How Much is Enough? Endings in Psychotherapy and Counselling

By Lesley Murdin

(2000. London: Routledge)

Reviewed by Eleanor Creed-Miles

I often wonder if our work (in both supervision and practice) is not so much a superior position that we adopt and process of our own supported by theory – as supervising and practicing alongside what our clients (supervisees) believe they are asking us to do. Thus a sort of mutual muddling along based on equality of expectation and assumption about the process. Endings in this ‘impossible profession’ are therefore (we hope) effective and mutual, based on what both parties assumed to be the case. Most psychoanalytic models suggest that the optimum desired outcome is the patient/client/supervisee deciding what is enough and then effecting the ending with the therapist or supervisor rather than a mutual process and Lesley Murdin sensitively and mindfully explores this with warmth and respect for her clients and patients and good humour throughout.

However, the introduction focuses on problematic ending rather than mutual review and conclusion,  which I felt might be because we turn to theory when the going has already got tough and something is unresolved, difficult or feels ‘bad’ about the way our work is going – we are looking for support in this delicate time. This Lesley Murdin carefully explores when looking at how we as therapists and supervisors are affected “ Ending is inherently painful if it is fully experienced, but it can bring strength and contentment when it is actually achieved” (page 21). Chapter five – The Therapist Ends – is tremendously detailed and helpful with this, as are the final three chapters.

In teaching I have recommended this book very highly as it boldly goes where no book has gone before and addresses issues that are otherwise distressing and difficult to approach – reflecting how impossible it is to really talk about (or work around) death and dying. Endings are redolent with past losses and this is carefully detailed in the book. Indeed, chapter four is titled ‘Staying Alive’ and most of the examples are in the context of a future for both the therapist and the client, even if that is a separate one.

Chapter three regarding illusions and narcissism around ending is the real jewel in the crown for me. It details both how our own unresolved primary narcissistic issues may obstruct our ability to end well – either in our professional practice or indeed in our personal lives. Rather than taking a purely psychodynamic approach here, Lesley Murdin carefully (and again with great warmth) explores the existential and ontological diaspora. In delving into the deepest of wounds and narcissistic affect she opens up the possibility of question and challenge to ourselves.

The patient’s unilateral ending (chapter four) is detailed and explores acting out with thorough examples and vignettes. This chapter was the most technical and generic for me, though extremely detailed and helpful.

For BAPPS membership and readership Lesley Murdin’s final chapter on Endings in Training and Supervision is most relevant and offers technique and speculation around implications and issues in equal measure.

This magnificent book never shirks the painful and difficult questions around endings and around our own responsibilities in attempting them therapeutically and well. It also does not shirk when endings and losses have to be bad, as they can sometimes inexorably be – whether that is reflecting upon and processing our pathology or our clients’.

This review may seem rather weak or praisefully bland and that reflects how hard it is to write pithily or critically about a piece of work that is so consummately helpful and thoughtful as this truly useful book is. I highly recommend it and not just in times of need.

Eleanor Creed-Miles is a therapist and supervisor in the NHS and private practice and has a passionate commitment to offering supervision so that it is both enabling and enjoyable.

Sadism in Supervision

 

ABSTRACT

Published discussions of psychotherapeutic supervision and training  represent a rational, ethically sensitive and progressive professional process of sharing expertise within a smooth and largely hierarchical structure (later referred to as a ‘ladder’ particularly in the context of training).  This paper sets out to explore the shortcomings of this rationale and to suggest progression towards deeper self questioning, both of our practice and conduct. Further, it aims to show a creative equality in the supervisory dyad and how this may emerge from the hard work of intensive self reflection, forming and re-building of supervision agreements.

INTRODUCTION:

I began thinking about this because I noticed a vacuum and no-one seemed to be talking about it, at least not openly or in a formal manner. Most publications offer wisdom about supervision from above; the polished, smooth position of seniority and lengthy experience. This paper looks at the ‘worm’s eye’ view rather than the bird’s; showing the struggle for a safe, comforting, yet still inspiring and challenging model that enables both parties in the relationship to flourish.

Existing papers focus on the positive; discussing supervision as ultimately beneficial and enabling, however many experiences do not bear this out either in training or post graduate and qualification professional practice. I hope to provide more than a brief mention of the flipside of the supervision coin. The Shadow side, the elephant in the room and to pose the question: What shall we do with the narcissistic supervisor? When supervision is envious, disabling and attacking; when it is wielded authoritatively rather than considered as an exploratory or enlightening journey. I am expecting that many of us assembled here will have some experience to bring of this ilk and I am hoping that many will have none at all and will be unable to recognise the negative and damaging experiences I am going to try and encourage discussion about.

