EXAMPLES OF SUPERVISORY INTERACTIONS (Part 1 of 3)
Example 1. The Supervisor Makes a Mistake
We told each other what we did not know and learned much in the telling. (J. Robert Oppenheimer, quoted in Fleming & Benedek, 1983, p.
Although the pedagogical and broader humane potential of supervisor and supervisee attending to their own communicative interaction seems to me open-ended, even in the teleological-redemptive Husserlean sense of the rational reconstruction of the world of life [(the Lifeworld, or: Lebenswelt)], the reasons our society allocates resources to psychotherapy supervision are more banausic: to train new therapists (to meet growing needs for services and to replace the old providers who will eventually retire from the service), and to monitor the quality of trainees' therapeutic efforts (protect clients from the students' inexperience).
Therefore, my first example will illustrate the proposed kind of self-reflective conversation's potential directly to benefit the therapy a particular patient receives from their student-therapist and the training the student-therapist receives from their supervisor. This example shows these potentials not just in a "general" way, but as directly contributing to helping the supervisee deal with immediately salient issues in the current patient's treatment. This focus addresses the potentially weighty criticism that I am proposing to turn a socially useful task-oriented activity into a speculative, asocial process-oriented activity, to the detriment of accomplishing the tasks for which the activity was underwritten. I will propose how, in a frequently occurring situation where the student has a serious impediment to effectively working with a client, and supervisory efforts to teach the student what to do are at best weakly helpful while efforts to treat the student's impinging personal problems prove counter-productive, self-reflection by supervisor and supervisee on their communicative interaction in the supervisory situation can be effective.
<a name="IUP">My example is from Joan Fleming and Therese Benedek's classic text</a> (see, e.g., A. Freud, 1971, p. 83), originally published in 1966, Psychoanalytic Supervision: A Method of Clinical Teaching (1983). [This material, from pp. 59-67 and pp. 101-104, would be reproduced verbatim below (Appendix A), in order that the reader could form his or her own opinion of my interpretation of it, if International Universities Press had granted me sufficient permission rights, but they only allowed me to cite the material in the dissertation itself, and no further, not even permitting University Microfilms to include it in the microfilmed text. A University Microfilms employee told me that International Universities Press was one of a very few publishers with which UMI had a history of difficulties. For the reader who is not already familiar with what goes on in supervision, the verbatim material would have helped furnish his or her imagination. Therefore, I regret that the material in Example 1, immediately following, will be somewhat untethered from its context. The reader may wish to skip ahead to [TBD] if Example 1 becomes too tedious or difficult to follow. [It might also be useful to speculate on the psycho- and socio-dynamics of why the psychoanalytic establishment's publishing house is uncommonly refractory in this regard, and, further, why it calls itself International Universities Press, when to the best of my knowledge, it has no official affiliation with any university, and, in general, psychoanalysis has had a "history" of difficulties in being recognized by academia.]]
My example is from Joan Fleming and Therese Benedek's classic text (see, e.g., A. Freud, 1971, p. 83), originally published in 1966, Psychoanalytic Supervision: A Method of Clinical Teaching (1983). [This material is [not (see above)] reproduced verbatim below (Appendix A), in order that the reader can form his or her own opinion of my interpretation of it; also, for the reader who is not already familiar with what goes on in supervision, the verbatim material may help furnish his or her imagination.]
The supervisor in the example, one of the authors of the book, Therese Benedek, is highly experienced and respected. She is empathic toward the supervisee, and sensitive to the interpersonal communication relationship dimension of therapy (p. 24). She and her co-author even quote Gregory Bateson in describing their orientation toward the supervisory process:
These facts make Fleming and Benedek's text especially
To summarize, we should like to quote Bateson who said,
"In any given learning situation one learns not only what one is supposed to learn but also something about the process of learning itself." Bateson spoke of this phenomenon as "deutero-learning." As a counterpoint of this idea, we will add that in any given teaching situation, the teacher becomes aware not only of what he is supposed to teach, but also of the process of teaching itself. (p. 80)
valuable for me. Fleming and Benedek promote an empathic orientation to psychotherapy (Benedek's training analyst, Sàndor Ferenczi, was the most emotionally engaged of the pioneers of psychoanalysis). They have an avowedly communication-oriented approach to supervision. They are sensitive that communication is complex (viz. the reference to deutero-learning), and emergent, i.e., that what communication is for persons (e.g., teaching) changes and develops through persons communicating.
I find all these desiderata congenial. A question which arises here [at least for me] is: If Fleming and Benedek agree with me, how did they miss something which I claim is central to these central issues? Perhaps the answer is that this too is something emergent (i.e., it is not so much a case of them not seeing something that was already there, as not yet having arrived at the point of bringing that thing into being); in that case, were they still alive, I hope the authors might look with favor upon this dissertation as an extension of their (and others') work.
In presenting the example, I follow Fleming and Benedek's usage and call the supervisor: "S," the supervisee: "A" (for: "Analyst"), and the patient, who is an attractive, unmarried white woman in her twenties: "P." The example I have chosen comes from near the beginning of A's first analytic case. This should not, however, be taken to imply that A is a complete tyro in psychotherapy. Although it is not stated in the text, he is presumably already a licensed M.D. psychiatrist, since that was the only category of applicant who normally would have been even considered for training at the authors' training institute, The Chicago Institute for Psychoanalysis (only if an exception had been made, e.g., if the student was "only" a Ph.D. psychologist, might his previous training have seemed worth noting). A has completed his own training analysis (p. 37), i.e., he has himself experienced the process of a psychoanalytic treatment from the patient's perspective. A is judged by S to be a good student (p. 37). It should further be noted that at institutes such as A's, training cases are carefully evaluated by senior faculty: when a patient (P) is assigned to a student (A), care has been taken to maximize the likelihood that P will be treatable by A.
