By Geraldine Fogarty, M.A. and Michael Dean
In Toronto, where I practise psychotherapy, the issue of supervision is an important point of focus for the representative body for independent therapists here – the Ontario Society of Psychotherapists – as it is for the IAHIP in Ireland. [Fogarty is an IAHIP member. Ed.] My own experience with Supervision in the past two years has involved two areas: the first is as a leader of a pilot project for the training of supervisors, and the other is as the organizer of a Supervision Group focused around Countertransference Resistance which is led by Jungian Analyst, Nathan Schwartz-Salant.
Last September, as a Board Member of the Ontario Society of Psychotherapists, I helped set up and lead a twelve-week pilot course for a Supervision Training Program that we were thinking of establishing. There were three of us in the leadership and twelve “student-invitees” who were professional psychotherapists from the OSP membership. The teaching model was from Ludmilla Hoffman’s book on Supervision, Old Maps, New Scapes1.
What I am writing here about this pilot course is not taken from a report on the project, and is not based on an OSP position on Supervision; rather, these are my own personal thoughts and reflections.
Early in the twelve-week pilot course it became clear that there were many diverse perspectives on Supervision, and hidden group conflict in the group about how Supervision should be framed within the larger context of Psychotherapy. Generally speaking, people’s Supervision experiences fell into two broad categories: the first was the Supervision they received during training, and the second was the Supervision they sought when they had become practising psychotherapists.
We identified the following types of Supervision undertaken by practising psychotherapists:
1. Formal Supervision: a continuing, ongoing Supervision with one supervisor in which cases are brought to each session by the therapist, and the progress of clients is discussed. This is a professional relationship and money changes hands.
2. Problem-specific Supervision: a similar professional paid relationship, but more situationally based: the therapist has a problem with a client and sees the supervisor for x number of sessions until the problem has been resolved. The supervisor may or may not be the same person the therapist goes to whenever a problem arises..
3. Group Supervision: in which a group hires an expert who has a particular focus and expertise, and through that focus the Supervision is conducted.
4. Formal Peer Group Supervision; with no identified leader, members meet on a regular basis, once a week or once a month and discuss cases with each other, no money is exchanged.
5. Informal peer exchange: collegial in nature, no money changes hands, colleagues phone one another for advice. It can also be the sort of thing that can happen when therapists work together in a Centre.
When we examined who it was that therapists were choosing as their supervisors, we found two types of supervisors. Both groups were comprised of seasoned professional Psychotherapists, some of whom had received Supervision training, and some not; however, this factor did not seem to be the determining one. In the first group were professionals who were chosen because of their skill and expertise in a particular area in which the therapist needed Supervision on their work with a client, such as a boundary issue, sexual abuse, or an eating disorder. This type of Supervision was, most typically, short term. The other type of supervisor was someone who was a senior practitioner considered to be generally skilled and expert in the practice of Analysis or Psychotherapy. This type of Supervision involved the development of a long term supervisory relationship in which the therapist would present cases over a long period of time.
Yet, within the whole area of “who can supervise” there was serious disagreement among members of the pilot course. Some members felt strongly that the therapists needed to be able to give and receive Supervision on a “supply and demand” basis; that is, therapists should be able to seek each other out on the basis of who they feel could best help them. They felt that any formalizing of this process would inevitably lead to hierarchical rigidity and irrelevancy. Others felt just as strongly that Supervision was too important to leave to chance, and that certain skills and training were absolutely necessary if the quality of Supervision – and by extension, of Therapy itself – were to be maintained within the profession. This fundamental disagreement has significant ramifications on the direction which a Supervision Course offered by OSP might take, and was left unresolved. However, the general consensus was that Supervision is too important for the life and ongoing development of individual psychotherapists – and for maintaining standards of practice for the profession as a whole – to be left unattended, and the issue is now with a Supervision committee whose members are long-time Supervising therapists.
Throughout the twelve-week pilot course the place where the group consistently moved beyond its disagreement over issues of Supervision, was the area of countertransference. Whenever this subject came up the group became cohesive and focused, and there was a liveliness in our discussion of this whole area. This was definitely where the interest lay, the place where the therapists felt they could develop both professionally and personally.
This brings me to the second area of my involvement with Supervision in the past two years. In the summer of 1993, I organized a Supervision project in Toronto in which I invited Jungian Analyst, Nathan Schwartz-Salant to come from New York to lead a series of Supervision weekends for independent Psychotherapists. There were 23 Psychotherapists in the group that first year, and we met for four weekends. We are now in our second year and, by next Fall, will have met for five further weekends. A weekend comprises 14 supervision hours.
Dr. Nathan Schwartz-Salant believes that the presence and use of the therapist’s countertransference resistance is a key element in the successful outcome of an analysis. Without engaging wounded and uncertain parts of a therapist’s psyche in the analytic process, the mad parts of a sane client will likely not be touched by the therapy.2
Generally, Supervision is an extension or enhancement of the therapist’s ability to remain self-reflective while in a session with a client. In the best of times we are all able to remain self-reflective, aware of how we are feeling within ourselves, and knowing how we are responding to what our client is saying or doing. Unfortunately, however, this is not always the case. Usually Supervision is required, or desired, when we realize we have run into a blind spot in our own psyche which makes us unable to see the client objectively, and we are either reacting inappropriately, or fighting within ourselves against the reaction. The following is an example which illustrates the occurrence of such a situation.
