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.     

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.     

Breathing Together: Reply to Harris and Shaw

These two very different but complementary discussions address two different “registers” of my thinking in my paper on patients who “live in airless intrapsychic worlds.” Harris is most interested in the meta-theoretical and historical contexts and frames of my theory and clinical approach, viewing my contribution as an example of various broad trends in contemporary relational psychoanalytic thought. Shaw, by contrast, engages with my particular insights and clinical/theoretical framework for understanding and working with patients whose struggles very much resemble and overlap with the struggles of the adult children of “traumatically narcissistic” parents, which his seminal work has focused on. In my Replies I voice my appreciation of each of their unique perspectives on my ideas, and engage with each of them regarding certain differences in our theoretical and clinical sensibilities.     

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.     

The Value of Integration: Psychoanalytic Psychotherapy Meets Ego Psychology in a Psychotherapy Group for Children

ABSTRACT

Psychotherapy integration requires us to look beyond the confines of a particular theoretical or technical approach towards other perspectives. Integrative work with children, in particular, meets the socio-emotional needs of the child while simultaneously modeling behaviors and skills. This paper presents an explicitly integrative approach to child group psychotherapy: Relationships. Individuals. Skills. Engagement (RISE) Group. We begin with an in-depth discussion of the RISE group structure illustrated by clinical examples (the “what”) followed by a review of the theory and treatment modalities that inform the approach (the “why” and “how”). The RISE group is grounded in two theoretical perspectives (psychoanalytic principles and ego psychology) and draws upon clinical techniques from multiple treatment modalities (including cognitive behavior therapy, psychodynamic play therapy and dialectical behavior therapy). Combined, the merger of these perspectives results in a multilevel intervention that forges pathways to mastery and competence within the child. Finally, we discuss the value and limitations of integration as applied to group psychotherapy for children.     

Psychotherapy Research and Psychoanalytic Practice: Commentary on Papers by Lester Luborsky and Hans H. Strupp

I discuss the views of Lester Luborsky (quite optimistic) and of Hans H. Strupp (less so) concerning the accumulating evidence for the favorable impact of psychoanalytic therapy research, as it has grown over recent decades, in shaping clinical psychoanalytic activity. I offer my perspectives on their views of the issues of (a) the effectiveness of psychoanalytic (psychodynamic) therapies vis-à-vis the varieties of nonanalytically based therapies; (b) long-term (time-unlimited) vis-à-vis short-term (time-limited) therapy, (c) the call for empirically supported treatments (ESTs), (d) the call for randomized clinical trials (RCTs), (e) the trend toward “manualization” of therapy approaches, and (f) the light that all these considerations can cast on the extent to which, and how, psychoanalytic therapy helps.     

Convergence,commonality, and context in psychoanalytic supervision

ABSTRACT

What are the binding commonalities that demark and define any and all psychoanalytic supervision perspectives? What do we all do as psychoanalytic supervisors that practically matters? Furthermore, might there be a unifying model that anchors those binding commonalities together into a supervision meaning-making, explanatory framework? In this two-part paper, I take up those questions. In Part I, based on a century-spanning literature review, I identify 50 (non-exhaustive) common Support and Learning factors that appear present across the panoply of psychoanalytic supervision perspectives. Relational, educational, and interventional, these 50 factors reflect the very stuff of which psychoanalytic supervision is made. In Part II, I present and elaborate upon the Contextual Psychoanalytic Supervision Relationship Model (CPSRM) – a theoretically-grounded model that anchors and contextualizes those common Support and Learning factors. Because common factors can be seen as nothing more than atheoretical amalgamation (i.e., lists of desirable characteristics endlessly strung together), the CPSRM is proposed as a theoretically-based antidote. A supervisory extrapolation of Wampold’s contextual psychotherapy relationship model, the CPSRM accentuates relational connection, expectations/goals, and educational action as preeminently supervisee change inducing and learner affecting.     

Uncanny Communication and the Porous Mind

In this paper I examine the phenomenon of “uncanny” unconscious communication and the plausibility of “telepathic” interconnectivity between patient and therapist. While reexamining long-standing psychoanalytic reluctance to engage with the topic of the “uncanny,” I present clinical examples of seeming anomalous transmission, followed by discussion from contrasting perspectives of psychoanalysis, neuroscience, quantum physics, and parapsychology. The patient’s and analyst’s reactions to these uncanny moments are explored, along with the potential clinical value of nurturing receptivity to this “frequency” of unconscious attunement.     

