Toward a tripartite vision of supervision for psychoanalysis and psychoanalytic psychotherapies: alliance, transference-countertransference configuration, and real relationship

The psychoanalytic supervision relationship is examined as a tripartite phenomenon, comprised of the supervisory alliance, transference-countertransference configuration, and real relationship. While most supervisory analysts would readily acknowledge that a real (or personal) relationship element exists in analytic supervision, that facet of the supervision relationship has not routinely been incorporated into considerations of psychoanalytic supervision. In this vision of supervision, real relationship, supervisory alliance, and transference-countertransference configuration are presented as integral and complementary constructs that define psychoanalytic supervision. Each of those three components is examined briefly with regard to its beginnings, evolution, and contemporary status; each component is also considered from an empirical perspective. While we have a growing quantitative and qualitative research foundation that supports psychoanalytic practice, psychoanalytic supervision has largely been ignored as a subject and object of scientific study. Supervisory alliance, transference-countertransference configuration, and real relationship are explored as research ready variables. Some clinical hypotheses--eminently testable and worthy of investigation--are proposed with regard to each component of the model, and some ideas--albeit tentative and preliminary--about how to initiate such inquiries are offered.     

Supervision Is a Relationship Too: A Contemporary Approach to Psychoanalytic Supervision

This paper discusses clinical cases presented by Comins and Eliot within a paradigm of psychoanalytic supervisory work based on relational theory. Here, in making the medium of supervision more symmetrical with the message of contemporary psychoanalytic ideas about structure of mind health, pathology, and treatment, the relationship between the supervisor and supervisee is considered to contain crucial supervisory data to be delineated and discussed by both members of the dyad. The supervisory relationship is described using three dimensions: power and authority, the data held to be relevant for supervisory conversations, and the mode of the supervisor's participation in the supervisory process.     

The competent psychoanalytic supervisor: Some thoughts about supervision competences for accountable practice and training

What are the competences required to satisfactorily practice effective or “good enough” psychoanalytic supervision? In this paper, I would like to consider that question. Over the past approximate 15-year period, increasing attention has been directed toward more specifically identifying and defining the components of competent psychoanalytic practice. But any parallel attention toward identifying and defining the components of competent psychoanalytic supervision practice has, in comparison, been sorely limited if not virtually absent. If we are to best practice competent psychoanalytic supervision and best train future psychoanalytic supervisors for competent practice, effort needs to be made to concretely delineate the competences that are requisite for such practice. In what follows, I present and adapt six broad-based families of internationally relevant supervision competence areas for use in psychoanalytic supervision: (1) knowledge about/understanding of psychoanalytic supervision models, methods, and intervention; (2) knowledge about/skill in attending to matters of ethical, legal, and professional concern; (3) knowledge about/skill in managing psychoanalytic supervision relationship processes; (4) knowledge about/skill in conducting psychoanalytic supervisory assessment and evaluation; (5) knowledge about/skill in fostering attention to difference and diversity; and (6) openness to/utilization of a self-reflective, self-assessment stance in psychoanalytic supervision. Although by no means an exhaustive list, 30 supervision competences (five per family) are proposed as significant for guiding competent psychoanalytic supervision practice and supervisor training, and a brief explanatory comment is offered in support of each broad-based family of competences.     

Attachment theory within clinical supervision: application of the conceptual to the empirical

Attachment theory, which has demonstrated application in caregiver-child, romantic, and psychotherapeutic relationships, also appears to be supervision relevant. But bad blood between attachment theory and psychoanalysis may well have hampered considering the relevance of attachment theory for psychoanalytic supervision. This project sought to investigate the application of attachment theory to the supervision situation, with the potential implications of our findings for psychoanalytic supervision being considered. Attachment styles, leader–follower dynamics, and attachment-based expectations were explored as predictors of supervisor-trainee working alliance using a prospective, longitudinal study design. Findings revealed the importance of measuring supervision-specific attachment, the particularly problematic nature of supervisee avoidant attachment, and the potential contribution of a leader–follower framework for understanding supervisory attachment. These attachment concepts may well be useful in, and additive for, psychoanalytic supervision practice.     

