Primitive Feelings Evoked by Some Features of Being Supervised

(1991).
Psychoanalytic Psychotherapy, 5(3):235-245

Good Supervision: On the Experience of being Supervised*
Penelope Crick
This paper was written for presentation at a symposium of
trainers when the author was a trainee in psychoanalytical
psychotherapy. The original title was ‘Good Supervision: a
consumer's guide’. The author drew not only on her own
experience of being supervised but also on that of colleagues in
training. It was found that it was essential to conceptualise the
experience in terms of the triangular relationship between student,
patient, and supervisor. Primitive feelings are evoked by the
supervisory process and some of these are described.
Characteristics of supervisors and the supervisory process and
how these are felt to help, or otherwise, are discussed.
Introduction
This paper was written for presentation at an international symposium
organised by the Tavistock Clinic, ‘Supervision as a Way of Learning:
Opportunities, Boundaries and Limitations' (August 1990), and attended by
trainers and supervisors in psychoanalytical psychotherapy. At the time I was
in the final year of a psychoanalytical psychotherapy training post in the
National Health Service. I was asked to speak about what it is like to be
supervised — to give a ‘Consumer's Guide’. As the only student at the
conference, it was a daunting task to address an international group of
experienced supervisors about what constitutes Good and Bad supervision.
Therefore, in preparing the paper, I drew not only on my own experience as a
student at the end of training, but also on that of some of my colleagues also in
training with whom I had some valuable discussions on this topic. We found
the experience of thinking back and reflecting on our supervisory history an
interesting and illuminating one. It helped, I think, in the task of drawing our
psychotherapy training to an end — to ‘view the body’, as it were, as a
necessary component of proper mourning and internalisation. I did not review
the literature because, although there is quite a lot written about how to do
Good Supervision, there is very little on being supervised.
—————————————
* This paper was first published in Danish in AGRIPPA Psykiatrisk
Tekster 12. Argang, Nr.2 1990.
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The questions about what it is like to be supervised, what it is that is good
about supervision, and what it is that is less than helpful, are complex. There
are many variables. Clearly, Good Supervision does not consist solely of
what is provided by the supervisor; it is also the result of an interaction
between a particular student and supervisor; and some pairings just do not
work. So in this paper I will not really be referring to the variable to do with
supervisor-student ‘fit’, but just taking it for granted that it is significant.
The sort of supervision that I am talking about here is supervision of
students training to qualify as psychoanalytical psychotherapists. So while
many of the attributes of good supervision will be common to any sort of
clinical work with patients, and with the supervision that therapists may seek
after qualification, there are some features that are specific.
The specific features that I will describe are the student's adolescent
position in relation to the training, the pains of learning, and the discomforts
of being assessed. The extent to which the primitive feelings evoked by all
this are dealt with will depend on the student's analysis, the containing
function of the training institution, and the qualities of the supervision
experiences during training. I will try to say something about the ways in
which supervision is either helpful or unhelpful in a student's management of
all that is stirred up by the experience of being in training. Lastly, I will talk
about ways in which students experience the tripartite relationship between
themselves, their patient, and their supervisor, with all the tensions inherent in
such a triangular situation.
Primitive Feelings Evoked by Some Features of Being
Supervised
Adolescent position in relation to the training
I will refer to the therapist in training as ‘the student’ simply so as to avoid
the confusing possibility of talking about ‘the therapist’, which could be
understood as being the student, the student's own therapist, or the supervisor.
The need to clear up such potential misunderstandings reflects something of
the ambiguity of the status of the relevant parties when the ‘student’ of
psychotherapy is generally in his middle or late thirties, already
professionally qualified with some years' experience of working clinically,
and now doing psychotherapy. This last point is particularly relevant for NHS
or public-sector-based trainings, where the bulk of the clinical service is
provided by ‘the students'.
The student then shares something of the ambiguity of adolescence —just
about fully grown but not yet entitled to take an adult identity. I certainly felt
like an adolescent when I was preparing this paper — one who is granted an
opportunity to ‘advise’ parents how to parent well: did we not all at some
time curse our parents and swear to our friends that we would never be like
that to our children, never be so unreasonable or out of touch with what really
matters; never so stingy or demanding when we became adults and parents. As
one gets older it gets harder to remember exactly what it was one had sworn
never to do. Similarly, I suppose,
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as one's professional identity comes to be more firmly established as that of
teacher/supervisor, rather than student, one maybe still retains an idea of how
one would like to be as a supervisor; but perhaps it becomes more difficult to
put oneself in the student's shoes and remember what it was specifically that
was helpful, horrible, persecutory, or invaluable about one's own training.
