Int J Psychoanal 2003; 84:1487–1500

The patient’s material as an aid to the disciplined

working through of the
countertransference and supervision
VIC SEDLAK
2 Foxhill Court, Weetwood Lane, Leeds, LS16 5PL, UK — sedlak@blueyonder.co.uk
(Final version accepted 20 May 2003)

The author argues that the patient’s largely unconscious observations of the
analyst’s functioning are, at times, communicated in the patient’s material and
that this can impart a sense of clinical relevance to the countertransference. The
concept of ‘understanding work’ is used to provide a psychoanalytical model of this
phenomenon. This is illustrated in a clinical case and it is argued that a selective
consideration of the patient’s material can provide a proper discipline which
steers the analyst between the twin dangers of megalomania, on the one hand, and
involvement in a symmetrical, self-disclosing relationship, on the other. The author
then applies these ideas to supervision and uses them to distinguish psychoanalytic
supervision from a practice that also derives from an intersubjective paradigm but
which, to the author’s mind, is not distinct enough from personal analysis.

Keywords: countertransference, intersubjectivity, supervision, ‘understanding work’

Introduction
In reading through the four excellent papers on countertransference published in the
IJP’s ‘Education’ section (Hinshelwood, 1999; Jacobs, 1999; de Leon de Bernardi, 2000;
Duparc, 2001), I was struck by the lack of acknowledgement given to what I believe is
a vital source of unconscious communication that enables analysts to work through and
understand the countertransference (Brenman Pick, 1987). The patient’s material as a
source of information appears to be disregarded in these reviews of the literature. It is
as though the profession, while agreeing with Freud that ‘no psychoanalyst goes further
than his own complexes and resistances permit’ (1910, p. 145), also continues to agree
with his remedy: ‘[the analyst] shall begin his activity with a self-analysis and continually
carry it deeper while he is making his own observations on his patients … (p. 145). Freud
did not add, ‘and while listening to and thinking about the patient’s observation on the
analyst’, although his own description of the way that the unconscious of the patient and
the analyst are tuned to each other might have suggested this further recommendation.
While in many cases it may be that this neglect in the literature of an acknowledgement
of the patient’s contribution is more evident in publication than in actual practice,
certainly some analysts put very particular stress on self-analysis using their own free
associations. To my mind, Ogden’s (1994) focus on the analyst’s reveries is one such