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.     

How does psychoanalytic supervision work? A brief communication

In this brief communication, we offer one perspective – the contextual psychoanalytic supervision model (CPSM) – on how psychoanalytic supervision works. The CPSM, a supervisory extrapolation of Wampold’s contextual psychotherapy relationship model, accentuates four psychoanalytic supervisor–supervisee relationship variables as crucial and change inducing: the learning alliance bond, supervisor–supervisee real relationship, creating supervision expectations/providing an expectation-consistent form of supervision, and the supervisee’s engagement in facilitative educational actions. The CPSM is presented in hopes of stimulating further discussion about what makes psychoanalytic supervision work.     

Disruption and Working Through in the Supervisory Process: A Vignette From Supervision of a Psychoanalytic Candidate

This paper describes the author’s supervision of a psychoanalytic candidate, including the development and resolution of impasse in both the supervised analysis and the supervisory relationship. When the author became aware of the degree to which her own anxieties and defenses were implicated, she sought consultation, after which both supervision and analysis moved forward. As supervision continued, work on supervisee’s and supervisor’s interlocking anxieties and defenses, and understanding of their impact on the supervised analysis, deepened. The author concludes that exploring supervisory disruptions allows both members of the supervisory dyad to come to grips with conflicts that subtly distort their work and facilitates a deepening of the supervised analysis.     

Dynamics of psychoanalytic supervision: a heuristic model

This paper presents a heuristic model for the dynamics of psychoanalytic supervision. It is not a manual for how to perform supervision, but a model for how to identify and think about the complex elements and forces influencing the supervisory process. The point of departure is that psychoanalysis is a composite craft in which seemingly contrary elements like strict rules and creative intuitions have their place and interact. Several aspects of supervision are discussed: aims, learning processes, teaching methods, relationship, emotional atmosphere and evaluation. Competence is given a pivotal place in the model. The main feature of the model is that these aspects of supervision are all seen as suspended in a field of dynamic tensions between phenomena in real or apparent opposition. One example of this is the tension in the supervisory relationship between supervisor as instructor acting as an authority for the candidate whilst being a mentor fostering autonomy in the candidate. It is argued that related kinds of dynamics characterize several aspects of psychoanalytic supervision and that these tensions are inherent in analytic work. In conclusion a key word picture of the model is presented.     

Moments of Real Relationship in Psychoanalytic Supervision

What role does the real relationship play in psychoanalytic supervision? While the real relationship's role has long been and continues to be considered with regard to psychoanalysis, it has received virtually no attention in the supervision literature. In this paper, using Horney's construct of the real self as conceptual anchor, I attempt to: (1) situate the real relationship squarely within the borders of the psychoanalytic supervision relationship; (2) examine the relevance of real relationship phenomena for the supervision experience; (3) provide some simple, ordinary yet meaningful examples of case dialogue that illustrate moments of real relationship in supervision; and (4) introduce the concept of real relationship rupture and consider its potential ramifications for and impact upon the supervisor-supervisee relationship. Just as ruptures can occur in the supervisory alliance, I propose that ruptures can also transpire in the supervisory real relationship, have the potential to reverberate throughout the entirety of the supervision experience, and depending upon how they are handled, can prove either constructive and relationally energizing and enlivening or enervating and eviscerating to supervision process and outcome.     

The supervisory field and projective identification1

Taking as their starting point the Baranger and Baranger model of the ‘psychoanalytic field’, the authors extend the notion of intersubjectivity in the analytic relationship to the supervision process. They use a practical example of a supervision to show the development of what they term the ‘supervisory field’, formed from the superimposition of the two fields of analyst‐patient and supervisor‐supervisee. They emphasize the interplay of projective identifications with objects emanating from the inner world of the patient that are relived in the analytic relationship and transposed to the supervisory field. They believe that the concept of the ‘supervisory field’ contributes to a deeper understanding of the unconscious processes occurring in the mind of analysand, supervisee and supervisor during supervision, particularly regarding the identification, comprehension and resolution of persistent disturbances in the supervisory process.     