I do not wish this to be an embittered rant borne only of negative personal experience, although whenever I mention I am trying to write about and stimulate discussion on this subject colleagues and trainees immediately flock forward with their own experiences of being persecutorily, unprofessionally and destructively supervised to add to my own! Some of the possible origins for this mountain of anecdotes of course lie with the supervisor and I am hoping that we will continue to gather experience and reflect on these together productively today.

I intend to essay a brave attempt to look at when and why supervision goes wrong and acknowledge destructive processes (particularly those which are evoked by and especially present within training organisations and groups) as well as in individual or 1:1 supervision.

In one of the foremost textbooks on supervision, Vernon Yorke states that “Everything necessary for understanding already exists in the supervisee’s unconscious” What about in the supervisor’s? Or the dynamic between supervisor and supervisee which may, of course, be inherently destructive as easily as it may be constructive. These inherently destructive and aggressive forces in my experience can be magnified and intensified not only in the dyad but perhaps more powerfully and primitively in groups. As supervision very often occurs in groups, in a money saving exercise I suspect, I will offer some case study later on along these lines. In the psychodynamic realm in either groups or individual work, I propose we are more alive to the negative and shadow aspects of any relationship and are possibly even duty bound to struggle with and interpret them?

 

Supervision of our work is an absolutely bounden necessity; never more so than when training as a counsellor or psychotherapist. It is bidden and involuntary, a requirement rather than a choice. Most of the psychotherapy and counselling professional registration bodies ask for a minimum of one and a half hours per 4 weeks either in a dyad or a group. This dictat in itself can excite resentment, persecutory feelings and considerable anxiety. Reading the small print further in the BACP guidelines there is a mere short sentence mentioning that peer supervision may be an acceptable alternative; but this emerges long after the stringent declarations about attending supervision in the regulated way. Some thoughts on supervision frequency and how increasing or decreasing this out there in the ‘real world’ of therapeutic practice will follow later and I hope in our small groups and plenary we will tackle questions about how often we engage in it and how much is enough?

THERE IS AN INHERENT SADISM IN SUPERVISION THROUGH SIMPLE NEGLECT OF STAFF, I.E: NOT OFFERING IT:

Widespread in the helping professions detailed here; I have diverse case studies in the fields of Psychology (Clinical, Forensic and Counselling), CDT, Smoking Cessation, Psychiatry, the church, medicine at all levels, the list is exhaustive and inexorable. This leaves everyone who strives and toils in the hardest jobs of all routinely feeling unimportant and unworthy of the time required to consider their professional practice well.

Supervision is hinted at in the wider and vocational helping professions and practices, but in reality rarely regularly offered, attended or valued sufficiently as a space to explore, develop and grow. For example, there were no formal guidelines or regulations for provision of supervision in Worcestershire’s CDT, although one research document is available which proposes it as useful but not mandatory. Certainly, there are no formal rules for attending or providing supervision other than line or case management in large groups and making a half hour appointment with a colleague about once a month. When drug workers hold a caseload of up to 90 clients or patients as they more commonly referred to, this conversation is unlikely to establish any depth of individual understanding. Maybe we can consider that the Western conventional medical model is to blame for this lack of provision, as it does deem supervision unnecessary and clinical case management is so infrequent and psychiatric mental health services rarely offer supervision per se, however we could see the malaise as spreading far wider in the helping professions.

Again, I am hoping that outcry will meet this statement and many gathered here might come forward to explain that the opposite is true and this neglectful and dismissive attitude towards the work of supervision is unrecognisable in their specific professional field.

Supervision courses are flourishing, showing a growing commitment to education and training in the specific practice of this endeavour.  Gone are what I might suggest are the bad old days when an assumption of authority and competency was a given and one could occupy a position as a supervisor without a specific training or even a mild challenge to one’s superiority and often established seniority. As Arnold Mindell points out “whether you earned or inherited your rank, it organises much of your communication behaviour” and thus an assumption of learnedness and superiority will pervade the role almost automatically. Unfortunately, he is quoted in a recent article in Therapy (the BACP magazine) that looks at Power and rank in the therapeutic relationship rather than the supervisory one.

