INSIGHT INTO SUPERVISON IN HOMEOPATHY
The Benefits of Not Going It Alone
Jane Tara Cicchetti, RSHom(NA), CCH
First published in Simillimum, Fall 2008 – Volume XXI
“Sometimes you can’t see yourself clearly until you see yourself through the eyes of others.”
Ellen DeGeneres
After Graduation
The profession of homeopathy is fortunate in now having a good number of excellent schools for the education of new homeopaths. Most programs provide students with some clinical training as well as supervision for their first cases. Assistance with their early cases may also be included in the process of becoming certified.
What happens after graduation is a different story. The first years of practice often turn out to be a sink-or-swim proposition, with many potentially good practitioners leaving the profession.
Once a new homeopath begins to see a number of clients and has followed their healing for months or even years, they may encounter difficulties that can be hard to manage without outside help. This is where supervision becomes an invaluable aid, bringing the practice to another level of expertise. While it is possible for some practitioners to overcome these obstacles on their own, it is rather like bushwhacking through a jungle.
Even for those with the tenacity to endure this ordeal, supervision can increase the speed of the learning process, and assist in areas that may be difficult to identify without the input of another person. Working with a supervisor in the early years of practice benefits both clients and practitioners through more accurate remedy choices and a better understanding of the healing process.
Supervision can be helpful or even essential in many ways. This article will cover the role of supervision in therapist/patient relationships, helping the homeopath find their individual stance, dealing with power and inflation, and understanding limitations to practice. It will discuss choosing the right supervisor and the format for supervision.
Therapist/Patient Relationships
The homeopathic interview is designed to uncover the essence of what needs to be healed in the individual. As such, it is a fertile field for the development of transference or projection. This is a subject familiar to most psychotherapists, where a patient projects their unconscious feelings onto a therapist. It also occurs in reverse, where the therapist projects onto the client. In this case, it is known as countertransference.
In his presentation, “Projection in the Consulting Room: Pervasive and Significant”, Dr. Nicholas Nossaman gives an example of how we might experience countertransference in case taking.
“When we are taking a case and feeling like an unbiased observer, we won’t experience a lot of emotions, except for moderate person-to-person reactions such as compassion, admiration, etc. There are times in case-taking or in follow-up in which we can feel much more than that, an indefinable vague discomfort, great sleepiness, anger, great sadness, extreme compassion, anxiety, physical attraction, etc. When this is present, we are involved emotionally for some reason, and we face more of a challenge to understand what is happening with the patient as well as with ourselves. The word “boundary” comes up a lot in describing these interactions. It is a major challenge to recognize whether we are in a state somewhat like that experienced by the shaman – mirroring an unexpressed emotion in the patient or experiencing a feeling in ourselves, having to do with our own psyche, which is in resonance with something expressed or unexpressed by the patient. Said in another way, “Is it “my stuff” or “their stuff” that I’m experiencing?”1
The difficulty of dealing with transference is one of the reasons that psychotherapists frequently undergo long periods of supervision. They must learn to recognize that powerful unconscious feelings are the constant companion of the therapeutic alliance. While homeopaths work in a different format from the psychotherapist, projections are a reality within our practice.
The inexperienced homeopath is usually not aware of this phenomenon. Even if they have heard of projection, they have not knowingly experienced it. Working with clients on an ongoing basis, without developing a method for dealing with these powerful emotions, can not only interfere with our ability to clearly perceive the remedy that is needed, it can become exhausting. The homeopath that does not make this process conscious, at least to some extent, begins to unconsciously develop ways of dealing with the emotional burden this creates.
Irritability, indifference, shortness with clients, or the reverse, blaming oneself, working too hard in order to compensate are some commonly seen strategies. These are obviously not in the best interest of the practitioner or client.
If this continues for a prolonged period of time, the homeopath may find the situation unbearable and feel unsuited to the practice of homeopathy. Supervision can be invaluable in these cases. An experienced advisor can recognize the difficulty, help the homeopath become aware of what is happening, and suggest ways to deal with transference. Some methods may include having the homeopath identify what is “their stuff” by journaling, recording dreams, and looking at which types of clients/remedy types are causing difficulty. These techniques will help increase awareness of formerly unconscious psychic content.