The Evolving Nature of Psychoanalytic Supervision: From Pedagogical to Andragogical Perspective

In what primary ways has psychoanalytic supervision evolved over the course of its 100-year plus history? In this paper, I address that question by: (1) sketching out some of the historical differences that have been identified as characterizing the patient-centered, supervisee-centered, and relational-centered supervision perspectives; (2) placing those three perspectives within an adult education framework; and (3) considering their pedagogical (youth-focused) versus andragogical (adult-focused) nature. Based on this examination, I propose the following. Due to the infusion of interpersonal/intersubjective views into the body psychoanalytic, (1) the “maturing” of vision in psychoanalytic supervision (i.e., the movement from a youth-focused to an adult-focused approach to supervision) was made possible; (2) a shift from a supervisory “one-person model times two” to a triadic conceptualization was actuated; (3) traditional perspective on power and authority in supervision was upended; and (4) a more egalitarian, empowering, co-participative approach to supervision emerged and now endures. Attending to the six core principles of adult learning is presented as one primary way in which that “maturing” of vision is most evident in the contemporary practice of psychoanalytic supervision.     

The Beginnings of Psychoanalytic Supervision: The Crucial Role of Max Eitingon

Psychoanalytic supervision is moving well into its 2nd century of theory, practice, and (to a limited extent) research. In this paper, I take a look at the pioneering first efforts to define psychoanalytic supervision and its importance to the psychoanalytic education process. Max Eitingon, the “almost forgotten man” of psychoanalysis, looms large in any such consideration. His writings or organizational reports were seemingly the first psychoanalytic published material to address the following supervision issues: rationale, screening, notes, responsibility, supervisee learning/personality issues, and the extent and length of supervision itself. Although Eitingon never wrote formally on supervision, his pioneering work in the area has continued to echo across the decades and can still be seen reflected in contemporary supervision practice. I also recognize the role of Karen Horney—one of the founders of the Berlin Institute and Poliklinik, friend of Eitingon, and active, vital participant in Eitingon’s efforts—in contributing to and shaping the beginnings of psychoanalytic education.     

Kontextanalytische Supervision in der psychoanalytischen Ausbildung

Clinical practice with supervision is that area of psychoanalytic education, in which psychotherapeutic competence is learned, developed and imparted. From the results of the current research about education and supervision, the tasks and aims of supervision are derived. Based on that a context-analytical concept of supervision is evolved. In context-analytical supervision a researching attitude is adopted by which the interactional evaluation of the patient/supervisee is captured and understood for to follow this in psychotherapeutic/supervisory acting and intervening. Finally the potential of context-analysis as a method of qualitative research is pointed out.     

Supervising Psychoanalytic Psychotherapy: Present Knowledge,Pressing Needs,Future Possibilities

Existing research from the fields of education, cognitive science, neuroscience, and psychoanalytic psychotherapy points us toward possibilities for the future of psychoanalytic supervision. This research suggests that we need to go beyond communicating abstract knowledge and make our supervisory relationships more experiential, participatory, relationship-focused, and personal in order to teach usable knowledge, develop complex psychotherapeutic skills, and facilitate emotional and relational development in our supervisees. The author concludes that a relational model of supervision fits this pedagogical profile. After grappling with our resistances to change, the author hopes that more psychoanalytic supervisors will make use of a relational model of supervision, as well as drawing upon new technologies and neuroscience-based teaching techniques.     

Supervisory reactions: an important aspect of supervision

Anne Alonso was passionate about the practice of supervision. An excellent supervisor herself, she sought to identify and teach the ingredients of effective supervision throughout her career. Her first book, The Quiet Profession (1985), was about the supervisory relationship and the various influences on it from within and without the relationship, and she insisted that the Center for Psychoanalytic Studies training program that she directed for many years include a required course on supervision. While the usual focus in supervision is on the supervisee and the clinical material presented, supervisors often experience powerful emotional reactions. Sometimes this is parallel process, in which the dynamics of the psychotherapy are replayed in the supervisory relationship. However, many other sources can contribute to supervisory affect, including the personality, background, and developmental stage of the supervisor, the impact of the clinical material, and the setting in which the supervision takes place. Supervisory reactions can be informative about the psychotherapy being supervised, about the supervisory relationship, or about the supervisor. Supervisors need self-awareness in order to identify their own contribution to their affective responses in supervision. The use of a supervisor decision tree of 1) awareness of reaction, 2) identification of its source, 3) relevance to current supervision, and 4) appropriate use of the reaction in the current supervision is recommended.     