The foregoing considerations argue that this example is a "good" one: not something highly idiosyncratic, or perhaps representative of what happens in a poorly managed situation (or even an example of work done by persons whose orientation is antagonistic to my own). The supervisory sessions in the example are the thirteenth and fourteenth from the start of the supervision, and the client hours worked on in the supervisory sessions are the fifty-second through fifty-eighth. Therefore, even though it is still early in the treatment (which lasted 630 sessions in all), the treatment is far enough along that real psychoanalytic work is being done. (In exploring the interaction, I will cite, as necessary, excerpts from the complete material in Appendix A, which I have divided into numbered segments, item 1 through item 45, for convenient reference.) A begins supervisory session #13 (item 1) by perfunctorily reporting P's ambivalence about A, especially P's resentment that A does not answer when she asks him questions. Then A recounts a dream P had told: P was in her apartment, lying on a couch the same way she lies on the couch in A's office while reporting the dream, and, in the dream, a cockroach walked across a cabinet and touched her flesh. Then the cockroach went away and P woke up. S interprets the dream as indicating that P is anxious and lonely. A continues his reportage without stopping to say anything about P's dream or S's observation. S assesses (thinks silently to herself) that A is not empathically connecting with P's feelings, and she tries to help A overcome this problem. S even tries to encourage A's emotional involvement by sharing with A some personal images she had experienced while listening to A's report. A acknowledges these images, but continues with his relatively detached reporting of P's material. S brings her and A's consideration of this material to an end by encouraging A: "Next time when [P] brings [the dream] up, try to get closer to her feelings." In other words, S, albeit in a non-threatening and supportive way, ends up directly instructing A what to do. [We may speculate whether P is telling A that he "comes across" like a cockroach; and, further, we may wonder if A may be obliquely conveying to S any feelings her....]
One of Benedek and Fleming's basic notions about supervision is the need to build up and maintain a learning alliance between supervisor and supervisee, which they see as parallel to the therapeutic alliance between patient and analyst:
This model orients the supervisor (and the analyst)
Motivation for health or learning, trust in the
mutuality of goals, and confidence in the ability of the helper to help are the factors which the patient or the student bring to these respective relationships.... These qualities of rapport are determined by the balance of need tensions operating between members of each system. This balance is easily disturbed by responses from one party that do not meet the expectations which motivate the other party at a given moment. When the tension resulting is too great in either subsystem, a strain is put upon the fundamental alliance and progress toward the mutually accepted goal is threatened....
In fact, the essence of either the analytic or the supervisory process is the activity on the part of the analyst or supervisor which regulates the disturbance of equilibrium in the system so that the variations in tension do not exceed the tolerance of any unit. (p. 53)
to modulate efforts toward reaching learning (or treatment) goals according to a communication model with a strong (what I will call:) "hydrodynamic" component (i.e., keep the pressure in the system below the bursting point of its components). As a loose metaphor, this desideratum likely seems self-evident, except to persons who, in supervision, therapy or whatever human relationships, employ anxiety as a "motivator," use various kinds of "paradoxical interventions" (e.g., the psychiatrist Milton Erickson -- I have addressed this issue elsewhere in this dissertation), or who [(provocatively?)] claim they have no goals (e.g., Wilfred Bion).
A straightforwardly empathic approach to difficult communication situations dictates keeping the anxiety level as low as possible without defeating the purpose of the interaction. But to make pressure-level considerations salient, as Fleming and Benedek do, probably following the emphasis on the "economic" aspect of psychodynamics in Freud's theories, seems to me likely to lead to a pedagogical orientation of what, above, I called "compromising": If the supervisor knows X amount of truth and the supervisee reaches tension toleration threshold after receiving Y amount of truth, then Z=X-Y, if greater than zero, becomes the truth which the supervisor must hold back from the supervisee at least for the present. An implication of this is that, if the cumulative sum of undischargable Z's remains large after extensive supervisory effort to reduce it, then the student may be recommended for remedial training or even failed out of the training program. I have dealt with this issue at greater length elsewhere in this dissertation under the general topic of the self-validating aspect of deutero-learning.
In writing up their book, Fleming and Benedek retrospectively evaluated the part of the example supervisory interaction so far described as follows:
The focus on keeping the pressure within manageable
...[R]esponding intuitively to A's sensitiveness
about his inexperience and his defensiveness about his emotional reactions, S felt satisfied by the result of her intervention and did not disturb the attained equilibrium.
S's avoidance of "intellectualizing" the teaching might have been motivated by her impression that the significant problem in this exchange was A's withdrawal from P's feelings of defended rejection in the dream.... Indeed, A does not "believe" the feelings in their symbolic expression. Thus S directs her teaching to indicate the significance of empathic understanding of P's feelings in the dream and in the present and future analytic situation, thus keeping the learning alliance in equilibrium.
The pressure of the material to be presented, of the problems to be discussed, did not permit either A or S to dwell long on the pleasurable sensation of equilibrium. (Fleming & Benedek, 1983, p. 63)
bounds ("hydrodynamic" considerations) is clear. Given the customary dichotomy in theory of supervision between learning needs that represent deficiencies of knowledge or experience, and errors in analytic behavior due to the student's own unresolved emotional issues (a.k.a. "countertransference") (pp. 71-2), which is often referred to as the "teach or treat" dilemma (which we have examined above), it seems S probably did the best she could under the circumstances. To more aggressively "go after" the student's own personal shortcomings which restrict his empathy (to treat more), or to insist more forcefully on what needs to be done and the theory behind it (to teach more) would both likely have been counterproductive by potentially raising the student's anxiety above maximum tolerable level, thus leading to a breakdown of the learning alliance and other possible negative reactions to stress (discouragement and withdrawal, acting out, etc.).
In my rescript of the interaction, below, I shall propose a third alternative, besides "teach or treat," which avoids the tradeoffs which shaped S's interventions (is orthogonal to this complemental series). Before continuing with the remainder of this supervisory session, however (the part so far covered is mainly background material), we note that, even in the leisure of studying the material in retrospect for inclusion in the book, Fleming and Benedek felt pretty good about what happened, to the extent of lamenting that, in the session, the press of other material did not allow more time to savor the "pleasurable sensation of equilibrium" S and A had achieved.
I would tend to agree with their lament about the pressure of time, but I would see the loss as more than just an opportunity for two persons privately to share some enjoyable sensations: For A to have been able to sit with this good feeling for a longer time would have provided him an experience of feeling comfortable (what D.W. Winnicott and others call a good "holding environment") which could have been explored in the supervisory interaction, and, even if it was not explored, would have contributed by example perhaps just a little to A providing more of such support to his patients in future.
