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The Supervisory Relationship in Music Therapy Internship

La relation de supervision dans l’internat en musicothérapie

Deborah M. Salmon, MA, MTA


McGill University Health Centre, Montreal, Quebec, CANADA

Abstract
Clinical supervision is based on an important and intimate relationship
between intern and supervisor. This dyadic relationship is closely
interconnected with a third party—the client—and can have a lasting
impact on the developing professional. In this article the author explores
the complex dynamics inherent in the supervisory relationship, addressing
parallel processes that often occur in the supervisor and intern and the
power differential inherent in this relationship. Roles played by supervisor
and intern and styles of clinical teaching and learning are described as
well as how they might evolve during the course of the internship. Finally,
the concepts of transference and countertransference are presented with
examples of these processes occurring in both supervision and clinical music
therapy. Awareness of dynamics at play in the supervisory relationship may
serve to enrich the process of supervision for both supervisor and intern.

Keywords: music therapy, supervisory relationship, internship


supervision, transference, countertransference

Résumé
La supervision clinique repose sur une relation importante et intime entre
un superviseur et son interne. Cette relation dyadique, intimement liée avec
une tierce partie, le client, peut avoir un impact durable sur le professionnel
qui se développe. Cet article explore les dynamiques complexes inhérentes
à une relation de supervision. Il discute des processus parallèles qui se
produisent souvent chez le superviseur et chez l’interne et parle des effets
différentiels des relations de pouvoir qui y sont inhérents. Les rôles tenus
par le superviseur et l’interne, les styles d’enseignement clinique et les
styles d’apprentissage seront décrits comme ils se déroulent au cours de
l’internat. Finalement, les concepts du transfert et du contre-transfert sont
abordés au moyen d’exemples qui découlent à la fois de la supervision et de
la musicothérapie clinique. Une prise de conscience des dynamiques en jeu
dans la relation de supervision pourrait enrichir le processus de supervision
tant pour le superviseur que l’interne.

Mots clés : musicothérapie, relation de supervision, internat, supervision


d’interne, transfert, contre-transfert
Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 11
Interns generally begin their internships with great anticipation; they
likely feel excited about this new stage of professional development but may
also be apprehensive about their skills or level of readiness. They may at the
same time be adjusting to the loss of people and support found in school or
to a new location. There may be some anxiety about the supervisor as well:
“Will she like me? Find me competent enough? Will I like her?” Previous life
challenges and how these have been navigated often provide a template for
coping with the excitement and stress of beginning an internship.

The supervisor may have similar concerns. It is exciting to mentor a


new music therapy intern, and the presence of an intern often benefits the
setting in which one works, but it is also an extra responsibility with its own
stressors: “How will this intern work out? How much support (and time) will
he require? Will I be competent enough? Have the patience and knowledge
that this intern requires? Will he like me? What if the intern is more skilled
than me in certain areas?” The supervisor’s anxieties and coping strategies
will also likely be influenced by and negotiated according to previous life
experiences.

This parallel process can promote a sense of mutual discovery in the


supervisory dyad. The excitement and pleasure of co-creating, the possibilities
of support in both directions, and the implementation of musical and life
skills such as listening, leading, following, and attunement may help the
two develop a good working alliance. While the intern is expected to benefit
from the supervisor’s experience, he or she also brings to the relationship
fresh ideas and questions, new skills, and innovative research interests, all of
which serve to stimulate and enrich the supervisor.

Thus the intern and supervisor, a new supervisory dyad, embark on a


journey with the expectation of deepening established skills and learning
new ones. They are partners in this endeavour, dependent on each other for
a successful arrival. The itinerary or structure of the internship may be set,
but the particular challenges faced and the joys and struggles encountered
along the way determine the nature of the internship. Each member of this
dyad constructs his or her particular path—indeed, as does the dyad itself.

This relationship also functions as a kind of home base: The intern moves
into the clinical field, then back “home” to supervision, which is ideally a
space where he or she can reflect upon, evaluate, and integrate what has been
experienced as well as refine skills, get support, lick wounds, and celebrate
successes. The supervisory relationship serves to anchor and make meaning
of the intern’s clinical experiences. It is the quality of this co-created space
that determines its safety: Do intern and supervisor feel respected? How free

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 12


does the intern feel to show vulnerability? Where do the boundaries of the
relationship lie?

A parallel between the intern–client and supervisor–intern dyads can


also be observed. In both relationships, one member is there to promote
development in the other. One is expected to have particular resources or
skills while the other benefits from these. Sometimes feelings or behaviours
experienced in one dyad are repeated in the other; such rich material can
be used in supervision to deepen understanding of dynamic processes.
These phenomena will be discussed in greater detail in the section under
transference and countertransference.

