PUBLICATIONS & PRESENTATIONS
PUBLICATIONS
Wells, M. & Bell-Pringle, V. (2004). Use of self supervision model: Relational, ethical, and cultural issues. APPIC Newsletter, (Nov.), p. 5, 12-14.
Bell-Pringle, V., Jurkovic, G., & Pate, J. (2004). Writing about Upsetting Family Events: A Therapy Analog Study. Journal of Contemporary Psychotherapy, 34(4), p. 341-349.
Bell-Pringle, V., Pate, J. & Brown, R. (1997). Assessment of borderline personality disorder using the MMPI-2 and the Personality Assessment Inventory. Assessment, 4, 149-157.
PRESENTATION OF RESEARCH AT PROFESSIONAL CONFERENCES
Bell-Pringle, V., Jurkovic, G., & Pate, J. (2002). A contextual therapy approach to writing about upsetting events. Poster presented at the Annual Meeting of the Southeastern Psychological Association, Orlando, FL.
Bell-Pringle, V., Pate, J., & Brown, R. (1997). Assessment of borderline personality disorder using the MMPI-2 and the Personality Assessment Inventory. Poster presented at the Annual Meeting of the Southeastern Psychological Association, Atlanta, GA.
PROFESSIONAL WORSHOPS
Bell-Pringle, V. (2007). Therapeutic Strategies in Couples Therapy. (CEU) Workshop given at Georgia Technical Institute's Counseling Center, Atlanta, GA.
Wells, M., Bell-Pringle, V., & Alves, M. (2005) Use of self in supervision: Relational, ethical, and cultural issues. (CEU) Workshop given at the Annual American Psychological Association’s National Conference, Washington, DC.
Bell-Pringle, V. (2005) Ethical Decision-Making Models in Clinical Counseling. (CEU) Workshop given at Southern Polytechnic State University, Atlanta, GA.
Wells, M., Alves, M., & Bell-Pringle, V. (2005). Cultural & Ethical Issues Embedded in Use of Self Supervision. Workshop presented at the Health and Psychological Services Department of the University of Georgia, Athens, GA.
Bell-Pringle, V. & Alves, M. (2005). Ethical and multicultural issues embedded in use of self supervision. (CEU) Workshop presented at the Georgia Psychological Association’s Division E Midwinter Conference, Asheville, NC.
Wells, M., Bell-Pringle, V., & Alves, M. (2004). Use of self in supervision: Relational, ethical, and cultural issues. (CEU) Workshop given at Georgia Psychological Association’s headquarters, Atlanta, GA.
Bell-Pringle, V. (2004). Ethical decision-making models in clinical work. Professional (CEU) workshop given at Georgia State University, Atlanta, GA.
Wells, M., Bell-Pringle, V., Wilson, N., & Smith, A. (2004). Use of self in supervision: Cultural, relational, and ethical issues. Professional (CEU) workshop given at the Georgia Psychological Association’s headquarters. Atlanta, GA.
Bell-Pringle, V. & Pringle, P. (2004). Motivational interviewing in the treatment of alcohol and drug abuse. Professional (CEU) workshop given at the Annual Meeting of the Southeastern Psychological Association, Atlanta, GA.
Bell-Pringle, V. (2003). Using motivational interviewing techniques to help addicted clients. Professional workshop given at Georgia State University’s Psychology Department, Atlanta, GA
Bell-Pringle, V. & Pringle, J. (2003). Time management in YOUR ophthalmic office. Professional (CME) workshop given at the Joint Annual Meeting of Alabama, Louisiana, and Mississippi State Ophthalmology Associations. Destin, FL.
Bell-Pringle, V. & Pringle, J. (2003). A palm isn’t just a tree anymore—Using a PDA to manage your office. Professional (CME) workshop given at the Joint Annual Meeting of Alabama, Louisiana, and Mississippi State Ophthalmology Associations. Destin, FL
Bell-Pringle, V. & Pringle, J. (2002). Promoting health behavior change with patients. Professional (CME)workshop given at The Third Annual Men’s Health and Fitness Conference. Sponsored by Three Rivers Area Health Education Consortium and The Medical Association of Georgia, Columbus, GA.
