Supervision in Psychoanalysis

The São Paulo Seminars

Antonino Ferro

• Publisher: Routledge
• Year: 2013
• eBook ISBN: 9781135043087
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

This book originates from a series of clinical supervisions that were held at the Sao Paulo Institute of Psychoanalysis by Antonino Ferro. Supervision in Psychoanalysis: The Sao Paulo Seminars reproduces the dialogues in the seminars that followed these supervisions in their entirety.

The transcripts of eight supervised clinical sessions along with the author's comments allows the reader to:

see the different styles of the presenting analysts first hand

understand the evaluation of Bion's thinking as developed by the author

With detailed exposure of clinical sessions, their supervision and clarification of the theoretical model of the supervisor, this book will be of interest to psychologists, psychotherapists and psychoanalysts

---

Clinical Seminar I

---

ANALYST IN SUPERVISION: The patient was first referred to me by a day hospital, in March 1989, at the age of three and a half. He had been attending the day hospital for three months, where he had been diagnosed as autistic. He has been coming for seven years.

When they first approached me, the parents said that he was a strange, quiet child, who did not communicate or reply when spoken to, and who did not recognize his own name or look at people. At times, he gave the impression of not being able to hear and said only a few words, such as “Dad”, “Mum”, “Grandpa” and “water”. He did not form complete sentences, produced no spontaneous language but would repeat TV advertising jingles, such as those for Banco Itaù, Casas Bahia, Liquidacao Mappin and Globo Rural. He never used the word “I”.

He seemed to live in a world of his own. He would sit for hours in front of the television or watch objects that moved, such as record players. Other times, he was extremely agitated and incapable of paying attention to anything. He would walk this way and that and make strange movements with his hands and arms. At times, he would cry, groan and give the impression of being desperate. On these occasions, both his parents would be desperate as well, not knowing what to do. He was afraid of birthday parties, he didn't understand what a present was, and if he was given a parcel he would never open it. He ate little, would only accept food that was doughy or liquid, never ate spontaneously and often vomited.

We started with four sessions a week. For the first two months there was absolutely no communication with me. He was not interested in toys and he would wander around the room, making strange movements with his hands and arms. Sometimes, he would stare at his hands for a long period, and at other times he would look distressed, sweat a lot, breathe heavily and walk around the room in a mood that swung from quiet to agitated. Occasionally, he would walk up to the wash-hand basin and start turning the tap on and off. He never replied to any of my questions and showed no sign of listening to what I was saying. As he walked around he would talk to himself, saying words such as Banco Itaù, Benespa, Liquidacao Mappin and Casas Bahia etc.

I observed him. I pointed out to him how strange the therapeutic situation was, since he did not know me, or whether he could trust me. I pointed out that he was turning the tap on and off, that the water was coming out and disappearing, and that I came out and disappeared as well. He showed no sign of having heard me. Sometimes, I stood next to him and imitated his gestures, and said to him: “What do you think R. can hear? What is R. trying to tell me?”. But it was as if he hadn't heard me.

After two months, I realized that R. was beginning to watch me surreptitiously out of the corner of his eye, and occasionally he would venture a glance at the toys in the box, albeit very furtively. After several sessions, he came up to me, took me by the hand, led me to the box and pointed at a little horse. I picked up the horse. He took it out of my hand and started to wander around the room holding it in his hand. At the end of the session, when I told him it was time to leave, he kept hold of the toy and showed no sign of wanting to let it go. I said that perhaps he needed it as a reminder of me and that he could take it with him and bring it back the next day. I was surprised when he came back the next day with the horse, because until then I didn't know whether or not he could hear what I was saying.

At the end of May, the father asked to see me because he was having difficulty keeping up with the payments for the therapy. He said he had hoped his medical insurance would cover part of the cost, but as this wasn't the case he wanted to have an appointment with me. R. was present during the conversation.

The following day I found R. barefoot in the waiting room and he followed me into the room barefoot, holding his shoes in his hands. As he came through the door, he said. “Watch out, danger!”.