At best, a “mutual selection” will have occurred between supervisor


and intern even before the beginning of the internship. Where possible, an
on-site interview that includes clinical observation is recommended. Such
encounters give both the supervisor and the intern the opportunity to assess
each other and sense whether or not there is a good fit between them. When
each party has chosen the other, both are likely to feel more confident and
optimistic about the collaboration and look forward to the opportunity of
working together (Salmon, 2005).

Power Differential in the Supervisory Dyad


The supervisory relationship is not one of equals; the supervisor
generally has more experience, clinical skill, education, income, and status
than the intern. Also, the supervisor is in the position of evaluating the intern,
which creates a hierarchical structure. As in a therapeutic relationship, the
supervisor is expected to use his or her resources and greater “power” in the
service of the intern.

Each member of the supervisory dyad brings previous experience, ideas,


feelings, and expectations about power and authority to the relationship;
these can influence the relationship itself, particularly in situations where
authority or evaluation is at play. Some interns may feel a sense of security
in the supervisor’s power while others may feel threatened or intimidated.
Similarly, some supervisors embrace the power differential inherent in
their roles with relative comfort, while others actively seek to minimize this
inequality as much as possible.

An example of the latter can be found in Forinash’s (2006) discussion


of feminist music therapy supervision. Forinash describes two supervisory
methods that aim to reduce the hierarchical use of power in supervision. The
first is contracting, which involves creating agreed-upon supervision goals

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 13


with the intern having the option to change or discard them as supervision
progresses. With the second method, mutual evaluation, each party evaluates
the other, and the intern has the power to challenge or add to evaluations,
which become part of his or her record.

The manner in which supervisor and intern negotiate the power


differential inherent in their roles may well change as the internship
progresses. Awareness of these dynamics, and of how each member of the
dyad experiences them, are key to a relationship in which open discussion
and negotiation of what is most fair and helpful to the intern can take place.

Roles Played in the Dyad


The supervisory dyad is a complex, dynamic entity. Various roles
are played, sometimes simultaneously, with some more dominant than
others at any given time. The roles enacted depend on such factors as the
personalities of the supervisor and the intern; the phase of internship;
and the requirements of the setting, the intern’s training program, and the
governing music therapy association. Maranto and Brucia (1987) identify
three types of role relationships in the supervisory dyad. These are teacher–
student, counsellor–client (in this paper the word counsellor will be replaced
by therapist), and consultant–colleague. A fourth may be added, that of
manager–employee.

Teacher–Student
In some music therapy training programs, internship is an academic
course. A learning contract, delineating the responsibilities of each party—
university, supervisor, and intern—may be in place. The supervisor is expected
to teach, evaluate, and pass or fail the intern. The student/intern must acquire
the expected competencies in this course in order to graduate and advance to
the next level, accreditation as a professional music therapist.

In this conceptual dyad, the teacher/supervisor functions primarily as


the one with more knowledge and expertise, with information to impart and
instruction to give. The job of the student/intern is to learn the knowledge
required in this setting. Information imparted can range from client
information to medical procedures to songs used. This role relationship is
often dominant during the beginning phases of internship when the student/
intern is being oriented to the clinical setting.

The quality of the teacher–student dyad can include both positive and
negative aspects. It may be burdensome for both parties, time consuming for
the teacher/supervisor, and overwhelming for the student/intern. Each may

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 14


fear failure or a negative evaluation from the other. On the other hand, there
is excitement for both parties inherent in learning and growing as well as
pleasure in mastery. The teacher–student dyad can also feel containing or
reassuring to both: “Someone is clearly in charge; all will be well.”

A further dynamic exists with the role that the university plays in
overseeing the internship. Does the university faculty provide supplementary
supervision or support, and if so, how does this impact the supervisory dyad?
Outside supervision may feel complementary or undermining to the intern or
supervisor. To what degree does the presence of the university create a triadic
relationship, and what impact might this have on the supervisory dyad?

Therapist–Client
The supervisory relationship is an intimate one where aspects of the
personalities of the intern and supervisor are inevitably revealed both in the
clinical work and in supervision. Internal struggles and enactments as well
as defenses, strengths, and coping strategies will come into play as they do
elsewhere in life.

