P1: FLF Journal of Genetic Counseling [jgc]
HS105-85
August 17, 2000
11:40
Style file version Nov. 19th, 1999
Journal of Genetic Counseling, Vol. 9, No. 5, 2000
Closing Thoughts on Supervision Seymour Kessler1,2
Supervision of genetic counselors has not received the attention it needs. There is much we do not know or understand about it and multiple questions might be asked. What standards should be met to qualify as a supervisor? What training in supervisory skills have such individuals received? What standards exist regarding the supervision of practicing genetic counselors? Who should provide such supervision? Should a requirement to obtain such supervision by the National Society of Genetic Counselors (NSGC) membership be set out more stringently than it is? These are not trivial questions. The answers have a considerable impact on the attitudes, working philosophy, and proficiency of new entrants into the field as well as on working professionals. In the long run, how these questions are answered will influence the direction the profession takes and, ultimately, the quality of assistance given to clients. There is much at stake for the profession of genetic counseling in how the issue of supervision is dealt with. Genetic counseling is a relatively new profession and standards of professionalism are evolving. An overall framework for providing genetic counseling is still in status nascendi with two models—teaching and counseling—competing for the hearts and minds in the field. The teaching model, to my knowledge, has no set of empirically-based techniques that can be codified and taught systematically to students. Even the psychological model has not developed standards of practice that can be taught coherently and provide a basis for pre- and postgraduate supervision for genetic counselors. In the face of these ambiguities, some genetic counselors have decided that if they want to mature professionally and hone their counseling skills, they will have to seek out, on their own time and at their own expense, appropriate supervision/consultation. In the absence of standards of professionalism, the counselors who authored the papers in this Special Issue have created their own standards. How many others have done the same? We simply do not know. Nonetheless, going public, as Bosco, Hiller, Likhite, Schneider, Rosenfield, and Kennedy have 1 Berkeley,
California. should be directed to Seymour Kessler, PO Box 7702, Berkeley, California 94707.
2 Correspondence
431 C 2000 National Society of Genetic Counselors, Inc. 1059-7700/00/1000-0431$18.00/1 °
P1: FLF Journal of Genetic Counseling [jgc]
432
HS105-85
August 17, 2000
11:40
Style file version Nov. 19th, 1999
Kessler
done, deserves our respect and approbation. They took a risk and are better professionals—and human beings—for it. Hopefully, their example will encourage others to follow in their footsteps. Dr. Kennedy’s article, and the series of papers that accompany it, make the case that on-going supervision should be part of each working genetic counselor’s professional life. Kennedy describes three models of supervision—one-on-one, peer group supervision, and, the one she favors, the leader-led group—all derived from the field of mental health; there’s a form for everyone. The bottom line is that getting supervision is what responsible professionals do. By choosing a life as a professional one takes on the obligation to obtain supervision and consultation as a core responsibility regardless of how busy we are, our sense of shyness, embarrassment, shame, or fear of being found to be inadequate, incompetent, or foolish. None of these excuses obviates our professional responsibility. I heartily support Dr. Kennedy’s plea for more supervision in the field of genetic counseling. I see supervision as a matter of survival for this profession. A field that does not grow in skill and competence will wither and stagnate and, eventually, be supplanted by others with a more certain sense of professional identity and skill. There is a general principle in life: growth only comes by overcoming obstacles. We all learned to walk by taking the risk of standing up and stepping out, falling down, crying, and starting all over again until we mastered how to stay upright and put one foot after another without falling. It’s only by acting, despite our anxieties and fears, that we master our personal obstacles and promote our maturation. The same reasoning is true for those of us who choose the life of a professional. Some counselors may not like being supervised, especially during or after a long and trying workweek. Supervision can be anxiety-provoking and, for some, terrifying. But, that’s no reason to avoid it or to rationalize it as unnecessary. On the contrary, its very frightening nature is a call, no, a demand, to each of us, to gird ourselves and face the beast within that keeps us from learning, growing, and maturing into the professionals we could be. As Dr. Kennedy points out, the group forms of supervision are powerful arenas to obtain validation and support and indeed, with her help, her group seems to have avoided some of the pitfalls I have observed in other supervision groups. In peer groups especially, a group dynamic can develop that is so supportive that the group becomes insufficiently challenging. The early life of a supervision group requires the development of trust and the presence of support, but if the group is to mature and the skills of its members are to become more sophisticated and effective, some degree of challenge needs to be present. Leader-led support groups tend to avoid this problem. Groups that trade off challenge for support can devolve into social rather than learning arenas. Also, within groups there are inevitable differences between individuals in their psychological understanding and sensitivity and this can lead to the formation of coalitions and subgroupings