©2003 Institute of Psychoanalysis

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example, even though in another contribution (1996) he has provided very convincing
material about a patient’s ability to help him comprehend his countertransference. I
will suggest that the discipline imposed by linking the countertransference with speciŽ c
clinical material can play a part in curbing what can appear to be claims of omniscience
in relation to one’s own psyche. I think this is what Pontalis refers to as ‘the fashion of
delighting in the display of one’s countertransference, as if to say that one is seeing with
one’s blind spots, listening to what one is deaf to, and conscious of one’s unconscious’
(Pontalis, 1975, quoted in Duparc, 2001, p. 161). I also wish to present a psychoanalytical
theory as to why the patient is an excellent source of insight into the countertransference,
using, in particular, the Sandlers’ (1998) concept of ‘understanding work’. I hope to show,
using a clinical example, that due consideration of the patient’s material is one means of
guarding against the danger of wild analysis which comes from an overvaluation of the
countertransference per se. In the second part of my paper I will consider the way that an
emphasis on the patient’s contribution may be used to provide a disciplined distinction
between proper consideration of the countertransference in supervision and a supervisory
style that, to my mind, approximates too closely to personal analysis.
I think there are a number of reasons why psychoanalysts have tended to play down the
importance of this vital source of information and clariŽ cation about the countertransference
in their published work (although exceptions to this are found in most of the psychoanalytic
traditions (e.g. Hoffman, 1983; Casement, 1985, 1986; Baranger, 1993; Faimberg, 1996;
Feldman, 1997). The profession was alarmed by some of Ferenczi’s experiments (Myers,
1996), particularly that of role reversal in which he encouraged the patient to analyse the
analyst. While psychoanalysts of most schools would view the analyst’s capacity to form
partial identiŽ cations with the patient as part of a process of empathy, few would advocate
the enactment of such an identiŽ cation in so total a fashion.
The change in Zeitgeist in relation to professional authority that has occurred over
the last few decades (in the Western world at least), which has led to a much greater
questioning of the legitimacy of claimed status, may also be important in this issue. In
psychoanalysis this has most prominently manifested itself in relational psychoanalysis
(best exempliŽ ed in the work of Greenberg and Mitchell (1983) and Hoffman (1994)).
Many analysts, including up to a point Greenberg himself (2001), are disquieted about some
of the implications and demonstrations of this more open,  exible and democratic style
of practising psychoanalysis. Eagle et al. (2001) have questioned some of the underlying
philosophical assumptions of what they refer to as a ‘new view’ in psychoanalysis. In
particular they challenge the ‘new view’ that there are no ‘truths’ to be discovered about
the patient’s character and the way this determines his relationships; that there are no
pre-existing and pre-organised schemas and cognitive structures determining behaviour.
Thus, according to Mitchell, ‘the analyst does not discover or uncover any mental content
“that has tangible existence”. Rather, “mind is understood only through the process of
interpretive construction”’ (Mitchell, 1998, quoted in Eagle et al., 2001, p. 462). Eagle
and his co-workers argue that such a view is not only philosophically untenable but that it
discounts much psychoanalytical knowledge about the mind. I would add that it might also
mean forgoing the analysis of the patient’s difŽ culties in relation to status in the broadest
sense, for example, the problems the patient may have about the differential status enjoyed
by the feeding mother, or the oedipal couple, in relation to the infant.
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I believe that it is, in part, a fear of seemingly subscribing to this kind of democratisation
of the analytic process that has led analysts to avoid spelling out the importance of the
patient’s observations on the analyst’s state of mind. I think that there is also an anxiety
that if the patient’s view of the psychoanalyst is given due credibility then what will follow
is not only self-disclosure on the part of the analyst, but also an agreement that it is the
psychoanalyst who requires clinical attention. While I agree that the more neurotic aspects
of a psychoanalyst’s character may emerge in a session, I want to argue that due attention to
this need not shift the focus away from the patient’s problems and his mental functioning,
as I shall demonstrate with a clinical example.
Before presenting clinical material to illustrate my arguments, I want to introduce a
theoretical point that I believe is very important to this topic.

The concept of ‘understanding work’

Sandler and Sandler (1998) make the well-accepted (by psychoanalysts) observation
that conscious experience such as dreams, symptoms and sublimations are manifest
expressions of latent unconscious phantasies and wishes. In their analysis of the way
that these behaviours are able both to give some expression to their unconscious origin
and, at the same time, preserve some feeling of conscious equanimity, the Sandlers have
elaborated the concept of ‘understanding work’. For example, they argue that the dreamer
must be unconsciously scanning the dream and unconsciously understanding its latent
meaning. This kind of monitoring and gaining of feedback is necessary if the dream
is to perform its function of having some ‘identity of perception’ with, and hence give
some expression to, the dream wish (p. 66). The Sandlers apply this analysis to ‘other
surface expressions of unconscious wishes and phantasies’. Most importantly, they use
the concept of understanding work in their analysis of object relationships and describe
not only how unconscious phantasies are actualised in object relationships, but also that
they are simultaneously understood to have been actualised without this monitoring and
the feedback it produces ever becoming conscious.

[T]he individual constantly scans his environment, in particular the reactions of others …
[T]here is a very rapid scanning of the responses of others to ‘trial’ signals or behaviour
indications of our own … we [also] have the capacity to understand, quite unconsciously,
the latent meaning of much of what is produced by others … If based on such unconscious
‘scanning’, ‘trials’, and ‘signals’, we Ž nd that the situation does not permit the gratiŽ cation of
an unconscious wishful phantasy through identiŽ cation of perception, then we may discard a
particular course of action (or seek other partners) in the attempt to attain unconscious wish-
fulŽ lment. [O]ur own conscious has to be protected, for we would surely be traumatically
overwhelmed if we were to be consciously aware of the latent content of what is manifestly
produced and communicated by others (pp. 44–5).