Knowing one’s own psyche as clearly as possible is important in order to perceive what needs to be healed in another. Otherwise, we may simply be projecting our unconscious psychic material onto the client. The antidote is to make this material conscious.
Dr. Edward Whitmont has written about the way the healers unconscious qualities interfere with the therapeutic process.
“… the healers complexes interfere most with the therapeutic process when they are unconscious. They can distort the healers objective view of the patients personality by merging it with his or her unrealized “shadow,” the idealized or dreaded archetypal images. They can cause inappropriate feelings to be projected upon the patient. Any of these may cause diagnostic misapprehensions.”2
Dr. Whitmont goes on to explain that this is one of the reasons why some homeopaths over-prescribe certain remedies. They are, he says, prescribing for their own projections.
Individuality in Homeopathic Practice
Power and Inflation
One of the occupational hazards that homeopaths succumb to is misuse of power. It happens very easily, as homeopathy is a very powerful healing art. No one is immune, and the more successful a homeopath becomes, the greater the risk. While very few would blatantly take responsibility for the healing process, there are subtle and pervasive ways that the ego lays claim to this power. Being surrounded by the adulation of clients who have been helped makes it even worse, leaving the practitioner in a blown up Lycopodium-like state. This is a problem not just within homeopathy; the medical arts, politics, and human interactions in general are problematic in this way.
In The Alchemy of Healing, Edward Whitmont addresses this problem:
“In discovering and using his capacities and skills for healing, the doctor of necessity experiences and uses power. To handle power adequately, to use it in a way that does not inflate ones sense of self-importance and does not harm or interfere with the needs of others, remains perhaps one of the most difficult psychological problems of humankind in general. This challenge we meet in therapeutic no less than in political and interpersonal relationships. The tendency to misuse power is a collective illness of mankind.” 3
In a trusting relationship between supervisor and homeopath, it is possible to identify circumstances that challenge the practitioners equilibrium in regard to power and inflation. Supervision cannot prevent the ego from attempting to usurp the power that is used in healing, but it can help address that natural inclination and make the situation more conscious. This gives the practitioner a choice, and one hopes, the choice will be a good one.
Understanding Limitations
Many new homeopaths are extremely cautious, perhaps overcautious, about which clients to accept into their practice. A surprising number seem to get involved with cases that are far too complex for even a seasoned practitioner. This may be because they are unable to perceive the depth of the disease from a homeopathic perspective and have no idea what the healing process will entail. An experienced homeopath, acting as the supervisor, can help the new practitioner make wiser choices. Students are taught Heringʼs Law, they are taught about suppression, but they do not experience what it is like to follow a person through treatment over months and years. With guidance, the new homeopath can learn to make better decisions about which clients to accept and which to refer to a more seasoned homeopath or to another healing modality.
Choosing the Right Supervisor
Choosing the right supervisor is a very personal endeavor and depends on the needs of the individual. If the homeopath is fairly experienced but would like help with the dilemma of power and inflation or with transference and countertransference, the right supervisor might not need to be a homeopath. Many senior psychotherapists have done supervision and could provide effective guidance on these subjects. In other cases, it might be important to choose an experienced homeopath. What is of utmost importance is that there is a comfortable relationship for both parties. This is an alliance that requires trust and a certain amount of compatibility. Both should be able speak openly to one another and to trust that what is discussed in supervision will be kept in confidence.
The supervisor must be able to draw out the best from the homeopath rather than inflict his or her methods. What is required is to be able to be an unprejudiced observer and to apply the correct remedy – the same qualities that are part of being a good homeopath.
A supervisor who is a homeopath should have many years of experience. Paracelsus once said that a healer only begins to mature after 12 years of practice. We might want to use that length of time as a guideline. Many times, the only supervision that students receive is from recent graduates of a school. While this is useful for help with basic skills of case taking and analysis, it does not help the student to master the challenges of an ongoing practice.