Thankfully, most of the latest waves of training and graduating supervisors are committed to learning more about it before they can assume they can do it. Some of my colleagues refuse to occupy the position of supervisor as they are wary of not only the assumption of authority, seniority and learnedness, but they are appropriately shy of the enormous responsibilities, both legal and psychological that a supervisor takes on. Maybe they are happier and most enabled by feeling nourished and helped in supervision without any aggrandised temptation to occupy the superior role; but most of the examples I am anonymously citing state that they have never felt entirely comfortable or happy in supervision and suffer it as a professional requirement for the continuation, if not the approbation of their practice. Maybe the refuseniks are simply more aware of their narcissistic needs (and therefore their own propensity for sadism and potential envious process). Maybe they don’t feel an impulse to indulge them in the supervisory role. I’m reminded of Oliver Postgate when he recorded Desert Island Discs here – at his experimental, liberal school in the 1960s asking ‘what can I do?’ and the teacher asking him back ‘well, what would you like to do?’

Particularly when we are training, the question as to “what can I do?” with a client (or even with counselling and psychotherapy as the impossible concepts that they are)  is definitely being repeatedly levelled at the supervisor. The supervisor is a teacher as well as a role model. Some people, however inspired creative and imaginative still are more comfortable being told what to do – directed – and relax into being led rather than leading. Perhaps in the position of teaching and leading we can drift in to becoming less creative and more established and inflexible – the assumption being we know what we are doing, indeed we are teaching and directing others how to do it, so examining ‘not knowing’ and exploring the paradoxes is even harder.

Our positive or negative experiences of our own supervision (particularly our training supervision) naturally inform and colour our commitment to it as a required, core element of professional practice. Indeed, many people may train to become supervisors not because they felt enabled and nourished by their own experiences of supervision, but the reverse – that they hope to do better based on having learned what not to do. Is this wish to offer reparative and restorative supervision partially to heal our own narcissistic wounds sustained in training? In the Jungian diaspora this motivation is approached more often and understood perhaps more compassionately than in the Post Freudian and Kleinian disciplines, however I will digress far too widely if I begin to attempt comparison and contrast among the different theoretical schools. Some thoughts on when differing theoretical models can encourage creativity and equality in supervision follow. ……

Just as Winnicott said there is no such thing as a mother without a baby, thus there is no such thing as a sadist or sadistic impulses without a corresponding masochist. I have had to struggle with my own ideas about my status and authority, what it means to be a supervisor. The transferences and projections on to both myself and the role that this activity brings. I do not intend to leave my own potential pathology out of this, nor perhaps should any of us? I believe there are distinctions in how these dynamics appear in individual supervision and in group supervision…….

Some thoughts on the potential sado-masochistic dynamics of the supervisory couple:

There can be a kind of Magnet or swinging  sadisticometer for the already beaten down/feeling inadequate person who becomes automatically the masochist – eg: A S talking about his role as a priest and how if you are already being beaten down at home you will get inevitably beaten down at work/in the group. GK describing the ritual humiliation, bullying and harassment that goes on in the hierarchy when training as a curate rather than the supportive development for a fellow man or woman of God. This example could be dismissed as I am using case study from the religious and spiritual world and maybe the difference between priests and psychotherapists is that there is less narcissistic attachment to the idea of a closeness to God in psychotherapy? In other words, narcissistic aggrandisement is more likely in priesthood leading to more instances of sadistic acting out behaviour? But I digress…..

Perhaps our own unconscious sadistic or aggressive behaviour is excited when we feel beaten down or weary ourselves and a parallel process of projection goes in to our work easily. It is so much harder to continually challenge and monitor ourselves and our behaviour – in supervision even more so as we are ostensibly observing the behaviour of our supervisee with their client….the triangle distracts and deflects us from contemplation of our own behaviour and reliance on interpreting parallel process only (as is trendy in theory at the moment) kicks over the traces even further.

On this note, we might be able to identify our own needs for support more easily and with less struggle; to acknowledge how crucial and important it is to have calm comforting and safe space and support as a bedrock in order to remain able to do the incredibly difficult and delicate work we do. This encourages me to ponder how vitally important then it is to have this calm, comforting and safe space above our work in supervision as well as below at home.

We cannot remain competent or perhaps even adequate as counsellors and psychotherapists if we are dealing with any persecutory anxieties and distress at home or in what should be the facilitating and nourishing environment of supervision.

How can we become more  aware of the vulnerability of the already beaten down person who might seek our help in supervision – should we be especially careful in identifying the unwitting masochist in order to check our own sadistic impulses before they develop in to a full blown process?

