Abstract
In parallel to analytic therapy, the theory and practice of supervision have significantly changed in recent decades, reflecting global cultural transformations. While wishing to preserve valuable traditional analytic insights and principles, many supervisors also wish to incorporate new ways of understanding the supervisory materials and the supervisees’ developmental needs. In this paper, I will suggest that three major changes have occurred and will probably develop in the future: from highlighting past orientation to future orientation, from educational and therapeutic goals to experiential goals, and from linear logical understanding to prereflective understanding in supervision. Discussing these future developments is essential because the supervisory encounter promotes an intergenerational dialogue and integration of the old and the new in analytic therapy and supervision.
Footnote1In recent decades, the theory and practice of psychoanalysis have changed significantly (Gabbard & Westen, Citation2003). Among these changes is the attitude towards fundamental human motivations and healthy and pathological development and the significance of perceiving sameness and otherness for personal growth. For many therapists, the analytic action changed from searching for inclusive genetic interpretations to constructing a therapeutic environment that promotes the patient’s struggle to be alive and develop authentic self-expression and a unique voice. Instead of exploring childhood memories and formulating persistent inner conflicts and responsive patterns, therapists are guided by questions such as: Does the patient experience a meaningful life worth living? Is the patient emotionally involved in reality? Does the patient have satisfying relationships and work? Helping patients answer these questions and understand what is missing and restrictive in their current lives has become an essential therapeutic goal.
Despite the vast influence on the perceptions of health, human suffering, development, and therapy, psychoanalysis has been criticised and attacked from the inside and outside, and the analytic community struggles to regain its centrality as a significant helping discipline and school of thought. Therefore, as analytic therapists, we might be reluctant to think about inevitable or necessary developments in the theory and practice of psychoanalysis. In addition, speculating about future developments might seem presumptuous because we live in an age of uncertainty. Climate change, the growing power of corporations, and the development of artificial intelligence and other technological innovations leave us confused and worried about the world we know. However, because of these global transformations, we must repeatedly think about their meanings and consider what we assimilate into our ways of understanding patients’ experiences and responding to their needs. Simultaneously, we are also committed to preserving the fundamental analytic principles, values, and norms that evolved over more than a century and proved helpful to society and individuals. Therefore, we search for a balance between these contradictory tendencies that can strengthen our professional identities and enliven the analytic theory and practice.
Transformations in analytic therapy urge us to consider significant changes in the theory and practice of analytic supervision. This professional activity that requires many personal and organisational resources involves therapists with various degrees of clinical experience and theoretical knowledge in the roles of supervisees and supervisors. Moreover, the dialogue that evolves in the supervisory space between different generations of clinicians helps to find creative solutions to the tension between the old and the new in the theory and practice of analytic therapy. In the following sections, I will examine three major changes in how contemporary analytic clinicians understand and practice supervision that will probably develop further in the foreseeable future. To this end, I will draw on analytic and existential literature that describes and explains these transformations.
From past to future orientation
In the traditional practice of supervision, the supervisor and the supervisee often explored the supervisee’s past, probably more than they wished. Therefore, to help the supervisees cope with current clinical challenges and develop professionally, supervisors examined and interpreted the unconscious forces and motivations underlying the unfolding therapeutic reality and particularly the supervisee’s countertransferences (Frawley O’Dea, Citation2003). Thus, for example, after discerning a perceptive or responsive pattern that disrupted the therapeutic process, supervisors often interpret it as a manifestation of dissociated traumatic memories. Other interpretations might include analytic terms such as projective identifications, mutual enactments, and other transference manifestations born from the re-enactment of past experiences. The rationale behind this supervisory action is that formulating the supervisee’s countertransference manifestations helps to differentiate and formulate the patient’s transference manifestations. It also helps supervisees expand their awareness of their unconscious influence on therapeutic processes. Finally, this supervisory action leads the supervisee to wonder: How do my past relationships and traumatic experiences influence my current relational therapeutic experiences?
