supervision is a relationship too: a contemporary approach to psychoanalytic supervision

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Supervision Is a Relationship Too: A ContemporaryApproach to Psychoanalytic SupervisionMary Gail Frawley-O'Dea Ph.D. a ba Manhattan Institute of Psychoanalysis , New Yorkb National Institute for the Psychotherapies , New York CityPublished online: 01 Jul 2008.

To cite this article: Mary Gail Frawley-O'Dea Ph.D. (2003) Supervision Is a Relationship Too: A Contemporary Approach toPsychoanalytic Supervision, Psychoanalytic Dialogues: The International Journal of Relational Perspectives, 13:3, 355-366,DOI: 10.1080/10481881309348739

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355 © 2003 The Analytic Press, Inc.

Supervision Is a Relationship TooA Contemporary Approach to

Psychoanalytic Supervision

Mary Gail Frawley-O’Dea, Ph.D.

Mary Gail Frawley-O’Dea, Ph.D. is Codirector, Faculty, and Supervisor at the

Manhattan Institute of Psychoanalysis, New York City; and Faculty, SupervisoryTraining Program, National Institute for the Psychotherapies, also in New York City.

Psychoanalytic Dialogues, 13(3):355–366, 2003SYMPOSIUM ON TRAINING AND EDUCATION IN PSYCHOANALYSIS

This paper discusses clinical cases presented by Comins and Eliot withina paradigm of psychoanalytic supervisory work based on relationaltheory. Here, in making the medium of supervision more symmetricalwith the message of contemporary psychoanalytic ideas about structureof mind health, pathology, and treatment, the relationship between thesupervisor and supervisee is considered to contain crucial supervisorydata to be delineated and discussed by both members of the dyad. Thesupervisory relationship is described using three dimensions: power andauthority, the data held to be relevant for supervisory conversations,and the mode of the supervisor’s participation in the supervisory process.

HE TWO CASES SUPERVISED IN THIS ISSUE ARE REPLETE WITH MATERIAL

highlighting some of the major psychoanalytic discussions ofTthe last 15 years. In treatment and in supervision, how docontemporary psychoanalysts and supervisors think about and workwith enactments? How do therapists and supervisors think about theorganization of the mind, and, in particular, how do we approach theconcept of dissociation? How does the therapist engage with a patientfor whom much material is experienced nonverbally, in moods orsomatic states? And how does the supervisor facilitate clinical workwith nonverbal material? How do psychoanalytic therapists andsupervisors view the organization of self—in patients and inthemselves?

This discussion addresses these questions through the lens of acontemporary relational model of supervision in which patient,

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356 Mary Gail Frawley-O’Dea

therapist, and supervisor are viewed as cocreators of two mutuallyinfluential dyads. It is a model of supervision that seems uniquely suitedto today’s relationally based, two-person paradigms of psycho-analytically informed clinical work. At the same time, writing about aconfiguration of supervision that considers the relationship betweenthe supervisor and the supervisee as central to the supervisory taskmakes it difficult to comment comfortably on the cases presentedby Eliot and Comins. Because I am not in relationship with theseclinicians, I cannot easily approach their work from a relationalsupervisory perspective. When addressing case material, therefore, Ifocus mostly on what appears to me to be missing from their discussionsand on the kinds of material I would hope to elaborate with Eliot andComins in our work together. In keeping with my belief that supervisorydata inevitably are embedded in and reflective of the relationshipbetween the supervisor and the supervisee, the extended example Iprovide here is taken from my work with another supervisee.

My delineation and embrace of a relational supervisory perspectivedeveloped over the course of my own doctoral and postdoctoraltraining (1984–1996) and my continuing educational and collegialpursuits, especially my coauthoring dialogue with Joan Sarnat, Ph.D.(Frawley-O’Dea and Sarnat, 2001). Although I am writing this articlealone, my voice as a supervisor and as a commentator about supervisionforever will include intonations and patterns that represent ourcollaboration.

