Talking About Supervision

10 Questions, 10 Analysts = 100 Answers

Laura E. Rubinstein

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9780367327347
• eBook ISBN: 9780429919800
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book offers us the wisdom of a distinguished group of international psychoanalysts about supervision and other aspects of the psychoanalytic training experience. It serves as a stimulus to our thinking about the most important aspect of psychoanalytic education.

Interviews

1
Jacqueline Amati Mehler

(Italy)

Every time I thought about possible answers to each of the ten questions, I felt tempted to begin by saying “it depends … “. In fact, some of the answers could differ according to the individual candidate who comes to my mind, the Institute to which he or she belongs, and the general culture in which the training takes place. This requires a clarification. We know that since the beginning of psychoanalysis theoretical debates have existed throughout the world, producing both institutional upheavals as well as an enriching of psychoanalytic knowledge. What has, in my opinion, been a less positive outcome is that such debates throughout the IPA have resulted in the variation of training standards most often connected to institutional politics rather than policies base on the result of an adequate research about training systems and their outcome. In this sense I think that, unlike two or three decades ago, training systems today are so different that I am not sure that we would all agree on how to define what psychoanalysis is. I therefore very much welcome this opportunity to confront various policies, rather than politics, on issues about training.

1 How much choice should candidates have in selecting their supervisor, and what are the qualities they should look for in him or her?

In principle, I believe candidates should have the right to choose their supervisors within their own Institute. However, from my experience, having had the chance to visit and supervise in several Institutes, I have been able to observe that sometimes candidates might request supervision from “famous” analysts or supervisors who are experienced as having some kind of real or phantasized institutional power, regardless of their capacity to supervise. This capacity, in my opinion, requires that the supervisor have long-standing clinical psychoanalytic experience and psychoanalytic theoretical culture such as to enhance the candidate’s capacity to visualize the clinical material from more viewpoints-in other words, to foster a non-eclectic pluralism strongly attached to Freudian theory and post-Freudian contributions. The supervisor, in my opinion, is an important figure who bridges the pathway leading from personal identity to professional and institutional identity. This said, we know that not all good and/or scholarly analysts tum out to be adequate supervisors. That has often been a reason to claim that supervisors need not be training analysts or very experienced analysts. I do not agree with this, for two main reasons.

(1) An institutional reason: the supervisor should be someone who is knowledgeable about institutional training problems-that is, the impact of his or her person and the Institute on the trainee, the displaced transference from one’s own training analyst onto supervisors and teachers, the peer interactions, and other issues that have been very well dealt with by Innes-Smith (1997), who claimed that a psychoanalytic candidate who must pass through the different elements of the tripartite structure

is exposed to a very complex dynamic situation which is specific to psychoanalysis. Although this may seem to complicate things, it is also part of the richness and profundity of the analytic experience. Because of its multiple functions, supervision demands different forms of communication, some of them familiar from other contexts, as is the language of teaching, for instance. However, this alone will not be adequate to discuss the free associations of the patient or the formulation of interpretations. So, as the candidate progresses, there is a change in the forms of communication which he is called upon to use, he learns to pass from one to the other in a flexible way, which constitutes one of the essentials of his training. Supervision plays a central role in the acquisition of this capacity …. [p. 90]

Innes Smith further claims-and I agree with him-that psychoanalytic supervision is not the same as other forms of supervision, and that

In trying to see this more clearly we may come nearer to distinguishing psychoanalysis from other forms of psychotherapy …. [p. 90]

(2) A scientific reason: the supervisor should be clinically and theoretically knowledgeable, which requires several years of personal psychoanalytic practice. I also believe that a supervisor should have developed experience with different psychopathologies in order to help the candidate deal with the different psychic functional levels that coexist within neurotic organizations. Regressed patients or serious pathologies call for countertransference reactions and defences, and a knowledgeable supervisor should be able to help the candidate to focus on and understand such reactions or help the candidate individuate blind spots to be explored in his or her own analysis. It is also necessary that the supervisor be as open-minded as possible when helping the candidate to understand the complexities of the mind that might require considering different psychoanalytic paradigms in order to connect or view clinical material from more perspectives. I consider this to be very important because it will in any case foster open-mindedness in the future analyst, regardless of the supervisors’ or other teacher’s views, and, last but not least, a better appraisal of the clinical material. A capacity to “understand” early and late Freud combined with a pluralistic approach is, far from eclecticism, a quality that candidates should search for in their choice.

Another quality that a candidate should search for in a supervisor is somebody who is able to be outspoken and help the student to realize mistakes and explore his or her countertransference, inasmuch as self-reflection and self-analysis when in contact with the patient is part of the specificity of psychoanalysis.

