You are on page 1of 10

J Contemp Psychother

DOI 10.1007/s10879-011-9201-5


Supervising Psychoanalytic Psychotherapy: Present Knowledge,

Pressing Needs, Future Possibilities
Joan E. Sarnat

! Springer Science+Business Media, LLC 2011

Abstract Existing research from the fields of education, characterizing the field today, I draw upon my impressions
cognitive science, neuroscience, and psychoanalytic psy- of the practices and attitudes that I have observed in
chotherapy points us toward possibilities for the future of supervisors whom I have encountered in my own training
psychoanalytic supervision. This research suggests that we (at the University of Michigan 19701975 and the Psy-
need to go beyond communicating abstract knowledge and choanalytic Institute of Northern California, 19972002);
make our supervisory relationships more experiential, in my professional life as a practicing psychologist, psy-
participatory, relationship-focused, and personal in order to choanalyst, and teacher of psychoanalytic psychotherapy
teach usable knowledge, develop complex psychothera- and supervision in the San Francisco Bay Area; and, before
peutic skills, and facilitate emotional and relational that, in Amherst, Massachusetts.
development in our supervisees. The author concludes that In all of my writing on supervision I have advocated for
a relational model of supervision fits this pedagogical moving beyond a didactic, patient-centered, one-person-
profile. After grappling with our resistances to change, the psychology model of psychoanalytic supervision to a more
author hopes that more psychoanalytic supervisors will experiential, intersubjective, and analytic approach which
make use of a relational model of supervision, as well as I call a relational model of supervision. My responses to
drawing upon new technologies and neuroscience-based Dr. Watkins questions reflect that commitment.
teaching techniques.

Keywords Psychoanalytic supervision ! What We Already Know About How to Supervise

Psychodynamic supervision ! Relational model of Psychoanalytic Psychotherapists
supervision ! Neuroscience ! Education research !
Cognitive science ! Psychoanalytic psychotherapy In reviewing the literature in preparation for writing this
paper, I was struck by how much empirical knowledge and
clinical understanding we already have that could help us
I am grateful for this opportunity to step back from daily to become better psychoanalytic supervisors. Yet, in my
practice and from my usual writing on the supervisory world, the world of psychoanalytic psychotherapists and
relationship in order to reflect on the Big Picture questions psychoanalysts outside of academia, much of the knowl-
that Dr. Watkins has posed. My answers reflect my per- edge contained in the literature remains unfamiliar, or has
sonal views as a clinical psychologist and psychoanalyst at least failed to be integrated into our practice.
who practices, writes and teaches about supervision from
an intersubjective/relational psychoanalytic perspective. In Core Competencies and How to Teach Them
in Supervision

A necessary first step in improving how effectively we

J. E. Sarnat (&)
3030 Ashby Avenue, Suite 109B, Berkeley, CA 94705, USA supervise our students is to define what we want our stu-
e-mail: dents to learn. Clarity has been slow in coming both

J Contemp Psychother

because of the complexity of the task of describing what Insights from Education and Cognitive Science
exactly a good psychoanalytic psychotherapist does; and
because of disagreements between psychoanalytic schools Given the lamentable absence of process and outcome
about what effective therapeutic participation looks like. research in psychoanalytic supervision itself (Watkins
However, recently progress has been made. 2010), Cabaniss (2008) borrows relevant research from the
Within psychoanalysis proper, Tuckett (2005) estab- field of education to define best practices in teaching psy-
lished common ground as to what psychoanalytic candi- choanalytic psychotherapy skills. In particular she refers to
dates should learn. He defined three frames that any research conducted by Tyler which demonstrated the
psychoanalyst should be able to create and sustain during effectiveness of specifying and operationalizing goals and
treatment. First is the participantobservational frame, objectives, designing ones teaching strategy specifically to
which emphasizes the analysts capacity to bear and pro- accomplish them, and later using ones goals and objec-
cess, rather than only acting upon, the emotional states that tives to assess the effectiveness of the teaching process.
the patient evokes within the analyst,1 while participating Drawing upon these ideas Cabaniss et al. (2011), in their
in a relationship with the patient. Second is the conceptual manual for training psychodynamic psychotherapists, pro-
frame which concerns the specific ability to conceptualize vide examples for how one might actively and intentionally
clinical experience (p. 41), by identifying the transference teach skills such as listening, understanding, and inter-
and countertransference and the development of an analytic vening. A psychoanalytic supervisor who followed this
process. Third is the interventional frame, which is the manual would, at least some of the time, shift from her
ability to intervene in a way that is consistent with the usual attitude of associative receptivity toward the pre-
analysts participant-observational stance and his or her sented clinical material, to a more focused effort to teach
conceptualization. specific skills which the supervisor feels that the supervisee
When I was asked to define the core competencies of the needs in order to help the patient in question at that
psychodynamic psychotherapist by selecting from Rodolfa moment.
et al.s (2005) list of competencies for professional But skill-building manuals go only so far in teaching the
psychologists, I selected relationship, self-reflection, art of psychoanalytic psychotherapy. After creating a
assessment and diagnosis, and intervention (Sarnat manual for short-term psychodynamic psychotherapy,
2010) as central for the psychodynamic psychotherapist. In Strupp and Anderson (1997) were struck by its limitations,
highlighting these particular competencies I drew upon and pessimistic about manuals in general for teaching
Tucketts work, relating these core competencies to his psychodynamic psychotherapy. As Binder (1999) put it,
it appears that manuals are most beneficial for
Cabaniss (2008, 2011) has been working along similar
promoting the simple use of prescribed technical
lines, defining learning objectives for psychodynamic
strategies and tactics. [But] manualized therapy
psychotherapists and analytic candidates. For example, she
training appears no more successful than other forms
breaks down the primary learning objectives for psycho-
of therapy training in facilitating the skillful use of
analytic interventions into the skill series listen, reflect,
techniques (Crits-Christoph and Luborsky, 1996;
intervene and then tries to specify precisely what needs to
Crits-Christoph, Cooper, and Luborsky, 1988: Piper,
be learned for each of these skills.
Joyce, McCallum, and Azim, 1993)Interpersonal
All of these approaches to defining our pedagogical
skills in establishing and maintaining an alliance with
goals in conducting psychoanalytic supervision suggest
the patient are essential however interpersonal
that we need to help our supervisees to learn three rather
skills are enormously difficult to teach (p. 707).
different kinds of things. First, we need to become effective
[italics added]
at transmitting knowledge about theory and technique in a
manner that is meaningful to our students and accessible Binder (1999) and Cabaniss (2011) understand that
for use. Second, we need to train our supervisees to become training psychoanalytic psychotherapists involves much
expert at a variety of complex psychotherapeutic skills. more than can be conveyed in a manual. Binder (1999),
Third, we must find ways to facilitate the development of drawing upon research from cognitive science, concluded
a variety of emotional and relational capacities in our that the central training task is to help beginning psycho-
supervisees. Improving our supervisory methods in each of dynamic therapists to transform declarative knowledge
these three areas should, in my view, be our goal for the knowledge of facts and theories learned from books,
future of psychoanalytic supervision. seminars, and didactically-oriented supervisioninto pro-
cedural knowledge. Procedural knowledge is knowledge
In my view, this is an ideal, since, from a relational perspective, about how to do something, like in-your-bones knowledge
enactment is understood to be inevitable and universal. about how to ride a bike. Cabaniss (2011) reached similar