My training years coincided with seismic changes in psychoanalysis.Theories of infant attachment and human development, models ofthe mind, health, pathology, and thus treatment took revolutionarytacks. The once-marginalized Sandor Ferenczi, whose early focus wason the centrality and mutuality of a coconstructed treatmentrelationship, was rehabilitated as cofather, with Freud, of ourfield. Daniel Stern (1985) and Beebe and Lachmann (1994;Beebe, Lachmann, and Jaffe, 1997) left Mahler, Pine, and Bergman(1975) in the developmental dust. Self-disclosure, especially ofcountertransference reactions, moved from the taboo to the possibleand even the advocated; and countertransference itself was elevatedfrom a suspect impediment to a sometimes-idealized roadmap tosuccessful psychoanalytic treatment. Mitchell (1988) came right outand said that drive theory, as designed by Freud, was dead. Oh, yes,and the gender mix within psychoanalysis shifted dramatically as

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Supervision is a Relationship Too 357

women flooded the field and inched their way into the previouslypatriarchal halls of power. Pretty dizzying stuff!

Meanwhile, back in the supervisory space, things did not seem tochange too much. Experienced analysts who, to incorporate newpsychoanalytic ideas into their working selves, were revising most ofwhat they had been taught to think and do, for the most part revertedto the familiar and the secure in their supervisory roles. My owntraining experiences during these heady years led me to conclude thatmost supervisors were “content consistent”—they indeed taughtsupervisees to attend to the data the supervisor considered importantin psychoanalytic treatment. The same supervisors, however, mostoften were not “process consistent”; they did not facilitate much ofan experiential analog between the kind of treatment relationship theyencouraged a therapist to have with a patient and the kind ofsupervisory relationship in which they engaged with the therapist/supervisee. It was especially surprising for me to realize that, evenwhen supervisors advocated paying exquisite attention to the nuancesof the analytic relationship, they tended not to discuss with thesupervisee the complexities of the supervisory relationship. Thisapparent lack of congruence between models of treatment and modelsof supervision is not surprising. Donnel Stern (1997) suggests thatthere often is a lag between the beginning of cultural change and itsverbal expression in cultural outlets. It is understandable, then, thatpsychoanalytic supervision may just now be starting to be reformulatedto fit better the great changes in psychoanalytic culture that haveoccurred over the past 15 or so years.

Various approaches to supervision can be compared along threedimensions: the nature of the supervisor ’s authority; the dataconsidered relevant for supervisory processing; and the primary modeof the supervisor’s participation within the dyad (Frawley-O’Dea andSarnat, 2001). Using these three domains of supervisory interfacefacilitates a conceptualization of the supervisory relationship thatreflects contemporary relational thinking and creates a template onwhich to rest supervisory consideration of the cases presented here.

In more traditional models of supervision, the power and authorityof the supervisor are assumed and depend on her standing in the widerpsychoanalytic community sponsoring the supervision. Her owntraining and analysis, years of experience, and position as a teacher/supervisor invest her with the right to supervise. Through this paradigm

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of power and authority, the supervisor is considered to be more or lessan objective expert who, removed from the relational matrix of thesupervised treatment, can teach the supervisee theory and techniquesapplicable to the case being discussed. In this way, knowledge isconveyed downward, didactically, from a senior to a junior clinician.

A relationally based supervisory model, on the other hand,approaches the source of a supervisor ’s knowledge, power, andauthority from a different angle. While the supervisor begins her workwith a supervisee with a general authority conferred by her community,the power and authority she wields within a specific supervisoryrelationship is authorized and reauthorized in negotiation with thesupervisee. Supervisor and supervisee coconstruct, mutually derive,and negotiate meaning about the data and processes of both thetherapeutic work being supervised and the supervision. Thisegalitarianism is not synonymous with symmetry; an inherent,necessary, and useful asymmetry remains and exists in tension withthe dyad’s negotiation of distributed power. The supervisor, with herown unique combination of humility and confidence, reflectively helpsto modulate the ebb and flow of shared power; she honors both heradvanced general experience and skill and the supervisee’s experiencewith a particular case, acknowledging as well the supervisee’s specialtalents and area of knowledge.

