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The importance of supervision


Supervision is very important for a psychotherapist. Personal psychotherapy, teaching, supervision, practice, reading and reflection have been the main components of psychotherapy training for decades. Supervision, if done well, should provide the psychotherapist with time for reflection, so that he can think about the pace of the session, the feelings that had been evoked, and the comments that both he and the client had made. The supervisor listens carefully to the trainee and offers alternatives to the treatment approach.


The supervision that I have had so far has been very important for my work. There is always the potential danger of being ‘stale’ or narrow-focused in work. When we talk to other psychotherapy practitioners, particularly ones that are reflective in their work, we are reminded about techniques that we had forgotten about, we are introduced to new approaches and we have another person with whom to plan our treatment strategy. I think that the supervisor should be supportive and should encourage the supervisee that he is working well in the consulting room. The supervisor should also highlight any events that have ethical issues. For instance, last month I was treating a lady, Delilah, who was worried about her weight. The lady has given permission for me to include this general information on my website. She came to me because she wanted to use hypnosis to help control her weight. The lady has given permission for me to include this general information on my website. However, during the session she revealed that she would have some sort of gastric operation in order to help reduce her calorie intake. I was not happy about this approach, but I said that I would support her. It was only in the supervision that we started to think about all the possible ramifications of this operation.


It seemed from the conversation that she intended to have a laparoscopic adjustable gastric band or lap band attached to the top part of her stomach. This is an inflatable silicone device. Delilah was over weight but she didn’t look to me as if she had a BMI index rate of over 40. This operation is bariatric surgery and is designed for obese patients. Some doctors recommend this line of treatment if the patient is at risk to themselves. Concomitant problems might include sleep apnoea (or Obstructive Sleep Apnoea Syndrome), osteoarthritis and metabolic syndrome. There are all sorts of complications with this surgery, such as infection, ulceration, erosion, internal bleeding, gastritis, slippage, mal-position of the band, problems with the port or the tube connecting port with the band.


These are complications but these problems are nothing when you look at the possible side effects. These include dysphagia, diarrhoea, diverticulosis, gastro-oesophageal reflux, constipation, stoma obstruction, abdominal pain, fever, incision pain, blood clots, gal stones, pancreatitis, and the list goes on. Some feel that they can’t eat properly for the whole period that they have the gastric band.


When talking to my supervisor, we realized that there could be other problems. My supervisor said that she might have got the terminology wrong and that she might be intending to have Gastric bypass surgery. This is much more serious. The complications of this include: bowel obstruction, infection, haemorrhage, internal hernia, venous thromboembolism, anastomotic leakage or anastomotic stricture, anastomotic ulcer and dumping syndrome. We, that is, my supervisor and I—the former of whom is, incidentally, a medical practitioner—decided that we really needed to play this one very carefully. He suggested that I should encourage her to contact her GP in order to ask him about the possible side effects and complications of the operation. In fact, she did not come for the next appointment. I phoned her twice, but felt that I could not ring her a third time. She had chosen not to speak to me again. However, both my supervisor and I felt that we had prepared ourselves for taking care of her the best that we could.


Often as a psychotherapist, one gets so close to the situation, that one is sometimes unable to see a solution. When you talk to a supervisor who is not treating the patient, you are given the opportunity to step back from the situation, and to analyse your thought processes, and comments in a more objective way. It is certainly not a supervisor’s intention to mould their trainees so that they become clones of their supervisor. We are all different therapists and have our own strengths and weaknesses, and skills that work best for us. And yet. It is very helpful to learn from more experienced practitioners and to remain fresh as a therapist.


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