International Journal of Group Psychotherapy

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Group Supervision: Focus on Countertransference

Eric Moss

To cite this article: Eric Moss (1995) Group Supervision: Focus on

Countertransference, International Journal of Group Psychotherapy, 45:4, 537-548, DOI:
10.1080/00207284.1995.11491302

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 H\TERNATIO!\ALJOURN.-\.L OF GROLP PSYCHOTHERAPY, 45(4) 1995

Group Supervision: Focus on

Countertransference

ERIC MOSS, Ph.D.

ABSTRACT
This paper examines the advantages of a particular way of supervising
psychotherapy, namely, in a group setting with a special fo cus on the supervisee's
countertransference experience. Group supavision is conceptualized as much
more than presenting a case and getting feedback . Rather, the group is used
in all its interactive complexity as it resonates in a myriad of ways to aspects
of the case being presented. Furthermore, because of the complexity of conscious
and unconscious interactions and reverberations during this process, it is ojien
helpful to have a focus in the supervision. One helpful possibility is to center
on the supervisee's countertransference experience and use the group to reflect,
amplify, and process that experience. This can be a highly valuable way of
helping the therapists increase their understanding of the case and enhance the
quality of therapeutic interventions.

Group supervision for individual and group therapy is widely used

particularly in clinics and teaching institutions. However, the specific
use in group supervision of countertransference as a focal point
appears less popular than in individual supervision.
This may be due to a variety of factors , including the psycho-
analytic process itself, which historically has been associated more
with d yadic than group interactions. Furthermore, the traditions of
confidentiality and therapist neutrality associated with analytically
oriented psychotherapy contribute to a certain reticence regarding
the public display of feelings and thoughts characteristic of group
countertransferential exploration. Finally, group members may be
reluctant a bout exposing themselves to colleagues because of anxiety

Eric Moss is a Clinical Psychologist, Supervisor in Tel Aviv, Israel. The author
wishes to extend special tha nks to Dr. Abraha m Cohen of Scarsdale, New York , and
Dr. Kathryn Moss of Durham, North Carolina, for their kind assistance in the
prepara tion of this article.

53 7
538 MOSS

associated with any number of conflicts, such as unworked out

competitive strivings.
These various restraints notwithstanding, a countertransference
focus in group supervision offers, in my opinion, a unique opportunity
to help therapists better understand their cases and improve their
treatments. It is the purpose of this paper to elaborate on this statement.

GROUP SUPERVISION

We may begin our considerations by asking first of all, what advan-

tages does group supervision in general have over individual super-
vision? A number of authors have addressed themselves to the
advantages of groups. Kibei ( 1987), for example, has written that
"Group dynamics produce phenomena that go beyond dyadic pro-
cesses and are insufficiently explained by existing theories of individ-
ual psychodynamics" (p. 17). Ableson ( 1968) has discussed the fact
that in groups there is the obvious opportunity of learning from other
colleagues' experience. I might add that when the spotlight is on the
presenter, the other supervisees may feel less anxious. They are freer
to engage in a state of "hovering attention" from which they can not
only listen to the presenter but also may be more open to thoughts
and feelings related to their own cases.
Another advantage of group over dyadic supervision occurs at
points of impasse between the supervisor and the supervisee. In the
group situation, when such impasses occur, the group members may
be asked for help, either by direct questioning or through the
expression of feelings and fantasies related to the case at hand. New
awareness of problematic aspects of the case and the supervisory
relationship may thus be obtained.
It is, however, particularly in the exploration of countertrans-
ferential issues that the group has a special contribution to the
supervisory process (Alonso & Rutan, 1888; Counselman & Gumpert,
1993; Kutash, 1968; Ormont, 1972). Now, we will turn our attention
to why this is so.

COUNTERTRANSFERENCE

It is my contention that there are elements in the group format that

particularly contribute to the crystalization and enhancement of a
 GROUP SUPERVISION 539

countertransference focus. The alert group supervisor will pick up

in group members, as well as in the group atmosphere as a whole,
reverberations of the case being presented. Affect and understanding
not immediately available to the presenting supervisee because of,
say, countertransference anxiety, may appear more clearly in less-
anxious group members. This offers the supervisor dealing with the
"resistant" supervisee a strategy not available to individual supervi-
sion. He/she can turn to other group members for their responses
to the material being presented. This can be done in a direct fashion
or indirectly, through, say, techniques for amplification of group
mood (Shalit, 1990). The resistant supervisee, hearing these reactions
from "outside" him/herself and not from the supervisor (with whom
there may be some interfering transferential feelings) may be more
open to recognizing and reclaiming his/her own warded off feelings.
A parallel "opening up" may also be experienced by the group
supervisor. It is not uncommon in individual supervision for the
supervisor to become blocked in thinking about the case. In the group
setting, in addition to listening carefully to the individual presenter,
the supervisor has available for consideration the responses of other
group members and the group atmosphere as a whole. Provided that
the supervisor does not get overwhelmed with countertransference
anxiety, these additional stimuli may open him/her up to new thoughts
and feelings about the case.