To that last sentence one could add, ‘and ourselves in our relationships with others’.
The experimental work of Howard Shevrin and his co-workers (1992) has conŽ rmed
the existence of the mind’s capacity to understand the latent meaning of incoming
information and then rapidly, almost simultaneously, to become unconscious of it.
The Sandlers’ concept of ‘understanding work’ has been largely ignored in the analytic
1490 VIC SEDLAK

literature (indeed, they only refer to it twice more in their book). I think this is unfortunate
since it is a concept that is not only experimentally demonstrable, but also provides a better
understanding of the means by which ‘the Ucs. of one human being can react upon that
of another, without passing through the Cs.’ (Freud, 1915). Psychoanalysts have tended
to stress this aspect of human cognitive functioning when writing of the psychoanalyst’s
ability to unconsciously understand the patient, but have been more wary of acknowledging
that the patient will have this capacity too. I think this neglect is regrettable and scientiŽ cally
unjustiŽ ed. In order to illustrate the usefulness of the patient’s material as a source of
understanding of the countertransference, I will now present some clinical material.

Clinical example
The patient was a professional man in his 30s who came for treatment because of his
difŽ culties in establishing and maintaining a relationship that might lead to the happy
married life that he consciously wanted. Typically he became infatuated with a woman
and would have all kinds of idealised fantasies about the life he and she would lead but,
when the ordinary difŽ culties of a relationship became apparent, he would lose interest
and withdraw. He had been doing this since his late teens and, as he approached his mid-
30s, he had become sufŽ ciently concerned about this to look for a means of understanding
why he continued in this pattern. He lived a very long away from where I practise and
hence we met three times a week, from Tuesday to Thursday. The material I am going
to present Ž rst comes from a Wednesday session.
He began the session in a dispirited mood and said that he was losing interest in his
treatment; he had to travel so far for his sessions, was it worth it; should he perhaps think
of stopping? This mood surprised me a little since it had been reasonably clear in the past
few months that he valued his treatment and was beginning to feel that it really might be
of some use to him. He had spoken of this only the previous day and had reported happily
about the good weekend he had spent. A little later in the session the patient compared
himself unfavourably with the patient he had seen leaving my consulting room as he had
waited for his session in his car. She, he reported, had looked so happy and appeared to
be someone who really got on with her life, unlike him.
This immediately opened up a number of thoughts in my mind, centring mainly
on his relationship with his younger sister of whom he has been jealous throughout
his life and about whom he had been speaking recently. She had just announced that
she was pregnant and he had recounted how pleased his mother and father had been
about this and how hurt he was by this, since he had always imagined that it would be
his child who would be their Ž rst grandchild. All this came to my mind because the
patient he had seen leaving the consulting room was very obviously pregnant at that
time. As the session progressed it was possible to make a number of interpretations,
for example, to link his disappointment about the treatment with his anxiety that I
would be disappointed in him when I compared him with my other patient. He made
various responses that seemed to conŽ rm the general drift of my understanding and I
thought he was genuinely able to see what had led to his sudden disillusionment with
his treatment and to the historical antecedents of this. Throughout the session, even at
the beginning when he had been expressing his disappointment with his treatment, I
 PATIENT ’S MATERIAL AIDS UNDERSTANDING OF COUNTERTRANSFERENCE FOR SUPERVISION 1491