Bell-Pringle, V. (2002). Talking to clients about their alcohol and drug use. Professional (CEU) workshop given at Georgia State University’s Psychology Department, Atlanta, GA.
Bell-Pringle, V. & Kelley, F. (2002). What the clinician needs to know about club drugs. Professional (CEU) workshop given at Georgia State University’s Psychology Department, Atlanta, GA.
Bell-Pringle, V. & Pringle, J. (2001). Dealing with angry patients. Professional workshop given at the annual meeting of the Georgia Medical Association, Atlanta, GA.
Chin, C., Nguyen, C., Wing, D. & Bell-Pringle, V. (1997). Substance abuse awareness: Are you in denial? Community outreach intervention for the Atlanta Federal Probation Department, Atlanta, GA.
Bell-Pringle, V. (1995). Dealing effectively with hyperverbal behavior and chronic absences with psychotherapy clients. Lecture and case presentation at Georgia State University, Psychology Clinic.
Articles/Abstracts
Use of Self Supervision Model: Relational, Ethical and Cultural Issues
By Marolyn Wells, Ph.D. and Virginia Bell Pringle, Ph.D.
Georgia State University --2004
Introduction
"An implicit assumption in most psychotherapy supervision models is that.the supervisee must disclose descriptive information about the client, the therapeutic interaction, the supervisory interaction, and personal information about himself or herself" (e.g., Bernard, 1979; Blocher, 1983;Bordin, 1983; Hes, 1980; Littrell, Lee Borden, & Lorenz, 1979; Loganbill, Hardy & Delworth, 1982; Patterson, 1983; Schmidt, 1979; Stroltenberg, 1981; Stroltenberg & Delworth, 1987)" (Ladany & Hill, Corbett, & Nutt, 1996, p.10) in order to maximally benefit from supervision. Despite this emphasis, little attention has focused on helping supervisors develop skills in how and when to self- disclose or otherwise use their emotional reactions, cognitive associations, or life experiences to further this supervisory process. The Use of Self Supervision Model described in this article places the supervisory relationship, the person of the supervisor, the person of the therapist and the therapy relationship at the center of focus. In particular, this paradigm emphasizes the importance of supervisors modeling self awareness, a multi-cultural perspective and conceptually informed, ethically guided use of self-disclosure.
This article will describe some of the more salient cultural and ethical issues imbedded in the use of self supervision model. In particular we will focus on use of self issues associated with self-disclosure. Use of self-supervision encompasses much more than self-disclosure, but the issues of self-disclosure and exposure of the self are central to its expression. Such a supervisory approach thus requires personal risk-taking for the purposes of learning and furthering the supervisory action. Both supervisor and supervisee enter a collaborative process based on the valuing of mutuality or learning from each other, the process of co-creating meaning, and corrective of facilitative relating. Supervisor and supervisee reciprocally observe and evaluate each other's use of self-knowledge to inform therapeutic uses of emotional reactions, cognitive associations and life experiences.
Therefore, both supervisor and therapist in the use of self model need to be able to tolerate enhanced levels of anxiety when aspects of their character become exposed and examined by supervisees and/ or clients (Peterson, 2002; Wosket, 1999). Learning and healing occurs through the exploration and examination of the interaction, in the intersubjective space surrounding the supervisor and supervisee, therapist and client. In order to facilitate this process supervisors "attempt to develop an atmosphere of openness to discovery about the patient and the therapist" (Talbot, 1995, p. 342).