SUPERVISORY STYLE AND PROBLEMS

OF GROUP SUPERVISION

Just as in psychotherapy there are different approaches and different

therapist styles, so too are there different styles of supervision
(Goguen, 1986). What style is most appropriate to countertransfer-
ence exploration within a group supervision setting?
With regard to issues of style, the very word "countertransference"
is rooted deep in psychoanalytic tradition. Therefore, we might
appear correct in assuming that countertransference supervision style
requires something of the emotional neutrality and detachment
associated with classical psychoanalysis (Freud, 191 0).
Yet, paradoxically countertransference exploration, with its em-
phasis on the therapist's feelings, requires of the supervisor a some-
what different style, one that facilitates the clarification and amplifi-
540 MOSS

cation of the therapist's affective side (Enright, 1971; Harman &

Tarleton, 1983). It must contribute to "playfulness" in the Winnicott-
ian sense while at the same time not abandoning basic analytic
principles and techniques.
At this point, we would play the devil's advocate and ask whether
there are aspects of group supervision that inhibit a countertransfer-
ence focus? Here I would like to point out what we all basically know,
namely, that it is not easy to get a group of colleagues to discuss their
feelings in an open fashion. Most therapists experience narcissistic
concerns; and for the reasons listed at the outset of this paper, they
are understandably reluctant to expose themselves. Their anxiety can
lead to various forms of"acting out" in the group, such as overactivity,
inability to empathically listen, or exaggerated passivity. These of
course would hinder using the group to help members better under-
stand their cases.
To attain the trust needed to work on countertransference issues
requires a supervisory contract of particular interpersonal sensitivity.
Group members and the supervisor must be aware of resistance
(conscious and unconscious) to personal exposure; and the supervisor
must be prepared to foster in every way possible a group culture of
safety (Tauber, 1988).

CLINICAL ILLUSTRATIONS

Following are two examples from a supervisory group with a focus

on countertransference that has been meeting for the past 4 years.
The group is composed of psychotherapists representing a variety of
disciplines (social work, psychiatry, psychology, and dance therapy)
that use different approaches to treatment including dynamic, family,
and cognitive-behavioral therapy.

Case I
Dr. B. asked to discuss his difficulties in treating a 16-year-old boy at a
community clinic that specializes in the treatment of adolescents . The patient
was brought to the clinic by his mother because of his poor academic
performance and her suspicion that he suffered from emotional problems.
In the individual sessions, Dr. B. quickly established rapport with the
youngster and grew to like him. He felt that the patient was making good
progress and that he was able to use the treatment to explore several important
ISSUeS .
 GROUP SUPERVISION 54 I