Furthermore, "pressure of time" is a salient aspect both of life and of therapy (few patients can afford as frequent therapy sessions as they could constructively use, leading to issues around trying to cram too much material into too little time, etc.). Therefore, by supervisor and supervisee not examining their pressure of time in the supervisory situation, they missed a good pedagogical opportunity to deal with an important issue in therapy and in patients' problems in living.
The supervisory session (still #13) continues with A telling S about the analytic session following P's report of the cockroach dream (items 27-38). A reports that he said something to P which P interpreted as grossly unempathic, and that she strongly told him she felt hurt. Due to S feeling that A was approaching the limit of his tension tolerance, S responds to A's report of his "mistake" in a way S herself feels is unsatisfactory. Even in retrospect, the authors saw no better way the situation could have been handled:
In the next supervisory session (#14; Items 39-45),
In responding to the immediate teaching problem,
S might have informed A of her interpretation of what motivated his untoward behavior. Considering, however, the unusual sensitivity of this student to criticism, S did not feel that the emotional climate of the supervisory situation would be conducive to learning if she actively proceeded along the path of confrontation....
...S, empathizing with A as well as P, chose to respect A's resistances without interpreting them, to intervene in his self-preoccupation only as far as she felt he could tolerate it, and to wait and see if he could get over this inhibition with this much help. There would be time to go into it further if A's block persisted.... (p. 66)
A shows the effects of S's interventions. There seem to have been no constructive results. A even laughs to S as an aside to reporting something P said (item 40: the reference to the little dog) which, at least in A's opinion, obviously was unflattering to P, but which P reported without showing the least awareness of this meaning. Lacking the non-verbal communication channels, one cannot be altogether sure, but the context seems to make it fairly clear that A is either mocking P or unempathically expressing his impression of how unobservant she was.
A completes his report of this session and then, without a break, continues to report the next therapy session, nowhere showing any empathic connection with P. A reports that P had started by returning to further explore the therapy session in which A had made his big "mistake," including P saying that she had forgotten to mention that after that session she had a bad asthma attack (S and A know from background material that this symptom relates to P's childhood issues of loss and abandonment). A discloses how he felt about this to S:
A seems entirely oblivious of (or, perhaps worse, indifferent to)
Really, quite a bit of time had gone by, so I
asked her why she's so intent on discussing this event a week ago, today. And she repeated that she has made some discoveries....
how important this material is to P. The last of P's discoveries which A reports is that P now recognizes that she used to talk on and on to her boyfriend about things that were on her mind but that did not interest him, but now she tries to think about what will interest him and not talk about her own concerns so much. A tells S, at this point:
A reports some more from this session and then proceeds
So I said, "Well, that's very useful socially, but not
in the treatment." And she laughed and said, "This is the result of the treatment." She said she realized that it's not possible to solve problems through advice and that help is not the same thing as affection, that the people closest to you cannot help you....
without a break to begin reporting the next therapy session. A cursory overview of this material shows that, as Fleming and Benedek noted in their retrospective commentary:
In other words, there is no evidence that S's
According to his report, [A] said very little to P during
the two analytic sessions covered by this exchange. He reports what he said, but his comments could be characterized as interventions for clarification and orientation to the treatment goal rather than as interpretations designed to mobilize or make conscious unconscious motivations. (p. 101)
advice to A to try to get closer to P's feelings was effective. A expressed lack of empathy to S, in laughing about the boyfriend's dream while reporting it to S. A's question to P why she was so intent on discussing the material from the previous week was an instance of lack of empathy which A exposed to P, directly. When, in response to A "lecturing" P what to do in therapy, which probably made her feel even more discouraged, P tells A: "the people closest to you cannot help you," one does not need to subscribe to Robert Langs' version of communicative therapy in its details to wonder whether P is here obliquely telling A in an only thinly encoded way that she feels he is not helping her, and, furthermore, that "advice" -- the kind of things A is telling her -- is a wrong kind of technique. When, in retrospect, the authors remarked that "for the most part, A omits a report of his own thinking regarding the meaning of what P says" (p. 104), I think they were making an unwarranted assumption that A considered P important enough to think anything about (maybe A had no such thoughts to withhold from S). It seems to me remarkable that A did not lose this client [(except that we know persons often have become accustomed to enduring disappointment and even abuse from those who should have nurtured them -- a pattern from which therapists (and, in their turn, supervisors) may "benefit")].
At this point, before criticizing S's handling of this situation and proposing how I would handle it in a radically different way, I feel it is important to situate my critique. I have just said, as the authors themselves observed, that S's telling A to try to become more empathic with P did not seem to help A become more empathic with P. I purposely hedge here, even though the following analysis will suggest that A's response to S's advice may have been for A to become, at least for a time, less empathic to P than A might have been had S not said what she said, i.e., that S's intervention perhaps had counterproductive effects.
I speculate that S's intervention probably did, over a longer period of time, during which S made many similar interventions, help A become a more empathic analyst. I propose this happened, at least in part, by A gradually internalizing the sincerely empathic way S worked with him, thereby (through role-modeling, etc.) helping A to become a more emotionally available person; i.e., I propose that S's pedagogy was at least somewhat effective as deutero-learning, combined with A's conscious efforts to do (to try to do; to try to figure out how to do...) what S instructed. Indeed, expectation that progress is often a long, slow process is captured in the authors' "wait and see... [t]here would be time" (p. 66) approach to the situation. (The alternative approach I will offer should work faster.)
Fleming and Benedek's model of supervision "works." At least it [deutero-]works well enough that they do not feel strongly motivated to try something radically different instead of incrementally refining it. I do not claim that my position is "right" and theirs is "wrong." I do propose that my position is "more right" than theirs, in the sense that it can account for everything their position accounts for, that it yields constructive results beyond what their position can offer, and that it accounts for why their position works as well as it does. (This is similar to the now familiar way of seeing Ptolemaic astronomical theory not as wrong but as "limited" when compared with Kepler's elliptical-orbit approach to planetary motion -- and as a constructive step which permitted the latter, later development.)
