveable” or “I don’t have to rescue my client, I’m sufficiently competent, and rescuing her doesn’t help her or me change”). These new meanings about self typically result in the construction of more functional, satisfying, and meaningful patterns of living and relating to others both personally and professionally. To sum, E-H therapists and supervisors use the phenomenological method to effect healing and change. Cultivating presence is another term for the phenomenological method. Presence is both the ground for a genuine encounter and a method for effecting transformational change. Presence involves aspects of awareness, acceptance, availability, and expressiveness in both therapist and client, as well as in the supervisor and supervisee. Presence implies that the encounter is real. For Martin 22

Introduction

Buber (1970), it means that the person who is before one has ceased being an “it” and has become a “thou.” If one can be truly present with another, a genuine encounter has occurred, in which previously disowned protective patterns and wounds can be faced, dissolved, or managed, and new, more functional patterns can emerge. This whole-bodied transformation can even, at times, lead clients and supervisees to notably new attitudes toward life in general: an attitude of humility and wonder or sense of adventure that can fruitfully be termed “awe-inspiring” (Schneider & Krug, 2010).

ROAD MAP TO THE CONTENTS OF THIS BOOK In this introduction, we have provided a background or context with regard to E-H supervision by providing the historical backdrop of E-H therapy, its theoretical underpinnings, and theory of change. We began here because supervision in this therapy is a model based on the key principles of E-H therapy; in other words, it is a therapy-driven supervision model. If readers understand the key principles of E-H therapy, as they apply to therapeutic and supervisory processes, the chapters that follow likely will be more easily comprehended. In Chapter 1, the essential dimensions of training and supervision are discussed and elaborated upon, such as the teacher/student relationship and the value of experiential learning. Two models of education and training are described in Chapter 2. They are the experiential retreat model and the more traditional individual or group supervision model. To create a more lived experience of these models, we’ve included the words of those who have participated in one or both of these training models. Chapter 3 offers a case illustration of the supervisory model. In Chapter 4 we explore ways to handle common supervisory and training issues that include dealing with difficult supervisees and navigating negative feedback and conflict in supervision and training. Chapter 5 focuses on the care and nurturing of the supervisor, whereas Chapter 6 explores the research and support for the E-H training approach. In the final chapter, we provide a summary and discuss future directions for training and supervision in E-H therapy.

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Essential Dimensions of Supervision, Consultation, and Training in Existential–Humanistic Therapy

W

hat are the essential dimensions of supervision and training from an existential–humanistic (E-H) therapeutic perspective? A reflection from one of the coauthor’s supervisees vividly alludes to some of these: Sessions with you helped me profoundly, not just as a therapist but also as an individual, learning to be more present with myself. Your presence showed me how using myself (as opposed to strategies and treatment tools) helps my work with my clients. Whenever I brought either my client’s issue or my struggle with a client, we eventually turned the attention to me, instead of getting caught up in the details of the case. This was very different from my experiences in [other] consultations and supervisions. Through this process of self-reflection, I was able to become more aware of how I am triggered by my client and work on myself, which in turn helped me become more present with my clients in therapy.

http://dx.doi.org/10.1037/14951-002 Supervision Essentials for Existential–Humanistic Therapy, by O. T. Krug and K. J. Schneider Copyright © 2016 by the American Psychological Association. All rights reserved.

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Supervision in E-H therapy aims to not only help supervisees master the key principles of E-H practice but also, as the previous reflection suggests, to develop their emotional maturity. In addition to this overarching aim, other essential dimensions and aspirations can be gleaned from the supervisee’s reflection: (a) E-H supervisors create a safe, collaborative, and supportive relationship in which supervisees clearly understand the expectations of the supervisory enterprise and feel safe to explore their own lived experiences relevant to the work; (b) E-H supervisors “walk the talk”—in other words, they embody presence, empathy, acceptance, and support when engaging with supervisees; (c) E-H supervisors help supervisees learn to cultivate relational and intrapsychic presence to grasp the feelings and lived experiences of their clients; (d) E-H supervisors work with supervisees’ personal contexts to develop their emotional maturity; and (e) E-H supervisors cultivate, within supervisees, a belief in the effectiveness of the approach and in themselves as a catalysts for healing and change. This chapter provides a bird’s-eye view of these dimensions; the next chapter illustrates the particulars with specific examples. Both chapters include personal reflections from students and supervisees.

THE ROLE OF THE SUPERVISORY RELATIONSHIP: WHERE CLINICAL COMPETENCY AND EMOTIONAL MATURITY TAKE ROOT E-H therapists believe a safe, secure, and collaborative therapeutic relationship is essential to cultivating healing and change in clients. Schneider and May (1995) compared the therapeutic relationship to Virgil’s journey with Dante into hell. Virgil, as therapist, does not intend to “cure” Dante; instead, he aims to be a fellow traveler “alive and present in Dante’s world” (p. 23). Similarly, E-H supervisors believe a safe, secure, and collaborative supervisory relationship is essential so that supervisees’ personal growth and professional competency may flourish. Like Virgil, E-H supervisors are fellow travelers, collegial, nonhierarchical, present, and real with their supervisees. Within this relationship, supervisees can experientially learn the principles of E-H practice and reflect on their world view and biases that may 26

Essential Dimensions of Supervision, Consultation, and Training

be facilitating or impeding the effectiveness of their therapy. E-H supervisors try to tailor the supervision experience to the particular needs of each supervisee, just as E-H therapists do for each client. Supervisors model evidence-based qualities of presence, empathy, and congruence and provide several didactic and experiential modalities from which supervisees can learn and practice E-H therapeutic principles. These teaching methods help supervisees: (a) experience the principles of presence, as lived in their supervisors; (b) learn how to cultivate relational and personal presence; and (c) work effectively with their clients’ emotional struggles and protective behavior patterns. In addition, supervisors provide exercises and engage in dialogue with supervisees to explore their biases and world views that are pertinent to effective therapy. As a result of this modeling, skill building, and personal reflective focus, supervisees frequently become more competent, confident, calmer, and accepting of themselves and their clients. The findings of Fauth, Gates, Vinca, Boles, and Hayes (2007) resonate with the focus described. In a comprehensive review of the psychotherapy training literature, they concluded “traditional psychotherapy training practices which emphasize didactic teaching methods, adherence to manual-guided techniques, and/or applications of theory to clinical work via supervised training cases, do not durably improve the effectiveness of psychotherapy” (p. 384). They went on to highlight the “heretofore overlooked organizational/treatment culture in the ultimate success of psychotherapy training” and demonstrated how this culture can be enhanced through the development of present-centered skills. These skills consist in what they call (a) “responsiveness,” or the capacity of clinicians to “recognize, attend, and empathically respond to clients’ needs, as expressed implicitly or explicitly within the psycho­therapy session”; (b) “pattern recognition,” or the expansion of the capacity to “respond to the most important events and experiences within a given psychotherapy session”; and (c) “mindfulness,” or the deepening of “moment-to-moment awareness and acceptance of one’s experience” (pp. 385–386). To facilitate these capacities, the researchers recommended a training environment that shifts from an emphasis on didactic-verbal learning to one that stresses individual and 27

Supervision Essentials for Existential–Humanistic Therapy

social (or “comindful”) meditation practices, role-play exercises, and critical observation of video demonstrations (pp. 386–387). That said, the E-H supervisory approach is often new and challenging for supervisees. A collaborative, experiential supervisory model that includes a focus on personal world views and biases should be helpful in mitigating supervisee shame. That is why supervisors need to clarify their expectations of the supervisory process with their supervisees. A rationale for various experiential learning, such as working with self and world constructs and supervisee’s personal context, needs to be provided, as do a rationale and description of the evaluation process. A normalization of such concepts as self and world constructs, protective patterns of behavior, and personal contexts also helps mitigate the onset of shameful feelings in supervisees. The aforementioned supervisee suggests this need: Being present during supervision with you was challenging for me yet most rewarding. You demonstrated to me what I needed to learn and experience through your own presence as you sat with me in my struggles, rather than showing me your techniques or knowledge. This changed the meaning and experience of our relationship significantly, at least for me.

This supervisee’s reflection highlights an aspect of the E-H supervisory relationship that differentiates it from many supervisory models— it is not intended as a transactional relationship in which the supervisor teaches the approach and the student learns how to do it. Quite the contrary, the intention of the E-H supervisory relationship is to be a transformative relationship in which the principles of practice are lived in the relationship in a manner quite similar to the transformative aspects of an E-H therapeutic relationship. For my supervisee and me (Orah Krug), our way of relating did change the meaning and quality of our relationship. It helped my supervisee first appreciate and eventually embody qualities of presence, empathy, and congruence in her life and in her work. For my part, I was transparent with some of my own therapeutic challenges and missteps. I believe my transparency helped her appreciate that, despite my status as a senior teacher/ supervisor, I am not immune to making therapeutic mistakes and losing 28

Essential Dimensions of Supervision, Consultation, and Training

my therapeutic footing. By revealing my lack of therapeutic perfection, I believe it helped her appreciate me as a fellow traveler, earnestly working, but sometimes failing, to understand the lived experiences of my clients.

TEACHING THE CORE PRINCIPLES OF EXISTENTIAL–HUMANISTIC THERAPY E-H therapists and supervisors cultivate presence to process, or put another way, they use the phenomenological method to have a direct encounter with the implicit, kinesthetic, affect dimensions of clients and supervisees, their music and movements beyond their words. This method allows them to be attuned to clients’ and supervisees’ lived experiences and feelings rather than to project onto clients or supervisees a particular theory or set of assumptions. Similarly, instead of receiving a manual of techniques to rely on, supervisees learn to value the human factors of therapy, relying on themselves and the therapeutic relationship to facilitate healing and change. The work has qualities of immediacy and intimacy as supervisees begin to experience the therapeutic encounter as a living laboratory. Supervisees learn how to build a safe and collaborative therapeutic relationship in which clients can experience ways of being and relating that may be out of conscious awareness. Remember how the “tissue behavior” of the client described in the Introduction was out of conscious awareness yet reflected a long-standing life stance? As Yalom suggests, working in the here and now is the power cell of therapy and supervision, in which therapists and supervisors understand the therapeutic and supervisory relationship as a microcosm of clients’ and supervisees’ relational and personal worlds—where the past is alive in the present moment. Thus, the therapeutic and supervisory relationship itself becomes the agent of change by which interpersonal and intrapsychic problems can safely manifest and be illuminated and worked through. Existential–humanistic therapists and supervisors attend to process as much as to content, with a particular focus on the concrete behavioral and relational manifestations of the meanings clients and supervisees have 29

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made about themselves, others, and their worlds. For example, my client’s tissue behavior manifested her life stance as, “I won’t ask for anything; I’ll just make do.” Similarly, my supervisee’s tendency to rescue her clients is likely a concrete manifestation of meanings she’s made about herself and others. How does one teach presence to process, empathy, and deep attunement to supervisees? Didactic teaching of these principles certainly has relevance, but the major emphasis must be on experiential learning because one cannot teach a way of being; one can only experience it. Consequently, after teaching, supervising, and training therapists for many years, the authors have formulated a brief list of lessons learned based on our students’ feedback: 1. Supervisees need more experiences of being and fewer explanations about being. Working in the here and now creates immediacy in the therapeutic setting and in the supervisory setting. In the here and now, we are in our experience of being. In the then and there, we are talking about our experience—abstracting and analyzing it. Too much then and there takes the life out of therapy and supervision. 2. Learning opportunities need to bring theoretical principles of practice to life. As my (Orah Krug’s) supervisee described, I brought the theoretical principles of cultivating presence and tracking process to life as she brought her clients into the supervision room. I helped her focus on her subjective and intersubjective experiences, her protective patterns, and the feelings behind them. I also created opportunities for her to role-play her clients so she could be more deeply attuned to their personal worlds and cultivate empathy for them. 3. Ground the principles of practice in personal experiences of being. There is a danger in using human features such as empathy in a technical way that can result in a mechanical understanding of the concept: that is, learning to act empathic instead of being empathic. But if empathy, acceptance, presence, and compassion are experienced by supervisees in a personal way, for example, if the supervisor embodies them, they do not become techniques to do but valued ways of being. 4. When supervisors model deep attunement to supervisees’ implicit experiences and processes underlying the stories about the clients 30

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and themselves, supervisees experientially learn the value of presence, acceptance, empathy, and compassion. Supervisees learn that presence to what is most alive in the moment (process) will illuminate their own and their clients’ self and world constructs (context) because the pasts of clients, as well as supervisees, are alive in the present moment. 5. By appreciating that contact is always informed by context, supervisees are more readily able to identify their own (and those of their clients) disowned experiences hidden behind protective stances that are embodied or enacted in the therapeutic relationship. Supervisees learn that in an atmosphere of safety and intimacy, dysfunctional relational patterns can be illuminated, disowned experiences incorporated, and new relational patterns formed. This is how the therapeutic relationship is the context for healing and change and how the supervisory relationship is a context for growth and development. 6. It is valuable for supervisees to focus on three dimensions of experience and process: (a) the personal or subjective dimensions of both client and therapist (i.e., a focus on self ), (b) the interpersonal or relational dimension (i.e., a focus on the in-between field of client and therapist), and (c) the ontological or cosmological dimension (i.e., an existential focus on the world). We believe that being present to all three dimensions of experience and process is crucial—all three dimensions are actual in the present moment and provide entry into the feelings and personal world of the client.

TEACHING ABOUT THE CLIENT AND THE TECHNIQUES Existential–humanistic supervisors don’t generally “teach about the client”; instead, they help supervisees learn how to brush away their presuppositions about the client and, with presence and acceptance, experience the personal world of the client. Supervisors help supervisees learn how to attend to and illuminate the client’s process (or implicit ways of being and relating). By attending to what’s happening in the here and now, supervisees learn to see the concrete manifestations of the meanings their 31

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clients have made about themselves, others, and their personal worlds. Such evidence is found in clients’ relational styles, behaviors, voices, body languages, and so forth. Supervisees learn how to cultivate an attitude of being with, not doing to, an attitude of unknowing. How is this attitude applicable, for example, when one is working with a client who describes himself or herself as “depressed”? If therapists understand the parameters and characteristics of depression but don’t overlay them onto clients, they are truly free to engage with an attitude of discovery and curiosity, wondering: “What is the meaning of these depressive symptoms? Why are they present now in my client’s life? What do they want to tell my client?” Therapists are not treating the client for depression with a list of manualized techniques. Instead, they enter the client’s emotional world with the intention of experientially helping the client to understand the meanings of the depressive symptoms. In what way may these depressive symptoms be serving to protect the client from disowned feelings or experiences? To explore these deeper meanings and embodied life stances, therapists attend to the client’s interpersonal and intrapersonal processes, perhaps focusing on the questions: “In what ways is my client living his or her life right now? How does my client relate to me? How does my client want to live his or her life in the future? To what extent is my client able to access his or her subjective and intersubjective experiences, and if he or she limits self, how does he or she do that?” When supervisees ask those questions, for example with a person who presents with depression, a way to be with the client begins to form, allowing the supervisee to explore the person’s particular experiences of depression, the meanings made about self, others, and the world at different points in the clients’ life. It also allows the supervisee to appreciate how they may react differently to similar experiences. This process helps supervisees be attuned to their personal world views or biases that may be interfering with their ability to be empathic and accepting of their clients’ choices and behaviors. One of the greatest challenges faced by therapists in training is to find their “pou sto” (e.g., their place to stand with clients; Bugental, 1999). When supervisees find themselves disoriented in the therapy hour, it is 32

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often a result of changing beliefs about personality development, the conduct of therapy, and psychopathology. The psychotherapeutic field is beset with numerous therapeutic approaches, treatment plans, and techniques that cause many students to seek a theoretical orientation that is most consonant with their own values. Based on our personal mentoring experiences with Rollo May, James Bugental, and Irvin Yalom and from our students’ feedback, we believe the E-H approach addresses students’ concerns and helps them address some of their most significant challenges. One such challenge is to glean structure from the particular perspective without obscuring the real, living person in front of them. If E-H therapy principles are valued as foundational for therapeutic effectiveness, then assessments and therapeutic stances will be formulated as the therapy process unfolds instead of following the typical sequence (e.g., traditional assessment, followed by treatment formulation after the intake session). This approach resonates with Rollo May’s essential stance of pursuing the person in the formulation rather than the formulation in the person. Certainly, psychosis or suicidal intentions must be addressed immediately, but even with these issues present, it is imperative that interventions be made without losing sight of the person who comes for therapy. As supervisees learn to cultivate relational and personal presence, they come to appreciate how the therapeutic relationship becomes a living laboratory. By cultivating presence and following implicit process with acceptance, compassion, and engagement, they help clients experience and face their problematic ways of relating or being. One supervisee summed up how we (the authors) teach about the client and the techniques: I learned not to conceptualize my client’s struggle as a problem to be resolved which objectified my client in the process—which is what I was trained to do. Now I’m able to see how my client’s way of being and relating could be her mode of self-protection that constricts her from experiencing life more fully, but allows her to function. I see my role as therapist to help her become aware of it so she can decide if this is how she wants to live. 33

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FACILITATING DEVELOPMENT OF SUPERVISEES’ EMOTIONAL MATURITY Research has shown that therapist qualities such as empathy, attunement, acceptance, and congruence are some of the most powerful predictors of therapeutic effectiveness (Elkins, 2012). The coauthors believe we are the tools of our trade and consequently hold the personal growth of supervisees to be integral to professional competency. How do we cultivate these qualities? The intimate journey of life-changing therapy requires supervisees to trust the subjective and intersubjective realms and cultivate fluid access to both realms. An outward focus on techniques and treatment plans does not promote this subjective and intersubjective awareness. On the other hand, a focus on intrapersonal and interpersonal process does. Intrapersonal process refers to the subjective realm; interpersonal process refers to the intersubjective realm or the space in-between. As the supervisee suggested, her supervisor cultivating presence with her enabled her to learn experientially the power of presence and learn ways to access her subjective and intersubjective awareness. Another supervisee reflected on his appreciation of the power of therapeutic presence: I’m now able to appreciate the focus on being present, what I believe to be the most fundamental “skill.” It allowed me to shift from my usual “doing mode” to “being with” my client so I could fully appreciate and empathize with what my client is experiencing. I learned the difference between being fully present with the client in comparison with just relating on a cognitive-matter-of-fact level.

A focus on supervisee’s personal context also helps to cultivate these personal qualities. Within the safety of the supervisory relationship, super­ visees explore their protective patterns or life stances, and how they may be hindering the supervisees’ ability to engage effectively with their clients. Sometimes supervisors will point out how supervisees’ protective patterns are manifesting concretely in the supervisory relationship. For example, a supervisee may have a rescuing type of relationship with her child that is out of her awareness. This rescuing behavior may manifest in the super­ visory relationship, leading the supervisor to illuminate it and explore 34

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with the supervisee how it may be manifesting in her therapeutic relationships. Role-playing a client is another way for supervisees to grasp the lived experiences of their clients and understand how they may be triggered by their clients’ ways of being. A by-product of this exploration often elicits within the supervisee greater empathy, appreciation, and acceptance of the protective patterns and life stances of clients. These models of experiential learning are described more concretely in Chapters 2 and 3. It should be noted that a focus on supervisees’ personal context is not considered a breach of the teach/treat boundary but rather a valuable aspect of developing supervisees’ emotional maturity. What does the term teach/treat mean? It refers to the intention of supervision, which is to teach supervisees the theory and practice of a particular approach using actual cases to bring the work to life. Typically there is a significant focus on the client’s disturbance and, depending on the approach, a focus on how best to treat the client. This type of supervision model may not value helping supervisees understand how their own personal challenges and protective patterns may be impeding therapeutic progress. In contrast, E-H supervisors believe in developing the person who is the therapist. One way to accomplish this is by helping supervisees understand how their world views and protective patterns may be slowing therapeutic progress. As we said, this focus is not seen as a breach of the teach/treat boundary but rather as an intention to develop the emotional maturity of the therapist. Because we understand that individuals always make contact with others from their personal context, that is, contact is always contextualized, the term countertransference is inadequate to describe how one’s personal context is always influencing one’s perceptions and consequently limiting, to some extent, one’s capacities for presence. This principle suggests that countertransference is not something that occasionally occurs and then vanishes; rather countertransference is actually a perpetual fact of limited presence, to a greater or lesser extent. Therefore, E-H supervisors endeavor not to cross the treatment boundary line (e.g., we would not engage a supervisee in an exploration of a deeply embodied trauma) but do engage supervisees in explorations of disowned aspects of themselves that are impeding and perhaps derailing the 35

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therapeutic work, as described in preceding paragraphs. An engagement in this exploration helps supervisees experience aspects of their personhood that need to be managed, reclaimed, or worked with rather than be unconstructively enacted with clients. Supervisees typically have a deeper appreciation for how their personal contexts affect client contact as a result of this exploration. They come to understand the need for constant vigilance so as not to “get caught in one’s context.” A quote from one of our supervisee’s illustrates this: “I am now aware of how my clients’ ways of relating may trigger some of my personal issues and how to use this constructively to assist my clients.” Of course there may be times when a supervisee’s personal concerns overwhelm the parameters of the supervisory relationship. Because E-H supervisors are keenly attuned to their supervisee’s process, it is quite likely that a supervisor would readily recognize a supervisee’s emotional overwhelm and quickly work to calm, soothe, and reduce it. Once the supervisee is more settled, the supervisor would suggest that further exploration of such personal concerns be handled within a therapeutic context. If the supervisee is not currently in therapy, the supervisor would do all he or she could to provide appropriate referrals to the supervisee, preferably with a therapist with an E-H orientation. To sum, if supervisors place a significant value on developing supervisees’ emotional maturity, the supervisees likely will develop the personal qualities that determine therapeutic effectiveness. We believe the assumption that Carl Rogers (Rogers & Russell, 2002) made about therapists readily applies to supervisors: supervisors are like gardeners, they can’t make something happen, but they can provide a soil that is rich in experiences that supports and nurtures personal growth. Several statements from our therapists in training suggest how supervisory education, focused not only on skill building but also on personal growth, results in transformative change: I’ve seen my work improve tremendously. I’m more spontaneous, more authentic and more attuned to my clients. I’m able to respond to their body language in a new way. I’m braver about bringing up what’s 36

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actually happening in the room. I’m also more relaxed and trusting myself more. Where do I even begin? In short, it has been an awakening experience for me. I’m not certain where this process will go, but I am experiencing my being to the fullest, for the first time in a long, long while.

CULTIVATE SUPERVISEES’ BELIEF IN A CAPACITY TO FACILITATE HEALING AND CHANGE We believe that therapists need to have a “good enough” belief in their ability to facilitate change. How supervisors can help develop this belief is an aspect of supervision that is not often explored but warrants greater attention. Our experiences working with our supervisees, as well as our personal experiences with our mentors, helped us develop this aim of training (Krug, 2007). Two related contentions constitute this general construct. First, therapists in training must have a theory or model of change they come to believe is effective. Common factors research has validated the significance of this belief to foster therapeutic effectiveness (Norcross & Wampold, 2011; Wampold, 2007, 2008). Second, supervisees need to believe in their ability to act as a catalyst or a midwife in this process of change. These two related beliefs, when developed and integrated by supervisees, provide the pou sto or place to stand with clients. Supervisees need to have a pou sto with clients; it helps them remain steady, strong, and calm when the therapeutic seas get rough and choppy. But how do supervisees come to value their clinical approach along with a belief in their ability to be a midwife for change? The most crucial factor is the attitude of their supervisors. If their supervisors have unwavering faith in their therapeutic approach and in their ability to be catalysts for change, then the supervisees will likely develop a positive attitude toward the approach and a belief in its effectiveness. Yet more is needed than mere trust in the supervisors for this belief to take hold. Supervisees must also have personal successes with the approach. If supervisees regularly employ the approach and repeatedly experience positive outcomes, their perception that the approach has value likely 37

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will increase. A sense of therapeutic efficacy (that is, supervisees perceive themselves to be effective facilitators of healing and change) seems to be a by-product of this reiterative process. In short, theory informs practice, and practice informs theory. Thus, when both parts are present, a belief in the potential of change and a belief in one’s ability to be a catalyst for change, the conviction in one’s power to facilitate change begins to develop. The more that conviction takes hold, the more the therapist embodies it; at some point, that ineffable quality of healer begins to be present in the therapist. We sensed that quality of healer in May, Bugental, and Yalom when we first met them and consequently were drawn to learn from them. But we believe all highly effective therapists have that quality, no matter what therapeutic approach they embrace. This is the nucleus of change—where the human elements of therapy transcend all techniques and modalities. Virgil walking alongside Dante as he journeys through hell beautifully illustrates this: Virgil is a fellow traveler, present and alive with Dante, not a disengaged practitioner who treats Dante from a manual of techniques. For this reason, education in E-H therapy values the human elements of therapy and understands psychotherapy as an art as much as a science. The psychotherapeutic field, in general, is truly remiss if it fails to do the same.

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Teaching Models, Methods, and Techniques in Existential–Humanistic Therapy

CREATING A RATIONALE FOR SUPERVISION AND TRAINING IN EXISTENTIAL–HUMANISTIC THERAPY Psychotherapist preparation from an existential–humanistic (E-H) perspective is incomplete to the extent that it neglects the development of the therapist as a person—the wellspring and instrument of creativity and artistry. Bugental (1987) posited, “The most mature psychotherapists are more artists than technicians [in that] they bring to bear a wide variety of sensitivities and skills so that their clients can release their latent potentials for fuller living” (p. 264). The seasoned therapist deftly integrates a sound knowledge base acquired through formal academic study and extensive supervised clinical experience with finely honed perception, interpersonal sensitivity and attunement, intrapersonal awareness,

http://dx.doi.org/10.1037/14951-003 Supervision Essentials for Existential–Humanistic Therapy, by O. T. Krug and K. J. Schneider Copyright © 2016 by the American Psychological Association. All rights reserved.