J Contemp Psychother

conclusions based on educational research that shows the be able to make use of such an intervention at that
importance of relevant, problem-centered, interactive, and moment? And how do you help a supervisee to develop the
affectively rich learning experiences for educating adult capacity to think at all while in the presence of an attacking
learners. Safran and Muran (2000), too, believe that or devaluing patient? Maintaining a self reflective stance
experiential, relationship-based teaching methods are most under pressure, being able to hear the patient deeply and
effective in facilitating the capacity of supervisees to apply respond non-reactively while under attack or refinding that
interpersonal psychotherapy technique in a skillful manner. capacity after losing it, are competencies that are essential
As Binder (1999) defines it, the task is therefore to help for the psychoanalytic psychotherapist (see Bion 1962;
beginner therapists, whose working models are rudi- Winnicott 1972; Safran and Muran 2000; Ogden 2003,
mentary and fragmented, to develop sophisticated and 2005; Sarnat 2008, 2010, 2011). These capacities are most
flexible working models by connecting abstract knowledge likely to develop in our supervisees when they are able to
about theory and technique to phenomenal experiences. As connect theoretical knowledge to lived experience in an
psychotherapists gain experience, they learn to more engaged, attuned, and safe supervisory relationship.
readily identify relevant patterns in material, make appro- Supervisees prefer supervisory relationships that they
priate judgments about those patterns, and take action experience as safe and secure, according to a study by
spontaneously. These capacities become increasingly Riggs and Bretz (2006) that related attachment processes in
unconscious and automatic with practice. Eventually an supervision to supervisee satisfaction. Using data from a
expert even adapts quickly and smoothly to sudden chan- survey of doctoral level interns, they concluded that
ges and unexpected conditions. This kind of expertise is supervisees who perceived their supervisors as having a
worlds away from what beginners learn when they develop secure attachment style had significantly more positive
simple skills like identifying a resistance or practicing feelings about both the supervisory task and the supervi-
accurate empathy. sory bond than those supervisees who did not perceive their
Psychotherapy integrationists such as Goldfried (1980) supervisor as securely attached. Remarkably, this finding
and Bordin (1979), who looked for therapeutic competen- held true regardless of the supervisees own attachment
cies that divergent psychotherapeutic approaches agree style.
upon, have similarly contended that the capacity to create a How can supervisors be helped to create a secure
therapeutic relationship is an essential, and perhaps the attachment, to provide a relationship that helps to make the
primary psychotherapeutic competence. Psychotherapy link between abstract knowledge and lived experience, and
outcome research confirms Binders (1999), Goldfrieds to thus facilitate the development of emotional and rela-
and Bordins conclusions. For example, Orlinsky et al.s tional capacities within their supervisees? A relational
(1994) meta-analysis of hundreds of psychotherapy process model of psychoanalytic supervision provides guidance.
and outcome studies concluded that a good psychothera-
peutic relationship was the strongest predictor of positive
outcome, stronger than any particular technical approach. Developing Emotional and Relational Capacities
Orlinsky et al.s findings affirm the importance of the and Teaching Through Experience: Insights
psychotherapist becoming expert in conducting the thera- from a Relational Model
peutic relationship so that new corrective experiences may
occur within it, and so that a strong working alliance The relational psychodynamic model of supervision, which
between patient and psychotherapist may be developed. I developed with Mary Gail Frawley-ODea (Sarnat 1992;
One need only consider the task of learning to work with Frawley-ODea 1997; Sarnat 1998, 2011; Frawley-ODea
transference, a therapeutic skill that lies at the heart of and Sarnat 2001; Sarnat 2006; Burka et al. 2007; Beck
psychoanalytic psychotherapy, to appreciate the centrality et al. 2008), explicitly prioritizes accomplishing those
of developing relational capacities in our supervisees. Most tasks. I briefly describe that model here.
students can be readily taught the skill of identifying the A relational psychodynamic model of supervision draws
major transference dynamic in a given session by practic- on contemporary psychoanalytic ideas (Aron 1996; Hoffman
ing finding it when reading a transcript or tape of a clinical 1998; Mitchell 1997; Pizer 1998) about the centrality of
hour, or in process notes that they present in supervision. relationships in structuring the mind. Patient, therapist, and
However, how do you teach a supervisee to decide whether supervisor are viewed as co-creators of two reciprocally
it will be more facilitative, with a given patient at a given influential dyads. Exploration of the supervisory relation-
moment, to address the transference directly, or to stay ship, as it relates to the clinical relationship, is considered
within the patients metaphor? Whether to speak from central to accomplishing the tasks of supervision. In contrast
within the transference or about the transference? Or per- to non-relational models of psychodynamic supervision, in
haps to say nothing because the patient seems unlikely to relational models the emphasis is upon acknowledging what