Despite the potential contribution to the therapeutic process, how can the supervisory dyad refer to past experiences without evoking suppressed and dissociated painful feelings, longstanding hidden conflicts, and yearnings? In addition, how can the supervisory framework process and contain overwhelming feelings likely to provoke regression in the supervisee? Thus, for example, a supervisor wonders about the supervisee’s avoidance of responding to the patient’s open criticism. In this case, the patient’s critical comments remind the supervisee of childhood experiences. She recalls protecting herself from her parents’ critical attitude with relational avoidance and emotional withdrawal. Inevitably, painful feelings associated with these memories overwhelm the supervisee and distract her from emotionally participating in the therapeutic process. Despite the atmosphere of safety and solidarity in this supervisory environment, it cannot provide the supervisee with the necessary conditions for entering and recovering from a regressive state in a way that promotes personal growth.
Whereas the therapeutic relationship consists of a person who offers help and another who receives it, the supervisory relationship is relatively egalitarian. In the supervisory encounter, two colleagues with different backgrounds and clinical experiences jointly struggle to understand the therapeutic reality and promote the therapeutic process. Often, the participants belong to the same therapeutic or analytic community, be it a professional organisation or a school of thought, meet each other in professional forums, and share acquaintances. As members of the same community, the supervisee and the supervisor share the same attachment and concerns about the analytic culture with its convictions and conventions. However, this collegiality is not ideal for exploring repressed or dissociated childhood memories and dealing with the subsequent anxiety and transference manifestations aroused by such memories.
In contrast to the past orientation, future orientation has many advantages for the supervisory process and the evolution of the supervisee as a therapist. Future orientation influences our current perspective, guides our immediate actions, shapes our anticipation, and, therefore, enlivens us. Whereas analytic thinkers often ignored or only related indirectly to the future orientation, existentialists highlighted its significance for human existence and creative life. They believe that we define ourselves by our perception of the future and the anticipation it creates because the self is not something that already exists, and all we need is to find it. From this perspective, we always project ourselves towards the future; as Sartre (Citation1957) writes: ‘Man first of all is the being who hurls himself toward a future and who is conscious of imagining himself as being in the future’. (p. 23). Therefore, our selves are always in the process of becoming who we are through our commitments, projects, and choices of positions and actions.
Thus, for example, the supervisee implicitly nurtures a fundamental professional project of helping patients strengthen their inner ties with their families of origin because the supervisee believes these ties consolidate our way of being in the world. Understandably, the supervisee’s fundamental professional project emerged from his developmental experiences and shaped his choices of positions and actions as a therapist. However, this personal professional project can sometimes become rigid and incompatible with the clinical situation and the patient’s needs and worldview. Thus, the patient’s most urgent need might be to distance emotionally from her family because she needs to reorganise her attitude towards her parents. Understanding and formulating this implicit fundamental professional project can help the supervisee modify it to be compatible with the current emotional and developmental needs of each patient.
Analytic literature does not refer directly to future orientation but emerges as a fundamental element when theorists highlight the centrality of yearning, hope, and anticipation for a better life. While nurturing hope, we gaze towards the future, secretly wishing to elicit deficient psychological nutrients from the environment. Despite many frustrations, we insist on seeking these nutrients and secretly try to coerce the environment to provide them. Though vague and disguised, these hopes and yearnings shape our personal and relational struggles in our familial, cultural, and occupational environments. Thus, Kohut (Citation2011) described this pursuit of deficient psychological nutrients by suggesting that under each psychopathology manifestation is a secret hope to achieve better emotional balance and psychological satisfaction. More specifically, childhood deprivation of selfobject responsiveness urges us to elicit such responsiveness from people who function as selfobjects.
