Silent thoughts,spoken wishes: when candidate experience of the supervisor converges with patient fantasies

How and why a candidate's private experience of two supervisors emerged in patients' fantasies about them is explored. Four issues are examined in light of two control cases: (1) Patients divide, rather than split, the transference between supervisor and candidate, experiencing both ambivalently. (2) Even a patient with no knowledge of the supervisor's identity may have a fantasy of the supervisor that is congruent with the candidate's experience of the supervisor. (3) When new professional traits emerge in the candidate as he or she identifies with his or her mentor, the patient may attribute them to the invisible person in the room--the supervisor; the patient may intuit and be influenced by the candidate's feelings about the supervisor as well. (4) A patient's fantasies about the supervisor may reflect parallel process in reverse, whereby the patient discerns what is going on between supervisor and candidate through his or her treatment, just as the supervisor reads what is going on between patient and candidate through the candidate's reporting of the treatment. Because the trio is the truth of the training case, it seems fitting and empowering to acknowledge and analyze the role of the supervisor in the patient's mind.     

A patient's transference to the analyst's supervisor: effect of the setting on the analytic process

A case is presented in which the patient's transference to the analyst's supervisor became evident just prior to the switch from clinic to private patient status. The patient experienced the supervisor as a restraining father figure who protected her from acting on her erotic wishes toward the analyst. Analysis of this led to the recall of previously repressed memories of sexual wishes toward her brother, and the sense of protection from these wishes that she had gotten from the presence of her father. The literature on transference involving the supervisory constellation and the training setting is reviewed, and the concepts of split and institutional transference are examined. Factors inhibiting the analysis of patients' fantasies about the analyst's status as trainee, including the presence of the supervisor and the institute, are discussed.     

Structural factors affecting the supervisor's devotion

The system of supervision in psychoanalytically-oriented psychotherapy consists of a young, relatively inexperienced trainee and a senior, experienced and knowledgeable supervisor. The issues generally discussed during the course of supervision are related to the dynamics of the patient, therapeutic values, difficulties encountered by the trainee and feelings aroused in him or her in connection with the patient and the therapy. The trainee goes through a process of growth and development in both the personal and the professional sense. This process may thus be studied by analogy with the process of human growth and development as it appears in the theoretical literature in the context of the mother-child or the therapist-patient relationship. The theoretical questions at the focus of the present paper are concerned mainly with a number of structural factors in the relationship between the supervisor and the trainee. These factors go beyond the differences in the participants' personalities. These factors are built into every supervisory system and serve to increase the supervisor's devotion to the trainee. The paper examines the components of the supervisor-trainee interaction that may help the supervisor ignore his or her own needs, wishes and self, and concentrate on the needs and wishes of the trainee. This enables the supervisor to create an accepting environment that permits the trainee to grow and develop as a professional and as a person.     

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.     

Trauma Triangles and Parallel Processes: Geometry and the Supervisor/Trainee/Patient Triad

Relational psychoanalytic literature is filled with discussion regarding how the concept of intersubjectivity has enhanced the space between and within patients and analysts. As the relationship between the dyad expands and contracts, prior traumatic experiences become ripe for reenactment. What happens when the therapist is a trainee and her supervisor reenacts the abuse experienced by the patient onto her? When the enactment extends beyond the dyad and moves into the triad, how can the trainee use this shared experience to create agency for both herself and the patient? And how does the institutionalized authority of the training environment expand or collapse the transitional space required for trainees to create their own analyst identity? This paper explicates a case in which the trainee was able to use a rupture in the supervisory relationship to further enter the subjugated space of the patient, ultimately empowering both to develop a new way of relating to each other that moved them out of such constricted complimentary roles.     

Making the Best of What Has Been Done to You and of What You Yourself Have Done: Commentary on Papers by Joan Sarnat and Emanuel Berman

In this commentary on the supervisory experiences presented by Joan Sarnat and Emanuel Berman, the author mainly focuses on the following issues: the fear of facing the negative feelings and the consequences of this fear in the patient, in the candidate, and in the supervisor; on the intrapsychic/interpsychic dynamics of role-reversal in transference–countertransference; on the tendency to use either intellectual and “jargon” interpretations or metaphors without before asking ourselves whether if the patient can comprehend them or whether, on the contrary, these kinds of communications leave the patient even more disorientated and confused. Further considerations are suggested on the fruitfulness of applying “a long wave perspective” in reading the analytical material and on which an ideal “good enough” work of supervision could be intended.     