P1: FLF Journal of Genetic Counseling [jgc]
Closing Thoughts
HS105-85
August 17, 2000
11:40
Style file version Nov. 19th, 1999
433
with all of the attending dynamic problems that come with it. Again, this is less true for leader-led groups. Just as no two counselors counsel in the same way, no two supervisors work in the same way. My own preference in pre- and postgraduate supervision, whether one-on-one or in groups, is to work with professionals who come with audio or videotapes and/or verbatim transcripts of their counseling sessions. I long ago learned that humans have an unlimited capacity for self-delusion and without some relatively objective check we cannot be confident that what we heard, saw, said, or did corresponds to reality. I recently heard an audiotape in which a counselor was taking a family history in the course of which the death of a child was reported. What the counselor, and the colleagues for whom the tape was played, did not hear—neither in the session nor in the initial replaying of the tape—was the manner in which the child died, a fact that shed light on the family’s dynamics and shaped their expectations of the then current pregnancy. And we are all prone to such mishearings and subsequent misunderstandings. I have also found that tapes help supervisees focus on their own words and behavior, allowing us to deal with countertransference in more concrete terms, rather than with hypotheticals and abstractions. Another advantage is that tapes rapidly identify areas of strength in the supervisee’s counseling on which supervisory interventions can build. Lastly, since genetic counseling is overwhelmingly verbal, tapes and transcripts allow supervisees to discuss the actual words used in a given situation and to learn how to modulate language so that overall counseling becomes more effective and its psychological impact is maximized. In supervising groups of physicians and other senior professionals in the field of genetic counseling, I have found that the greatest area of need is in the development of flexibility in switching rapidly from the role of providing information to that of being a counselor on a more personal, human level. These role shifts require adroit, dextrous adjustments in the management of the psychological distance between professional and client. In turn, the acquisition of such nimbleness requires a reconsideration of preconceptions and long-held beliefs about one’s professional role—beliefs developed and influenced by one’s (often superficial) initial training and the flotsam and jetsam of misunderstood or misapplied ideas embedded in the genetic counseling literature (e.g., nondirectiveness), which have impeded the counseling side of the field. As the field of contemporary genetic counseling developed, it had little choice but to borrow concepts from other fields of counseling and psychotherapy. Genetic counselors frequently deal with people who are undergoing enormous anxiety, confusion, and distress, and when also faced with other profound life issues, such as morbidity, mortality, and loss, are unable to reach an understanding of complex issues or make important, sometimes urgent, life decisions. Using some of the practices of counseling and psychotherapy, genetic counselors can assist and empower clients, reduce their anguish, and help them feel better about themselves
P1: FLF Journal of Genetic Counseling [jgc]
434
HS105-85
August 17, 2000
11:40
Style file version Nov. 19th, 1999
Kessler
and their circumstances. Are the counselors doing psychotherapy? No, they are just doing good genetic counseling. One of the primary functions of supervision in the mental health field is to socialize the professional into their professional role. That is why clinical psychologists, for example, receive the major portion of their pre- and postgraduate supervision from other clinical psychologists. The goal is to prepare the individual for their professional life and imbue them with certain attitudes, ways of thinking, standards, and values expected of all psychologists. How can the field of genetic counseling achieve a similar degree of professional autonomy if it does not have full control over its own standards and, as important, the mechanisms to socialize new entrants into the profession? Turning to mental health professionals for supervision at this point in its history of genetic counseling may not be a choice; where else can genetic counselors turn? But, someday, and I suspect that day is not that far off, genetic counselors will develop an independent approach to the principles and practices of their profession and to their standards of professionalism. I envision that they will take the best that other fields—including mental health—offer and make it their own. The articles by Kennedy and the professionals who work with her show us not only how far the field of genetic counseling has come but also how much further it needs to go to develop its professional individuality, autonomy, and authority. The good news is that some of the genetic counselors in supervision today will be tomorrow’s supervisors, hopefully bringing to genetic counseling higher standards and a more mature, integrated view of professionalism.