Self Disclosure
Supervisor self-disclosures regarding the successes and failures of their own clinical work, training experiences and/or personal reactions to the client or supervisee can facilitate the creation of a trusting atmosphere (Norcross & Halgin, 1997) to the extent that the impact on the supervisee includes: 1) normalizing the supervisee's feelings, concerns, temporary "failures" or struggles, 2) modeling learning from mistakes, 3) providing examples for handling difficult situations, 4) demonstrating healthy ways to express emotions, 5) encouraging further supervisee self-disclosure, 6) increasing supervisee self-awareness or understanding, 7) developing a broader perspective and/or 8) fostering a safe and supportive supervisory alliance (Glickauf-Hughes, 1994; Hutt, Scott & King, 1983; Norcross & Halgin, 1997; Weiner, 1983; Worthen & NcNeill, 1996). Training and practice in how, not just what, one offers in terms of self-disclosure remains critical so that the supervisor maintains an alliance with the supervisee while still able to broach sensitive or difficult dialogues (Wachtel, 1993). Sharing both sides of the supervisor's ambivalence or both sides of any bind the supervisor identifies can sometimes accomplish this aim. For example, one supervisor shared with her supervisee that she both wanted to maintain the mutual admiration they seemed to genuinely have for each other and she wanted to raise a topic that she thought could be meaningful to their work together but which would probably rock their boat.
Where supervisees are expected to openly share their clinical work and self-disclose their negative as well as positive reactions to clients in order to better understand enacted or latent communications, supervisor self-disclosures are intended in part, to demonstrate mutual vulnerability to the supervisee, thus mitigating some of the shame stimulus associated with the evaluative and potentially voyeuristic nature of supervision (Hahn, 2001). For example, when working with supervisees who are anxious about sharing their tapes in supervision, use of self supervisors might share some of their own fears about having been taped as a trainee or even about sharing one of their own tapes in the present (Bradley & Ladany, 2001).
Admitting to their anxieties can help supervisor and supervisee strengthen their relationship through the similarity of their experience, especially if the supervisor can feel comfortable with a mutual learning format and has faith in his or her overall level of advanced competence or in the process itself. In this model, anxiety is assumed to be part of the learning and familiarization experience, especially when individuals are trying to stretch themselves in some way. Supervisor self-disclosures that help supervisees feel generally well regarded as well as identify their clinical strengths and weaknesses can be especially helpful in further mitigating the shame proneness so easily induced by the training format in supervision (Hahn, 2001).
The problem is that "there is always a theme of stifle yourself juxtaposed with encouragement to be authentic" in training (Kottler, 1986, p. 52). While the use of immediacy, the deepening of relationship, modeling techniques, and the address of alliance ruptures often raise the issue of supervisor or therapist self-disclosures, supervisors and therapists-in-training often feel discouraged from self-disclosing as the safer default position. Supervisors in training as well as novice counselors can thus feel confused by these double messages and find it difficult to determine which aspects of self are legitimate to express and which are not (Wosket, 1999).
Ethical Mindfulness
Wells (1994) identified four different kinds of therapist self-disclosure, which can also apply to supervision. These four categories include:1) information about the supervisor's (or therapist's ) training and practice; 2) revelations about personal life circumstances , experiences and attitudes; 3) personal reactions to or feelings about the supervisee (or client); and 4) admission of mistakes. In the use of self model any of these self - disclosure categories can meet the criteria for ethical principles (APA, 2002) such as beneficence (of benefit to the recipient), nonmaleficence (do no harm), integrity (truth-telling), justice (fairness), respect for people's right to self-determination (informed consent) and fidelity (trustfulness). On the other hand, any self-disclosure can be detrimental depending on the reasons behind the self-disclosure and the impact on the supervisee or client. The use of self model thus requires supervisors and therapists to remain particularly mindful of these ethical principles as they consider self-disclosing.
For example, in order to honor the ethical principles of respecting supervisee self-determination and informed consent, the new ethical guidelines require training programs to explicitly advertise a program's expectation of trainee's self-disclosure of personal information as part of the training (APA, 2002). Supervisors ask trainees to verify informed consent regarding such expectations before beginning supervision. The profession supports supervisees' right to know, but what if a supervisor's underlying motivation in engaging trainees in a use of self model is more out of their own need for intimacy and connection, or is employed to gratify voyeuristic needs? If the supervisee experiences supervisor self-disclosures as manipulative, exploitative, or intrusive, then the learning alliance is jeopardized.