had felt relatively comfortable and was able to maintain an interested and emotionally
equable state of mind.
The next day he began by telling me that he had met a psychologist friend of his in
the pub on the previous evening, and that they had talked about the research this man was
doing for his doctorate. It involved investigating the ways that one’s early family life can
in uence later relationships. My patient had been very taken with this research and thought
it was tremendously valuable. As I listened to this I initially thought that the patient was
unconsciously also referring to my work the previous day and I prepared myself to say as
much when the opportunity presented itself. However, as he continued to talk about the
psychologist and described his character, his many good qualities and his qualiŽ cations, my
feeling about this changed and I began to Ž nd myself having thoughts like, ‘Never mind
the psychologist, what about the work that was done here yesterday?’ I then felt rather
ashamed of this ignoble thought and tried to dismiss it from my mind as evidence of my
own narcissism and overstated self-importance. Nevertheless, I felt discomforted by this
material, rather fed up with the patient and with myself, and without really knowing what
to do with these feelings. My strongest wish was to ignore this material and wait to see
whether he might go on to say something that would be more workable.
Further into the session the patient told me that later that day he had to go to a board
meeting of the company where he worked. He said he was looking forward to this because
he had tabled an agenda item that a rival of his in the company would have to deal with.
He thought that this rival would Ž nd it difŽ cult to answer adequately the various points
that would come up and he looked forward to seeing his discomfort as it became clear that
there was some work that he had not done sufŽ ciently well. This material led me to think
more deeply about what had taken place so far in the session and eventually I interpreted
that he had placed an item on my agenda, namely the problem of having rivalrous feelings.
I described how he had put me in a position in which I was to feel rivalrous with the
psychologist and I added that he was enjoying seeing how I dealt with this difŽ cult situation.
He responded to this with some surprise and said that he did not think that a
psychoanalyst would feel rivalrous with an academic psychologist. He said this in a
way that implied that a psychoanalyst would naturally consider himself superior to
a psychologist. He remembered that, as a student, he had gone to hear an eminent
psychoanalyst speak and, while he had been extremely impressive, he had also made
the audience feel that they would never be able to understand things in the way that he
could. I thought this was connected to what the patient had said about it being discovered
that his rival had not done some work sufŽ ciently well. I interpreted that he believed
I had avoided the painful work of having to deal with feelings such as rivalry and
inferiority by becoming a psychoanalyst. Having achieved this eminent position I could
now make other people feel inferior. The patient found this interpretation amusing and
the atmosphere in the session became much warmer. He conŽ rmed that this was, indeed,
his belief about other analysts and me, although he had not been conscious of it before.
Thus, the phantasy that it might be possible to live a life free from painful affect became
clearer. Throughout most of the session it was a phantasy that the patient felt belonged
to me and his picture of me emerged as someone who always wanted to ensure a top
position from which I could look down on others. However, near the end of the session
the patient said that he realised he was always seeking a partner who would make every
1492 VIC SEDLAK

other man extremely envious, and whenever a woman revealed herself to be less than
perfect this possibility was threatened and then the relationship would break down.
This material can be used to contrast an old model of analytic change with a more
modern one. For example, Fonagy (1999) argues that it is insight into one’s current
ways of relating that is the pivotal factor in change brought about by psychoanalysis.
Freud’s early model was based on the theory of repression of painful memories and
their associated feelings. Neurosis was the result of a failure of repression and the
emergence into conscious experience of these painful affects. The therapeutic goal
was to help the patient remember the original traumatic event, work through the
feelings associated with it and, having done so, realise that while the affect might
have once been appropriate it was not so any longer. Such a process would diminish
the transference of historical events and the feelings associated with them on to new
situations. This model is still useful, as one can see in the Ž rst session. Thus, my patient
may realise that his rivalry and his jealousy belong appropriately to a time when he
was a child and to the Ž gures of his parents and his sister, but that he is transferring
this historical scenario into the present time and on to his analyst and a fellow patient.
The analytic work enables him to discover that he has reacted to the perception of the
pregnant woman by wanting to withdraw from the therapy. He becomes aware of his
sensitivity to jealousy and rivalry, and their historical antecedents.
Something quite different occurred in the second session. He engaged these
dynamics in me by stimulating that part of my personality that Ž nds it similarly difŽ cult
to hear of others who are better thought of. However, that was not the only thing that
the patient engaged in me: he also tapped into the part of me that shares his phantasy
that painful emotions should be bypassed. Hence, I found myself wishing to move
on from his material about the psychologist. In part, this is because my defences are
similarly structured to those of the patient and I have a narcissistic reaction to Ž nding
myself feeling rivalrous. What becomes evident is a very omnipotent and narcissistic
phantasy of being able to live a life in which one is untroubled by painful emotions such
as jealousy, feeling second best or shame. The patient’s unconscious belief was that
such feelings could be avoided by engaging them in others. Not only had he structured
much of his life and many of his relationships on the basis of this phantasy, but it
also became evident in the session that he also believed me to have done likewise; he
believed me to have chosen my career as a means of enacting this phantasy.
This means of considering the material puts the analyst’s personality, or rather his
capacity to think about his personality, as a pivotal factor in the consulting room. Of
course, this capacity will be limited by the fact that the analyst’s mind is structured
defensively and this means that the analyst cannot always arrive at an understanding
of what is going on simply by self-analysis. The analyst’s ability to triangulate his
thinking and attempt to take a third perspective on what is occurring is, of course, very
important but limited. Like the patient, the analyst will need, at times, another mind
to enable him/her to understand.
The material also illustrates how durable unconscious phantasies can be and how
consistent and prolonged analysis is needed before they begin to change. Part of their
durability stems from the fact that they can be felt to have moved from one person to
another; thus, in the Ž rst session the phantasy of never having to be in a position in
 PATIENT ’S MATERIAL AIDS UNDERSTANDING OF COUNTERTRANSFERENCE FOR SUPERVISION 1493