So it is not surprising to find that the demands that we make of ‘a good
supervisor’ are as contradictory and paradoxical as the demands familiar to
the parents of adolescent children:
‘You should be more protective
of me’ vs. ‘Don't be so over-protective’
‘You expect too much of me’ vs. ‘Your expectations of me are too low’
‘You should tell me what to do’ vs. ‘You should let me find out my own
way of doing things
‘Tell me what you have done in vs. ‘Don't bore me with your
similar situations in the past’ reminiscences and anecdotes about the
old days'
‘Be kind to me’ vs. ‘Be tough with me’
‘Give me space!’ vs. ‘Give me structure!’
The Pain of learning
Quite apart from ways in which a supervisor can facilitate or inhibit one's
capacity to learn, the task of learning is itself very difficult. We know from
our clinical work how powerful the resistance to change can be, no matter
how intense is the conscious desire and striving for change. When there are
gains, new identifications and internalisations, there are corresponding losses
— relinquishments of earlier identifications and parts of the self. Such giving
up of old ideas and habits and ways of thinking is difficult and painful —
everyone feels ‘de-skilled’ at the beginning of psychotherapy training. One
feels that one's intuition and spontaneity are being attacked, devalued, or lost.
Trying out new recommended ways of speaking to a patient can feel, and
indeed probably often is, wooden and stiff, and while it may be the beginning
of a process of successive approximation to a new, good standard of practice,
it can feel uncomfortable, and something that one cannot be confident about at
all.
Of course, the needs a student has of supervision in some ways change
over time. A student feels far more comfortable, and has a better learning
experience, if the supervisor has demonstrated that he is interested in the
course of the student's training, knows what ‘developmental stage’ they are at
in terms of training. To give an extreme example, a supervisor who is talking
about, say, the manifestation of projective identification in a session, before
the student has got a good grasp on managing the basic setting of time and
place, is not going to be very helpful in promoting that student's learning about
the fundamental requirements of psychoanalytical
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psychotherapy — but rather will give them a persecutory experience which
undermines the establishment of a good, firm basis, necessary if one is to
learn from experience.
The Discomforts of being assessed
Particularly early in training, students are very conscious that one of the
functions of supervision is assessment of them and of their work. Fantasies
abound about what the supervisor is inferring about one's pathology and one's
aptitude or otherwise for this sort of work. The most prevalent fantasy is that
the supervisor hears the presentation of a session and sees at once that one has
not got a clue about what is going on, and indeed that one seems to have
totally missed the point of what psychotherapy is all about. This fantasy is
maintained by stories that are told like the one about the supervisor who, on
hearing a new student's material for the first time, said ‘Well, whatever else
is going on, it's certainly not psychoanalytical psychotherapy!’
Students are highly sensitive to signs in the supervisor of anything that
appears to be approval or disapproval. Is the supervisor interested? Bored?
Pleased? Is he saying a lot — or not saying much? And what does that mean,
either way?
If this all sounds a bit persecuted, it is. Primitive feelings are stirred up in
the student both in the work with patients, and in the supervision situation —
and it is a test of a good supervisor to see how he or she facilitates the student
dealing with these. Clearly in a psychoanalytical psychotherapy training, the
student will be in analysis themselves, and such experiences will come up
there. Perhaps it is worth mentioning here that primitive feelings like envy,
persecution, idealisation, and so forth, are not only experienced by the student
in relation to the supervisor — it seems clear from people's experiences that
it can be the other way round too. There may be times when the student's
analyst may have occasion not so much to help the student with his envy or
idealisation of a supervisor, as to help the student to see how the supervisor
is envious or idealising of the student.
How Can the Supervisor Help?