HIERARCHY AND LADDER:

Some clues are available in the deconstruction of the word – Super precedes the Vision superiority and the sense of being above the other dominate the vision and occlude any insight as well as coming before it. Super=Over and vision= sight – oversight. Our question here could be –what are we both missing in the supervisory couple and therefore, what are we all missing in a group?

The external conditions around the supervisory relationship are of course crucial to the endeavour’s success. The ladder of our necessary supervision experiences extends and has many rungs. At the base of the ladder, the early stages of supervision in counsellor or psychotherapist training can seem punitive, destructive and persecutory, an effort to police the relationship between client and counsellor and to judge it worthy or unworthy. Frequently, supervisors are part of the same training body as the counsellor and this leads to further rigidity in its practice. Not uncommonly, the unconscious, semi-conscious and fully conscious expressions of envy, competition and rivalry rear their ugly heads and have remained unchallenged in the profession; almost as if one must suffer and go through a baptism of fire in order to emerge competent and trained. Any serious questions as to why and how the process of assessed supervision is so destructive are difficult to ask since the darker possibilities of the power relation undermine freedom of enquiry, raising the very real fear: will the trainee actually receive their diploma or certificate if they go up against those further up the hierarchy? Too much power is held in one place, at the top of the training institute. I am asking that we all try to consider whether assessed supervision in training is functional as supervision at all? Further, I hope we can come up with some ideas in our small groups and plenaries as to what else we would propose? How could we do especially training supervision differently?

I make mention of “unconscious sadism” in supervision, particularly in context of training organisations and institutions. The emphasis on hierarchical relationships is present and often marked in any training and it is difficult at the outset not to feel the ‘newcomer’ or junior, unskilled trainee with these feelings provoking the headlong rush that they can in to the role of masochist as mentioned before. With so much regressive anxiety on the part of the trainee and so much aggrandised, senior ‘grown up’ role modelling going on in the supervisor it seems hardly surprising that so much seems to go wrong. Again, when there are distinctions and differences in theoretical training, orientation and experience the hierarchical lines are drawn in bold and natural rivalry and competition abound. Mine is the ‘best’ way…..rather than mine is an alternative yet equal way. This is clearly seen in the HPC arguments about what distinguishes a counsellor from a psychotherapist in advance of our pending registration. It is also pervasive and dominant in the hierarchy that exists between counsellors and psychotherapists with the latter imagining they are somehow higher up a ladder rather than practitioners in a different frequency. Counsellors working once weekly potentially need to be even more mindful of the complexities of the interactions given that they spend less time with clients, we could argue that they hold and deal with more due to the gap inbetween sessions than psychotherapists practising on a thrice weekly basis.

 

INSITUTIONAL TRAINING INSTANCES OF THIS:

 

1. 1 supervisor who every year without fail eliminates 1 supervisee (usually a younger male) from the training group. This appears to go unchallenged and has done so for many years, certainly no open interpretation has been offered about the repetition or frequency of the destruction and elimination of one person’s career and education.

2. 1 supervisor who in two consecutive years suggested that all 3 members of her individual supervision group should stop training altogether (only one survived and continued after challenging this decision) and the next year that all 3 group analytic supervisees also should discontinue. This mass elimination of trainees (or suggestion that they were unfit to continue training) was again unchallenged at supervisor level and certainly not aired publicly within the training body.

Even if the motives of the supervisor were protective of the institution, the trainee’s client, of the trainee, or a combination of all of the above (which is of course the tricky position training supervisors are in!) that is still a very assumptive and narcissistic place for them to be coming from. Why do we think we can ‘protect’ the supervisee when all we can realistically offer is conversation and the thinking space to address even the most vicious and difficult of clinical situations.

I am put in mind of Patrick Casement’s recent tours on the hazards of being helpful in therapy. Maybe these hazards are just the same in supervisory relationships – we get led in to all sorts of patronising and infantilising assumptions about what we can do FOR the supervisee rather than appealing to the adult, rational, capable part of their psyche and professional practice and trusting their responsibility.

I am putting in another plea for us all to consider that when the anxieties or envious processes are running high we are more prone to primitive, sadistic, power hungry behaviour.

CLINICAL SUPERVISION or CASE MANAGEMENT VERSUS ANALYTICAL SUPERVISION?

What does the task of ‘covering’ clinical practice or caseload of supervisees work do to the dynamics? I believe this method steers them away from the speculative and reflective and the ‘wondering more and asking less’ and towards the regulation and approbation of the work; asking more and wondering less.