The priority given to the intra-psychic in his analysis will not only help the candidate to arrive at his own capacity for self-analysis, as with any personal analysis, but also to recognize and differentiate the different levels in the hierarchy of communication in his training and later in his own consulting room. [lnnes-Smith, 1997, p. 89]

2 What should today’s candidates expect to be the future of psychoanalysis, and, in light of that, what are your recommendations to them?

I would suggest that we should differentiate between what a candidate should expect and what can be expected to be the future of psychoanalysis. The kind of training and the sociocultural conditions experienced will determine what he or she can expect of the future, taking into consideration the local situation and its relationship with and within the international panorama. I have written very often about the so-called crisis of psychoanalysis, saying that I do not think it is psychoanalysis in itself as a discipline and theory of the mind that is in crisis. On the contrary, it is thriving. Rather, it is psychoanalysts who are in crisis and this, in turn, has an impact on the way in which the profession is currently being developed. Many have lost trust in our psychoanalytic tools and specific method, and they advocate changes in the setting either for economic or social reasons or because the current patients present psychopathologies that provoke conscious or unconscious defences. The outcome is that patients with serious pathologies, many of them analysable, are displaced to other mental health professions or therapeutic methods, whereas they belong in the domain of psychoanalytic treatment.

Essentially, the trend among professionals in many Institutes and Societies is to give priority to socioeconomic issues rather than to privilege an allegiance to the specificity of our discipline and the necessary requirements in order to transmit psychoanalysis and its professional practice. It is not that we should neglect socioeconomic issues at all. It is the solutions that our psychoanalytic community is privileging that put at stake the future of psychoanalysis and put a question mark on the future survival of psychoanalysis that candidates should be able to expect. Therefore, what a candidate can expect from the future is connected, on the one hand, with the policies that local or international administrations of the psychoanalytic community can “invent” in order to deal with the economic problem and the ways of investing their economic resources. On the other hand, what a candidate can or should expect from the future is connected with the training policies put in place to transmit psychoanalysis, whether one chooses to become a clinician, an academic, or a researcher.

I have often said that loans to gifted candidates ensure a better future to our profession than money invested, for example, in empirical research. Bad practice resulting in the decay of psychoanalytic credibility will not be solved by scientific validation of our theories. What a candidate should expect is to get the best training opportunities and economic aid when necessary in order not to have to “sacrifice” good psychoanalytic experience in favour of (albeit meaningful and necessary) prevalent psychotherapeutic practice. However, this is what happens currently in many Societies because: (1) patients cannot pay and therefore resort to short-cut treatments, which (2) the candidate might agree to (even if an analysis is indicated) either because otherwise he or she would not have patients or because he or she needs to survive economically during a costly training. Fewer sessions, we all know, can be charged at a higher rate.

I would also like to mention that one of the solutions proposed to solve current problems, such as the lack of analytic patients and economic or social strain, has been that of shortening the training—especially the training analysis—or even doing away with training analysts. I have dealt with this elsewhere in a Forum on Training problems, at the 2004 IPA Congress in New Orleans. Let me just say that, paradoxically, the more we acquire knowledge of archaic mental content and functioning—implying not only longer and deeper analyses, but also major intersubjective involvement on the part of the analyst—the more there is a tendency to:

1. shorten the training analysis;
2. consider obsolete a group of more experienced analysts who have acquired the function of training analyst by virtue of their competence, demonstrated through transparent and fair methods of peer evaluation;
3. upgrade parallel-trained psychoanalysts or psychotherapists with a psychoanalytic orientation within the IPA, rather than upgrade the training of psychoanalysts to render them capable of psychoanalysing patients with pathologies hitherto considered unanalysable.

One could wonder whether the possibility of exploring—and thus ourselves being internally exposed to—deeper and more primitive psychic layers within the transference-countertransference interaction enhances, as mentioned above, defensive attitudes and theoretical arguments for the displacement of certain pathologies onto other methods of treatment. In fact, in order to treat the so-called current pathologies, some people think that we need to resort to modifications of our method. While this is true for many cases (even for neurotics), for many others it is the lack of adequate training and internal preparation that prevents analysts from being able or qualified to deal with cases that do not fall into the classic category of neuroses.

An adequate training analysis should lead one to explore one’s own mad and psychotic levels, to diminish the blind spots and defensive distancing from such areas of psychic functioning of our patients. Supervisors are in a privileged position to monitor the candidates in these processes at the beginning of their professional development. This requires, on the part of the analyst, vast clinical experience and competence to explore such areas whose existence we start learning about from our own personal analysis, but which only heralds the need to further develop adequate psychoanalytic skill and psychoanalytic knowledge to deal with them. Such capacities are built up over a period through the continuous development of self-analytic ability by virtue of sufficient and consistent psychoanalytic practice with different pathologies and with knowledge about different theoretical paradigms.