Eliot and Comins provide cases in which issues of power, knowledge,and authority are set in relief. Frank, for instance, appears to havebeen raised in a family in which adults refused to assume an appropriatedegree of authority as parents and shepherds of developingpersonalities. At the same time, his mother’s unspoken domination ofhis sexual development seems to have left him subjectivelyexperiencing himself as powerlessly in thrall to his sexual compulsionsat the same time that he, in fact, concretizes and imposes his fantasylife on others. Laura’s father, directly expressing his power over her,overstimulated and frightened her with sexualized “tickle torture”while her mother refused to assume maternal authority to protect herchild. Further, Laura appears to feel that children wield a toxic powerto destroy an adult’s life. For both patients, these family and personaldynamics obviously have implications extending well beyond issues ofpower and authority, but it is helpful to note this dimension as onethread in the psychological fabrics presented by these patients, a threadthat also is woven into the warp and woof of the treatment and as wellas the supervisory relationships.

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The relational supervisor is conscious of the necessary and ever-present tension between assumed and authorized power that infusesthe work of the supervisory pair. Her sensitivity to that dyad’s ongoingnegotiation of power—as well as her willingness to make explicit herown and the supervisee’s experiences of the shifting distribution ofknowledge and authority—models for the supervisee an approach tothe lived experience of these issues in the therapeutic dyad.

For example, the supervisor or the supervisee might notice that thesupervisee has begun to defer to the supervisor’s hypothesis about aspecific aspect of the supervised clinical work when, in fact, thesupervisee earlier had been thinking and speaking along a very differentpath. Here, the supervisory dyad can pause not only to consider theapplicability of differing, even competing, conceptualizations but alsoto examine mutually the process occurring between supervisor andsupervisee. Who is influencing whom in a way that leads the superviseeapparently to relinquish her own mind? Is this a dynamic signifying atransference–countertransference constellation particular to thesupervision, or does it have parallel meaning for the supervisedtreatment? Does this relational phenomenon have psychologicalsignificance for the supervisee? For the supervisor? How far shouldthe supervisory dyad pursue the psychology of the supervisee or thesupervisor in a blurring of the “teach/treat” boundary? What will bethe experience of each party to the supervision if the supervisor yieldsto the supervisee? If the supervisee yields to the supervisor? If theyagree to disagree? If they arrive at a blended hypothesis?

As supervisee and supervisor consciously and explicitly attend tothe vicissitudes of assumed and negotiated power, and of knowledgeand authority within their relationship, the supervisee, in turn,becomes more able to think about, play with, and ultimately put intowords those aspects of the treatment relationship.

The second dimension of the supervisory relationship concerns thedata considered relevant for supervisory processing. Relationalsupervisors attend to all the material important to most psychoanalyticsupervisors, including explication of the patient’s psychodynamics, andthe supervisee’s countertransference reactions, anxieties, self-esteem,and struggles with technique and theory. In addition to theseconventional supervisory foci, however, the relational supervisor alsosees the patient’s conscious and unconscious expression of his dynamicsand the supervisee’s conscious and unconscious expression of herexperiences of the patient, of herself, and of the supervisor as

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relationally mediated phenomena embedded within the supervisorymatrix. Moreover, the supervisor is assumed to play an activelyinfluential role in coconstructing the relational events taking place inboth dyads.

In this contemporary model of the supervisory encounter, a workingassumption is that the more fully and freely supervisor and superviseerepresent the intricacies of their own relationship, in particularclarifying aspects of it centrally related to the supervised treatment,the more completely and effectively the supervisee can engage withthe patient in identifying and speaking about the relational paradigmsoperating within the treatment. The medium of supervision is thenconsistent with the message of clinical theory, and the process ofsupervision models more closely the advocated approach to clinicalengagement.