Even with solid theoretical grounding, empathy and the intent of beneficence supervisor self-disclosure can fail or backfire because "it is inappropriate, causes hurt feelings, disrupts the flow. Then it is time for the (supervisor) to candidly acknowledge the error, apologize, make correction, and learn valuable lessons" (Wosket, 1999, p.72)
Supervisors thus need to carefully and honestly self-monitor for their own semi-conscious, self-serving intentions and attend to any negative impact on their supervisees. For example, one supervisor who was consistently late to session, apologized to her supervisee, but did so in a weary and self-denigrating way, partially out of guilt and out of wanting to mitigate the supervisee's understandable annoyance with her. In response, the supervisee felt pressured to stifle her annoyance and care-take the supervisor by empathizing with how busy she knew the supervisor was.
How supervisors handle these raptures makes a significant difference. If the supervisor uses the opportunity to explore with the supervisee how the supervisee experienced the self-disclosure, empathizing with the supervisee's world view and validating his or her experience, the rupture may be mended and the relationship strengthened. In the previous example, the supervisor stayed honest with herself, realized she was feeling especially needy and overwhelmed, and needed to consult with and get support from her colleagues. At the next supervision session she let the supervisee know that she realized she had apologized in a way that put pressure the supervisee to take care of her, expressed appreciation for the supervisee's sensitivity, and made it clear she thought the supervisee's annoyance was appropriate and justified.
Both supervisors and supervisees may benefit from being introduced to Peterson's (2002) recommended considerations prior to self-disclosing: "(a) Is this information necessary to protect the client's informed consent? (b) Is my purpose in disclosing this information to benefit the client or to benefit myself? (c) Will this particular client use this information in a way that is helpful? (d) Will disclosing this information interfere with our therapeutic progress, such as by contaminating the client's therapeutic transference?" (p.30), (e) Do I know the client well enough to speculate about the potential consequences or impact of self-disclosure? Discussing these questions with supervisees and applying them to critical junctures in the therapeutic process can facilitate ethical mindfulness.
Cultural Interface with Use of Self
Effective supervisor self -disclosures take the supervisee's cultural values into account. More specifically, supervisors are advised to attend to the supervisee's unique individual as well as cultural group values in tailoring the format of the supervisory learning environment, including the kind of self-disclosures that may be most effective in creating a safe, supportive and optimally challenging learning alliance. For example, a White female supervisor's self-disclosure of her own clinical struggles or openly exploring her contribution (e.g., value system, bias, prejudice) to an interpersonal struggle in the supervision may be particularly effective with minority supervisees who view supervisor self-disclosure as a sign of authenticity and trustworthiness (Sue &Sue, 2003).
Additionally, supervisors sensitive to their own multi-cultural identity development can use this awareness to further a supervisee's self- exploration. Female supervisors might share how they dealt with the competing cultural demands associated with power issues related to being a female in a role of authority. Beginning female supervisors working with male supervisees in the author's supervision of supervision seminar often note that they find themselves giving their power away to the supervisee, assuming a supportive, less challenging role. While this role matches cultural values associated with being female, it often denies the supervisor's evaluative or accountability responsibilities and misses opportunities to appropriately challenge the supervisee. Such discussions are particularly important as they address recent empirical findings (Bradley& Ladany, 2001; Ladany, Ellis, & Friedlander, 1999) indicating that supervisees cite one of the most common supervisor ethical failures as giving insufficient feedback regarding areas of deficiency or weakness in the supervisee.
"Becoming culturally competent means acknowledging biases and preconceived notions; being open and honest with one another; hearing the hopes, fears, and concerns of all groups in this society; recognizing how prejudice and discrimination hurt everyone." (Sue, 2001, p. ). The willingness of supervisors to model the open examination of their own internalized cultural biases and prejudices, including internalized racism and homophobia, can help to invite the active participation of trainees who fear evaluative repercussions around making politically incorrect blunders or being seen as troublesome. Additionally, minority supervisees can find it particularly helpful for supervisors of the dominant culture to discuss the potential impact of their unearned privileges as well as to admit to when they are not as competent in the area of multiculturalism as their supervisee, and to invite mutual learning in all competency areas (Cook, 1994).
Risks and contraindications for self-disclosure
The risks of supervisor or therapist self-disclosure included saying too much, saying the wrong thing at the wrong time or saying too little. For example, supervisors can err by putting the onus on the supervisee for bringing up diversity issues, often because such a discussion is out of their comfort zone, and too often because the supervisee has had more training in multiculturalism than the supervisor. In addition, supervisors and therapists often err by saying too little when they want to buy time.