At the point where S encourages A to try next time to get closer to P's feelings (items 25-6), the stage seems set for -- nothing. It seems the supervisory session should end here, with A going off and trying to apply S's advice. But the session not only does not end here. It continues in an entirely unanticipatable way: A hastens (item 27) to report that, shortly after the beginning of the next analytic session, he made a mistake. This "mistake" clearly is the center of A's concerns in the supervisory session. An interesting question is why A didn't go directly to it at the very beginning, instead of letting less important material consume substantial time first (this is another point to which I shall return later in making specific recommendations how to reorganize supervisory practice).
What happened in the therapy session, as I try, like S, to reconstruct the external events from the supervisee's report of them, trying to compensate for A's possible distortions in reportage, seems to be: P risked bringing up some anxiety-producing material in the session (this is, of course, something patients are supposed to do). Her anxiety brought her to a halt. She was anxious that A would treat her in the same way as her parents would have responded to this material. A's response: silence, does strike P, whether or not correctly, as similar to what her parents would have done (silence and "forbidden" often go together). P takes the further risk of begging A to say something. A continues to be silent, raising P's anxiety level. A is aware that his silence is making P increasingly anxious, and consciously tries to manage the anxiety level (a lesson he has presumably learned from Freud's "economic" model of psychodynamics, and S's "hydrodynamic" approach to managing the supervisory interaction). A finally speaks when he feels P can tolerate no more anxiety. He tells her: "It seems that you want me to approve of this intelligent discussion that you have made."
Every interpretation has a validity ground somewhere, but it seems to me that the grounds for A's interpretation here must lie, as indicated, largely outside the therapeutic interaction being reported. P probably does want approval, but not of "the intelligent discussion she has made." It seems much more likely she wants approval that it's OK to "be herself" (in this case, to talk about forbidden topics). And even if she was doing exactly what A thought she was doing (seeking approval for her intelligent discussion), she was doing something she wanted to do and expecting to be criticized for it, so that, even in this case, what she would really be looking for is approval that it's OK to "be herself," even when her self is not what other people want it to be (in this case, "making intelligent discussion" instead of whatever would have pleased A more).
At this point in the presentation, S intervenes with item 28: "Intelligent discussion?" -- echoing A's own words from his self-defined confession of having made a "mistake" (which term may well be a euphemism for how badly he really feels he messed up -- sufficient contextual evidence is not available to test this hypothesis in the present instance, but understatement in confessing behavior of which one is ashamed and/or for which one fears one may be punished is a widely occurring communicative behavior in reality). S's remark here is, I propose, the key to the entire interaction, both how it in fact turned out, and how it might have been changed to turn out in a very different and more constructive way.
The supervisor's nonverbal metacommunication also is not available, which makes it impossible to be entirely certain what feelings she was expressing by her remark. But if we note that silence ("saying nothing") is a frequent psychoanalytic maneuver, to the point that analytic writers often advise that, when unsure what to say, the analyst should say nothing, we may presume that for S to make this comment is probably significant, especially since it appears almost as an interruption of A's report of what he did: he has not yet reported P's response to his intervention. (A probably did pause at this point, to catch his breath, punctuate the finality of what he had done, and to test if "the other shoe would fall," i.e., if S was going to "really come down hard" on him.) If S wanted to say anything at this precise point, to indicate that she was listening and help smooth the conversational flow, she could have said something like: "Ummh. And then?" Alternatively, and more empathically, S might have said something like: "I think I hear that you are worried that you really did some damage here." Always, an aspect of understanding a communicative act is knowing what alternatives were conceivable but not chosen by the speaker. The foregoing seem to me likely candidates in this situation.
I propose that the most plausible interpretation of S's comment ("Intelligent discussion?") is that it is sarcastic, and expresses annoyance with A. It seems unlikely that S was unsure what words A had spoken, although it is possible that S (to use a colloquialism:) "couldn't believe her ears." I grant there is no direct evidence for this interpretation, since, as noted, the metacommunicative side channels of this interaction are unavailable. To parrot back a person's words is a widely-used and effective way of expressing sarcasm, annoyance, impatience (etc.). Furthermore, S has ample reason to be annoyed with A, since A has just presented a gross example of what S had just previously urged A to try to improve upon (A's lack of empathy for P).
This hypothesis immediately receives further support when, after A reports in item 29 that P told A that he had been sarcastic to her, thus bringing the issue of sarcasm into the supervisory conversation even if it wasn't there already, S, a second time, parrots back to A the words A uses to report his next intervention, which he also feels was a mistake. In response to A's report that he had told P what P had said was "not relevant" (item 29), S parrots back to A (item 30): "Not relevant?"
Sarcasm not only objectively informs its target that the speaker deems the latter to have done something incorrect; it also belittles the person (makes the person "feel small"), unless, of course, the person can come back and "put the smart aleck in his or her place," which does not happen here, although, as I will soon show, A could have done this to S (by which I mean that A could have done this if he had had a certain kind of strongly confidence-building childrearing, if he had integrated the ideas in this dissertation, etc.).
P felt she was the object of A's sarcasm. I have proposed that A is the victim of S's sarcasm (or at least of words which, however "consciously" intended, could plausibly enough have been interpreted as sarcastic to merit an apology from S, had A told S he had taken them that way, and S, after looking into her heart, concluded she really had no such intention). Furthermore, it seems likely that A had some "vague" (disattended) sense of having been "put down," but, most likely, integrated this into his already self-accusatory orientation, for, at the start of item 31, A's next words after S's second echo remark are: "This chicken really came home to roost afterwards. She really rubbed this in." These words of A's could apply as easily to S's echolalia in the supervisory session as to P's remonstrations in the therapy session.
What A is subjected to in the supervisory situation is a very close parallel to what P experienced in the therapy situation. If A can be brought to recognize this, he will have an opportunity to experience in the supervisory situation what P experienced in therapy. In future, A would be able to get closer to his patient's feelings, not because he was trying to figure out how to implement his supervisor's well-intentioned but also intuitively empty advice ("mere words" without any clue how to carry them out), but because he would already have had the same experience to which the words refer (he would "have been there"). Actually, he would not just have "had" the experience, but, with the collaboration of S, he could also have had the experience of resolving the problem, and of having explored ("worked through") both these experiences, in the supervisory situation. In consequence A would also have had experience orienting himself to these kinds of situations (have "gotten a handle on" them), so that he would be able to orient himself to what was happening in the therapy situation instead of passionately (i.e., passively -- being unwittingly manipulated by his feelings) identifying with it.