This has a negative effect of rendering supervision an intensely critical and persecutory place – the ghastly sense of ‘slipping up’ or being judged and found wanting pervades the scene. PARADE of work rather than a perusal; like watching the red arrows fly past leaving trails in the sky rather than experiencing and appreciating the whole spectacle– including taking in to consideration the many hours of training, rehearsal and the complexity of the immediate drama. Very often, the supervisee is assumed to be junior and unskilled, less practised than the senior supervisor, lulling the supervisor in to an assumption of superiority and authority again. In this complacent place, the supervisees many hours of training, intense self reflection, learning and practice remain unappreciated and are systematically disregarded. Perhaps even more harmfully, the intensity and complexity of their self reflection and scrutiny are also forgotten about and unappreciated again. I often wonder whether it is possible to recall clearly every time we sit with a supervisee or even client how very much they are bringing to the meeting and how very intensely and courageously they do so. We can get jaded and work weary very quickly and err towards complacency and carelessness in the relationship.

Two years ago the BAPPS Autumn conference focussed on the question: what shall we do with the narcissistic supervisee? Today with all of your help I am going to try and address might we do with the narcissistic supervisor – the uncomfortable, pathological, envious, sadistic part of ourselves. There is also Eros to be considered in the supervisory role, although again exploring this and awkward and downright difficult erotic transference and countertransference are the work of another whole conference and of smaller more private groups!….In other words, we are engaging in looking at the aspects of our own persons and professional practice which we mind find the most difficult to address, especially as we are in the most part not constantly engaged in asking those difficult questions in our own personal therapy. I am no doubt doing many of you in this room a disservice by mentioning this; but it has been my observation that very close to the ending of a training and at the point of qualification many therapists end their own therapy. * caveat Lacanians here* May I also make a caveat about those who are able to engage in weekly analytical supervision where there is less or no distinction between supervision and personal therapy, particularly in the Jungian model where it has ever been thus! I remember being taken aback and also interested by the firm statement that was made to me about this when I first moved out of London and contacted a Jungian Analyst nearby for possible supervision, to find the expectation was that I would attend and work once weekly regardless of the frequency or amount of clinical work I was engaged in. At the time, I was working with only one client on a once weekly basis and simply (or as we might all interpret – defensively) could not afford the difference in my fees and the cost of the supervision. This got me thinking deeply about the function supervision serves, with or without its connection to client work.

In the Jungian axiom, what is thought and believed to be a fitting and self-evident principle, the intensity of self reflection and monitoring, nay moderation that occurs in analysis on a once weekly basis removes some of the persecutory and therefore harmful anxieties – it is oneself that is criticised and reflected upon not the client or the therapeutic relationship. Perhaps this could bear some fruit in our small groups and plenary, does this give the Jungian practitioner too much responsibility to bear? Does this encourage narcissism by continually checking if it is all essentially about oneself with a big s? Or is it a sincere acknowledgement that it is only what we can bring ourselves that can matter?

I did and do still feel that probing in to our own unbearable or unpleasant motives or behaviour is a tremendously delicate business and too threatening and unsafe in a presentation forum, so I am not going to point fingers or elicit self disclosure in public here, perhaps not even in small groups and certainly not in the larger plenary and feedback. Perhaps we could use the time later to collect anecdotes, experience reported or our own, memories and recollections and explore the instances where we have noticed eros, thanatos, envious attack and sadistic/narcissistic process happening in supervision in order to open up discussion?

Unsurprisingly, perhaps because it is so ‘risky’ and painful, there isn’t much written about this uncomfortable, challenging narcissistic material (either that we might own or that we might be presented with by our supervisees) in the wide body of literature: I had to dig deep and do a lot of reading to gather quotations! Gertrud Mander courageously explores the potential narcissism of the supervisor in relation to this; proposing that the need to be thought of and idealised as ‘knowing’, experienced, powerful and senior and to occupy a position of status and authority can provide  “weekly instalments of narcissistic gratification” (Mander. 2002. p.49). The only other material I found was a joint American paper from counselling psychology which details what the anxieties might do in terms of preventing disclosure in supervision, there isn’t the scope in this presentation to detail this but I give the reference at the end of this paper. There’s only a brief exploration of the results of the persecutory anxieties in the supervisees as opposed to the causes of them in supervision relationships. This work is not necessarily useful in terms of challenging ourselves and our potentially narcissistic, envious or sadistic practice as it shows merely our defense mechanisms and the avenues they might lead us down in terms of avoidant behaviour. Clearly though, the paper describes our need for self protection and preservation from harm and proposes that supervision can function in an intrusive and damaging way which forces the supervisee to shut up completely. Again, it is mentioned that this is especially the case when the supervision is wielded authoritatively and/or in a case management/validating/ box ticking way as opposed to a fluent, creative wondering  and wandering way. We are generally believed to be about 10 years behind the United States in terms of the wonderful world of mental health and therapy of all kinds, but perhaps in looking carefully at what causes us to behave in a persecutory, envious, destructive and sadistic manner in our roles as supervisors then we might finally catch up  – maybe even get ahead?