By fostering the development of an optimally creative and flexiblepotential supervisory space, a relational model of supervision acceptsas inevitable, and therefore welcomes, regressions, defined asaffectively intense, cognitively primitive, usually nonverbalexperiences, in supervisor and supervisee alike. Far from consideringregressions within supervision as suspect phenomena better reservedfor the supervisee’s own analysis, the relational supervisor believesthat valuable information about the supervisory relationship, as wellas the therapeutic process, may be gleaned from explorations ofregressions taking place within the supervisory dyad. Similarly,dissociative experiences in either supervisor or supervisee areconsidered potential postcards, communicating as yet unformulatedself-states or transference–countertransference reactions relevant tothe supervisory relationship, the supervised treatment, or both. Ratherthen engaging only with data encoded through secondary-processverbalizations, therefore, the relational supervisor is open toconsidering primary-process material delivered into the supervisionby way of the dreams, somatic states, fantasies, and dissociativeexperiences of the supervised patient, the supervisee, and even thesupervisor.

When working with Eliot and Comins, the supervisor’s interest innonverbally processed, regressive, or dissociative material might beparticularly helpful in supervising clinical work with Frank and Laura.Both these patients appear to have internalized experiences, alongwith their fantasied elaborations, for which they have few or no words.Frank, for example, is just beginning psychologically to be able to

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suspect that his mother was a coparticipant in his sexually mediatedadolescent relationship with her. Laura’s still only partially formulatedexperiences in her friend’s house apparently live on in her confusingconcerns about pregnancy and her somatic symptoms involving bodytemperature and taking in air or matter. The dissociated experiencesof the patients can be conceptualized as contained and enacted byself-states that think, act, feel, and react somatically quite differentlyfrom the “I” with whom each patient most identifies. Both Frank andLaura seem more interested in getting rid of or getting past theseaspects of self rather than getting to know and getting along withthem.

It is interesting to note that, despite many indicia of dissociativeprocesses at work in these patients, both therapists so far have followeda traditional, verbally mediated, interpretive or mirroring treatmentapproach, one grounded primarily in secondary-process relationalexchanges. Also striking is the omission from these case summaries ofextensive elaborations of countertransference experiences. Especiallygiven the traumatic histories and intensely regressive features of thesepatients, volatile and intense transference and countertransferenceenactments would not be unusual. A supervisor working from themodel proposed here, therefore, might want to help these therapistsopen themselves up and attend to a broader range of nonverbalcognitive, affective, and somatic experiences. In supervision, I mightbe as interested in what these therapists felt—physically andemotionally—during sessions with the patients and when discussingtheir clinical work in supervision—than in what they thought. I mighteven be more interested. And I would want to be alert to and reflectiveabout my own shifting body sensations, affective range, and passingmental images as I entered into the supervisee’s presentation of herwork. Facilitating the cocreation of a supervisory space in which bothsupervisor and supervisee developed an increased freedom to play withtheir full ranges of cognitive, affective, somatic, and relational reactionsto—as well as dreams and fantasies about—treatment and supervisorymaterial and processes might enlarge the potential space of clinicalendeavors with these patients, for whom so much comes to life throughunsymbolized, powerfully affective, disruptively somatic phenomena.

Similarly, as a supervisor adhering to a view of a multiply organizedself-system, I would invite Eliot and Comins to consider playing withtheir own and their patients’ various configurations of self. As Davies(1996) suggests, psychoanalytic treatments like the ones presented

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here can benefit from therapists engaging with patients to reifytemporarily those aspects of self that are currently disowned ordenigrated by the “I” most accepted by the patients. Thus, these statesof self, currently relegated to the outskirts of consciousness wherethey operate seemingly independently, can be seen, heard, understood,and related to by patient and therapist during the treatment hours.As Merlin helped the young Arthur appreciate the creatures of theearth by transforming him into birds and beasts for brief periods oftime, so a therapist can help a patient better appreciate the “other”within himself by inviting the patient to visit with self-states hesometimes fears to be woolly monsters indeed. In this way, “thedissociation of the self into multiple subselves marooned onunbridgeable islands” can grow into a self-system characterized by“distributions of the self into multiple (bridged) islands of memory,affect, meaning, awareness, and intention” (Pizer, 1996, p. 904).