The Basic setting
A supervisor will help with the containment of difficult feelings in the
supervision situation if he is mindful of the details of the basic setting and
conduct of the supervision. Getting the basic setting right is of course
fundamental in psychoanalytical psychotherapy, and in this as well as in other
respects, the supervision situation acts as a model for a student in setting up
his therapeutic work with patients. This is about the importance not only of
the extrinsic features, such as taking care of reliability and regularity of
sessions, observing time boundaries, ensuring that the supervision session is
unlikely to be interrupted by telephone calls, and so on, but also the more
intrinsic aspects to do with the basic stance of the supervisor. This stance is
of course an extremely important aspect of what is to be
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identified with and internalised. When the parameters of the ‘basic setting’
are too greatly disturbed this provides scope for all kinds of primitive
feelings to be generated and elaborated to the detriment of the task in hand. If
a supervisor suddenly cancels a few supervisions, or too readily submits to
the student's attempt to avoid presenting a session felt to be not very good, the
student can feel that disapproval of his performance is being conveyed.
For example, a colleague of mine, early in his training, had the following
experience. The supervisor, who was also a senior colleague to whom the
student was professionally responsible in his employment, unilaterally
decided to use the supervision time as a convenient moment to assume one of
her other roles in relation to the student and to discuss the possibility of the
student taking on some unrelated pieces of organisational consultation work at
some time in the future. This could be all right, thought it would be better if
the supervisor had asked first and agreed the change of task with the student,
but in fact at this early stage of the training, where the student was still feeling
particularly vulnerable, it was experienced by him as a lack of interest in the
patient and stimulated fantasies of being found to be ‘a boring student’. In this
vulnerable state of mind, the student may feel that his perfectly proper
continuing interest in the patient is seen as being ‘over-identified’ or ‘over-
anxious'; and so when a supervisor fails to legitimise a student's interest by
appearing to be bored it can be felt as unnecessarily persecutory.
Students of psychotherapy like their supervisor to be interested in their
patient. This was something that came up a lot in discussions. Those
supervisors who manage to convey that they are basically not interested in the
patient one brings are not felt to be helpful at all. There are always exceptions
to any rule of course. One supervisor was often cited as one who, while
making clear his boredom by apparently dozing off and having no
compunction about saying that he finds a case dull, is found to be pretty
exasperating, but is also very much appreciated for what he teaches and
imparts to students. There are, however, accounts of supervisors who ‘rest
their eyes' during supervisor of particular patients an are clearly regularly
preoccupied or bored, but try to cover up for this with the occasional burst of
active interest and enthusiasm. The unspoken sense of boredom lingers,
however, unaddressed, and the whole situation becomes one dominated by a
sense of falseness: the student tries to be more interesting, to make the patient
less boring; the supervisor rewards this with a spurt of interest; the student is
relieved, but also has a nagging sense of something important about the patient
and the therapy slipping away into an obscurity which my be comfortable but
which is not doing the patient's therapy or the student's training any good
whatsoever.
Individual versus group supervision
An important variable in the ‘setting’ of supervision is whether it is
conducted one-to-one, or in a small group. There are usually between three
and five students in a supervision group. Obviously there are positive and
negative features of both individual and group supervision: small-group
supervision gives a student the
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unique opportunity to hear about other people's work. The students who are
not presenting, like the supervisor, can be free to hear the material in a way
that only someone outside the relationship between patient and therapist can
be free — free of the pressures of projections and of the transference. This
opportunity to identify with the supervisor, to stand in a third position relative
to the patient and the therapist, helps in the development of one's own
‘internal supervisor’, the observing self that can stand back a bit from self and
patient in the session.
However, small groups can also generate powerful and uncomfortable
feelings of rivalry and competition. Some supervisors are better than others at
handling this and utilising the group constructively. The main difference
seems to be in the supervisor's conception of the dynamic relationship
between the student/patient couple and the supervision group where the
material is regularly presented. The supervisors who are less good at
handling the group supervision situation seem to be those who tend to
disregard this dynamic and so base their interventions purely on what is
reported by the student. They may invite, but then in fact take little account of,
the views and comments from the other students, accepting these if they agree
with them, dismissing them as of no help if they do not. This is not only
potentially boring and frustrating for the other students, but also stimulates and
builds on existing splits and rivalries in the group. The members of the group
may come to dread the week when the ‘most gifted’ or the ‘least experienced’
student is to present, knowing that ‘old Clever-Clogs' is going to get another
chance to shine, or that pool old So-and-So is going to feel publicly exposed
again*.