We are quick to identify narcissism in the supervisee and to analyse it as part of their motivation for even applying to train as therapists or counsellors, let alone in doing their work with clients; yet, at the risk of repeptition, slow to identify the trait in our own motivation to occupy the role of supervisor. Arnold Mindell helps again here: “rank is a drug, the more you have, the less aware you are of how it affects others negatively” and perhaps we can all get stuck, complacently occupying our position receiving the weekly instalments of narcisstic gratification (as well as the payment of course!). Complacency can be more dangerous than extremism in that it allows the same situation to continue without challenge. It is much harder to move out of this position or to go cold turkey from the weekly instalments of gratification drug. My experiences working as an analytical supervisor in Worcestershire’s Community Drug Team are germane here – working in small Balint groups which incorporated an hour of free time too allowed for a collegiate and equal feeling to emerge and for some exploration of the gratification/addiction processes not just in the client group but in the way the workers practised. We swiftly became aware of the destructive and curtailing aspects of individual ‘clinical’ supervision and how this had hampered process and gained much from the mutual support and exchange that was created in the group. My role as a supervisor was re-defined, I felt movingly very much part of the group on a journey, as well as struggling with holding the boundaries (again interesting in a substance misuse service!). Containing the anxieties became everyone’s job and interpretation and insight began to flow.

To return to the aim of supervision as it predominantly is; i.e; to check, police and authorise a therapists ongoing work as well as to support it, it stands to reason that both supervisor and supervisee in a dyad feel equally anxious and uncertain and are likely to experience transference and counter-transference dynamics specifically to do with a sense of powerlessness and unknowing. As, of course there is no such thing as actually ‘knowing’ especially in supervision where we are dealing with reportage third hand and out of context. Louis MacNeice writes in ‘Woods’ about perception being “ a series of half truths and not quites” which is poignant in relation to our listening at the minimum of 3 removes in supervision.

 “The sheer unconsciousness of the unconscious” (Freud) needs to remain respected in supervision as much as in therapy despite the pressure of needing to know what is going on in the client work that supervision applies. I was astonished in conversation with a colleague who described her supervisees as ‘absolutely hopeless’ as they ‘knew nothing of the unconscious’. I didn’t have the heart to retort that none of us really do or should have! Comfort and ease in supervisory work comes from NOT KNOWING and the supervisor affording respect for the supervisees rounded knowledge and experience of their client and how it feels ‘in the room’. Accepting that we don’t have a camera recording the dynamics and developments of and in the relationship and in fact, that if we did have it wouldn’t offer us a real or rounded perspective on what was going on is also useful. We are pretending to work in camera when we are actually working in theatre. Back to Louis MacNeices’ half truths and not quites.

Bion springs to mind here with the idea that the one thing a therapist needs is to be able to tolerate ‘not knowing’, perhaps it is the pre-requisite for an enabling and positive supervisor as well? One who isn’t indulging their own narcissistic pathology or enviously and sadistically attacking the supervisee and their client(s), but who is prepared to muse along with a colleague on the sheer impossibility of our profession? A useful supervision arrangement is one maybe where tolerance of ambiguity forms a platform from which creativity and insight can spring. This could resemble a model more like differential diagnosis in medicine and the manual therapies. Can we all consider together what we propose instead of the traditional model? How do we assess if we don’t adhere to a hierarchy? How do we cope if we find ourselves confused and upset by ambiguity or our own humility?

-OBSERVATION of the supervision groups and dyads as OEDIPAL configurations – there is a huge Narcissistic grown up burden of being the parental figure in a supervision group. A parents place is in the wrong and acknowledging this may well liberate the process of supervision. Oedipal anxieties are clearly to the fore in supervision. The benign, helpful or even idealised mother or father figure can also be experienced as malign and maleficent, holding the ‘child’, (the regressed supervisee) back or enviously attacking their youth and years of career ahead of them. I have usefully explored the supervision transferences as part of the oedipal phase in terms of needing a ‘third’ person to mediate and facilitate; this is conventionally again the supervisor, client and counsellor triangle which I have already referred to.

