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 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 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.     

Is Psychoanalytic Education Effective? Comment on Damsa et al. (2010)

While a growing body of empirical data attests increasingly to the efficacy of psychoanalytic treatment, what data do we have that attests to the effectiveness of psychoanalytic education? In this comment on Damsa et al. (2010), I briefly address that question and suggest that—if we are to truly generate passionate interest in psychoanalysis among psychiatric residents and other mental health professionals in training—perhaps we need to begin by researching the largely unresearched process of psychoanalytic education and supervision.     

You Can Get Here From There

This paper is a review of my development from psychology intern and research assistant to the psychoanalytic tester and theoretician David Rapaport at the Menninger Clinic in the 1940s, through my career in psychological testing, my psychoanalytic training in the Western New England Institute, and my working successively at the Austen Riggs Center, Yale Department of Psychiatry, Yale Student Mental Health Center, Cornell Department of Psychiatry, and eventually private practice in New York City. During this period, I rose to the academic rank of Professor and the analytic position of Training Analyst. I have written extensively: first on testing, then more or less in turn on psychoanalytic ego psychology, action language for psychoanalysis, feminist issues, narrative in psychoanalysis, and the contemporary Kleinians of London. This memoir traces the intellectual continuity that characterizes these writings and my continuing development as a psycho-analyst—my first ambition and great love.     

Psychoanalysis at the Millennium: A Personal Odyssey

A review of my development from psychology intern and research assistant to the psychoanalytic tester and theoretician David Rapaport at the Menninger Clinic in the 1940s, through my career psychological testing and my psychoanalytic training in the Western New England Institute and my working successively at the Austen Riggs Center, Yale Department of Psychiatry, Yale Student Mental Health Center, Cornell Department of Psychiatry, and eventually private practice in New York City. During this period, I rose to the academic rank of Professor and the analytic position of Training Analyst. I have written extensively: first on testing, then more or less in turn on psychoanalytic ego psychology, action language for psychoanalysis, feminist issues, narrative in psychoanalysis, and the contemporary Kleinians of London. This memoir traces the intellectual continuity that characterizes these writings and my continuing development as a psychoanalyst—my first ambition and great love.     

Max Eitingon and a Question of Politics

Max Eitingon is thought not to have left behind original theoretical work, despite the fact that he wrote some 40 articles and a dozen psychoanalytic congress reports. He has been almost forgotten over the years, even though he occupied an important political place in the history of the psychoanalytic movement. In recent times, he has again become a subject of attention. In this article the author takes a look at Eitingon as an activist who was intensely involved in the social and political struggles of his time. He represents the political aspect of psychoanalysis on two counts: first, within the psychoanalytic movement, where he had a particular role in the institutionalizing of psychoanalysis, and, second, in relating it to wider social and political ends.     

Contemporary Visions of Psychotherapy Supervision: Sharing Perspective,Identifying Need,and Charting Possibility

Psychotherapy supervision has now celebrated its first centennial, is poised to move boldly forward into its second century of contribution to psychotherapy education, and seems perfectly positioned to further advance our knowledge about and practice of how to effectively facilitate, influence, and mentor our supervisees. Professional interest in and recognition of psychotherapy supervision appears to be at an all time high, and its value as a potentially alchemical educational event seems increasingly incontrovertible. But if supervision is to maintain and even enhance its substance and significance in 21st century psychotherapy education, what are the matters to which we as supervision practitioners, researchers, and theorists must vigilantly attend and vigorously address? In this special supervision issue of the Journal of Contemporary Psychotherapy, we would like to examine some of those matters. The topics that are addressed include: competencies, evidence-based practice, and supervising psychoanalytic/psychodynamic, cognitive/behavioral, humanistic/existential, and integrative/eclectic psychotherapies. The binding theme of “pressing needs and impressing possibilities” will be evident throughout this journal issue. In this introductory paper, I briefly define psychotherapy supervision, consider its beginnings, provide a rationale for this special issue, and identify the specific questions that give focus and frame to each of the succeeding contributions.     