HS105-85
August 17, 2000
11:40
Style file version Nov. 19th, 1999
Journal of Genetic Counseling, Vol. 9, No. 5, 2000
Closing Thoughts on Supervision Seymour Kessler1,2
Supervision of genetic counselors has not received the attention it needs. There is much we do not know or understand about it and multiple questions might be asked. What standards should be met to qualify as a supervisor? What training in supervisory skills have such individuals received? What standards exist regarding the supervision of practicing genetic counselors? Who should provide such supervision? Should a requirement to obtain such supervision by the National Society of Genetic Counselors (NSGC) membership be set out more stringently than it is? These are not trivial questions. The answers have a considerable impact on the attitudes, working philosophy, and proficiency of new entrants into the field as well as on working professionals. In the long run, how these questions are answered will influence the direction the profession takes and, ultimately, the quality of assistance given to clients. There is much at stake for the profession of genetic counseling in how the issue of supervision is dealt with. Genetic counseling is a relatively new profession and standards of professionalism are evolving. An overall framework for providing genetic counseling is still in status nascendi with two models—teaching and counseling—competing for the hearts and minds in the field. The teaching model, to my knowledge, has no set of empirically-based techniques that can be codified and taught systematically to students. Even the psychological model has not developed standards of practice that can be taught coherently and provide a basis for pre- and postgraduate supervision for genetic counselors. In the face of these ambiguities, some genetic counselors have decided that if they want to mature professionally and hone their counseling skills, they will have to seek out, on their own time and at their own expense, appropriate supervision/consultation. In the absence of standards of professionalism, the counselors who authored the papers in this Special Issue have created their own standards. How many others have done the same? We simply do not know. Nonetheless, going public, as Bosco, Hiller, Likhite, Schneider, Rosenfield, and Kennedy have 1 Berkeley,
California. should be directed to Seymour Kessler, PO Box 7702, Berkeley, California 94707.
2 Correspondence
431 C 2000 National Society of Genetic Counselors, Inc. 1059-7700/00/1000-0431$18.00/1 °
P1: FLF Journal of Genetic Counseling [jgc]
432
HS105-85
August 17, 2000
11:40
Style file version Nov. 19th, 1999
Kessler
done, deserves our respect and approbation. They took a risk and are better professionals—and human beings—for it. Hopefully, their example will encourage others to follow in their footsteps. Dr. Kennedy’s article, and the series of papers that accompany it, make the case that on-going supervision should be part of each working genetic counselor’s professional life. Kennedy describes three models of supervision—one-on-one, peer group supervision, and, the one she favors, the leader-led group—all derived from the field of mental health; there’s a form for everyone. The bottom line is that getting supervision is what responsible professionals do. By choosing a life as a professional one takes on the obligation to obtain supervision and consultation as a core responsibility regardless of how busy we are, our sense of shyness, embarrassment, shame, or fear of being found to be inadequate, incompetent, or foolish. None of these excuses obviates our professional responsibility. I heartily support Dr. Kennedy’s plea for more supervision in the field of genetic counseling. I see supervision as a matter of survival for this profession. A field that does not grow in skill and competence will wither and stagnate and, eventually, be supplanted by others with a more certain sense of professional identity and skill. There is a general principle in life: growth only comes by overcoming obstacles. We all learned to walk by taking the risk of standing up and stepping out, falling down, crying, and starting all over again until we mastered how to stay upright and put one foot after another without falling. It’s only by acting, despite our anxieties and fears, that we master our personal obstacles and promote our maturation. The same reasoning is true for those of us who choose the life of a professional. Some counselors may not like being supervised, especially during or after a long and trying workweek. Supervision can be anxiety-provoking and, for some, terrifying. But, that’s no reason to avoid it or to rationalize it as unnecessary. On the contrary, its very frightening nature is a call, no, a demand, to each of us, to gird ourselves and face the beast within that keeps us from learning, growing, and maturing into the professionals we could be. As Dr. Kennedy points out, the group forms of supervision are powerful arenas to obtain validation and support and indeed, with her help, her group seems to have avoided some of the pitfalls I have observed in other supervision groups. In peer groups especially, a group dynamic can develop that is so supportive that the group becomes insufficiently challenging. The early life of a supervision group requires the development of trust and the presence of support, but if the group is to mature and the skills of its members are to become more sophisticated and effective, some degree of challenge needs to be present. Leader-led support groups tend to avoid this problem. Groups that trade off challenge for support can devolve into social rather than learning arenas. Also, within groups there are inevitable differences between individuals in their psychological understanding and sensitivity and this can lead to the formation of coalitions and subgroupings
