Supervision

I will now examine how this parent-child like dynamic extends to the supervision. I will explore how boundaries in supervision are conceptualised and maintained and describe some of the challenges to maintaining boundaries within the small music therapy community in Korea, and the implications of these challenges.

Tseng (2004, p. 155) points out that East Asians’ “interpersonal dependency…extends into therapist-patient relations, as well”. It would also extend to supervisor-supervisee relationships in Korea. Traditionally teachers are regarded as important as one’s parents and “are idealized as moral exemplars and counsellors”. (Lin and Cheung, 1999).

Supervisors and therapists would be regarded as trusted teachers or parental figures by most Koreans.

Yi (1995, p. 311) explains:

“The Asian person's relationship to an authority figure involves positive benign idealization of the authority figure's power and wisdom, trust in that person's benevolence, and expectations that the figure will guide them, protect them, or otherwise take care of them…. However, when either or both in the dyad cannot fulfil the expected role or responsibility, the mutual idealizing cannot be maintained, resulting in loss of face, shame,

disappointment, and resentment. In fact, ruptures of this kind may be the Asian client's presenting problem.”

The supervisor-supervisee pair naturally form an authority and subordinate relationship because of the imbalance of power. The nature of this relationship tends to be more complex and potentially more difficult in culturally hierarchical Korean supervisor and

supervisee relationships. The Korean view of a supervisor (teacher) as an idealized parental figure tends to put too much power in the supervisor and it may blur the professional boundaries. A study that explored supervisees’ negative experience in South Korea found that a hierarchical relationship is inherent in supervision in Korea’s Confucian-influenced society (Bang and Goodyear, 2014, p. 353). The indirect

communication and difficulties in expressing their dissatisfaction directly towards a supervisor, an authority figure, create distress in supervisees as well as supervisors. A supervisee also feels shame, losing her face, when she feels she does not meet the expectation of her supervisor. Manathunga (2007) argues that the power plays in supervision need to be acknowledged and one needs to be aware of any complexities found in the supervisor-supervisee relationship. She especially cautions against blurring boundaries by interfering in the supervisee’s personal life during the supervision. Heru et al. (2004, p. 76) found that maintaining good boundaries between the supervisor and supervisee is essential to the integrity of the supervisory relationship.

Marshall (1997) studies the complex interwoven dynamic in the “triadic system of supervisor, supervisee, and patient” (par. 1). He sees that the supervisor is “an integral part of the system wherein s/he is influenced not only by the therapist, patient, and his/her own promptings, but is a prime source of feedback to the patient through the supervisee” (par. 1). Crick (1991) compared the role of a supervisor to that of a father who protects the mother-baby couple [supervisee therapist-client] so that they are free to know each other (par. 29).

Meissner (2007) and Watkins Jr. (2011) consider three components of the

psychotherapeutic relationship: the ‘real relationship’, the therapeutic/working alliance and transference-countertransference. The real relationship is characterized by two components according to Greenson (1967), “realism”, “the transference-free or undistorted element of the analyst-patient relationship”, and “genuineness”, authentic relatedness between analyst and patient (Watkins, 2011, p. 102).

Watkins (2011, p. 113) brings attention to ‘the real relationship’ in supervision and he argues the real relationship is “a central, eminently significant component of the psychotherapy supervision relationship”. He understands that the real relationship is silently present yet substantively contributing to the relationship and utilizes and unfolds the transference-countertransference configuration.

Like the real and genuine ‘real relationship’ that is a basic foundation for the therapeutic relationship, I think the social relationship norm influenced by culture impacts the therapeutic relationship between the therapist and the client and the therapist and the supervisor. Thus I believe understanding the cultural norm present in the therapeutic relationship as well as in supervision is important.

As the world has become more multicultural than ever, the cultural sensitivity in the psychotherapy treatment seems to be greatly increased. Hook et al. (2016, p. 149-164) consider that “cultural humility” needs to be incorporated in supervision and “culture must be located at the centre of all work with supervisees”. Watkins Jr. and Hook (2016, p. 488) emphasise a culturally informed and culturally humble approach in supervision and argue that the supervisor creates ‘a cultural third’ in the supervision space. They explain the cultural third as “a unique space where cultural meanings and experiences are welcomed, respected and privileged and can be openly explored and examined for their treatment/supervision significance.”