Similarly, while writing about environmental failures to provide the child with emotional needs, Winnicott (Citation1960/1965 indirectly describes hopes to elicit psychological nutrients from the environment. He explains that the ‘hopeful half of the patient’s illness’ urges the therapist to ‘correct and to go on correcting the failure of ego-support which altered the course of the patient’s life’ (p. 162). Moreover, past losses and emotional deprivation lead the patient to construct an omnipotent unconscious ‘curative fantasy’ in which the environment will satisfy the debilitating emotional hunger (Ornstein, Citation1995, p. 113). Often, the ‘cure fantasy’ receives the form of an imagined play with various situations of ‘what if’. Thus, for example, the patient can develop a fantasy in which the therapist will offer emotional support when the patient feels helpless and yearns for a metaphoric embrace. For this patient, the imagined metaphoric embrace by the therapist can be curative and compensate for many traumatic childhood experiences of abandonment while being desperately dependent on the parental environment. In other cases, the patient’s ‘cure fantasy’ to receive significant praise can compensate for many occasions of the parental figures’ depreciative and dismissive attitude. Therefore, despite many past disappointments, we gaze towards the future hoping that the next time we are lost, abandoned, or scared, a saviour will provide us with the emotional response for which we yearn.
In parallel to patients, the supervisees’ future orientation is shaped by the hope to elicit deficient psychological nutrients from the therapeutic and supervisory environments. For example, the supervisee might hope to be acknowledged as warm, caring, responsible, or competent, which will compensate for many past experiences that contradicted these emotional needs. Usually, these hidden motivations are sublimated and serve the best interest of the therapy and make the therapeutic work meaningful and rewarding for the supervisee. Importantly, future orientation formed by the hidden hopes and yearnings determines the supervisees’ positions and responsiveness in the therapeutic and supervisory spaces. The supervisor who identifies the supervisee’s hopes and yearnings can visualise the supervisee’s future professional self-image, like the parent who visualises the child’s future self-image ahead of the child. This capacity reminds Corradi Fiumara’s (Citation2009) metaphor of midwifery for therapeutic work. In this metaphor, the therapist helps the patient give birth to a healthier part of the self, enabling the patient to feel real and alive. Similarly, the supervisor’s role is to help the supervisee give birth to a healthier part of the professional self that enables the supervisee to feel real and alive in the role of therapist.
Accepting the centrality of future orientation leads the supervisor to ask: What psychological nutrients does the supervisee secretly hope to elicit from the therapeutic relationships that determine moment-to-moment therapeutic positions and choices? What is the implicit fundamental professional project shaping these therapeutic positions and choices? Answering these questions can help the supervisee to satisfy these hidden hopes without disrupting the therapeutic process or the patient’s wellbeing.
From educational and therapeutic goals to experiential goals
Historically, analytic supervisors believed their role was somewhere between the educational and treating poles, highlighted by the Vienna and Budapest analytic schools. On one pole, the educational approach emphasised the supervisee’s need to acquire clinical capacities and learn the analytic theoretical principles and their clinical implications (Watkins, Citation2011). Internalizing and employing these principles and capacities transform an open and genuine interaction into a professional encounter that draws on vast experiential and theoretical analytic knowledge. Conversely, the treating approach to supervision emphasised the need to ‘cure’ the supervisee’s professional personality from ‘blind spots’ and disruptive countertransference responses. In due course, the two approaches integrated, and supervisors struggle to expand and deepen the supervisee’s clinical theoretical knowledge and simultaneously explore the supervisee’s inner vulnerabilities and conflicts that might disrupt the therapeutic work.
Compared with the teach-treat approach to supervision, many contemporary supervisors believe that their role includes highlighting the supervisee’s experiences while reconstructing and interpreting the therapeutic reality in the here and now of the supervisory space. According to this approach, focusing on the supervisee’s experiences in the present helps the supervisee become attuned to his or her subjectivity as manifested in clinical situations and the way it meets others’ subjectivities. When the therapeutic goal is helping the patient develop the organising principles of the experiential world, the focus on the supervisee’s subjective experiences and emotional responsiveness becomes central. While listening to the supervisee’s narrative, the supervisor explores the structure and evolution of the supervisee’s therapeutic experiences that emanate from passing thoughts, embodied sensations, and idiosyncratic associations. To understand the supervisee’s experiences, the supervisor examines the similarities and differences between the current and previous therapeutic experiences in different clinical contexts and the meanings for the supervisee. In this process, the supervisee can identify with and internalise the supervisor’s way of understanding and formulating implicit experiences.