In supervising the work with Laura, for example, supervisor andsupervisee might imagine interventions encouraging Laura to accessthe little girl who actually visited that house long ago. The superviseemight say something to the patient like, “I wonder, Laura, if that littlegirl part of you has more to say about that day and what it means. Iwish she could sit here with us and tell us the story in her own words.”Perhaps better yet, the supervisor might also model this approachwithin supervision, saying to the supervisee, “I wonder if you can putaside your together, very competent, analytic professional self for aminute and imagine hearing again from Laura her narrative about thathouse. Receiving it just as another human being interested in anotherhuman being, tell me, if you can, what you experience listening to it.What do you feel? What images come to mind? What’s your bodydoing?”

Here the supervisory process offers the supervisee an analog to apossible treatment approach. It invites her to use the supervisory spaceto try out a temporary immersion in potentially primitive, nonverbalexperiences. In so doing, the supervisor and supervisee may clarifythe supervisee’s anxieties or blocks, if any, to opening up herself, thetreatment, and the supervision to that kind of material. Together, thetwo may generate new hypotheses about the treatment, possibilitiesthat remain possibilities until and unless they find meaningful lifewithin the supervised treatment. Or supervisor and supervisee maydiscover aspects of their own process that open or foreclose possibilityfor the supervisee to work well in supervision or with the patient.

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In emphasizing the potential value of fostering the emergence intothe treatment and the supervision of primitively organized data, I donot mean to denigrate in any way the importance of secondary-processinterpretations or the exploration of verbally symbolized material inboth dyads. Rather, I am setting in relief the kind of analytic and,especially, supervisory work that often has been omitted from thesupervisory conversation in part because it threatens to open the dyadto regressive experiences often thought to be inappropriate forsupervisors to consider within the teaching framework.

The third, and last, domain of supervision pertains to thesupervisor’s primary mode of participation in the supervisory process.Analysts following a classical model of supervision have functionedmostly as didactic teachers (Dewald, 1987). Other supervisors, workingwithin a more supervisee-centered paradigm, have served to containand interpret the supervisee’s anxieties (Jarmon, 1990; Newirth, 1990);to maintain an empathic, mirroring stance with supervisees(Brightman, 1984-1985); or to confront, clarify, and interpret thesupervisee’s “learning problems” or “problems about learning” (Eksteinand Wallerstein, 1972). A relational approach, however, assumes thatsupervision is an analytic endeavor in and of itself (Rock, 1997).Fiscalini (1997), for example, puts it well when he says, “Thesupervisory relationship is a relationship about a relationship aboutother relationships” (p. 30). As happens between therapist andpatient, supervisor and supervisee engage in enactments ofconscious and unconscious, verbal and nonverbal transference andcountertransference constellations cocreated by them during thesupervisory process. In addition, supervisor and supervisee may enactrelational configurations that, although bespeaking elements of theirown relationship, represent as well currently unformulated features ofthe treatment relationship. The relational supervisor holds that it iscrucial to live out mindfully with the supervisee and eventually tomake explicit with him relational patterns set in play within theirrelationship.

Herein lie the excitement, the richness, the potential, and the terrorof supervision. Through the dyad’s ever-more complete delineationof the analytic relationship, mediated in substantial measure throughincreasingly deeper and wider elaboration of the supervisoryrelationship, more becomes possible. The patient comes to know aboutand be able to speak more about herself, her intrapsychic functioning,and her relational patterns—her affects, cognitions, body states, and

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fantasies. These changes occur in part because, within supervision,the supervisee develops a capacity for more—more theoretical andtechnical knowledge, more insight into his own intrapsychic andinterpersonal capacities and limitations, more affect, and moreconfidence in his abilities as an analytic practitioner. In this way, thesupervisory relationship is second only to the supervisee’s owntreatment in potentiating the clinician’s development as apsychoanalytically informed therapist. Finally, of course, the supervisor,too, discovers more possibility as a teacher, learner, and analyticinstrument.

