The Third Eye

Supervision of Analytic Groups

Meg Sharpe

• Publisher: Routledge
• Year: 2003
• Print ISBN: 9780415106344
• eBook ISBN: 9781134844449
• Topic: Psicologia
• Subtopic: Salute mentale in psicologia

The Third Eye provides a detailed and practical exposition of one of the most important but least documented skills required of those practising in the expanding discipline of group analysis. The relevance of the material, which is contributed from the dual perspective of both experienced practitioner and inexperienced trainee, extends far beyond its field of origin. It will be of significant interest to a wide readership of all those concerned with the training assessment and development of others working with groups.

Chapter 1
The integration of theory and practice

Harold L.Behr

Supervision lies in the terrain between the teaching of theory and practice of therapy. As such, it allows for an integrated experience which combines the conceptual thinking of the former with the experiential learning of the latter. In supervision the supervisee’s work comes under the benign scrutiny of the supervisor, enabling the two to focus together on the supervisee’s skills and technique, and providing a major influence on the supervisee’s overall professional development.

In the context of individual psychotherapy, supervision can be seen as a conversation between two persons about a third. However, the conversation is carefully structured, and the situation is complicated by the fact that the third person is never physically present. A series of relationships arises within a common matrix. The therapeutic relationship between supervisee and patient is brought into the supervision room through the reporting of material from the therapy sessions, and this in turn impinges on the supervisory relationship. Supervisor and patient are destined never to meet, yet each affects the other through the intermediacy of the therapist. The purpose of supervision is twofold: firstly, to catalyse the therapeutic relationship for the ultimate benefit of the patient, and secondly to enhance the supervisee’s skills as a therapist. It is assumed that the supervisor has certain attributes, be they greater knowledge, experience or ‘know-how’, which can be imparted to the less knowledgeable, less experienced supervisee. Supervision therefore becomes a way of transmitting an accumulated body of knowledge and expertise from one generation of therapists to the next. It is a vehicle for the ‘oral tradition’ of the school of psychotherapy which it represents.

In the context of supervision for group psychotherapy, an analogous process occurs. Here the focus moves between the supervisee’s therapeutic relationship with a group of patients (referred to in a training context as the training group) and the supervisory relationship, which may be with just one person (the supervisor) or with a whole group. The supervision group can be understood as a figure-ground constellation, the foreground of which is usually occupied by the interaction between the supervisee and the training group, while the background constitutes a kaleidoscopic pattern of configurations which connect the therapeutic relationship, the supervisory relationship and the wider training setting, including the supervisee’s relationship with the training institute and the supervisee’s own personal therapy group. From time to time any of these may emerge into the foreground and become a focus of dynamic work.

GROUP SUPERVISION IN THE CONTEXT OF GROUP-ANALYTIC TRAINING

It is easy to underestimate the degree of bewilderment and apprehension which engulfs trainees at the beginning of their group-analytic training. Moving uncertainly between the rarified atmosphere of unfamiliar theoretical ideas and the deep waters of personal therapy, the trainee often feels most grounded in the supervision group. Here, together with three or four fellow trainees and the supervisor, in an attitude of shared learning, group process can be looked at objectively, and techniques for intervening therapeutically can be rehearsed and understood within a dynamic matrix.

The model of training provided by the London Institute of Group Analysis offers a tripartite structure in which personal therapy, theory teaching and supervision are held within a single dynamic framework. Trainees are encouraged to regard the three components of the training as informing one another, and material from the one may become the subject of one or both of the other two. In practice, supervision is often the forum for this integrative process, since it is here that the trainees can make connections between their own work as therapists and the newly digested ideas emanating from the theory seminars. At the same time, the supervision group, composed as it is of individuals committed to an analytic understanding of groups, often captures the feelings generated by members of the supervisee’s training group, reflecting them back to the supervisee and replicating a group dynamic which resonates with the patient group.