Highlighting the experiential aspects of supervision reflects therapists’ growing belief that despite the richness of the different analytic schools, their conceptualisations cannot capture each therapeutic couple’s subjective and intersubjective experiences. For example, Ogden (Citation2004) is convinced that the analyst ‘must invent psychoanalysis’ and ‘learn anew how to be an analyst with each patient in each session’ (p. 862). In parallel, the self-experience of the individual supervisee who interacts with both the patient and the supervisor is singular because it originated and developed in specific historical, cultural, and environmental contexts. Therefore, from this perspective, theoretical abstractions and generalisations derived from theoretical and experiential knowledge can create only broad guidelines for understanding specific supervisory materials. This perspective leads the supervisor to ask questions such as: How did the supervisee experience the narrated therapeutic events? How do I resonate with the supervisee’s therapeutic experience? Does the current emotional response reflect the supervisee’s self-experience as a therapist?
After answering these questions in a preliminary way, the supervisor needs to create an open and genuine dialogue with the supervisee. In the supervisory space, such a dialogue encourages each participant to openly share feelings, thoughts, and perceptions while simultaneously listening, taking in, and flexibly considering the interlocutor’s thoughts and perceptions. The dialogical process enables the participants to develop their preliminary understandings of each other’s subjectivity and of their shared intersubjectivity. In a dialogue characterised by an I-Thou relationship, we can develop an inquiry consisting of questions and answers that enables us to understand unsymbolised subjective experiences (Bohleber, Citation2013). Moreover, such a dialogue promotes personal growth by prioritising freedom, singularity, creativity, and authenticity over adhering to accepted rules and values. It also encourages the supervisee to experiment with different versions of being a therapist and to shape his or her own professional evolution while holding the supervisor as an identification model. Understandably, the experiential approach differs from unilaterally interpreting the supervisee’s unconscious motivations and conflicts and drawing on theoretical abstractions and generalisations or teaching the supervisee clinical analytic concepts.
However, prioritising the here-and-now experiences over linear logical and theory-bound principles raises the following question: How can the supervisee develop essential epistemic clinical capacities or, in other words, learn to interpret the evolving therapeutic reality? From the experiential approach, the most relevant epistemic capacities are derived from embodied experiences instead of linear-logical thinking. Acquiring these capacities is essential because they enable us to translate unsymbolised materials into verbal and organised expressions. In the following section, I will elaborate on the prereflective understanding that uses embodied experiences and promotes the supervisory process and the supervisee’s professional growth. I will also discuss the complexity of prereflectively understanding the therapeutic reality that is recreated differently by the supervisee and the supervisor. Finally, I will suggest that this complexity urges the supervisor to negotiate new discoveries with the supervisee in an environment of safety and solidarity.
From linear logical to prereflective understanding
The supervisor is often surprised by the emergence of a significant understanding of the narrated therapeutic reality that feels authentic without using a linear logical thinking process. Despite the inability to explain how this understanding was obtained, it illuminates the supervisory materials and promotes the supervisory goals. The process that led to this emergent understanding is prereflective and implicit and differs from the scientific investigation of objects and phenomena later validated by objective criteria. It is a spontaneous, intuitive, subjective, and immediate mental activity that occurs outside of awareness and translates the unsymbolised materials of the narrated therapeutic reality into verbal expressions and interpretations. The unsymbolised therapeutic materials can vary from clear representations to affective and bodily states (Green, Citation2000).