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and intuition (Duncan, 2015; Edelstein, 2015). The “intimate journey” (Bugental, 1990) that constitutes psychotherapy of life-changing depth requires such artistry. The training program, supervisory models, and methods highlighted in this chapter are grounded in the notion that the development of the therapist as a person and the acquisition of the skills and techniques of psychotherapy should be given equal priority. Recent research, reviewed in previous chapters, supports this view, as does Elkins (2012), who advocates for training that helps students develop superior personal and interpersonal skills by valuing empathy, attunement, and connection. Even more directly related to E-H therapy training is Wampold’s (2008) argument that all therapists may need an understanding of the key principles of an existential approach because it may provide the basis for all effective treatment. Consequently, the various models of teaching E-H therapy described in this chapter give equal emphasis to skill building, person building, and relationship building, using various forms of experiential learning as its primary method. The first part of this chapter describes a group-training program, its learning objectives, and teaching techniques; the second part describes E-H supervision with individuals and groups. The learning objectives are basically the same in both learning models, although the different contexts create some differences, which are noted. The linear structure of this narrative means that these learning formats are described separately, but in reality, most of the students engage with the authors in a comprehensive teaching program that includes (a) online courses in E-H theory and practice, (b) two 4-day experiential trainings, and (c) a minimum of 10 individual or group supervision hours each year. The varied learning models and methods inform each other, creating a vibrant, complex educational soil rich in nutrients in which students grow and thrive. The reader is asked to remember this actual learning context even though the program in this context is deconstructed to focus on its separate parts. Consequently, a brief description of the overall training program is presented first.

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PART ONE: A MODEL FOR GROUP TRAINING IN EXISTENTIAL–HUMANISTIC THERAPY Background and Description In 2012, heartened by the recent groundbreaking research on contextual factors, which will be discussed in Chapter 6, the faculty of the Existential– Humanistic Institute (EHI) launched a training program awarding certificates in E-H therapy. It remains the only formal training program in E-H therapy designed for licensed therapists and graduate students desiring to learn therapeutic principles of practice that go beyond behavioral techniques and treatment protocols. The faculty wanted to give to the next generation of therapists their interpretation of the unique education and training given them by their mentors, James Bugental, Irvin Yalom, and Rollo May. The EHI currently awards three certificates. Two yearlong Foundations of E-H Practice certificates are available: one is issued exclusively through EHI and the other in partnership with Saybrook University. The third certificate was established at the behest of the students, launching in 2013 as an advanced training program that culminates in certification as an Existential-Humanistic Therapist after the successful completion of 2 additional years of training. In fall 2014, the Modular Training Program was created for participants desiring to simply learn E-H therapy through the EHI’s experiential trainings and consultation groups. A teacher in training program also exists. Participants are selected from the pool of advanced training graduates who display significant therapeutic competency and emotional maturity. Those selected for this program have been practicing E-H therapy in consultation with a master E-H therapist for at least 5 years before being recommended by a member of the EHI’s training faculty. Consequently, their therapeutic competency, particularly their relational skills and capacity for personal introspection, are well known to at least one faculty member. These teachers in training are learning, through our training program and continued individual consultation with a master therapist, to become the next generation of master therapists, teachers, and supervisors of E-H therapy. There is no time span for this training program.

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Completion depends on how well and quickly the teacher in training can attain a level of mastery that is evident to the entire teaching faculty. When that happens, the trainee is deemed ready to supervise and teach E-H therapy independently. The Experiential Retreat: A Component of an Existential–Humanistic Training Program The experiential retreat is the centerpiece of EHI’s Certificate and Modular Training Program. Jim Bugental’s “Art of the Psychotherapist” (or “Arts”) workshop series, developed in 1996, was the inspirational model. The EHI’s founders enthusiastically embraced the Arts retreat model of learning, appreciating its rich and varied learning structure. Most of the EHI’s faculty has participated, some for more than 20 years now, in a version of Arts. All have come to deeply appreciate the value of a retreat setting for learning the craft of psychotherapy. The Experiential Retreat: An Effective Context for Learning Existential–Humanistic Therapy The experiential retreat model of education is designed to explicitly and implicitly bring E-H therapeutic principles to life. In a serene, rural setting, participants can immerse themselves in the approach over a 4-day period. The retreats are held in the fall and spring of each year. The environment is flush with humanistic values of acceptance, compassion, presence, support, courage, and creativity. Participants are invited to cultivate authenticity, be attuned to the relational and subjective realms, and develop a capacity to be more fully present to what is most alive within oneself and the client and emergent in the therapeutic relationship. Participants are also encouraged to fully experience and convey to others, as they feel comfortable, the complex mix of feelings such as hope, awe, satisfaction, dread, and confusion inherent in the practice psychotherapy—and that are considered, by some, to be unprofessional, unacceptable, or unsafe to discuss with colleagues. The structure of the retreats not only facilitates focused, intensive clinical training sessions but also allows time for reflection, relaxation, hiking, expressive arts, and various group activities that typically fall outside of 42

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professional roles. Thus, participants reap the benefits not only of working closely and collaboratively but also of laughing, crying, imagining, playing, and otherwise fully sharing their humanity. The retreat-training model germinates a therapeutic community of like-minded people to turn to for support and stimulation, thereby reducing or eliminating the often-felt isolation of therapeutic work. Although these training programs have been held at a country retreat center, the model does not preclude retreats held in dissimilar locations, such as at a city hotel. The crucial elements of the retreat structure are (a) sufficient time (i.e., 4 to 5 days) devoted to learning and practicing and (b) a safe environment, separate from the demands of everyday life. With these elements in place, participants can immerse deeply in the work, irrespective of location. Educational Aims and Objectives: Skill Acquisition and Personal Development One of the learning implications for a program that equally emphasizes skill acquisition and personal development is that these objectives interrelate. Another understands skill acquisition to mean the ability to use techniques appropriate to client needs, always incorporating those techniques into E-H therapy’s foundational principles of empathy, sensitivity, and deep attunement. Therapy is much more than a simple delivery of treatment protocols; it is an artistic and creative endeavor. Therapy is an intimate, personal encounter between two people that requires the therapist to possess sensitive attunement to underlying processes emerging in self, in the other, and in the relationship. It requires the therapist to know when to lead and when to follow, when to deepen and when to brush over lightly. It requires that one deposits at the door all that one has studied and learned because being with a client and thinking about a client are incompatible modes of being in a therapy session. To this end, mature therapists must cultivate self-awareness about their personal and interpersonal qualities as much as they must cultivate presence, empathy, and compassion for their clients. Consequently, we focus students on their subjective and intersubjective experiences, including reflections on their personal world view and biases, historical contexts, 43

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and attachment styles. The following sections describe how this is accomplished. Participants are encouraged to continually attend to how these constructs affect their personal and professional lives. Clinical training is structured in 2- or 3-hour learning modules over the course of the day to achieve the particular learning objective. Depending upon the particular learning objective, some combination of lecture, demonstration, experiential exercise, role-play, and/or dyad practice is included within the learning module. The core learning objectives are to (a) be present to and reflect back the process dimension of therapy. Presence to and reflections of the subjective and relational processes of client and therapist encourage the emergence of what is most alive in the moment, also known as “invoking the actual”; (b) reflect and vivify contextualized meanings and/or protective life patterns, also referred to as one’s protective life stances or one’s “spacesuit.” We understand meaning construction as an aspect of human nature grounded in one’s particular context and understand protective life patterns as recurring “ways of being” that often are out of awareness and have been created as a means for coping with overwhelming experiences. In other therapeutic approaches, these patterned ways of being are understood as resistance; (c) work relationally with transference and countertransference enactments, cocreated by therapist and client, understanding that within a safe and intimate therapeutic relationship, disowned painful experiences can be faced, resolved, or managed; (d) work not only with explicit existential issues but also with implicit existential issues underlying presenting problems; and (e) work with dreams to visually illuminate intrapersonal and interpersonal processes. Topics may include (a) understanding the therapeutic encounter as a context for transformational change, (b) learning effective methods for illuminating protective life patterns (one’s spacesuit) so as to explore the underlying self and world constructs, (c) ways to mirror the client’s internal battle, (d) utilizing dreams to deepen the work, (e) working with the meaning-making process, (f) exploring the existential givens, (g) ways to awaken to awe, (h) bringing the then and there into the here and now, and (i) working with personal context to promote contact. Technical skills, such as attunement and reflection of underlying intrapersonal and inter­ 44

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personal processes, mirroring, and illuminating the emotional atmosphere (i.e., invoking the actual and vivifying protective life patterns), are consistently reviewed. The structure and process of the program emphasizes that each therapist must incorporate and amend these learning objectives and topics in accord with his or her values, beliefs, and cultural-historical context. The advanced training deepens this foundational learning with the goals being to (a) explore and extend the scope of one’s E-H orientation, (b) recognize special circumstances in which one’s work may require adaptations, and (c) acknowledge personal limitations. Topics may include (a) assessing and taking into account the client’s emotional maturity or fragility, (b) working with special populations (e.g., children, elders, and mandated clients), (c) teaching and supervising, (d) developing shorterterm models of E-H psychotherapy, and (e) working with couples. In addition, technical skills are refined: for example, exploring more complex and client-specific aspects of the therapeutic contract, coping with acting-out impulses, modulating intimacy and eroticism, and preparing for termination. Finally, advanced students explore how to use the E-H principles as a basis on which to employ particular modalities or techniques, such as cognitive–behavioral approaches or trauma techniques (see Schneider, 2008; Schneider & Krug, 2010). The teacher in training/supervisor in training track is the most advanced level of training. Students who have successfully completed the advanced training and demonstrated sufficient emotional maturity and skill develop­ment to assume a future teaching and supervisory role are invited to participate. Participants volunteer to present conceptual materials, learning exercises, or related artistic productions. They help faculty organize the learning material modules and act as liaisons between students and faculty. Most significantly, senior faculty help them learn how to observe and provide constructive feedback to students in dyad practice. This is a form of supervising the supervisor in training. Initially, the supervisor in training will simply observe how an EHI teacher/supervisor works with a practicing dyad, noticing how the teacher/supervisor asks each dyad participant for his or her feedback first, starting with the one role-playing the client, and then moves to reviewing the positive aspects of the therapist’s 45

Supervision Essentials for Existential–Humanistic Therapy

work saving the less-positive aspects for last. Afterward, the supervisor in training has an opportunity to review the observed supervised dyad practice with the senior teacher/supervisor. Specific learning takes place when trainees have these opportunities to observe senior teacher/supervisors at work. One of our teachers in training commented on his experience watching a teacher/supervisor give feedback to a trainee: I was struck with how much of what was said (even in pieces where it was hard for me to find strong points) was positive, supportive, and genuine. You seemed to see through what appeared to me to be mistakes or missteps, straight to the positive intent and the being qualities of the therapist. This was a totally different way of engaging that beautifully modeled what E-H therapy (and supervision) is all about: being present and acknowledging what is here, and supporting it in order to help it come further into the foreground.

Additional learning occurs when the roles are switched and the teacher/supervisor observes the teacher/supervisor in training working with a practicing dyad, providing the trainee, after the practice session, with constructive feedback on his or her teaching and supervisory style, therapeutic competency, and relational skills in the same supportive and genuine manner as described. A Sampling of Various Learning Objectives and Learning Activities All of the learning activities are designed to help therapists in training develop competency with the principles of E-H practice and increase their self-awareness. The phenomenological method, also understood as the cultivation of presence, is the foundation of the E-H approach. It is both the ground from which the therapist works and the primary method for effecting healing and change. Cultivating personal and relational presence enhances the attainment of the overarching goal: increased sensitivity to the implicit process dimensions of therapy more than to the explicit, content dimensions. Of particular importance is presence to concrete manifestations of clients’ and therapists’ self and world constructs: that is, the protective patterns or life stances emergent in the here and now. 46

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Students learn how to listen to the music (the subjective and inter­ personal process) as much as the words (the story, the content). They learn to assume the client’s past is alive in the present moment; that is, the client has constructed meanings of past experiences, which now manifest in the present as protective patterns or life stances. These patterns and life stances are concretely evident in behaviors, voice patterns, expressed attitudes, and body language. Students also learn to focus on the ways in which clients relate to them, assuming that the therapeutic relationship is a microcosm of clients’ larger worlds. They learn how to bring the then and there into the here and now: for example, by asking a client who expresses mistrust of a friend “out there” if he is mistrustful of the therapist who’s “in here.” Lectures usually begin the learning module. The faculty keeps them brief; lectures usually are no longer than 20 minutes, with handouts and visuals provided along with exercises interspersed to engage the group and deepen the learning experience. Live demonstrations typically follow wherein a group member volunteers to “work” with a teacher/supervisor. Live demonstrations allow the volunteering trainee to receive supervision by role-playing a client, working with a dream, or addressing a pressing concern. By working with the teacher/supervisor in this way, trainees personally experience how the teacher/supervisor cultivates presence to the underlying implicit process more than to the explicit content. The teacher/supervisor invites curiosity for and engagement with, for example, a trainee’s quivering voice or incongruent laugh or a trainee’s overly compliant manner with the intention of deepening trainees’ experiences of self or self in a relationship. These methods demonstrate how to “invoke the actual” (i.e., hold up a mirror to what is most alive in the moment, such as the quivering voice). Finally, if the volunteering trainee is role-playing a client, the teacher/supervisor may demonstrate how to vivify a client’s protective behavior pattern or attitude, such as constant “lateness” or self-critical statements. One way to do this is to tag the behavior, “I notice you’re late once again. Could it have anything to do with your feelings about our therapy work?” Another way is to have a conversation with the protective 47

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pattern asking it, “Who are you and when did you get constructed?” This intervention will be described later in the chapter. Students observing the demonstration also receive value; observing allows them to actually see, for example, how to engage subjective presence by slowing the process and encouraging an inward searching so as to access images, thoughts, feelings, and memories out of objective awareness. For examples, if the phrase “it isn’t fair” is repeatedly expressed, the teacher/supervisor may invite the volunteering trainee to explore the phrase, assuming the repeated phrase reflects a significant meaning the trainee has made about himself or herself, another person, or experience. The teacher/ supervisor doesn’t know the meaning but is curious because the trainee has repeatedly invoked the emotionally charged phrase. So the teacher/ supervisor might say: “Where do you feel that in your body? Put your hand there. Gently and slowly make some space for any thoughts, images, associations that might emerge.” A question-and-answer period follows the demonstration, to debrief the experiences of instructor and student. The questions often elicit explanations related to therapeutic aims, ways to work with protective patterns, and ways to deepen the work. Afterward, the group breaks into dyads to practice the demonstrated skill. Students take turns as “client” and “therapist,” with an instructor or a teacher in training to observe, coach, and give feedback. The teacher/supervisor working with a dyad may ask the student role-playing the therapist if he or she would like help during the practice session. If the student agrees, the teacher/supervisor may suggest a possible relational intervention, such as “How are we doing? What’s been helpful so far? What’s not been so helpful?” Many trainees find this coaching model helpful because it gives them a chance to try out a new way of being therapeutic. If a trainee is stuck in the role of an “interrogator,” the teacher/supervisor might suggest he or she eliminate all questions in the practice session and only reflect back the implicit process. The trainee is encouraged to “play” with this new way of working. This suggestion often eliminates the pressure to perform or unwarranted shame while being observed. A deeper

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focus on the trainee’s “interrogator style” might also reveal how it is related to the trainee’s context in such a way that his or her therapeutic effectiveness is compromised. To sum, all teacher/supervisor feedback obviously needs to be supportive, constructive, and delivered kindly so that shameful or hurt feelings can be prevented. Viewing a video of a teacher/supervisor working with a client is another activity. The length of the video is usually longer than a live demonstration, allowing students to view an actual E-H therapy session unfolding. Students are divided into three groups, each assigned a particular focus: (a) how the therapist develops the therapeutic alliance, (b) how the therapist tracks and works with subjective and interpersonal process, and (c) how the client’s self and world constructs manifest in the here and now. After viewing, each small group reports on what they saw, then as a large group, questions are raised and reflections shared, making for a rich and lively discussion. The activity helps students see a client’s implicit process and protective patterns that underlie the story and how an E-H therapist might work with these processes and patterns. The range of communication skills (i.e., learning to monitor, mirror, and illuminate significant moments) is discussed, demonstrated, and practiced in dyads, often in the context of working with patterns of self-protection. Because there are no prescribed treatments in E-H therapy, we don’t use the word resistance to understand repetitive behavior patterns that resist therapeutic interventions. These protective patterns, also described as clients’ life stances or spacesuits, are understood metaphorically as the tips of an iceberg. Lying below these observable, concrete behaviors and attitudes are the self and world constructs. For example, a client or supervisee who is consistently late may be unaware that his lateness is a protection against rejection, behind which may be a personal feeling of “I’m not loveable.” Trainees/supervisees learn how to mirror back these actual but unregarded behavior patterns and own them if appropriate. The aforementioned self-protective pattern and others (e.g., clients with hair-trigger anger patterns, those who collect and embrace injustice perceptions, those who consistently express disproportionate dependency, and those who

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seem unwilling to take responsibility for their actions or life) are understood to be paradoxical in nature; on the one hand the spacesuit was constructed for survival but it typically constricts aliveness, satisfaction, and joy. Moreover, this life stance or spacesuit constructed in youth may no longer be needed because the environment is no longer hostile, but the client doesn’t know the air is safe to breathe, so to speak! E-H therapists/supervisors understand resistant behavior patterns in this appreciative way and view them as windows to change; said another way, we help clients and supervisees experience the air as safe to breathe. Activities in which student “clients” enact protective behavior patterns with student “therapists” help them learn how to work effectively with such patterns, both subjectively and relationally. Empathy, curiosity, and respect for the protective patterns are encouraged. Awareness of client readiness or reluctance as it emerges in the relationship and effective responses are also emphasized. Trainees are encouraged to continually reflect on the meaning and influence of these dimensions in their work and lives. Clarifying and mobilizing implicit elements of psychotherapy, such as client concern and intentionality and the therapist’s pou sto or philosophical stance (Bugental, 1999, p. 85), are also addressed. Ways to be sensitive to clients’ explicit and implicit existential issues are explored via lectures, demonstration, and exercises. An existential issue (e.g., a client’s relationship toward death and dying) often is a neglected aspect of therapy, whether or not it is explicitly expressed. Yet at the core of many constricting patterns of protection may be an avoidance of a particular existential issue, such as mortality or separateness. For example, Dr. Krug and her client Mimi, while exploring Mimi’s repetitive and emotionally charged phrase “It’s not fair,” discovered Mimi’s sense of personal betrayal. Mimi, a victim of an accident that could have killed her and her children, assumed up until the accident that if she stayed “on top of things” she and those she loved would be out of harm’s way. The accident ripped back that illusory curtain and revealed her vulnerability. Mimi’s “it’s not fair” phrase morphed from an expression of anger to an expression of resignation and acceptance (i.e., “it’s not fair that there’s no real protection, I’m not special, and bad things can happen to me and to those I love”). 50

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Dr. Krug’s exploration with Mimi of “it’s not fair” led Mimi to face her illusion of specialness and engage more realistically with the contingencies of vulnerability and death (for an expanded description, see “Mimi,” A Case Study, in Existential–Humanistic Therapy, Schneider & Krug, 2010). Some of the activities in the existential learning module are specifically designed for students to experientially relate to the existential givens. The intention of the activities is to highlight those givens, such as death anxiety, that student therapists might not recognize as present, or might avoid engaging with because of their own death and dying anxieties. The aim of one activity is to consciously face one’s mortality. Students draw a line on a piece of paper; at the start of the line, one’s birth is marked, and at the end is marked one’s death. Students are instructed to put a mark on the line they feel they are in their life. They are asked to take about 5 minutes to reflect on this mark. What feelings, thoughts, memories, and bodily sensations do the mark’s locations evoke? The students break into dyads and share their experiences of the exercise with each other and then the whole group. Reflections on Personal Patterns of Protection: A Valued Aspect of Existential–Humanistic Training and Supervision The notion that we are the tools of our trade implies that inward examination of protective patterns is crucially important. E-H therapeutic training and supervision whole-heartedly embraces this notion and consequently provides many opportunities for trainees and supervisees to appreciate how their protective patterns affect their clinical work. A particularly salient activity intended to illustrate the meaning-making process is the following: students are asked to think of a childhood experience before age 8 and reflect on the meanings they constructed about self, others, the world, and any associated feelings. Then they’re asked to reflect on whether and, if so, in what ways those meanings are active today, manifesting as constrictive behavior patterns or attitudes? Participants are invited to share their reflections. The teacher often works with a few volunteers, demonstrating how to work with these protective patterns and the personal meanings that have been constructed. Sometimes the group is enlisted to help the 51

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volunteer work with a long-standing construct of self, such as “I don’t matter.” A student, commenting on this activity said, “I found the exercise to be a simple, clear and direct way to understand and get in contact with the meaning-making process.” A follow-up activity in the afternoon might be to create one’s “context bag.” Students are given colorful small paper bags with six index cards. They are instructed to write their names and “context” on the outside, and then write on five index cards significant experiences, including the one discussed in the morning session, that shaped their sense of self, others, and the world. On a sixth card, students reflect on how these experiences may manifest as protective life stances in their present lives. This activity helps to vivify students’ meaning-making process, their self-and-world construct systems, and their protective behavior patterns. By attending to aspects of personal contexts in this manner, students are more able to recognize embodied meanings and emotions constructed from personal experiences. The exercises engage their curiosity. Many begin to ponder this question: “How has my context affected my life, my relationships, and my clinical work?” Slowly they begin to appreciate (a) how interpersonal contact is always contextualized, thus limiting presence to some extent, and (b) how awareness of one’s world view and biases ameliorates the impact of context on contact. This inward focus has been significant for many students, whose previous training did not include it. A quote from an advanced training student illustrates this point: I gained a deeper understanding of my own context and how that has directed and influenced so much of my existence. I have always had an understanding certainly that what is experienced in the early, formative years is paramount in shaping our belief systems and personality, but somehow I have never before been able to feel this in such a palpable way.

Attention is paid to one’s personal context in relation to specific client patterns. Students begin to understand how they may rescue clients, avoid intimacy, focus on content, problem solve, or unwittingly keep the work shallow. They are encouraged to examine tendencies to objectify clients, 52

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resist being present, and become preoccupied with theory, technique, or diagnosis. This type of learning is, we believe, unique and rare. It challenges students to shift their focus from learning to do to learning to be, not only with their clients’ processes but also with their own. It requires a willingness to be curious with an unknowing attitude, accept risk, be vulnerable, and look deeply within oneself. Not all students are able or willing to swim in these waters, but those that are have reported life-changing experiences, as the feedback from a foundational student suggests: The community interactions and the exploration of our own context in relation to how we practice were most valuable. I think that exercise was particularly powerful for me because it highlighted and contradicted my own context of “doing it right” or “there is supposed to be a way of being.” This retreat in particular was great at providing new learning experiences without eliciting “there is a particular way to be” which is a script that often gets run when I am trying to learn. For me the inquiry into choice and freedom were a fundamental theme and reinforced my own experiments in creatively dealing with my internal sense of helplessness.