Feelings ran high in a group conducted by a male trainee after two women members of the group got into an irritable conflict over the marital difficulties of a man in the group. One identified fiercely with the man’s partner, the other with the man himself. The conductor allowed the conflict to escalate, and a point was reached where one woman burst into tears and the other lapsed into a grim silence. The following week one of the women (the silent one) was absent, having sent a message that she was not well.

In the supervision, the trainee admitted to having felt paralysed by the conflict which had raised echoes of arguments between his parents when he was a child. He had justified his silence however, with the consoling thought that ‘the feelings were all there in the group and the group seemed to be working well with the problem’. This generated a heated exchange amongst his peers, some of whom felt that he should have supported the more vulnerableseeming woman (who had cried), others that the silent woman was more at risk of dropping out. The supervisor helped the group to look at the chain of events which had developed from the male group member’s tendency to ‘split’ the group, through to the conductor’s silent collusion with the process, to a similar scenario that was being replicated in the supervision group itself. This freed the trainee to acknowledge that he had private sympathy with the woman who had cried and that he could think now about the personal significance of this for him. The way was open for an exploration of these issues in his own therapy and the supervision group could address the task of retrieving the potential drop-out.

RECONCILING THEORY AND PRACTICE

Group analysis as a subject does not lend itself readily to teaching. The problem lies in the elusive character of those concepts which can be regarded as specific to group analysis (e.g. the group matrix, mirroring, resonance, and dynamic administration) and the many non-specific concepts which inform group-analytic thinking derived from well-established schools of discourse, such as psychoanalysis and systems theory. A large number of theoretical antecedents are therefore woven together in a single fabric, making it difficult for the neophyte group analyst to discern a coherent theoretical entity.

In practice, however, the hybrid organism which is group analysis has a clear and distinctive identity which distinguishes it from other models of group psychotherapy. The principle of investing the group as a whole with therapeutic potential, while never losing sight of the individual, lies at the core of group-analytic practice. Around this principle have developed an array of techniques, each of which is by no means specific to group analysis, but which cumulatively, and within the context of group therapy, amount to a distinctive therapeutic approach.

Learning, therefore, advances along a broad front, as the trainee acquires various techniques for addressing the multiplicity of practical and dynamic issues which can arise in groups and matches them with the many facets of group-analytic theory which underlie those techniques. In supervision, it is mainly the technical aspects of group analysis which are examined: preparing the ground for the group, interviewing, assessing and preparing potential group members, protecting the group setting from incursions, managing the group boundary, coping with difficult situations as they arise, steering the group towards a more reflective mode of functioning, and helping the group to make sense of the rich, confusing and emotionally charged material which contributes to the group process.

STRUCTURE AND DYNAMICS OF THE SUPERVISION GROUP

At the level of a Qualifying Course, our experience at the Institute of Group Analysis is that a mix of beginners and more advanced trainees works well. To some extent this composition of a supervision group reproduces the slow-open model of the therapy groups. Trainees have to welcome new members and say goodbye to old ones with the same ripples of feeling which run through a patient group over such issues as: ‘What will the new person bring to the group?’ ‘Am I ready to leave?’ ‘Have I done well enough?’ ‘How will I continue to get support after I have left?’ The vigilant supervisor will ensure that time is set aside to address these issues, and that the group of peers is mobilised to make its own dynamic contribution to the process.

Beginners’ lack of clinical or therapeutic experience turns out to be a ‘non-problem’, as does the fact that the trainees come from diverse professional backgrounds. The group is made up of individuals who have been through a careful selection process and who almost invariably provide an immediate and constructive input into the supervision. All trainees will have been in their own personal therapeutic groups for at least a year prior to joining the formal training programme, and come to supervision equipped with a good sense of how to function in a group-analytic setting.

Occasionally trainees have to unlearn habits acquired in their core professions, and here the diversity of professional backgrounds provides a salutary opportunity for exchange transfusions between trainees. For example, those from a teaching background occasionally have to modify a tendency towards excessive structuring and didacticism; psychiatrists may have a proclivity for medicalising therapeutic problems, being too preoccupied with diagnostic categories, or taking inappropriate responsibility for the medical care of their patients (e.g. offering ‘helpful’ professional advice about medication, or illness). The multiprofessional composition of the supervision group rapidly neutralises these professional defences and frees the trainee to think and function in a more psychodynamic way.