Thus, for example, the supervisor experiences embodied heaviness, as if carrying a heavy bag on her shoulders, while listening to the supervisee’s therapeutic narrative and imagining the therapeutic scenes. This embodied experience feels real and urges the supervisor to believe it is strongly rooted in the intersubjective occurrences in supervision. After reflecting on this surprising, embodied experience, the supervisor forms an understanding that this experience represents the supervisee’s unconscious subjective experience. It occurs to her that the context of the supervisee’s sense of heaviness might be the greater clinical responsibility that the supervisee recently feels in her role as a therapist. The supervisor speculates that the supervisee transmitted her sense of the heavy burden of clinical responsibility that has become intolerable, recently, through projection and identification processes. Understandably, the supervisee must corroborate or refute this speculation in an open dialogue between them.
Throughout history, thinkers from different schools have investigated the process of knowing something spontaneously without explicitly reflecting on it. Thus, Bion (Citation1970) writes that we come to know the absolute truth about something unknown, ineffable, and unthinkable (the O) by eschewing memory and desire and becoming unified with this thing. Bion explains that this continuously evolving process enables us to grasp the unsymbolised, inexpressible, and unknowable. The spontaneous prereflective and surprising knowledge emerges in our minds and influences our way of being and acting. In different concepts, Kohut (Citation1959) describes a process in which we perceive, comprehend, and come to know the essence of our interlocutor’s inner experience ‘from within’ through empathy. Despite the emotional closeness in this process, we maintain the separateness between ourselves and the interlocutor. In both analytic descriptions, the understanding of another person’s subjective experience is intuitive, spontaneous, implicit, and far from scientific thinking.
The existentialists suggest that this spontaneous way of understanding enables us to grasp different phenomena in the self or the world in a non-objectifying way. They explained that in prereflective understanding, we unite with the other person with whom we interact. In this process, we submerge ourselves in the other person’s intimate experience and momentarily erase the ‘I’ or the ego (Merleau-Ponty, Citation1945/1962). By leaving the ego outside of the mental process, we do not relate to the interlocutor as an object, and, therefore, this is a non-objectifying way of grasping this person’s self-experience ‘from within’. Later, we can translate our understanding into verbal expressions and interpret this person’s position and communications. The existentialists believe that this way of prereflective understanding of unsymbolised materials is also applied to appreciating an artwork. For example, we can grasp a tune’s ‘sadness’ despite the tune being only a sequence of tones by becoming united with it.
We need to make some conceptual changes to apply these theoretical suggestions that refer to therapy to supervisory work. Despite the similarities between therapy and supervision, these professional activities differ in structure and goals. The apparent fundamental difference between them is that in therapy, the participants struggle to understand their current intersubjective reality, whereas, in supervision, the participants also struggle to understand the unfolding therapeutic reality. Moreover, the therapeutic reality they wish to understand is recreated differently by the supervisee and the supervisor. Whereas the supervisee recalls and relives the therapeutic reality, the supervisor conjures up the therapeutic scenes from the supervisee in the role of a therapist’s perspective. Therefore, the prereflective understanding of the therapeutic reality is less complicated for the therapist than the supervisor, who needs to conjure up the narrated therapeutic scenes. I will elaborate on the supervisor’s recreation of the therapeutic reality that adds to the complexity of prereflective understanding of it.
The supervisor struggles to imagine the supervisee’s narrated therapeutic experiences to recreate the therapeutic reality. It is important to note that imagining has great power in our lives because it has no limits: we can imagine something from many perspectives in contrast to something real that is always observed from one perspective. Secondly, it can bring to life situations that existed in the past or might exist in the future, even if we do not physically participate in them. Today, we know that, neurologically and psychologically, we respond to imagined actions or emotional responses in the same way that we respond to actual actions or emotional responses, albeit less intensely. Therefore, while imagining the therapeutic scenes narrated by the supervisee, the supervisor and the supervisee share the same therapeutic reality. What helps the supervisor to imagine and recreate a version of the therapeutic reality is many recollections of therapeutic situations from which the supervisor draws the relevant scenes that represent, to some extent, the supervisee’s therapeutic experiences. Moreover, the supervisor can conjure therapeutic scenes from the supervisee’s perspective as a therapist because of the supervisor’s familiarity with the supervisee’s professional identity acquired through numerous interactions that include projections and identifications.