The production-and-investigation (which two here are one, i.e., oscillate back and forth somewhat like seeing a double-reading Gestalt psychology image now the one way and now the other) of this kind of communicative interaction, wherein being and knowing coincide and there is relief from anxiety, not "elsewhere" (e.g., a Heaven of ideas or after one has passed one's licensing examination, etc.) but in the immediacy of the here-and-now, is the "core" of this dissertation. It is offered as a recommendation both for psychotherapy supervision and for interpersonal communication in all areas of life, insofar as persons have the good fortune not to be acting under imminent duress. <a name="reright">As Edmund Husserl wrote in 1935</a>, during the rise of Nazi power:
In these latter cases, however, once [presuming that]
For the sake of the life-task that has been taken up
[i.e., the foregoing] , in times of danger one must first let these very tasks alone and do what will make a normal life possible again in the future. The effect will generally be such that the total life-situation, and with it the original life-tasks, has been changed or in the end has even become fully without an object. Thus reflection is required in every sense in order to right ourselves. (Husserl, 1954/1970, p. 392; italics in original [TBD to a dream I had which illustrates this quote])
the threat has been addressed, the persons involved can then examine both their new (post-crisis; renormalized) situation and also what they did during the crisis when there was not time to examine it "in process."
The kind of self-reflection here recommended connects with D.W. Winnicott's notion of therapy as a space in which therapist and patient can imaginatively play with their symbols (their representational image of the world), and that, where the patient cannot engage in such play, the aim of therapy needs first to be to bring the patient to a condition where the patient can play (Winnicott, 1971, p. 38). Whereas "equilibrium" (Fleming and Benedek's guiding image) is always a compromise, there is no limit to the possible growth of rapport (the result of mutual self-reflection).
A way to implement this proposed change in the example interaction is for S, instead of item 30 ("Not relevant? Why wasn't it?"), to say:
Then I would be quiet and let A take this in
You know, A, as you tell me this about P saying she
felt you were sarcastic, I have an uneasy feeling that maybe my remark to you, where I parroted back your words "Intelligent discussion" was sarcastic. I don't think I consciously intended it that way, but I think I felt annoyed that, just after I encouraged you to try to get closer to P's feelings, you tell me about this -- as you called it -- "mistake" you feel you made. I think I've done to you, A, what P thinks you did to her. I'm afraid I shamed you like P's parents used to shame her and now P feels you also shamed her. That was my mistake. I'm sorry.
and process it. A might show immediate recognition and relief. If, however, A seemed to be uncomfortable with the silence, I would encourage him, again calling his attention to the parallel between his situation and P's:
In any case, we would eventually get on to talking
Your being silent makes me think you're anxious and
ashamed of yourself, and also suspicious of what I just said. As your supervisor, I am an authority figure, and you're probably afraid, or at least I would be if I was you. You took a risk in telling me about this [item 27] -- like P did in telling you about her family's shaming her about bodily functions and sex. I'm glad you had the courage to tell me. It's OK. I'm here to help you handle these things that happen.
about A's experience in the here-and-now, comparing it with the interaction between P and A, and learning many different things relevant to both situations through self-reflective conversation.
This intervention, I propose, would have gotten A involved in examining and getting closer to his own feelings at the moment, and also imaginatively comparing his present situation with P's, thereby getting A closer to her feelings. It would have accomplished what S's earlier intervention ("Next time... try to get closer to her feelings") merely urged in [to repeat my phrase from above:] an intuitively empty way. I will elaborate what I mean here by letting S explain it to A, which will once again take advantage of the experience of the supervisory interaction to enable A to "grow," i.e., enrich his insertion in life, and not just acquire new information to process according to the vicissitudes of his current deutero-beliefs. S's words, as acts, will again be evidence (i.e., self-evidence) for what they assert. [(Here is my rescript of S's response to A's presentation:)] I would have S explain to A:
Acceptance of the "teach or treat" dichotomy gave
You see, this is what I was trying to get at,
before, in urging you to get closer to P's feelings. I wonder what effect my saying that had on you. If I was you and my supervisor had told me that, I would probably have thought something like: "Of course I have to empathize with my patients' feelings." But I'd have heard that advice many times before, so I don't think it would have any more effect on me now than any of those other times. I'd feel discouraged to be told yet again to try to do something that I didn't really understand but felt I should understand so that I'd be too ashamed to ask about. I'd be pretty angry at my supervisor for telling me what to do without helping me see how to do it. But I'd be afraid to ask, and I'd feel even worse about myself and "unconsciously" -- as we psychoanalysts say about so many things without necessarily knowing what that means and being too embarrassed to ask -- I'd try to put it out of mind and hurry on to something else.
S, in the interaction as it actually happened, little room to maneuver. In their retrospective assessment of the interaction, Fleming and Benedek explicitly noted that S had to withhold from A much that S perceived:
Further, in assessing A's behavior in the subsequent
The transcript reveals a quick change from the calm
S-to-A interaction [ending with the "try to get closer" advice] to a marked increase in tension, tone and tempo [beginning with item 28]. This change is not unexpected by A. He is aware of the mistake he made and its consequence. Thus he reports (1) the disequilibrium in the A-P system, "I said that she was hurt; this chicken came home to roost." (2) S responds only with questions which underline the inappropriateness of A's remarks. S does not even attempt an explanation of the motivations of A's behavior, since the tension, the state of disequilibrium in the S-to-A system, causes too much resistance to learning. (pp. 64-5)
supervisory session (#14), the authors noted that S's intervention, as restrained as it was, still resulted in "a need to maintain some distance from S and from P" (p. 104), i.e., not only in A not getting closer to P's feelings, but also temporarily damaging A's learning alliance with S.
To elaborate on something I said above, over the long term, these problems largely worked themselves out, or at least the tensions between A and P and between A and S subsided. How much of this, however, was due to genuine increase in A's empathic attunement? And how much was due to the various participants adapting to the situation in oblique ways (as P put it to A: trying to think of what will interest -- i.e., be acceptable to -- the other person in the first place and not talk about one's own concerns so much (item 43))?
