Episode 36: Moving Beyond Clinical Cases: Integrating the Process of Therapy with Learning Goals with Kristi Kerford

Welcome back to your Clinical Supervisor’s Couch podcast, and I’m your host, Kayla Das.

In today’s episode, Kristi Kerford, Registered Psychotherapist and clinical supervisor, will share how to integrate the process of therapy with supervision learning goals.

Hi, Kristi. Welcome to the show. I’m so glad to have you here today.

Hi, nice to meet you. It’s fun to be here.

Kristi, before we dive into today’s episode, please introduce yourself and tell us a little bit about your practice and your path to becoming a clinical supervisor.

Sure. I’m in private practice and I work in Ontario. And I would say that I feel that I’ve been in the field for sort of 20 plus years, but it’s been a meandering path. And so what I mean by that is I actually started out as a career counselor, and somewhere along the line, pretty early on I began to really feel that mental health and career transition had a lot of overlap. And so that sort of took me more into the psychotherapy side of things.

So when I think about my supervision path. Originally it was less clinical supervision and more supervising students who were entering the field and supervising and coaching staff in different roles. And so those skills lended themselves very well, to be transferrable to clinical supervision once I was a psychotherapist. And it’s something that I’ve always really enjoyed and it’s nice to be able to continue to do it now more clinically.

That’s amazing. And I think most therapists out there can relate because very few therapists I’ve spoke to that follow the exact path that they thought they were going to have and then move into where they are today.

And I know I’m a prime example, I was a recreation therapist, then did my BSW, then did frontline, then did management thinking that I was going to run non-for-profits, which I did. And then I went into private practice and then business coaching. I think a part of that navigation is how we grow and how we learn, to be who we need to be and who we want to be.

You remind me of myself, right? You’re speaking like a career counselor when you say that, right? Your paths meander, it’s like building blocks. You learn as you go. So yeah, I can very much relate to that.

Absolutely. So let’s break this down. When we’re discussing the process of therapy and supervision, what do we mean by that and what does integrating the process of therapy look like?

Sure. So when I think about the process of therapy, I when I’m working with students, I’ll say, clients bring their story to the session, and that’s the content of the therapy, right? Those are the narratives and the stories that you’re talking about. Whereas the process of therapy is what’s happening between the therapist and the client. Or for the client themselves, or sometimes for the therapists themselves as well. So it’s what’s happening in the room.

So from a therapy standpoint, I often will say to a client, what’s happening for you right now if we want to move a little bit out of the content and more into the process. And so I like to take that same approach. In supervision and there’s a couple of levels that can work on. So on the one hand, it might be that you and your supervisee are reflecting on the process of therapy that the supervisee had with their client. And so if they are feeling stuck with a particular case or they are feeling that they are having difficulty getting the client to slow down or to go deeper, then I’ll work with them on how to start thinking about process over content in their own therapy sessions.

Now, the other way I think about it is actually in the supervision, and that can be that there is a relationship between myself and the supervisee. It’s different than a therapeutic relationship in therapy, but we are creating a safe space and we are having a dialogue and we do have a relationship. And so I may use that same approach, but very transparently with the supervisees where if they are talking to me about a particular case or something that’s going on that same sort of language can I get you to pause for a moment? It felt like you got hung up on that one word. What was happening for you both in supervision when you were telling me about it. And maybe in the therapeutic session. And so to pause and to be able to get them to reflect on their experience. Again, it’s on a couple different levels. But as a therapist and as a supervisee.

I’m going to give you one example in supervision, of course there’s the possibility that there’s going to say, be some feedback. And so that is a really great time to then be checking in. What was it like for you to hear me say that there may be another approach or. Would you want to try this? Because you’re wanting to help them to be able to integrate and make sense of the information that you’re sharing.

So I’m going to just say very simplistically this idea for me of content and process. And they’re both important. But sometimes we get stuck in the content. And it’s like, how do we get back into the process of what we’re doing?

I love that. And I’d actually like to go a little deeper into what content would look like for any listener who might not understand what that means and what process looks like. Can we define that a little bit?

Sure. In a supervision setting if my supervisee comes in and says, okay, I have a case. The person is this age and these are their presenting concerns and this is what I did and this is what I think I’m going to do next. How does that seem? Now, I’m not giving all the specifics, but that’s like content. You’ve told me a bit of a story and so I could respond to the content, I could give you some feedback on the case that you’ve shared with me, or I could also say, it sounded like when you were talking about where you want to go next with this case. It felt like there was a little bit of uncertainty or I felt a hesitation in your voice. And I’m just wondering how are you feeling about that course of action? And so that’s me getting more into what’s happening for you. What’s this process for you?

And again, I want to stress content is also important. But there are a lot of times where our supervisees, have a good understanding of the content and it’s allowing them to pause and reflect that I think can be really valuable in their conceptualizing the case.

I love that. So if I could even break it down even further, it sounds like that the content is more of the demographics or what is happening. However, the process is what’s literally happening either in the therapy session and or clinical supervision session and how the therapist feels.