I was very surprised. He started to wander around, very agitated, sweating profusely and making strange movements and groaning. After a quarter of an hour in this agitated state, his groans came to resemble someone humming a song, and I recognized a Christmas carol, which I then began to sing:

I left my shoe at the garden window,
Father Christmas left me my Christmas present.
How does Father Christmas manage not to forget anyone?
Rich or poor, the old man always comes.

When I started to sing, he looked at me in surprise. It was the first time he had looked at me. He stopped walking around the room, came up to me, and looked me in the eyes. When I stopped singing, he asked me to sing again, saying “I left …” (the first words of the carol). So I sang it again, over and over, because he asked me to several times. I tried to talk to him, but he insisted I sing again. After repeating it many times, I said: “R. is telling me that he heard and understood perfectly the conversation between Luzia and Dad”. I went on, saying that he was very worried and anxious because our work was in danger, that's why he had come in barefoot, because he wanted to leave the shoes at the garden window. I also said that he wanted to know if Luzia was a Father Christmas who wouldn't forget R., and if she would continue to look after him, whether he was rich or poor.

I don't know if you can image how I felt: I was surprised, I had goose pimples, and although I hadn't the slightest idea how he was feeling, it was still a very exciting moment. Then R. took me by the hand, led me to the waiting room and pushed me towards his father. I told R. that he was very anxious, that he wanted the situation with his father to be resolved at once. I also said that I had arranged an appointment for the weekend and that I expected him to come the following day as usual.

The father watched us with an astonished look on his face, without understanding anything.

For me, this first communication by R. was surprising, unexpected and moving. I was pleased, and thought that the first step had been made. Up to then we had had fifty sessions. I thought that from now on the prognosis for R. was good. When I started to treat him, I didn't know whether the work would be possible, which is why we decided on a temporary contract. I agreed with the father that we would work for three months and then discuss how to go on. From that moment onwards, R. began to communicate with me through songs. We spent the next two months singing. R. began to sing with me, at first only one or two words, then each time a bit more. He didn't let me speak very much; he asked me to sing all the time, and I sang so much I got a sore throat. But when he spoke I paid careful attention. Then he started to use the words of the songs to speak, and he would repeat my words.

Every day when he arrived I followed a never-changing ritual to make things easier. I would say: “Hello R., how are you?”. After a while he would come up to me and say: “Hello R., how are you?”. Or, at the moment of leaving, I would say to him: “See you tomorrow”. And he would say the same thing: “See you tomorrow”.

His language was developing rapidly and in a surprising way. His parents felt happy and confident about the future. They reported to me that R. had not only started to talk but now would come up to them and ask them to do things. We were all so enthusiastic that we upped the number of sessions to five a week. Later, R. came up with a new song (“Sereno”):

Dew, I fall, I fall
Dew, let fall
The dawn dew
has not let my love sleep.

For the first time with this song, R. started to play a game with me. He would sit on my lap, ask me to sing the song and then he would slip off my lap, fall to the f loor and burst into tears; a f lood of tears.

The game was repeated numerous times and I told him that he was telling me a sad story, about a child falling and hurting himself and that he needed help so as not to carry on falling and hurting himself.

In the game I changed the words of the song:

Dew, I fall, I fall
Dew, do not let me fall
The dawn dew
does not let my R. fall.

R. laughed for the first time and seemed to like this game a lot, so we went on playing it until the end of the year.

On his return from the holidays the game of singing and falling from my lap was expanded to include a second part in which he strangled me. I spoke to him about the anger he felt when we separated and I “dropped” him. (The strangulation gesture was frightening: he would put his hands round my throat and put all his strength into it. The effort would screw up his face, but he never hurt me.)

R. developed a very strong bond with me and suffered greatly during holidays and at weekends. He started calling me “Banco Itaù”, and for a long time I couldn't understand why.