The first thing to notice about my rescript of the interaction is that it "holds nothing back." In my scenario, the supervisor can directly say just about anything, no matter how potentially "threatening" to A, because my [modality of] intervention continuously defuses the material. I use the word "defuse" here, not in the sense of "toning down" (the "economic" model, again) the material so that it comes across less threateningly, in consequence of which, the recipient of the communication might be done a disservice by reinforcing his defenses against the "deeper" aspects of the problem (so that the small gains of today may make future work more difficult than it would otherwise have been).
No: I here mean "defuse" in the sense of separating distinct things that were previously blurred together. For both A and P, there is the need to separate speaking freely from being shamed and hurt. The inappropriateness of A's remarks to P does not need to be "underlined" by S: A has already done this himself. Instead, A needs a different model of what a "mistake" is in certain situations, namely, those in which persons help one another, including, hopefully, therapy and supervision.
Let's assume that, even after my proposed reassurances by S to A, A is still upset, probably thinking to himself: "Yeah. S says that. They all say that, but then they get you anyway. I'd best cool it and try to cut my losses." This is not "paranoid ideation": authority figures (e.g., parents) frequently tell their charges (e.g., children) that they can trust them (etc.) and then use their power to punish them.
Either because he does not really believe S, or, even if he does genuinely believe S, but still has his old notion of what an error is, I imagine A continues just as in item 31 in the original version of the interaction: "This chicken really came home to roost afterwards. She really rubbed this in...."
If A mistrusts S's sincerity, A may say this in a rushed way, to cut his losses, by fessing up to his mistakes (so that he cannot later be accused of withholding incriminating information), and punishing himself before S has a chance to punish him, in hopes S will accept his self-flagellation as sufficient and not punish him even worse. If A really trusts S, then A will feel somewhat less anxious, and more willing to listen to S, but still troubled by what he thinks he did, i.e., what he has deutero-learned a "mistake" is. I would have S address this problem as follows:
In other words, for both A and P, a fundamental
OK. You made a "mistake." I've just shown you
how I handled my mistake: remember that I just made a mistake with you. Well, maybe you think your mistake is much worse than mine. Maybe that means it will be an even richer opportunity to help P overcome her anxiety. Probably no authority figure in her whole life has ever hurt her and then admitted his error instead of trying to cover it up to preserve his dignity. I might just say to her: "What I said really was hurtful, and it was my problem, not yours." -- and take it from there. But I think the more important issue is for you to really understand that I mean what I said to you, that just as therapy isn't (or at least oughtn't be) for P a repeat of the way her parents treated her, so supervision shouldn't be a repeat of any bad experiences you've had. What I said really was hurtful, and it was my problem, not yours.
I don't expect you to believe that, but just to remember it, and keep comparing my actions with my words, and if you find they don't match, tell me and see how I respond to what you think is a new mistake I've made. It's my responsibility to earn your respect and trust. Everybody makes mistakes. We can help one another.
learning (or therapy) issue is to understand how the present relationship really is different from previous relationships in which authority figures, truly, fused such things as self-righteousness or false-promises with trusteeship. The supervisory payoff of this intervention should, I propose, be: (1) for A to become more self-assertive and attentive to his feelings of being hurt or even just not helped by others, and also to be able to differentiate when it is safe to express these feelings and when not (it's safe with S, but maybe not with the pompous head of his institute's Student Evaluation Committee, e.g.). Consequently, (2) A should be better able empathically to "read" such issues in others', including his patients', conduct of life -- and more sympathetically motivated to help overcome them.
As a general change in A's orientation in life, this learning (actually: deutero-learning) will change A's work as a therapist, not because A has learned new "therapeutic skills," but because he now sees all situations in life in a richer way. The therapeutic payoff for P will be a much more open and self-affirming therapy experience, in which, instead of just learning better how to keep out of trouble, she too can become more appropriately self-assertive via A being better able to deal with (in psychoanalytic jargon: "contain") the vicissitudes of her assertiveness. Since P already seems to have a fair amount of self-assertiveness (she does, after all, tell A what she thinks of him!), the accent here may be more on appropriateness: knowing when to say what, and, when she does decide to express herself and she gets a shaming response, to be confident that is probably the other person's problem, not a result of something she should feel ashamed about in her self.
In colloquial language, we sometimes say that a person has "learned a lesson" when experience has deutero-taught the person something important about which the manifest content of communication (proto-learning) was either silent or misleading. These experiences often are of quite brief clock-time duration. My aim in cultivating the kind of self-reflection in supervision illustrated above is to make use of opportunities which arise in supervision for the supervisee to learn (i.e., deutero-learn!) lessons as important as those to which the colloquialism usually refers, but with the opposite valence, i.e., not hidden traps to avoid, but unsuspected constructive possibilities of life.
These experiences are most effective when they are most powerful. Fleming and Benedek's constraint to "hold back" what is too anxiety producing is not applicable here. The presupposition on which this depends is that, (1) in truth and reality, no harm will befall the person to whom the otherwise anxiety producing material is communicated, and (2) this fact, i.e., that he or she will not be hurt and therefore the material is no longer cause for anxiety, is also communicated effectively to the person. If, however, the supervisor or analyst "uses" this technique in a deceptive way, and, especially if a student or patient learns of the abuse [in deed, and of trust], then the latter will have "learned a lesson," too, with potentially catastrophic consequences (e.g., psychotic breakdown or suicide or retribution against the person who broke trust or innocent bystanders). Here, words are powerful deeds.
If this kind of communicative interaction is cultivated in a genuine way, however, then its constructive potential, as said, can only benefit from intensity of the material involved. When inappropriately fused material is separated into its parts, to "dose" the truth, i.e., to not complete the separation of the inappropriately joined material, should vitiate the constructive (and anxiety relieving) effect of the intervention, by still leaving some of the old mix-up unresolved and possibly introducing new distortions. Instead of the issue raised by the teach or treat polarity, of how much anxiety can the supervisee "take," the question in a self-reflective approach to supervision more frequently becomes how much anxiety can the supervisee be relieved of -- here "more" is straightforwardly also better.
These interactions do not take more time than traditional "teach or treat" methods. They may take less time, due to a lesson needing to be repeated less often. "Gestalt shifts" instantaneously produce major changes in a person's orientation in life; incremental learning within a given orientation in life is generally much slower, even though the net enrichment in the person's capabilities is far smaller. My proposal does not take "time off task" of supervision examining students' work with their clients, because a vital element of the interaction is that the fact that it relates to a problem in therapy is attended to in the supervisory situation.
