Sunday, July 01, 2007

The best defense is offense -- meeting certification committees

This past Friday an educational group for CPE supervisors-in-training I attend focused on the ins and outs of appearing before committees.

Committee appearances are one of the most anxiety-provoking things about training to be a CPE supervisor. It's kind of like the bar exam for law students; it's a huge thing you have to get through in order to truly enter the profession you've been training for so long and hard. But the big difference is that committee appearances -- as opposed to an exam paper -- are very personal. And the experience of going through them (and, especially failing them) is very personal as well.

Me and my supervisor both did presentations that sought to understand the dynamics of committee appearances through the psycho-dynamic lens of Ekstein and Wallerstein's The Teaching and Learning of Psychotherapy. Ekstein and Wallerstein introduced something called the clinical rhombus for understanding the dynamics in the relationships a person training as a psychotherapist faces. I wrote about that in my entry on The magic of parallel process (and the clinical rhombus).

One thing I learned in all this is that you cannot be passive with a committee and expect to do well. The worst thing that can happen is that you end up feeling attacked and the committee feels like you feel you're being attacked. This is a form of getting defensive. You need to be assertive with the committee and one way to do that is to try and set the agenda yourself at the beginning. This is counter-intuitive for many people (isn't the committee the ones in charge? they're the ones in a position of authority here, are they not?). But it is a way of showing the committee members that you've "grown up" enough in your role that you're ready to move on to being one of their peers. It also shows that you can set the agenda elsewhere, especially with your students.

My presentation was based on this handout that talks about the clinical rhombus.


My supervisor started his lecture by setting forth a framework of four interrelated characteristics of good helping professionals (like CPE supervisors!) and where those might go wrong in the context of a committee appearance:

Assurance in a role of Authority
(breakdown: you might feel like an impostor)
Articulate in understanding of the field
(breakdown: you lack a grasp of your theory about the field)

withholds Judgment of others
(breakdown: you lose objectivity and compassion for students and peers)
conveys accurate Empathy
(breakdown: you over-identify with students or patients and thus can't tell the difference between what's really going on with them and what's happening with you
another breakdown: becoming disconnected from others)

For an aspiring CPE supervisor seeking to demonstrate competency to a committee it's the two on the first row that are likely to be especially problematic. Almost anyone feels like an impostor at the beginning of a new career/role. Like a pack of dogs smelling fear, a committee is likely to smell any lack of confidence a person has about their role. The rookie response is to try and hide that anxiety, but that is highly unlikely to work. What's left, then, is to try and talk about it. Admit to it and try and show how you're working with coping with that anxiety.

This is where theory can help you. The committee will appreciate it if you can talk about your anxiety (and how you're coping with it) through the lens of your theory. If you can do this, you will also be demonstrating your ability to be "articulate in your understanding of the field" at the same time.

This is also where the best defense is offense. Of course, you should not take this too literally (that is, don't attack the committee). But taking the first step by admitting to your anxiety and starting to talk about it is a potentially successful course.


My supervisor went on to talk about this in the Ekstein and Wallerstein framework. They talk about
  • Learning problems, and
  • Problems about learning

Learning problems can be thought of as a goal. So, the goal here is to get certified.

Problems about learning are about your (psychological) resistances to achieving your goal/learning.

Now, this is where things get pretty counter-intuitive. Why would anyone resist getting certified (that is, resist succeeding before a committee)? Why would you want to fail?

Well, here you need to think about change. Everybody resists change. It's just a natural part of who we are as human beings. Change is threatening.

To put this in terms of a theory, Kurt Lewin described this kind of resistance to change in terms of a force field analysis.

And what might be some reasons behind why a person might resist certification?
  • Fear of loss of relationship with peers (other students)
  • Fear of "growing up" as represented by no longer being a student (which can relate to fears of death/aging and/or "not being good enough" . . . which can relate to issues leftover from childhood ("daddy never thought I was good enough, so maybe I'm not"))
  • Fear of the loss of mentor relationships
  • Fear of responsibility.

The things I listed in the last paragraph might all be termed as problems about learning. They might also be termed as neurosis or developmental issues. They all, certainly, are very personal.

Everything is very personal about this committee appearance process and that can be really maddening and draining for the student. In addition to what is fair and good about all this, there is something that is fundamentally unfair about it as well -- especially the random nature of the selection of the committee members you appear before. They may have their own personal issues and you may trigger them. (God, forbid, you should, for example, look like the overbearing mother of one of the members!)

If you run into this kind of countertransference during an appearance, you may just be screwed (and get a nice lesson in how unfair life can be). But you can try and do something about it. Again the best defense is offense. You can confront the committee member by spelling out what you're experiencing. This is a pretty intimidating thing to do, but it might work!

One final thing that might be worth saying is that anxiety can be your friend. That is, it can help you keep aware and on your toes. And you really need that in a committee appearance!

1 comment:

T.R. Gartin said...

Thank you for this post and others you have written about CPE. I'm currently finishing my first unit of CPE, with Gwinnett Medical Center in Georgia, as part of requirements for ordination in the Episcopal Church. I also really appreciate your comments in other posts about your experience as a Jewish caregiver and comments on interfaith work.
Grace and peace,