One day I arrived at my studio and found R. desperate and in tears; he was calling for his father, who wasn't there. In the midst of all this convulsive crying, he asked me: “do you do vaccines?”.

He said he wanted to tell me about having had a vaccine; that he had been very frightened; that he had needed me and I wasn't there. Gradually, he calmed down, went out of the room and picked up a magazine and showed me an ad for Banco Itaù. The slogan was “Banco Itaù, the electronic bank: the bank that is there for you when you need it”. He pointed at the ad, and then asked: “Does the Banco Itaù bite?”.

Then I said to him that he felt that I bit, that I was bad when I wasn't there when he needed me. I said he needed a psychologist who was a Banco Itaù.

From then on, R. would come in and tell me about the state of the Stock Exchange, which astonished me. For a few days I decided to note down the figures he gave. Later, I checked them and discovered that they were right. This was the period when Governor Collor was in power and everything was in great turmoil. R. had already repeated various things he had heard on television during the election campaign, and the people who appeared every day on TV seemed to keep him calm. He particularly liked Afif Domingos, who had a campaign ditty about hope. When the election and the political advertising came to an end, he was desperate; he kept on asking where the people had gone.

When Collor took power, he tightened the money supply and nobody knew whether to go to work or not. Everything was in chaos. R. suffered a lot; he had the fantasy I might disappear, like the candidates on TV.

Later, R. began to repeat a telephone number and to knock on my door. It took me some time to work out where the number came from: it was the number of the CVV (the Samaritans), which people phoned when they were desperate and contemplating suicide. Little by little I understood that he wanted me to say that he could come in when he knocked on the door, and that I wouldn't abandon him in moments of despair.

It was during this period (about a year and a half after the beginning of the therapy) that his parents told me that they were thinking of having another child. R. was their only child and they were afraid they might have another autistic child, but now they were more certain that they did want another child.

R. began to come out with fantasies about this possible brother or sister. He talked about thieves, policemen, murderers; he talked about removing the calendar from his parents' room; and also about falling and hurting himself. I spoke to him about his desire to know what happened in the parents' bedroom; how babies were born; his fear of losing his place because of the brother-thief; and his anger at the possible brother or sister he didn't want, or who he wanted to kill.

R.'s aunt, his mother's sister, was pregnant at the time and he spoke a lot about surrogate mothers. At the time there was a TV soap opera with this title, and he thought that this child would be his brother or sister. But then, in the sixth month of pregnancy, his aunt lost her baby. This was followed by a paranoid period that went on for about four or five months.

One time, R. came into the room, took the toy cart and buried it in a little garden that is part of my room. After burying it, he heard the siren from a police car that was, in fact, passing by at that moment, and started to shout for help, saying that the police were looking for him. A few moments later, he came closer to me, hid behind me and asked me to protect him from the police. At other times, he ran away from me saying that I was going to report him to the police. He remained in this state of confusion for several months.

It was a difficult period: there were times when he didn't want to come in; other times when he didn't want to go out. And he would often ask me, where is Luzia? Because I wasn't Luzia; I was a witch dressed up as Luzia, and I had locked Luzia up somewhere.

He got over this episode and some months later his mother became pregnant. Then R. went back to being very anxious and told me that his parents were mad. At that point he was speaking relatively well.

I said that, in his opinion, his parents were mad to have another child because he thought he would become so furious and jealous as to want to kill them. I said that in my view, however, the parents were not mad and trusted in his ability to control himself, and that I trusted him too. He calmed down and we spent months working on his confusion between ...

Table of contents

• Cover
• Half Title
• The New Library of Psychoanalysis
• Title Page
• Copyright Page
• Table of Contents
• Foreword by Maria Olympia de A. F. França
• Acknowledgements
• Introduction
• Thematic Seminar I
• Clinical Seminar I
• Clinical Seminar II
• Clinical Seminar III
• Clinical Seminar IV
• Thematic Seminar II
• Clinical Seminar V
• Clinical Seminar VI
• Clinical Seminar VII
• Clinical Seminar VIII