which one feels second best was revealed as existing in the patient. However, pointing
this out and linking it to some of its historical antecedents was not sufŽ cient to disarm
its power. In the next session it was intact but was now felt to be dominating the mind of
the analyst. It then had to be revealed and analysed as part of the picture that the patient
had of the analyst at that moment. Only after it had been analysed in that way could the
patient reclaim it, so to speak, and understand the degree to which his need to actualise
this phantasy governed his relationships with women and men. This happened towards
the end of the session when the patient spoke with some insight into the way he selected
his girlfriends with the intent of making other men jealous and envious. Of course, the
work in that session was in itself only a small step in really helping the patient to function
in a different way, since the phantasy repeatedly manifested itself in different ways and
had to be gone over time and time again.
I described two of my reactions to the patient’s material about the psychologist’s Ž ne
work and I think they are typical in such a situation: the Ž rst is to think that the feelings
aroused in one are solely a personal problem (Money-Kyrle, 1956); the second is to wish
to move on to something else and away from the personal discomfort. What enabled me
to do otherwise was the communication about the board meeting and the patient watching
his rival to see how he dealt with the agenda item that the patient had tabled. This was
the turning point of the session; it can be considered to be the ‘selected fact, [from which]
there emerges a conŽ guration as the other psychic particles cohere by virtue of their
relationship to it’ (Britton and Steiner, 1994, p. 1076; see also Bion, 1970). It is what gave
interpersonal meaning to what, up to that point, I had experienced as an uncomfortable
personal reaction. The fact that the patient thought of this at that moment shows, I think,
evidence of what the Sandlers have called ‘understanding work’. In order that the patient
is able to actualise the phantasy he wishes to create, he must monitor carefully the reaction
he is having from his object in order to register how successful he is being. Although this
monitoring and evaluation of feedback occurs at an unconscious level, the information
gained can at times be expressed verbally, as in my example. When this happens it is often
said that the patient is being unconsciously co-operative. As in the above case, this kind
of material can be tremendously helpful in enabling a clinician to believe that his feeling
state is countertransferentially relevant rather than his own individual and inappropriate
response. It is a useful rule of thumb not to interpret on the basis of the countertransference
until there is such corroborative evidence. Then the patient’s material can give resonance
and meaning to the countertransferential response of the analyst.
I want to emphasise that unconscious recognition on the part of the patient of what
he may be up to is not therapeutic per se. Nor is it sufŽ cient for the analyst to contain
and not enact his rivalrous reaction, although that is a good start. What is still needed is
the analytic activity of interpreting the board-meeting material in the context of what is
happening in the consulting room. And, as I have indicated, this can only be done if the
analyst has, to some degree, been able to monitor his own unconscious ‘understanding
work’, at least to the level of registering that he has been discomforted.
One point that I want to stress, using this clinical material, is that it is possible to use
the countertransference without indulging in self-disclosure. At no point do I tell the patient
what I am actually feeling. I do not think this is simply a matter of personal preference
but rather one of some technical importance, which touches upon some of the anxieties
1494 VIC SEDLAK

