Psychoanalytic supervision of the difficult patient

Control cases from the broad group of non-neurotic but potentially analyzable patients appear with increasing frequency. The intense, complex transferences they develop place great stress on the psychoanalytic relationship and evoke marked countertransference reactions in psychoanalytic candidates, which reverberate within the supervisory relationship. Through application of a case study method, common themes emerge in the candidate-supervisor dyad: idealization of the supervisor and of classical technique, identification with the patient, parallel process enactments, difficulty maintaining the analytic frame, and the importance of concurrent training analysis. Classical supervisory techniques must be adapted to the "difficult" (non-neurotic) control case. Complex countertransference issues must be carefully addressed while maintaining the teach/treat boundary.     

Psychoanalytic developmental psychology and the supervision of psychotherapy supervisor trainees

While literature on psychotherapy supervision abounds, literature on supervisor supervision (i.e., the actual supervision of a supervisor trainee who is in the process of learning to supervise) is far more scarce. How might the supervision of supervision process be best understood? What is the developmental experience of supervisor trainees? How can supervisors effectively intervene when working with supervisor trainees? Those questions have been addressed in only the most meagre fashion, and guidance on how to engage in the supervision of supervision is sorely lacking. In this paper, a psychoanalytic developmental framework is used to provide a means of conceptualising the supervisor trainee experience and to suggest a programme by which supervisors can best respond to their supervisor trainees' needs. Supervisor trainee ‘unfolding’ and ‘becoming’ are captured within a developmental progression that punctuates separation and individuation processes. The place of the supervisor – in holding and containing, loosening and liberating, buffering and bolstering, and refuelling and reloading – is considered in the facilitation of supervisor trainee development.     

Psychoanalytic supervision in the new millennium: On pressing needs and impressing possibilities

Having now completed its first century, psychoanalytic supervision has been and continues to be regarded as the cornerstone of psychoanalytic education; it is the primary means by which (1) psychoanalytic ideology becomes translated into practical product, and (2) budding analytic practitioners develop and grow in their therapeutic skills and professional identity. The supreme significance of supervision in contributing to the “making” of the competent psychoanalytic practitioner now seems a widely accepted given, even axiomatic. But as its second century gets underway, what have we learned from psychoanalytic supervision's first 100 years? What are its most pressing needs and, in turn, impressing possibilities at this time? And what needs to most change if psychoanalytic supervision is to most profitably advance in the years and decades ahead? In this paper, I would like to consider those questions, giving focus to five needs that seem to most require attention now: (1) making the practice of psychoanalytic treatment an increasingly competency-based, concretized learning affair; (2) enhancing the efficacy of supervisors through competency-based practice and training in psychoanalytic supervision; (3) more effectively incorporating existing technology and emerging technological advances into supervision and using them to enhance the psychoanalytic learning process; (4) better attending to matters of difference and diversity, and striving to seamlessly integrate them into the conceptualization and conduct of the psychoanalytic supervision experience; and (5) vigorously researching the psychoanalytic supervision process and working to establish an evidence base for supervisory practice.     

Tuning into the psychotic wavelength: Psychoanalytic supervision for mental health professionals

In this paper, material is presented from supervision groups run for mental health professionals in different mental health settings. I will argue that a psychoanalytic framework, which puts the transference and countertransference at the centre of clinical practice, offers an important model for thinking about psychosis and psychotic means of communication. When staff are able to ‘tune in’ to their patients' communications it can help to change a patient's monologue about his/her delusional world into a meaningful dialogue about their emotional world.     

Psychoanalytic psychotherapy and its supervision via videoconference: experience,questions and dilemmas*

The American Journal of Psychoanalysis - The patient lives in Berlin, the therapist in Lisbon and the supervisor in Budapest. Not long ago, continuous psychotherapy and supervision would have been...     

Ethics and the Psychoanalytic Hard Problem

The ethical aspect of self and other engagement is recognized as essential to analytic inquiry, practice, and theory, indeed as central to understanding the life of humanity in general. This valid and important viewpoint apt for relational views lives alongside the intrapsychic aspects of mental functioning that are autonomous and nonethical in their essential processes. Integrating the simultaneous truths of two-person and one-person points of view is the hard problem of psychoanalysis.     

The truth and nothing but the truth,yet never the whole truth: Frege,Russell and the analysis of unities

It is widely assumed that Russell's problems with the unity of the proposition were recurring and insoluble within the framework of the logical theory of his Principles of Mathematics. By contrast, Frege's functional analysis of thoughts (grounded in a type-theoretic distinction between concepts and objects) is commonly assumed to provide a solution to the problem or, at least, a means of avoiding the difficulty altogether. The Fregean solution is unavailable to Russell because of his commitment to the thesis that there is only one ultimate ontological category. This, combined with Russell's reification of propositions, ensures that he must hold concepts and objects to be of the same logical and ontological type. In this paper I argue that, while Frege's treatment of the unity of the proposition has immediate advantages over Russell's, a deeper consideration of the philosophical underpinnings and metaphysical consequences of the two approaches reveals that Frege's supposed solution is, in fact, far from satisfactory. Russell's repudiation of the Fregean position in the Principles is, I contend, convincing and Russell's own position, despite its problems, conforms to a greater extent than Frege's with common sense and, furthermore, with certain ideas which are central to our understanding of the origins of the analytical tradition.     

Psychoanalytic Companioning

In this paper I offer an integration of object relations and relational conceptions of clinical interaction and suggest a register of psychoanalytic companioning. I suggest that when working with patients and states where there is no self-other definition and therefore no mutuality, the path to healing and growth is via companioning the patient into the darker, more regressed and unformed states of illusion and merger rather than via the promotion of separateness and relatedness, which, I propose, will accrue from within the companioning register. The analyst works from within an unobtrusive relational position. I offer a case example of my work in this register and suggest that this offers a different register of the use of the analyst’s subjectivity: one that is receptive, “cooperative” (Trevarthen) and responsive to the patient’s internal world and objects, rather than analytic and knowing. I consider the dimensions of intersubjectivity that cohere with the dimensions and levels of the patient’s mentalization as outlined by Leciurs and Bouchard (1997).     

Psychoanalytic aims and attitudes

This paper explores distinctions and relationships among psychoanalytic aims, psychoanalytic attitudes, and psychoanalytic techniques. The author proposes that these distinctions can illuminate a number of important tensions and problems within our clinical theories.     

Psychoanalytic observation

The recent focus on empathy as the essential activity in psychoanalytic data gathering has underemphasized the complexity of psychoanalytic observation and has failed to identify what truly makes it unique among modes of psychological investigation. It is a process that includes introspection and empathy. However, it also includes the analyst's observation of the patient's behavior, and particularly verbal behavior, in a way that is not necessarily empathic. The psychoanalytic use of introspection and behavioral observation together, as they are modified by the analysand's free association and the analyst's evenly hovering attention, provides a unique method of data gathering. The transient, mutually related regressions of analyst and analysand which partly constitute the analyzing instrument modify the field of observation available to both, providing better access to derivatives of the analysand's unconscious mental functioning. This more complex concept of psychoanalytic observation, as opposed to that in which empathy is predominant, has important implications for psychoanalytic training, clinical work, and theory.     

Psychoanalytic process

Differing concepts of psychoanalytic process and views of its "locale" are related to how essential the interactivity of the analyst is judged to be. Scientific scrutiny of clinical psychoanalysis requires that the interactive nature of the process be recognized. In this endeavor the concept of "process model" is helpful, as is the view of psychoanalysis as a form of treatment in which therapeutic process and therapeutic agent are distinguished.