However, as the treatment proceeded, Dr. B. felt increasingly bothered

by the boy's mother. She was pressuring him to "move faster," to "stop wasting
time," and to "get my son's grades up." He told the group that he was getting
increasingly angry with her and could imagine how pressured the son felt.
On prodding from the supervisor, Dr. B. further explained that the boy's
father was a somewhat passive, quiet person. He was out of the house several
evenings a week, working as a volunteer in the municipal library. Hearing
this, several members of the group tittered. "No wonder, with a wife like that!"
said one. This was followed by a general round of laughter in which Dr. B.
and the supervisor joined.
The supervisor found himself thinking about the laughter in which he
himself had participated. The levity contrasted with the seriousness of the
patient's school problems and the mother's anguish, and it felt out of place.
Furthermore, it seemed that it was the men in the group who were laughing
the hardest. Perhaps, he reflected, the laughter had to do with gender-related
issues. Remarking on what had transpired, the supervisor initiated a discussion
among the men about what Dr. B's case touched in them. With some reticence
several men talked about their feelings toward powerful women .
At this point the supervisor made a group interpretation to the effect
that it seemed to him that the subject of mother-son relationships aroused
strong feelings. As the group "digested" this remark, the supervisor turned
his attention to Dr. B. who was leaning forward in his seat and clearly quite
involved . Dr. B. started talking about his own ambivalent attitudes toward
strong women. He mentioned that at his clinic he was the only male on staff
and didn't like it. He had a fantasy that the boy's father was not going to the
library at night, but that instead he joined the "boys" at the local pub. He
realized how much he too wanted to run away from the boy's mother.
Thinking out loud how these feelings could have affected his perceptions
and his interventions, it became clear to Dr. B. that his anger was interfering
with his ability to empathize with his patient's mother. Although her over-
involvement was indeed annoying, she was, he could see, under genuine
pressures. Some of these were conscious and "real," including repeated
telephone calls from teachers and the threat that her son might be expelled
from school. Others were unconscious derivatives of her own school traumas
and poor self-esteem, which she hoped to repair through her son's success.
Further elaborations and interactive explorations in the group helped
Dr. B. regain a certain degree of professional distance and an empathic
attitude toward the boy's mother. He felt he could deal with her more
effectively, and he realized how his countertransference had led him to
overidentify with his patient and risk "acting out" a fantasy to get the mother
out of the therapy altogether.

Case 2

Another supervisee in the group, Dr. C., as ked for the group's help deciding
on whether to accept a new referral. The potential patient was an 18-year-old
542 MOSS

girl whose parents made the request ostensibly on her behalf. Dr. C . knew the
girl from circumstances he would soon clarify. He said he was inclined to take
her on; but he had a nagging worry that he was overlooking some problem.
He began by explaining that the girls's parents were in the last stages of
treatment with him, treatment that had started some time before when they
found out that their son had made repeated sexual advances to his sisters,
that is, the potential patient as well as his second sister. Dr. C. had at that time
treated the boy as part of an overall family intervention.
Gradually, the focus of the treatment had shifted from the children to
the parents. It came to light that the husband had been prone to violent
outbursts since he was a young man and the wife had been abused as a young
girl. These and derivative issues had been attended to in the therapy, much
to Dr. C.'s and the couples' satisfaction. Recently the treatment had become
stale, however, meetings had become repetitive and there was a feeling of
"being stuck.'' He had been thinking of terminating the treatment.
During the time the parents were in treatment, their daughter (the
potential patient) had gone into obligatory service in the Israeli army, where
she had had two boyfriends in a short period of time. She was lately
experiencing considerable anxiety, something the parents attributed to her
leaving home and the relationship with the boyfriends. They felt that their
daughter needed immediate treatment to deal with these issues, as well as
with her past history of incest.
Dr. C.'s presentation of his case was followed by a lengthy silence.
Eventually, someone made a general comment about the difficulties of
working with child abuse cases. This was followed by detached discussion of
incest and child abuse. Dr. C. then repeated his request to hear members'
opinions about whether to take the girl on . After some silence, there was a
slow discussion about problems that arise when members of the same family
are in individual treatment with one therapist. The group consensus seemed
to be against the whole idea, and some members were surprised that Dr. C.
would consider this proposal.
At this point, a supervisee with a family-systemic orientation pointed out
that perhaps the couple wished to refer their daughter to their own therapist
in order to take the heat off themselves. Dr. C.'s first reaction was a vigorous
rejection of this interpretation. He didn't think they were avoiding anything.
"They are at the end of their treatment," he protested .
The supervisor paused to reflect on all that had transpired in the group,
including the dry sluggish atmosphere and Dr. C.'s staunch resistance to his
colleague's interpretation of treatment developments. He thought the former
may have resulted from an identification with Dr. C.'s projection of an
unconscious, defensive immobility, and it occurred ·to him that Dr. C . and the
couple were locked in a mutual denial pact similar to what was happening in
the group. Rather than looking into this resistive situation, both sides, as the
systems-oriented therapist observed, may have been using the daughter as a
diversion , a seemingly justifiable cause to terminate the parents' treatment.
The supervisor, considering all this, then asked the group about their
 GROUP SUPERVISION 543