In an acknowledgement of their importance, cultural aspects have been integrated in treatment and diagnosis recently. The Outline for Cultural Formation (OCF) in DSM-IV has provided “a framework for clinicians to organize cultural information relevant to diagnostic assessment and treatment planning” (Lewis-Fernández et al., 2014, p.

130).

1.5.1 Use of reflexivity

Henderson (2009) refers to the process of doing the self-reflective practice of monitoring one’s experience during the sessions and developing sensitivity in the therapist’s work as “internal supervisor” (Casement, 1985 cited by Henderson, 2009, p.

89). She writes that the supervisor assists the “supervisee to develop, with awareness, an internal encouraging voice that is also disciplined and rigorous about looking at practice” (p.89).

Summer (2001, p. 70) writes that her first objective of supervision for the beginning therapist is “to reinforce the therapeutic qualities inherent in each student’s character”.

She differentiates between the supervision approaches for the undergraduate training and the graduate training. While the graduate level students are mature enough to learn

from imitating the supervisor [twinning] without being dependent as suggested by Feiner (1999) (Summer, 2001, p.71) undergraduate students who are used to “an authoritarian type of teaching” may end up simply mimicking their supervisor without developing their own professional identities. For such an undergraduate student, Summer aims at creating “a reflective, independent student” to become a music therapist with her own individual style independent from her teachers and supervisors (Summer, 2001, p. 71).

Based on Summer’s belief in learning through a reflective process, our MI/GIM training in Korea encourages our trainees to carry on personal reflective work,

“Personal Music and Imagery (PMI)” (Summer, 2008, 2009, 2010, 2011b, 2012) and a therapist’s reflective work, "Therapist Reflection Music and Imagery (TRMI)" (Paik-Maier, 2008, 2009, 2010) using a music and imagery process. The therapist uses TRMI before and/or after the session to reflect and work on her feelings stirred by the session and/or the client by using music and other expressive media, for example, drawing, body movement, writing or music improvisation. The process is similar to SMI except this is done by the therapist alone to understand her issues and countertransference (Paik-Maier, 2014). The therapist shares her understanding from the TRMI during the supervision without revealing her personal details. This has been an integral part of my supervision since 2008.

1.5.2 Roles and boundaries

Supervisor roles vary from being a teacher to being a sympathetic listener and often there are no set boundaries between these roles (Paik-Maier, 2014). Watkins Jr. and Scaturo (2013) explained various functions in supervision by proposing a “three-stage supervision structure,” (p.78): “Supervision Alliance-Building and Maintenance”:

“Educational Interventions”; “Learning/Re-learning” (p.78). One of the educational interventions, “stimulus questions”, is reflective questioning “to stimulate and expand the supervisee’s critical thought process” (p.83). I use reflective questioning heavily in my supervision with a similar intention.

Instead of telling the supervisee what to do or invading her personal boundary, she becomes aware of her feelings and issues raised from the session, which leads her to understand her countertransference. For Korean students who were used to an

‘authoritarian’ style of didactic teaching, I find that such a self-directed reflective learning process is a very effective way of nurturing the students to grow as therapists.

As the boundary between the therapist and the client needs to be clear and professional, the boundary between the supervisor and the supervisee should be protected (Thomas, 2010; Heru et al., 2004). This boundary is not only a physical but also a psychic boundary (Goren, 2013, p. 737).

Because the music therapy community in Korea is small, I ensured that the supervision relationship was kept within the supervision context and personal involvement was avoided outside of the professional realm. As Thomas (2010) suggests, I advised the supervisees to seek personal therapy to deal with their issues that cannot be dealt with during the supervision. I believe the use of reflexivity, “Therapist Reflection Music and Imagery (TRMI)” (Paik-Maier, 2008, 2009, 2010), is a valuable approach to promote the supervisee’s independence, protect her privacy and maintain her boundary.