Of the most frequently cited supervisor self-disclosures (personal issues, neutral counseling experiences, and counseling struggles), the wisdom of disclosing personal issues is the one most often and seriously questioned (Ladany & Lehrman-Waterman, 1999). In particular, while such self-disclosure can increase trust, supervisors who self-disclose personal issues are advised to watch closely for any signs of role reversal, whereby the supervisee is supporting the supervisor, or the time devoted to supervisee concerns is diverted or diminished (Woskett, 1999).
Supervisor's empathic failures in use of self are "often related to their shadow side, represented by arrogance, grandiosity or narcissism" (Brightman, 1984, p. 189). Supervisors who are unaware of or deny their shadow side, but act out of those energies in a self-serving fashion, are most likely to do harm. Knowing one's dark side can actually be asset, however, as it can help supervisors to empathize with the dark side of supervisees and clients and stimulate compassion for the human condition. We all have our dark sides. What we do with those energies is what matters. This is one reason the supervisors own therapy is so encouraged. Self-knowledge rests at the cornerstone and is imperative for the use of self supervisor and therapist.
Being real and immediate supervisees harbors inherent risks. A full listing of contraindictions or cautions is beyond the scope of this article. However, supervisors are advised to resist self-disclosure if it represents: 1) an attempt to manipulate the supervisee; 2) an expression of the supervisor's feelings without direct relevance to the supervisor's needs; 3) the supervisor's attempt to rationalize, deny or minimize a mistake or deficiency; or 4) an effort to push supervisees into making an intervention that they are not ready for or that invalidates their or their client's cultural value system (Woskett, 1999).
Teaching supervisees when self-disclosure is contraindicted is thus just as important as teaching them when it is. Goldstein (1994) suggested a noninclusive list of contraindications, including when: 1 ) the client demonstrates poor boundaries and poor reality testing and so manifests tendencies to distort self -disclosures or use them as excuse to act out or attack therapist; 2) the client tends to caretake the needs of others; 3) the client fears strong affect or intimacy; 4) the therapist is needy, stressed, deprived, lonely; 5) the therapist is experiencing an intense countertransference reaction.
Summary
In the model, supervisors are responsible for fostering the development of the supervisee's consistent application of ethical and conceptual principles to the culturally informed use of self, and in particular, to the use of self-disclosures. Supervisors are always encouraged to check to see how their self-disclosures, especially personal comments, impact their supervisees. The timing, content and appropriateness of self-disclosures depend in large measure on the supervisor's conceptualization of the supervisee's needs in the moment, the values underlying this model of supervision, the supervisor's intent, and the impact on the supervisee.
References
American Psychological Association. (2002). American Psychologist, 57 (12). American Psychological Association: Washington, DC
Bradley, L.J. & Ladany, N. (2001). Counselor supervision: Principles, process, and practice, 3rd ed. New York: Brunner-Routledge.
Brightman, B.K. (1984). Narcissistic issues in the training experience of the psychotherapist. International Journal of Psychoanalytic Psychotherapy, 4 (10) 293-317.
Cook, D.A. (1994). Racial identity in supervision. Counselor Education and Supervision, 34, 132-141.
Glickauf-Hughes, C (1994). Characterological resistance in psychotherapy supervision. Psychotherpy, 31, 58-66
Goldstein, E.G. (1997). Self-disclosure in treatment: What therapists do and don't talk about. Clinical Social Work Journal, 25, 41-58.
Hahn, W.K. (2001) The experience of shame in psychotherapy supervision. Psychotherapy: Theory, Research, Practice/Training. 38 (1), 272-282.
Hutt, C.H., Scott, J. & King, M. (1983). A phenomenological study of supervisees' positive and negative experiences in supervision. Psychotherapy: Theory, Research and Practice, 20, 118-123. Kottler, J. (1986). On being a therapist. San Francisco, CA: Jossey-Bass.