feelings concerning what was going on between the man and his wife. The
ensuing discussion was electrifying. Members spoke about violence, abuse,
defenselessness, and sexual perversity. They expressed feelings of humilia-
tion, disgust, and rage. Most felt that there were many painful issues the
couple needed to work through.
Dr. C. was very uncomfortable with the groups' intense expression. He
had difficulty discussing his feelings about the couple. He observed that he
had treated the son for his incestuous behavior with a somewhat detached
behavioral approach; and, although he judged that treatment successful, he
may have continued to relate to the couple in a similar operational manner.
He could see, he said, that perhaps a certain affective side was lacking.
Additional expressions of angry feelings toward the father for his violence
and the mother for overlooking the son's abuse of her daughters were
expressed by group members. This seemed at last to stimulate similar feelings
in Dr. C., which he was able to express. He felt energized and revitalized, and
he recognized how he had been avoiding the painful confrontation of delicate,
yet explosive issues still to be dealt with by the couple. He concluded that
referring the daughter to another therapist would be more appropriate, and
he would continue with the couple's treatment using the new perspectives he
had gained.

DISCUSSION

It seems clear from the above illustrations that focus on countertrans-

ference in supervisory groups can be of great benefit. Yet, both from
a practical as well as theoretical viewpoint, there are certain issues that
must be considered.

Boundary between Supervision and Therapy

Supervision is intended to help the therapist help the patient. How-

ever, when supervision places a particular emphasis on the therapist's
feelings-as happens in a countertransference group-there is a risk
that the focus will shift too much in the direction of the therapist; and
supervision will turn into personal therapy.
To assure that a proper balance is kept between desirable coun-
tertransference exploration and off-limits personal therapy, certain
restraints are expected of group members. There are at least two
sources of this restraint. The first lies in the experience and self-aware-
ness of supervisees. They must have the personal maturity and
professional experience to be able to differentiate between legitimate
544 MOSS

self-exploration on behalf of their patient and self-exploration for

more personal and narcissistic needs. The ability to make this distinc-
tion comes with clinical experience and personal growth. Therefore,
countertransference supervision groups are not recommended for
beginning therapists until they have had some focused training in
countertransferential exploration. This could be didactic in nature
with emphasis on both theory and technique as well as experiential,
such as specific training workshops. Personal therapy should also be
a requisite for participation.
A second source of this balance between affective openness and
responsible self-restraint is the existence of a clear supervisory con-
tract. I fully subscribe to the comments of Counselman and Gum part
(1993) on this subject. They write: "Professionals who need group
therapy should be in groups that are defined as group therapy, where
their emotional problems are the defined focus and where the leader
is a trained group therapist" (p. 45). In the supervision group, on the
other hand, the task of the leader is clearly different. It is "to establish
and maintain an effective group in which supervision can occur" (p.
45). Participants in a supervision group subscribe to a contract that
"binds everyone together for the same purpose, to which everyone
adheres, and lays the provision for a safe environment" (p. 46) .
One of the provisions of this contract is the requirement of
absolute confidentiality. Not only does this guard patients' rights to
privacy but it guarantees an environment in which therapists can risk
exposing their own personal and professional fears, anxieties, and
ambivalences.
We can see an example of this boundry issue in the first clinical
vignette. Dr. B's negative reaction to his young patient's mother was
no doubt related to his personal difficulties with powerful women,
which stemmed from some unresolved conflicts with his mother. He
talked somewhat guardedly about these in the group, chosing to
focus particularly on his relations with women colleagues. His
attitudes found echoes and were amplified in the responses of some
of the male members. A few of them spoke of their relations with
their mothers.
As open as the discussion became, however, there was a certain
limit maintained by Dr. B. and the others. All seemed to be aware of
the need to relate these feelings to the case at hand. The leader at
one point referred to the possibility of people going deeper into these
 GROUP SUPERVISION 545

feelings in their separate therapy settings. He alluded to the supervi-

sory contract and harnessed the expressed affect to better understand
the case. The restrained personal exploration enabled Dr. B. to
achieve a degree of empathy toward the boy's mother, which he had
not experienced before.