J Contemp Psychother

is mutual within the supervisory relationship. (See over her feelings of shame and anxiety as she first began to
Bergmann 2003 and Frawley-ODea 2003 for illustrations conduct psychodynamic psychotherapy. She left our
that contrast non-relational and relational approaches). The supervisory hour, in which I think she had found me to be
supervisor is mindful that she, as well as her supervisee, has emotionally available and a source of needed security,
an unconscious, and that both members of the supervisory feeling relieved. When, in the next therapy session, her
dyad introduce their transferences, anxieties, and resistances patient exploded at her, she was able, for the first time, to
into the interaction. At the same time, the supervisory rela- sit with the patients feelings, as well as her own, and then
tionship is understood to be an asymmetrical one in which the to reach out to her patient. As a result of this moment of
supervisor has greater power and carries primary responsi- connection, Lisa and her patient were able to begin to
bility for establishing the frame, tending the boundaries of create an alternative to the dismissive-of-attachment pat-
the supervisory situation, and adapting to the supervisees tern that this patient had established with Lisa, and that the
learning needs. patient had apparently created in many prior relationships.
Attending to disruptions in the supervisory relationship In trying to articulate the theory of pedagogy that was
is necessary in order to strengthen the learning alliance implicit in my work with Lisa, I said:
(Watkins 2010). Strong learning alliances are desirable, of
I was working to create a supervisory relationship
course, in all supervisory approaches, including CBT,
into which Lisa could safely bring intense affective
family therapy supervision, and others. However in a
states, and in which we could do psychological work
relational model of psychoanalytic supervision, attending
with those states. Creating this kind of supervisory
to disruptions in the relationship is important for reasons
environment is essential to supporting the develop-
that go beyond protecting the learning alliance, and that go
ment of a supervisees capacity to bear the emotional
beyond protecting a secure attachment relationship as well.
intensity of the psychotherapeutic relationship and to
The relational supervisor uses tensions in the supervisory
learn from that experienceI often use experiences
relationship as opportunities to give the supervisee a first
in supervision to teach clinical theory, but only after
hand experience of how one works in treatment. In my
the crisis has passedIn this case we might discuss
experience, after a supervisory disruption has been worked
such concepts as unconscious transference/counter-
through, talking about what was helpful to the supervisee,
transference enactment, resistance, defense, parallel
and why it was helpful, allows the supervisee to connect
process, holding, and Bions (1962) concept of con-
abstract clinical concepts to lived experience, and to
tainer/contained. We would discuss each concept as it
develop more sophisticated working models. Frawley-
had come alive in our shared experience. By inte-
ODea and Sarnat (2001) put it this way:
grating theory with experience in supervision, my
So much of what supervisees need to learn is difficult hope is that my supervisee will feel that theorizing
to make explicit in words, and they too often hear, I can provide containment in the midst of turbulent
cannot explain to you how to do this if you have not relational events, rather than being primarily an
experienced it yourself. And so as supervisors we intellectual activity. (2010, pp. 2526)
strive to supplement our technical advice, our theo-
Working with parallel process is another way of helping
retical conceptions of the patient and of technique,
a supervisee to connect an abstract conceptualization to
with a relationship, a medium that is also the mes-
lived experience. Sometimes a supervisees relationship
sage. We embed our teachings in our own way of
problem with the patient parallels into the supervisory
being and doing within the supervision. We do
relationship, and comes alive there. The supervisor then
not take the supervisory process for granted, or ignore
has an opportunity to address the issue in the here-and-now
it, but rather recognize it as the carrier of so much we
of the supervisory relationship. When a supervisor does so,
want to teach. We endeavor to engage supervisees in
and in the process acknowledges her own participation in
an experience that transmits, unconscious to uncon-
the difficulties, powerful experiential learning can occur.
scious, what we can never communicate directly or in
(For examples see Frawley-ODea and Sarnat 2001; Filho
words (p. 229230).
and Pires 2010; Sarnat 2011).
In a previous paper (Sarnat 2010) I offered a vignette to The relational model of supervision rejects the myth of
illustrate how working with a beginners conflicts and the supervisor as an objective expert who is more or less
anxieties during the supervisory hour allowed her to immune to countertransference reactions (Frawley-ODea
develop new emotional competencies in her relationship and Sarnat 2001; Sarnat 2006). This shift in how we
with a difficult patient. I described how my supervisee, understand the nature of the supervisors authority opens
Lisa, used our affectively intense, quasi-therapeutic the way for supervisors to seek consultation early and
supervisory interaction to reflect upon and gain mastery often. I recently had an experience in supervising a