An example illustrates the supervisor’s mode of participation withinthis model. Recently, Jake began his supervisory session with me bywondering if it might be time for him to change supervisors. Therequirements of his psychoanalytic training program are loose and leaveit up to the supervisory dyad to negotiate, within certain limits, thelength of the supervision. I was surprised and a little hurt by whatseemed to be a sudden and off-handedly presented idea. I asked Jaketo tell me more about his thinking. He seemed uncharacteristicallyinarticulate, simply repeating, “Maybe it’s just time.” I asked him ifthere was something going on between us that had led him to feelthat we should begin to terminate right now. Eventually, Jake said hethought that I was getting tired of him and that he wanted to takecontrol of separating. He would quit before I could “fire” him or, worse,nonverbally live out with him a decreasing interest in him andhis work.

Since I like Jake very much and respect and enjoy his clinical andsupervisory work, I was curious and concerned about having conveyedweariness with him and our work together. Jake reminded me that Ihad canceled several sessions over the past three months, twice at thelast minute. He thought I was getting sick of him. As he spoke, Irealized that I had been generally weary lately, even when I was presentphysically. Summer vacation was approaching, and, in fantasy, Iimagined myself as an exhausted traveler, my backpack overloaded. Iwas crawling on all fours toward a beautiful oasis that promised rest,relaxation, family time, and fun.

I shared with Jake some of my reflections. He, in turn, asked if Ithought that I was coming across in the same way to other superviseesor patients, or was it “just him”? I responded that I was not sure, butthat it was an important question for me to ponder. Did he have anyreason to think that it was “just him” I wondered?

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As our discussion continued, Jake offered that he often felt that hisfather, who had just visited him and his family for a week, got sick ofhim. Since childhood, Jake had defended against the pain associatedwith his father’s perceived attitude by “leaving first.” Further, Jakerecognized that his analytic sessions had seemed stale ever since hisanalyst had announced his own summer break. Jake had not told hisanalyst that he feared the analyst was tired of him, but he hadconsidered taking his own vacation the week before treatment wouldhave to be suspended for the analyst’s vacation.

I suggested to Jake that, although our relationship was importantto him, the stakes were lower than with his father or with his analyst,and thus he was freer to focus his “leaving first” pattern within ourrelationship, especially since I had given him plausible reason to thinkthat I was sick of spending time with him. We also noted that leavingfirst seemed to protect him from the anger as well as the more conscioushurt he experienced when he sensed someone was tired of him. Atthat point, we considered the possibility that this dynamic also hadlife within the supervised treatment but, after discussing it, we decidedthat it did not, at least at this time. We also agreed that we woulddiscuss more intentionally our ideas about the length of our worktogether—after his, my, and his analyst’s vacation!

Eliot and Comins have provided rich cases that can be approachedfrom a myriad of supervisory angles. This discussion picks up on just afew of many themes that could be pursued. Ultimately, psychodynamicsupervision from within any model is about therapists finding andrefinding their unique therapeutic voices through the cocreatedconversations they have with their patients and supervisors. Morebroadly, clinical training in general is about analysts shaping theirvoices through the intersubjective experiences of classes, personalanalyses, supervisory encounters, collegial relationships, professionalactivities, and work with patients. When things go well, the superviseedevelops a voice that is uniquely her own, yet within which aredetectable nuances, accents, and dialectical tones internalized throughher supervisory encounters. As psychoanalytic theory and practicecontinue to grow over the second century of our profession’s life, thestudents we now train will revise clinical and supervisory models tomeet emerging theory and research. The relational model ofsupervision presented here strives to free those in training to use theirminds and voices to challenge as well as to learn from those who havegone before them.

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supervision is a relationship too: a contemporary approach to psychoanalytic supervision

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