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.     

The explicit and implicit dance in psychoanalytic change

How the implicit/non-declarative and explicit/declarative cognitive domains interact is centrally important in the consideration of effecting change within the psychoanalytic arena. Stern et al. (1998) declare that long-lasting change occurs in the domain of implicit relational knowledge. In the view of this author, the implicit and explicit domains are intricately intertwined in an interactive dance within a psychoanalytic process. The author views that a spirit of inquiry (Lichtenberg, Lachmann & Fosshage 2002) serves as the foundation of the psychoanalytic process. Analyst and patient strive to explore, understand and communicate and, thereby, create a 'spirit' of interaction that contributes, through gradual incremental learning, to new implicit relational knowledge. This spirit, as part of the implicit relational interaction, is a cornerstone of the analytic relationship. The 'inquiry' more directly brings explicit/declarative processing to the foreground in the joint attempt to explore and understand. The spirit of inquiry in the psychoanalytic arena highlights both the autobiographical scenarios of the explicit memory system and the mental models of the implicit memory system as each contributes to a sense of self, other, and self with other. This process facilitates the extrication and suspension of the old models, so that new models based on current relational experience can be gradually integrated into both memory systems for lasting change.     

Countertransference, supervised analysis, and psychoanalytic training requirements.

Because psychoanalysts have an ever expanding appreciation for the many factors that contribute to the psychoanalytic treatment process, they no longer view themselves simply as the receiver of the patient's transferences. When patient and analyst meet in the consulting room, they bring along with them a blend of intrapsychic and external ingredients--including countertransference--that make up the analytic soup. Candidates in psychoanalytic training must contend with even more sources of indirect countertransference reactions (Racker 1968) than experienced graduate analysts, due to aspects of the training experience itself. The author contends that minimum graduation requirements for supervised analyses are one such source of indirect countertransference. Four clinical examples of control analyses demonstrate this form of indirect countertransference during the assessment, opening, middle, and termination phases. These examples are followed by implications and recommendations for didactic psychoanalytic training curricula, countertransference awareness, supervision of control cases, institute governance policies and procedures, publication of clinical material, and future research.     

After pluralism: Towards a new,integrated psychoanalytic paradigm1

After a restatement of the isolationism of psychoanalysis from allied disciplines, and an examination of some of the reasons for the diversity of schools of thought and the fragmentation of psychoanalytic knowledge, the author suggests the need to adopt principles of correspondence or external coherence along with those of hermeneutic coherence to validate psychoanalytic hypotheses. Recent developments in neurocognitive science have come to the aid of psychoanalysis in this period of crisis, resulting in the proposition of integrating both areas to form a new paradigm for the construction of the theory of the mind. This emerging paradigm tries to integrate clinical knowledge with neurocognitive science, fi ndings from studies on the process and outcome of psychotherapy, research into the early mother‐infant relationship, and developmental psychopathology. The author examines theoretical‐ technical models based on the concept of drives and of relationships in the light of interdisciplinary fi ndings. He concludes that the relational model has a broad empirical base, except when the concept of drives is discredited. Interdisciplinary fi ndings have led to the positing of the replacement of the Freudian model of drives with a model of motivational systems centred on affective processes. He draws certain conclusions which have a bearing on the technique of psychoanalytic treatment. These arise from the adoption of the new integrated paradigm.     

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.     

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.     

INTERFACING INFANT MENTAL HEALTH KNOWLEDGE: PERSPECTIVES OF SOUTH AFRICAN SUPERVISORS SUPPORTING LAY MOTHER–INFANT HOME VISITORS

This article is part of a project investigating the interfacing of clinically and research‐generated knowledge in the field of infant mental health (IMH) with local cultural models of child care and development. The article explores the experiences and challenges reported by psychology‐trained supervisors in supervision with local, lay, trained home visitors. Supervisors and supervisees were drawn from two early intervention programs which apply relational IMH mental health models in socioeconomically deprived townships in South Africa. Literature that considers supervisors’ experiences of conducting supervision with lay counselors has been limited, and even more so in settings where there are marked cultural and contextual differences between supervisors and supervisees. These differences pose particular challenges regarding the finding of a shared theoretical understanding of the work as well as to the establishment of a secure working alliance. While it was found that psychoanalytic and attachment‐informed theories of infant development are applicable in these South African settings, differences in race, language, education, socioeconomic status, and culture between supervisors and supervisees challenge the supervisor–supervisee relationship and require psychological processing and creative solutions to ensure integrity in the application of the model.     

