Notes on supervision – a stance of disciplined ignorance
In preparation for a live public supervision I am providing for Tavistock Relations [https://trtogether.com/events/live-supervision-lunchtime-nov23 ], I thought I would write a few notes to clarify and make explicit, for myself as well as others, some of my thoughts and assumptions regarding the process of supervision of psychoanalytically-informed psychotherapy.
A first point to emphasise is that neither practitioner nor supervisor initially has full conscious awareness of what is going on with the patient – what is troubling them, where they are in emotional pain, what he or she is warding off, and the layers of protective barriers and strategies that have developed over the years to build a wall around the heart in relation to the formative traumas and dilemmas of early life. However, both practitioner and supervisor do know much more unconsciously. The individual mind, which is not contained by the brain (as evidenced by advanced contemporary physics [Matzke and Tiller, 2020]) connects also to a shared mind-space (with the practitioner and patient) and to the collective mind-space. Latent knowledge can be accessed partly through free-associative speech and thought – and can also be facilitated by tapping the side of the hand (small intestine meridian acupoint). Both practitioner and supervisor can do this.
A traditional British psychoanalytic approach would emphasise the importance of listening for the leading anxiety in the transference, right from the first meeting. This listening to what is underneath the surface discourse can be enhanced by attending to the emotional mood of the session – e.g., whether it is agitated, somewhat manic, humorous, calm and detached, droning and soporific, sad, etc. Is the person communicating a thoughtful processing of their own emotions with relevant metaphors and allusions to dreams (Bion’s 1962 ‘alpha function’), or does the speech seem like a torrent of unprocessed emotional discharge (Bion’s ‘beta elements’, [Langs, 1978])? In addition, we pay attention to our own emotional responses (our counter-transference, which contains emotional information [Heimann, 1956]). We can consider the question “Where does it hurt?”, where is this person in emotional pain.
Although these aspects are all helpful, we also need to listen to what the person is actually telling us directly. If it is unclear, we need to enquire and seek clarity. An initial assessment based predominantly on counter-transference and the psychotherapist’s own impression, without taking into account the patient’s own conscious concerns and point of view, is likely to be of limited value (I have come across such presentations). We need to understand what traumas and other adverse experiences have shaped this person’s development. Often these can be ascertained by asking simple questions – such as: “what do you think are the origins of this difficulty?”; “when have you felt like this before – when was the last time – do you recall such feelings as an adolescent – as a young child, etc?”
Another related perspective is provided by energy psychologist Asha Clinton, in her distinction between the recent trauma, acting as the trigger for the onset of a current state of disturbance, and the childhood 'originating trauma' that has been activated by the more recent event.
In addition to taking account of, and addressing, the formative traumas of a person’s early development, we also have to be aware of the shaping influences arising from the fact that we are born into environments of the other’s desire. We become attached to figures who desire, who want something of us. There are three key questions we can bear in mind, or even put directly to the client. These are:
- What did your mother want of you – and how did you respond to this?
- What did your father want of you - and how did you respond to this?
- If you had siblings, how did they respond to your arrival – and how did you respond to this?
Exploration of these three questions will unveil much about the key influences on personality development. One further point regarding the ‘desire of the other’ is that a feeling that nothing is desired of us can be a source of profound emptiness at the core of our being, giving rise to a lifelong desperation to be desired or needed.
A prevailing but hidden affect that is very often present in initial consultations is shame (Mollon, 2002). This can lead a person to appear awkward or evasive, as if not quite speaking the truth – but it may be a temporary expression of the patient’s worry about how he or she is viewed by the psychotherapist, and one which will diminish with increasing trust and comfort in the process. A friendly and tactful stance from the therapist can help to alleviate shame.
When we first encounter a client/patient, everything about them is novel. It is easy to become distracted by odd or unusual features of their presentation. We need to get to know the person’s relational and communicative style – including their mannerisms and cultural idioms. In Britain, different geographical areas have quite distinct linguistic and expressive styles and it can be important to grasp these in order to understand the patient adequately. A similar consideration relates to neurodiversity (Mollon, 2015). People’s brains and styles of processing and communicating emotional information do vary – and we need to be attentive to this.
The most important skill and capacity of the psychotherapist is to be able to listen with deep empathy and acceptance (Kohut, 1971; Mollon, 2001). This requires a suspension of any rush to ‘understand’, categorise, or judge – and a putting aside of illusions of knowing or understanding. The client/patient/analysand in the consulting room is in essence an ‘unknown Other’ – who may, if we show ourselves to be emotionally trustworthy and sincere, gradually reveal to him/herself and to us, the truth of who they are and what has shaped them (Mollon, 2020). It is the supervisor’s task to help the psychotherapist approximate this facilitating stance.
References
Bion, W.R. (1962). Learning from Experience. London. Heinmann.
Bollas, C. (1989). Forces of Destiny: Psychoanalysis and Human Idiom. London. Free Association Books.
Heimann, P. (1956). On countertransference. International Journal of Psychoanalysis, 31: 81-84.
Langs, R. (1978). The Listening Process. New York. Aronson.
Kohut, H. (1971). The Analysis of the Self. New York. International Universities Press.
Matzke, D. & Tiller, W. (2020). Deep Reality. Why Source Science May be the Key to Understanding Human Potential. Cardiff, CA. Waterside Productions.
Mollon, P. (2001). Releasing the Self. The Healing Legacy of Heinz Kohut. London. Whurr (republished by Wiley).
Mollon, P. (2002). Shame and Jealousy. The Hidden Turmoils. London. Karnac.
Mollon, P. (2015). The Disintegrating Self. Psychotherapy with Adult ADHD and Autistic Spectrum. London. Karnac.
Mollon, P. (2020). Pathologies of the Self. London. Confer.
Racker, H. (1957). The meanings and use of countertransference. In (1968), Transference and Countertransference. London. Hogarth.