J Contemp Psychother

psychoanalytic candidate that brought home to me both the interpersonal development of the supervisee and facilitates
power of recognizing parallel processes and the value of the linking of abstract knowledge and direct experience.
consultation (Sarnat 2011). After a year of supervising my Although, admittedly, complex boundary issues must be
candidates work with a severely traumatized patient, dis- negotiated by supervisors who work in this way, the
sociative defenses overwhelmed all three of us, causing supervisors capacity to maintain a clear focus on the
both the supervised analysis and the supervision to go dead. learning task, as opposed to a therapeutic task (Burns and
I requested consultation from my peer group. Within this Holloway 1989; Ekstein and Wallerstein 1972; Frawley-
supportive group, I was able to become aware of anxiety ODea and Sarnat 2001), provides one safeguard. The
and feelings of failure that had been triggered in me by the relational supervisors commitment to accepting the inev-
supervision, as well as becoming more fully aware of my itability of her own areas of unconscious participation also
emotional withdrawal from my supervisee and her patient. offers some protection from the supervisee becoming the
In the course of the consultation, I was able to recontact container for the supervisors unconscious conflicts (Sarnat
both my self-confidence and a feeling of emotional con- 1992). The models emphasis on supervisory consultation
nection to my supervisee and her patient. In our next and collaborating with other team members provides a final
supervisory hour, as I told my supervisee about the con- check on boundary crossing.
sultation, and about my understanding of what had hap-
pened to us all, her dissociative fog began to lift as well. In Facilitating the Development of Emotional Capacities
that moment my supervisee got the value of using in Supervision: Insights from Neuroscience
another mind to process overwhelming affect. She also had
a first hand exposure to an experienced analyst, her Research in neuroscience provides further guidance as to
supervisor, getting help with her anxieties and defenses. As how we can help our supervisees develop the emotional
a result her feelings of shame about her work decreased and capacities they need to become effective psychoanalytic
she was able to move ahead with her patient. psychotherapists. This research also provides neurophysi-
The relational models extensive focus on the imbedd- ological correlates for many of the convergent insights
edness of the individual mind in networks of relationships from cognitive science, education, and the relational
provides supervisors with a powerful tool for thinking model. Divino and Moore (2010) summarized this litera-
about the impact of the organizations and cultures in which ture and described how they made use of it to improve
they and their supervisees are imbedded. The impact of the their classroom teaching of psychoanalytic psychotherapy.
organization on the supervisory dyad is an area that Ekstein Specifically, they looked at research documenting the
and Wallerstein brought to supervisors attention over fifty neuroplasticity of the brain; the importance of affect
years ago with their concept of the clinical rhombus regulation to attachment processes; the impact of trauma
(Ekstein and Wallerstein 1972, p. 11), although their the- on brain development, especially in terms of the role
ory, ego psychology, did not allow as full an understanding played by implicit/procedural memory; and the function
of the impact on individuals of the organizations in of mirror neurons. Divino and Moores understanding of
which they work as does relational theory (Berman 2004; this research caused them to create a classroom environ-
Frawley-ODea and Sarnat 2001). Because supervisees ment in which the medium is the message and students
often unconsciously carry the unresolved organizational have an opportunity to learn from direct experience. For
issues of their agencies and/or training institutions into example, Divino and Moore consciously strive to make
their supervisory and clinical relationships, a supervisor their theoretical lectures personally relevant to their stu-
who is able to become aware of such conflicts and put them dents in order to engage more parts of their students
into words can free the supervisee to learn and to grow. brains, and thus increase retention; they return a second
This is similar to how a family therapy intervention can time to material that they have perceived to be anxiety
free up the development of a child who has been a symp- provoking so that their students can have a chance to
tom carrier for a family. absorb the material when in a calmer state of mind; they
Finally, the relational model highlights the perspectival bring into the discussion the performance pressures and
nature of the individual supervisors take on the super- competitive anxieties that students generally experience
visee, and the value of collaborating with other supervisors but dont talk about, as they teach about the reduced brain
who work with the same supervisee who inevitably see the processing capacity of brains that are highly anxious; they
supervisee somewhat differently. Team meetings provide co-lecture and use the instructor relationship to provide an
an opportunity to address unconscious splitting dynamics, in vivo model of working with interpersonal disruption,
and help each supervisor to better understand her own thinking out loud about the unconscious process that may
relationship to the supervisee (Ebbert 2011). In all of these have triggered a tense or irritable interaction between
ways a relational approach facilitates the emotional and them.