3 Are there suitable patients for analysis still out there? And how are the candidates to find them?

I believe that the response to this question is contained in my above statements. I might just have recalled that in one of our many international training forums the difficulty of finding analytic patients was thoroughly discussed. Without neglecting external reality, there was consistent evidence that in the same area, with its shared local characteristics, some candidates would find control cases while others would systematically fail to find analytic patients. It is certainly true that our current culture, endowed with increasing uncertainty, collective fears, and a tendency to quick and rapid gratification, does not enhance self-reflection or attention to individuality. Nevertheless, I have often thought that perhaps it is not only analytic patients that are lacking. I tend to think that there might be fewer psychoanalysts able to find patients or to encourage a psychoanalytic journey.

4 How and to what extent do you recommend candidates to study/read Freud’s writings?

I believe that reading and studying Freud is not an option, it is a must. But I would like to clarify that I do not think that reading Freud and studying Freud is the same thing. Many students have read Freud at university and even quite extensively during their residencies as psychologists or (at least in some places) during their psychiatric residencies. However, when they start the training at the Institute, they “realize” that they knew a “different” Freud.

Let me give an example from my own teaching experience (both in seminars and in supervision). After reading Freud’s “Formulations on the Two Principles of Mental Functioning” (191lb), most students are capable of describing the main themes dealt with in the paper: the pleasure principle and its interaction with reality, as well as the way in which these processes are intertwined with primary and secondary processes. Merely reading it without exploring and studying its connections with the “Project” (1950 (1895d]), the essay on aphasia (1891b), and The Interpretation of Dreams (1900a) (abundantly mentioned in the footnotes of the Standard Edition) will lead to a very limited understanding of this short paper. This is essentially for two reasons: (1) because candidates would miss the historic development of Freud’s thinking and of the building-up of a model of mental functioning that he revised throughout his life; and (2) it would prevent them from realizing what we need to put together-like the pieces of a puzzle-in order to be able to get the picture of what happens during the journey that transforms the body ego into the ego proper, the fate of cathected mnestic traces connected with experiences of satisfaction or frustration, and the foundations of thought processes through the link of thing-presentations with word-presentations. All these issues need to be studied, not just read. It is also very important that candidates realize that different concepts were formulated but, several times and for different reasons, were reviewed and changed throughout Freud’s life. This is why in my teaching I insist quite strongly that constant references and quotations in the editor’s introductions and footnotes of the Standard Edition require the same attention as the main text.

5 Have you ever supervised a candidate with a language and culture other than your own? If so, what useful advice can you give us for such supervision?

Yes, I have often supervised candidates with a different culture from my own. As far as the language is concerned, it has not been much of a problem for me because I speak several languages. In a book that I co-authored on multilingualism (The Babel of the Unconscious: Amati-Mehler, Argentieri, & Canestri, 1993), we dealt with many issues related to the analytic relationship when analyst and patient do not share the same mother tongue or culture. When we supervise, I think that the problems involved regarding the language are different from those regarding the culture. I also think that in a supervisory situation we should consider a threefold problem-not only the difference between the candidate and the supervisor, but also the language and the culture of the patient-and listen to what countertransference currents are at play on this three-dimensional stage. Is the patient’s language the same as that of the candidate, or is it the same as that of the supervisor? Am I supervising a candidate in a country other than my own? Or am I supervising a foreign candidate in my own country? All these situations imply different issues that would require individual solutions. In my experience, what I have found very interesting are the communicative events in group supervisions with candidates of different languages and/or cultures-for example, in some international or regional meetings. What I have experienced while listening to the discussions about the clinical material presented by the different participants led me to understand how we did not only need to translate the terms, but also explore together how the same term could have a different meaning according to the psychoanalytic model envisaged by that particular participant. Such situations often proved to be fruitful learning experiences while trying to establish not only linguistic but also conceptual bridges between different psychoanalytic cultures, resulting in the enrichment of the possible significance of the material and the way it was “listened to and thought about”.

Of course, if we add to the linguistic and the conceptual differences another dimension-namely, that of more extreme differences in the sociocultural milieus of the supervisor and the supervisee-then I believe that we need to be very cautious about the way we attribute significance to the material communicated. I have not had the experience of supervising in cultures that were much too different from those that I have known through various emigrations. However, I am sure that if I were to supervise in China or Japan, I would need to learn much more about the cultural aspects and the impact of the culture on the signs and words used to...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• CONTENTS
• PSYCHOANALYTIC IDEAS AND APPLICATIONS SERIES
• EDITOR AND CONTRIBUTORS
• PREFACE AND ACKNOWLEDGEMENTS
• Introduction
• Interviews
• Commentary
• REFERENCES
• INDEX