Now I turn to another point where I propose my alternative is significantly more effective than Fleming and Benedek's approach (and other theories which are stuck in the "teach or treat" polarity), namely verification that learning has occurred and what has been learned. My proposal extends to the supervisory process, mutatis mutandis, something Freud wrote about the therapeutic process:
Without direct verification by A exhibiting
It cannot be disputed that controlling the
phenomena of transference [i.e., the interactional process between patient and therapist] presents the psycho-analyst with the greatest difficulties. But is should not be forgotten that it is precisely they that do us the inestimable service of making the patient's hidden and forgotten... impulses immediate and manifest. For when all is said and done, it is impossible to destroy anyone in absentia or in effigie. (1912/1958, p. 108)
a changed attitude in the supervisory situation, it is difficult for either S or us to determine whether A has genuinely grown in empathy. Without an accounting from A in which he reflectively points out his growth to S, it remains uncertain whether A has "processed" the effect of the learning experience, i.e., whether he can responsibly apply what he has learned or still acts "blindly," but now in a way which, judged by a third party (e.g., S or P) is more felicitous.
Attending to the phenomena of supervisory process may present the supervisor (and supervisee) with difficulties. But I propose that it is precisely these phenomena that do them the inestimable service of making the supervisee's (and supervisor's) mode of interpersonal relating immediate and manifest. For when all is said and done, the only social interaction for which evidence can be open-endedly explored is the situation oneself is in, and, in the supervisory process, that is the supervisory situation and not (e.g.) a therapy situation about which supervisor and supervisee may converse.
Psychoanalysts sometimes argue that the meaning of the supervisee's communications in the supervisory interaction is not appropriate material for psychoanalytic learning because the supervisee's "free associations" are not available, due either to ethical limitations on how much the supervisee may be required to reveal of him or herself in the supervisory interaction, or simply lack of time to examine both the patient's material and the supervisee's inner process. This argument seems faulty in both its directions: (1) the patient's free associations are not available in the supervisory situation, and (2) the supervisee's responses to the supervisory interaction are available, and, indeed, are the only communicative material which is available for further exploration (as opposed to merely speculative extrapolation).
The material from the patient which is available in the supervisory situation is the [[student-analyst's report of the]] patient's responses to the interaction in the therapy session with the student-analyst. The patient's "free associations" are [[student-analyst's report of]] the patient's responses to that interaction. Insofar as supervisor and supervisee discuss the patient's situation in the supervisory session, they cannot get the patient's responses to this new material which they elaborate, and therefore their discussion can only speculatively elaborate typical potential scenarios, not anything verifiable vis-à-vis the particular patient (see, e.g., Schutz, 1932/1967, pp. 181-6; Habermas, 1981/1984, p. 126). As Plato observed (Phaedrus 275:d-e) about writing (e.g., verbatim reports of therapy sessions):
Of course the student can be instructed to get more
[W]ritten words... seem to talk to you as though
they were intelligent, but if you ask them anything about what they say, from a desire to be instructed, they go telling you just the same thing forever. And once a thing is put in writing, the composition, whatever it may be, drifts all over the place.... And when it is ill-treated and unfairly abused it always needs its parent to come to its help, being unable to defend or help itself. (Hamilton & Cairns, Eds., 1961, p. 521)
information from the patient in the next therapy session, but this material is not yet available in the present supervisory session (and this way of proceeding tends to turn the patient's therapy into treatment by the supervisor by proxy, as opposed to the student actually doing the therapy).
Clarification and elaboration of meaning can occur only in the here-and-now of "living speech" (Phaedrus, 276:a; Hamilton & Cairns, 1961, p. 521). Supervisor and supervisee can mutually explore and clarify their interaction, by each offering material he or she feels is relevant and/or questioning the other's presentation. The issue of the supervisee not being obliged to expose his or her thought processes ("free associations") is not as formidable as prima facie it may look, since the material I am arguing supervisor and supervisee should "analyze" is that which the supervisee has already exposed -- both in words and metacommunicatively -- in the supervisory interaction.
Donald Spence, in his book Narrative Truth and Historical Truth (1982), effectively debunked the simplistic notion of "free association" as the therapist's passive translation of the patient's spontaneous production of material, by noting that, the closer the patient's verbal productions come to being totally spontaneous, i.e., entirely unstructured "word salad," the more the therapist has to bring his or her own interpretive speculations to bear to make any sense at all out of the flow of material (Spence, 1982, p. 29). A more useful notion of "free association" is for the patient to present a relatively coherent narrative from which the things he or she currently feels are important (embarrassing, etc.) are not omitted. The therapist can then imaginatively play with this material to look for its hidden meanings. The analog in supervision would be for the supervisee to not omit from his or her presentation material which the supervisee feels is important to the therapeutic interaction under discussion or the supervisory interaction in progress (both of which kinds of omissions are frequent in practice).
In urging increased self-reflection between supervisor and supervisee on their communicative interaction, I am proposing that there are basically two forms the supervisory interaction can take: (1) to speculate on the therapeutic situation, or (2) to truly clarify ("analyze," etc.) the supervisory situation. Supervisor and supervisee can learn from experience which is not altogether homologous to the therapy situation (if only because the patient is often less an expert on human communications, and therefore less fully able to engage in reflection on the interaction in which he or she is involved), or they can engage in speculative discourse about experience (what may have gone on in the therapy situation).