Format for Supervision
The format for supervision is something that is agreed upon by the parties involved. It could be a meeting at regular intervals or as needed. It is helpful to have an initial session where the homeopath presents several cases for review, along with an interview. This will allow for the evaluation of strengths and weaknesses and the identification of any missing fundamental skills. Once these are determined, a plan for how to proceed can be discussed.
Sometimes, the written case taking must be improved upon so it can be understood and evaluated. This can be a very important part of the learning process. Many homeopaths do not write down all of the information that they originally prescribed upon, a problem particularly true of intuitive types. Lack of written information results in cases that cannot be used in supervision, and in information eventually becoming lost to the homeopath. It also makes follow-up appointments difficult.
Because we are taught to write down the patients words verbatim, what is frequently seen in cases taken by unseasoned homeopath is page after page of verbiage from a loquacious patient. The homeopath needs to learn to draw the line between what reveals the patient and what is “running on.”
This is not a simple feat because it is easy to move in the opposite direction, so that the opportunity to know the patient is lost. Here the supervisor must be able to help the homeopath walk that fine line – getting enough information and listening in an unprejudiced way, while not letting the patient go off on a tangent.
The issue of countertransference may also be found in case taking, with some homeopaths making assumptions about a patient that are based on their own unconscious agenda. When the tendency is very strong, it can be seen in the review of just a few cases.
Once the homeopath presents cases in a manner that can be used, the supervisor can review the case analyses. Here the challenge is to find the characteristic symptoms in the case. This seems to be the area that requires the most refinement during supervision. While experienced homeopaths may have varying opinions on the subtleties of choosing characteristic symptoms, new homeopaths often choose symptoms rather randomly, which is not at all helpful in finding the remedy. A review of cases can show whether the choice of characteristic symptoms represents the patients problem and, if not, the supervisor can review more cases until the homeopath begins to perceive and choose characteristic symptoms.
As supervision continues, issues of transference and countertransference may become clear and must be addressed. The same is true of issues regarding power struggles and inflation. The homeopath will gradually learn what cases to refer to others without feeling it is a failure on his or her part.
Long-term follow up, second prescriptions, and the use of nosodes are addressed as the supervision progresses. While these are skills that are taught in any good homeopathic curriculum, revisiting these skills in actual practice lends a deeper appreciation of how these are applied to clinical practice. It is through many years of long term follow up that the seasoned homeopath has gained experience with the healing process and this is what is conveyed to the new homeopath in supervision.
Can We Do It Alone?
Many homeopaths today have developed into master practitioners by working on their own. The question is not really “can it be done?” but would it be easier and more efficient to work under the guidance of a supervisor who can mentor a homeopath into mastery of this difficult healing art? Would more graduates of homeopathic schools continue to practice if supervision were available when needed? And would it improve our profession?
The answer to these questions is yes. New homeopaths would develop more quickly into expert practitioners. They would become more confident and less likely to fall prey to inflation and abuse of power. There would be less of a tendency toward burnout from the onslaught of unconscious feelings in the consultation room. Supervision would help to assure that homeopaths are fully trained in the basic skills while allowing the individual to develop a practice that brings out his or her best.
Homeopathy is an elegant healing art that can help relieve the suffering of many people. It is also a difficult art to practice. Because the intellect, emotions, and intuition of the homeopath are the vehicles through which the vital force of the patient is perceived, the practitioner must be as clear as possible. In supervision, the insight of another allows for as few barriers to clear perception as is possible.
Notes
1 Nicholas Nossaman, “Projection in the Consulting Room: Pervasive and Significant” (Presented at the 25th Anniversary Meeting of the National Center for Homeopathy, in Fort Lauderdale, Florida, April 17, 1999.)
2 Edward C. Whitmont, The Alchemy of Healing, Psyche and Soma (Berkeley, California: North Atlantic Books, 1993),190.
3 Ibid., 203.