The client enters the office and throws down their coat carelessly so that it lands perilously close to a personal treasure of ours, a refined little statue that symbolizes, for us, our healing core and our personal centre. In fact, the coat lands so close that we find the client’s act personally offensive, an insult to what is important to us, and we find ourselves ready to snap at the client to hang their coat in the hall like everybody else. But we decide not to say anything because what they’ve done is not really so bad, and surely a good, objective therapist would not snap at their client anyway, so we nurse the wound throughout the session, searching in vain for some therapeutic perspective that can address this transgression meaningfully, wondering how we can tell them to move their coat in a nurturing and positive way, while inside ourselves, if we are able to listen to our body at this point, we feel angry, hurt and misunderstood. And if we go deeper still, we find strangely violent feelings about this annoying, but essentially minor, event.
None of these feelings are comfortable ones for a therapist to experience towards a client, and mainly we want to find a way to make it all stop: stop the client from doing what irritates us, or stop our reactions so that we’re clear-headed and know what to do. However, attempting to be clear-headed is exactly the opposite route to the one that takes us into “the field” which is being created by the mix of the client’s material and our reaction to it. It is by entering this field, rather than by somehow eliminating it, that the work happens.
If, when the client throws down their coat, we are able to resist the tendency to dismiss this action as something inconsequential or as a personal affront to us, we are able to read their action as information; information about what the client wants to tell us. And if we are able to resist the tendency to dismiss our own negative reaction to their act as some form of incompetence, and can pay attention to our inner feeling-state instead, we then have the possibility of reading our own reaction as part of the information the client is trying to relate to us, information about what is going on inside them.
When our own material is not being constellated, we can do this more or less successfully. It’s a different matter, however, when our own material is being evoked, and the more unconscious we are of this material, the less able we are to read it objectively.
Countertransference resistance in the therapist refers to those reactions and feelings which a therapist has to a client but which the therapist denies, resists, or is uncomfortable with. Supervision which focuses on counter-transference resistance deals with this by, first of all, identifying that resistance is happening – and the therapist’s resistance will always be unconscious to some degree.
If resistance is present it can manifest itself in a number of ways: by the therapist politely asking the client to move the coat thereby ignoring the countertransference response; or by the therapist quickly moving to restore a positive aspect of the therapeutic relationship; or by the therapist taking issue later in the session with something the client says – the session ends in a somewhat confused state.
During the Supervision process, once the therapist has become aware of their resistance, the identification of the triggering event is possible, and an exploration of the feelings that the triggering event has opened up in the therapist can follow. Most often the feelings are those that the therapist least wants to think about generally or have anything to do with is a session, and they usually turn out to be feelings not dealt with fully in our own therapy. The feelings are often deep early ones involving the young child aspect of ourselves, so that we’re afraid either of feelings of vulnerability and helplessness, or of feelings of anger and violence, because they are so young and undeveloped. In the triggering event, somehow the client has become someone in our psyche, and we are overcome by unconscious childhood feelings. In short, we are overtaken enough by these feelings that we are unable to maintain an objective position and be able to help the client.
The first step in recovery of the situation is for the therapist to take care of this child. Until the child within us feels safe we are in danger of being retraumatized by the clients act. A terrified therapist cannot help their client. Once we know what we need to do to keep ourselves safe, we can begin to use our own feelings as information about what’s going on in the dynamic between the client and us. We can feel the covert hostility in the client’s apparently innocent act of dropping their coat too close to our special statue, and also we can feel our own reaction of helplessness and anger.
There now exists the possibility of uncovering “the unconscious couple” that is being enacted between us and the client. This “unconscious couple” operates between the therapist and the client in the same way that it operated originally between the client-as-child and the traumatizing parent. The difficult part for us is that, likely as not, we, the therapist, now get to play traumatized child in this couple.
Nathan Schwartz-Salant, during our Supervision sessions in Toronto, has likened the space we enter when we lean into the charged psychic field between us and the client to the alchemical bath of transformation – and the therapist and the client are in that bath together. When we stay in the charged psychic field with the client we engage the depths of their psyche with our own depths, and here healing is possible.
Supervision which works with the resistance we feel when our own unconscious material is stirred by a client is a challenging experience. But, when the therapy is stuck it is inevitably in the area of the therapist’s counter-transference resistance that the solution to the impasse lies.
Geraldine Fogarty, M.A., is a Jungian Psychotherapist in private practice in Toronto, Canada, and is the founding president of the Ontario Society of Psychotherapists. She was born in Dublin and is a member of the IAHIP.
Michael Dean is a Psychotherapist in Toronto, Canada, where he has led men’s groups for a number of years, and is a member of the Nathan Schwartz-Salant Supervision Group. He is also a writer of fiction.
Geraldine Fogarty and Michael Dean are married and trying to work out their own unconscious couple.
Schwartz-Salant, N.(1992) Transference and Countertransference, Chiron.
Schwartz-Salant, N. (1989) Borderline Personality in Analysis, Chiron.
Schwartz-Salant, N. (1982) Narcissism and Character Transformation, Inner City Books
1. Hoffman, L (1990) Old Maps, New Scapes, Milusik Press
2. Schwartz-Salant, N (1992) Mad Parts of Sane People in Mad Parts of Sane People in Therapy, Murray Stein (ed.), Chiron Press