A consideration of knowledge and authority in the case seminar

This paper examines difficulties in the management of knowledge and authority evidenced in some case seminar settings. The author suggests that the traditional model for the case seminar has not kept pace with evolving ideas about authority and knowledge in the psychoanalytic situation. The tension between our current ways of conceptualizing knowledge and authority in psychoanalysis, and the often unwitting idealization and constriction of knowledge and authority in the case seminar format, are explored. Following a review of the literature on the case seminar, three recommendations for change are discussed: (1) differentiation of the goals of the seminar from those of supervision; (2) reconsideration of the way in which the 'failed case" is discussed; and (3) encouragement of the instructor to present clinical material.     

Gender on the modern-postmodern and classical-relational divide: untangling history and epistemology

This essay considers the historical periodization and epistemology of psychoanalytic thinking about gender. Overlapping historically with feminism itself, psychoanalytic thinking about gender has two periods of efflorescence, the 1920s and 1930s, and the contemporary period beginning in the 1970s. Two divides have characterized our gender thinking, the modern-postmodern and the classical-relational. From the early theorizing of the 1920s and 1930s until around the early 1990s, most psychoanalytic thinking about gender should be considered modernist, as it draws on traditional views of scientific evidence and holds more universalistic and dichotomized conceptions of men and women. In the contemporary period, although postmodernism tends to be associated with relational psychoanalysts and modernist thinking with classical analysts, the divisions overlap. The author argues that considering any psychoanalytic theory as "premodern" is misleading: from its inception, psychoanalysis formed part of modernism.     

Neutrality,tenderness and the analyst's subjectivity

Addressing the rôle of the analyst in the psychoanalytic relationship, the author takes issue with the emphasis on acknowledging the analyst's subjectivity and the critique of concepts like neutrality and abstinence as these issues are presented in the relational tradition. He advocates a better articulation and emphasis of these concepts in the service of understanding the impact of the analyst's subjectivity, and demonstrates how the mere loosening up of analytic neutrality and abstinence and an acceptance of the analyst's self-disclosure make transference analysis more difficult to handle. Such an attitude also increases the risk for ethically dubious conduct, since there is a close link between clinical methods and ethical standards in psychoanalysis. In conclusion, the author points to the importance of the analyst's continuous self-reflection and countertransference analysis.     

The “Rituals” of the Relational Perspective: Theoretical Shifts and Clinical Implications

This paper attempts a closer look at the theoretical foundations for some of the clinical shifts that underlie a relational psychoanalytic approach. It also posits that what unites relational writers who come from different psychoanalytic traditions—that is, Freudian, Kleinian, Object Relations, Self Psychology—has more to do with the kinds of questions asked than with the particular answers that are offered. Specifically these questions have to do with the epistemological basis for how we know what we know as analysts, the model of mind we employ to understand our patients, and the mode of therapeutic action that evolves from these two earlier shifts. Several clinical examples are offered.     

Supervision and Analysis at a Crossroad: The Development of the Analytic Therapist: Discussion of Papers by Joan Sarnat and Emanuel Berman

This discussion of papers by Sarnat and Berman on psychoanalytic supervision explores the complex nature of the contemporary psychoanalytic supervisory relationship. It considers how developments in psychoanalytic theory and practice, reflecting relational, intersubjective, attachment, and field theory influences over the past 30 years, have changed the ways in which many analysts practice and theorize supervision. Contemporary supervisors attend not just to the patient being presented, or to the therapeutic dyad, but to the supervisory relationship itself as part of the clinical/supervisory frame of reference. Similarities and differences between therapy and supervision are considered.     

New Windows on Understanding Addictive Vulnerability: Commentary on Papers by Lisa Director and Noelle Burton

The author discusses papers by Director and Burton, placing their work in a context of contemporary psychoanalytic models for understanding addictive behavior. Whereas early psychoanalytic models stressed drive theory and a topographic model of the mind, the contemporary models discussed here emphasize themes of dissociation—integration, helplessness—omnipotence, self-organization, and relational therapy. The author considers how these modern themes resonate with psychoanalytic formulations of addictive vulnerability that have considered disturbances in affect recognition/tolerance, self-esteem, relationships, and self-care. The author concludes by suggesting that the dyadic paradigms advanced by Director and Burton likely have implications for psychodynamic group treatments.     

PSYCHOANALYSIS AND COGNITIVE BEHAVIOUR THERAPY ‐ RIVAL PARADIGMS OR COMMON GROUND?3

The author suggests that contemporary enthusiasm for cognitive‐behavioural therapy reflects our longing for swift, rational help for psychological suffering. Competition for funding threatens the psychoanalytic presence in the public sector. The psychoanalytic and cognitive‐behavioural models are contrasted, and the relative richness of the psychoanalytic paradigm outlined. The author suggests that a cognitive model is commonsensical, but less complex, with less potential explanatory and therapeutic power. She discusses how the analytic stance is always under pressure to ‘collapse’ into simpler modes, one of which resembles a cognitive one. This also occurs inevitably, she argues, when attempts are made to ‘integrate’ the two models. Cognitive and ‘integrated’ treatments nevertheless have the advantage that they are less intrusive and hence more acceptable to some patients. Selected empirical process and outcome research on cognitive and psychoanalytic therapies is discussed. Brief psychotherapies of either variety have a similar, modestly good outcome, and there is some evidence that this may be based more on ‘dynamic’ than ‘cognitive’ elements of treatment. Formal outcome studies of more typical psychoanalytic psychotherapy and of psychoanalysis itself begin to suggest that these long and complex treatments are effective in the more comprehensive ways predicted by the model.     