It is not uncommon, and at times may be useful, for the intern to bring
struggles, insecurities, or even personal dilemmas into supervision. The
supervisor may well have the therapeutic skills to explore these and is faced
with the question of where to place professional boundaries and when to
step in therapeutically. Feiner (2001) identifies three contexts in which the
intern’s personal issues must be addressed in supervision: (a) when they
interfere with the intern’s understanding or treatment of clients, (b) when
they interfere with the intern’s relationship with the supervisor, impeding
the learning process, or (c) when they interfere with the intern’s relationship
with other staff (p. 105).

But to what degree should the intern’s personal issues be explored in


supervision? It is this author’s opinion that it can be appropriate and helpful
for the supervisor to identify issues in a supportive manner and for the intern
and supervisor to observe together the impact these have in the clinical
milieu. Promoting self-reflection and increased awareness of inner processes
can help deepen clinical understanding and further develop empathy for self
and others. Self-awareness may also minimize the projection of personal
issues and make for a more emotionally present intern. Deeper exploration
and the working-through of enduring personal issues, however, is the place
of psychotherapy, to be conducted outside of the clinical and supervisory
setting. Engaging in one’s own therapy promotes personal growth and allows
for external support. This applies to all therapists, interns and supervisors
alike.
Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 15
Supervisory interventions that help increase awareness and draw
links between personal and clinical issues, when made with respect and
sensitivity, may be extremely useful to the intern. One technique that
facilitates the development of a self-reflective practice is journalling; the
intern is encouraged to keep a private journal in which she or he records
objective clinical reflections (observations, techniques, etc.) in one section
and personal feelings and reactions in another. This gives the intern practice
in distinguishing between his or her objective observations and subjective
responses and further provides a safe place in which to vent and reflect.
As the journal is private, it can also be used to process feelings about the
supervisor, both positive and negative.

Manager–Employee
The supervisor is primarily a clinician, responsible to the clients and
to the facility in which he or she is hired to work. In this role, the supervisor
must ensure that the intern’s work is within the expectations and needs of
the clinical milieu. The intern is somewhat like a new employee, joining a
professional clinical team and being trained to do the job as effectively as
possible. In this conceptual relationship, the supervisor plays the role of
manager (or boss) and is ultimately responsible for the quality of the intern’s
work and the delivery of services.

The intern may benefit from this role relationship by taking on


incrementally greater responsibilities until he or she is able to function
as a professional music therapist in the clinical setting. Growing levels of
competence and confidence are acknowledged and supported in supervision
and through periodic performance evaluation. The intern may also be
encouraged to monitor his or her growth and development. This role
relationship may be present throughout the internship but is likely activated
more and more as the intern gains independence.

Consultant–Colleague
In this author’s experience, the consultant–colleague roles evolve most
naturally toward the end of internship as the intern prepares to take his or her
place as a fully trained professional. Supervision may become more intern-
driven, and a greater sense of collegiality is felt in the dyad. The supervisor
continues to offer support but is far less directive. Essentially, the intern
internalizes the supervisory process, draws increasingly from his or her own
knowledge and experience, and uses the supervisor as more of a sounding
board than a teacher.

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 16


Styles of Supervising and Learning
Styles of supervising and learning intersect with the roles described
above. When the supervisor’s preferred style of supervising is well-aligned
with the intern’s learning style, there will be little tension or conflict. On the
other hand, dynamic tensions between conflicting styles, when addressed,
can lead to increased flexibility and growth for both parties. Ultimately, when
the supervisor and intern can openly acknowledge their supervisory and
learning styles with respect for their differences, each feels validated and
trust is increased. This enables further development of the working alliance
in the supervisory dyad.

The supervisory style used may be influenced by the supervisor’s


personality, degree of expertise, and confidence as well as the phase of
internship. Although not mutually exclusive, three main styles may be
described: expert, mentor, and collaborator.

The expert supervisor assumes and is comfortable with his or her


advanced skill, experience, and expertise. This style tends to be more
directive; the supervisor imparts knowledge and models and shapes clinical
behaviour. The message is “Learn my way (and then make it your own).”

Warmth, support, and approachability are key elements of the mentor


style. The supervisor focuses on the personal and professional growth of
the intern (Nassif, Schulenberg, Hutzell & Rogina, 2009) and encourages
exploration and the finding of one’s own path. Here the message is “I will
support you in finding your own voice, and where necessary, guide the way.”

In the collaborator style, supervisor and supervisee are seen as more


equal; both parties are on intersecting paths of learning. Supervision is only
directive where issues of safety are concerned and may be conceptualized
more as “co-vision” (Forinash, 2006). The message imparted is “I can share
what I’ve experienced, but each of us brings our own valid experience and
perspective, and I honour your process.”