This contrasts vividly with the supervisor who assumes from the outset that
the views of the other students hearing the material have countertransference
significance and should be taken into account in trying to understand the
material that is presented. One supervisory style colleagues commented on is
where the supervisor makes a particular point of always asking the
supervision group for their sense of the mood or affective atmosphere of a
session before allowing an exploration of the content, and generally uses
constructively what people contribute. This, in my view, achieves a
sharpening of awareness of one's own countertransference, a training in
inhibiting the temptation to take flight into a premature or intellectual
assessment of the content, and a training in paying deliberate and careful
attention to both the verbal and the non-verbal communication. My impression
is that showing how over-determined unconscious material can be responded
to in different ways also helps members of the group to respect each other's
work and reduces the damaging effects of rivalry and competition.
Style: dialectic versus didactic
One would think that a supervisor's style, or model of supervision would
be an important determinant of how good a learning experience they are able
to offer
—————————————
* Such a supervisor may well be an excellent supervisor, in the sense of
giving a rich and helpful understanding of one's case; but my emphasis here
is on the experience of being in a supervision group conducted in this way.
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to a student. The main ‘styles' of supervision have been described in the
literature, using all sorts of evocative metaphors: the supervisor as potter,
moulding crude clay into serviceable containers; the supervisor as gardener,
pruning and watering the tender young shoots; the ‘jug-versus-spectacles'
methods; and so on. One classification that comes out of talking to my
colleagues, while not being very poetic, is descriptive of the models as
experienced on the receiving end. This is the dialectical versus the didactic.
Is the dialectical style better at containing a student's primitive anxieties in
supervision? Or is the didactic style better, offering as it does the sense of a
firm frame?
Earlier on in a student's training, and at points where even the most
experienced student is caught up in something difficult, say when a patient is
acting out, a more didactic approach is found to be particularly helpful and
containing. It can often be very helpful to hear how a supervisor would
actually phrase how they would put something to a patient or what they would
have done in similar situations. It is a frequent complaint that we never get the
opportunity to hear the work of experienced therapists, except in formal,
distilled versions in published papers. While supervision can be thought of as
a model for the conduct of psychotherapy, it is not psychotherapy; the aims are
educational and distinct from the therapeutic aims of psychoanalytical work.
Recommending books and papers, instructing about theoretical or technical
points, is not, as some supervisors seem to indicate, acting out, although of
course it could be if it is used as an escape from a painful consideration of the
material in the sessions presented. There is, though, an essential tension that
good supervision holds between the task for the student of taking in new ideas
and the work of developing her own internal capacities.
The consensus seems to be that a Good Supervisor is neither dialectical
nor didactic in style; nor occupying some broad middle position; but is able
to move appropriately and flexibly from one style to the other — sometimes
giving information, imparting his knowledge and telling the student what to do
or what is going on in the session, and sometimes reflecting on the material,
thinking with the student, offering his opinion or perception of what is going
on between the student and the patient for discussion.
It is not, however, as simple as that. There are both ‘bad’ and ‘good’
supervisors who, when operating in the didactic style, have their own very
clear and insistent way of seeing the material and understanding the case, and
do not hesitate to tell the student their views. Now from some people this is
experienced by the student as good, and from others as bad, paralysing, and
intrusive. With the good one, the student goes to her next session with the
patient feeling that she has something new that is helpful and that she can use,
either then or later, as a means of understanding something previously elusive.
The bad one leaves the student feeling not just that she has got the patient to
deal with, but also that the supervisor's views are to be accommodated. And
the result is often paralysis, a wooden compliance, or a tacit dumping of the
supervision, which leaves the student feeling left alone and unsupported in her
work.
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The basic test seems to be: Does the student feel that she is being told what
is going on between her and her patient largely for the benefit of the therapy;
or largely so that the supervisor can have an experience of being clever and
perceptive, the one who really ‘knows' the patient, where the student fails to
‘know’?
Those supervisors who are able genuinely and effectively to impart their
knowledge and understanding based on their experience may well be
experienced as pretty persecutory from time to time, but are felt to have one's
interests at heart rather than their own. One has respect for them; they for you.
There is a big difference between the supervisor who uses what one says,
including one's reported countertransference, in order to get his picture; and
the supervisor who disconfirms one's view and one's countertransference or
uses it ‘selectively’ in order to confirm his own view.
So, in short, the main feature distinguishing a good use of the didactic style
from a bad use, is how narcissistic and competitive or omnipotent the
supervisor seems to be.
