Seeing is Not Believing: Group Supervision By Telephone

By: Simon Y. Feuerman, PsyD, LCSW

I had always looked down on telephone supervision as inferior to face-to-face meetings. I even held the idea that it was a compromise in the worst sense, maybe even a sell-out—a watered-down, weak tea version of the “real thing.”

    My own treatment and supervisory experiences seemed to lend support to this idea. My analyst and supervisor were on opposite ends of town, and both were far from where I lived and worked. I rode the subways, buses, and trains in all kinds of weather, hustling, hailing cabs. On occasion, when I had a car, I struggled to find a parking space, scrounged for fistfuls of quarters to shovel into the meter.

    All of this seemed part and parcel of the “work,” whatever “work” meant. Once, while driving into Manhattan to get to a supervision appointment, I became stuck in a mammoth traffic jam in the Lincoln Tunnel. I pleaded with my supervisor to be allowed to have the session on the telephone while I sat idly in traffic. He wouldn’t hear of it. “No way,” he said brusquely. “You’re either here or you’re not. See you at your next appointment.” I turned around and went home. There would be no session and no makeup. Precious dollars and time seemingly wasted. My supervisor at that time was an ex-Marine. He was renowned for his brilliance, but also for being stubborn and inflexible. He insisted on making his point: There was no way of getting around the substantial investment that was needed to get intellectual and emotional nourishment. It’s not helpful or progressive to look for shortcuts.

    When I questioned him about it, he explained that under certain extenuating conditions, one could work on the phone, when no other alternative existed, but as a general rule, this was no way to conduct a relationship. If I was late, that was not his problem.

    In addition to the individual supervision and analysis I underwent, I was a member of a supervisory group that also met in person. Part of what I had thought kept the group coherent and connected with each other was the fact that we could see each other. There was so much you could learn by watching people. What kind of group could it be when people could not see each other? How would they make connections with each other that were emotional?

    People make profound connections when they put their feelings into words—feelings are almost always connected to and registered in the body—our own and someone else’s. In one group I was in, a man told a woman that her legs were perfectly sculpted—“Michelangelo could not have done better a job.” Her eyes were like “chocolate chips” and her blonde hair was a “burst of sun.” I can assure you that she will never forget those comments, because the body has a memory of its own.

    On the basis of these experiences, I thought that a group on the phone would be all but impossible. At least that is what I thought until about two years ago, when serendipitously, I together with a colleague participated in a telephone conference with a few therapists from all over the country. Perhaps there was something magical about that one night, but there was a therapist from Grand Rapids, MI and one from Jupiter, FL and a third one from Encino, CA, and we were talking about fees in treatment. I could “feel” Sallie from Grand Rapids. To this day, I do not know whether it was the timbre of her voice, or that lilt or that accent, but I felt something toward her. In fact, a warmth blanketed the whole group. It sounds corny, but I thought of us late into the evening as little points of light twinkling over the United States.

    That night after we hung up the phone, we thought: This kind of group supervision could be done on an ongoing basis via telephone. We began to invite acquaintances to join group supervision on the telephone. Several therapists immediately accepted. I was surprised. Most of them were in metropolitan areas where face-to-face groups were feasible and accessible. Why did they want to “settle” for phone supervision?

    One colleague told me that even though she could travel by subway uptown to a group, she didn’t want to. Telephone supervision saves me two hours of travel time and the exhaustion of having to go up and down several flights of subway stairs. Another one told me that she found this form of supervision more effective than in-person. “We can get right down to business, and I am not distracted by what people look like.”

    I myself, for the first time, considered the idea that what people looked like, and what they were wearing (or not wearing) or doing, might actually be a distraction. I noticed that in phone supervision, there were fewer cases of competitive talking. People seemed to have a rapport that in some cases was almost instant. They knew somehow intuitively when to let the other person talk. This might be particularly true in supervision in which dynamics and rhythm may be more prominent than arbitrary impulses and feelings whose urgency tends to dominate some in-person groups.