J Contemp Psychother

Divino and Moore (2010) concluded from their review the analyst sustaining something akin to this state of mind.
of the neuroscience research that experiential, emotionally Freud (1912) in his Recommendations to Physicians
engaged, relationship-based approaches to teaching and Practicing Psycho-Analysis emphasized the value of the
learning are most effective. This kind of learning situation analyst sustaining evenly hovering attention. Schafer
provides a combination of activation of the left hemisphere devoted an entire book of essays to something similar,
of the brain, the part of the brain that deals with cognition which he called the analytic attitude (1983). Bion (1962,
and language; and moderate activation of the right hemi- 1970) spoke of the importance of the analyst sustaining a
sphere, midbrain, and limbic areas, the parts of the brain state of reverie and entering an analytic hour without
that deal with impressions and affects. memory, desire, or understanding.
Divino and Moores (2010) conclusions apply not only Ulmer (2011) notes that Ogden foregrounds a contem-
to classroom teaching but to supervision as well. Take, for plative state of mind in his paper on psychoanalytic
example, a moment when a supervisees affectively intense supervision. Ogden (2005) referred to the supervisory
here-and-now experience is received by a supervisor who is relationship as guided dreaming, and in explaining a
able to remain present for that intensity and helpfully successful supervisory encounter, he observed:
regulate it. Under these conditions, an activated supervisee
It was only because we were in a frame of mind akin
can be helped to hold on to some measure of reflective
to the analysts state of reverie (Ogden 1997a, 1997b)
capacity, or to regain it after losing it, thus integrating the
that we could use the supervisory hour in the utterly
functioning of the left brain with the right brain and the
unexpected way we did [talking about a novel]. This
limbic system. This might describe what happened in
sense of having all the time in the world, of having
Lisas brain in the vignette referred to above. Such
time to waste,2 to my mind, is a necessary element of
moments not only facilitate emotional development in the
the emotional background for an important kind of
supervisee, but also model for the supervisee how to
associative thinking in the analytic supervisory set-
facilitate psychological growth with the patient.
ting (pp. 12721273).
Schore (2011), also citing neuroscience research, urged
psychotherapists who regard interpretation and other verbal Here Ogden seems to be appealing to the supervisor and
communication with the patient as the central curative supervisee to mobilize their right brains to share in a
factor in treatment to reconsider. He, too, recommended contemplative state of mind.3
paying attention to the patients non-verbal right brain, According to Ulmer (2011), neuropsychological studies
since it is the site of the infantile self. When a therapist of meditation demonstrate that entering a state of con-
communicates right brain to right brain a more complete templation contributes to the development of five cogni-
connection is made with the patient, a connection that goes tive/emotional capacities that are important for the
beyond words. Lobbying for the importance of developing psychoanalytic supervisor.4 First, a state of contemplation
competence in making right brain to right brain contact, strengthens the connections between the parts of the brain
Schore said: that generate intuitive feelings and the parts of the brain
that generate executive thinking and creative ideas (Holzel
At the most fundamental level, the work of psycho-
therapy is not defined by what the therapist explicitly,
objectively does for the patient, or says to the patient. Note that Ogdens article is about supervising psychoanalysis rather
Rather the key mechanism is how to implicitly and than psychoanalytic psychotherapy. A supervisor who works in a
clinic setting, where multiple cases must be discussed in a given
subjectively be with the patient, especially during supervisory hour, may not feel she has the luxury of relaxing into the
affectively stressful moments when the going-on- state of mind he describes. Yet I believe that the value of supervisor
being of the patients implicit self is dis-integrating and supervisee being able to enter the state of reverie that Ogden
in real time (pp. 9495). describes applies to all psychoanalytic supervision, no matter how
time-pressured the setting.
In supervision, too, this reordering of priorities makes For a discussion of how more structured mindfulness exercises may
sense. Supervisors are most effective when they take seri- be utilized in a relational approach to supervision, see Safran and
Muran (2000).
ously the importance of attending to the relationship and 4
Research in this area has been complex and my discussion is
the nonverbal, affective, unconscious-to-unconscious bond
necessarily simplified. In reality there are multiple subtly different
between supervisee and supervisor. contemplative states of mind that involve different parts of the
Neuroscience research also highlights the therapeutic brain and that are developed by different forms of meditative practice
value of a person coming into contact with the contem- (Goleman 2003). For example, focused meditation strengthens
ones ability to focus on a single thing, while open-monitoring
plative state of mind that we most often associate with
meditation fosters an open awareness of the full range of experi-
meditators. As Ulmer (2011) pointed out, many psycho- ences, without privileging one over another. These different contem-
analytic thinkers have emphasized the beneficial impact of plative states of mind support different functions of the supervisor.

J Contemp Psychother

et al. 2010). Such connections could be helpful to a draws upon the meta-analyses of the outcome literature on
supervisor who is trying to draw upon her unsymbolized psychoanalytic psychotherapy, upon cognitive science,
countertransference experience to formulate what is going upon educational theory, or upon neuroscience, all arrows
on between herself and her supervisee, as well as what is point toward experiential, actively engaging, emotionally
going on between the supervisee and his patient. Second, rich, secure, and well-regulated relationship-based teaching
maintaining a contemplative state of mind increases ones methods. A pressing need, in my view, is to encourage
capacity to read micro-emotions (Ekman 2003) and thus psychoanalytic supervisors to make better use of this
increases ones capacity to accurately empathize with the knowledge. In order for more of us to integrate this
other. Third, being in such a state allows one to maintain a knowledge into our way of working, we will need to
physiological state of calm while in the presence of intense understand our resistances.
affective activation of another person (Ekman 2003).
Fourth, a person in a contemplative state of mind is more Pressing Needs: Confronting Resistances to Working
alert, positive, open, flexible, and compassionate (Ekman Relationally in Supervision
2003; Davidson 2003; Lutz et al. 2004), all excellent
qualities in a supervisor. Fifth, being in a contemplative Watkins (2011) observed that psychoanalysis has led the
state of mind increases ones mentalizing capacities way in the transition from patient-focused to supervisory-
(Fonagy and Target 1998) that is, ones capacity to reflect relationship-focused supervision. However, in my experi-
upon both ones own state of mind and the state of mind of ence, many psychoanalytic supervisors continue to work
another person. In summary, being with a person who is in from a non-relational, patient-centered, didactic model.
a contemplative state of mind increases in both parties the There are undoubtedly many reasons for this: commitment
capacity for accurate empathy, positive and open states of to a particular clinical theory; comfort with supervising the
mind, and integration between gut feeling and executive way one had been supervised, and a feeling of disloyalty
thinking. about changing ones approach; uncertainty about how to
The implication of this research is that the atmosphere engage relationally without crossing the teach/treat
one creates in the supervisory houran atmosphere of boundary; anxiety about meeting the supervisee on the
spaciousness, emotional receptivity, and calmnesscan more level playing field created by a relational view of the
have a profound impact on the supervisees ability to feel supervisors authority (Frawley-ODea and Sarnat 2001;
secure in supervision, to settle down emotionally, and to Sarnat 2006).
think and feel deeply and creatively. This then translates Avoiding tensions in relationships is also a universal
into the supervisees increased ability to offer both secure human tendency, and as such knows no theoretical
attachment and a containing, analytic attitude to his boundaries. Even the most interpersonally oriented of
patients, essential capacities for sustaining the participant- psychoanalytic supervisors sometimes do so, and we are
observational frame that Tuckett (2005) described as a not motivated to change if we dont fully appreciate the
primary psychoanalytic competency. ways in which such avoidance undermines supervisory
The pedagogical importance of a supervisor sustaining a effectiveness. For example, psychoanalyst Irwin Hirsh,
contemplative state of mind seems clear. But to prioritize when asked under what circumstances he would explore
achieving such a state of mind, a supervisor would need to the relationship between himself and a supervisee, asserted
value the stillness of reverie as much as more active forms that he would not do so unless there is a problem
of teaching. Clearly a single supervisory stance doesnt (Frawley-ODea and Sarnat 2001, p. 112). In my view, this
optimally facilitate the development of all therapist com- statement overlooks the possibility that unexpressed ten-
petencies, and a variety of supervisor states of mind and sion may exist, as well as showing a lack of appreciation of
activities must be given place within the supervisory the power differential between supervisor and supervisee
relationship. and how this discourages supervisees from bringing up
problems unless directly or indirectly invited by their
supervisors to do so. This attitude, held, I believe, by many
Pressing Needs and Future Possibilities psychoanalytic supervisors, creates an atmosphere in which
dynamics in the supervisory relationship, which need to be
In summary, as I reviewed the literature in preparation for explored in order to help the supervisee develop in his or
writing this paper, I was amazed to realize how much we her work with the patient, go unaddressed, and the super-
already know about the art of teaching psychoanalytic vised treatment flounders (Frawley-ODea 1997; Hirsch
psychotherapy, how much consensus there is about what 1997).
works best in supervision, and how much research from As another example of the avoidance of tension in the
related fields backs those conclusions up. Whether one supervisory relationship, consider the transcript in