Boundary between Group Supervision and Group Analysis

A similar boundry problem arises when considering how much

attention should be paid to group dynamics. On the one hand,
supervision in a group setting contributes special benefits not always
available in individual supervision. The group is a complicated form
of social network, and the skilled supervisor can help the supervisee
to better understand his/her case by monitoring this mill of affective
and cognitive interactions. The multitude of projections and projec-
tive identifications often provide an excellent map of the presenter's
countertransference, his/her patient's dynamics, and the treatment
situation at that specific stage.
There is a further rationale for paying sensitive attention to
group dynamics, and this lies in the fact that the countertransference
group is a task group. As with any task group, attention must be
paid to major group phenomena, such as continuity of setting,
competition for leadership, harmony and disharmony among mem-
bers, and so on. By doing so, the sensitive leader assures the group
that it can continue with its particular task. In this case, the task is
clinical supervision with a special emphasis on countertransference
exploration.
Yet, as against the need to be open to group interaction issues,
there is the counter need to maintain a certain restraint with regard
to group interpretations. The supervisory contract assumes that this
is not an analytic therapy group, nor is its function to serve as a
learning arena for group dynamics per se. The supervisor must
remember that the purpose of group interpretations is to facilitate
understanding of the supervisees' countertransferential reactions.
This was clearly demonstrated in the second vignette, in which the
group interpretations were used to help Dr. C. realize that he had
been avoiding certain painful issues in the couple he had been
treating.
546 MOSS

Relevance to Supervision of Therapists

from Nondynamic Orientations

Though the term "countertransference" is rooted square in the history

of psychoanalysis, it is my position that this supervisory approach is not
limited to analytically oriented therapy, but is relevant also to more
structured therapies. It will be recalled that members of the counter-
transference group referred to in this paper came from a variety of
orientations, including family therapy and cognitive/behavioral ther-
apy.
Certainly family therapists-faced with the intense affects raised
in family sessions-experience strong feelings related to their own
personal families. In addition, they are often the object of multiple
and varied projections by the different family members in treatment.
These can leave family therapists with a myriad of feelings that they
need to sort out to make effective professional interventions.
Although cognitive/behavioral therapists traditionally emphasize
the nonaffective aspects of a patients life, these therapies do not
entirely ignore affective reactions. Rather, these emotional reactions
are considered a by-product of behavior and of cognitive formula-
tions. Therapy focuses on changing these, which in turn produces
change in patients' emotionality.
Cognitive/behavioral therapists can find their patients displaying
on the one hand intense emotional resistance or on the other, strong
affective pleasure and excitement. Not less than their dynamically
oriented colleagues, cognitive/behavioral therapists have their own
responses to these affects in their patients. These must be attended
to, otherwise they will ~e unconsciously detracted from effective
interventions.
In short, it is suggested that therapists of these more structured
persuasions can certainly derive benefit from group supervision,
which emphasizes a focus on countertransferen<;:e dynamics. This
focus can help them understand the affective aspects of cases, to which
they traditionally have paid less attention.

The Use of Audiovisual Equipment in Supervision

The point of countertransference group supervision is to help thera-

pists better focus on the affective experience of their therapeutic
 GROUP SUPERVISION 547

relationships. Sometimes therapists are blocked or unaware of certain

feelings . In other cases, they may be flooded or overwhelmed with
feelings and anxiety and, as a result, feel confused and insecure.
Audio and video cassettes make it possible to focus on therapists
while they are presenting or listening to other presenters. Viewing
these recordings in the group, members can see and hear themselves
in ways they could not do otherwise. They can also observe other
people in the group, some of whom they may have only been vaguely
aware of during a meeting. Finally, subtleties and nuances in the
overall group atmosphere may be clarified and amplified when played
back and viewed on the recording.
These heightened viewing possibilities open up new opportunities
for clarifying affective states and nonverbal communications during
presentations. Physical gestures as seen on the video may highlight
and corroborate the content and affect of a particular verbal ex-
change. Or they might do the opposite, that is, belie the content of a
verbalization unit. Body language that might otherwise go unnoticed
in a group of 5 to 8 people can be examined. The leader using
recording material can greatly enhance members awareness of the
emotional quality and group affective reverberations to a particular
presentation.

SUMMARY

The purpose of this paper has been to discuss the advantages of a

particular way of supervising psychotherapists, namely, group super-
vision with a special focus on the supervisee's countertransference
experience. We have seen that supervision in a group is much more
than presenting a case in the presence of colleagues and getting
feedback. Rather, a group supervision means using the group in all
its interactive complexity as it resonates in a myriad of ways to aspects
of a case.
Because of the complexity of conscious and unconscious interac-
tions and reverberations during this process, it is often helpful to have
a focus in the supervision. Centering on the supervisee's countertrans-
ference experience and using the group to reflect, amplify, and
process that experience is a highly valuable way of helping the
therapist increase his/her understanding of the case and enhance the
quality of therapeutic interventions.
548 MOSS

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Eric Moss , Ph.D. Received: July 22, 1994

12 Buki Ben Yogli Street Revision received: December 15, 1994
Tel A viv, Israel Accepted: January 31, 1995