And within the dialectical style, there are also ways in which it is ‘good’
and ways in which it is ‘bad’. The worst is when ‘not knowing’ and an
attitude of being uncertain about what is gong on between oneself and one's
patient is idealised so that proper attempts to strive to know are inhibited.
Equally, of course, it is awful when ‘certainty’ is idealised.
There are occasions when it is better to be told didactically ‘You have
made a mistake there’ than to be asked dialectically ‘I wonder what was it
that made you make that apparent mistake?’ Being in that way protected from
the fact that one really made a mistake because of one's own shortcomings in
technique, or one's own personal blind-spots, can so easily lead to some false
pseudo-understanding.
I would like to give an example of this sort of thing, but it is difficult to
describe in a brief vignette something that is more typically the result of a
process in supervision that develops over a longish time. However, I will try
to give an example which I hope will illustrate something of this.
A colleague had been taking a patient to supervision for just under a year.
While he could not really find anything to complain about in the supervisor,
he had a distinct sense that there was ‘something missing’ from the
supervision. The work with the patient was all right: the supervisor had been
very helpful with the case, and she gave positive reports on his work. The
patient would occasionally ask for changes in session times when something
came up in her work or family life that clashed with the time. Quite frequently
the patient would be late for sessions, and recently she had begun to come late
more often. The supervisor and therapist had recognised that there were ways
in which the patient attempted to control the therapist, and that one of these
ways, which was pretty effective with this particular therapist, was the
patient's tendency to get furiously angry with the therapist if there was a
conflict about something. The supervisor and the student agreed with each
other that this was a very difficult, touchy patient. The student began to
realise, through some work in a clinical workshop where he would
occasionally
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present the case to a group convened by another member of staff, that he had
been avoiding interpretation of the attacks on the frame of the therapy that
were represented by the lateness and demands for changes of session times.
He realised that he was more afraid of the vitriolic fury that would greet him
than he had allowed himself to know. Although the supervisor had also
noticed the tendency for those attacks on the therapy to be passed over by the
student, she had, it seems, also wanted to protect the student from having his
avoidance pointed out. The result was that the student then had the difficult
task of dealing with the way in which the patient had corrupted him over the
year into colluding with the attack. On reflection, he thought he would have
preferred to have been told more directly that he should be taking up the
lateness, and so on, than to have been left to learn from his mistakes, most
probably at the cost of the patient's therapy. Whatever her personal motivation
for it, the supervisor's ‘protection’ of the student turned out to have been an
extension of the patient's corruption of her therapist.
There are also times when it is better to be asked ‘I wonder what it is in
the situation that made you make that mistake?’ than to be starkly told that you
have made an error, or said the wrong thing, or failed to say the right thing. As
an example: once, fairly early on with a new supervisor and a new patient, the
patient reported that his mother was about to take her first journey abroad, and
was very anxious about it. The patient felt irritated by being burdened with
his mother's unreasonable anxiety. This was shortly before the first holiday-
break in therapy. The supervisor asked me why I had not taken up this very
obvious reference in the transference. The truth was that I had not thought of
it, and I felt rather ashamed of myself. As so often happens, material is so
much clearer when it is reported than when it was actually produced in the
session. The supervisor then wondered what it was in the session or in the
patient that made me fail in this way. I felt very uncomfortable at first, feeling
sure that the supervisor would now realise that it was nothing about the
patient but simply evidence of my lack of sensitivity as a therapist. But in the
end it was a very productive piece of work, it being characteristic of the
patient to have me as the worried, over-anxious, incompetent mother in the
transference, where he is free of such neurotic worry.
The Triangular Relationship between the Supervisor, Patient and
Student
Thinking of the triangular relationship between supervisor, student, and
patient is helpful in describing a number of aspects of what it is like to be
supervised. The big paradox about the supervisory situation illustrates well
the value of keeping this triangular relationship in mind. The paradox is that
while everyone would agree that the person who knows most about the patient
and who speaks most sense about him is the therapist who works with him;
everyone would probably also agree that the person most liable to be wrong
about the patient and have a distorted view of him is also the therapist. It is
only when there is a third party, one who can stand outside and observe the
relationship between patient and
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therapist, that there is a chance of understanding the projective processes that
are going on. The third party of course is also the therapist — the observing
part of the therapist, able to think about the relationship in the therapy without
getting too caught up by it. But during training, and no doubt at other times too,
one needs the support of an external supervisor to sustain and develop one's
own ‘internal supervisor’.