The learning environment of this educational program invites this openness because the faculty values and cultivates safety, intimacy, support, acceptance, and collaboration. Documentation and Evaluation of the Students Documentation is maintained on each student with respect to progress toward completion of the program requirements. Certificate program students have assigned instructors to read and evaluate the required papers for their online courses. On the last day of the fall and spring experiential trainings, all students are paired off, and with an observing instructor work for 20 minutes as the “therapist” for their “client” partner, who addresses a relevant concern. In the 10-minute debriefing period, the two students and instructor share their perspective of the therapy and provide constructive feedback to the therapist student. Students then switch roles, and the 53

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process repeats itself. The advanced students demonstrate their competency in front of the entire group and receive constructive feedback from students and faculty. Orah Krug, the clinical director, keeps written documentation of each student pertaining to his or her strengths and areas for improvement generated by these evaluation sessions. Between the fall and spring training, the students participate in either individual consultation or group consultation with selected senior faculty. The faculty receives copies of these evaluations and also knows the students’ therapeutic competencies because they have worked closely with them at the trainings. This knowledge helps faculty build on the students’ strengths and focus appropriately on the areas that need improvement in case consultation meetings. Documentation and Evaluation of the Faculty and Training Program The training program has a 360-degree evaluation process—the faculty, as described, evaluate the students at the end of each experiential training retreat. The students evaluate the faculty and program formally with a before and after experiential questionnaire and informally during scheduled group process check-ins throughout the 4-day training. During these check-ins, instructors ask, “How are we doing—what’s been helpful, what’s been missing, what would you like more of, less of?” Sometimes issues between participants or between participants and instructors need to be addressed and resolved. Occasionally, participants ask a faculty member to help them work with a challenging personal issue that has arisen over the course of the 4-day training, not an uncommon occurrence when deep personal exploration is part of the curriculum. Students may elect to do this work as the group watches or in private; most choose to work in front of the group. This seems to be a reflection of the safety and acceptance that participants feel about the training group. The pretraining and posttraining questionnaires (see Appendixes A and B) are intended to assess the efficacy of the training program and its value to the participants both professionally and personally. Questionnaires include six open-ended questions and 12 evaluative questions. At the start of each year of training, the incoming and returning students are 54

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given the pretraining questionnaire, and upon completion of the yearlong program, they are given the posttraining questionnaire. From a training standpoint, we are primarily interested in two major qualities of experience. First, to tailor the teaching of E-H theory and practice to the students’ needs, we examine their responses to questions such as “What did you gain professionally from the program? What did you gain personally?” and “Having completed the certificate program, how comfortable do you feel with incorporating E-H theory and practice into your professional work?” These open-ended questions are intended to help us paint a thematic picture of what aspects really took root in the weeks following the second experiential training. The second focus is to evaluate which E-H constructs students integrated in a deeper, broader, and more personal way than others. This is accomplished by having students give their personal definitions of 12 E-H specific terms, such as process, life-limiting protections, and paradox. A complete set of results, distilled after year one of the training program, can be found in Pierson, Krug, Sharp, and Piwowarski (2015). The discussion that follows presents a limited set of results: themes gleaned from the open-ended, qualitative questions, collected over a 3-year period, that represent what students value about the program. From the postquestionnaires, four main themes emerged from the open-ended questions: personal growth and shifts, professional growth and shifts, deeper relationship to E-H concepts, and influential qualities of the experiential training. Personal Growth and Shifts.  The person of the therapist has a pervasive presence in E-H therapy. E-H therapists understand the importance of selfdevelopment as a conduit to deeper work with one’s clients. Some of the students found shifts and growth through confrontation with the program. For example, one student wrote: “The program has challenged me to walk my talk, to be open to some of the existential questions myself.” Many students commented on the value of examining their own context in a safe environment: for example, “I was able to do some very deep inner work. I continue to grow in confidence.” Two students’ statements captured well the sense of confrontation within a holding space. One commented, “The program 55

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illuminated and deepened my internal conflicts, while the group served as a place of safety.” The other said, “In a safe place, I was able to attend to my agenda and triggers that so easily get in the way of the therapeutic process.” Another subset of responses focus on an increased comfort with vulnerability. “The awareness of how much more growth I have ahead is no longer intimidating and I am more willing to take risks.” Another student reported, “I think I have . . . dropped some of my own protections . . . my heart is more open.” Yet another student said, “I recognize the ways in which I am becoming freer from reacting and taking things so personally.” An integral part of these statements is their partnering with the sense of feeling affirmed and strengthened, which serves as a ground from which to take risks toward exploring new territory. Finally, a third subset simply celebrates the depth and breadth of personal change from the program. “It would not be a stretch to say I am a completely different person than I was before . . . more secure, present, willing, and mostly alive.” Another student pithily remarked, “I am experiencing my Being more fully.” Professional Growth and Shifts.  Several students commented on the ways in which they are already incorporating skills learned at the training into their professional environments. Generally, these statements fall into categories of overall confidence with the E-H orientation and more specific shifts in students’ clinical work. Specific skills mentioned are an increased ability to see process, to cultivate presence, and to work in the here and now. There is a resounding increase of confidence with the E-H perspective for most students. Examples include “E-H therapy is the personal and professional perspective I want to take,” “I have increased my confidence and reliance upon the E-H orientation—I have restructured my entire private practice,” and “I have a deep enough foundation to continue developing myself as an existential practitioner.” Other comments are directed toward therapy as a whole, including “I feel a greater capacity to create healing conditions with the experience of the training,” or simply gratitude for feeling validated in their preexistent ways of working with clients. 56

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More specifically, one student remarked on “learning to be in the moment with clients, rather than in my head.” Students reflected on “relating in and from the moment” as a new option in their work, and many spoke of an increased trust in the following process: “I can really see, feel and sense process happening in the room.” Another said, “If I get out of the way of the client’s process, I believe she will reach her truth.” Others spoke of the profound effect that grounded presence had on clients they typically worked with from a more analytical stance: “I am able to bring more of myself to the session and that seems to create a stronger connection between me and my clients.” Finally, a profound shift took place for one student, who learned “not to conceptualize my client’s struggle as a problem to be solved.” In sum, these responses reflect an emerging appreciation for the profundity of moment-to-moment process and presence. The theoretical constructs of presence and process emerged as two of the areas of greatest evidence of integration in the evaluative portion of the research. Perhaps this is an unsurprising coincidence, given the previous theme of the personal nature of learning. Deeper Relationship to Existential–Humanistic Concepts.  Every student pointed toward a shift from a drier, more theoretical knowing to a livelier embodied kind of knowing. The following examples illustrate the various coloration of this fundamental movement: “I felt the concepts come alive,” “We moved from words and theory to a lived experience,” and “There was a shift from theoretical to kinesthetic knowing.” Some students became more specific about how the concepts gained new life. One student remarked how he was “now able to help clients contact themselves in new and useful ways.” Another reflected on her newfound skill of noting clients’ discrepancies by responding to clients’ body language and not simply their stories. Several students reported shifting from a “‘doing’ to a ‘being’ mode” in the weeks following the certificate training. Another commented that despite years of psychoanalytic training, which emphasized the importance of the past on one’s present functioning, she “gained a new understanding of how the past is present in therapy.” Finally, many students reported gaining facility with existential themes as 57

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they emerge in therapy, expressed by one student as: “Now I readily look for existential themes in my client sessions, when I name them, the material becomes very rich.” Influential Qualities of the Experiential Training.  Much like the previous three themes, there seemed to be an undercurrent of appreciation for the personal touch to the training experience for students. This emerged in several ways. First, students highly valued the instructors’ ability to model the concepts. One student observed: “The experientials were reflections of true encounters among like-minded people . . . willing to relate to one another at a much deeper level.” Several commented that the instructors allowed the moment to lead and modeled ways of being that eluded description but were deeply valuable. One student commented on the consistent atmosphere of “no one right way to be.” Within the theme of modeling, students pointed out a cultivation of presence throughout the experiential trainings in particular. One student summed it up well by saying, “This program was a living laboratory of presence.” Many students expressed appreciation for the varied teaching methods, the lectures, experiential exercises, and especially the dyad practice and feedback from their peers and instructors. Many expressed appreciation for the faculty’s commitment, availability, and engagement with the students. There was resounding enthusiasm for the group experience, as recalled by one student: “The support of the group was profound.” Another said, “It’s so wonderful to make friends and to know people share similar views on the human condition, the givens of existence, and a more meaningful exploration into the work we do.” Finally, students commented on valuing the live demonstrations, being able to experience E-H work “in action,” and having chances to try it out from several different vantage points—as clients, therapists, observers, and students in a trial run that included specific instructor feedback. Overall, students commended the instructors on “balancing theory and relationship” with great mastery.

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Conclusion The preliminary results of our study, based on students’ responses over 3 years, seem to suggest that our assumptions regarding the value and efficacy of the EHI Training Program have merit. With its comprehensive and integrated approach to learning, combining skill development with personal development, the program apparently creates a sufficiently rich learning environment to help participants effectively engage in lifechanging psychotherapy. We hope, with the publication of the final study, this program may be seen as a unique and effective model of training, which can serve as a template for other psychotherapeutic training programs. The highlighted program also may provide helpful learning ideas and suggestions for students, interns, and practitioners interested in further developing their artistry as psychotherapists.

PART TWO: SUPERVISION MODELS, METHODS, AND TECHNIQUES OF TRAINING Creating a Rationale for the Existential–Humanistic Supervisory Approach The E-H supervision model is a more traditional type of therapeutic education that also focuses on experiential learning. Participants meet weekly, biweekly, or monthly, either individually or in a group, with a supervisor/ consultant. As mentioned, most students working with Dr. Krug or Schneider in E-H supervision or consultation are also participating in the experiential trainings. These students typically are licensed professionals who have practiced psychotherapy for several years. As with the retreattraining model, the supervision model places equal emphasis on relationship building, person building, and skill development. Experiential learning, a cornerstone of the retreat-training model, is similarly emphasized in supervisory models. It affords students fewer explanations and more experiences of being—specifically experiences of how one cultivates presence within oneself, within the other, and within

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the relational field so that the personal worlds of clients and therapists are revealed. This here-and-now way of working with supervisees, utilizing techniques such as role-play to enter the experiential worlds of clients, is vividly illustrated in the consultation sessions described in Chapter 3. We have found that for students to readily engage in this type of learning, they need a safe, supportive, and accepting supervisory relationship. For this reason, E-H supervisors carefully attend to every aspect of the supervisory relationship to ensure that any rupture is noticed and repaired as quickly as possible. With a collaborative and safe relationship in place, students likely will feel secure and free enough to engage in this type of experiential learning, as did the supervisee who worked with Kirk Schneider (see Chapter 3). As suggested, E-H supervisors are as opposed to “standardized” supervision as they are to standardized therapy. One way to build a unique relationship with each client and each supervisee is to frequently check in. Here is a sampling of questions to shape the therapy/supervision to the particular needs of the client/supervisee: “How are we doing? What was difficult today? What parts of the session/consult were you disappointed with today and what parts were you pleased with? Is there anything I could have done differently to have helped you more today?” Another method used to destandardize supervision is for the supervisor to occasionally present her own clients’ dreams, or even her dreams, especially if they are about clients or supervisees, or share an intriguing here-and-now encounter with supervisees. By engaging this way, she models what it means to be a fellow traveler and cultivates a collegial, nonhierarchical atmosphere with them. Combining Experiential Learning With Auxiliary Aids Individual and group supervision utilizes experiential learning primarily through demonstration, dyad practice, and exercises. Process notes, case summaries, audio recordings, and client dreams are excellent auxiliary aids that complement these learning modalities. One of us (Dr. Krug) created a process note and case summary handout for supervisees to use in sessions and case consultation (see Appendix C). The handouts help 60

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students focus on (a) working with the process dimension, explicitly seeing what is most alive in the moment; (b) the client’s behaviors and/ or attitudes manifesting concretely that reflect his or her self and world constructs; and (c) the interpersonal realm (e.g., the personal context of supervisee and client being embodied or enacted). Audio recordings are valuable in providing a microview of the interaction, helping supervisees to hear the music behind the words. Tone and attitude of the client can be heard more clearly with repeated listening, as can key words or repeated phrases that indicate significant meaning about self or other, such as “maybe I’m really nothing.” Listening together allows for an in-depth exploration of the supervisee’s communication skills with regard to mirroring, empathizing, and deepening the process. It also invites exploration into the supervisee’s world view and biases. Video recordings are of course most desirable because they allow supervisor and supervisee to observe the “dance between client and therapist.” It is difficult because of logistics and the presence of a third party, but on rare occasions they are made and viewed. Client dreams are another aid to enter the experiential world, acting as a gateway to the nonverbal, visual worlds of clients. Consequently E-H supervisors encourage their supervisees to work with clients’ dreams and bring them to supervision. Appendix D contains a “dream-work” guide to aid supervisees in understanding clients’ dreams as well as their own. In the experiential retreats, several learning modules explicitly focus on dream work. Chapter 4 provides an example of how a student’s learning block was resolved by working with a significant dream in one of these dream-work learning modules. The Supervision Session: The Process, Methods, and Techniques The Supervision Process The supervision session typically begins with the supervisee briefly describing his or her client, including a brief history. Then using process notes, case summaries, audio recordings, or a dream the supervisee hones in on the client’s way of relating and being in the therapy. The supervisee 61

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proceeds with the reason for bringing the client to supervision—perhaps a specific therapeutic issue or a more general sense of being stalled or stuck that requires exploration and clarification. Depending on what seems most helpful, the E-H supervisor may suggest the supervisee play an audio recording, enact the client’s dream, or role-play the client. If the supervisee describes a more general feeling of being stuck the supervisor may invite the supervisee to explore the feeling by slowing down and making space for it with presence and an accepting attitude, allowing images, associations, and thoughts to emerge. The value of role-play and personal work cannot be overestimated. In both situations, supervisees experience the E-H approach in action as their supervisor works therapeutically with them. In the role-play, they embody their clients, grasping their feelings, lived experiences, and self and world constructs. By engaging in inner work, supervisees explore and work with personal life stances that may be interfering with their therapeutic effectiveness. Specific interventions are described in the next section that vividly illustrate how one works in the here and now to cultivate personal and interpersonal presence. Model and Demonstrate the Cultivation of Personal and Interpersonal Presence Existential–humanistic supervisors find numerous ways to model and demonstrate how to follow personal and interpersonal processes manifesting in the here and now. For example, a supervisor may comment on a supervisee’s just reporting what happened with a client (tagging reporting behavior), helping her become more aware of how the reporting behavior limits genuine presence. A supervisor might say, “You’re leaving yourself out of this description. You seem to be only reporting about yourself, not talking with me. Can you bring in your feelings and thoughts? I wonder if it’s hard for you to risk just being here.” This sample intervention demonstrates how one attends to intrapersonal process, listening as much to the music as to the words, to hear not only the story but also the attitude underlying the story. In short, how is the story being conveyed? Is the attitude urgent, impassive, critical or 62

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compassionate, distant, flat, or highly emotional? Other ways to illuminate protective patterns might be to say, “You know, I’d never guess you’re upset; you’re saying it so calmly” or “How continually you critique yourself.” E-H supervisors focus on the growing edge or in other words the leading edge of a person’s life stance pattern, with an intention to attend to what is limiting an ability to be with inner experiencing by mirroring the limitation as concretely as possible. They may broaden the frame with a focus on how a protective behavior pattern, such as needing to be perfect, reflects a life structure by saying, “This is your life right now; you’re acting it out right now.” Or they may slow the process so that behaviors and attitude about one’s self and others may be truly experienced. Supervisors continually stress and demonstrate that change is facilitated not by urging supervisees to be somewhere else but by showing them where they are right now. By slowing the process, the supervisee can get present, inviting reflection on his or her subjective experiencing, and affirming whatever may come next. For example, if the supervisee says, “I feel foggy,” the supervisor may say, “The foggy feeling is a window, go slow and see what is there.” Supervisors want to teach supervisees how to expand an experience, understanding that the statement “I feel foggy” has personal meaning and perhaps is a protective stance intended to shut off disowned feelings or experiences. Supervisors try to cultivate curiosity for the flow of subjective experiencing and concern for what really matters by saying, “Feel into the place where the anger was and see what is there now” or “Pause for a moment and just get here—feel how it is to be here with me.” E-H supervisors believe that education and transparency often are needed to support the supervisee and clarify the therapeutic aims, such as accessing the subjective and interpersonal realms. The interpersonal or relational realm is given equal attention in E-H therapy. In demonstrations or discussions with supervisees, supervisors may focus on the interpersonal dimension to help a supervisee effectively address a client’s protective relational pattern or address the supervisee’s protective relational pattern. Why is a focus on the interpersonal dimension so important? E-H therapists believe that many people come to therapy 63

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because of an inability to form and maintain close and satisfying interpersonal relationships. Similarly, E-H supervisors understand that some supervisees have great difficulty building relationships outside the therapy room, and inside the therapy room they tend to avoid a real encounter with their clients. Learning E-H therapy is challenging for supervisees who have difficulty with intimacy and transparency because E-H therapy values authenticity and immediacy; as Irvin Yalom said in The Gift of Therapy, “The here-and-now is the major source of therapeutic power, the pay dirt of therapy, the therapist’s (and hence the patient’s) best friend” (2002, p. 46). Supervisors try to cultivate interpersonal presence. They teach supervisees ways to bring attention to the interpersonal realm by instructing, demonstrating, and modeling a relational focus in the supervisory relationship. A few examples of how one can work interpersonally are provided here: A. Find here-and-now equivalents of then-and-there events taking place outside the therapy room. This intervention assumes that when clients (supervisees) describe relational difficulties outside the therapy room, those specific relational difficulties are likely manifesting in the therapeutic relationship in some way. B. Be transparent about interpersonal here-and-now experiences with clients (supervisees). Give clients (supervisees) feedback about the impact of their behaviors on you (the therapist, the supervisor). The underlying assumption is twofold: if the therapeutic (supervisory) relationship is a microcosm of clients’ (supervisees’) relationships outside the therapy room, therapists’ (supervisor’s) feedback about clients’ (supervisees’) behaviors will bring awareness not only to relational difficulties with the therapist (supervisor) but also to clients’ (supervisees’) broader relational difficulties; and openness cultivates honesty, safety and intimacy in therapeutic and supervisory relationships, which make the relationships themselves agents of change. C. Give clients (and supervisees) feedback that does not trigger guilt or defensiveness: use “I” statements about how you feel when they do such and such, and note how the behavior being examined in some way keeps you (the therapist or supervisor) from getting closer to the client or supervisee. 64

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D. Explore clients’ (supervisees’) disclosures across as well as down. Ask “What made you decide to share this with me today?” This inquiry cultivates immediacy and intimacy and can open clients to as yet unacknowledged aspects of self. E. Do a process check-in. Ask “How are we doing?” “What’s been helpful, difficult?” The check-in helps therapist and supervisor shape the therapy (supervision) to the needs of the client/supervisee to create a more intimate and safe relationship. F. Ask questions intended to teach empathy, such as “How do you imagine I feel when you come consistently late to our sessions?” The intention is to bring awareness of and empathy for the other. Many interpersonal problems stem from a lack of empathy. If therapists teach clients empathy for the therapist, they can extrapolate that learning to other people. This relational focus is a recontextualization of the meaning of transference. No longer is transference explained, as Rollo May said, “as one would an arithmetic problem . . . [instead] it gets placed in the new context of an event occurring in a real relationship between two people rather than an event being ‘just transference’” (May, 1983, p. 160). A Vivid Example of Experiential Learning: The Role-Play Technique.  The role-play technique bypasses the “detached reporting” about the client, characteristically found in many individual and group supervisory sessions. Role-play is an effective method for entering and living in the experiential world of a client. Being the client gives supervisees the space and time to grasp their client’s self and world constructs, to feel into the client’s subjective experiencing. Most supervisees find the role-play technique to be quite valuable, as attested to in the following reflection: Role-playing the client helped me gain empathy and develop a greater understanding of my client’s experience. It helped lead me into the inner world of my client, giving me an experiential sense of what it might be like to be him or her.

The instructions to engage in a role-play are straightforward. The E-H supervisor asks the supervisee to be the client as genuinely as possible 65

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while the supervisor serves as therapist. In a group case conference, the supervisor might ask a supervisee sitting next to the presenter to be the therapist as the presenter role-plays his or her client. Each of these role-play interactions provides a different learning experience. By role-playing their clients, supervisees can cultivate empathy for their clients and construct an embodied understanding of them. By serving as therapist, a supervisee can practice following and illuminating the unfolding process. Role-playing a client often allows supervisees to enter the client’s inner world, where as Bugental often said, “we most truly dwell.” The exercise can also help supervisees recognize how they are identifying with their client or how their client’s protective patterns are triggering countertransference issues. Molly Sterling conducted a phenomenological exploration of this role-playing technique (Sterling, 1993). Her findings suggest “when a good working relationship exists between therapist and super­visor, such role-playing brings a new dimension into the work” (p. 39). She calls this new dimension the “meld experience,” which according to Sterling, occurs when at some point during the role-play the therapist, playing her client, experiences a oneness with the client. One of us (Dr. Krug) filmed a case consultation with Jim Bugental in 1996 (Bugental, 2005). It illustrates this meld experience quite vividly. The consult began with my (Dr. Krug) describing to Bugental my client named Joe, a young architect raked by self-doubt and self-criticism. Shortly into the description, Bugental asked me to be Joe. As Joe, I enacted his shifting back and forth between his feelings and his inner critic’s judgments about his feelings. After listening for a time, Bugental said simply, “Joe, whose side are you on?” His question riveted me. Asking this question was Bugental’s method of illuminating what was actual but unregarded within Joe. My client’s shifting back and forth was a protective pattern that had not yielded to any of my interventions, the focus of which had been on the existence of his shifting. Bugental’s question expressed a deeper level of presence with Joe’s protective pattern. By asking Joe to reflect on whose side he was on, Bugental indirectly encouraged him to trust his experiences and feelings, understanding that Joe was fearful of doing just that. Bugental did not tell this to Joe; instead, he facilitated an experience of this for Joe. 66

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Watching the video, a viewer can see how I (role-playing Joe) was stopped in my tracks as I felt the impact of Bugental’s words as both myself and as Joe. Bugental immediately recognized that something was occurring within me and shifted me toward that awareness saying, “What’s happening inside Orah now?” I replied, “Your question to Joe reverberates in me. Whose side am I on with myself? I feel that inner battle, my feelings of competency battling with my fears of incompetence. I want to be on my side.” Saying that, I realized how much I was identifying with my client’s difficulty trusting in his capabilities. Not only was I able to have an experience of my client’s struggles, but I also came away with a valuable experience of my own internal struggle. Another vivid example of the role-play process is presented in Chapter 3, illuminating a supervisee’s countertransference issues and her clients’ enactments of limiting life stances and attitudes. In summary, a focus on subjective experiencing within both client and therapist helps supervisees identify, work with, and diminish their own and their clients’ protective patterns, which initially are constructed to protect but ultimately constrict one’s ability to be fully alive. As a result of this focus supervisees develop (a) empathy for themselves and their clients, (b) greater emotional maturity and steadiness, (c) personal and interpersonal skills, and (d) an appreciation for and ways to work with the impact of personal context on interpersonal contact. Documentation and Evaluation Existential–humanistic supervisors typically keep separate case notes on each of the clients presented by their supervisees. Each case includes the supervisee’s name, client’s pseudonym, date of presentation, a brief client history and/or update, and the therapeutic issue needing attention. The method of the supervisory work is documented (i.e., review of audio recordings, dream work, role-play, or personal work). A collaborative evaluation of the supervisee’s growing edge with the presented client is also included. Existential–humanistic supervisors often take the temperature of the supervisory relationship with process check-ins, which have been described in preceding sections. As discussed, attention to the relationship is uppermost in the minds of E-H supervisors to ensure that any rupture 67

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is quickly addressed and resolved. Obviously, this supports the creation and maintenance of a safe, secure, and accepting learning environment in which supervisees can feel free to share mistakes, personal challenges, and successes. It also invites supervisees to freely express their positive and sometimes less-than-positive experiences of the supervisor and the supervision. A formal evaluation of both the supervisee and supervisor is often taken at the end of the supervisory experience. The supervisor and supervisee may write reflections on the work accomplished and the work that lies ahead. Each includes his or her perspectives on the positive and negative aspects of the supervisory experience under examination. These reflections are then exchanged and discussed. Terminating sessions often are flush with appreciation and gratitude for the learning each person has received from the other. Sometimes the termination sessions reveal relational or personal blocks that could not be resolved. Regardless of the outcome, the transparent termination process generally is experienced as a worthwhile endeavor. Modifications of the Existential–Humanistic Approach: Supervisee’s Development, Therapeutic Setting, and Client’s Situation The aforementioned description of the supervisory process is simply a guide for E-H supervision and certainly is not intended as a manual. Supervision, like therapy, must be tailored to meet the needs of each person. For example, a supervisee who has had little practical experience with clients requires basic instruction on how to simply sit in the room with a client or how to manage the business of therapy, such as callbacks and missed appointments. Basic instruction in listening, monitoring, and mirroring content and feelings typically begins the learning process. Then a focus on cultivating presence to the client’s process is introduced. Ways to cultivate presence are demonstrated, such as slowing down the therapeutic process by suggesting the client focus on his or her attitudes, feelings, and/or behaviors that are emerging in the here-and-now. Gradually, more complicated aspects of the therapeutic relationship are addressed, such as client and therapist enactments and the existence of existential issues. The setting in which the supervisee works is also taken into consideration. Private practice, clinics, or counseling centers typically give thera68

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pists greater freedom to work in the way they believe is most effective. Other settings, such as assisted living dwellings or homes for delinquent teenagers, whose values resonate with the E-H therapeutic approach, are an easy fit for the supervisee. However, supervisees have a less than easy fit if they work in settings such as a hospital or clinic that insists on a particular approach, for example, a cognitive–behavioral one. In such cases, E-H supervisors need to help supervisees meet the requirements of the clinic and at the same time help them find ways to integrate the E-H approach with the other. For example, E-H supervisors can help supervisees learn to write therapeutic goals using the language of cognitive–behaviorism and help them learn to focus on the implicit, process dimensions while still using cognitive–behavioral interventions. The client’s unique situation in life is another therapeutic condition that requires consideration. Again the axiom that E-H therapists create a new therapy for each client applies here. The authors have supervisees who see a wide range of clients—from elders, runaway teenagers, and abused women, to culturally and sexually diverse individuals. The applicability of E-H therapy with this diverse group stems from its fundamental premise and method: to help clients, therapists must truly know them, which means therapists must find ways to bracket (i.e., set aside their world view and live in their clients’ experiential worlds)—not merely project onto them various theoretical notions of human functioning. Supervising in a Group: The Value of Group Case Conference Group supervision is similar to both individual supervision and experiential group training. It is similar to individual supervision with respect to frequency of meetings and some goals, methods, and techniques. It has more in common with group experiential training because participants take turns practicing therapeutic skills in a role-play or in a dyad. Being the therapist offers opportunities to receive support, clarification, and differing views on the observed work from the group members. A group setting also encourages lively discussions among members on specific approaches, attitudes, and the efficacy of particular interventions. Perhaps most importantly, group supervision gives its members many opportunities to watch their supervisor in action. A discussion about the 69

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client or about the work is a pale substitute for the real thing. An aspect of E-H training and supervision that perhaps distinguishes it from other educational approaches is the supervisor’s transparency with respect to his or her actual practice. Students have repeatedly shared how important it is for them to see supervisors work (and sometimes struggle). Showing students how we actually practice our craft by working with them, sharing where we get challenged, and how we work through it (or don’t) is invaluable learning. Group case consultation also cultivates a sense of clinical competency among group members when they are encouraged to engage with the presenting supervisee. This occurs if the supervisor stays quiet, silently inviting the group participants to take the lead. Consequently, group members ask questions of the supervisee, such as about the client’s way of relating, or offer opinions about the therapeutic issue being discussed. A collaborative atmosphere develops as group participants begin to feel more comfortable and competent in forming opinions about therapeutic situations and issues. Most importantly, group members begin to trust their clinical instincts. This type of dynamic is of course more likely to happen with seasoned clinicians, but it also can occur in groups of less experienced therapists if an atmosphere of acceptance and trust is cultivated. Finally, case consultation is similar to experiential group training in that it affords participants opportunities to work with emergent group process. Currently, the EHI training offers both live consultation groups and online groups, which meet monthly. The group dynamic and interplay among participants are much the same, due in part to the familiarity of the group participants with each other. The online group has allowed participants from Canada and all parts of the United States to participate, ensuring them a continued connection with each other and the instructors between the experiential trainings. As a postscript, note that if the supervision group endures over many years (such as Orah Krug’s “twenty year and counting” consult group has with Irvin Yalom), it becomes a small but sturdy community of intimate friends and colleagues who love and support each other when the vicissitudes of life inevitably appear. 70

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Case Illustrations: Excerpts From a Transcript of Two Supervisory Sessions

T

he following are two case illustrations of supervisory sessions that took place with Kirk Schneider’s supervisee, Bea Craven. The first session describes the case of “Christina.” Kirk recorded this session for the Clinical Supervision Essentials DVD Series produced by the American Psychological Association (APA; Schneider, 2016) to demonstrate some of the highlights of the existential–humanistic (E-H) supervision approach.1 The second case describes that of “Carlos,” from another APA recording that is not currently commercially available. This chapter includes excerpts from a transcript of these sessions; however, viewing the full 48-minute video of the case of Christina will markedly increase the reader’s understanding of this material.