Similarly, interns have varying styles of learning. Some interns need


more support or guidance while others need more independence; some read
everything available on the clinical population, others jump in and learn by trial
and error; some thrive on taking risks, others feel more comfortable staying in
the supervisor’s shadow until they are ready for greater independence. And,
of course, the learning process is dynamic, changing throughout the course
of the internship. Herein lies the dance of the supervisory dyad. Where the
shared goal of helping the intern grow into the best possible music therapist

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 17


remains central, the dance continues with partners leading and following as
required.

Transference and Countertransference


The psychoanalytic concepts of transference and countertransference
help us to understand how patterns from early significant relationships may
reoccur in later relationships. These processes acknowledge and make use of
the emotional resonance between therapist and client and, for the purposes
of this discussion, between supervisor and intern. Both of these dyadic
relationships are potentially intimate and intense, lending themselves to the
emergence of strong feelings and transferential phenomena. In this article,
transference and countertransference will first be presented as originally
conceived—that is, in terms of the therapist–client relationship—and then
applied to the supervisory dyad.

Transference may be defined as an unconscious redirection of feelings


(positive or negative) from client to therapist. These feelings originate in the
client’s experience with earlier significant figures. As explained by Bateman,
Brown, and Pedder (2000):
As inner representations of figures from the past become superimposed
on to the image of the therapist, feelings are expressed towards him that
belong to the past. The consciously forgotten past becomes re-enacted
in the present of the transference. (p. 56)

Countertransference refers to a similar redirection of feelings, but from


therapist to client. Strong feelings toward a client may represent unresolved
conflicts or issues on the part of the therapist, which is one reason why
therapists benefit from engaging in their own therapy. However, as Bateman
et al (2000) write, countertransferential feelings may also arise in the
therapist in resonance with the client’s inner life and thus help us to better
understand what the other is experiencing:
Provided we can be sure that we are in reasonably good humour, not too
distracted by our own problems or too pressurized by a badly organized
workload, then our feelings about a patient can be most instructive . . .
by acknowledging such feelings in ourselves and reflecting on them—
rather than immediately acting on them . . . we can begin to wonder
what it is in the patient that is making us feel this way. (p. 59)

Identifying transference and countertransference phenomena in the


supervisory relationship promotes deeper understanding of dynamics at
play and may well shed light on therapeutic issues with clients. While these

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 18


processes are often unconscious, the following signs may be indicative of
their presence:
• unaccustomed feelings of discomfort (e.g., the supervisor or intern
notes feelings of irritation, sadness, or fear);
• unusual behaviours (e.g., avoidance or overinvolvement in the
supervisory process);
• a strong identification (e.g., the intern or supervisor reminds the
other of someone significant or treats the other like somebody in his
or her family); or recognition of a familiar interactional pattern being
repeated (e.g., engaging in particular known defensive behaviours).

An external therapist, colleague, or supervisor may also be helpful in


identifying the presence of transference dynamics.

Exploration of a transference phenomenon that is expressed


simultaneously in the supervisory dyad and the intern–client dyad can be
particularly helpful to the intern’s clinical development. As the transference
and countertransference feelings are brought into awareness, discussed,
and worked through, therapeutic understanding is deepened and greater
freedom of response may be available. Below, two types of transference
phenomena are described with examples illustrating how addressing these
in the supervisory dyad can enhance clinical work.

Parental Transference
A parental transference occurs when the intern experiences or treats
the supervisor as a parental figure. This can, of course, take different
forms. The idealized supervisor (positive parental transference) may be
experienced as providing all nourishment in the form of wisdom, care,
instruction, understanding, and guidance. Supervisors may find such interns
to be gratifying (compliant, adoring) or overly dependent. A supervisor may,
countertransferentially, feel overprotective of such an intern or, conversely,
irritated with the idealized role.

A negative parental transference might be occurring when the intern


anxiously anticipates being judged as if by a harsh, critical parent. He or she
may use various defensive strategies to avoid feeling this anxiety such as
withdrawing, taking on extra work, or becoming angry and critical him or
herself. The supervisor may, countertransferentially, feel confused or even
become critical of such an intern.

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 19


Example: Ron and Scott
Ron works as the music therapist at a geriatric facility and has been
supervising interns for three years. His new intern, Scott, does a great
job of listening to clients’ stories but has trouble initiating music therapy
interventions in his groups. When discussing this in supervision, Scott
seems eager to please Ron and agrees with all suggestions, but he doesn’t
follow through with any. Ron finds himself feeling irritated with Scott
(countertransference) and wonders what might be going on.