The frequency, time scale and duration of the supervision sessions parallels that of the training group. The supervision group meets at weekly intervals for one and a half hours, and experiences the same rhythm of working periods and breaks as the training group. Because of the need to allow for detailed reporting of group process and discussion of group material by the trainees, it is necessary to structure the supervision sessions quite carefully. Enough time has to be set aside for peer group interaction while ensuring that all members of the supervision group have the opportunity to bring up issues concerning their training group and explore them in depth. Within these time constraints there has to be enough flexibility to accommodate discussions about the inevitable crises or acute problems which erupt from time to time in training groups. I find that the system which works best is one in which everyone has an opportunity to report on their group each session, some only briefly, perhaps for no more than a few minutes, others (not more than two) in substance and in depth, while anyone can claim additional time to deal with more pressing issues. Through a gradually rotating system of turn-taking for ‘major’ and ‘minor’ presentations, each trainee has a regular ‘slot’ for detailed attention to his or her group, and all are kept in touch with one another’s groups. This does mean, however, that the supervisor has to be especially watchful of the time boundaries, and mindful of when to ‘cue in’ the peer group, when to invite a pause in the presentation (or ‘freeze the action’), and when to offer comments.

Listening to the material from a session, I try to place myself in the trainee’s shoes, monitoring my own possible interventions alongside those of the trainee’s. What might I have said at that point? Would I have intervened just then? If our paths seem to be diverging, I might recapitulate the process as I have understood it and invite a response from the peer group. This opens up fresh dynamic insights and often achieves the reconciliation of contrasting perspectives.

It is especially important to acknowledge therapeutic competence. If a training group is functioning well, or if a trainee seems to be handling a particular situation effectively, I look for an opportunity to draw attention to this. Trainees feel affirmed by a supervision in which their strengths and skills, as well as their blind spots, are recognised. The awe of the training situation and the confusion intrinsic to group interaction can sometimes lead to unjustified feelings of pessimism and self-doubt, which positive feedback by the supervisor helps to counteract.

The actual reporting of material is as varied as the personalities of the trainees. Beginning trainees are given a structure in which they are encouraged to record as much of the raw material of the sessions as they can hold on to, capturing it in sequence as far as possible, and not bothering to analyse or ‘package’ it in theoretical terms. That task will be left to the supervision group. Trainees sometimes have to be prompted to remember and record their own interventions. Not infrequently a beautiful process account of a session is presented, from which the conductor’s participation is conspicuously absent!

Trainees are encouraged to plot the group’s attendance record week by week, from which it becomes possible to see at a glance the pattern of attendances, absences and latecomings. This provides a useful chart of the group’s course through the turbulent waters of arrivals, departures, holiday breaks and other group events. Schematic representations of group sessions showing how people seat themselves can provide a useful prop for the presentation and can help the supervision group to visualise interpersonal interactions. In general, however, I discourage handouts which list biographical details of the individual group members, or record complicated psychodynamic or diagnostic formulations. Too often a preoccupation with this kind of information gets the supervision bogged down in a welter of facts which contribute little to an understanding of the group-analytic process.

As trainees become more experienced, the supervision group comes to feel more like a group of colleagues, sharing thoughts with one another about the complexities of group analysis. The group being presented becomes a focus for comparing notes on counter-transference and technique, and the realisation dawns that there is no definitively ‘correct’ intervention at any given point. The collective voice of the supervision group speaks clearly, as it does in a patient group.

I occasionally proffer my own experiences as a conductor (for better or worse) to the supervision group, setting them alongside those of the trainees. In a well-functioning supervision group the trainees come to realise that the training is designed, not to create clones of some imaginary, idealised group analyst, but to encompass a diversity of styles, techniques, and approaches.