For purchase info, please visit http://www.apa.org/pubs/videos.

1

http://dx.doi.org/10.1037/14951-004 Supervision Essentials for Existential–Humanistic Therapy, by O. T. Krug and K. J. Schneider Copyright © 2016 by the American Psychological Association. All rights reserved.

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THE SUPERVISEE Before the supervision session presented here, Bea Craven and I (KS) had consulted for approximately 1 year in my capacity as instructor for the Existential Humanistic Institute’s Foundations of Existential–Humanistic Practice Certificate Program, in which Bea was a student. At the time of this supervision session, Bea was 29 years old, had just completed her PhD in clinical psychology, and was engaged in a postdoctoral internship at a college counseling center. Regarding Bea’s demographic background, and in keeping with the personal nature of this work, I’m going to let Bea speak for herself: My background is that I’m half Peruvian and half Colombian. I was born in Lima but moved to Houston at 8 months old and was raised mostly in a small, conservative suburb with the exception of 4 years in Caracas, Venezuela, during late elementary and middle school. I have extensive Jewish family here in the states that I am very close with. Needless to say, I have always had a hard time fitting in boxes, and I’d say this has impacted my sensitivity to understanding the story behind a demographic label.

Bea’s case presentation involved a client of whom I had no previous knowledge.

SUPERVISION SESSION 1: THE CASE OF CHRISTINA I began my supervision with Bea, as I characteristically do, by asking her to summarize some basic demographic information about her client, Christina (a pseudonym). I believe it is helpful to gather key data about a client’s past before proceeding to discuss the client’s present circumstances. Although I support the existential perspective that stresses the past as it manifests in the present supervisee–client relationship, I also believe that as supervisor, a succinct knowledge of the client’s history is vital to forming a deepened picture of the client’s current concerns. In this context, I especially ask for data about the client’s age, ethnicity, marital status, and major precipitating factors, such as traumas, that brought her to therapy. 72

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Bea conveyed to me that Christina is a 25-year-old graduate student majoring in social work. She is from Poland and came to Bea’s clinic to complete her therapy hours for her social work program. She had been in therapy with Bea for about 14 sessions. Christina’s presenting problem, according to Bea, was difficulty adjusting to life in the United States. In particular, Christina felt alienated by what she perceived as the false connections people made in the United States, such as pretending to be friendly but ultimately being indifferent or even rejecting in relationships. She felt that in Poland the people tended to be more straightforward. When I asked Bea to elaborate, she explained that at a deeper level, Christina was terrified of abandonment and that trust was a major issue for her, which tied directly to her frustrations here in the United States. I then asked Bea to elaborate on Christina’s trauma history. At first Bea seemed unsure but then realized that Christina seemed to have suffered significant distress in her childhood upbringing. Christina had been raised by a series of different babysitters, Bea explained, and seemed to have a fragmented connection to her parents. “One day [her babysitter] might be gone,” Bea elucidated, and her “parents were [frequently] absent.” However, as we explored deeper, Bea noted that Christina’s main problem at present was her boyfriend. She perceived him as the “sun of her world.” The word “sun” struck me as particularly rich in significance. The sun has a centrality associated with it; it is the center, the core, and Bea affirmed this when she stated about the boyfriend: “Everything revolves around him.” His influence is like a “death grip” . . . a “death grip like her fear of abandonment.” Without him “her whole world would crumble.” These were powerful phrases for me. As with my experiential focus in therapy, I try to hear the music in supervision. This music about Christina’s boyfriend and her fear of abandonment struck me as profound, and I wondered how Bea both internalized this profundity and held it in her contact with Christina. This puzzlement led me to invite Bea to become more personal in her description of her work with Christina. Here is an excerpt of our dialogue at this point: Kirk: So what’s [Christina’s] relationship like with you? Bea: So we have a really good relationship. It’s been a really challenging thing to come to, because . . . especially at the beginning—I might make 73

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[what felt] like a really a tame intervention, and [Christina] would read into it something that was so off base from what I was saying. Kirk: Hmm hmm, that distortion. Bea: [Yes] that distortion would come in. The way I experienced it was like a porcupine or something. All of a sudden all her sharp edges would come out. Kirk: Sounds like it was scary. Bea: Yes, it was like “Whoa . . . what was just happening right then?” So a lot in the beginning, I was really worried. I was afraid that our therapeutic alliance wouldn’t fully form. I was worried that we’d never be able to have that cohesive and trusting relationship. That was really my concern, and we had gotten to a place where she would . . . test me—[as in] “did I care for her?” [She] would test our relationship. But we really made it through; we were able to talk about all these things, and she got to a place where she would say, “You really care about me; I feel that’s real—even though I didn’t really feel that at the beginning, but I feel that now.” Kirk: So if you could just take a moment right now, check in with how you are feeling as you talk about Christina? Bea: When I think about it, I have two distinct feelings. When I think about her right now, I care about her, genuinely. There’s so much I really enjoy about her. And then when you ask about the relationship I start looking back at the past [laughs]. Kirk: I see some changes in your expression, Bea. Bea: Absolutely, yeah. I feel like taking a deep breath, and it takes a good amount of energy at times. It takes a lot to contain that space [as] she’ll push and challenge, and that porcupine feeling isn’t always easy to sit with. Kirk: So she’s stretching you, it sounds like. Bea: Hmm, yes, and we still have those moments, for sure. We still have those moments of different kinds of resistance. It’s something that I wanted to ask for some feedback on. 74

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Kirk: So is that kind of your growing edge with her right now, these resistances that keep coming up? Bea: Yes. Kirk: What is your growing edge with her right now? Bea: So I’m working within a 12-session limit with her, but we’re on session 14, so I do have a little bit of leeway with her, and our work seems to be a little bit slow paced—the work is not something that comes overnight with her. And so her goals are [in Christina’s own words] “to feel more comfortable with people . . . [not to] have that abandonment feeling with other people, not to [have such] fear of being alone; and yet I want to feel more comfortable with other people. I don’t want to feel such fear of being alone, and yet I can’t really move in that direction, unless I’m willing to really enter into some really distressing parts of myself.” So [I, Bea] feel that where her goals are and where that wall is, is like “I don’t want to go there; I don’t want to do some of that work.” Kirk: Hmm hmm, that ambivalence. Bea: Yeah, that ambivalence comes in. And part of it, too, is that she’s been in other therapies, and they’ve just kind of gone on and on, and she doesn’t want to do that, so she appreciates the challenge to face that wall. But at the same time she doesn’t want to do that. Kirk: Now you have been challenging her on that [along] with that focus on the sun and her boyfriend. And yet these sound like sides of her battle. Bea: Yeah. Kirk: And clients often have these sides of a battle—where on the one hand [one] seems to be wanting to rid [oneself] of these horrible fears of abandonment but also [one is] resistant to becoming more interdependent . . . Bea: Absolutely, yeah. So then part of my struggle becomes “how do I meet you where you are, how do I get to you”—cause there are times where she’ll become very defended, like “this is the sun, this is how it is, nothing’s going to change, it is what it is, and I would appreciate it if you could just let me do this.” And this is how it was with previous clinicians as well. 75

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Kirk: And yet she was frustrated by that . . . Bea: She was frustrated by that, and there was that ambivalence again. It’s like “I want it; I don’t want it.” And she feels the same tension in our relationship, like “I want you and don’t want you to [press me] on this.” And it’s really frustrating for me, too. Kirk: I wonder if we could play it out a little bit, if you’re willing. Bea: Yes. Kirk: So can you take a moment to intimately embody Christina. And maybe attempt to connect with her at the point where you’re having particular difficulty . . . this kind of hard edge she gets to around the “sun.” Experiencing the Client From the Inside In keeping with my experiential orientation, I gradually attempted to offer Bea a more here and now, palpable sense of what it’s like to sit with Christina and to bring their relationship alive in the room. This shift in my view helps us, and Bea especially, to have a deeper understanding of herself, Christina, and the impact of their relationship on the therapeutic process. Put succinctly, I tried to help Bea shift from “reporting about” Christina to living her relationship with Christina here and now, with a whole-bodied experience. I find that this shift in the tenor of supervisory relationships (similar to therapeutic relationships) can unveil powerful yet relatively undisclosed dimensions that can deepen the work. Whereas the first shift in this personal, experiential offering was marked by my question to Bea about what her relationship was like with Christina, the more intensive shift occurred with my invitation to enter into a role-play in which Bea mindfully attempts to embody the world of Christina and I occupy the role of Bea to see what we can discover. As is my style, I periodically shift from Bea’s role-play of Christina to Bea’s actual current feelings as she engages in the role-play. This check-in helps to render palpable how Bea is personally feeling about and potentially affecting her client (also viewed as the countertransference).

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One other note, although it is clear that Christina has experienced frustration with previous therapists who appeared to let her “ramble” about her battle between succumbing to the power of others, such as her boyfriend, versus becoming more autonomous, without making concrete gains, it is also evident that Bea is approaching Christina more intensively about this battle—and it is my impression that the difference is Bea’s attention to Christina’s whole-bodied experience of her battle versus simply encouraging her to report about it. This experiential or process-oriented mirroring of the client’s battle is key in my view. Mirroring helps the client to see “close up” how she has been holding herself back in her life (i.e., clinging to devitalized relationships) and how profoundly she desires to break through and overcome her block to greater autonomy. The intensive focus on this battle highlights the intensive and ongoing question to Christina as to how she’s willing to live her life, with which part of herself will she “align.” With that context, I present here an excerpt reflecting the point at which I invite Bea to engage in the role-play.

Transcript of the Experiential Role-Play Bea: I’m trying to think of where it would be most helpful [to start]. Kirk: OK, take a moment for yourself. Bea: I should also mention that [Christina] is dating other men while she’s focusing on her [main] boyfriend . . . Kirk: Yes, well that sounds like part of her ambivalence. She can indirectly limit her relationship with her boyfriend by dating other men. So these don’t sound like very fulfilling relationships. Bea: [laughs] Yeah. You’re already giving me good material to work with because I’m already wanting to say “No.” I’m already wanting to fight you on that . . . Kirk: OK, that’s alright . . . so now you’re becoming Christina.

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Bea: Yeah. So I’m dating this guy—I met him on Tinder. He’s pretty interesting. We’ve gone on a few dates. He’s pretty buff . . . masculine. He is “hot.” I really like that. Kirk: So what’s your feeling, [Christina], as you reflect on this person? Bea: I don’t know. I feel like it’s pretty good—don’t really have too many strong feelings about it. It isn’t anything really serious—we’re just having fun, so it’s been good. Kirk: You sound very lighthearted about it, like this is cool. Is this where you want to be? Bea: Yeah . . . it feels good right now, so I’m going with it. Kirk: Alright—and I wonder where that leaves you right now? Bea: What do you mean, like in my life? Kirk: Or just right now, what comes up for you? Bea: Well, actually I’m pretty tired—we were up late last night. I wasn’t even sure I was going to make it to session today. So I’m kinda out of it. Kirk: Seems like you’ve been this way in the past. Bea: Yeah, I don’t know that that’s a problem [long pause] Kirk: So why don’t you take a few moments and check in, see what you’re sensing, feeling, imaging right now—and see how you’d like to use the rest of our time. Bea: [long pause] I don’t think I’ve been slowing down much lately. Kirk: Is that very important to you? Bea: I feel like it probably should be. Kirk: “Should” sounds like it’s somebody outside of you telling you; I wonder what Christina feels? Bea: I don’t know that I really like . . . slowing down. Kirk: Your face just changed at that moment; looks like it brings some emotion to you. 78

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Bea: I know we’ve been talking about my depression and how low I’ve been feeling lately, and I feel like when you ask me to slow down and . . . check in with myself, I start to think about that more. And, um, I don’t know that I want to go back there—I feel like I’m OK where I am right now. Kirk: Hmm, are you willing to share what you fear about going back there? Bea: It sucked, it sucked—and I feel like I’m finally finding things that are making me happy, and I don’t want to let them go. So I feel like if I look back I’m going to go back, and that’s definitely not something I want to do. Kirk: So if we trace that out a little more, what do you feel it would be like just to focus on this positive period in your life and not focus on the darker part? Bea: It definitely sounds a lot more enjoyable, you know. I’m having fun. I’m having fun. Kirk: Hmm, you really miss that. Bea: Yeah. Definitely. Kirk: So it sounds like you have . . . a battle but that right now the side of you that wants to have fun, and keep it light is winning the battle, does that sound accurate? [Note: Here, I’m metaphorically holding the mirror close to her so that she can observe vividly what it might be like to continue in this “light” vein. I find such tracing out, especially at an experiential level, can help clients intensify their sense of both what they’re up against in their battle as well as how they may break through.] Bea: I would say so. It’s like why would I want to focus on anything than just what makes me . . . feel happy? Like why would I want to do that? Kirk: Well I notice you have done that in the past, and it hasn’t necessarily brought you a lasting kind of happiness, from what I’ve seen. Bea: Oh, you mean like the dating and stuff. I feel like you’re trying to call me out on something. Kirk: I’m just trying to understand where you’re coming from. 79

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Bea: I mean I know it hasn’t been fulfilling or anything, but for the moment, it feels good. I feel like that’s the only thing I really know . . . like the only thing I can really bank on. So I think it’s really just easier to focus . . . on what makes me feel good right now. Kirk: Yeah, it looks like it brings some emotion to you just declaring that. Bea: [long pause] I guess I don’t want to go back. I don’t want to go there [looks distressed]. Kirk: [softly, empathically] Yeah, I hear you—I really want to give you a chance to see where you’d like to go right now. Bea: It’s like I know where I want to go, and if I do that, it’s almost like I’m not supposed to be choosing that. I just want to talk about what’s happening now. I want to talk about the people I’ve met stuff. But I feel like now that you’re giving me the choice, it’s like I feel that it’s like I’m avoiding something. So I don’t want to go there. Kirk: [long pause] I wonder what’s coming up now? Bea: [long pause] [Note: In my experience, slower pacing and long pauses often indicate deepening of exploration.] It’s like I’m not even sure; I’m not even sure. Kirk: Take your time. Bea: I guess . . . I don’t even want to let myself let feelings come up from me. Kirk: Are you willing to share what keeps you from being open to those feelings? Bea: I guess I feel like if [long pause and haltingly] I let myself go into— whether it’s old feelings or feelings I have right now—it’s difficult for me, I feel like I’d have to let go of the good feelings I have right now. Kirk: Like it has to be one or the other. Bea: Yeah. Kirk: Like you’d be locked in. 80

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Bea: [nods somberly] Yeah, like I’d have to let go of both, and I really can’t let go of what I have right now. Kirk: So what I’m feeling is that again you’re in this clash with yourself and that what you’re choosing is to go with the more positive or lighter side. [She nods.] Even though it’s difficult for you—because these are both parts of you. Bea: I guess I really don’t know what choice I have. At the same time it’s like what choice do I have if I don’t choose to like people who connect with me, who want to have more fun. We go out and . . . party together, like we’re having a good time. And so it’s like, I can’t let myself let that go; it’s like I was so depressed. You remember what it was like for me? Kirk: [empathically] I do. And I’m also struck by how you did come out of that to the place you’re at right now. But I’m also aware of how painful it is to go into that place. The Shift Back to the Supervisee’s Experience Kirk: So I wonder if we could go back to you, Bea, and if you would check in with what it was like for you as Christina, and what that brought up for you? Bea: What was really interesting for me—even just trying to embody her and connect with her, I felt disembodied within myself. Kirk: Hmm, that’s interesting. Bea: And there were times that as her therapist with her—that’s part of my struggle, too. It’s like you’re way over here, your goals are in a different direction, and it’s like uh uh, [I, Christina, am] not going there. And [I, Bea, am] feeling so distant from you right now, wondering how am I going to get to you? How do I get to you right now? Kirk: Well, again, do you need to get to her . . . or simply preside by her process? Bea: That’s a really good question. Hmm, that’s a really good question. I wonder about that internal struggle that [says] “what is my client struggling 81

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with, or what is it that she’s needing? What is my client saying that her goals are, and what is . . . my own desire for my client?” And so I’m wondering how much of that also plays into our dynamic together? Because it’s really frustrating for me to really sit there with her when she is so . . . rigid and focused on what makes her feel good. Kirk: What frustrates you about that? Bea: That she’s been doing that for so long . . . Kirk: But what frustrates you about . . . that? Bea: It frustrates me because—and this is definitely some of my own stuff—because this is her life. This is her life [shaking her head]. Kirk: You’re frustrated by that, too, it seems. Bea: Yeah, it’s like . . . I think I’m becoming aware about how my own stuff is impacting this. Because life is so important to me and so precious to me. And so my clients come in and it’s so much easier when you’re in a place of readiness for change. Kirk: Yes. Bea: Because your alliance is there, too, because it’s like “Yes, fantastic . . .” Kirk: [smiling] You’re there, yes. Bea: Yes, it’s like “let’s do it!” How can I give you the space to have that movement . . . towards your goals and live the life that you want for yourself? And so when someone’s in that ambivalent place, I think that’s part of my own tension, too. It’s like what are we waiting for? Like why are we stuck here? Kirk: Are you speaking to Bea, or are you speaking to Christina? Bea: I think I’m speaking to both but that personal part [points to herself ] I think is really important. But I think it is for both. Kirk: Yeah, I think so too. But how do you think it affects Christina? Bea: I think that’s that part where . . . she says “I like that you don’t let me keep going,” but at the same time I think she reacts to that personal side 82

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that says “what are we doing here; we’re here again . . .” if that makes sense. And so I’m wondering about how much of my own desire for us—you see I’m already saying “us”—may be impacting her [and be part of her ambivalence]. Kirk: Yeah sometimes when we as therapists are pushing—even subconsciously—for a certain direction, our clients take that as kind of scary. In a way it’s like pushing them into a place that they’ve spent their entire life around avoiding. Bea: Yeah. Kirk: So I think you’re very perceptive in taking a look at how that energy may be playing out with Christina, and may even be hardening her resistance in some ways—even at the same time that it may be seen as an invitation to go into those more painful places. But it certainly sounds like she’s pretty locked in to keeping it light, at least in our role-play, and putting that wall up. And yeah, that has something to do with her connection to you, too, and what kind of space is created between the two of you and is it conducive to her finding her own way and making the choice to go into one place or the other. I feel like one thing you can be pretty sure of in this work is [that] if something [is] important, it’ll come out . . . in the wash, so to speak, if you stay attuned . . . to process, to her feelings, her way of engaging. If that side that she’s blocking out is not holding up or is making life very restrictive for her, I think that’ll come out organically, at least for many people. Some people need a nudge. But here’s a good question for you and Christina: Is she at a point where she’s ready to encounter the fuller sides of her being, and where you can nudge her toward that? Or does she need to come around to that more organically, more naturally? Bea: Yeah, it’s a good question. There are times I feel her move. But it’s like Texas weather, she’s one way one day and the next day “what happened? We’re back here again.” You know what I mean? Kirk: Ahuh. Bea: And I think it’s like sometimes when we have that movement and we come back—it’s like [Christina says], “Why shouldn’t I have those 83

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other relationships, even though I know I said just the other day that I shouldn’t.” And that’s a tough place for me to sit with . . . Kirk: Just to step back a little bit and at least appreciate her process? Bea: Yeah. Kirk: Well what do you fear about her just going more with her own process . . . and going with whatever direction seems most present to her? Bea: I think her pattern in the past of having been able to have the freedom to just keep doing what she’s doing in her life and how that’s worked out therapeutically with other people where . . . they would just let [her] keep doing this—she would tell me about how frustrated that would make her feel. She would even talk to me about how much [space] her partner would take up in her life, and how much she hated it . . . Kirk: I hear that, but she wasn’t presenting that, in this role-play anyway. She wasn’t presenting how “you’re just like my other therapists” and how much she hates that. I just wonder if that might be worked with more concretely at a point where she’s expressing that frustration with you or expressing her frustration at not encountering these deeper fears that she has in keeping her life . . . superficial? Bea: Yes—[but] I keep wanting to ask you a question. How do I help her get past her resistance? Kirk: Yeah, and again that sounds like your agenda to “get her to do it” even though I know that it’s her agenda, too. Bea: Right. That’s such a hard thing for me to gauge. Like I think a lot about something that really attracted me to this style of work . . . what Rollo May would say about the client’s life being at stake? Kirk: Yes. Bea: That is intensely personal and is a way of engaging that says, “This is not a set of symptoms we’re working with . . . this is important. This is your life!” And there’s a personal side . . . that brought me to that and to resonate with that and I think that’s how I feel some of that stuff play out too . . . and I start saying, “How do I get her past her resistance? How do 84

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I get her moving again?” Because her life is at stake here, and she’s saying that, and darn it, we’re here again, and I start getting exasperated. Instead of saying like “OK, how can I stay with her in those moments, when some of that tension might be . . . my own?” Kirk: Yes, well that’s very tricky. I would say intuitively if you’re sensing that this would be a good moment to share your exasperation or your sense of exasperation with her shutting down, maybe it’s worth sharing with her at that moment; it’s an intuitive call. It was hard for me to pick up in that roleplay at that moment; I could see where you might get some sense of the importance of her breaking into that painful side of herself, and by sharing some of your own frustration for her not living fully, might be very powerful. Bea: Yeah. Kirk: The one caveat I’d put in there is to really be discerning about over identifying with the outcome of you offering that to her. That’s where your personal part I think is really important. So it’s really worth your reflecting about how your personal stuff comes up with her, and your ability to use it as part of a real relationship with her but without imposing that on her and turning it into your agenda more than hers. Because I think you have a real point there about her life being at stake and your holding of that life, the opportunity to have that fuller life. But it’s also a question of timing and whether you’re really encountering that part of her that’s ready to encounter that. And there’s also the whole issue of respect for what we’re calling “resistance;” which I would call “self-protection.” Bea: Right, right, exactly. Kirk: [It’s] really important to respect one’s need to self-protect, especially given the fragility of this client—you [see] her as having borderline features. And I do think some prudence is called for in how you’re pressing her, what kind of space you’re co-creating with her. I’m sorry you were going to say something, quickly—we need to wind up. Bea: Sure. The word that was popping up in my mind was [the issue of] establishing goals. And I was thinking, what our goals are. Kirk: Yes, that’s an important question. 85

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Bea: And reassessing that and reassessing that her life is at stake and all this . . . was reassessing how that translates with her like today in this moment. And if even we have only so much time together, like in this short-term model, I was wondering if I could really be with her and really feel that wall with her . . . and just even be in that space with her. Kirk: Feel her battle? Bea: Yeah. Kirk: Like maybe that’s enough. Bea: Yeah, like even just to feel that—maybe that’s enough, and that in itself is kinda like the goal. Kirk: Maybe so, and I know you only have [how] many sessions with her? Bea: We technically have only 12, but we have a little leeway. Kirk: You have a few more sessions with her . . . maybe as a part of your summary that you have with her you could share with her what you see with her, and that maybe you could share with her your feeling about her life being at stake. Bea: Yeah, and knowing her it would be really meaningful for her to hear that from me. Kirk: And then maybe refer her on to longer-term work if warranted. . . . Well, I really appreciate our time today, but we really do have to stop. Bea: OK. Kirk: Take care. Discussion and Summary Remarks This was a high-quality session that richly reflects the E-H approach to supervision. It comprises four main transition points: (a) a brief but substantive demographic and clinical history of the client; (b) a discussion of the main challenges presented by the client both intrapersonally and interpersonally with the therapist; (c) an invitation to bring the concerns of the therapist about the client alive through role-play and periodic check-ins 86

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with the therapist’s own personal process or experience in working with the client in this comparatively live and intensive way; and (d) a consideration of how the therapist’s personal responses to the role-play may help the therapist better understand the client’s struggle or battle and how the therapist’s own countertransference reactions are affecting the client’s battle. Therefore, if we look more closely at each of these dimensions of the supervision, we can get a fuller sense of what was accomplished. First, it was clear that the client experienced significant ruptures in her connections with her parents over the course of her childhood. Some of these ruptures may have been typical for her culture and her class (e.g., the frequent use of babysitters or nannies is not unusual for middle to upper class East European households). However the degree and frequency of these ruptures, and the intensity of the client’s fears around perceived rejection and abandonment suggest that she experienced profound wounds and unstable feelings within herself and toward others as a result of her wounds. The manifestation of that result was evident in Christina’s tumultuous battle between the side of herself that desired to distract and pre­occupy herself with men who may not have been good for her and the side that dearly yearned for a more dynamic and expansive life, a life of more balance, personal meaning, and freedom. Bea’s role-play as the client and the periodic check-ins with Bea as therapist helped Bea see how Christina’s struggle with the rivaling sides of herself may ultimately prove fruitful. These struggles did not have to become exasperating cycles of disembodied processing but could become powerful opportunities for Christina to weigh her patterns and make a substantive choice about the direction she alone was willing to pursue. However, through the supervision, Bea saw equally how such opportunities for Christina’s self-discovery could be derailed by Bea’s overidentification with Christina’s liberation, thus shifting the impetus for change to Bea. The issue here is for Bea to find an organic balance between holding the hope (and “life”) for Christina while recognizing that such hope and life ultimately need to derive from Christina and her hard-won battle for wholeness. 87

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A secondary issue is Bea’s realization that she does not have to devolve into the passive therapist that Christina had rolled over in earlier treatments but could balance comparatively passive mirroring of Christina’s self-world construct with comparatively active mirroring through attention to Christina’s preverbal, kinesthetic process and not just reports about her struggle. Bea’s active mirroring could also be manifest in her sharing, at appropriate junctures, her own vicarious frustration with Christina’s sense of being stuck. Yet for all these interpersonal engagements to flow, Bea further realized that she needed to critically examine her own investment in Christina’s transformation and how that investment affects implicit and explicit aspects of their relationship together.