that I hypothesised in my introduction were underlying the profession’s reluctance to

acknowledge the patient’s contribution. By not disclosing that I am actually feeling
competitive with the psychologist, I am acting on my belief that the patient’s improvement
is dependent upon his understanding his view of his objects and the relationships he forms
with them. An alternative view would be that a therapeutic factor for this patient would
be for him to meet with a psychoanalyst who is able to tolerate his own competitiveness,
openly acknowledge it to himself and the patient, and hence provide some kind of model
with whom the patient could then identify. I believe that the patient’s experience of an
analyst who is able to tolerate his countertransference with minimal enactment is very
important but that it can be achieved without self-disclosure (Carpy, 1989). I also wish to
put more stress on the importance of insight into the perceptions one has of one’s objects
and the ways that these perceptions are in uenced by one’s own psychology, and less
stress on what might be termed a corrective emotional experience.

Supervision
I now want to turn to the topic of supervision and make another point: that the patient’s
material can be used to inform the supervisor about ways in which consideration of the
supervisee’s countertransference can be brought into the supervision without compromising
the distinction between supervision and personal analysis. I think this is a distinction that is
in some danger of being lost by some psychoanalysts. For example, Berman has recently
described some of the implications, as he sees them, of adopting a view of psychoanalysis
that acknowledges the intersubjective aspect in the creation of the analytic relationship.
He argues that, in order for the supervisor to understand and help the supervisee with the
personal elements that they bring to the analysis, the supervisor should be aware of certain
aspects of the supervisee’s history and feelings towards the patient. He writes,

If we assume that important elements in the transference are relative to the analyst’s actual
personality and behaviour, it follows that we cannot fully understand the analysand’s
experience if relevant aspects of the analyst’s own personality and emotional reactions are
not discussed in the supervision (2000, p. 274).

A little later in his paper he gives an example:

We need to know … that the analysand reminds the analyst of her brother, if we are to help
her in attempting to clarify for herself how this association affects her countertransference,
uncover the ways in which this countertransference unavoidably colours the analyst’s actions
and verbalisations and therefore unknowingly in uences her analysand as well, changing in
turn his transference to her and the whole atmosphere in the consulting room (p. 275).

To my mind, this kind of approach confuses supervision with personal analysis. I

would agree that the supervisor should strive to understand ‘the whole atmosphere in
the consulting room’ and that inevitably the analyst will have contributed personally to
this atmosphere. I think, however, that one can do this without actually going into the
personal details underlying the analyst’s contribution, and that the means of doing this
involves a very close examination of the patient’s material. By doing this the supervisor
 PATIENT ’S MATERIAL AIDS UNDERSTANDING OF COUNTERTRANSFERENCE FOR SUPERVISION 1495

can understand the dynamics of the atmosphere without delving into the particularly
personal contribution of the analyst.