The Berlin Poliklinik: psychoanalytic innovation in Weimar Germany

After Freud proposed in 1918 the creation of "institutions or out-patient clinics [where] treatment will be free," Max Eitingon, Ernst Simmel, and other progressive psychoanalysts founded the Berlin Poliklinik, a free outpatient clinic. Guided by Weimar Republic principles of "radical functionalism," the Poliklinik and its companion inpatient service, the Schloss Tegel Sanatorium, pioneered treatment and training methodologies still used--and still debated--today. Their funding strategies, statistics, and approaches to clinical problems like length of treatment tell the history of an innovative psychoanalytic institute where men and women were generally treated in equal numbers and patients (ranging in occupational status from unemployed to professional) of all ages were treated free. Franz Alexander, Karl Abraham, Theresa Benedek, Paul Federn, Otto Fenichel, Edith Jacobson, Karen Horney, Erich Fromm, Helene Deutsch, Hanns Sachs, Sándor Radó, Hermine von Hug-Hellmuth, Wilhelm Reich, Annie Reich, and Melanie Klein all worked at the Poliklinik, and from there initiated decades of original clinical theory, practice, and education.     

The Search for Integration or How to Work as a Pluralist Psychoanalyst

In my professional path, I strove for the integration of my identity as a psychiatrist and as a psychoanalyst, in the frame of pluralism, which exists in modern psychoanalysis. Having been trained in a Kleinian approach, I will explore the painful breach experienced during my parallel trainings as a psychoanalyst and as a dynamic psychiatrist. I worked for five years as a psychoanalyst and a researcher in Germany and was involved to a large extent with the psychoanalytic world, which increased my self-definition as a pluralist. On my return to Chile, I discovered the need for political changes in the psychoanalytic society and curricular modifications in my training institute to recover psychoanalysis from its academic isolation. Finally, I will analyze the extant connections between the ideology of pluralism in psychoanalysis and its application in clinics. I will show that the exploration of the inference processes of the psychoanalyst inside a session—the psychoanalyst's mind at work—demonstrates that the analyst in fact functions as an artisan thinker. This means that pluralism—that is, the use of more than one theoretical frame and of different levels of abstraction and explicitness—is the way the majority of psychoanalysts “naturally” work. What probably differs is the self-consciousness, scope, and rank of pluralism.     

Book Reviews

Book reviewed in this article:
Escritos clnicos sobre perversiones y adicciones [Clinical essays on perversions and addictions] Edited by Rodolfo Moguillansky
The present moment in psychotherapy and everyday life by Daniel N. Stern
Sndor Ferenczi: El mejor discpulo de Freud [Sndor Ferenczi: Freud s best disciple] by Antoni Talarn
Blind trust: Large groups and their leaders in times of crisis and terror by Vamik Volkan
Sigmund Freud Max Eitingon, Briefwechsel 1906-1939 [Freud Eitingon correspondence,1906 1939], Vols 1 and 2 Edited by Michael Schrter
The texture of treatment: On the matter of psychoanalytic technique By Herbert J. Schlesinger
Family romance, family secrets: Case notes from an American psychoanalysis,1912 By Elizabeth Lunbeck and Bennett Simon
Hate and love in psychoanalytic institutions. The dilemma of a profession By Jurgen Reeder     

The technique of psychoanalytic therapy

This article is reproduced in translation a half century after its original presentation by Dr. Horney. It was her first psychoanalytic publication and her first article on psychoanalytic technique. In it we get glimpses of future directions of her thinking and of the spirit of research and investigation which so characterized her life's work — Editor.     

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.     