Intersubjectivity Theory and the Dilemma of Intersubjective Motivation

This paper explores the topic of intersubjective motivation, understood as the process of being motivated by the subjectivity of other subjects. The author outlines a general conception of intersubjective motivation, arguing for the importance of that conception in advancing the relational project within psychoanalysis. The author reviews a handful of relational and intersubjective approaches, identifying and evaluating strategies that might be employed to explain the phenomenon of intersubjective motivation. Using Jessica Benjamin's theory of intersubjectivity as a starting point, the author proposes an original model of the intrapsychic conditions for intersubjective motivation identified as the intersubjective relational configuration. The clinical implications of these ideas are traced out, and an argument is made for the development of a comprehensive psychoanalytic theory of motivation, one that includes intrapsychic as well as intersubjective elements.     

The “death of freud”; and the rebirth of free psychoanalytic inquiry

The relevance of Grunbaum's recent critique of psychoanalytic theory is explored as it relates to relational/interpersonal theories. Griinbaum finds no scientific evidence for repression, the cornerstone of psychoanalysis. I argue that studies demonstrating the effects of motivated, unconscious processes are beginning to emerge in psychological research. This research, as well as interpersonal theory, refers to these processes as dissociated, not “repressed.”; I agree with Griinbaum that scientific validation of psychoanalytic theories of the mind, personality, and change cannot be gleaned from case studies alone. In relational theories the analytic situation is admittedly “contaminated”; with the analyst's participation by its very nature. There is beginning to be support for some relational hypotheses, but measures to validate these hypotheses are only now being developed. Grunbaum's criticisms have come at a time when the convergence between relational theories and theories in social/clinical psychology makes it more likely that relational hypotheses will be articulated in a more precise manner by researchers, if not by analysts.

The issues of the difficulty of measuring unconscious processes and the quest for knowledge seemingly beyond human limitations are addressed. Psychoanalysis is not only less than scientific, but more encompassing, in that it is also a creative activity that cannot be understood through science alone.

Science is not enough, nor art: In this work patience plays a part [Goethe].

The most beautiful and deepest experience a man can have is the sense of the mysterious.... To me it suffices to wonder at these secrets and to attempt humbly to grasp with my mind a mere image of the lofty structure of all that there is [Albert Einstein, quoted in Pagels, 1985].     

Thinking about psychoanalytic curricula: an epistemological perspective

The author discusses the role that curriculum development can play in preparing psychoanalytic candidates to understand the challenges created by theoretical pluralism in our field and by the growth of knowledge in neighboring disciplines. Curriculum design can be used to encourage the development of epistemological perspectives that can serve as organizing frameworks to help candidates think critically about psychoanalytic knowledge. It is possible to teach these complex matters in a way that students find accessible and useful. The author presents exemplars taken from the curriculum at the Columbia University Center for Psychoanalytic Training and Research in New York.     

Has Sexuality Anything to Do with Relationality?

This paper discusses sexuality in the framework of relational psychoanalysis. Contemporary psychoanalytic approaches, turning away from drive theory, often abandoned sexuality altogether. This paper calls for a return to the centrality of sexuality in understanding the mind, development, and interpersonal/object relations. The author emphasizes a relational approach that highlights dialectical thinking, the third, and that positions sex and sexuality as the link between the intersubjective and the intrapsychic, highlighting the private, internal, enigmatic, and fantastic realm along with the pragmatic, bidirectional, two-person exchange. The paper discusses how our way of thinking and working clinically with sexuality has shifted accordingly.     

The concept of the 50-minute hour: Time forming a frame for the unconscious

Abstract

The 50-minute hour is a feature of psychoanalytic work that is most commonly discussed in the context of case reports. This paper examines it as a concept. The author starts by describing the origin of the 50-minute hour and its development as an element of the psychoanalytic setting or framework. Next, he considers the significance of the clock as a relational factor in the session and reflects on the alienness of the time of day to the unconscious, and the consequences of this alienness. He then uses a clinical example to illustrate the phenomenon of the stretching effect of time in analytic sessions. Finally, the author demonstrates how cleverly the 50-minute hour excises the time needed for unconscious processes from our accelerated present; he shows that it challenges the social convention of time, and has a structuring effect in that it “times” psychic processes.     

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.