There is a place in supervision for both undertakings. If, however, the primary objective of supervision is for the student to become a better interpreter of persons' meanings, then it would seem that opportunities for reflectively exploring the communication dynamics of the supervisory interaction itself should be nurtured even more than (not, however, instead of!) speculations about the patient. Indeed, one lesson to be learned from reflecting on discourse about the therapeutic interaction in the supervisory situation is that such discourse is speculative, and that its primary value lies in freeing the imagination, not in fixing the memory (see, e.g., Stern, 1966), just as, in therapy, it is frequently more productive to get the patient to explore his feelings about extra-therapeutic life events which he or she reports than to try to figure out exactly what happened. <a name="interp">In this connection,</a> Freud, in The Interpretation of Dreams, has a recommendation concerning how to treat uncertainly recalled dream material in analysis, that may be suggestive for handling material concerning the therapeutic relationship in supervision:
But perhaps one can do precisely what Freud says doesn't
...[I]n analysing a dream I insist that the whole scale of
estimates of certainty shall be abandoned and that the faintest possibility that something of this or that sort may have occurred in the dream shall be treated as complete certainty.... If any doubt is thrown upon the value of [an element of dream material], the psychical result in the patient is that none of the involuntary ideas underlying that element comes into his head. This result is not a self-evident one. It would not make nonsense if someone were to say: "I don't know for certain whether such and such a thing came into the dream, but here is what occurs to me in connection with it." But in fact no one ever does say this; and it is precisely the fact that doubt produces this interrupting effect upon an analysis that reveals it as a derivative and tool of psychical resistance. Psycho-analysis is justly suspicious. One of its rules is that whatever interrupts the progress of analytic work is a resistance. (1900/1953, pp. 516-7) [TBD to descriptions of some of my own dreams]
happen, and there may even be an advantage to it, in not putting the supervisee (or patient) so much "on the spot." The supervisor can say to the supervisee: "OK. Let's assume what happened in the therapy session is as you have described. Let's see what we can learn how to deal with it."
An obvious advantage here is to "let the supervisee off the hook," so that, instead of focusing (discouragingly) on how he or she may have done poorly in fact, the supervisee can (proactively) consider how in future, if he or she encounters such a situation, he or she might handle it better. This removal of a potential impediment to the supervisory work is analogous to something Harry Stack Sullivan observed about working with patients:
In terms of theory of interpersonal communication, the
...[I]t is much easier for patients to tell you what is
important and unimportant, even about you, if they talk about a third party. (Kvarnes, Ed., 1976, p. 125)
thrust of all these tactics is to bring the supervisee more richly (including: more comfortably) into the role of co-subject of conversation with the supervisor. One reason for this is to provide the supervisee experience for bringing the patient more richly into the role of co-subject in the therapeutic conversation, with the ultimate objective of the patient becoming more effective in communicative interactions in his or her real life.
Example 1a. The Supervisor Gets It Right the First Time
The rescript I have just proposed makes use of a mistake by the supervisor to help the student solve an important personal problem interfering with his therapeutic effectiveness. From this it may seem that my procedure depends on the supervisor making mistakes (and then correcting them).
In general, I propose it is highly important for the supervisor to bring his or her own mistakes into the interaction with the supervisee, for at least two reasons: (1) if the supervisor only uses self-reflection when it does not reflect badly on him or herself, the supervisee will at least implicitly detect the supervisor's barricading him or herself behind his or her position of power and thereby deutero-learn that the whole self-reflective process is not "really real." (2) Only by modeling him or herself admitting and working through his or her mistakes with the student can the supervisor give the student experience which the student needs to cultivate in the therapy relationship: the experience of not hiding behind his or her own position of power with the patient. Here, however, I shall offer an alternative rescript in which the supervisor makes no mistakes (and therefore does not have to correct any), but still is able to help the student with his problem through a self-reflective use of the supervisory interaction.
We return, once more, to the point in the example (item 28) where S was about to parrot back to A part of A's description of his "mistake": "Intelligent discussion?" Now, I offer the following alternative intervention by S:
From here, A could have gone on to report how he compounded
I hear you, A. Well, I'm not going to see how long you
can take this. I'm guessing what you did is making you anxious here with me, like what P did made her anxious in the therapy. A couple minutes ago, I urged you to try to get closer to P's feelings. Right now, I want you to try to get closer to your own feelings. So, take a moment and just attend to how you're feeling right now (or just take a couple deep breaths), and then I'd like to hear the rest of what happened.
his mistake (items 29 and 31). S could then have responded:
Perhaps this rescript is not as "tight" as the earlier
Wow, A! P really told you, didn't she? Robert Langs has
an idea -- he even has an article with the title -- "The Patient as Unconscious Supervisor." It sounds to me like when P said she wanted to know whether what she said was right or wrong, she wasn't looking for intellectual agreement or disagreement, but for you to tell her -- unlike her parents -- that it was OK for her to say what she wanted to say (whatever it was).
And now you're maybe wanting to know how wrong what you said was, and wanting assurance from me. Well, you have my support. And, if we don't come up with anything better as we look at this together, next session you might think of saying to P, something like: "I realize I hurt you last time. I did just the kind of thing it sounds like your parents would have done. At least you were able to stand up to me, unlike, when you were a child, you probably couldn't stand up to them." It takes courage for a supervisee to stand up to his supervisor, A -- like P stood up to you. You're an authority figure for her, like I'm one for you.
scenario. That possibility suggests some important points: The self-reflective potential of communicative interactions probably varies. Also, the process of wisdom's unfolding in time (Rabelais, 1532-1534/1955, p. 710, quoted in "Itinerary" section, above) is not a straight and narrow line. When this unavoidable condition is recognized and thematized, then the pursuit of wisdom (and even knowledge and information) is seen to be optimally nurtured as a relaxed space of undirected play in which creative reaching-out (and stumbling, and falling, and getting back up again, etc.) can take place (Winnicott, 1971, chap. 4).
Another criticism which might be offered to this second
alternative is that a supervisor who had no thematic orientation
toward cultivating self-reflection in the supervisory relationship
might have offered the same intervention just on the basis of empathy
and "experience." That is true. The issue with which I am concerned,
however, is not isolated interactional sequences which can be
interpreted by an outside observer in a certain way, but rather in the
guiding intentions of the participants. "Man lives by those
propositions whose validity is a function of his belief in them"
(Ruesch & Bateson, 1951, p. 212; italics in original).
Natanson's observation further focuses this principle, and
bears repeating here: "The thematization of some aspect of
experience places that experience in a horizon of expectation"
(Natanson, 1973, p. 205). --Only by placing them in a horizon
of expectation can felicitous but fortuitous processes be secured
and their potential developed in a disciplined way as part of a
universally self-accountable human world, instead of remaining
at an unaccountable and adventitiously elaborated
[(or, what is of greater concern
here: adventitiously neglected and possibly altogether lost!)] level of
localized intuitive customs (this point has been elaborated
elsewhere in this dissertation).