BEFORE ATTACHMENT THEORY: SEPARATION RESEARCH AT THE TAVISTOCK CLINIC, 1948–1956

This article traces the formation of attachment theory to the pioneering research program of Bowlby and his colleagues at the Tavistock Clinic between 1948 and 1956. Through a discussion of the concepts and practices that informed Bowlby's program, I examine the efforts of his team to reconstruct psychoanalytic objects according to preventive objectives and operational criteria. I discuss how the exploratory techniques that Bowlby and his colleagues were developing during these years ultimately led to the establishment of a hybrid investigative framework, in which the prophylactic requirements of mental hygiene, the psychometric model of personality disturbances, the psychoanalytic theory of object relations, and a direct‐observational methodology were brought to bear on the problem of the psychological consequences of early separation experiences. I further claim that this shift in investigative practice was crucial for the succeeding theoretical developments that eventually gave rise to the statistically validated constructs of attachment theory.     

A reassessment of psychoanalytic education: Controversies and changes2

To understand the many controversies surrounding psychoanalytic education, it is necessary first to understand the unique role played by education in our field where control of educational structures remains the most important measure of professional success for the majority of psychoanalysts. To keep debate about educational policy focused on the task of strengthening the intellectual basis of psychoanalysis, it is also necessary to understand that forces affecting education arise from at least three different domains which can too easily become confused with one another: 1) the domain of knowledge‐ intellectual, scientific and clinical; 2) the domain of the organized professional community; and 3) the domain of local institutional politics. The authors explore controversy arising within and among each of these domains. They also explore the major alternatives proposed to the Eitingon model of psychoanalytic education, arguing that excessive authoritarianism in education arises not from the existence of hierarchical structures per se (as suggested by the ‘French model’), but from two other factors: the condensation of all important professional functions into the single ‘monolithic’ position of the training analyst, and the lack of agreed upon methodology for determining the validity of theoretical propositions. The solution lies not in obliterating all gaps in expertise and status by doing away with hierarchical structures altogether, but rather in strengthening the intellectual, scholarly and research context within which psychoanalytic education takes place. We must attempt to relocate our experience of a gap where it belongs: not between those who are training analysts and those who are not, but between what we feel we already know about mental life and what we do not yet know.     

Unpacking Competitiveness Within and Between Women: Discussion of “With Friends Like These,Who Needs Enemies?”

F. Diane Barth’s paper (this issue) illustrates how a woman’s competitiveness can set her up for significant psychic conflict and interpersonal strife. Achievement strivings are an arena in which “being for oneself” may undermine—in fantasy, but also in reality—one’s ability to “be for the other,” and vice versa. My discussion contextualizes Barth’s thinking in relation to earlier psychoanalytic explorations of the female gender identity and its development. I elaborate on the special challenges involved in the achievement-oriented and competitive urges of women in particular, and I attempt to parse more fully the diverse nature and motivational wellsprings of such strivings. While recognizing the author’s clear helpfulness to the patient, I raise a few questions about her theoretical position and technical approach in the case study she presents. In particular, I address what seems to me to be a dominant-submissive element that to some extent reenacts the competitive dynamic being analyzed.     

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.     

The Task of the Translator

This discussion reflects closely on Dominique Scarfone’s call to consider psychoanalysis as a practice founded on ethics, and to rely on this premise in charting a fundamental common ground such that has eluded psychoanalysis for most of its history. Out of the three points Scarfone centers on, I dedicate most attention to the third—psychoanalysis as modeled on the notion of translation—because I find his suggestion inspiring, and promising toward the goals he sets for his paper. Building on the basis Scarfone offers in this context with the help of ideas developed by Walter Benjamin and Emmanuel Levinas, I suggest that the vision that can pull us together as psychoanalysts indeed relies on an ethics of attending to the other’s speech, its meaning as well as its fundamental yet complicated striving for comunicability. More specifically, we need to recognize that words can hide our need to say them. That what we say obscures our vulnerability and shame. That when we try to recall, the language we speak is distorted by the personal and historical forces collaborating to make us forget ourselves. I argue that the task of the psychoanalytic translator is therefore to uncover and resignify the scattered, coded fragments; to help us restore our ability to tell our stories; and to recognize that more than everything, we want to tell them.     

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.