When discussing this, Ron and Scott are able to draw a link
between Scott’s difficulty in taking leadership with his older clients and
his timidity with Ron. In both cases Scott feels uncomfortable with those
he perceives as authority figures. He notes that the seniors seem to treat
him as a grandson (their transference) and that in fact they remind him
of his grandparents. To request anything of them feels disrespectful
(Scott’s countertransference toward clients). Ron is also seen in the role
of a parent or teacher who is sure to see Scott’s inadequacies (negative
transference toward supervisor).

As these dynamics are identified, Ron is able to validate Scott’s


feelings and note they are not unusual in the beginning of a new
internship. Scott’s anxiety is reduced, Ron’s irritation is replaced with
understanding, and Ron is better able to support Scott in moving more
into the role of therapist. Scott begins to take risks and feel more confident
with the clients and with Ron. He also brings the issue of his relationship
to authority into his personal therapy for further exploration.

Sibling Transference
Here the intern may see and treat the supervisor as a sibling, peer, or
friend, possibly as a way of minimizing the power that the supervisor is
perceived to have. There may be elements of competition felt by the intern
and countertransferentially by the supervisor. Who will the clients respond
to most? Whose musical skills are better? The relationship may include
more self-disclosure or more distancing than usual (as with close or distant
siblings). This type of transference, when the feelings are positive, can create
a strong bond between supervisor and intern but may also interfere with the
supervisor’s ability to observe, teach, and give feedback and with the intern’s
ability to make good use of the supervisor.

Example: Jill and Anna


Jill, the new intern in an outpatient mental health centre, is a skilled jazz
musician and offers to teach Anna, her classically trained supervisor,

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 20


some jazz techniques. Jill frequently calls Anna at home to clarify small
things and also invites her to play in a small jazz combo for a fundraising
event. In supervision, Jill reports on her successes, discussing the music
with little focus on therapeutic choices or client responses. Jill has extra-
long sessions with her individual clients and expresses reluctance to be
observed as she feels this would disturb her work with the clients.

Anna begins to feel uncomfortable and insecure in her ability to


supervise Jill (countertransference) thinking, “Jill is a terrific musician
and the clients seem to like her; perhaps she is doing such a great job
that she doesn’t need supervision.” Anna brings these concerns to her
own supervisor. Together they wonder if Anna’s increasing feelings of
insecurity are clues to something occurring in the supervisory dynamic.
Jill seems to have minimized Anna’s impact as a supervisor, perhaps
as a means of avoiding her own feelings of inadequacy (a transference
reaction). She stretches the framework of supervision with Anna in
several ways (calling her at home, avoiding being observed, initiating
playing music together outside of the facility) as well as the timeframe
of therapy with her individual clients. Further, Anna may also be
unconsciously acting out her own fears around her ability to supervise
by not challenging Jill (countertransference).

With this increased awareness Anna begins to work on setting


boundaries and reclaiming her role as supervisor in a way that would
be supportive to Jill and her skills. They speak openly about supervisory
and therapeutic frames and how Jill’s tendency to function as a peer
might interfere with her capacity to benefit from supervision. Together
they set learning goals: Jill’s strengths are recognized, and areas where
she could develop further are identified. Anna implements structures
that help them both feel more contained, including regular times for
observation and supervision, limits to non-essential home phone calls,
and set time limits for client sessions. Both continue to learn from the
other within a supervisory relationship with clear boundaries, and the
clients also likely benefit from the safety of greater containment.

As seen in the examples above, the supervisor may become alert


to transference and countertransference dynamics through observing
interactional patterns in the supervisory dyad or intern–client dyad and
through awareness of his or her own feelings. Trusted outsiders (e.g., a
therapist, peer, or supervisor) can often help detect, understand, and address
these dynamics.

Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 21


Conclusion
Forinash (2001) describes supervision as embodying both process and
relationship:

It is a process of unfolding —not simply following a recipe, but


engaging in a rich and dynamic relationship. Supervision then is also
a journey . . . in which supervisor and supervisee learn and grow and
from which both will very likely leave transformed in some way. (p.1)

Indeed, to supervise an emerging music therapist is both a privilege and


a responsibility. The relationship is at once professional and intimate and can
profoundly impact both the intern’s and the supervisor’s clinical work and
sense of self. The supervisor must hold the supervisory space respectfully,
with clear but flexible boundaries, so that the intern may safely risk and grow.
Whereas responsive, flexible supervision will embrace many of the concepts
discussed above, each supervisory dyad must negotiate its unique path.
Discovery is born of the challenges and delights encountered along the way.

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Canadian Journal of Music Therapy ∞ Revue canadienne de musicothérapie, 19(1), 22


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