P1: FLF Journal of Genetic Counseling [jgc]
Closing Thoughts
HS105-85
August 17, 2000
11:40
Style file version Nov. 19th, 1999
433
with all of the attending dynamic problems that come with it. Again, this is less true for leader-led groups. Just as no two counselors counsel in the same way, no two supervisors work in the same way. My own preference in pre- and postgraduate supervision, whether one-on-one or in groups, is to work with professionals who come with audio or videotapes and/or verbatim transcripts of their counseling sessions. I long ago learned that humans have an unlimited capacity for self-delusion and without some relatively objective check we cannot be confident that what we heard, saw, said, or did corresponds to reality. I recently heard an audiotape in which a counselor was taking a family history in the course of which the death of a child was reported. What the counselor, and the colleagues for whom the tape was played, did not hear—neither in the session nor in the initial replaying of the tape—was the manner in which the child died, a fact that shed light on the family’s dynamics and shaped their expectations of the then current pregnancy. And we are all prone to such mishearings and subsequent misunderstandings. I have also found that tapes help supervisees focus on their own words and behavior, allowing us to deal with countertransference in more concrete terms, rather than with hypotheticals and abstractions. Another advantage is that tapes rapidly identify areas of strength in the supervisee’s counseling on which supervisory interventions can build. Lastly, since genetic counseling is overwhelmingly verbal, tapes and transcripts allow supervisees to discuss the actual words used in a given situation and to learn how to modulate language so that overall counseling becomes more effective and its psychological impact is maximized. In supervising groups of physicians and other senior professionals in the field of genetic counseling, I have found that the greatest area of need is in the development of flexibility in switching rapidly from the role of providing information to that of being a counselor on a more personal, human level. These role shifts require adroit, dextrous adjustments in the management of the psychological distance between professional and client. In turn, the acquisition of such nimbleness requires a reconsideration of preconceptions and long-held beliefs about one’s professional role—beliefs developed and influenced by one’s (often superficial) initial training and the flotsam and jetsam of misunderstood or misapplied ideas embedded in the genetic counseling literature (e.g., nondirectiveness), which have impeded the counseling side of the field. As the field of contemporary genetic counseling developed, it had little choice but to borrow concepts from other fields of counseling and psychotherapy. Genetic counselors frequently deal with people who are undergoing enormous anxiety, confusion, and distress, and when also faced with other profound life issues, such as morbidity, mortality, and loss, are unable to reach an understanding of complex issues or make important, sometimes urgent, life decisions. Using some of the practices of counseling and psychotherapy, genetic counselors can assist and empower clients, reduce their anguish, and help them feel better about themselves
P1: FLF Journal of Genetic Counseling [jgc]
434
HS105-85
August 17, 2000
11:40
Style file version Nov. 19th, 1999
Kessler
and their circumstances. Are the counselors doing psychotherapy? No, they are just doing good genetic counseling. One of the primary functions of supervision in the mental health field is to socialize the professional into their professional role. That is why clinical psychologists, for example, receive the major portion of their pre- and postgraduate supervision from other clinical psychologists. The goal is to prepare the individual for their professional life and imbue them with certain attitudes, ways of thinking, standards, and values expected of all psychologists. How can the field of genetic counseling achieve a similar degree of professional autonomy if it does not have full control over its own standards and, as important, the mechanisms to socialize new entrants into the profession? Turning to mental health professionals for supervision at this point in its history of genetic counseling may not be a choice; where else can genetic counselors turn? But, someday, and I suspect that day is not that far off, genetic counselors will develop an independent approach to the principles and practices of their profession and to their standards of professionalism. I envision that they will take the best that other fields—including mental health—offer and make it their own. The articles by Kennedy and the professionals who work with her show us not only how far the field of genetic counseling has come but also how much further it needs to go to develop its professional individuality, autonomy, and authority. The good news is that some of the genetic counselors in supervision today will be tomorrow’s supervisors, hopefully bringing to genetic counseling higher standards and a more mature, integrated view of professionalism.