Having the courage to tolerate a “deep psychic engagement with the supervisee, while forgoing the comfort of rank and status” (Yorke. 2005. p.49) has allowed me to discover a humbling equality, an alliance in supervisory work. I think we often seek this style of supervision in our peer arrangements and some deeply difficult trouble certainly arose for me when a peer arrangement mutated in to a training course requirement and the hierarchical status came in to play.

There are naturally many crossovers between therapy and supervision, the distinctions between the two processes need to be protectively made clear on occasion. The sense of propriety and assumed right in analysing a supervisee too deeply might benefit from also being carefully monitored. The common negative supervisory experience of being judged and found wanting can spread cancerously to cover both the practitioner’s role as a counsellor, their functionality in supervision and more deeply narcissistically wounding as a person. Where supervision threatens to replace or become therapy this is the risk for the supervisee and supervisor alike. Furthermore, a collegiate, collaborative, enabling, creative way of working together can become quashed.

A balance can usefully be struck where both parties muse on the material together, both free associating: “an expansion of the capacity to associate, thereby broadening and perhaps deepening the reach of the unconscious mind of all participants. In this way supervision can be seen as having a therapeutic potential (my italics) for both supervisor and supervisee”. (Driver 2002a: p.9). It takes some courage and a sense of one’s own humility to achieve this, having reached the lofty heights of ‘supervisor’ one must clatter back down to earth.

Perhaps this equal musing in supervision is most possible where the theoretical and clinical orientations of supervisor and supervisee aren’t congruent, allowing for a sense of ‘not better or worse, just different’? Here, creative play and comparison along an equal axis are positive assets and enrich understanding of the process. “It is important for supervisors as well as therapists, to keep in mind that they do not have a monopoly on insight” (Crawford. 2005. p.58) vital, I would say!

NARCISSISM LEADING TO SADISM

Many of my difficulties and sense of masochism in engaging in a supervisory relationship have centred on the process of being assessed, judged negatively by someone I had either hoped for or previously experienced as my equal: “a supervisory impasse or stalemate that inhibits creative play can be extremely difficult to unpick or shift and can involve many complex factors including strong negative transferences between supervisor and supervisee, or between supervisee and the institution, when the supervision takes place in the institutional setting” (Crawford. 2005. p.119) and never more so than at the point of assessment and all the persecutory anxieties that this provokes. “The element of assessment powerfully affects the supervisory relationship and can feel like an unwanted intruder to both supervisee and supervisor” (Crawford. 2005. p.121).  

This is where my own narcissistic disturbances and distress fuelled conflict in the supervisory dyad and allowed it to become sadistic/masochistic. On another painfully notable occasion the sibling rivalry and envy reared its head and I became very troubled and rageful (it is difficult to remember the constant pain that the primary and secondary narcissistic wounds evoke especially as they can remain hidden behind the rageful outburst – the active part of the narcissism) as it appeared my supervisor favoured another colleague with referrals and I was left out. We were able to discuss this in the supervision and it has made the dyad stronger as we have looked at angry, competitive, negative, potentially destructive emotions and processes straight in the eye. My supervisor was able to let me see my own competitiveness and envy and not feel ashamed of it or too woefully embarrassed. A feat indeed given the monthly frequency of our meetings!

I would argue further that these deep seated persecutory and narcissistic anxieties are related to the (in)ability to play (on both supervisor and supervisees’ parts) and can be located at an early stage of emotional development, much of Winnicott’s thinking illustrates this for me. Thomas speaks of the “uncontained baby-self” (Thomas, 2005. p.127) of the patient in the room and leads me to remain very mindful of my own negative experiences of supervision and particularly of the baby self of the supervisee (rather than their client) and how very present this is when there are  so many persecutory anxieties around. There is wisdom in keeping this to the forefront of the supervisors mind, remembering that the ‘baby’ needs to be held safely and allowed to play in order to develop.

In a past struggle when a supervisory relationship changed from a peer/collegiate one to a more traditional hierarchical one for the purpose of additional training,  I and my supervisor sought the help of another colleague, a ‘third’, to assist when this struggle inevitable became painful and potentially destructive. Although the magic wand of complete resolution wasn’t waved, the process in this symbolic oedipal triangle was helpful and illuminating.

