Imre Szecsödy

Supervision: A didactic or mutative situation

SUMMARY This paper discusses the nature of learning in the supervision of psychoanalytic psychotherapy. It considers the complexities of the relationship between therapist and supervisor, especially in the context of a training where the supervising relationship occurs as part of complex relationships to the parent institution and is subject to potentially conflicting pressures. It is with this background that the author examines methods of supervision in the literature, noting that there have been few systematic studies and that there is certainly no standard or generally accepted method. The author discusses the nature of learning, especially from a psychoanalytic viewpoint, and then considers his own systematic study of supervision, which included the detailed study of transcripts of supervision sessions. This enables exploration of the interactive process between supervisor and therapist and allows for some general consideration of the types of interaction which allow for mutative change in the therap...

Supervision should be a mutual learning experience

The primary task for supervision is to help the trainee to comprehend the “system of interaction” with his patient. This also means that the trainee has to be able to “step out” of the system of interaction he has with his patient, to be able to observe and understand it. This can be facilitated by the creation of a “formal system for supervision”. This means that trainee and supervisor agree not only on theories about development, psychopathology and psychotherapeutic technique, but also on the rules of their interaction, constituting the frame for their work. To establish the frame, the supervisor has to maintain the boundaries around the primary and specific task of supervision, by separating it from the trainee’s task of conducting psychotherapy/psychoanalysis. Rather than giving support, advice and suggestions, the supervisor should encourage the trainee to organize information actively. By consistently focusing on and helping the therapist to reflect on the combined interaction of the patient (patient-therapist) therapist, the supervisor maintains the formal system and can enable the trainee to step out of and observe his own system of interacting with the patient. Doing so, the supervisor has also the opportunity to learn more about what is happening during supervision and how to encourage mutual learning. It is also most important to train supervisors and to continuously carry out research on it. According to the Webster Dictionary, supervision is: “An overseeing, surveillance, to inspect, scrutinize, examine, to have control over, to manage, to direct, to conduct”. It refers to a situation, where psychotherapeutic or psychoanalytic work, carried through by an inexperienced trainee, is done under the control, the surveillance of a senior (”controlling, directing, managing, and conducting”) supervisor. The supervisor, as a member of a training institute, has not only a status, but also the power and responsibility to judge, evaluate and influence the status of the trainee. The Oxford Dictionary defines a student “as a person who is engaged or addicted to study”, and the candidate: “as one who offers himself or is put forward by others as aspiring to be elected to an office, privilege, or position of honour” ― as candidate means being clothed in a white toga (Candida) who is aspiring for an office in the Forum Romanum (Ekstein-Wallerstein, 1958). Nonetheless, the primary task for supervision is and should be, to provide optimal conditions for the supervisee to integrate her/his experiences, theoretical knowledge and her/his personality for a competent participation in and handling of the psychotherapeutic or psychoanalytic situation and process. The aim is for the supervisee to acquire core competences enabling her/him to conduct psychotherapy or psychoanalysis on her/his own. There are some stable differences in the way supervisees and supervisors work together that can be placed under the heading “cognitive and working style” (Jacob, 1981). The cognitive style is an ever-present general influence in the screening and organizing process. The personality embodies stabilized dispositions of perception and cognition which define the cognitive style. Close to this, but not synonymous, is the working style. It differs according to how and what basic concepts are characteristically used and how they are integrated into the actual work situation. The so-called “defensive style”, is the third differentiating manner, which is related to the ways control is used (Jacob, 1981). To provide conditions in which learning can develop is not easy and can be complicated by the supervisee as well as by the supervisor. Parallel to the wish to learn and change, there is the fear of the unknown and a tendency to stay with the accustomed and to remain untouched by change. The supervisor has to be prepared for and aware of all the ambiguities that are inherent in the supervisory situation. There is “a crowd present” in the supervisory room: a mentor, teacher, evaluator, judge, supervisor, future colleague, a staff member who is dependent on the supervisor’s acknowledgement and successful development, as well as the supervisee or candidate her/himself who has to accept and carry a number of different rôles. Thus, it is important to differentiate between the supervisee’s interest in increasing knowledge and skill, on the one hand, and acquiring a profession, on the other. As a result of these twomotivations, the supervisor can expect to be experienced as a teacher,

A single-case study on the process and outcome of psychoanalysis

This study aimed to explore the specificity of psychoanalytic treatment by investigating one psychoanalysis over a period of its five years as well as two and five years after its termination. The patient and analyst were interviewed and the analyzand filled out questionnaires and self-rating scales every year during the treatment as well as at the follow-ups. The analyzand reported that he found “a space for himself in himself” in which he could contain a range of strong affects. The psychoanalytic relationship was stable and consistent, and the patients initial complaints decreased significantly over time. “Reflective functioning scores” increased during the treatment; the self-ratings already showed positive changes in the first year of treatment, which were maintained throughout treatment as well as at the two- and five -year follow-ups.

Sándor Ferenczi—the first intersubjectivist

Sándor Ferenczi MD. (1873–1933) has been a controversial person in the history of psychoanalysis. He was on the one hand closely attached to Freud, on the other he experimented with a methodology different from Freuds, that led to a schism between him and many leading analysts. Contrary to his contemporaries, who saw countertransference as an impediment to analysis, Ferenczi emphasized that the analyst has to concern himself with the experienced trauma of the patient in order to find the core of the relationship between analyst and analysand. By placing the personal relationship between patient and analysis as the essence of treatment, he aimed to refine the gold of psychoanalysis itself. Today there are few analysts who do not accept that intersubjectivity is central to psychoanalysis. Nevertheless, in spite of his undeniable importance to psychoanalysis, none of Ferenczis numerous publications have been translated into any of the Scandinavian languages.

How can we end psychoanalysis—and still have a follow-up of it?

In its first part, this paper describes and explores different kinds of terminations of psychoanalytic treatments; forced and unilaterally decided ones, as well as terminations in interrupted and successful analyses. Following this, the author describes the process of termination, and discusses the alleged positive value of planned post-termination contacts with analysands. Finally, the author emphasises the importance of more systematic empirical research on psychoanalytic treatment.