SUPERVISION SESSION 2: THE CASE OF CARLOS The following is a briefer version of another supervisory session with Bea that focused on “Carlos,” a 21-year-old single Latino male born in the United States whose parents originally were from Colombia. Carlos, Bea informed me, was referred to the counseling center because he had been unfaithful to his girlfriend and was confused as to why. He reported that he was committed to her and that they had been in couples therapy. But where Carlos was currently struggling, Bea elaborated, was with the divorce of his parents and the traumatic past this stirred up for him. Carlos indicated that his upbringing was volatile. His father was alcoholic, and this put Carlos under constant stress. At any moment, Carlos noted, his father would “lash out” at him—it could be verbal or physical. This volatility also happened when Carlos was very young and innocent, which made the terror from his dad that much more jarring. Carlos’s mother was always his “safety.” He was “really close” to her, but part of the trauma of the divorce for Carlos was that unbeknownst to him, his mother was having an extramarital affair, which profoundly shook Carlos’s world. This turned Carlos’s view of his mother totally upside down, from a “hero figure” to a kind of “monster” that he could not reconcile, particularly in the wake of how he had experienced his mother as a refuge from his father in the past. Here’s an excerpt from my interaction with Bea at this point. (Note that because the previous case is 88

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more elaborated and discussed in detail on video, I weave more personal reflections into the ongoing narrative of the current case to bring some counterbalance to the respective cases.) Kirk: Sounds like a lot of shattering for Carlos . . . disillusionment. Bea: Yes, absolutely. And so what he was coming to me for was to process that history. There’s anger, and . . . some other things that he has a hard time letting himself feel. He thinks he’s really bad, and he wants to shield [them]. He doesn’t want other people to know when he has those feelings. Kirk: Like you? He doesn’t want you to know when he has those feelings? [At this point, I began shifting the tone of our discussion to a more personal vein. I invited Bea to not just report about but begin to experience her relationship with Carlos.] Bea: Yeah, well we’ve talked about that too . . . and how I might react, how I might view him differently. Definitely. Kirk: So I appreciate that background. So now I’d like to know what’s alive for you in terms of the challenge of working with Carlos. Bea: One of the things we’re working on right now is helping him explore his anger and getting him into his body more. So not just exploring it and having him talk about it at the cognitive level, but really into his own skin. [He has a competing] desire to cut off that human part of himself. And this is a part of that existential–humanistic work [that’s] more physical . . . what kind of thoughts, feelings, images come up for him as he sits with me. It may be a certain tension or . . . feeling that comes up for him in his body. And that’s the type of work that I’ve struggled with a little bit more—and I think it’s something that would be really helpful for him. And so I’m kind of struggling with my own limitations as I’m . . . working with him therapeutically. Kirk: Yeah. I’m wondering how you’re feeling right now as you’re talking about this particular growing edge for you? [Again, working to personalize the experience for Bea.] Bea: [laughs] I feel like a little bit tense all of a sudden, like in my shoulders. 89

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Kirk: Maybe you can stay with that a little bit. See what emerges as you stay with your tension. Bea: [nods, pauses] I can really feel it. Kirk: Any associations come up as you feel that in your shoulder area? [Here I’m attempting to help Bea not only experience her personal reactions to Carlos’s impasse with regard to anger but also potentially the part of Carlos that she may vicariously be identifying with—what the analysts call “projective identification,” in a very potent, felt way. This sort of insight has also been called “inner vision,” by Jim Bugental, because it is more than intellectual insight—closer to whole-bodied sensing.] Bea: I . . . really want to [offer] this whole-bodied experience [to Carlos], especially because he cuts [it] off. But I also think, “Oh gosh, I don’t know where I can go with this,” too, and so I think I start to feel more hyperaware of “can I help you get to that place? Do I have this capacity myself?” Kirk: Right. So it’s also a question of whether you can stay with him if he gets into that place. And I’m also hearing that you have some agenda maybe about . . . getting him into this place? Bea: I would say I do and that I really think it would be helpful for him— yeah, definitely. Kirk: How has it gone then when you’ve tried to work with him from that [embodied] place? Bea: Well [as we go into the difficult material] . . . he’ll start to break eye contact and start entering into that [embodied] space a little bit more, and begin to get tearful. And so I’ll ask him what he feels in the moment, if he feels anything in his body? And one thing he’d share with me . . . is I’m feeling really tense in my hands, like I feel like clenching my hands. And I’ll reflect that back to him and ask if any other feelings or images come up for you . . . and then I don’t what else to do. See that’s where that struggle comes up . . . the edge for me. There’s something about working with the body . . . that interferes with letting that process unfold. Kirk: Can we try it now, live? A little role-play? 90

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Bea: Yeah. I think that would be really helpful. Kirk: See if you can take a few moments and really try to embody Carlos . . . to the degree possible. And I’ll play you. . . . So, Carlos, I wonder what you’re feeling right now if you’re willing to share? Bea: I don’t know. I’m feeling some tension—feeling like clenching my hands. Kirk: Why don’t you just stay with that . . . clenching your hands. See what other feelings or sensations come up. Bea: [long pause] I’m just thinking about that guy . . . that hurt my little brother. Kirk: Your whole face just changed. See if you can stay with it Carlos. It feels like a very critical moment. Bea: [intense, looking down] I just . . . I really wanna hurt that guy who hurt my little brother. Kirk: Hmm. Would you be willing to share what’s coming up now? Bea: I feel like the left part of my forearm is like shaking a little bit. Kirk: Hmm hmm. But it feels important to follow that thread of you really wanna hurt that guy. Do you want to share what you want to do to that guy? [Here, I’m breaking some from closely following her (Carlos’s) last observation about his forearm because I try in this work to stay attuned to my intuition as well as what I overtly observe, and in this case it seemed the main gestalt was how Carlos really wanted to hurt that guy who hurt his brother.] Bea: [solemnly] I just want to hit him. I want to hit him for what he did to my little brother. My little brother was just so innocent. He didn’t deserve what this guy did to him. I want him to just hurt. Kirk: I notice you’re talking in very soft tones. Is that how you’re feeling, or is there more that’s welling up? Bea: I feel like I’m just holding it back. Kirk: What’s the “it.” 91

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Bea: What I wanna do to this guy. People aren’t supposed to, um, feel like this. Kirk: What does that mean “not supposed to?” You’re not supposed to feel like this? Bea: Yeah, you’re not supposed to wanna hurt another person. Kirk: Yeah. That sounds like it’s coming from the outside, but right now you are feeling like you want to hurt him. That’s what I’m hearing. And you know that this is a place where you can say or feel anything you want, and . . . that I’m here to hear you out—because it may be very vital for you to really name what you feel about this guy. [What’s implied here is a difference between feeling and acting on those feelings; making the relationship safe for disclosure of feelings is paramount in this E-H work.] Bea: I wonder about what would happen if I didn’t hold back. Kirk: What do you fear? [Again, here is an example of the value of tracing out the fear fantasy, to unpack what’s really operating here versus one’s impulsive projections on what’s operating.] Bea: I would never like really hurt anyone. I just wonder what would happen if I didn’t hold myself back. Cause you’re not supposed to do that . . . you’re not supposed to want to hurt anyone else. [This statement is an important clue that adds to my sense that Carlos can probably contain his anger— he doesn’t really want to hurt anyone—and that exploring his anger could have powerful therapeutic value. On the other hand, as I note to Bea later, there is always risk, especially with a volatile emotion such as anger, and as a therapist, one needs to be prepared to work with the potential “fallout,” which could also be problematic if Bea refrained from exploring Carlos’s anger and he engaged in a backlash.] Kirk: Yeah, you keep going back to that “should”—it’s very hard for you to own or have your own feelings here. Bea: I don’t want to be like my dad. Kirk: You fear you’d be just like your dad. Bea: Yeah [seems on the verge of tears]. 92

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Kirk: You fear you’d be like your dad even if you just let [the anger] out here? Bea: Anger just hurts people. Kirk: So that’s what you’ve seen in your life, that anger just hurts people. [Bea nods.] Do you fear it would hurt me . . . or hurt somebody now if you let that anger be expressed? [I’m modeling a very “living” yet supportive container here.] Bea: I don’t know—I think I’m more afraid of people . . . looking at me differently. Kirk: Well, here we are now, I’m [one of those] “people” for you. Do you have concerns about how I would feel if I witnessed your anger? Bea: [nodding] Kind of. Kirk: Want to share what you fear? Bea: I feel like you may feel there’s something wrong with me . . . like there’s something you wouldn’t want near you. [There are many potential overtones to this statement by Bea as Carlos—interpersonal between us, cultural, ethnic (e.g., as in can you trust a Latin American male to get angry, to let go of his feelings?).] Kirk: Can you share what that something is? Bea: Maybe if you saw what I really felt, maybe it would create distance. Kirk: And you feel we couldn’t work it out, like that would mean some kind of ending to our connection? Bea: Maybe—but we haven’t gotten that far yet. Kirk: And my feeling is that we could work it out, even if you showed this really dark and painful side of yourself. [I’m trying to give Bea encouragement here that perhaps she can trust herself to be containing and supportive of Carlos, even if he’s afraid that his anger is too much, like his father’s was too much, and that he, Carlos, is in lockstep with his father.] Bea: [nodding] Kirk: I wonder how you [Bea] feel reflecting on this . . . with me right now? 93

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Bea: I felt a kind of tension in me . . . like I can feel it in my face, like around my eyes and in my jaws. . . . When I was role-playing, that was illuminating. I feel like taking it back to Carlos and how [it would] work for him. Kirk: We have a few minutes, we could try that if you embody Carlos [again]. Whatever you are picking up in Carlos, we can go with that. Where are you now, Carlos? Bea: I feel I am doing better expressing myself overall. I’m sharing more with you and the anger I feel. [Still] there are certain times I’m holding back. I feel I can’t express myself fully with anyone, but especially when I’m by myself . . . I feel I can express that. And sometimes I feel like hitting someone, not like a person or anything, or something like a pillow . . . Kirk: [spontaneously] There’s a pillow right here [handing it over to Bea/ Carlos]. Are you willing to try? [Note: I often feel that these moments of evocation or even gentle provocation can be helpful in loosening things up, promoting a new—and deeper—level of relating, and in a case like this, modeling a trust with Carlos that he rarely finds or believes is possible.] Bea: [takes deep breath] I don’t know. Kirk: Take your time. Bea: You’re really prepared [chuckling] with the pillow and everything. Kirk: I’m prepared to be with you wherever you are. Bea: It’s weird. It’s like it’s so easy to fantasize about it and think about it, but now that the invitation is here . . . Kirk: What comes up for you? Bea: I feel I can’t do it. Kirk: You can’t or you won’t do it? Bea: Maybe a little of both. Kirk: Uh huh—can you say what’s coming up now. 94

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Bea: I [realize] I’m smiling . . . Kirk: I notice that. What does the smile bring up for you? Bea: I think it just helps me feel more comfortable [and] I feel very uncomfortable. Kirk: Yeah, I see that. You’re touching on a place that’s very scary it seems. Yeah, and there’s that welling of emotion in your face. See if you can stay with that and see what emerges. Bea: I feel like the closer we get to . . . me really wanting to feel the anger, the more I hold back. Like there’s no way I can do that . . . Kirk: What comes up about “no way.” Bea: Like how could I let myself be that person . . . hit something or be violent . . . Kirk: It almost seems like you fear that you’re going to totally become that person if you become violent with the pillow. Like there’s no more to Carlos than this ugly rageful creature. [Really pressing here to help Bea/ Carlos potentially see the “more” of who they are, the more of what they can be even in such a volatile moment with me. Again I’m raising the question of trust and of being able to show and potentially work through Carlos’s most estranging feelings and perhaps cultural stereotyping.] Bea: [long pause] Yeah. I feel like it’s almost an invitation to be like my dad or something, and I’m just . . . looking at this pillow, and if I just let myself [hit the pillow] then I’m like making that choice to be like him. And so there’s something about this that makes it really real. It makes me want to push away from it, like I’m not going to be that person. Kirk: So let’s go with that for a moment; say you push away from it and just cut it off, where does that leave you, right now? Bea: Actually, it’s weird . . . it’s almost kind of . . . empowering in a way; it’s like by looking at this [decision not to hit the pillow or follow in dad’s footsteps] [then] it’s like I have a choice; it’s so weird, it’s like as soon as I said that I can feel myself getting emotional about it. 95

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Kirk: Ah, yes, take your time. Bea: It’s like I don’t have to be him. Kirk: Wow, that’s huge. It’s giving you a power of choice right now. Bea: Like there’s another way. Kirk: Another way? A “Carlos way?” Bea: [nodding] Yeah, maybe a Carlos way. I don’t know that I still know what that way looks like, but there was something about this [pillow encounter] that feels really good. Kirk: Like “this” being the choice? Bea: Yes, like this [hitting the pillow, violence] doesn’t have to be the way for me. Kirk: Hmm hmm. It really hits me here. [I point to my gut and Bea/Carlos acknowledges my being moved.] Bea: It hit me hard at that moment, but now I’m feeling calm. Kirk: Are you ready to switch back to Bea? Bea: I think so. That was wild. That was like superwild for me. Kirk: Say more if you can. Bea: Yeah. And we [Carlos and I] have talked about [the appropriateness of letting his anger out], but there was something about confronting the pillow itself and you giving me the permission, like “here’s the pillow.” Kirk: Yes, like it’s real now . . . Bea: Because there was some part of me [the clinician] . . . that wondered if it was appropriate [because of the fear that hitting the pillow could make his violence worse] Kirk: Yeah, I know what you’re saying . . . and my feeling is that I have a pretty trusting relationship with Carlos [Bea acknowledges this], and I would trust that if he hits the pillow he doesn’t necessarily become a 96

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different person or his father [Bea again acknowledges this], and that it’s something we can work with. Bea: So even if he tilts in that [violent] direction? Kirk: Yeah. One thing I sometimes tell clients, especially if they’re very angry or have a potential for violence, is that you can say or feel anything in here at all, short of destroying me or my property. Now I don’t know if you need to say that to Carlos because I felt that was something that was understood. So I was wondering when you go back to Carlos, what would you say to him? Is there anything that you gleaned from this engagement? Bea: I think one of the biggest things that I take away from our supervision session today . . . is that even if there’s . . . a subtle sensation of myself holding something back, how that’s impacting our therapeutic work together. [This is a key discovery for Bea—she’s unveiling the power of her energetic connection with Carlos and considering its impact on the potential for deepening his and their exploration of his fears]. Discussion Bea appreciated the live encounter in the supervision with Carlos’s anger, despite her concerns that it may be “reinforcing his violence.” But she also saw how she perhaps was overly rigid about the live encounter with Carlos’s violence and that a more fruitful balance could have been struck between enabling his expression of the violence and containing it within the safe and supportive confines of the therapy relationship. She also recognized how some of her fears of his violence could be reexamined to enable this fruitful balance and Carlos’s sense of empowerment that seemed to emerge from it. By looking closely at his potential for violence, Carlos, as conveyed by Bea, seemed to be most empowered through the realization that he had a choice, and that choice distinguished him from his father. As I suggested, there may also have been a cultural component to Carlos’s sense of empowerment that went relatively unexplored. My sense is that if Bea and I were to continue our supervision of her encounter with Carlos, this cultural aspect could emerge. The aspect to which I refer is 97

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Carlos’s Latino heritage and the stereotype, which Carlos may well have internalized, of being a dangerous male. Such a self-perception could well have combined with Carlos’s fear of being like his father to intensify his reluctance to express his anger, and this combined with his relationship with Bea, as a professional female, may have further complicated the problem. These all could be ripe areas for exploration, both for Bea personally, in regard to her feelings about this dynamic, and for Carlos, to the extent he experiences class or cultural discomfort within himself and/or toward Bea. To the degree it may be significant, no context should be overlooked in this work, and living explorations of such contexts need to be pursued. As a postscript to these two supervisory sessions and in keeping with our intention to have 360-degree evaluations, what follows is Beatriz Craven’s reflection on her experience working with me, several weeks after our supervision. In general, and as a guide to optimize our work together, we ask for these reflections from supervisees at various points during the supervision, but because of the abbreviated nature of this particular supervision, I asked Bea for feedback at a point of mutual convenience: My supervision experience with Kirk says everything about his capacity to bring the existential–humanistic approach to life. At the most basic, fundamental level, I feel emotionally safe with Kirk as I divulge my thoughts and struggles. I do not feel that I have any expectation to meet as a clinician aside from being present with myself. As a supervisee, I may technically be in a place of less power and yet I feel liberated to be my true self in his company. I feel I have his respect regardless of what I say. Having been in the role of supervisor and supervisee in my career, I understand how critical this openness is to cultivating growth as a clinician. In this field in particular, we must be curious and honest about our experiences in the therapy room if we want to bring forth our best work. It is a gift to have a supervisor like Kirk who can support the kind of space needed to expose my areas of growth and experiment freely with new ways of being.

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Handling Common Training/ Consultation Issues

DEALING WITH “DIFFICULT” SUPERVISEES From an existential–humanistic (E-H) supervisory perspective “difficult” supervisees don’t generally exist; who does exist are “fellow travelers” with unique and entrenched protective ways of being that may be impeding their therapeutic effectiveness. As mentioned in previous sections, we engage with our supervisees in an exploration of their world views and biases so they may develop empathy for and understanding of their protective patterns, for example their anxiety, shame, anger, or avoidant behaviors. By our engaging them in personal reflections, dream work, or role-play, supervisees experience how their biases, personal contexts, or protective patterns may be preventing them from connecting and empathizing with their clients. A brief recollection of a supervisee will illustrate this point: The issue I was having with my client was clearly relational, but I was not seeing just how much judgment I had toward this client. You http://dx.doi.org/10.1037/14951-005 Supervision Essentials for Existential–Humanistic Therapy, by O. T. Krug and K. J. Schneider Copyright © 2016 by the American Psychological Association. All rights reserved.

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invited me to bring into the room the judgments that felt so terrible in my head and allowed me the space to sort out how those were contributing to the huge relational block I was having with her. The work I did with her after that was more profound than I could have imagined . . . I knew I would not have been able to do that without first acknowledging and working through all the things I hated about her!

If a supervisee is unwilling to engage in the experiential activities or in the personal reflections, the supervisor is challenged to convince said supervisee of the value of such activities for his or her personal and professional growth. Given this criterion, a definition of a difficult E-H supervisee would be one who is unwilling to engage in experiential exercises such as role-playing and personal reflections. We have been fortunate to have few, if any, students who were unwilling to engage in such explorations. Beatriz Craven, role-playing her clients Carlos and Christina (see Chapter 3) in the supervisory session with Kirk Schneider was certainly not one of them. Bea’s work with Kirk illustrates an exemplary way in which supervisees can acknowledge what they bring to the therapeutic encounter. As Kirk focused on Beatriz’s feelings and attitudes, she began to recognize how the interactions with her clients were being informed by her personal context related to Carlos’s anger and her desire to help Christina change. She was able to experience how her ability to make effective contact with Carlos and Christina was somewhat constricted and, to some extent, out of her awareness. With a focus on personal context, supervisees such as Bea, develop more understanding, compassion, and empathy for their own biases and world views, protective patterns, and core vulnerabilities. As a result, empathy and effectiveness with clients typically increases when personal attributes, inclinations, and attitudes are acknowledged. A reflection on this process from an advanced training program student follows: [A] . . . really significant insight that has come from the group consultations as well as processing my experiences on my own is a direct understanding of the context(s) I have. This awareness seems a key construct for training at EHI, and rightly so. It is not only what I might 100

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call my own “issues,” although certainly my inner state and psychology are at play here. But what has come from my education, my socialization, my own unique experiences—and at times also my unique gifts and talents—all this is at play in the psychotherapy interaction, in any interaction. At our last training, with this awareness of context, I suddenly saw things much differently. Interactions with people that might have triggered my own issues in the past I saw as just their constructs (and perhaps my own), which depersonalized some of the friction I might have felt. Seeing my own constructs is freeing, allows me a way of separating from them and making choices rather than going with my habitual automatic reactive behaviors. In therapy sessions, it can free me to more objectively hear and see the client or know which of my responses are because of my own context and which are arising truly out of the moment.

Another vivid description follows of a trainee/supervisee who engaged in this type of personal work. The vignette also highlights the flexibility of an E-H training perspective with trainees from diverse backgrounds. This is the experience of one of our students who came from China to participate in our yearlong training. In China, he had practiced psychotherapy for a number of years. After completing the fall experiential retreat he wrote a reflection paper on his experience. With his permission, I (OK) created a third person narrative, sprinkled with first person quotes. That narrative follows. This trainee/supervisee was fearful of being close to people, fearful of making a mistake and being judged. His way of coping was to “fix” his tension and fear, to be perfect and make a good impression. When he came to our fall experiential retreat, he was thrilled to be engaging in the work but terrified to speak, much less practice in dyads for fear of being judged inadequate. Several experiential activities and work with a dream helped him explore his defensive patterns and core vulnerability. One of the first activities of the retreat helped him feel more comfortable and accepted. It was a “trust walk” with a partner to encounter, blindfolded, a flower, a stone, the bark of a tree, and so forth. Our supervisee discovered on this walk that his partner also had a fear of being close to people, a disclosure 101

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that occurred on the way back after they had gazed upon two hawks gliding in the sky. “As we talked about the common tenseness [with people], I felt [that our] connection broke through a wall in me.” Another activity that helped was viewing Jim Bugental work with a very controlled, rigid woman who our supervisee felt he’d fear to meet and/or work with. He recognized in himself a great deal of judgment about her way of being, as he put it “because I am a humanist.” He assumed that Bugental would try to “fix” her powerful and controlling character because it was causing her problems. To his surprise, “Bugental entirely respected and appreciated [her] controlled character, even acknowledging the value of the control given her history of alcoholism. At this point I realized that what I feared was being ‘out of control’ in front of a controlling client, and to avoid this, I tried to control every situation and fix every problem.” Our student, who was now opening to his protective pattern and underlying fear, volunteered the following day to work with a recent vivid dream during a dream work segment. By being one of the main characters in the dream, using “I” statements, he recognized that his fear of getting close to people was a result of an earlier, childhood wound. The hurt from the wound resulted in jealous feelings and revengeful fantasies toward others that scared him into maintaining a rigid self-control and a presentation of a “good and nice man.” In his words he expresses what else unfolded in the dream work: “Behind the jealousy was the yearning for unconditional love. When I spoke of the yearning for love, my heart was deeply touched and I burst into tears. I cried for quite a while. I felt the group with me in an atmosphere of warmth, care and respect. My tense and rigid heart was melting in the warm and nourishing ‘soup.’” With further exploration, our supervisee came to understand that his jealousy and vengeful fantasies in his dream came from a belief that he had lost his father’s love because his brother had “snatched” it away. Because of his inability to deal with his rage and fears of abandonment, he constructed a rigid, controlled, “good man” persona that left him tense and fearful of people. His engagement in the experiential activities at the experiential retreat and later in personal therapy led to an intense exploration of these disowned feelings, which limited his ability to be fully present with his 102

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clients and others. In his words, our student describes the value of the dream work: Writing this reflection, I start to understand how dream work can cultivate intrapersonal presence. By playing the role of the figure in my dream and telling her story in “I am” statements, my past and my patterns became alive in the here and now, in a language of visual imagery. So I can “see” it, feel it and stay with it, much more vividly. It gave me a much easier way to be present to my inner pain with the colorful imagery of the dream story.

Evident in this student’s quotation and in his personal reflection is the varied experiential learning activities of our E-H training and supervision that invite supervisees to explore their subjective and interpersonal realms, often allowing them to experience for the first time their protective patterns constructed to protect them from vulnerable core feelings. E-H supervisors’ nonjudgmental and accepting attitudes cultivate an atmosphere of safety and security in individual supervision and in group supervision and training. Difficult supervisees generally don’t exist within this nurturing soup because there is no prescribed way of being, so there can be no resistance, just an understanding that we all have personal contexts, formed from personal experiences that inform and often limit our ability to be present with ourselves and others. If we invite our supervisees to explore their world views, they gain empathy, compassion, and deeper understandings about themselves and others, resulting in expanded emotional maturity and personal development. That said, there are times when a supervisee may lack certain competencies that need to be addressed, such as a sustained lack of personal or professional maturity. Here we take up this exceptional matter.