Given this triangular model, how is a ‘good’ supervisor experienced?
Towards the end of the first year or so of being supervised on a fairly
intensive case, I noticed that my ‘good’ supervisor's style towards me had
changed quite a bit over the year. I realised that in the earlier days he had
listened to detailed accounts of sessions without intervening very much except
on issues to do with technique and other aspects of the therapy concerning the
maintenance of a setting that held the developing therapeutic relationship.
Later he had begun to be more interventionist, telling me more about his view
of the patient and what was going on between us, as well as recommending
ways in which I might interpret, and pointing out things I should take up. This
mirrored his advice to me to be cautious in making transference
interpretations in the early days of therapy, so as not to preempt the
‘unfolding’ of the transference. The role of the supervisor here could be
compared to that of the father in relation to the mother and new baby: his role
is to protect the mother-baby couple from intrusions and impingements, so that
they are free to get to know each other properly. A ‘bad’ father would be one
who interferes too much and prevents the establishment of a secure
relationship with the object. As time goes on, it is important that his role
changes — the mother and baby each need there to be a third object to relate
to and with whom to identify.
There are times when, as the student, one needs the supervisor to ally
himself with one, so that one can see that a patient is, say, seducing or
undermining one. As an example of this, I will describe how a supervisor
showed a colleague how he had got too caught up in an identification with his
patient to be able to stand back and understand what was being unconsciously
communicated. My colleague came to supervision one day, very excited about
a session he wanted to present because it was so full of such rich and
interesting material. The supervisor listened carefully to the session, which
curiously now sounded rather ordinary and unexceptional, and then showed
my colleague how his patient was wanting to impress and dazzle him with her
vivid dreams and rich associations, in order to distract her therapist from
seeing the rather miserable, empty, and depressed little girl she was wanting
to disown.
Similarly, there are times when the supervisor allies himself with the
patient — perhaps very rightly in order to show the student that she is in the
grip of some projection that is making her behave in a persecutory way
towards her patient. But sometimes this can be maddening. When a patient has
one at the end of one's tether and one is just managing to control one's
irritation and fury at being, for example, constantly passively attacked, it can
feel quite devastating when the supervisor mildly says what a basically
decent person the patient clearly is, and
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describes calmly how that patient had no option at the moment but to make the
therapist feel so diabolical.
The situation that I referred to before, where a ‘comfortable’, but actually
acutely uncomfortable, pseudo-understanding about the work develops
between a supervisor and student is one where the essential tension in the
triangular situation between student, patient and supervisor has been lost.
What I mean by this is that where there is a problem between patient and
therapist due, say, to the student's blind-spot, the good supervision is where it
is possible for that to be recognised and the bad is where supervisor and
student join up to deny that problem and instead maybe project it onto the
patient. These alternatives are nicely illustrated in the much-cited story of
Mrs Klein's supervision, where a student told her that ‘at this point the patient
projected her confusion into me’, and Mrs Klein replied, ‘No, my dear, you
were just confused!’
Conclusion
In this paper I have tried to address some aspects of the experience of
being supervised that were recognised as important by me and my colleagues
while training as psychoanalytical psychotherapists in the NHS. In summary,
these are as follows.
1. The primitive feelings evoked in students by:
- the student's adolescent position in relation to training;
- the pain of learning;
- the discomforts of being assessed.
2. How can the supervisor help?
3. The basic setting for supervision;
4. Individual and group supervision;
5. Style: dialectic versus didactic.
6. The triangular relationship between supervisor, patient, and student.
I have tried to emphasise that the most important qualities of what is
experienced as good supervision are those which reflect a respect for honesty
and psychic reality in the face of the significant and specific pressures under
which a student is working when training in psychoanalytic psychotherapy.
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Article Citation [Who Cited This?]
Crick, P. (1991). Good Supervision: On the Experience of being
Supervised*. Psychoanal. Psychother., 5(3):235-245
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Primitive Feelings Evoked by Some Features of Being Supervised

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Primitive Feelings Evoked by Some Features of Being Supervised

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(1991).

Psychoanalytic Psychotherapy, 5(3):235-245

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