J Contemp Psychother

Chapter 8 of Ladany et al.s (2005) interpersonally-ori- It seems to me that much of the literature cited has made
ented book on supervision. The transcript shows a super- an implicit interpretation to psychoanalytic supervisors:
visor thoughtfully but persistently confronting a supervisee Didactic teaching and skill development in supervision
who has a serious blind spot, and who is unwilling or are not enough. It is important to engage directly with our
unable to face her difficulties. When the supervisee supervisees and to reflect upon the difficulties that emerge
becomes upset by the confrontation, the supervisor sug- within our supervisory relationships, if we are to effec-
gests that the supervisee leave the room for a few minutes tively teach the art of psychoanalytic psychotherapy. But
and take a break. This otherwise skillful supervisor the working through of this interpretation is far from
believed that it was pedagogically necessary to interrupt complete. Continuing that working through is a pressing
the supervisory hour because the supervisee was upset. But need.
in my view, the supervisor who does not sit with a super-
visee, and help him or her to calm down, misses an More Pressing Needs: Confronting Resistances to Other
opportunity to teach in the here-and-now how emotional New Methods Including New Technologies
distress can be tolerated, worked with, and transformed in a
helping relationship. The supervisor misses an opportunity Traditional supervisory methods, which require the
to provide an experience of containment that might con- supervisee to see a patient before getting help, are not the
tribute to the development of the supervisees capacity to best way to train novices. We should, therefore, add
contain his patients distress (Burka et al. 2007). It is no Binders (2011) fourth elementlearn-by-doing delib-
easy task to stay in emotional contact with a supervisee erate practice models that make use of interactive com-
during moments of intense distress, and to process ones puter programs and videotapes to the tripartite model. In
own responses sufficiently to provide affect regulation. these analogue therapy situations the novice therapist can
Doing so requires comfort with the idea of making use of practice responding to a progressively graded series of
ones clinical capacities to facilitate supervisee develop- situations, such as working with an angry or demeaning
ment. When supervisors dont sufficiently value such client. Along similar lines, Cabaniss et al. (2011) and
moments as pedagogical opportunities, or cant imagine Safran and Muran (2000) point the way to integrating
how to work with such moments in a way that maintains many skill-developing activities not only into the class-
appropriate boundaries, they will naturally avoid them. room but also into the supervisory situation. These peda-
Binder (2011) cautions that we may use our clinical gogical strategies have been adopted by too few
skills in supervision as a rationalization for avoiding the psychodynamic training settings, at least among those with
challenge of learning new supervisory methods: which I am familiar.
Similarly, while it is considered standard practice by most
clinical theories have been stretched to accommo-
non-psychoanalytic supervisors and by many psychodyna-
date explanations of the components of therapist
mically-oriented supervisors in graduate school settings,
performance, of the supervisory process, and as a
video and audio taping of clinical hours continues to be
guide to teaching and supervising strategies. The
rejected by many psychoanalytic supervisors. Kernberg
theory of parallel-process in the supervisory rela-
(2010) has recently called psychoanalysts to task for this
tionship is a prominent example of how applying
attitude. To me the exclusive focus on recording devices as
clinical theory to the understanding of the supervisory
intrusions that are to be kept out of the sanctity of the psy-
process allows therapy teachers to rely on their
chotherapy hour is myopic. This attitude brings to mind
clinical skills when training therapy students. The
classical psychoanalysts fantasies of being able to protect
reliance on clinical theory as a substitute for a gen-
their patients from their personalities and unconscious
uine pedagogy for psychotherapy training may have
conflicts if they try hard enough to be anonymous and
contributed to the relatively slow adoption by psy-
neutral (Mitchell 1998).
chodynamic therapy teachers of new technologies.
Some psychoanalytic supervisors reluctance to use
(p. 1)
recording technology, however, comes not from concern
While Binders point about why psychodynamic teach- about the taping itself but from a worry about how the tapes
ers have been slow to adopt new technologies may be will affect the supervisory process. They fear that viewing
valid, drawing upon clinical theory in supervision does a tape in supervision will take away their supervisees
not have to stand in opposition to genuine pedagogy. freedom to organize in their own way what they bring to
Clinical-model-based approaches can actually contribute the supervisory hour. Yet if the supervisor allows the
to effective pedagogy and, as I will discuss in the supervisee to decide what in the tape to focus on, and
next section, need not contribute to avoidance of new the supervisor pays attention to both what is avoided and to
technologies. the supervisees anxieties and conflicts in discussing the