The phenomenology of hypo- and hyperreality in psychopathology

Contemporary perspectives on delusions offer valuable neuropsychiatric, psychoanalytic, and philosophical explanations of the formation and persistence of delusional phenomena. However, two problems arise. Firstly, these different perspectives offer us an explanation “from the outside”. They pay little attention to the actual personal experiences, and implicitly assume their incomprehensibility. This implicates a questionable validity. Secondly, these perspectives fail to account for two complex phenomena that are inherent to certain delusions, namely double book-keeping and the primary delusional experience. The purpose of this article is to address both problems, by offering an understanding “from the inside”. Our phenomenological approach is a form of “radical empathy”, and crosses the Jaspersian limits of understanding. It compares delusional experiences with variations of reality experience in everyday life, and makes use of the structure of imagination. Six factors influencing the experience of reality are discussed and illustrated by clinical and non-clinical examples. These factors are: continuity (1), materiality and resistance (2), multiplicity of sensations and perceptions (3), intensity (4), the sense of authorship (5), and the complex role of intersubjectivity (6). I suggest that experiences of hypo- and hyperreality are not restricted to pathology, but have their place in everyday life as well. Delusional phenomena can be better understood by investigating the interplay of these six factors. With this framework, the two complex phenomena consequently prove to be better understandable to us. Our approach remains within the phenomenal experience and might thereby contribute to the validity of psychopathology.     

Like a phoenix from the ashes – or “sack cloth and ashes”?:1 The reconstitution of psychoanalytic institutions in Germany since 1945 and its consequences

Abstract

Here, I attempt to formulate some thoughts about the past, present, and future of psychoanalysis and its institutions in Germany. To do this, I have employed my varied experience as a supervisor and consultant to many such psychoanalytic institutes over the past several years. Themes discussed include the history of psychoanalysis in postwar Germany, the organizational structure of German psychoanalytic institutes, and their cultures in regard to group and organizational dynamics, and political and economic aspects. Finally, I add brief thoughts about the future, taking into account recent developments relating to planned changes in laws governing psychotherapy in Germany. Further, I attempt to analyze and comment on: coming to terms with the past; how to begin after the “Zero Hour”; the form of organization of psychoanalytic institutes in Germany; missing patients and missing candidates; constructive debate and hurting people’s feelings; the lack of “detoxification” and “recycling” of the poisonous remains of psychoanalytic processes; and the future of psychoanalytic institutions in Germany. I end with an example of a typical primary task used in conducting large groups in the institutes in which I worked, and include an anonymized table listing individual interventions, their duration, and frequency. These should provide an idea of my way of working, and an overview of the dimensions of the task.     

MASTER OF THE UNIVERSE: SCORSESE’S “THE WOLF OF WALL STREET” THROUGH A PSYCHOANALYTIC LENS

In this essay I wish to present some reflections on Jordan Belfort, the protagonist of the movie “The Wolf of Wall Street” from a psychoanalytic prism. The movie, “The Wolf of Wall Street”, is a 2013 black comedy film directed by Martin Scorsese and adapted by Terence Winter from Belfort’s memoir (2007) of the same name. This movie has already been analyzed from cultural and historical perspectives, with the protagonist representing American culture of the 1980s. I will first summarize some of these views, and then present my psychoanalytic perspective of Jordan’s wish to become “Master of the Universe” (Wolfe, 1987; Grunberger, 1993), as expressed through his abuse of drugs, hyper-sexuality, and his aggressive and self-destructive behavior. As the craving for omnipotence and immortality is a universal wish that has existed from time immemorial, I will draw an analogy between certain aspects and symbolic elements in “The Wolf of Wall Street” and Wagner’s (1848–1872) four epic operas “Der Ring des Nibelungen.” I will conclude with a brief reference to the charismatic appeal of a man like Jordan to the general public.     

Binocular Vision in the Total Situation

This paper investigates the concept of “total situation” which, even though introduced into psychoanalytic thinking via sister disciplines, such as sociology, the neurosciences, etc., has gradually acquired a relatively prominent position in current therapeutic practice. It is used as a metaphor for the envelopment of the unfolding transferential and related events in the analytic process. Irrespective of whether one focuses on the individual analytic condition or the group-analytic one, contemporary psychoanalytic perspectives include both the bi-personal unconscious interactions and the various levels of the total situation in their conceptualizations of the nature of the process. Such a complex approach in conceptualization can only be achieved through the so-called binocular vision of the analyst.     

