To be 'on-model' enough

The supervisor will be looking for the core principles of a mentalizing approach in the supervisees’ work as well as in her supervision approach. However, being ‘on-model’ will look different for each adolescent and therapist dyad varying according to the needs of the adolescent and the personality and style of both patient and therapist. The МВТ-A supervisor welcomes and values the expression of this individuality within the clinical encounter. Equally, the МВТ-A supervisor also needs to ensure that the clinical skills of МВТ-A are understood and competently applied to the clinical setting. The supervisor must confidently and lightly hold their expertise in mentalizing theory and thoughtfully find ways to share knowledge and experience. There is a subtle distinction between helping the supervisee to be ‘on-model’ whilst at the same time refraining from conveying criticism or fault-finding, with the former best supporting the supervisee’s confidence in mentalizing. Through respect, transparency and warmth the supervisor can most helpfully convey when she believes the clinician to be ‘off-model’ or when breaks in clinician mentalizing are present, inviting the supervisee to consider what might be happening. In this sense, the supervisor also needs to normalise the going back and forth between effective and ineffective mentalizing. When the supervisor notices that the supervisee shifts into a more ineffective, or even non-mentalizing way of being, the supervisor tries to give a ‘nudge’ back to more effective mentalizing.

‘This passage intrigues me as it seems you get caught up in explaining to her why she behaves in that way. This feels different from earlier when you were working together to understand how she got into the argument with her boyfriend. Can you see a difference? Could we pause and look at what passed through your mind at this moment?'

‘Did you find yourself in psychic equivalence? Please let me know if I’m unclear, I’m thinking about the state of mind where our innerfeelings take over everything - if we feel it's hopeless, it is hopeless. What we feel inside becomes an external reality. Do you recognise that?'

‘From your descriptions it sounds as if an ‘Alien Self has got a grip on this patient. I notice you haven’t used this МВТ-A idea to describe this situation and I’m wondering if it’s something you feel comfortable with? Shall we take a few minutes to review the concept and see if it makes sense in relation to this patient and self- harming? Then, if it does, we might think about how you can use it with your patient.'

In these instances, the supervisor, like the clinician in an МВТ-A session, might engage in a form of psychoeducation with the supervisee, reviewing and reinforcing the supervisee’s knowledge base of МВТ-A through revisiting concepts and considering how they make sense in relation to the clinical material. Again, the supervisor invites collaboration and seeks agreement with the supervisee on what might be helpfully revisited. Throughout the process, the supervisor continually checks out and clarifies whether their pedagogical endeavour is making sense to the supervisee and is felt to be clinically relevant and helpful.

Going alongside - understanding the therapist's subjective sense of themselves as an MBT-A therapist

In order to ensure the supervisor)' endeavour is meaningful and supportive to the supervisee, the supervisor needs to have a comprehensive understanding of the therapist’s subjective sense of themselves as an МВТ-A therapist. Having a detailed profile of the clinician’s level of МВТ-A knowledge whilst being mindful of their stage of practice and professional needs concerning implementing a new model will strengthen the supervisory relationship and increase the supervisee’s effectiveness in delivering МВТ-A. Many supervisees are accomplished therapists with well-developed basic therapy skills and further competencies in particular techniques. Some of these skills will sit well within an МВТ-A model, whilst others might not. The supervisor needs to draw the supervisee’s attention to approaches which are contraindicated within МВТ-A whilst emphasising existing techniques which might complement a mentalizing approach. It is not unusual for highly experienced clinicians to struggle in re-orientating themselves to the МВТ-A model, evoking feelings of anxiety' and low professional confidence, which undermines their capacity to maintain a mentalizing stance. A key element of the supervisory process is sensitively understanding and managing these processes in addressing the supervisee’s developing mentalizing skills.

Supervisor: ‘I’m getting a feeling that our conversation about use of therapist self is a little unsettling?’

Clinician: 'Well, it feels, ahh, odd. I’m just not used to being that transparent with

my own emotional reactions.’

Supervisor: ‘I see and I’m kind of talking about transparency as if it was the most natural thing in the world!'

Clinician: ‘Yeah, a little bit.’

Supervisor: ‘I’m sorry, I wasn’t mindful of that, I just went off on my own little

journey on the delights of transparency without checking out if you'd like to come with me!’

Clinician: ‘I think I get it, in theory, it makes sense - modelling feelings, being

human and showing how my mind is different from hers, but doing it feels uncomfortable!’

Supervisor: ‘What about exploring that a bit, the uncomfortableness of trying to be more transparent?’

Clinician: When I trained years ago one of my first supervisors told me to never talk

about my own feelings, no self-disclosure, but I think this is different from what he was referring to at that time. ’

Part of ‘going alongside’ a supervisee will also involve getting an understanding of the supervisee’s previous supervisory relationships. It can be useful when first meeting to both explain the aims of a mentalization-based supervision and what the supervisee can expect in working with you, as well as gaining some understanding of what they found helpful or unhelpful in previous professional help-seeking relationships. Equally, establishing the supervisee’s more general aims for developing their МВТ-A practice is useful in getting a sense of where they are at now and where they hope to go. Is the supervisee in the early stages of МВТ-A practice and looking to integrate mentalizing approaches to current cases? Or, are they experienced in the model and working toward establishing themselves as an MBT-A practitioner, supervisor or trainer? Having a clear understanding of the supervisee’s hopes and expectations of you as a supervisor, alongside their professional ambitions, will increase the likelihood of a strong collaborative working alliance benefitting the supervisee and their adolescents.

Also, it seems to be the case that as clinicians, we benefit the most from supervision if it is active in terms of using role-play or video-taped sessions (Hilsenroth & Diener, 2017). We would encourage working with these means, whenever possible. Otherwise, audio recordings, transcripts, notes and an active engagement in thinking together about the well-defined difficulties will support the effectiveness of the supervisor)' process. Yet another part of ‘going alongside’ a supervisee is to introduce these means in a mentalizing way. Showing video-clips of oneself working can create anxiety in most clinicians. The supervisor needs to show a non-judgemental and mentalizing stance in this respect.

The mentalizing supervisory stance

Embedded in the aforementioned supervisory processes and tasks is the mentalizing supervisory stance, the supervisor’s way of being with her supervisee which embodies ‘the mentalizing stance’ and lies at the core of all МВТ models and mentalizing endeavours. This is the supervisor’s ability to communicate in a direct, authentic and transparent manner, showing warmth, respect and a genuine empathic curiosity towards her supervisee. By ‘walking the talk’ the mentalizing supervisor not only models a mentalizing stance but crucially provides the supervisee with a lived experience of being understood by another, thereby supporting their mentalizing abilities within their clinical work. МВТ-A supervision is conducted through the supervisor actively embracing a mentalizing stance alongside further mentalizing interventions which are consistently deployed within the supervisory setting.

 
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