J Contemp Psychother

tape, this concern becomes a non-issue. (Safran and Muran differences are safe to acknowledge, and growth in self-
2000). The supervisor can refer to avoided aspects of the awareness becomes possible.
video tape as the supervisee becomes able to tolerate this, Another exciting future possibility would be for
in order to begin to work with the supervisees blind spots departments of psychology, in collaboration with computer
and the anxieties that motivated those blind spots. science departments in our universities, to create and dis-
Unstructured reporting of a clinical hour, requesting seminate interactive computer programs, and other tech-
help with specific clinical or diagnostic questions, reading nological innovations, for use in clinical training programs
of detailed process notes, playing of tapes, or engaging in that are in the community as well as within academia. Not
specific skill-building activities, computer-assisted or only our supervisees but also their patients will be grateful
otherwiseall are modes of participation that make sense if we provide trainees with laboratory experiences for skill
for teaching certain supervisees in certain situations. One development.
size fits all doesnt take into account the diversity of The neuroscience-based teaching techniques of Divino
learning styles of different supervisees and of a single and Moore (2010) and Ulmer (2011) also beckon us,
supervisee at different developmental stages. Just as we promising the possibility of broadening and deepening the
individualize clinical technique with patients, we need to educational experience of the therapist-in-training. In
individualize pedagogical technique with supervisees. future we might, as Safran and Muran (2000) have already
Overcoming our resistances to making use of all of these done, supplement psychotherapy supervision with mind-
possibilities, whether motivated by a lack of information fulness training in order to help trainees to develop their
and resources, anxiety about trying something new, or capacity for reverie and for tolerating disturbing feelings
loyalty to orthodoxy, is therefore a second pressing need. stirred by their patients and the treatment process.
I hope that in future we can also expand the quantity of
Future Possibilities empirical research studying the process and outcome of
psychoanalytic supervision. When and if this happens, I
Once we address our resistances to change, exciting new look forward to discovering more about how best to teach
possibilities emerge. For me, first among these possibilities useful knowledge, hone psychotherapeutic therapeutic
is that more psychoanalytic supervisors will come to value skills, and develop emotional and relational capacities
and make use of a their own construction of a relational within our supervisees.
model of supervision. Viewing the supervisory relationship
as a tool for developing emotional and relational capacities,
and as a means of facilitating learning-through-experience,
seems to me to open up one of psychoanalytic supervi- References
sions most exciting potentials.
The creative challenge of devising focused, participa- Aron, L. (1996). A meeting of minds. Hillsdale, NJ: The Analytic
tory teaching exercises that are sophisticated enough to
Beck, J., Sarnat, J., & Barenstein, V. (2008). Chapter 4, Psychother-
develop complex clinical skills also beckons us. Safran and apy-based approaches to supervision. In Shafranske. Falendar
Muran (2000) as well as Cabaniss et al. (2011) have (Ed.), Casebook for clinical supervision: A competency-based
already begun to forge a trail in this direction in training approach (pp. 5796). Wasahington: American Psychological
psychodynamic psychotherapists. Even at the meetings of
Bergmann, M. S. (2003). A contribution to the supervisory panel.
the International Psychoanalytic Association, change is Psychoanalytic Dialogues, 13, 327339.
afoot. Listening-To-Listening workshops, developed by Berman, E. (2004). Impossible training. New York: Routledge.
Haydee Faimberg, demonstrate how a well-designed quasi- Binder, J. (1999). Issues in teaching and learning time-limited
psychodynamic psychotherapy. Clinical Psychology Review,
experiential training activity can attract even seasoned
19(6), 705719.
psychoanalysts. In her workshops, transcripts of analytic Binder, J. (2011). Teaching and supervising psychodynamic psycho-
sessions are divided up into units of 5 or 10 min of clinical therapy. Paper abstract from C. E. Watkins, Jr. (Chair), Teaching
process and distributed sequentially for discussion in a and Supervising Psychotherapies in the 21st Century: Pressing
Needs, Impressing Possibilities. Symposium presented at the
small group of psychoanalysts. Participants thus have the
Annual Meeting of the American Psychological Association,
opportunity to experience the unfolding of the hour just as Washington, DC.
the analyst did. During discussion, three senior analysts Bion, W. R. (1962). Learning from experience. London: Tavistock.
listen for how each analysts inferences about the clinical Bion, W. R. (1970). Attention and interpretation. London: Karnac.
Bordin, E. (1979). The generalizability of the psychoanalytic concept
material stem from their unique implicit theoretical
of the working alliance. Psychotherapy, 16, 252260.
assumptions, and how one analysts assumptions differ Burka, J., Sarnat, J., & St. John, C. (2007). Learning from experience
from others. These groups strive to create a setting where in case conference: A Bionian approach to teaching and

