The Insufficient Intern
Supervisees often react negatively to clients because they feel insufficient.
“I don’t understand my client’s [poly-amorous lifestyle, choice to have an abortion, sexual orientation, gender] how can I possibly help them?”
The insecurity that comes from feeling like we lack the skills to proceed or are unfamiliar with the lives in front of us can cloud our counseling compassion. Like a drowning person, our interns cling tighter to what they KNOW (their religious beliefs, how they were raised, their life cycle experiences, their culture) like a life ring, turning normal counter transference (bias, judgement, dislike, fear) into unethical behavior like client abandonment.
Everyone experiences counter transference. We all have biases and must often ‘think twice’ when we are counseling and supervising. Most of us completed a values clarification exercise in graduate school or during our supervision experience so we were prepared when bias slammed us in the head during our first sessions.
Values reflection doesn’t end in internship though. Professional counselors are in a constant state of ‘observe, reflect, learn, consult, rinse, repeat.’ In the end, practicing ethically within our scope of practice means we seek special training when we notice we lack skills, and seek consultation when we recognize our biases.
Jake and Joan
Let’s look at Jake. Jake is an experienced licensed mental health provider. Joan comes to see Jake, and after three sessions reveals she lost a young child in a car accident a few years ago. Jake’s scope of practice includes Joan’s presenting issue but he has zero experience with grief. His counter transference is screaming because he has two young kids at home and lost a brother twenty years ago in a car accident. Jake is a professional though. He knows referring Joan out to another counselor after they have built rapport just because he doesn’t have grief counseling skills or her issue has thrown him onto the struggle bus is not the best solution. Instead Jake calls a trusted professional to provide ongoing consultation and supervision in grief counseling, ramps up his personal self-care (i.e. therapy, his own grief support, men’s group, religious group, etc.), and gets back to work.
It's Not Easy Being Green
Expanding our scope of practice and ironing out our biases is an ongoing developmental process. It begins when we are Level 1 Interns and have zero scope of practice, and continues until there is just nothing left to learn about our clients or ourselves. Level 1 Intern bias tends to fall into two categories: ‘First Appointment’ bias and ‘Oh no! And I was Just Beginning to Like You’ bias.
First appointment bias usually happens when the client does not look like, have the same genitalia as, have sex like, or exist in the same life cycle stage, as your intern. Graduate programs do a pretty darn good job helping interns understand this type of bias and the resulting counter transference and continue to work well with clients. The second type of bias is more difficult. The problem? Most Level 1 Interns are lucky if they were able to experience a graduate practicum where clients came to several consecutive sessions. As a result, most have very little experience processing what to do when, after several sessions of joining and building rapport, their clients finally trust them and reveal:
- Their child’s other parent is the same sex
- They are having an affair
- They used to be a woman
- They love men and women
- They are part of a polyamorous unit or in ‘the lifestyle’
- They need help with erectile dysfunction
- They are a pregnant victim of non-consensual sex and belong to the intern’s religion that does not permit abortion
Cultivating One-Down and I-Thou
Let’s get one thing straight; Level 1 interns exude hope and trust but they lack confidence and this is NORMAL. This lack of confidence makes them SELF-focused and while they are highly motivated, their self-focus means they don’t want to screw up. As a result, they are overly dependent on authority. We want that authority to be you the supervisor, but more likely, ‘authority’ will be their conscience, religious convictions, life cycle stage, life experiences, and their own internal morals, values, and instincts.
Your Level 1 Interns don’t know this yet, but the single best way to find sufficiency, confidence, openness, and a one-down I-thou stance is to do precisely the opposite of what their instincts might tell them to do: be open and vulnerable to supervision. In a profession based on connection, trust, and attention, trusting a supervisor to teach new ethics and challenge preconceived ‘authorities’ is not only the highest-yielding strategy, it’s also the right thing to do.
By the end of supervision your intern should be familiar with ethics and how they relate to specific issues, including counseling same sex couples. They should have a framework for understanding how religion and issues like sexual orientation, identification, family/partner configuration, consent, contraception, and infidelity may create ethical issues for them and their clients. Finally they should have a better understanding of their own professional ethics and how to successfully join with and counsel those who are different from them, whose experiences they may not understand, and whose lifestyles they may not agree with.
WANT A GREAT COMMUNITY OF AMAZING SUPERVISORS? Today is a great day to sign up for the monthly Texas Supervisor Training consultation group. This is one of Kate’s most popular workshops, and for good reason. If you have something to say and need to be heard, I think you’ll find that the Texas Supervisor Training Facebook Group is a great way to share your ideas. Hope to see you there.
Blog post by Kate Walker Ph.D., LPC/LMFT Supervisor
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