Yes. Absolutely. And the example I just gave, I was talking about like process in supervision, right? If we think about, if I was noticing their process. And this would be after the fact, right? They’re telling me about it and they may talk about a case, and sometimes when people talk about a case, I might be able to say them. It sounds like you were feeling on shaky ground in that session. Were you feeling a little uncertain? And they might say. I was, that was a very uncomfortable feeling. And then we can then take some time to be like, I wonder what that was about. And we may then go back to content, right? So you may be in process and be like, is there anything that you need to do to help you right, with this? Or is this just, the process of the dialogue and you’re going to have to be comfortable with being uncomfortable.

I love that. I want to add another layer to this now. How does learning goals, specifically supervision, learning goals fit into integrating the process of therapy in the supervision session?

Yeah, so I’m going to handle it a couple of different ways. So for me, I think process is one of the key things that I’m always trying to pay attention to. And so I will encourage supervisees to have that as part of their learning goals, right? This sort of idea of how do I pay a little bit more attention to process. Guess what? It’s natural for therapists, it’s quite organic, so it’s not a difficult thing, but bringing them back to that.

Now, if a particular supervisee also had other goals that we say we collaboratively set because I think it’s important in supervision, like a case conceptualization in a therapy setting, is that we have an overarching idea and then we have the work that we do.

And so I like supervisees to be able to say my long-term goal this year is to become more comfortable with emotion-focused therapy. Okay. So we’ve got that as this overarching goal. And that doesn’t mean that’s all that we do in our supervision sessions. We’re still doing case studies.

But now, I’m going to be paying attention more to the emotional process that is going on because I know that’s their goal. And we have talked about it openly, right? And so I would say an important thing for me with my supervisees is on the onset to say, are there any learning goals that they have? If they don’t, I let them know where I lean. So it’s very transparent.

I love that. So when working with clinicians, how do you structure your clinical supervision sessions?

Great question. They are highly collaborative and I feel like the supervisee really needs to drive the process. And what I am usually doing is getting a sense on the micro level, what do they need that particular day, right? And then we make sure we manage our time that we meet whatever their needs are.

On a broader level, because I’m trying to focus on process. If I have a particular supervisee who is very focused on content and cases. I’ll let them bring what they need to bring, but then I will try and shift our conversation a little bit and I’ll let them know I don’t need to know everything about every case. Just feel like you need to share what you need to share, and then we can shift to more of a reflective practice. Then just providing demographic and content information. So I try and meet them where they are, but then nudge them a little bit if they’re really stuck in the more content side of things.

Absolutely. And you touched on this, but how do you connect the process of therapy and the supervision learning goals together?

Yeah I think in tying to what I said before, one of my goals is a focus on the process of therapy, and that’s both in my work as a therapist and as a supervisor. And so if someone indicates to me, I want to learn more about this modality, or I want to learn more about this intervention or working with this sort of client group, I’ll be thinking about that from the lens of process.

A great example of that would be something said, I want to learn a new modality. There’s probably a pretty good chance that in learning a new modality, they are feeling uneasy about it and they are feeling less confident in their skills initially. And so part of the content is what’s the modality, what are the interventions? How do I work through this? But then it’s What was it like for you to deviate from what you typically do or to ask different questions and how was the client’s response and what was that like for you, and does it feel difficult bringing cases to supervision that you feel less sure about? And so we’re just trying to get to that kind of more reflective stance. Yeah. So that’s how I try and marry them.

So this also makes me think about when you mentioned about therapists learning new modalities, and often we want to learn the modality, but at the end of the day we’re not just learning what it is, we’re learning about how to apply it into our practice, which is of course the process of the specific therapeutic modality. And I always say this, with all of the trainings that we take, the next step is to have someone like yourself, like a supervisor or consultant, help you integrate that process or that modality into your practice?

Because we often hear a lot of therapists say, oh, I want to learn this. I’m going to take this training, I’m going to take this training. But you hear less therapists being like, I think I’m going to get a clinical supervisor, a clinical consultant, to help me with integrating that particular modality. And that is like the extra step that helps us put the knowledge into practice.

Yeah. You hit the nail on the head and we’re all guilty of it. I’m the same in that I go to things and I consume the information and then the next step takes work. And yeah, I completely agree.

Absolutely. So Kristi, I know you offer clinical supervision who might be a good fit to work with you and how can they connect with you?

Yeah, so that’s a really great question. I would say I generally work with early to mid-career psychotherapists and counselors from across Canada. Supervision serves different purposes for different people, and for me, while I understand it, it sometimes feels like a requirement. I also want to make sure that it feels worthwhile and like a learning opportunity and an opportunity for self-reflection.

So while I practice from an emotion-focused lens in therapy. Supervision. I just pull out that focus on process and try and use that in my supervision sessions, and that tends to cross a lot of different modalities. I did want to mention as well that I understand that cost is sometimes a factor in supervision, and so I do offer small group sessions.

I generally try and keep them to four people, so that way it can still be fairly intimate and intensive and we can incorporate some of that learning and self-reflection in a small group setting. So if that appeals to you, then I would be a fit for you.

Amazing. So to check out Kristi’s website head to ptbotherapy.ca, or you could simply scroll down through the show notes and click on the link.

Kristi, thank you so much for joining us on the podcast today to discuss how to integrate the process of therapy with supervision learning goals.

Thanks so much.

Thank you everyone for tuning into today’s episode, and I hope you join me again soon on Your Clinical Supervisors Couch podcast.

Until next time, bye for now.