J Contemp Psychother

consulting. The International Journal of Psychoanalysis, 88(4), gamma synchrony during mental practice. Proceedings for the
9811000. National Academy of Sciences, 101(46), 16,36916373.
Burns, C., & Holloway, E. (1989). Therapy in supervision: An Mitchell, S. A. (1997). Influence and autonomy in psychoanalysis.
unresolved issue. The Clinical Supervisor, 7(4), 4760. Hillsdale, NJ: The Analytic Press.
Cabaniss, D. L. (2008). Becoming a school: Developing learning Mitchell, S. A. (1998). The analysts knowledge and authority.
objectives for psychoanalytic education. Psychoanalytic Inquiry, Psychoanalytic Quarterly, 67, 12.
28, 262277. Ogden, T. (2003). On not being able to dream. International Journal
Cabaniss, D. L. (2011). Teaching psychodynamics in the 21st century. of Psychoanalysis, 84, 1730.
San Francisco, CA: Lecture at the Meetings of the American Ogden, T. (2005). On psychoanalytic supervision. International
Psychoanalytic Association. Journal of Psychoanalysis, 86, 12651280.
Cabaniss, D. L., Cherry, S., Douglas, C. J., & Schwartz, A. R. (2011). Orlinsky, D., Grawe, K., & Parks, B. (1994). Process and outcome in
Psychodynamic psychotherapy: A clinical manual. West Sussex: psychotherapy. In A. D. Bergin & S. L. Garfield (Eds.),
Wiley. Handbook of psychotherapy and behavior change (4th ed.,
Davidson, R. (2003). Chapter 8, The neuroscience of emotion. In D. pp. 270376). New York: Wiley.
Goldman (Ed.), Destructive emotions (pp. 179204). New York: Pizer, S. A. (1998). Building bridges: The negotiation of paradox in
Bantam Dell. psychoanalysis. Hillsdale, NJ: The Analytic Press.
Divino, C., & Moore, M. S. (2010). Integrating neurobiological Riggs, S. A., & Bretz, K. M. (2006). Attachment processes in the
findings into psychodynamic psychotherapy training and prac- supervisory relationship: An exploratory investigation. Profes-
tice. Psychoanalytic Dialogues, 20, 337355. sional Psychology: Research and Practice, 37(5), 558566.
Ebbert, N. (2011). Learning from experience together: Perils and Rodolfa, E., Bent, R., Eisman, E., Nelson, P., Rehm, L., & Ritchie, P.
pleasures of collaborative supervision. Oakland, CA: Presenta- (2005). A cube model for competency development: Implica-
tion at the Psychotherapy Institute Supervisors Conclave. tions for psychology educators and regulators. Professional
Ekman, P. (2003). The universality of emotion, 119156. In D. Psychology: Research and Practice, 36, 347354.
Goleman (Ed.), Destructive emotions. New York: Bantam Dell. Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic
Ekstein, R., & Wallerstein, R. (1972). The teaching and learning of alliance: A relational treatment guide. New York: Guilford
psychotherapy (2nd ed.). New York: International Universities Press.
Press. Sarnat, J. (1992). Supervision in relationship: Resolving the teach/
Filho, G. V., & Pires, A. C. (2010). Benign and disruptive treat dilemma in psychoanalytic supervision. Psychoanalytic
disturbances of the supervisory field. International Journal of Psychology, 9, 387403.
Psycho-Analysis, 91, 895913. Sarnat, J. (1998). Rethinking the role of regressive experience in
Fonagy, P., & Target, M. (1998). Mentalization and the changing psychoanalytic supervision. Journal of the American Academy of
aims of psychoanalysis. Psychoanalytic Dialogues, 8, 87114. Psychoanalysis, 26(4), 529543.
Frawley-ODea, M. G. (1997). Whos doing what to whom? Sarnat, J. (2006). Authority relations in psychodynamic supervision:
Supervision and sexual abuse. Contemporary Psychoanalysis, A contemporary view. In R. Raubolt (Ed.), Power games:
33(1), 518. Influence persuasion, and indoctrination in psychotherapy
Frawley-ODea, M. G. (2003). Supervision is a relationship too: A training. New York: Other Press.
contemporary approach to psychoanalytic supervision. Sympo- Sarnat, J. (2008). Reuniting the psychic couple in analytic training
sium on psychoanalytic training and education. Psychoanalytic and practice: A candidates experience. Psychoanalytic Psychol-
Dialogues, 13, 355366. ogy, 25(1), 110121.
Frawley-ODea, M. G., & Sarnat, J. (2001). The supervisory Sarnat, J. (2010). Key competencies of the psychodynamic psycho-
relationship: A contemporary psychodynamic approach. New therapist and how to teach them in supervision. Psychotherapy:
York: Guilford Press. Research, Practice, Training, 47(1), 2027.
Freud, S. (1912). Recommendations to physicians practicing psycho- Sarnat, J. (2011). Disruption and working through in the supervisory
analysis. Standard Edition, 12 (pp. 111120). process. Paper delivered at the 47th Congress of the International
Goldfried, M. (1980). Toward the delineation of therapeutic change Psychoanalytic Association, Congress of the International Psy-
principles. American Psychologist, 35, 991999. choanalytic Association, Mexico City.
Goleman, D. (2003). Destructive emotions. New York: Bantam Schafer, R. (1983). The analytic attitude. London: Hogarth Press.
Publishing. Schore, A. (2011). The right brain implicit self lies at the core of
Hirsch, I. (1997). Supervision amidst abuse: The supervisors psychoanalysis. Psychoanalytic Dialogues, 21(1), 75100.
perspective. In M. H. Rock (Ed.), Psychodynamic supervision Strupp, H. H., & Anderson, T. (1997). On the limitations of therapy
(pp. 339360). Northvale: Jason Aronson. manuals. Clinical Psychology: Science and Practice, 4, 7682.
Hoffman, I. Z. (1998). Ritual and spontaneity in the psychoanalytic Tuckett, D. (2005). Does anything go?: Towards a framework for the
process. Hillsdale, NJ: The Analytic Press. more transparent assessment of psychoanalytic competence.
Holzel, B., Carmody, J., Evans, K., Hoge, E., Dusek, J., Morgan, L., International Journal of Psycho-Analysis, 86, 3149.
et al. (2010). Stress reduction correlates with structural changes Ulmer, N. (2011). Contemplating supervision: A neuropsychoanalytic
in the amygdala. Social Cognitive and Affective Neuroscience, relational perspective. Lecture for the Supervision Study
5(1), 1117. Program. Berkeley: The Psychotherapy Institute.
Kernberg, O. (2010). Psychoanalytic supervision: The supervisors Watkins, C. (2010). Psychoanalytic constructs. American Journal of
tasks. Psychoanalytic Quarterly, 79, 603627. Psychotherapy, 64, 393416.
Ladany, N., Nelson, M. L., & Friedlander, M. L. (2005). Critical Watkins, C. (2011). Celebrating psychoanalytic supervision. The
events in psychotherapy supervision: An interpersonal approach. Psychoanalytic Review, 98, 401418.
Washington, DC: American Psychological Association. Winnicott, D. W. (1972). Holding and interpretation. New York:
Lutz, A., Greischar, L., Rawlings, N., Ricard, M., & Davidson, R. Grove Press.
(2004). Long-term meditators self-induce high-amplitude