Who is the Hero in the Life of the Traumatized Patient? Reflections on Bodansky’s Work with Mrs. E

The vexed question of how to explain analytic success with traumatized patients like Bodansky’s Mrs. E is considered from a perspective on psychoanalytic history and the specific theory-buttressed assumptions and practices of earlier generations of analysts that led them to conclude that traumatized patients couldn’t be helped via psychoanalytic work. I then consider Mrs. E’s life with an organizing question, Who is its hero?, applying perspectives from Charles Dickens and from Fraiberg and colleagues’ work, and use these perspectives to question the theory-based assumption that Mrs. E must have somewhere had a good object experience to have a life. These perspectives allow contemplation of a saving forceful agency at Mrs. E’s core (perhaps one experienced by her as “animal”) that seems essential to understanding her successes in living. The success of her treatment in assisting her with building a life suggests that her analyst’s helping her with mirroring and, even more important, with mentalizing, contribute importantly to her life improvement. Some potential limitations of his approach to her are also implied in his account; in particular, his limited work with her intimate desires and feelings, both libidinal and aggressive.     

Day,Night, or Dawn: Commentary on Paper by Steven Stern

It was in the years immediately following World War II and through the 1950s that the psychoanalytic establishment officially defined psychoanalysis as a subspecialty of psychiatry, and it was in that context of the professionalization of American medicine that they codified the distinction between psychoanalysis and (psychoanalytic) psychotherapy. In this commentary on Steven Stern's “Session Frequency and the Definition of Psychoanalysis,” I deconstruct a series of binaries that was built into the analysis/therapy distinction and that has plagued our discipline. It is argued that psychoanalysis identified itself with the culturally “masculine” and heterosexual values of autonomous individuality (the intrapsychic), while it split off all that was relational and social (interpersonal), marked as “feminine,” homosexual, and “primitive,” onto psychotherapy, which it then devalued. The paper then examines the implications for practice and psychoanalytic education.     

UN Convention on the Rights of the Child and Global Childhoods: Transdisciplinary Reflections from Nepal

Abstract

Globally, humans face innumerable socioeconomic, cultural, and environmental problems while being threatened by ever more interconnected and complex geopolitical concerns. In this planetary context, unidisciplinary research and related teaching approaches often work to constrain our ability to move beyond institutional and bureaucratic mind-sets to become agents of social change within local systems impacting children. During its 40-year evolution from a sub-discipline of psychology, the international field of child and youth studies has sought common ground for interpreting these pedagogical and professional issues. Many authors now argue for transdisciplinary approaches to address and overcome these tensions in the effort to re-integrate epistemologies of the global South within more dominant global North knowledge production systems. Such approaches have been posited to add new analytical and methodological tools to achieve praxis—the Greek word for translating theory into practice. Transdisciplinary research transcends the usual gap between academia and the broader public by acknowledging the value of knowledge obtained from diverse, nonacademic stakeholders in the community, government, and business. In addition, these approaches in child and youth studies offer us new possibilities for translating and understanding the local and global implications of implementing the 1989 United Nations Convention on the Rights of Child, and the vast differences in the experiences of childhood amongst and between various socioeconomic, cultural, and political contexts in recognizing their own rights in situ. Moving beyond adult-focused and Eurocentric understanding of the childhood literature (and of children’s human rights), this paper reflects our experiences working with young people affiliated with the Lalitpur Metropolitan City Child Clubs in Nepal, and observing their participatory planning processes for annual budgets. In response to increasing complexity throughout all regions of the world, we consider historical, political, and cultural experiences in Nepal through this transdisciplinary approach to child-centered research and activism. Our paper details key learning and transitions from being “academic researchers” and “observers” of a participatory, child- and youth-focused budgeting process to “collaborators” and “co-constructors of knowledge” with key stakeholders—the young people of Lalitpur, Nepal.     