TRAINEE IMPAIRMENT/SKILL DEFICIT Occasionally, E-H supervisors encounter a trainee with a core problem that is evidently intractable even with his or her engagement in extensive personal therapy and intensive supervision and training. We, the coauthors, have rarely encountered such a student, perhaps because in general, students attracted to the E-H approach are individuals with significant empathy and 103

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self-awareness. This is not to say that some of these individuals have not been traumatized or deeply wounded but only to say that they are willing to engage in self-exploration and personal therapy with significant success. However, there are a few individuals who lack sufficient empathy or who have severe emotional disorders. These individuals are truly unable to handle the challenges of becoming an E-H therapist. If such is the case, it is incumbent upon the supervisor to work gently and compassionately with the individual, helping him or her to understand that he or she is unlikely to master the requirements needed to become a competent E-H therapist. This, of course, is a difficult topic that needs to be handled with sensitivity over an extended period of time. It would be ideal if the trainee could come to this realization on his or her own because of overwhelming self-evident data, but if this realization is not arrived at organically, the responsibility falls to the supervisor. Our bias would be that this conclusion is arrived at in concert with fellow supervisors who have seen and worked with the trainee over an extended period of time. This approach is eminently feasible for us at EHI, given the number of supervisors who work with each trainee in our E-H training program and group consultation. This topic raises an even broader issue: the number of inappropriate candidates who are accepted to private graduate psychology programs. Of course, there is a wide range of private psychology graduate programs, some of which adhere to high admittance standards, but some admit any and all who apply purely for the financial gain of the school. This admittance practice results in a number of graduate psychology students who garner thousands of dollars of debt before they recognize, or are informed of, their unsuitability for the profession. On a less problematic but nevertheless significant level are the reputable graduate schools that evaluate candidates’ admissibility solely or for the most part on academic achievement as opposed to lending equal weight to candidates’ personal and relational attributes. Given that therapy is a personal and relational enterprise and not a medical one (Duncan, 2015), it seems obvious that candidates for the therapeutic profession must have both: academic competency and personhood competency. Without screening for both, the likelihood of encountering trainees with significant personality impairment or deficits increases. 104

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POWER AND EVALUATION (E.G., NAVIGATING CORRECTIVE FEEDBACK) The E-H supervisory approach values a nonhierarchical, collegial relationship between the supervisor and supervisee. At ground level, these values translate to transparent communication from the supervisor, with respect to expectations, tasks, and evaluation of the supervisee. What this relationship actually “looks like” and how it actually unfolds has been described in the preceding chapters. The result is that even with an inherent power differential and an evaluation process, the collaborative and transparent attitudes of E-H supervisors tend to create an atmosphere in which corrective feedback is given and received with little or no conflict or adverse effects. The reason for this is that the E-H supervisors live the values they espouse to the supervisee: (a) being present, that is, an attitude of “I’m with you,” and not “I’m doing to you”; (b) having empathy, that is, “I desire to know what it feels like walk in your shoes”; (c) being genuine, congruent, and authentic, that is, “I am a real human being with you”; (d) being transparent and compassionate, that is, “I am a fellow traveler who shares similar struggles and missteps as you do”; and (e) collaboration, that is, “you and I together make this supervisory relationship a place where competency and personal growth occur.” With these values embodied in the E-H supervisor, the supervisory relational road becomes one where the supervisor and supervisee together forge a path of individualized learning and growth. The process typically becomes one of mutual engagement in supervisees’ therapeutic struggles and blocks appreciating that one’s protective patterns and life stances are unique in the particular but universal among all humans. Kirk’s work with Bea in Chapter 3 illuminates how Kirk’s accepting and compassionate attitude both supported Bea and at times challenged her to explore her assumptions about her two clients. Bea’s assumptions were based on her world view and biases, specifically with regard to anger in one case and an unacknowledged assumption in the other (see Chapter 3). Kirk masterfully navigated the supervisory process, by illuminating the positive aspects of Bea’s work and providing corrective feedback in a collaborative style. By first engaging Bea in the experiential role-play, Kirk 105

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laid the foundation for the collaborative discussions with Bea that followed. Their supervisory session illustrates a common learning process for E-H supervisees: (a) supervisees first learn about clients’ lived experiences through experiential role-play, and (b) then the learning evolves to a more theoretical level, with a focus on how the supervisee’s context might be affecting his or her work with clients. The positive value of this learning process is evident in Bea’s personal reflection of her supervisory experience with Kirk (see Chapter 3).

MULTICULTURAL/DIVERSITY ISSUES Multicultural and diversity issues are integral to the contemporary E-H approach to practice, training, and consultation (Schneider & Krug, 2010). These issues stem from the value placed on social justice within the E-H psychological and philosophical tradition (Rice, 2015). Although multicultural and diversity issues only recently have been made more explicit within the E-H professional community (Hoffman, Hoffman, & Jackson, 2015), their lineage can be traced to the philosophical and political writings of Rollo May, Abraham Maslow, Carl Rogers, Erich Fromm, Albert Camus, Tom Greening, Adelbert Jenkins, Charlotte Buhler, Karen Horney, Martin Buber, Paul Tillich, William James, and other pioneers of the movement who stressed the following values: 77 77 77 77 77 77 77 77 77

The prizing of the whole human being as both separate yet related. The appreciation of contrasts and contradictions as part of a rich and vital life. The prizing of person-to-person dialogue among diverse groups, cultures, and ethnicities. The prizing of experiential engagement with peoples of diverse backgrounds. The tolerance for ambiguity and mystery. The passion for discovery. The trust in human inquiry. The love of life in its manifold forms. The love of existence in its manifold forms. 106

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77 77

The emphasis on democratic processes. The repulsion for tyranny, bigotry, and oppression.

(See Friedman, 1991; Fromm, 1965; Greening, 1984; Jenkins, 2001; May, 1981; Moss, 2015; O’Hara, 2015; Schneider, 2013; Schneider & Krug, 2010; Tillich, 1952; Vontress & Epp, 2015, for an overview.) It is out of this seedbed that the E-H approach to diversity and multi­ culturalism continues to evolve and deepen. How does the approach concretely affect E-H consultation and supervision? Consider the case of Carlos, discussed in Chapter 3. Carlos was a Latino American male who struggled with his anger. His father was abusive, and his mother was recently discovered to be unfaithful toward his father. Bea, who was Carlos’s therapist, had concerns about supporting Carlos to express his anger and her ability to handle it. There appeared to be many layers to this situation that could only begin to be broached in this initial supervision session with Bea. However, one layer that I considered was the possibility that Carlos may have been afraid to express his anger not only because of the experience he had with his father but also because he feared being stereotyped by Bea as an angry Latino male. I also considered the possibility that Bea may have inadvertently contributed to this fear through her role as a female professional, which Carlos may have associated with containment and control. However, from an E-H point of view, these speculations did not need to be made explicit and indeed could not be made explicit until and unless they emerged explicitly in our supervision dialogues, which they had not. The speculations did arise for me, and the E-H approach supports a radical openness to such speculations so that they can be “tagged” for possible future discussion. In a similar manner, the E-H approach supports and trusts that as long as the therapist stays attuned to process and not just content, the relevant issues are likely to emerge. In the case of Carlos, I sensed something that spurred me to consider that the interaction between Bea and Carlos may have had cultural overtones. It is entirely possible that I was projecting my own biases about such overtones in my role-play as Bea, working with Carlos, which I also tag for potential relevance. Indeed, it was this uncertainty on my part that kept me from suggesting to Bea that cultural stereotyping might be an underlying issue in 107

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her work with Carlos. At the same time, perhaps I should have shared my reflection with Bea and possibly would do so in a future session with her; it’s a judgment call. My point is that from an E-H standpoint, any hunches, speculations, impulses, and the like are important to acknowledge and are all the more noteworthy because they derive largely from experiential, as distinct from intellectual, engagement. I sensed something in my experience of Carlos (as well as Bea) that hinted at this cultural question. To the degree that I support Bea to deepen her experience of Carlos, she too may find all kinds of intriguing layers of fantasy, emotion, and bias. One of these may be cultural in quality, in which case my hunch could be validated. But the overarching point here is that it is the sensitive contact with the client that from an E-H view is likely to bring out the most important themes, and because of their sensitivity, cultural diversity themes are particularly susceptible to being detected, acknowledged, and addressed in such a context, whereas a more distant encounter may nimbly skirt the problem. That said, the E-H perspective on diversity and multiculturalism is not confined to experiential contacts. With our more integrative orientation, there is a definite appreciation of the value of demographic knowledge about a given client’s background. There is also a place for becoming substantively knowledgeable about clients’ family and cultural heritages, behavioral patterns, and symptomatology. The rub is that from our standpoint, these indicators tend to be of limited value, which again may be quite adequate in certain circumstances (e.g., when the therapy is short term, symptom focused, or acutely circumscribed in its aims). However, for many other situations, the experiential level of contact with a given person is central to understanding that given person’s struggle with multi­ cultural and diversity issues. I have seen many clients who on the surface appear to have cultural or racial issues as their core concerns, but as I work with them more closely, as I live and laugh and sweat with them, I find them to have issues that overlap with but also notably exceed strictly cultural or racial contexts. Such issues may include conflicts of personal meaning, value questions, questions of goals or aspirations, or problems common to humanity. This is not to say that culture and diversity issues 108

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are irrelevant for such people but that through closer contact such issues may be more at the periphery of deeper concerns. Likewise, I have had clients who have presented as conflicted about sundry goals or relationships, but at a deeper level struggle with cultural or racial issues that could only emerge through a more intimate encounter. In sum, the E-H perspective on multiculturalism and diversity encourages supervisees to remain open to many possible challenges facing their clients. It also encourages them to remain open to their own unacknowledged biases. At the same time, it discourages supervisees from making premature assumptions about their clients and to concertedly attune to process, the experiential level of contact, as a key barometer of what’s “really going on” for a client, and within the relationship between client and therapist. For it is this latter sensibility, that which is really going on, that seems to be best explicated by living, breathing presence to a client and not some outside “map” that presumes but does not intimately traverse the actual terrain.

LEGAL/ETHICAL ISSUES The E-H values of phenomenology and social justice form the bedrock of the E-H perspective on the legal and ethical issues of therapeutic training. The aim of the perspective is to sensitize trainees to the many personal, social, cultural, and political contexts that may bear on his or her work with clients. This means helping the trainee develop a multilevel awareness of what traditionally are called transference and countertransference issues but in existential therapy are termed issues of the encounter (May, 1969). To the extent that trainees and therapists remain sensitized to the many possible breaches of the therapeutic encounter, they proceed along the pathway of a legally and ethically informed practice. Some examples of such breaches include presumptions about clients’ attitudes or dispositions that do not dovetail with the phenomenology of their presentations; therapists’ (witting and unwitting) imposition of values on clients; therapists’ imposition of their own personal needs or conflicts on clients; and therapists’ lack of attunement to clients’ fears or aspirations that shortchange clients’ capacities to explore or optimally heal. 109

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The teach/treat boundary is one of the most delicate legal and ethical issues touched on previously in this book. Although this boundary is pertinent for any supervisory orientation, it has particular significance for the orientation of E-H supervision and consultation. The basis for this significance is the E-H stress on the personal experience of the practitioner as integral to the conditions for therapeutic facilitation. This centrality of concern in E-H therapy is exemplified by the supervisory emphasis on trainee introspection and relational awareness, along with live enactments with the supervisor. To the extent that these emphases are directed toward the supervisee–client context and not the explicit healing of the supervisee, they are ethically and legally sound from an E-H point of view. On the other hand, to the extent that such foci on the personal challenges of the supervisee cross into personal therapy for the supervisee, there are unsettling dangers both for the supervisee (e.g., with regard to inappropriate supervisee–supervisor relations) and the supervisee’s client (e.g., in the form of restricted focus on his or her case). Either way, E-H supervisors endeavor to curb such conflicting scenarios by sensing when and with what degree of intensity to refer supervisees to formal individual therapy. Because most of the coauthors’ supervisees have been in personal therapy as a supplement to their supervision sessions, we have rarely perceived a need for supervisee referrals. However, that which we have perceived frequently is the need to recommend the “working through” of problematic gaps in supervisees’ abilities to be present either to themselves or their clients, and these recommendations have paid off invaluably for the supervisee’s own individual healing and the renewed sensitivity, solidity, or courage the supervisee was then able to offer clients. In short, supplemental individual therapy, and particularly experiential depth therapy, is critical to the ethical and legal optimization of E-H practice. Moreover, such supplemental therapy is even more critical at the supervisory stage, when trainees are just beginning to form their personal and professional styles of practice. As a result, we the authors can think of few more crucial recommendations for budding E-H practitioners than to hone the instrument that will be most central to their practices—their own intrapersonal and interpersonal identities. 110

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Supervisory Development and Self-Care

SUPERVISOR TRAINING AND DEVELOPMENT The training, development, and self-care of the coauthors of this volume will be the primary basis on which this construct is explored. Our rationale for this type of discussion is to provide the reader with personal reflections regarding our professional journeys, specifically how we came to hold the perspectives and values that have been enumerated and illustrated in this volume. They are not intended as directives for others but are simply narratives of our paths to becoming existential–humanistic (E-H) therapists and supervisors. Although numerous theorists and therapists, including Rollo May, Erich Fromm, Paul Tillich, and Alfred North Whitehead, influenced me (OK), two masters of E-H therapy have been most prominent in shaping my therapeutic values, attitudes, and style: James Bugental and Irvin Yalom.

http://dx.doi.org/10.1037/14951-006 Supervision Essentials for Existential–Humanistic Therapy, by O. T. Krug and K. J. Schneider Copyright © 2016 by the American Psychological Association. All rights reserved.

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Essentially, my entire psychotherapeutic career, 30 years and counting, has been spent learning the art of E-H therapy exclusively from Jim Bugental and Irvin Yalom. I have never regretted my “limited training experiences” or my continued participation in a monthly consultation group. I trained with Jim Bugental for 20 years by participating in a weekly consultation group and for 6 years of those years attending his “Art of the Psychotherapist” series. When “Arts” ended, some colleagues and I wanted to continue to meet in this context, so we formed our own retreat-training group. First, we invited Jim to work with us, and when he retired, we invited prominent therapists to consult with for a portion of the retreat. Many of the Existential–Humanistic Institute (EHI) faculty continue to participate in this group, called “Arts Omega,” whose membership has expanded from the core “Arts” founders. We continue to meet each spring at a beautiful retreat center in Sonoma, California. My training with Irvin Yalom began in 1994, when five experienced therapists and I asked Dr. Yalom to be our consultant. Since then, our little consultation group, composed of the same six people, has eagerly shown up, each month, at Irvin’s apartment in San Francisco. My years of learning from Bugental and Yalom keenly shaped my vision of what constitutes effective therapy, so much so that I felt called to follow in their footsteps as a teacher of my craft. Inspired by my mentors, I became fascinated by the therapy process and pondered two questions: “What constitutes effective therapy?” and “What constitutes effective therapeutic training?” Indeed my dissertation was a comparative study of James Bugental and Irvin Yalom with respect to their practice and teaching of E-H Therapy (see Krug, 2007). Although both worked in the here and now to cultivate presence to the implicit dimensions of process, they practiced E-H therapy somewhat differently. For example, Bugental’s focus was almost exclusively on the client’s subjective processes, whereas Yalom’s focus, inclusive of the subjective, was even more attuned to “the in-between,” the interpersonal dimension. Bugental and Yalom’s differing foci challenged me to understand how integrating an intrapersonal focus with an interpersonal focus helps people change. My research in this area has helped to widen the scope of E-H therapy—in recent years E-H therapy is understood to be an integrated therapy, having a relational focus equal 112

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to a subjective focus (Krug, 2007, 2009; Schneider & Krug, 2010). I’ll briefly summarize Bugental and Yalom’s similarities and differences; the summary includes an exploration of how each influenced my supervisory approach and training style. Some of these conclusions have been taken from my dissertation findings (see Krug, 2007). As teachers, Bugental and Yalom share many similar attributes. One is a belief in the ability to facilitate growth and change. They managed to instill this belief in their students, in part because they skillfully conveyed the value of therapeutic presence. By attending to the here and now (i.e., the implicit interpersonal and subjective processes underlying the content), they showed us how to cultivate experiences of being with clients, bringing the then and there into the here and now. Being present with clients means less time spent talking about life outside the therapy room and more time experiencing ways of being that are alive and present in the therapy room. We learned how working in the here and now brings immediacy and vitality to the work; my mentors gave me powerful lessons in how to effect change. In addition, Bugental and Yalom demonstrated the art of relationship building and the value they had for it. They also conveyed their belief that therapeutic training needs to attend to developing the person of the therapist as much as mastering skills and techniques. Both were dedicated to teaching and skillful in conveying these lessons. Finally, both created opportunities for community building. Each in their own way conveyed the value of close-knit groups from which lasting bonds of friendship and professional collaboration could be established. There were significant differences between them as teachers, similar to their differences as therapists. Bugental focused his students’ learning almost exclusively on how to cultivate intrapersonal presence—that is, illuminating what is actual but unregarded within the individual. He brilliantly reformatted the traditional consultation experience to include exercises, demonstrations, and role-play techniques that provided students with experiential learning about their clients’ and most importantly their own lived experiences. This type of learning facilitated explorations of my own protective patterns, world views, and biases that was impeding my work. This learning about myself, while immensely important with regard to my work as a therapist was probably more significant with regard to 113

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knowing myself as a person and the type of relationships that I cultivated. Certainly the high value that I place on the development of the person of the therapist comes directly from my consultation encounters with Jim Bugental. This was the gift he gave me. The other gift was his brilliantly constructed 5-day, yearly intensive training retreats, as I mentioned, which was my inspiration for EHI’s residential training program. Yalom’s significantly more relational and eclectic therapeutic approach differentiates his existential perspective from Bugental’s. As a teacher, he believes with Bugental in focusing on intrapersonal process, but also believes perhaps more significantly in focusing on interpersonal process. He provides his students, in a typically structured consultation meeting, with unexpected experiences of group process and interpersonal learning, such as when he may ask a member of the consult group: “How are you feeling in the group right now, and who would you like to speak to?” Yalom also encourages us to work with clients’ dreams, often sharing his clients’ dreams with us. Finally, he always attunes to the implicit and explicit existential issues arising in therapy. Bugental and Yalom differed significantly in their style of teaching and consulting. Bugental’s teaching style was at times less supportive than his therapeutic style although no less present. Although his personality played a part, his occasional critical feedback seemed a reflection of his passionate desire to have his students truly understand his approach. Unfortunately, Bugental’s kind and supportive therapeutic coach sometimes became a tough drill sergeant-like teacher. His style created a hierarchical, less-collegial learning environment. Yalom creates a no less challenging learning environment than Bugental, but Yalom’s way of teaching is always supportive and accepting, resulting in a more collegial, less-hierarchical consultative atmosphere. Yalom’s teaching style brilliantly models what it means to be a compassionate fellow traveler. With a fellow traveler at one’s side, I believe clients and supervisees are more likely to open to aspects of self that are limiting, isolating, or terrifying because they feel safe, accepted, and understood. How did Bugental’s and Yalom’s teaching approaches and style influence my perspectives on E-H therapeutic education and training? The literature suggests that a heavy focus on teaching techniques may hinder the 114

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development of therapist competence and therapist relationship building skills, two elements predictive of successful therapeutic outcome (Elkins, 2007; Fauth, Gates, Vinca, Boles, & Hayes, 2007; Holloway & Neufeldt, 1995; Norcross & Lambert, 2011; Wampold, 2007). My experiences with Bugental and Yalom place me squarely on the side of those humanists who advocate training that emphasizes the art of relationship building and the development of the whole person (Bugental, 1987; Duncan, 2015; Elkins, 2015; Gendlin, 1994; Mahrer & Boulet, 1999; Norcross & Wampold, 2011; Zeig, 2002). My mentoring relationships with them most definitely cultivated and nurtured my psychological transformation. Similar to Milton Erickson, Bugental and Yalom are in the “people-building business” (Zeig, 2002), as each, in his own way, conveys an existential attitude toward life and education. Bugental’s riveting presence and attention to the subjective realm implicitly shouts, “Wake up, be conscious, venture forth, and become who you are!” As my teacher and mentor, he provided a soil rich in experiential nutrients, which fed my capacity for personal reflection and selfunderstanding (see Krug, 2007). Yalom wholeheartedly attends to building relationship: whether he is suggesting how to cultivate intimacy and safety with clients or actually engaging in this process with one of his consultees. Yalom’s relationship building encounters with me over the course of many years substantially increased my sense of safety, trust, and attachment with him and the group (see Krug, 2007). The existential therapy teacher faces the dilemma of not being able to teach about lived experience. As Tillich (1959) suggests, the existential teacher “can only create in his pupil by indirect communication that ‘Existential state’ or personal experience out of which the pupil may think or act” (p. 90). Bugental and Yalom certainly created those personal experiences as each recognized that abstract ideas do not transform, but lived experiences do. They understood that lived experience, such as presence, couldn’t be taught; rather they embodied an authentic and congruent presence, thus indirectly communicating the “existential state” to their students. One evident conclusion from my training experiences is the need for E-H therapeutic education to cultivate a belief in the potential for change, 115

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provide a model for the process of change, and germinate a belief in one’s ability to “midwife” change. Another crucial element of therapeutic training, not often explored, is the need for a safe and accepting learning environment. Such an environment develops, in part, when a therapist remains with one master therapist, in a constructive and supportive supervisory relationship, for a significant number of years. The familiarity of the same teacher in and of itself lays the groundwork for a sense of safety and acceptance. What also matters is the teacher’s style. My inclination to cultivate a more collegial, less-hierarchical learning context with my students was clearly influenced by my personal values but also by the difference with which each mentor treated me. It certainly is true that who we are as therapists and super­ visors can be significantly influenced by how we were treated by our therapists and supervisors. Putting style differences aside, both mentors were successful in develop­ ing a sense of community among their students. Their approach to this was different, and yet the outcome for their students was similar—close and personal relationships were made. My experiences in their communities left me with a lasting insight: that the psychotherapeutic field, specifically teachers and supervisors, need to value and develop close, supportive therapeutic communities in which their students can feel held, accepted, and loved. Being part of a therapeutic family can significantly reduce the isolation of private practice and enhance one’s competency, satisfaction, and enjoyment of the work. The value of creating a therapeutic family is unfortunately an underappreciated and underdeveloped aspect of therapeutic education that should be addressed. My desire to create a community of training program students most certainly was inspired by my mentors’ intentions to build community. A final and important implication for E-H therapeutic education is appreciating the person of the student in the success of the teaching relationship. I am reminded of a phrase attributed to Kierkegaard (1985) that vividly illuminates the experience of becoming: “To venture causes anxiety, but not to venture is to lose one’s self, and to venture in the highest sense is precisely to become conscious of one’s self.” This phrase captures the flavor of my professional and personal development. It has been a process 116

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of becoming by venturing forth, gradually developing a sense of competency and deep satisfaction in my work while simultaneously living my life with more passion, engagement, and personal freedom. My mentoring relationships with Bugental and Yalom cultivated and nurtured this development. And yet, my successful mentoring experiences are also similar to findings on common factors, which indicate that nontherapy client factors are highly significant in determining successful therapeutic outcome (Bohart & Tallman, 2010). My successful mentoring relationships were also significantly determined by personal factors (e.g., my attributes, choices, and actions). The choices I made to resolve my personal protective pattern of overt detachment that hid my yearning for deep connection became more evident as I trained with Bugental. That work matched my willingness to engage more personally and transparently with clients and to those most close to me as I progressed in my training with Yalom. My experiences as a student confirm the theory addressed in the literature regarding student influence on the formation and maintenance of the mentoring relationship (Rodenhauser, Rudisill, & Dvorak, 2000).

ONGOING CONSULTATION AND LEARNING FOR THE SUPERVISOR In May 2015, I (OK) interviewed Irvin Yalom at the opening ceremony of the First Congress of Existential Therapy in London. After an hour of lively conversation, I asked Irv if he had any closing thoughts to share with the international audience. To my surprise, he pointed to me as an example of a master therapist who continues to hone her craft in an ongoing consultation group. He went on to say how important this ongoing learning was if one is fortunate to have a “therapist–colleague–friend group” with whom one can risk sharing therapeutic and life missteps, confusions, and dreads as well as joys, successes, and awe. As I reflected later on his words, I realized that both Jim and Irv had modeled ongoing learning, as they both participated in leaderless consult groups as master therapists. I have the good fortune to participate in three forums of ongoing learning: my monthly consult group with Yalom, my yearly retreat with colleagues and friends from the Bugental “Arts” series, and my participation as a teacher/ 117

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consultant and curriculum developer of EHI’s training programs. The value of each cannot be underestimated: each affords me different learning experiences as a therapist and as a supervisor; each invigorates and stimulates me, challenging me to reflect, change, and grow in different ways. A brief description of each follows to explore three possible models of ongoing learning for E-H supervisors. The consult group with Irv offers a forum in which to bring a case about a client or a supervisee with whom I feel “stuck” or disempowered. My group never disappoints, as they invite me to explore some aspect of myself, the client/supervisee, or the relational field that I’ve missed. Sometimes we share our personal challenges, a process that Irv participates in as well, and occasionally Irv raises a group process issue that has been running unseen in our background process. Our 20-year connection has cemented our bonds of friendship, germinated a joyful camaraderie, and forged mutual respect and trust for one another. My “Arts” group affords 5 days in which to relax, engage in deep personal work, and share my newest projects with my friends and colleagues in beautiful and nurturing Sonoma Valley, California. The opportunity to work on personal issues in our large and small groups that meet daily is always a possibility. If I have a pressing personal, relational, or professional issue that requires attention, I know that my skilled colleagues and invited consultants will engage with me to explore it. Some of my deepest psychological work has been done at these retreats. I’ve learned a great deal about group process and also how the group can be useful in facilitating the illumination or resolution of a personal or relational challenge. And of course, if conflict arises between members, the group has become a safe container in which the conflict can be resolved. This learning has contributed enormously to my competency as a group leader of our training retreats. Last, but certainly not least, is my EHI family, which formed in 1997 and continues to be a group that supports learning about leadership, curriculum development, and teaching. We offer each other support and feedback on the effectiveness of our various teaching modules and our overall teaching and relationship-building skills as we facilitate our experiential retreats. At each experiential retreat, we have at least two teachers always 118

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present in addition to three teachers in training. The village of teachers supports teaching transparency, which allows for immediate feedback and self-correction when necessary. Because we teach in front of our colleagues, there is always the opportunity to give and receive feedback from fellow faculty related to our teaching style, content value, and teaching competency. It is therefore an optimal learning environment in which to cultivate one’s teaching and supervisory skills. To sum, my ongoing learning keeps me curious about the mystery of being and the myriad ways that humans can construct their personal worlds. It fills me with awe and wonder for the therapy process: how is it possible for two people, usually meeting once a week for an hour, to affect one another so profoundly that healing and change occur at a cellular level for one and often for the other as well? The various learning forums stimulate and challenge me, affording different contexts in which to expand my knowledge and understanding of my clients, my students, and myself.