THE DEMOLITION OF MYTHS ABOUT GROUP-ANALYTIC TECHNIQUE

Whether or not they have had previous experience of psychotherapy prior to entering their group-analytic training, most trainees bring with them assumptions about the sort of behaviour which constitutes good therapeutic practice. In their early endeavours as group conductors, they attempt to implement techniques which, by their reckoning, will move the group in the direction of the ideal. The supervision group has to provide a corrective learning experience without undermining the trainees’ confidence in their skills. Often this amounts to no more than a nudge towards greater flexibility, allowing the pendulum to swing towards the midpoint between two polarities. Anxious beginners are notoriously rigid in their application of real and imagined rules. In a field as nebulous as group psychotherapy, it is always tempting to adhere to clear and dogmatic assumptions and to deal with uncertainty by adopting a handful of monolithic formulas in the hope of bringing some order to the confusion.

THE RETICENT THERAPIST

One of the commonest pitfalls facing the beginning group analyst lies in the tendency to withhold interventions to a point where the group starts to move in a counter-therapeutic direction. Sometimes this well-intentioned position is governed by an overzealous adherence to the group-analytic tenet that ‘the group does the work’, forgetting that the conductor is very much part of the group, and failing to realise that the group members, for all their inherent therapeutic capabilities, depend heavily on the conductor to actively mould the therapeutic culture towards an attitude of openness and interpersonal exploration, especially in the group’s formative stages.

Another reason for therapeutic reticence lies in a misguided translation from psychoanalytic technique into group analysis, of the notion that the therapist should furnish a ‘blank screen’ to draw out transference projections. This therapeutic stance is sometimes fuelled by the therapist’s genuine anxiety, a fear of saying or doing something that might interrupt a delicate process, and perplexity about what is really going on in the group. When in doubt, it is often easier to take refuge in silence, especially if one’s silence can be justified by some respectable professional axioms.

PREOCCUPATION WITH THE GROUP AS A WHOLE AT THE EXPENSE OF THE INDIVIDUAL

Related to the problem of excessive reticence is an attitude which assumes that the therapist should confine interventions to pronouncements about the group as a whole. Often these pronouncements take the form of interpretations, another technique borrowed from classical psychoanalysis and from some forms of psychoanalytic group psychotherapy, and often used inappropriately or prematurely in an effort to hold the group to a psychoanalytic mode of functioning.

The problem with predominantly group-as-a-whol...

Table of contents

• COVER PAGE
• TITLE PAGE
• COPYRIGHT PAGE
• FIGURES
• CONTRIBUTORS
• EDITOR’S ACKNOWLEDGEMENTS
• INTRODUCTION
• CHAPTER 1: THE INTEGRATION OF THEORY AND PRACTICE
• CHAPTER 2: A TRAINEE’S VIEW OF SUPERVISION
• CHAPTER 3: SIMULTANEOUS SUPERVISION AND PERSONAL ANALYSIS
• CHAPTER 4: PRESENTING GROUPS EFFECTIVELY
• CHAPTER 5: DIFFICULTIES AND CONFLICTS
• CHAPTER 6: MONITORING THE SUPERVISEE
• CHAPTER 7: SUPERVISION IN THE NATIONAL HEALTH SERVICE
• CHAPTER 8: ST BARTHOLOMEW’S HOSPITAL PSYCHOTHERAPY SERVICE
• CHAPTER 9: SUPERVISION IN TRANS-CULTURAL BLOCK TRAINING COURSES
• CHAPTER 10: SUPERVISION ON THE MANCHESTER BLOCK COURSE
• CHAPTER 11: A GREEK MODEL OF SUPERVISION: THE MATRIX AS SUPERVISOR—A VERSION OF PEER SUPERVISION DEVELOPED AT IGA (ATHENS)
• CHAPTER 12: EFFECTS OF INSTITUTIONAL DYNAMICS
• CHAPTER 13: SUPERVISION IN THE ORGANISATIONAL CONTEXT
• CHAPTER 14: TRAINING OF SUPERVISORS
• FURTHER READING