Regression,Dissociation, Self-States,and the Developmental Dimension in Therapeutic Action

The concept of regression is at the core of psychoanalytic accounts of what goes on in analysis. It is, however, so “in our bones” that we are tempted to overlook it. In its justifiable enthusiasm of theories of self-states and dissociation, Relational psychoanalysis may be underemphasizing how much regression—both to earlier developmental stages and less organized modes of experiencing—is central in our approach to therapeutic activity and mutative action. In responding to Rina Lazar’s analysis with Sheli, I call for enhanced attention to the most powerful Freudian ideas from the new intersubjective perspectives.     

Lernziel: Kontextbezogene psychotherapeutische Kompetenz

Several authors (e.g. Thomä 2004) of critical reviews about psychoanalytical training stated repeatedly, that the learning objective of psychoanalytical training is not to be defined. In the case of psychoanalytical training, being at the same time a pedagogical undertaking, the search for a learning objective is seen as indispensable. Wampold (2001) presented a metaanalysis of psychotherapeutic outcome studies. He examined and evaluated the results of psychotherapeutic research on the basis of hypotheses derived from the “medical model” and the “contextual model”. He concludes that psychotherapeutic treatments based on theoretical models and implementations derived from the “contextual model” are those which are effective. Starting from Wampold’s empirically evaluated theses a definition of contextual psychotherapeutic competence is developed. This definition is proposed to serve as the central learning objective of psychoanalytic education. With regard to this learning objective aspects of a contextual pedagogical conception of the psychoanalytical education are discussed. Which pedagogical theory and concepts of learning and teaching, are to be subsumed under the “contextual model” and are, therefore, suited for psychoanalytical training? What is the difference between psychotherapeutical and pedagogical relationship in psychoanalytic training? What is a contextual pedagogical competence of the analytic teacher? Are learning opportunities in psychoanalytic training apt to challenge psychoanalysts-in-training to develop spontaneously contextual psychotherapeutic competence? With regard to these questions the practice of psychoanalytic training, i.e. self-experience, supervision, imparting of theory and family observation are discussed.     

Exit Dora: Freud's Patient Takes Leave

Why did “Dora” leave Sigmund Freud—why did she end her psychoanalytic treatment with him prematurely? This question haunts Freud's Dora study, his first extensive and perhaps most famous narrative of a psychoanalytic treatment. I pursue this question through a close reading of Freud's text. I focus not only on the interaction between Freud and Dora but also on the literary qualities of “Fragment of an Analysis of a Case of Hysteria” (1905)—qualities that place this work firmly in the tradition of Viennese fin de siècle drama and prose.     

Where Have All the Psychoanalytic Patients Gone? They're Still Here

Abstract

I develop my argument concerning the question of where have all the patients gone in a sequence of three parts. First, I indicate, very briefly, the nature of the issue and the array of confluent socioeconomic causes—as they are usually outlined—that are held responsible for it. Then I take up the remedy for this problem posed by Arnold Rothstein in his book (1998). which is the trigger to this series of invited commentaries, and I indicate how I both appreciate the merits of his proposal to recast the issue as much as possible within a psychological framework, amenable to psychoanalytic influence, and nonetheless feel his approach to be based on a one-sided, and to that extent, a limited and flawed assessment of the problem, and therefore an only partially useful remedial perspective. And lastly, 1 offer an alternative view of the internal historical developments in psychoanalysis that have played their complementary role in the evolution of this perceived “crisis” and the alteration of perspectives, based on my account of our contending current viewpoints on the nature of the relationship between psychoanalysis and its derivative psychoanalytic psychotherapies, that can perhaps promise a more effective counter to the crisis, despite the multiple external socioeconomic developments that are usually accorded causative primacy and that no doubt are indeed formidable.     

Ferenczi and Winnicott: Searching for a “Missing Link” (of the Soul)

The aim of this paper is to present the close link between Ferenczi's and Winnicott's theoretical, clinical and therapeutic thought, indicating how this link has become something of a “missing link” in the history of psychoanalytic ideas, an implication which we retain, in part, to this day. In the first part entitled “Who's speaking to whom?”, I aim to explore the contents of the most essential parts of their messages, stressing the similarities and differences between them, and citing the most important authors whom they address (Freud for Ferenczi, Klein for Winnicott). In the second part, I aim to tackle the general direction underlying both their work and their lives, concentrating specifically on “the maternal”, and examining the repercussions of this aspect on psychoanalytic technique and practice. In the third part, as a kind of “Parting”, I will present further brief conclusions on the relevance and significance of their thoughts in modern day psychoanalysis, defining Ferenczi and Winnicott as “founders of future discursiveness”.