督导重要事件对新手咨询师专业成长的影响

目的：了解个别督导过程中重要事件的类型、内涵及对新手咨询师专业成长的影响。方法：采用重要事件法,访谈4对受督者和督导师,并用共识性质性研究法分析。结果：有益重要事件包括督导关系、概念化、历程化、个人化4大类;督导促进了新手咨询师干预技巧能力、治疗计划目标等8个专业领域的成长。结论：督导对于新手咨询师专业成长非常重要。各类督导事件对于新手咨询师的促进作用并不均衡。     

The triadic match: the interactive effect of supervisor,candidate, and patient

The triadic match is the author's term for the interaction among analytic candidate, supervisor, and patient. Overlapping or diverging characteristics of candidate and supervisor may influence the candidate's learning for good or ill depending on the way patient's and candidate's character and conflicts interact. Four candidates who had found their supervisors' character and supervisory styles particularly beneficial in relation to a particular patient volunteered to describe their experiences. Candidates and supervisors were interviewed. The aim of the paper is to illuminate factors in the match that enhanced or interfered with the candidates' learning. While the paper is presented from the perspective of the candidates' experiences, the balance between challenge and comfort in learning situations is also considered.     

督导重要事件对新手咨询师专业成长的影响

目的：了解个别督导过程中重要事件的类型、内涵及对新手咨询师专业成长的影响。方法：采用重要事件法，访谈4对受督者和督导师，并用共识性质性研究法分析。结果：有益重要事件包括督导关系、概念化、历程化、个人化4大类；督导促进了新手咨询师干预技巧能力、治疗计划目标等8个专业领域的成长。结论：督导对于新手咨询师专业成长非常重要。各类督导事件对于新手咨询师的促进作用并不均衡。     

Supervision, transference and countertransference

The author discusses supervision, transference and countertransference as seen in the context of the clinical case of a patient who had been first seen as a training analysis case and who later, in a fortuitous way, was treated by the supervisor of the training analysis. The supervisor, who in the first instance did not recognize the patient, discusses the reasons for this unusual experience in terms of the presence and absence of transference during the analysis of this patient as a training case and the problems inherent in the task of supervising. The patient's feelings towards the first and the second analyst and the vicissitudes of transference and countertransference during the supervision of the training analysis and its influence on the presentation of the analytical sessions by the student are also detailed and discussed. The question of recorded supervision presentations and their possible influence on the dynamics of supervision is raised.     

The effect of supervisor and trainee therapist gender on supervision discourse

The effects of supervisor and trainee therapist gender on supervision discourse were examined in this study. Forty episodes of supervision discourse, with ten drawn from each of four types of supervision systems were videotaped. The systems were (1) male supervisor and male trainee therapist; (2) male supervisor and female trainee therapist; (3) female supervisor and male trainee therapist; and (4) female supervisor and female trainee therapist. The episodes of supervision discourse were analysed using a supervision discourse coding system which showed adequate inter-rater reliability. For supervisors, the coding system allowed a directive discourse style and a collaborative discourse styled to be coded. A cooperative discourse style and a resistant discourse style could be coded for trainee therapists. Two statistically significant findings of considerable theoretical and clinical importance emerged. First, contrary to stereotypic expectations, discourse characterized by a directive supervision style and a resistant trainee therapist style was more common for systems containing a female supervisor than for those containing a male supervisor. Second, for same gender supervisor-trainee-therapist supervision systems, a collaborative systemic supervision style was correlated with both cooperative and resistant trainee therapist styles. This discourse pattern did not occur for opposite gender supervision systems, indicating that a collaborative supervision discourse style is consistently associated with trainee therapist parti-cipation (either cooperatively or resistantly) within same gender pairings of supervisors and trainee therapists. These results are discussed in light of relevant literature on gender, power and supervision process and the limitations of the study are considered.     

Being, thinking, creating: when war attacks the setting and the transference counter-attacks

When trauma enters into the reality of the analyst and of the analysand, when it attacks the setting, what becomes of the analyst’s role? How can transformations be brought about? With reference to three clinical situations, the author attempts to explore how the articulation between transference and countertransference – the inter‐relation – structures the situation; the analyst must remain in his or her role as analyst through managing to create and to reflect upon the clinical aspects of that situation when faced with the unpredictability of what war brings in its wake. It then becomes possible to see how the work of the negative can be confined to the outer limits of the setting.     