SUPERVISOR IMPAIRMENT, BURNOUT, and COUNTERTRANSFERENCE An environment rich in the aforementioned learning opportunities makes supervisors much less likely to suffer impairment, burnout, or countertransference. If in fact one or all of these conditions occur, the skilled members of these learning forums most likely will alert the supervisor in question to the condition. The reason is obvious: if supervisors engage in ongoing learning forums such as those described, the problems inherent in practicing and supervising in isolation are eliminated. These forums afford supervisors varied opportunities and contexts in which to work on personal and professional issues with skilled therapist–educator colleagues and consultants. Impairment and countertransference conditions with students, clients, and colleagues become highlighted in a learning context in which transparency of clinical practice and exploration of personal issues are valued and supported. Feedback about such conditions is more readily received in an atmosphere of safety and support forged over many years. I and all of my colleagues have had positive experiences of working 119

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through various challenges because of the healing contexts in which we have worked. Burnout is similarly unlikely because of the challenging and stimulating E-H therapeutic and supervisory approach. An absence of manualized therapy or supervision generates an atmosphere of ongoing curiosity and engagement with the therapeutic and supervisory process. How can one not remain curious and engaged with clients’ or supervisees’ personal life experiences and the meanings they construct about self and others? Once these experiences and meanings are understood, the question becomes, How can I create the most effective healing and/or learning environment for this particular individual? This is a fascinating and stimulating enterprise that, for this coauthor, acts as an antidote to burnout and in fact is a perpetual recipe for engagement, awe, and wonder. As the other coauthor of this book, I (KS) would like to briefly comment on my own journey and approach to self-care. My road to becoming an E-H therapist and supervisor began as a small child when I observed my father reading the early humanistic psychologists, such as Abraham Maslow, Carl Rogers, and Rollo May. My father was a humanistic educator who wrote his dissertation on creative thinking and childhood. My mother was also very psychologically minded and supported me by engaging me in psychoanalysis at a very young age, following the untimely death of my older brother. These early influences, coupled with my natural curiosities about the human condition, led me to pursue studies in clinical psychology. After a series of pivotal meetings and mentorships in humanistic psychology, I had the privilege to study with some of the founding luminaries in the field, from James Bugental and Rollo May, to Stanley Krippner and R. D. Laing. For my part, personal therapy and, to the best of my ability, living the E-H therapeutic principles (of presence, experiential reflection, engagement with family/friends, and creative processes—writing, teaching, being active in nature) all have contributed to my self-care and that which I encourage in my supervisees, as warranted. I have also found that if I can really be there when I am with my clients but also make every effort to fully be there in my own life following my sessions with clients, I am nourished to more optimally sustain my capacity to engage both. 120

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This approach is an ideal, of course, but early on I learned some hard lessons about its value during my work at a state hospital and other challenging mental health settings. Most recently, I’ve labored with a condition called cervical dystonia, which entails an involuntary turning of my neck. It is a neurological disorder for which I have applied, partially successfully, a number of medical and nonmedical remedies (although there is no cure as yet for this condition). Perhaps my most important elixir has been the existential attitude I’ve acquired over time, which is to maximally live my life in spite of and in light of the condition. My experience as both client and practitioner has helped me to acknowledge but also see the more of who I am beyond my given malady. Thus, when I have found this work to be overpowering at times and complicated by my dystonia, I have discovered that spiritual connection or what I (and my coauthor) call a sense of awe toward living to be of great solace. This sense of awe, which I derive both from the rich experience I have with clients, as well as in life itself, helps me to lift out of crippling identifications, narrow self-judgments, or catastrophic fears and glimpse the journey that overarches all. This journey or mystery helps me to feel a part of something much greater even as I fixate on a problem with one of my clients or indeed myself. Thus, it is in these ways that I attempt (and have attempted over some 20 years of consulting and supervising) to nourish and provide a model for others to nourish this most intensive form of practice.

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nfortunately, there is a dearth of research specifically on existential– humanistic (E-H) supervision, with the exception of Krug’s (2007) qualitative study of supervision with James Bugental and Irvin Yalom, and Sterling’s exploration of the “meld experience” (1993). Existential Perspectives on Supervision (van Deurzen & Young, 2009) provides a compilation of perspectives on this topic by therapists at the New School of Psychotherapy and Counselling. The scarcity of research supporting the E-H supervisory process speaks to the crucial need for this to be undertaken. Although comparatively modest, the research support for the E-H approach to training is both positive and increasingly influential (Gendlin, 1996; Mahrer, 1996; Pierson, Krug, Sharp, & Piwowarski, 2015; Pierson & Sharp, 2001; Wampold, 2008). Among those who have been researched in the aforementioned studies on an E-H approach to training are the dozens of students who participated

http://dx.doi.org/10.1037/14951-007 Supervision Essentials for Existential–Humanistic Therapy, by O. T. Krug and K. J. Schneider Copyright © 2016 by the American Psychological Association. All rights reserved.

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in James Bugental’s “Art of the Psychotherapist” seminars, mentorship courses (held at the Humanistic Psychology Institute [now Saybrook University]), and private consultation and supervision sessions often conducted with his gifted wife, Elizabeth. There have also been many reports of successful training in Eugene Gendlin’s focusing method of E-H practice, as well as in Alvin Mahrer’s experiential therapy (Gendlin, 1996; Watson & Bohart, 2015). In addition, there have been many anecdotal reports of successful E-H training in the “Advanced Seminars” offered by Rollo May at the California School of Professional Psychology (Bugental, 1995), as well as in the private consultations of James Bugental and Irvin Yalom (Krug, 2007, 2009). In more recent years, there have been encouraging reports about the E-H training offered by the Existential–Humanistic Institute (EHI) and the International Institute for Humanistic Studies, both in California (Pierson et al., 2015; Schneider & Längle, 2012). In this chapter, we present an elaboration on these findings, which supplements the case material presented in this book. However, first we present the all-important background for the data on E-H training—the quantitative and qualitative research on therapy effectiveness. As we shall see, this research both informs and strongly dovetails with the effective training practices promoted by E-H programs and instructors. Groundbreaking psychotherapy outcome research has challenged the prevailing notion that particular modalities and techniques are primarily responsible for therapeutic effectiveness (Duncan, 2015; Wampold, 2001, 2007, 2013). After reviewing a substantial number of meta-analyses concerning the therapy relationship, the interdivisional second Task Force on Evidence-Based Therapy Relationships (Norcross & Wampold, 2011) came to the conclusion that “the therapy relationship makes substantial and consistent contributions to psychotherapy outcome independent of the specific type of treatment [and that it] accounts for why clients improve (or fail to improve) at least as much as the particular treatment method” (p. 98). Norcross and Wampold (2011, p. 98) go on to state that “practice and treatment guidelines should explicitly address therapist behaviors that promote a facilitative therapy relationship,” which 124

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points to the need for training programs that cultivate the evolution of the therapists’ capacity for presence, mindfulness, and attunement (see Siegel, 2010). Mounting research evidence affirms (Norcross & Wampold, 2011; Wampold, 2012) what E-H–oriented practitioners have long articulated (see Bugental, 1987; Elkins, 2009; May, 1983; Rogers, 1980; Schneider & Krug, 2010): An effective therapeutic relationship requires something more profound than technical skill or theoretical understanding. Effective psychotherapy, regardless of orientation, is predicated on a humanistic relationship (Wampold, 2012). The research on therapeutic effectiveness has converged recently along two major axes—the contextual and the relational (Norcross & Lambert, 2011; Wampold, 2007). The contextual factors are the atmospheric sensibilities characterized by the therapist–client alliance: empathy; capacity for moment-to-moment collaboration and re-alignment, as needed; the believability of the therapist; and the inclusion of the sense of hope. The contextual factors also make up the client’s readiness for change, the extratherapeutic dimensions of clients’ nontherapy lives, the influences of the therapeutic setting, and so forth (Bohart & Tallman, 2010; Wampold, 2001). On the other hand, the relational factors specifically focus on themes pertaining to the therapist–client relationship, such as those mentioned in conjunction with contextual factors (e.g., the alliance, empathy, and the like; Norcross & Lambert, 2011). Taken together these axes cleave closely to what existential–humanistic–integrative theorists have maintained for decades—contextual and relational factors are the most salient dimensions of effective therapy. Elkins (2007) summarizes, it’s not so much “theories and techniques that heal . . . but the human dimensions of therapy and the ‘meetings’ that occur between client and therapist as they work together” (p. 496). Wampold (2008) went even further when he wrote, “It could be argued that an understanding of the principles of existential therapy is needed by all therapists, as it adds a perspective that might . . . form the basis of all effective treatments” (p. 6). The following are some highlights of the contextual–relational research in existential and humanistic dimensions of practice. 125

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On the qualitative side of the equation, E-H psychotherapy has produced some of the most poignant case studies in the professional literature (e.g., Binswanger, 1958; Boss, 1963; Bugental, 1976; May, 1983; Schneider & May, 1995; Spinelli, 1997; van Deurzen, 2015; Yalom, 1989). These studies help us to understand lived experience, not just reports about experiences. They also help us to understand how the intimacy of relationships facilitates comparatively deep client disclosures and capacities for transformation. For example, Krug (Schneider & Krug, 2010) showed how phenomenological dream analysis can illuminate a client’s subjective grasp of her suffering; Bugental (1976) vividly elucidated his personal struggles— thoughts, feelings, and even kinesthetic reactions—in his depictions of his work with clients; Schneider and May (1995) and Schneider (2008) showed the value of existential principles for some of the least “typical” client populations; and Yalom (1989) explicated the liveliness and even humor of profound therapeutic rapport. In the area of more formal qualitative studies, Bohart and Tallman (1999) and Geller and Greenberg (2012) demonstrated the value of such E-H concepts as presence and the expansion of the capacity for choice in effective facilitation. Successful psychotherapy, they have shown, necessitates a “process of self-reflection,” and a consideration of “alternative courses of action and making choices” (Walsh & McElwain, 2002, p. 261). In a related study, Hanna, Giordano, Dupuy, and Puhakka (1995) investigated what they termed “second order” or deep, sweeping change processes in therapy. They found that “transcendence” (moving beyond limitations), which is compatible with existential emphases on liberation, was the essential structure of change. They also found that transcendence consisted of “penetrating, pervasive, global and enduringly stable” insights accompanied by “a new perspective on the self, world, or problem” (p. 148). Finally, in a study of clients’ perceptions of their existentially oriented therapists, Schneider (1985) reported that although techniques were important to the success of long-term outcomes, the “personal involvement” of the therapist (her or his genuineness, support, and understanding) was by far the most critical factor identified. In addition, such involvement inspired clients to become more self-involved and to experience themselves as increasingly capable, responsible, and self-accepting. 126

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On the quantitative side of the ledger, Angus, Watson, Elliott, Schneider, and Timulak (2015) summarized the contemporary state of research on humanistic practice. Here are their conclusions: 77 77 77 77 77

77 77 77 77

Humanistic psychotherapies are associated with large pre–post client changes. Clients’ large posttherapy gains are often maintained over early and late follow-ups. Clients in humanistic psychotherapies show large gains relative to clients who receive no therapy. Humanistic psychotherapies in general are clinically and statistically equivalent to other therapies. Person-centered therapy is as effective as cognitive–behavioral therapy (CBT), and emotion-focused therapy (EFT) might be more effective than CBT. Humanistic therapies are most effective for interpersonal/relational problems/trauma. Humanistic therapies meet criteria as evidence-based treatments for depression. For psychotic conditions, humanistic therapies appear to meet criteria as an evidence-based treatment. Humanistic therapies have promise for helping people cope with chronic medical conditions and reducing habitual self-damaging activities.

Returning to the research on E-H training specifically, Pierson et al. (2015) noted that effective work with trainees strongly paralleled successful encounters with clients. In particular, it was not so much techniques that helped trainees to become more effective practitioners, but the contextual and relational factors that underlie technique. These factors converged on therapeutic presence or the capacity to hold and illuminate that which is palpably significant between therapist and client and within the client (or between consultant and trainee and within the trainee in service of his or her work clients). Specifically, Pierson et al. (2015) stated, An “overarching assumption” of the EHI’s training program “is that it is the client’s inthe-moment-experiencing that forms both the underlying and the actual process in therapy” (p. 644). This assumption, in turn, led to the corollary 127

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emphasis on trainee attunement to “process,” that is, preverbal/kinesthetic dimensions of practice, as much if not more than “content,” or verbal/ analytical dimensions. Trainees engaged in this “process emphasis” through a “mix of didactic presentations, relevant videos, faculty demonstrations, experiential exercises, and role play practice” (p. 644). Finally, Geller and Greenberg (2012) echoed all of these findings when they concluded Training . . . needs to include relational practices (e.g., group drumming, relational mindfulness) to help therapists remove the barriers to meeting another with presence as well as to deepen the ability to be fully open with another while in contact with their own experience, the foundation for relating with presence. Rather than minimizing the value of intervention, we are strongly suggesting that the cultivation of therapeutic presence of the person and his or her personal growth should be an equal adjunct in psychotherapy training and can enhance the efficacy of therapeutic technique. It is essential to balance the doing mode of therapy with the being mode for greatest efficacy in the client’s healing. (p. 260)

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n this volume we describe several different models of training and supervision in existential–humanistic (E-H) therapy with a core curriculum emphasizing the human or contextual dimensions of therapy over and above an emphasis on various techniques and protocols. Our students learn to cultivate presence to the personal and relational dimensions, to illuminate what is most alive in the moment, to help clients experience their protective patterns, and to integrate their disowned feelings and core vulnerabilities. They become sensitively attuned and responsive to implicit needs and personal meanings, recognizing the therapeutic relation­ ship as a microcosm of the client’s relational world. Although there is scant research on E-H supervision per se, current research overwhelmingly supports the validity of this type of psychotherapeutic training and education, finding that contextual and relational

http://dx.doi.org/10.1037/14951-008 Supervision Essentials for Existential–Humanistic Therapy, by O. T. Krug and K. J. Schneider Copyright © 2016 by the American Psychological Association. All rights reserved.

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factors are at the heart of therapeutic effectiveness. Schneider and Längle (2015) elaborated on these factors: (1) The authentic personal relationship is fundamental to effective practice. (2) This relationship is fundamental to all recognized approaches to psychotherapy. (3) Human suffering is rendered more bearable within the context of an attuned and understanding relationship. (4) The collaborative nature of this relationship is key to its unfolding. (5) When appropriately supported, the encounter with emotional distress can foster a fuller capacity to adapt, a broader capacity to choose, and a deeper appreciation for one’s personal and cultural life. (p. 432)

Elkins (2012) noted that these findings are not unprecedented; in fact, they support the conclusions of previous studies (see Bergin & Lambert, 1978; Frank & Frank, 1991; Lambert & Bergin, 1994) but in effect were disregarded by psychology’s policy makers. The past and current findings have major implications for clinical training programs, suggesting that such programs should place more emphasis on the relational and contextual factors that are actually responsible for healing and change. Students should spend more time cultivating such qualities as presence, empathy, and responsiveness to client needs, qualities that are associated with therapeutic effectiveness, and not spend an undue amount of time learning standardized protocols. Unfortunately, this is not the way things are. Most clinical training programs today still place little value or emphasis on cultivating in the budding therapist such human attributes as warmth, caring, and acceptance (Duncan, Miller, Wampold & Hubble, 2010; Duncan & Reese, 2012; Elkins, 2015). Why? Because most clinical training programs are based on the medical model, which assumes that techniques are what heal the client and not the relationship between client and therapist. If techniques heal, therapist qualities (e.g., warmth, care, acceptance) are not necessary conditions for change. This medical view of therapy wants to make the client and the therapist irrelevant, when in fact, as Barry Duncan (2015) pointed out, “psychotherapy is decidedly a relational, not a medical endeavor, one that is wholly dependent on the participants and the quality of their interpersonal connection” (p. 457). 130

Future Directions

The authors of this volume wholeheartedly embrace Duncan’s position and harbor concerns with those positions that highlight tech­niques to the neglect of relationships. Consequently, if we accept the past and current research and understand psychotherapy not as a medical endeavor but a relational one, the E-H therapeutic training and supervisory models presented in this volume can be used as a template for effective psycho­ therapeutic and supervisory training. We believe this is a valuable template; furthermore, its aims, tasks and functions are aligned with the views of respected educator David Elkins (2012) and leading researchers such as Barry Duncan (2010, 2015), Bruce Wampold (2007, 2008), John Norcross (Norcross, 2002; Norcross & Lambert, 2011), and many others who advocate for psychotherapeutic education that emphasizes the personal and interpersonal dimensions of therapy at least as much as the apprehension of specific techniques and standardized protocols. Training programs and supervisory settings must help students become sensitive to the human condition as much as learn therapeutic skills. Their hearts, as well as their minds, need our attention. Exposure to art, literature, and philosophy can stimulate these attributes, as can experiences with role-play and dyad practice. David Elkins (2012) challenged the profession to no longer disregard the overwhelming research and “to correct this historical mistake by making major changes in research, training, and practice” (p. 453). We hope that in the near future a rebalance of clinical training programs is realized, and we align with Bruce Wampold (2008) in offering E-H therapeutic principles of practice as a foundation for all effective therapies supervisions. Wampold (2008) has argued that existential therapies are effective beyond the usual common factors such as empathy and the alliance because of their additional attention to meaning. He suggests that clients come to therapy seeking explanations for their experiences. When skilled therapists provide compelling explanations, clients understand them not as particular theoretical explanations but rather as “alternative narratives never considered.” Consequently, Wampold hypothesizes that “perhaps it is the client who makes psychotherapy existential” (p. 4) by rewriting his or her narrative. This rewriting process is clearly illustrated in Krug’s case study of “Claudia” in Schneider and Krug (2010). Claudia came to therapy 131

Supervision Essentials for Existential–Humanistic Therapy

with a narrative about herself as “damaged” and consequently unworthy of being loved. With intensive relational and intrapersonal work, Krug helped Claudia rewrite her narrative: she came to understand how her father had hurt her terribly as a child and how she could allow this hurt to remain in the past and not negatively influence her sense of self in the pres­ ent. She also came to appreciate how she is much more than just this hurt. By experiencing “the more” in herself, she eventually developed a feeling of worthiness. Now she was able to love and be loved. Claudia’s process rewriting her narrative makes this and every other therapy in which this happens “existential” because it is the client who is reforming his or her sense of self and others and not the therapist. It is the client who has the agency to make new meanings from new experiences, not the therapist. This principle has implications for the supervisory process as well. If supervisors create a soil rich in experiential and relational nutrients for their supervisees, the supervisees will also make the supervisory process existential as they rewrite their narratives, making new meanings about themselves as competent and effective therapists. The testimonials from our training program students attest to this process in action. Finally, Wampold points to a valuable marker of therapeutic effectiveness: if clients rewrite their narratives, the therapy model is effective. Similarly, we can conclude: if supervisees and trainees rewrite their narratives, the supervision and training models are effective. The results of Krug’s (2007) study of E-H supervision with Bugental and Yalom and Pierson, Krug, Sharp, and Piwowarski’s (2015) study substantiate this hypothesis. Wampold’s position adds support to the consideration of E-H therapeutic training as a valuable foundation for all effective therapies given its focus on the process of meaning making, a process that seems to be related to therapeutic effectiveness beyond the agreed-upon common and relational factors. (See also Vos, Cooper, Correia, & Craig, 2015.) A second related focus of E-H therapy and supervision is experiential learning, specifically the cultivation of personal and relational presence. This focus could be the therapeutic juice that drives the change process (see Krug, 2010; Schneider, 2015). We have anecdotal evidence in our clinical work that the two variables of (a) attending to the meanings of clients’ narratives and (b) cultivating personal and relational presence are crucial to 132

Future Directions

clients rewriting their narrative. Future research is needed to explore a link between these two variables and therapeutic effectiveness. Complimentary qualitative research could be conducted on the additional benefits of E-H therapy that have gone unrecognized, such as attention to meaning making and the cultivation of relational and personal presence. These findings would shed light on the value of E-H therapy as differentiated from other experiential and humanistic therapies. The premise of E-H therapy, as an effective foundation for a strikingly wide range of client populations and therapeutic modalities, would then be more solidified. There is a pressing need for research to be undertaken related to specific aspects of E-H training and supervision that correlate with key relational and contextual factors. This data would allow E-H supervisors and trainers to confidently emphasize such factors as the cultivation of personal and relational presence. The dearth of specific research on supervision and supervision training in E-H therapy also needs to be remedied. Although it is true that E-H and other bona fide therapies have been found to be roughly equal in effectiveness (Elkins, 2012), it is also true, as previously intimated, that the technical aspects of these therapies have played only a relatively small role in that effectiveness (Wampold, 2007). Doesn’t it stand to reason then that the route to optimizing effectiveness is not through incidental cultivation of therapists’ personal and interpersonal qualities but explicit cultivation of these qualities? Aren’t the E-H principles of practice at the core of these qualities? Much more research, both qualitative and quantitative, should help us refine our understanding of this problem. We conclude with a statement by Eugene Taylor (1999), a wise humanistic theorist and educator, who suggested, “Therapy is more than linear science, medical procedures, and mechanistic method. It is also poetry [and] art . . . it is the artistic, creative, spiritual, ‘poetic’ dimensions of therapy that are most central” (p. 8). To engage in life-changing therapy, the therapist must prepare by cultivating attributes of personal and interpersonal attunement and responsiveness in concert with acquiring traditional academic and clinical training. In doing so, the therapist weaves together the art and science of psychotherapy. In our judgment, all psychotherapeutic and supervisory training should be dedicated to this mission.

133

Suggested Readings

Bugental, J. F. T. (1976). The search for existential identity: Patient–therapist dialogues in humanistic psychotherapy. San Francisco, CA: Jossey-Bass. Bugental takes us inside his consulting room for an in-depth experience of how he actually practices existential–humanistic (E-H) therapy. The five clients he describes and their existential crises vividly come to life as the text unfolds. Bugental, J. F. T. (1978). Psychotherapy and process: The fundamentals of an existentialhumanistic psychotherapy. Reading, MA: Addison-Wesley. Bugental outlines the principles and process of E-H therapy. The source may be difficult to find but is well worth the search. Bugental, J. F. T. (1987). The art of the psychotherapist. New York, NY: Norton. Bugental focuses on the skills needed to develop competency as an E-H therapist. The text includes dialogues between clients and therapist that highlight specific skills. Also included are Bugental’s personal reflections on how he became an E-H therapist. Bugental, J. F. T. (1990). Intimate journeys: Stories from life-changing therapy. San Francisco, CA: Jossey-Bass. The text is an update and reformatting of The Search for Existential Identity (1976). This may be easier to find than the original 1976 text. Bugental, J. F. T. (1999). Psychotherapy isn’t what you think. Phoenix, AZ: Zeig, Tucker. Bugental’s final book vividly and brilliantly summarizes his contributions to developing the principles and the practices of E-H therapy. If you read only one of Bugental’s texts, this is the one to choose. Duncan, B. L., Miller, S. D., Wampold, B. E., & Hubble, M. A. (Eds.). (2010). The heart and soul of change: Delivering what works in therapy (2nd ed.). Washington, DC: American Psychological Association. 135

Suggested Readings

This is an extraordinarily valuable collection of chapters written by therapist– researchers who discuss what works and how to deliver effective therapeutic change. This text is valuable for every therapist to have close at hand. Keenan, K., & Rubin, S. (2015). The good therapist: Evidence regarding the therapist’s contribution to psychotherapy. In D. J. Cane, K. Keenan, & S. Rubin (Eds.), Humanistic psychotherapies: Handbook of research and practice (2nd ed.). Washington, DC: American Psychological Association. Kottler, J. A., & Carlson, J. (2014). On being a master therapist: Practicing what you preach. Hoboken, NJ: Wiley. May, R. (1983). The discovery of being. New York, NY: Norton. Classic introduction to the existential perspective: it includes the history and key concepts of existential theory and practices as well a perspective on the key figures responsible for the formation and development of existential therapy. Schneider, K. J. (2008). Existential–integrative psychotherapy: Guideposts to the core of practice. New York, NY: Routledge. Schneider outlines his conceptualization of existential–integrative therapy followed by vivid case studies of talented therapists who illuminate the “nuts and bolts” of the existential–integrative approach. Schneider, K. J., & May, R. (Eds.). (1995). The psychology of existence: An integrative, clinical perspective. New York, NY: McGraw-Hill. Rollo May’s last text, coauthored by Kirk Schneider, is an updated and expanded version of the landmark Existence (May, Angel, & Ellenberger, 1958). This text provides a brilliant variety of sources that illustrate the existential–integrative perspective through literature, biographies, and case studies. Schneider, K. J., & Krug, O. T. (2010). Existential–humanistic therapy. Washington, DC: American Psychological Association. Schneider and Krug provide a description of the theory and practice of E-H therapy using client–therapist dialogues and extended case studies to illustrate the perspective. Schneider, K. J., Pierson, J., & Bugental, J. (Eds.). (2015). The handbook of humanistic psychology: Theory, research, and practice (2nd ed.). Thousand Oaks, CA: Sage. An expansive edited volume of articles that span the theory, research, and practice of E-H psychology. The handbook is a valuable and important text for every therapist to own. Spinelli, E. (1997). Tales of unknowing: Therapeutic encounters from an existential perspective. London, United Kingdom: Duckworth. An engaging representation of a British existential practice. Spinelli is a member of the London School of existential therapists. van Deurzen, E. (2015). Paradox and passion in psychotherapy: An existential approach. London, United Kingdom: Wiley-Blackwell. 136

Suggested Readings

van Deurzen’s work with clients also illustrates the British version of existential practice. Yalom, I. (1980). Existential psychotherapy. New York, NY: Basic Books. Yalom’s classic text on existential psychology using stories, case studies, and current research to illustrate Yalom’s “ultimate concerns” of existence: death, freedom, meaninglessness, and isolation. Yalom, I. (1989). Love’s executioner. New York, NY: Basic Books. An engaging and skillfully written account of a master existential therapist at work. It reads like an engrossing compilation of short stories that vividly illustrate Yalom’s existential givens of death, meaninglessness, freedom, and isolation. Yalom, I. (2002). The gift of therapy: Reflections on being a therapist. New York, NY: HarperCollins. Yalom provides his “gift” of ideas and tips on practicing therapy for the next generation of therapists. He particularly emphasizes how to cultivate the therapeutic relationship and how to work in the here and now.