Since the supervisor’s and supervisee’s versions of therapeutic reality are different, their prereflective understanding of the therapeutic process is also different. This difference is added to the difference in their social and cultural backgrounds and worldviews and leads them to different conclusions about the supervisory materials. Therefore, they must create an intersubjective environment of safety and solidarity in which they can negotiate the gaps in their perceptions and decisions.
Concluding remarks
The theory of analytic supervision has not received adequate attention because it is often viewed as a by-product of the theory of analytic therapy that is passed on from generation to generation. Moreover, many experienced supervisors who believe in their version of analytic theory and their vast accumulated clinical knowledge are convinced that simply sharing their knowledge with their supervisees can help them function and grow as therapists. Other supervisors believe that their role is centred on expanding the supervisees’ awareness of countertransference manifestations that might disrupt the use of their professional selves. However, the contemporary perception of supervision that focuses on subjective experiences suggests that it needs more than simply passing the analytic knowledge to the next generation or interpreting countertransference. Instead, the supervisor helps the supervisee grasp the complex and multi-layered therapeutic reality that is recreated in the supervisory space. The supervisor’s way of understanding this reality is internalised by the supervisee, who develops as a therapist. Therefore, the supervisory process deserves a comprehensive study integrating the traditional with the new analytic perceptions and practices.
Beyond promoting the therapeutic process and the supervisee’s professional growth, the supervisory encounter promotes the evolution of the analytic culture by providing an opportunity for a meeting between people from different generations. This intergenerational encounter enables clinicians with different experiences and theoretical knowledge to revisit accepted analytic concepts. The significance of this action is highlighted by Winnicott, who wrote in a letter to Klein in 1952: ‘If you make the stipulation that in the future only your language shall be used for the statement of other people’s discoveries, then the language becomes a dead language, as it has already become’. (Rodman, Citation1987, p. 176). Winnicott argues that to keep the theory alive and well, the language used to describe clinical phenomena and accepted analytic concepts must be rediscovered and applied in new ways. Moreover, the intergenerational dialogue between supervisors and supervisees helps balance traditional analytic convictions and conventions and new perceptions of health, pathology, development, relationships, cultural and gender differences, wellbeing, and suffering. The more open and genuine this dialogue, the more alive and dynamic will be the psychoanalytic culture despite economic, political, and cultural obstacles.
Despite and perhaps because of the current time of uncertainty, thinking about future developments in analytic supervision can prepare us for new types of clinical obstacles and challenges to the theory and practice of supervision. Indeed, we often learn that reality is different from how we imagined it, albeit shortly before, because numerous contextual elements influence its development. However, to reduce anxiety from unpredictable future events and actualise our potential, we must imagine them and rehearse different ways of coping. The readers of this article might create their own versions of future developments in analytic supervision because they have different perspectives. Therefore, a dialogue among clinicians about these possible developments can promote the analytic culture and, indirectly, the wider culture.
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Additional information
Notes on contributors
Hanoch Yerushalmi
Hanoch Yerushalmi Department of Community Mental Health, University of Haifa, and Gordon College of Education, Israel, is a Submissions Editor in Psychodynamic Practice, UK, and a Consulting Editor in Psychoanalytic Social Work, USA. Prof. Yerushalmi served as the Director of the Student Counseling Center at the Hebrew University, Jerusalem, Israel, and a consultant to psychotherapy centers in Israel, the USA, and Central America. He published numerous articles on supervision, therapists’ development, relational psychoanalytic therapy, crisis and growth, and psychiatric rehabilitation.
Notes
1. This paper will be given as a presentation at the annual meeting of BCA and the Psychodynamic Practice journal on November 11 in London, UK.
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