The peer supervisory group for psychoanalytic therapists

The recent interest in peer supervisory groups for psychoanalytic therapists raises important questions regarding both psychoanalytic training and group process. The present paper explores these issues and suggests that there exists a continuum from case-centered peer supervisory groups to process-centered peer supervisory groups. Transference and countertransference and the recognition of parallel processes in psychotherapy supervision are examined in their relation to the supervisory group experience. The authors suggest that the model a therapist employs regarding the role of countertransference will most likely influence the kind of peer supervisory group that s/he will choose. Further, there are specific techniques, as well as experiences, which may foster alteration of the group's psychic organization. Illustrative case examples are provided throughout.     

Psychoanalytic Supervision in a Heterogeneous Theoretical Context: Benefits and Complications

This paper explores the influences of a heterogeneous psychoanalytic training setting, such as the Israel Psychoanalytic Institute, on the individual supervision of trainees. While this kind of institute reduces the dangers of submission, uniformity and indoctrination, it creates its own difficulties, “the perils of diversity.” The examples offered include the impact of divergent views of analyzability; aspirations encouraged by certain theoretical models, which may be frustrated in a supervision guided by different views; and controversies regarding psychoanalytic technique, which may confuse a candidate and create inconsistency vis-à-vis the analysand. The open joint exploration of such issues, and of their influence on the supervisory process, is strongly recommended.     

The analyst's countertransference when supervising: friend or foe?

This paper explores transference and countertransference dynamics in the supervisory relationship and their impact on the task of supervision. The development of analytic theory in relation to supervision is described and the value-and ambiguity-of the concepts of 'mirroring', 'parallel process' and 'reflective process' are discussed. The impact of organizational dynamics on the supervisory relationship is investigated in relation to four main unconscious forces: a) organizational defences, b) power and authority, c) accountability and responsibility, d) ethical concerns. Clinical situations which illustrate these issues are described and explored and used as a basis for examining the role of the supervisor's countertransference in supervision. The different framework of practice in supervision, as opposed to analysis, is described in terms of its focus, the supervisor's ways of responding and the dynamic process, and the concept of refracted countertransference is introduced and explained.     

SUPERVISION: A CONTAINERÆCONTAINED APPROACH

The authors illustrate an approach to the supervisory process as a learning experience for both supervisee and supervisor built on the containment of unconscious anxieties. It is argued that a core function of psychoanalytic supervision is to help contain the emotional turbulence and the unconscious anxieties arising and evolving in the two interacting domains of the analytic and the supervisory sessions. From this perspective, the analyst-patient interaction and that of the supervisee and supervisor can be understood as twin, tiered transformational arenas, the supervisory one being at the service of holding and grasping the roles the supervisee/analyst goes through as part of the analytic process. On the basis of detailed clinical material from a disturbed 7-year-old girl, the authors explore the interrelated issues and difficulties in containing anxieties and turbulence in both the analytic and the supervisory situation. When emotional containment is adequately handled, the supervision helps the understanding and development of the supervisee's use of his/her own personality as a treatment instrument, as advocated by Fleming and Benedek decades ago. The supervisory session thus furthers the resolution of clinical issues through symbol-formation, clinical sessions and supervision being twin domains for recording and understanding emotional evolution.     

Focus and process in supervision

Key dimensions of the supervisory process are not fully articulated in the literature or in the practice of supervision. Three particular areas are identified: the purpose of supervision, the importance of the supervisory relationship, and the development of competence. In relation to purpose, it is suggested that a superordinate focus should be on the 'quality of service' to the client. The supervisory relationship is discussed in terms of a process which unfolds over time through a series of stages. The challenge of defining competence is reviewed within a framework of developing 'reflective practitioners'.