A fundamental change in vision: where black lives matter

Using the lens of clinical work, the author, a white supervisor, plots her concerns about unconscious racism in the training of a black supervisee. Years later this supervisee brings a distressed black trainee nurse to supervision who is struggling with relational difficulties while suffering from unconscious racism in her hospital. Supervisor and supervisee grapple to offer the patient treatment on both fronts. The author explores the underlying presence of ‘white privilege’ and ‘unconscious racism’ which finds a global audience as a result of the killing of George Floyd – an event which also had implications for the long-term supervisory partnership. Links to Jessica Benjamin’s concept of ‘doer and done to’ are made, as well as discussion of a gradual change of vision in the supervisor herself. The author also makes use of insights gained from consultancy work in a multi-racial company and two Channel 4 UK television programmes that feature workshops on unconscious racism in a mixed secondary school in the London Borough of Sutton.     

On supervising the pregnant psychoanalytic candidate

The role of the psychoanalytic supervisor is complicated when the psychoanalytic candidate is pregnant. Pregnancy is a special event that brings a unique set of opportunities, as well as problems, into the analysis, though in the past, it was usually regarded only as an impediment. The goal of this paper is to help the supervisor of the pregnant candidate to seize the opportunities and mitigate the problems. The authors make practical suggestions about the handling of maternity leave and the complex theoretical and technical issues surrounding the question of when and how to tell the patient about the analyst's pregnancy.     

Seeking an Analytic Identity

Abstract

Rothstein has stimulated all analysts to rethink how we can better commit ourselves to our analytic work. In this paper I focus on factors in analysts' personalities and experiences in their training and practice that contribute to or distract from establishing an analytic identity.

First, I explore analysts' background and motivation. In admissions to psychoanalytic institutes we look for candidates who can see psychoanalysis as an intellectual puzzle to be solved and an emotional involvement to be experienced. We look for earlv conflicts that the candidate can sublimate in the service of analytic functioning. We assume that the capacity to sublimate is only partial and that analysts in their development continue to recognize conflicts in transference—countertransference reactions.

Second, I give some examples of experiences from analysts' training that stimulate the formation of their analytic identities. These include transient identifications and counter-identifications with the training analyst, supervisor, seminar leader, and favorite analytic authors.

Third, I discuss more external factors that influence the development of analytic identity. These include the climate in training and continuing education at the institute. How much does the institute support its members in immersion in psychoanalysis? Economic factors continue to he an important factor in determining individual choice in this immersion.

Finally, I review studies on the effectiveness of psychoanalysis. Dedicated analysts with considerable experience believe that analysis works despite some limitations. Part of high motivation to continue analytic work includes understanding how analytic results differ from the simpler solutions achieved by nonanalytic therapies.     

Effect of context on performance approach orientation

We proposed and tested a theoretical model that argues that different work contexts influence the relationship between performance approach orientation and work performance. Across three studies and three different types of work performance, results consistently supported a theorized interaction between performance approach orientation and rewarding climate. Two self-rating studies showed generally similar interactions, with some important differences in the significance of the simple slopes. Larger differences emerged between the self-rating and a supervisor rating study. The present research supports a model in which type of work (part time vs. full time), rewarding climate, the criterion of performance (supervisor vs. self-rating), and type of work performance are important contextual components of a model relating performance approach orientation to work performance.     

Silence and communication: nonverbal dialogue and therapeutic action

The subject of this article is silence as communication, with the starting point in the silences of three patients in treatment—in one of them his silences lasted up to a year. Silence is also seen as a specific dimension linked to speech, as the treatment of a third patient shows. The nonverbal interaction between patient and analyst is illustrated. This interaction led to a developmental process in each of the patients, characterized by fusion and separation processes, which included a development of three-dimensionality. The curative process taking place in each of the three, not through verbalisation but through the relation, is understood in the light of Modell's (1990) concept of “dependent/containing transference”. The treatment results demonstrate that the “dependent transference” is curative in itself when the therapeutic setting is maintained. The analyst's inner work during the dependent transference is described: a form of nonverbal participation and joint creativity in the intersubjective field.     

Countertransference, conflictual listening, and the analytic object relationship

Analytic listening is an ongoing conflictual process, containing all the components of conflict and shaped in every moment by both the patient's and the analyst's conflicts. The mutual responsiveness that develops between analyst and patient stems from a complex conflictual object relationship, fundamentally no different from any other object relationship, in which countertransference at all times simultaneously facilitates and interferes with the analytic work. Detailed clinical process is used to illustrate these and related phenomena, including the use of signal conflict, the benign negative countertransference, the function of countertransference structures, and the analyst's use of projection. The analyst's affects, thoughts, and actions trace the shifting nature of the patient's transference and resistance, and the level of the object relationship continuously being created between patient and analyst.