    A colleague of mine reinforced the idea when he told me that when one sense is closed off, other senses tend to work harder and compensate. For example, the blind man may be more perceptive than average, because he cannot see; therefore, he must sense or feel or intuit something as a form of “seeing.”

    Recent research on certain kinds of blindness may help explain the effectiveness of group and individual telephone supervision. The following case is an excellent illustration of the idea that there is more than seeing involved in sight and perception.

The Case of D.B.

    D.B. is an Englishman in his early 50s....When D.B. was about 14, he started to have violent headaches every six weeks or so, accompanied by a temporary oval of blindness in the left portion of his visual field. In his early 20s, the attacks started to come more often, resulting in a partial blindness that became permanent. An angiogram...revealed a  mass of enlarged blood vessels at the edge of the visual cortex on the right side of the brain. This visual part of the brain and the distorted blood vessels were removed surgically. Immediately, his headache attacks stopped and D.B. was able to lead a reasonably normal, productive life. However, after the operation, D.B. was blind in the left half of his visual field....

    So far this blindness, though unfortunate, was as expected, given that the brain tissue from the right visual cortex had been removed. However, some informal observations seemed to show that D.B. could locate objects in his blind field. For example, he could reach for a person’s outstretched hand accurately, even though he could not see it. Furthermore, he could correctly guess the orientation (horizontal or vertical) of a stick that he claimed he could not see. In fact, D.B. vehemently denied that he saw anything in a portion of his left visual field, and he attributed his success on these informal tasks to lucky guesses.  

(Kantowitz, Roediger, & Elmes, 2005, p. 183)

    D.B.’s psychologist, Dr. Lawrence Weiskrantz, began to undertake a series of controlled experiments to determine D.B.’s real ability to “see.” These experiments confirmed that D.B. had the capability of “seeing” without seeing.

    Weiskrantz called this capacity “blindsight.” This gave strong impetus to the notion that D.B. and others make complicated sensory judgments without being aware of anything. D.B. sensed without perceiving (Kantowitz, Roediger, & Elmes, 2005).

    This brings us back to the question of what is going on in the minds of supervisees while on a group phone call. Why did people seem to intuitively not talk into and against each other? People reported “feeling” things from other people over the phone. One woman, Kathy, said she could hear Brian’s simmering anger, even though he had hardly uttered a peep and it was his first session. What kinds of feelings were transmitted over the phone lines? If participants were not reacting to the feelings generated by sight, what were they reacting to?

    As one researcher, Dr. Alex Green, puts it, “The content of the mind is a representation of the world.” The problem is defining the transformation that occurs between the brain’s activity and that of the mind. Apparently, perception and seeing are both biological processes. We do acknowledge, according to Stanford University researcher Barbara Tversky, that some biological processes are redundant in the sense that they overlap. We might think of them as similar to each other but with some differences.

    Given this kind of thinking, what is the purpose of sight in adult human relations if we are already seeing something in our minds? My own mother (a stunningly beautiful woman) unfailingly asks me, whenever I return from a trip where I have seen relatives, how did so-and-so look? I remember when we used to watch TV together and we would see an old rerun or perhaps a clip of the royal family, perhaps the Queen Mother (my mother is British). She would remark and still does to this day, “My god, she’s aged,” or conversely, “She looks wonderful.” I remember to this day, when I was 10 years old, watching Richard Nixon and Pat on the tarmac stairs of Air Force One—flashing a V-sign to the nation as he resigned in disgrace. He looks ois-gemitched (Yiddish for tired out) but Pat looks wonderful, dressed like a Rebbetzin (a rabbi’s wife). Somehow, in the mental space of her mind, she equates appearance unfailingly with psychological and physical health.

    The special role of body in cognition is a wonder by itself. It is what Tversky calls a “privileged category.” We may see many things in a setting, but it is the body that stands out for us in memory. We will notice the person holding a gun, rather than a gun that is in the hands of a person. Why do bodies receive this special prominence in cognition?