Ladany, N. & Lehrman-Waterman. (1999). The content and frequency of supervisor self-disclosures and their relationship to supervisor style and the supervisory working alliance. Counselor Education and Supervision, 38, 143-160.
Ladany, N., Ellis, & Friedlander, M (1999). The supervisory working alliance, training self-efficacy, and satisfaction. Journal of Counseling and Development, 77, 447-455.
Ladany, N., Hill, C., Corbett, M., & Nut, E. (1996). Nature, extent and importance of what psychotherapy trainees do not disclose to their supervisors. Journal of Counseling Psychology, 43 (1), 10-24
Norcross, J.C.& Halgin, R.P. (1997). Integrative approaches to psychotherapy supervision. In C.E. Watkins, Jr. (ED.), Handbook of Psychotherapy Supervisor (pp.203-222). New York: John Wiley & Sons.
Peterson, Z.D. (2002). More that a mirror: The ethics of therapist self-disclosure. Psychotherapy: Theory, Research, Practice/Training. 39 (1), 21-31.
Sue, D. (2001). A conceptual model for cultural diversity training. Journal of Counseling and Development, 70, 99-105.
Sue, D. & Sue, D. (2003). Counseling the Culturally Diverse: Therory and practice, 4th ed. New York, NY: John Wiley and Sons.
Talbot, N.L. (1995). Unearthing shame in the supervisory experience. American Journal of Psychotherapy, 49 (3), 338-349.
Wachtel, P.L. (1993) Therapeutic communication: Principles and effective practice. New York: Guilford Press.
Weiner, M.F. (1983). Therapeutic disclosure: The use of self in psychotherapy (2nd ed.). Baltimore: University Park. Wells, T.L. (1994). Therapist self-disclosure: Its effects on clients and the treatment relationship. Smith College Studies in Social Work, 65, 23-41.
Worthen, V. & McNeill, B.W. (1996). Changes in supervision as counselors and supervisors gain experience: A review. Professional Psychology: Research and Practice, 18, 189-208. Wosket, V. (1999). The therapeutic use of self: Counseling practice, research and supervision. Routledge: New York.
Writing About Upsetting Family Events: A Therapy Analog Study
Virginia J. Bell-Pringle, Gregory J. Jurkovic, and James L. Pate
Georgia State University --2004
Journal: Journal of Contemporary Psychotherapy
Publisher: Springer Netherlands
ISSN: 0022-0116 (Print) 1573-3564 (Online)
Subject: Behavioral Science
Issue: Volume 34, Number 4 / December, 2004
DOI: 10.1007/s10879-004-2528-4
Pages: 341-349
Online Date: Tuesday, January 11, 2005
Abstract: This therapy analog study investigated whether a writing intervention based on contextual therapy would have positive effects on physical, mental, and relational health. One-hundred-and-three college students were randomly assigned to write about either an upsetting family event/issue from childhood or a trivial event during a four-day period. As anticipated, relative to the control participants, those in the experimental condition reported an increase in negative mood and physical symptoms immediately after writing each day. Also as anticipated, the experimental participants also reported feeling better about themselves and their topics at post-test. Unexpectedly, there were either no significant differences or differences in the unpredicted direction between the control and experimental groups in physical, psychological, and relational functioning at posttest and follow-up. However, post-hoc analyses revealed differential changes within the experimental group as a function of the personal relevance and the degree of previous disclosure of the topics. Limitations of written expression as a therapeutic tool are discussed.
Assessment of Borderline Personality Disorder Using the MMPI-2 and the
Personality Assessment Inventory.
Bell-Pringle, Virginia J.; Pate, James L.; and Brown, Robert C.
Georgia State University --1997
ERIC_NO: EJ557696
JOURNAL_CITATION:
Assessment; v4 n2 p131-39 Jun 1997
PUBLICATION_TYPE: 080; 143
CLEARINGHOUSE_NO: TM520617
REPORT_NO: ISSN-1073-1911
ABSTRACT: Using the
Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the
Personality Assessment Inventory (PAI) (L. Morey, 1991) to classify patients
with Borderline Personality Disorder (BPD) was studied with 22 female
psychiatric patients and 22 college students. BPD classification using the PAI
was more accurate than classification based on the MMPI-2.