In both of these examples “the conflict has arisen in the supervisory relationship, this is where it needs to be taken up, as (it) is likely to be evoked by unconscious elements in the supervisory material” (Thomas, 2005 p. 119 after Martin, 2002 and Szecsödy, 1990). This could be seen to be so on further examination of what was going on in the client work, but it was much more enlightening to consider the supervisory relationship as standing alone, in other words dispensing with the all too often used theory of parallel process. Parallel process for me is a little like a ‘cop out’ – oh look, we are experiencing difficulty in between us two, it must be the pathology of the client, transference from client to you, etc.

ENVIOUS PROCESS RATHER THAN NARCISSISTIC:

We are potentially simply envious of our supervisees, their youth, earlier and excited stage of learning and can often perceive that they benefit from having what we don’t have in this regard. Perhaps harking back to Patrick Casement here we are envious of our own capacity to help (in the therapeutic relationship we can often envy our clients all their development, enlightenment and change –their basking in the warmth of our assisting process). How do we monitor our own envy and our own narcissism? They are so difficult to grapple with at the best of times that a systematic process of exploring them might be the best way as mentioned earlier on.

CONCLUSION

 

In setting up any kind of psychoanalytic or psychodynamic supervision arrangement there is plenty of de-skilling and ‘not knowing’ to be felt. Narcissistic and envious sore spots are waiting ready to be prodded…..A once weekly model or monthly supervision is intensive and demanding and requires significant commitment. The more usual model for the jobbing therapist of once monthly for an hour and a half (and indeed the basic requirement of BACP, BPS and UKCP) allows for defences to be re-built in the gap of time elapsing between sessions, both on the part of the supervisor and the supervisee. Perhaps change or equalisation is more likely to be retarded under these circumstances? Perhaps our own narcissistic needs are met better and are therefore less likely to erupt in to full blown envious and sadistic/masochistic process if we met more frequently?

If the relationship began on a more traditional hierarchical footing….the once weekly model with its intensity and its holding of the needs of therapy as well as the requirements of supervision potentially allows for more fluidity and progress. And more capacity for exploring the shadow aspects of the relationship – the aggressions, distinctions, differences and of course the narcissistic, sadistic and masochistic aspects belonging to each party.

Please do feel free to argue with me here – less frequent meetings of course may do just as well if the relationship is equal and creative enough.

The reading and teaching concur that fostering and enabling an exploratory, playful and creative space where reflective process can occur alongside challenging and critical (in the best sense of the word) thinking is the pinnacle. However, we can use our psychodynamic insight and understanding to actually struggle with and account for the conflicts when they emerge and the diversity in our working practice to forge more equal and creative supervisory space. Understanding our own needs for gratification (the narcissistic side of ourselves as supervisors) and confronting the sadistic and envious aspects of the work are the most difficult and ‘taboo’ subjects. Perhaps they are only safe to emerge in peer groups and even then only if gently asked for and explored. Perhaps they are embedded and institutionalised in training bodies, where they are most difficult to challenge; I rest my case that we need to try.

REFERENCES:

Bion, WR. (1967) Notes on Memory and Desire. Psychoanalytic Forum 2 (3): 272-3

Bion, WR. (1963) Elements of Psychoanalysis. London: William Heinemann. Re-printed (1984) London, Karnac books.

Crawford, S. (2005) Free Association and Supervision in Driver, C. and Martin, E. (eds.) Supervision and the Analytic Attitude. London. Whurr Publishers.

Driver, C. (2002a) ‘Introduction: orientation and themes’ in Driver, C. and Martin, E. (eds) (2002) Supervising Psychotherapy. London, Sage Publications.

Mindell, A. (1995) Sitting in the Fire: Large Group Transformation Using Conflict and Diversity. Portland, Lao Tse Press.

Thomas, M. (2005) Through the Looking Glass: Creativity in Supervision in Driver, C. and Martin, E. (eds.) Supervision and the Analytic Attitude. London. Whurr Publishers.

Winnicott, DW. (1971) ‘The use of an object’ . In Playing and Reality. London, Tavistock (reprinted, London, Routledge, 1996)

Yorke, V. (2005) Bion’s ‘Vertex’ as a Supervisory Object in Driver, C. and Martin, E. (eds.) Supervision and the Analytic Attitude. London. Whurr Publishers.

 

BIBLIOGRAPHY:

Bion, WR. (1961) Experiences in Groups. London: Social Sciences Paperbacks.

Symington, J. & N. (1996) The Clinical Thinking of Wilfred Bion. London, Routledge.

Ekstein & Wallerstein (pres.2006). The Teaching and Learning of Psychotherapy. Paper presented for module 4 at STPN.