    It seems that it is because we experience the world through our bodies and other bodies have impact on our bodies. Let us say that the greatest potential for impact on our body (one could say, “our body, our life”) is from another body. We feel other bodies through the impact that they have on our own. This may be why people say, “I am terrible with names, but I never forget a face.” The face is something you feel—but the name does not often carry feeling, so it is not remembered. And here is what might provide an exciting idea: the mind’s eye and the brain’s eye may not be redundant after all. They overlap for sure, but each one brings something to the table.

    There is a famous Oscar Wilde quip: “After a few years of marriage, a man can look right at a woman without seeing her, and a woman can see right through a man without looking at him.”

    The brain sees what it always sees, but the mind is processing a mental representation. Perhaps she is as beautiful as she always was to the brain, but the mind sees her in more human form. Maybe he has that charisma that swept her off her feet, but she “sees” through it now.

    In the Bible, Moses famously asks Jethro, his father-in-law, to stay on with the people of Israel. “You will be for us our eyes,” he tells him. The Israelites had just seen the “face of the L-rd” for what did they need Jethro’s eyes? In common parlance, we say the business needs a cold eye. Or, regarding a spinster, someone might say, “With a kind eye, you could see that this woman is marriageable.”

    There is a famous section of Talmud I studied when I was a boy in the Tractate of Kiddushin. The Talmud in tractate Kiddushin forbids a man from marrying a woman by proxy—in other words, without seeing her first. Shema yimtza boh davar meguneh. The reasoning goes because he may dislike her and he must love her, as he loves himself, for the marriage to have the best chance.

    There is a special poignancy in this ruling of the Talmud regarding romance and marriage. Marriage is understood by many in our field to be a mature replay of our earliest feelings of love and connection. The intersecting fields of sight and language and feeling by all accounts are pivotal when we examine neural activity in the early years of life. It is in these years that feelings and sights and sounds become imprinted in the brain.

    The sounds together with the facial changes and subsequent recognition are necessary to relieve enormous tension and anxiety states. To put it in proper context, the baby has been catapulted from the warm womb (Freud called it the Garden of Eden), into a strange land where he must work for his food and breathe on his own. People around him speak a strange language, and he doesn’t realize he has a body, never mind how to work with it. The sounds accompanied by the touch and the face of the mother, her rhythm, her smell, this is what calms, soothes. Romantic love and attraction may indeed derive from these early calming and anxiety-reducing feelings.

    Earliest learning of language (mother-tongue) comes from the mother, because she makes facial expressions and sounds as she teaches her child language. Here is some m-i-l-k for you, she might say, elongating the vowels and doing something with her face when enunciating the word. It has been suggested that comic books may help children learn to read more effectively than textbooks, because comics contain words with associated pictures and facial expressions.

    As we grow, we begin to store mental representations of what we saw early in life. This is why adults don’t speak to each other in baby talk. In fact, for some of us, the mental representations in our minds are the only thing we really see, making vision superfluous and maybe even misleading in some cases.

    But what about the facial cues that people put so much investment in? A colleague of mine, reluctant to participate in phone supervision, said, “There are so many facial cues that we miss when we don’t see people.” Yes, I thought. “Precisely…and that could be a good thing, at least as far as supervision goes.” We might even want to miss them. The mental dynamics evident in the speech pattern and verbal interactions with others are so manifest that when we concentrate on them only—we are able to “see” the person better.

    The following is an example of a more or less typical supervision session. Brooke, a 40-year-old therapist from California, speaks of her sadness and self-doubt when a number of patients left her without “warning” or “trying to work things through.”

    Brooke: “I thought I had done great work with this couple, and then they leave.”

    Sandy: “This happens all the time. Why take it personally?”