Suggested Videos Bugental, J. F. T. (Speaker). (2005). James Bugental: Live case consultation. [DVD]. San Francisco, CA: Psychotherapy.net. Watch a master E-H therapist engage in a case consultation with an experienced therapist. May, R. (2006). Rollo May on existential psychotherapy. [DVD]. San Francisco, CA: Psychotherapy.net. May responds to questions from four experienced therapists about the theory and practice of existential therapy. Schneider, K. J. (2009). Existential–humanistic therapy. [DVD]. Washington, DC: American Psychological Association. Schneider demonstrates E-H therapy in action with a client. Yalom, I. (Speaker). (2005). Irvin Yalom: Live case consultation [DVD]. San Francisco, CA: Psychotherapy.net. Yalom engages in case consultations with several experienced therapists in a group consultation format.

137

Appendix A: EHI Certificate Program Pre-Program Questionnaire for the Foundations Certificate Please read each question and provide a 2–3 sentence answer based on your subjective experience of each. We use your answers to continually improve and enrich our certificate program, so please be thoughtful in your responses.

1. (a) What attracted you to the certificate program? (b) How did you hear about the program?

2. What do you hope to gain professionally from the program?

3. What do you hope to gain personally from the program?

139

Appendix A

4. Provide 1–2 sentences describing your understanding of the following concepts, as you might use them in E-H psychotherapy:



i.  Attending to process (vs. attending to content)



ii.  Presence (interpersonal vs. intrapersonal)



iii.  Working in the here and now



iv.  Context (historical vs. immediate)



v. Freedom



vi. Responsibility

140

Appendix A



vii. Paradox



viii.  Meaning and meaning-making process from experiences



ix. Choice



x.  Being vs. nonbeing



xi.  Relational styles



xii.  Self and world constructs

141

Appendix A



xiii.  Life-limiting protections

5. At this point in time, what experience have you had with E-H psychotherapy? Rate yourself on a scale from 1 to 5, where 1 is “Almost none,” 3 is “Some,” and 5 is “Many years.” Supplement your answer with 1–2 sentences explaining your rating.

6. To what degree does E-H theory and therapy inform your clinical practice? Answer on a scale from 1 to 5, where 1 is “Not at all,” 3 is “Somewhat,” and 5 is “Very much.” Please supplement this number with 1–2 sentences explaining your answer.

142

Appendix B: EHI Certificate Program Post-Program Questionnaire

Please read each question and provide a 2–3 sentence answer based on your subjective experience of each. We use your answers to continually improve and enrich our certificate program, so please be thoughtful in your responses. 1. What aspects of the program were most salient to you?

2. What did you gain from the program professionally?

3. What did you gain from the program personally?

4. Provide 1–2 sentences describing your current understanding of the following concepts, as you apply them to your own work as an E-H therapist. Be mindful in your answers of how you understand these concepts differently after completing the training:

i.  Attending to process (vs. attending to content)

143

Appendix B



ii.  Presence (interpersonal vs. intrapersonal)



iii.  Working in the here and now



iv.  Context (historical and immediate)



v. Freedom/responsibility/choice



vi.  Meaning-making process from experiences



vii.  Being vs. doing



viii.  Self and world constructs



ix.  Life-limiting protections

5. After completing the program, how would you rate your level of familiarity with E-H psychotherapy? Rate yourself on a scale from 1 to 5, where 1 is “Almost none,” 3 is “Some,” and 5 is “Very familiar.” Supplement your answer with 1–2 sentences explaining your rating. 6. After completing the certificate program, to what degree does E-H theory inform your work as a therapist? Answer on a scale from 1 to 5, where 1 is “Not at all,” 3 is “Somewhat,” and 5 is “Very much.” Please supplement this number with 1–2 sentences explaining your answer. 7. How do you imagine it will be to integrate your learning from the certificate program with the theoretical lenses you already have? How will this training experience influence your conceptualization of your client’s existential struggle? 8. Reflecting on the program, is there any aspect you would change if you could? Is there anything more you would like us to know about your experience? 144

Appendix C: Summary Case Notes

Summary Case Notes for______________________________________ Date______________________________________

Summarize the content and process of the session (focus particularly on the client’s attitude and tone toward self and you. How does the client relate to you? Also note any dreams. How were they described?):

****Significant phrases, words, and intense feelings expressed during the session:

145

Appendix C

Cultivating the therapeutic relationship—did you ask, “How are we doing today?’ What was difficult? What was helpful?” At some time during the session, did you focus on the therapeutic relationship (i.e., “How was it to tell me that?”). Or did you share your experience with the client today? If so, describe.

Describe your understanding of your client’s sense of self and world constructs—what are his or her life-limiting patterns of behavior that are evident in the therapeutic encounter? How did you illuminate and/or work with them in today’s session?

146

Appendix D: Working With Dreams From an Existential–Humanistic Perspective Rationale: Working with dreams can deepen the therapeutic work by (a) solidifying the relationship, (b) illuminating self and world constructs, and (c) engaging with a client’s world metaphorically. Assumptions: Dreams represent a restatement of a client’s deeper problems, only in a different language—a language of visual imagery. The agency of the mind turns feelings, attitudes, and experiences into visual form (e.g., a journey, a dilapidated house, descending into a basement). No need to fully and accurately interpret a dream—it can’t be done, and it isn’t the point. The point is to use them to facilitate the therapy. Method: Bring the dream into the here and now. Have the client retell the dream in the present tense. Take notes, focusing on the imagery and the statements the client makes about himself or herself and others in the dream, etc. Focus on where and how the client is in the dream. What is the context? Who comes in and out? “What is the most prominent feeling in the dream?”

147

Appendix D

“What part of the dream catches your attention?” Carefully explore all aspects of this; that is, the part of the dream that engages the most attention. Perhaps have the client “be” (enact) a person or a thing in the dream. Ask “it”: “What brings you here?” “Who are you?” Go back to client: “Did you hear what ‘it’ said?” “What’s your reaction?” “What feelings and thoughts occur to you?” Maybe it’s a dream that needs to be finished: “How do you want it to end?” Have the client enact the ending that he or she wants.

148

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155

Index

Abandonment, 73, 75

E-H therapy contributions of, 9–11 inner vision from, 90 ongoing learning and, 117–19 personal struggles and, 126 protective patterns and, 22 psychotherapist skills and, 39–40 qualitative study of supervision by, 123, 132–33 role-playing and, 66 The Search for Existential Identity by, 3–4 therapy process research of, 112–17, 133 Buhler, Charlotte, 106 Burnout, 120 Business, people-building, 115

Advanced Seminars, 124 Agency, 13 Agent of change, 29 Alcoholic father, 88 Ambivalence, 75–77, 82–83 Anger, exploring, 89, 92–94, 107 Angus, L., 6, 127 “Art of the Psychotherapists,” 42, 112, 124 Arts Omega group, 112, 118 Attitude, “being with,” 32 Audio recordings, 61, 62 Auxiliary aids, 60–61 Awareness, 14, 17–18, 110, 125 Awe, sense of, 121 Awe-based consciousness, 11

Camus, Albert, 106 Carlos (Latino male), 88–98, 107 Case studies, 126, 131–32 CBT. See Cognitive-behavioral therapy Cervical dystonia, 121 Change, 13, 22–23, 29, 37–38, 126 Childhood experiences, 51–52, 73 Choice, power of, 96 Christina (pseudonym), 72–88 Claudia case study, 131–32

Behaviors, 10, 17, 69, 127 Being the therapist, 69–70 “Being with” attitude, 32 Biases, 100, 104–5 Bohart, A., 126 Boles, S., 27 Breaches, of therapy process, 109–10 Buber, Martin, 22–23, 106 Bugental, James, 111, 120 “Art of the Psychotherapists” by, 42, 112, 124

157

INDEX

Clients feedback from, 64 inner world of, 66 life situations of, 69 parent’s ruptured connections with, 87 role-playing, 47–49 sense of self of, 16 sensitive contact with, 108 supervisee’s experiences and, 99–100 supervision and needs of, 68 supervisor’s illuminating process with, 31–32 supervisor’s knowing history of, 72–73 therapy process relating to, 61–62 Clinical competency, 70 Clinical Supervision Essentials DVD Series, 71 Clinical training, 44–45, 130 Cognitive–behavioral approach, 69 Cognitive–behavioral therapy (CBT), 127 Collaborative style, 28, 105–6 Communication skills, 49 Community, 53, 113, 116 Competency, clinical, 70 Constancy, of personhood, 15 Consultation, 4, 70 Consultee, 6, 115 Contact, personal context and, 15, 31 Contemporary E-H therapy, 10–12 Context bag, 52 Contextual factors, 125–27, 129–33 Corrective feedback, 105–6 Countertransference, 35, 87, 109, 119 The Courage to Be (Tillich), 18 Craven, Bea, 71–98, 100 Cultivating presence, 22–23 Cultural heritage, 108–9

Demonstrations, live, 58 Depressive symptoms, 32 Depth psychotherapy, 3 Didactic-verbal learning, 27 Disclosures, 65 Disembodied processing, 87 Disowned feelings, 102–3 Diversity issues, 106–9 Documentation, of supervision models, 67–68 Dream work, 61, 99, 102–3, 126 Drill sergeant, 114 Duncan, Barry, 130–31 Dupuy, F., 126

EFT. See Emotion-focused therapy EHI. See Existential–Humanistic Institute E-H therapy. See Existential– humanistic therapy EI. See Existential–integrative therapy Elkins, D. N., 40, 125, 130–31 Elliott, R., 6, 127 Emotional maturity, 26, 34–37 Emotion-focused therapy (EFT), 127 Empathy, 65, 100, 106 Empowerment, 97 Erickson, Milton, 115 Ethical issues, 109–10 Existence, 13 Existence: A New Dimension in Psychiatry and Psychology, 9 Existential–Humanistic Institute (EHI), 11 Arts Omega group of, 112, 118 certificates awarded by, 41 teaching modules of, 118–19 training offered by, 124 Existential–humanistic therapist, 41 Existential–humanistic (E-H) therapy, xi–xii. See also Therapy process Bugental’s contributions to, 9–11 contemporary, 10–12

Dante, 26, 38 Demographic information, 72 158

INDEX

Experiences, 13, 30, 67, 101 childhood, 51–52, 73 clients and supervisee’s, 99–100 lived, 7, 14, 35, 57–58, 113–15 meld, 66, 123 past, 21–22 patients and therapists needing, 5 supervisee’s expanded, 63, 81–86 of teachers, 46 whole-bodied, 23, 77, 90 Experiential activities, 100–103 Experiential depth therapy, 110 Experiential learning, 59 auxiliary aids used in, 60–61 lived experiences in, 113–15 role-playing in, 65–67 Experiential retreat, 101 disowned feelings explored at, 102–3 in E-H therapy, 42–43 model, 23 Experiential therapy, 124 lessons learned from, 30–31 life-limiting protections in, 7 relationships and, 76 role-playing in, 77–81, 83–85 Experiential training, 58 Experiential world, 17–20 Extramarital affair, 88

contextual and relational factors in, 129–33 contributors to, 9–10 core principles of, 29–31 deeper relationships from, 57–58 description of, 6–7 educational objectives of, 43–46 emphasis in, 9 experiential retreat in, 42–43 faculty and training program evaluation in, 54–57 learning activities in, 46–51 living experiences in, 7 multicultural issues in, 106–9 multifaceted approach to, 4 personal and relational ways in, 20–21 phenomenological method in, 46 protection pattern reflections in, 51–53 standardization in, 5–6 student evaluation in, 53–54 subjective and relational focus of, 11 supervision approach in, 71, 123–24 supervision models in, 3–4, 23, 59–60 supervision transition points of, 86–87 supervisor development in, 4 teach/treat boundary in, 110 theoretical and embodied standpoint of, 5 therapy process of, 33 Existential–Humanistic Therapy (Schneider and Krug), 12 Existential–integrative (EI) therapy, 12 Existential learning module, 51 Existential Perspectives on Supervision, 123 Existential Psychotherapy (Yalom), 10 Existential theory, 12–13

Faculty, 54–57 Father, alcoholic, 88 Fauth, J., 27 Fear fantasy, 92 Fears, 102–3 Feedback, 74, 118–19 from clients, 64 corrective, 105–6 from supervisee, 98 Feelings, 76, 102–3 Fellow travelers, 19–20, 114 Finite freedom, 18 First Congress of Existential Therapy, 117

159

INDEX

Intrapersonal process, 34 It’s not fair phrase, 50–51

Foundations of Existential– Humanistic Practice Certificate Program, 72 Frankel, Victor, 4 Freedom, 13 Fromm, Erich, 106, 111

James, William, 106 Jenkins, Adelbert, 106

Kierkegaard, S., 9, 11, 116 Krippner, Stanley, 120 Krug, Orah, xi–xii, 4, 12, 51, 54–55, 59 Claudia case study of, 131–32 dream analysis by, 126 mentors of, 11 role-playing and, 66 qualitative study of supervision by, 123, 131–33

Gates, S., 27 Geller, S. M., 126, 128 Gendlin, Eugene, 124 The Gift of Therapy (Yalom), 64 Giordano, F., 126 Goals, 85 Greenberg, L. S., 126, 128 Greening, Tom, 106 Group case consultation, 70 Group supervision, 69–70 Group training, 41–42

Laing, R. D., 120 Längle, A., 130 Latino male, 88–98, 107 Learning. See also Experiential learning activities, 46–51, 117–19 didactic-verbal, 27 experiential, 65–67 modules, 47, 60–61 objectives, 44–45 processes, 106 “Learning to be,” 53 Lectures, 47 Legal issues, 109–10 Life-changing therapy, 133 Life-limiting protections, 7 Life situations, 69 Life structure, 63 Live demonstrations, 58 Lived experiences, 7 in experiential learning, 113–15 relationships in, 57–58 role-playing and, 35 self-world constructs from, 14 Live enactments, 110

Handbook of Psychotherapy Supervision (Watkins), vii Hanna, F. J., 126 Happiness, 79 Hayes, J. A., 27 Heraclitus, 14 Here and now therapy, 29, 64, 113 Horney, Karen, 106 Human beings experiential world of, 12–13, 17–18 four givens of, 10 as free and determined, 14–15 as part of nature, 13–14 Human condition, 131 Humanistic principles, 6, 125, 127

I am experience, 13 Identity formation, 14–15 Impairment, 119 Inner vision, 90 Interpersonal presence, 62–67, 103, 113–14 Interpersonal process, 34 Intrapersonal presence, 103, 113–14

Mahrer, Alvin, 124 Maslow, Abraham, 106, 120

160

INDEX

Pattern recognition, 27 Pauses, long, 80 People-building business, 115 Perception, 15 Personal betrayal, 50 Personal context, 103. See also Contextual factors contact influenced by, 15, 31 perception and contact influenced by, 15 of supervisee, 35 of therapists, 52–53 Personal development, 43 Personal experiences, 30 Personal freedom, 15 Personal growth, 55–56 Personal presence, 33–34, 62–67 Personal reflections, 99–101, 115 Personal relationships, 130 Personal struggles, 126 Personal therapy sessions, 110, 120 Personhood, 15, 104 Phenomenological method in E-H therapy, 46 experiential world entered by, 19–20 healing and change from, 22–23 supervisors and, 19 Philosophers, 4 Pierson, J. F., 55, 127 Piwowarski, T., 55 Postquestionnaires, 54, 55 Pou sto, 32–33, 37, 50 Prequestionnaires, 54, 55 Present moment, 15–17, 57 Principles core, 29–31 existential, 126 humanistic, 6, 125, 127 of practice, 30 therapeutic, 27 Process emphasis, 128 Professional growth, 56–57

Maturity, emotional, 26, 34–37 May, Rollo, 4, 12, 84, 106, 111, 120 Advanced Seminars by, 124 E-H therapy contributions of, 9–10 existential principles of, 126 fellow travelers and, 19–20, 114 I am experience and, 13 therapeutic relationships and, 26 transference explained by, 65 Meaning-making process, 11 childhood experiences in, 51–52 creation of self in, 13–14 protective life stances in, 52 supervisors and, 14 Medical model, 130–31 Meld experiences, 66, 123 Mentoring relationships, 117 Mindfulness, 27 Mirroring, 77, 88 Modalities, 124–25 Models. See also Supervision models of change, 37–38 documentation of supervision, 67–68 experiential retreat, 23 medical, 130–31 retreat-training, 59–60 Modular Training Program, 41 Moustakas, Clark, 4 Multicultural issues, 106–9

Nietzsche, F., 9, 11 Norcross, John, 6, 124, 131

Objective awareness, 17–18 Open-ended questions, 55 Over-identifying, 85

Paradoxical unity, 18 Parents, 87 Passion for form, 13 Past experiences, 21–22 Patients, 5

161

INDEX

Research, on therapy process, 112–17, 133 Resistance, 49–50, 74–75 Responsibility, 13 Responsiveness, 27 Retreat-training model, 59–60 Rogers, Carl, 4, 36, 106, 120 Role-playing, 99 with client, 47–49 client’s inner world and, 66 collaborative style with, 105–6 in experiential learning, 65–67 in experiential therapy, 76–81, 83–85 feelings in, 76 lived experiences and, 35 therapists and, 86–87, 90–97 value of, 62 Rule-bound behavior, 10 Rule-risk-taking behavior, 10

Protective life stances, 52 Protective patterns, 66 E-H therapy reflections of, 51–53 in life structure, 63 past experiences and, 21–22 students enacting, 49–50 supervisees engagement and, 34–35 underlying fears in, 102–3 Psychology programs, 104 Psychosis, 33 Psychotherapy, 4 Bugental and skills of, 39–40 depth, 3 hearts and minds developed in, 5 humanistic principles in, 6, 125, 127 modalities and techniques of, 124–25 relational process in, 131 self-reflection process in, 126 training in, 27–29 unique experiences in, 100–101 Puhakka, K., 126

Saltman, Sonja, 11 Schneider, K., xi–xii, 4, 10, 59–60, 127 awe-based consciousness from, 11 Craven supervisee of, 71–98, 100 EI therapy of, 12 existential principles of, 126 humanistic principles of, 6, 125, 127 influences of, 120–21 personal relationships and, 130 therapeutic relationships and, 26 therapist’s involvement and, 126 The Search for Existential Identity (Bugental), 3–4 Second order change process, 126 Self care of, 120 client’s sense of, 16 constructs of, 28 creation of, 13–14 development of, 55–56, 115 discovery of, 87

Qualitative study, 123 Question-and-answer period, 48

Racial issues, 109 Reichman, Frieda Fromm, 5 Relational awareness, 110, 125 Relational factors, 11, 125–27, 129–33 Relational practices, 128, 131 Relational presence, 33–34 Relationships, 57–58 experiential therapy and, 76 fake people rejecting, 73 mentoring, 117 personal, 130 skills in building, 114–15 therapeutic, 26, 29 transactional, 28 transformative, 28 trusting, 74, 96–97

162

INDEX

own biases understood by, 100–101 personal context of, 35 protective patterns and engagement of, 34–35 relational and personal presence of, 33–34 subjective and interpersonal realms of, 103 supervision feedback from, 98 supervisors and internal battle of, 18–19 Supervision, 6 client’s needs and, 68 corrective feedback in, 105–6 defining, vii–viii as distinct activity, viii E-H therapy’s approach to, 71, 123–24 emotional maturity and, 26 experts approach to, xi group, 69–70 importance of, ix–x personal therapy sessions and, 110, 120 qualitative study of, 123, 132–33 supervisee feedback on, 98 transition points in, 86–87 Supervision models collaborative and experiential, 28 documentation and evaluation of, 67–68 in E-H therapy, 3–4, 23, 59–60 methods and techniques in, 61–62 personal and interpersonal processes in, 62–67 Supervisors client process illuminated by, 31–32 client’s history known by, 72–73 consultation and training of, 4 experiential activities and, 100–103 interpersonal presence cultivated by, 64–65

perception of, 98 protection of, 85 reflection on, 126 Self-alienated people, 9–10 Self-world constructs, 14 Sense of awe, 121 Sense of self, 16 Sensitive contact, 108 Sessions, 71–98, 110, 120 Shabahangi, Nader, 11 Sharp, J. G., 55 Social justice, 106, 109 Standardization, 5–6 Standardized supervisors, 60 Stereotypes, 98, 107 Sterling, Molly, 66, 123 Students, 6 E-H therapy evaluation of, 53–54 experiential training of, 58 human condition sensitivity and, 131 learning to be, 53 protective patterns enacted by, 49–50 relating in moment by, 57 sense of community among, 116 Subjective awareness, 17–18 Subjective experiencing, 67 Subjective focus, 11 Subjective realms, 103 Suicidal intentions, 33 Supervisee, 6. See also Clients “being with” attitude of, 32 clients and experiences of, 99–100 common learning process of, 106 Craven as, 71–98, 100 dealing with difficult, 99–103 emotionally overwhelmed, 36 emotional maturity of, 34–37 experience expansion of, 63, 81–86 experiences of being and, 30 explore disclosures of, 65 model of change for, 37–38

163

INDEX

Supervisors (continued) meaning-making process and, 14 ongoing learning for, 117–19 phenomenological method and, 19 problem understanding of, 16–17 standardized, 60 supervisee’s internal battle and, 18–19 teachers and, 48–50 Symptoms, depressive, 32

cognitive–behavioral, 127 contemporary E-H, 10–12 contextual and relational factors in, 125–27 of E-H therapy, 33 emotion-focused, 127 experiential, 7, 30–31, 76–81, 83–85, 124 experiential depth, 110 here and now, 29, 64, 113 life-changing, 133 medical model of, 130–31 personal encounter in, 43–46 research on effective, 112–17, 133 setting for, 68–69 training program’s value in, 116 value creation in, 116 Therapy sessions with Craven, 71–98 holding back in, 97 long pauses in, 80 personal, 110, 120 value of, 92 There I go again, 21–22 360-degree evaluation process, 54, 98 Tillich, P., 18, 106, 111, 115 Timulak, L., 6, 127 Tissue behavior, 17 Trainee, 6, 103–4, 110, 128 Training program advanced, 45 clinical, 44–45, 130 dimensions of, 25–26 EHI offering, 124 E-H therapy evaluation of, 54–57 experiential, 58 group, 41–42 human condition sensitivity from, 131 participants selected for, 41–42 in psychotherapy, 27–29 relational practices in, 128 supervisor’s, 4

Tallman, K., 126 Task Force on Evidence-Based Therapy Relationships, 124 Taylor, Eugene, 133 Teachers experiences of, 46 style used by, 114 supervisors and, 48–50 village of, 119 Teaching methods, 27, 40, 118–19 “Teaching novels,” 10 Teach/treat boundary, 35, 110 Techniques, psychotherapy, 124–25 Therapeutic presence, 34, 104 Therapeutic principles, 27 Therapeutic rapport, 126 Therapeutic relationships, 26, 29 Therapists. See also Psychotherapy being the, 69–70 countertransference reactions of, 87 development of, 40 Existential-Humanistic, 41 experience needed by, 5 frustrations with, 77 personal context of, 52–53 personal involvement of, 126 pou sto and, 32–33 role-playing and, 86–87, 90–97 in training, 36–38 Therapy process breaches of, 109–10 client’s relating in, 61–62 164

INDEX

Wampold, Bruce, 6, 12, 40, 124–25,

therapeutic value from, 116 therapists in, 36–38 360-degree evaluation process in, 54 Transactional relationships, 28 Transcendence, 126 Transference, 65, 109 Transformation, 88 Transformative relationships, 28 Transparency, 119 Trauma, 73 Travelers, fellow, 19–20, 114 Trust, 73–74, 94, 96–97 Trust walk, 101

131–32 Watkins, Edward, vii Watson, J. C., 6, 127 Whitehead, Alfred N., 13, 111 Whole-bodied experience, 23, 77, 90 World constructs, 28

Yalom, Irvin, 5, 11, 19, 111 Existential Psychotherapy by, 10 The Gift of Therapy by, 64 here and now therapy of, 29, 64, 113 ongoing learning and, 117–19 qualitative study of supervision by, 123, 132–33 teaching novels of, 10 therapeutic rapport from, 126 therapy process research of, 112–17, 133

Video recordings, 61 Vinca, M. A., 27 Violence, 97–98 Virgil, 26, 38

165

About the Authors

Orah T. Krug, PhD, has been clinical director of training and education at the Existential–Humanistic Institute of San Francisco (EHI) since its inception in 1997, where she oversees its educational offerings, developing the curriculum and the programmatic structures for the varied training programs. Dr. Krug leads the faculty and supervises the teachers-in-training at the experiential retreats in Sonoma County, CA. (Information about the educational programs is available at http://ehinstitute.org/existentialtherapy-certificate.html.) She also maintains a private practice in Oakland and Sausalito, CA, is an adjunct faculty member of Saybrook University, and is an editor for the Journal of Humanistic Psychology. In addition to this text, she and Kirk Schneider coauthored Existential–Humanistic Therapy (2010), which is part of the American Psychological Association’s Theories of Psychotherapy Series. Kirk J. Schneider, PhD, a leading spokesperson for contemporary existential–humanistic psychology, is a graduate of Saybrook University, where he was mentored by James Bugental and Rollo May. Dr. Schneider is the president of the Society for Humanistic Psychology of the American Psychological Association (2015–2016), recent past editor of the Journal of Humanistic Psychology (2005–2012), cofounder and vice president of the Existential–Humanistic Institute, and adjunct faculty at Saybrook University and Teachers College, Columbia University. His previous 167

About the Authors

books include The Paradoxical Self, Rediscovery of Awe, Awakening to Awe, Existential–Integrative Psychotherapy, Existential–Humanistic Therapy (with Orah Krug), and The Polarized Mind. Dr. Schneider’s primary interests are helping to broaden the therapeutic field through the individual and collective applications of existential–integrative practice and the spirituality of awe, or the humility and wonder, and sense of adventure toward living.

168