    Bob: “Yeah, Brooke, what does this have to do with you? You cannot attack yourself when a patient leaves. It’s just the way it is. People are treacherous, and we don’t know what may be going on for them. It’s not a judgment on your work.”

    This patter goes on for about 10-12 minutes with colleagues chiming in with the same tune, but playing a slightly different musical instrument in a light orchestra of condolence and reassurance.

    This seems to help for the moment, but there is still an undertow of Brooke’s self-attack and blame.

    Me: “Well, maybe this group can help Brooke hang on to the patients so that they stay longer? Why should Brooke have to suffer through with these “terrible” uncooperative patients?” I say somewhat facetiously.

    Brooke: “I don’t like that idea at all. I think it is about the patients and shouldn’t be at all about the therapists. I hate [the idea] that all these discussion groups talk about is how to keep the patients—for our benefit—it sounds self-centered. It is about the patients! I really don’t care about the few patients that leave. I have a huge and successful practice. I know what I am doing!”

    But Jack from Sarasota said he felt angry at Brooke. “There is a pattern to your sharing, Brooke. You come in with some kind of sob story and you ask for reassurance or condolence or whatever. Then when you are about to get help, you back away and say that things are really wonderful. I wonder what is really going on here.”

    Jack is correct that Brooke has a pattern of relating. It begins with some moderate tale of woe, and the rest of the group instinctively attempts to comfort her. There is a pattern of engagement that is almost contrapuntal in nature—an almost daring foray—into the unknown and then a hasty retreat. (When she has something to say, one gets the feeling that it is being released under great pressure, as though it is being burped up.) Although it is not a perfect parallel, the composite picture of her practice resembles this form of nourishment-taking—intermittent as opposed to continuous—hesitant as opposed to forthright.

    What makes this even more salient and astonishing in a way is that she in fact has one of the largest and most successful practices of anyone you will ever meet. And yet, it is punctuated and truncated by a zig-zag of engagement and interruption.

    Sight unseen, the group recognized that it was stuck in a verbal pattern of undernourishment as it pertained to Brooke. She felt underserved and undernourished by the group, and they too did not feel that feeling of satisfaction and connection that you get when you feel that you truly helped somebody.

    Cindy, a newcomer to the group, said she noticed Brooke’s pattern of speech is to hide and then appear out of nowhere—“a duck and a weave” was how she termed that.

    I suggested that when it came to nourishment, things were out of rhythm.

    Brooke felt that “hit home.” She had been an anorexic when she was younger and had recovered, but her young teenage daughter had recently been hospitalized with several eating disorders.

    At this moment, she acknowledged to the group that she understood that her practice, as wildly successful as it was, resembled her early life with her alcoholic mother. Flashes of brilliance, with intermittent nourishment, followed by feelings of abandonment and self-attack.

    But how could the group know this about her without seeing her and having met only for a short time? she wondered.

    Lately, in one group after having worked together by phone for two years, there has been almost a spontaneous yearning for people to meet and see each other. The group reflected on this wish. Lara, one of the members, suggested that this wish arose out of a desire for completion or more accurately, for wholeness, rather than for curiosity or stimulation. Perhaps this wholeness stems from reconciling the two separate systems of seeing. Maybe this is why we were given two eyes, instead of just one.

Reference

Kantowitz, B. H., Roediger, H. L., & Elmes, D. G. (2005). Experimental psychology: Understanding psychological research (8th ed.). Monterey, CA: Wadsworth.

Simon Y. Feuerman, PsyD, LCSW, is a licensed clinical social worker and psychotherapist. He is an adjunct psychology professor at Kean University in New Jersey and the director of the New Center for Advanced Psychotherapy Studies. He received advanced training in psychoanalysis at the Center for Modern Psychoanalytic Studies in New York and group psychoanalysis at the Center for the Advancement of Group Studies. He is a graduate of Yeshiva University’s Wurzweiler School of Social Work. He received his doctorate in clinical psychology from Cal Southern.