Clinical example
The therapist is a psychologist who is training to be a psychoanalytic psychotherapist.
She had had some difŽ culties in the training in that she had assessed a number of previous
patients before successfully engaging one in treatment. That was her Ž rst case and when
she was ready to take her second case there were similar problems. Finally, a man of
30 who was complaining of depression following the break-up of a relationship began
three-times-a-week treatment, which she brought to me for supervision. The patient had
a history of very difŽ cult relationships and he had come for treatment after the last of
these broke down and he had begun to feel depressed. He was physically attractive and
quite successful professionally as well as being a gifted sportsman. He had had numerous
brief relationships but whenever one began to become serious he panicked and Ž nished
it. Alternatively, his partner would Ž nish it because she became fed up with his lack of
commitment. He began his therapy by giving the therapist a list of dates he would not be
able to manage in the Ž rst few weeks of the treatment. Early indications were of a very
narcissistic man who used his attractiveness to be seductive but who also played a cruel
game of getting his objects to desire him and then treated them badly and met with them
only on his terms. This could be understood as a means of defending himself against the
vulnerability of being rejected himself and it was possible to link this with abandonment
he had suffered as a child (he had been rejected by his mother and brought up by strict
grandparents). However, this kind of understanding was premature in that it was only
intellectual; the emotional problem that was uppermost in the treatment was, as one
would predict, that the patient, although knowing that he needed to undergo treatment,
was unable to commit himself fully to it.
This supervision session is taken from very early on in the treatment—the sixth
week to be precise. As we began the supervision I asked how it had been going
generally. The therapist said it was going OK but that she was still worried about the
treatment. I said that this was natural since it was very early on and the task was still
one of trying to help the patient settle into the therapy, and we knew that committing
himself was his primary difŽ culty. The therapist agreed with this but added that there
were times when she felt very inhibited with the patient. She felt this was due to her
anxiety about keeping him in treatment but there were times when she thought that
the patient did something that made it hard for her to think and interpret as she would
wish. She then told me about the latest session.
The patient was ten minutes late and apologised, saying that he had been to his
physiotherapist (he had recently suffered a bad sporting injury to his back). He had had a
very bad night; his back pain had been awful, he had had some reports to write but could
only sit for Ž fteen minutes at a time; he felt he was crumbling, his spine did not feel it could
hold him upright. The work of writing the reports had not gone well. It was something
he would usually do without any difŽ culty but not now. The therapist told me that at this
point she had wanted to say that she thought he was telling her not only about the back
problem, but also about how difŽ cult and painful he was Ž nding it to be in therapy; that
1496 VIC SEDLAK

it felt to him as though the way he had managed in the past, which had served as his
backbone, was crumbling, leaving him unable to function. However, she told me that she
had felt curiously inhibited about making this interpretation and had stayed silent.
The patient had gone on to describe in a much more cheerful way how well he was
thought of in the last company he had worked for. There was still talk there about what
a good salesman he had been and there were myths about the deals he had pulled off.
He then told quite a complicated story. In essence, it concerned a man who worked for
an organisation that bought the products of the company the patient had worked for. The
patient had reason to believe that this man had been inŽ ltrated into the organisation by
a rival Ž rm in order to put lucrative contracts their way. This was to the detriment of
the patient’s Ž rm. (As I listened to this story I found it improbable but then thought that
perhaps such shenanigans really did go on in big business.) The patient was wondering
whether to expose this in the newspapers but feared the repercussions that might follow.
Later on in the session the therapist tried to take this up in terms of how hurt the
patient was and how difŽ cult he found it to accept this part of himself. The patient agreed
and said that he always tried to pass his pain off as a joke but, he added thoughtfully, this
might be because he was never sure if he was wanted unless he was successful. This was
said movingly but the patient quickly moved on to describe a colleague who had been
talking to him about a problem but who, when the patient had said the word ‘problem’
had said, ‘don’t call it a problem, it’s defeatist’.
He then went on to describe a job he might apply for in London. When he had been
down there to investigate this he had been invited to an exclusive London club. The rest
of the session was spent describing the wonderful luxurious furniture and Ž ttings of this
club, and the therapist reported that she felt unable to intervene in any effective way up
to the end of the session.
As I listened to this account one of the Ž rst things that struck me was the thought
that if the patient were to go down to London he would have to abandon his therapy and
I was surprised that the therapist did not seem alive to this. I was also struck with the
fact that the therapist had been able to formulate a good interpretation (about the way
that the patient felt his defences were crumbling and that what had served as his spine
or backbone was not able to support him any longer) but had felt unable to give it. She
had, however, been able to make other less telling interventions.
I initially went back to the interpretation she had not given and said that I thought
it had been right, and that one could see other material in the session that supported it.
I based my observations around the man who said that even using the word ‘problem’
was defeatist, and I tried to show the therapist that the patient, at critical parts of the
session, functioned as though this was his belief too. I said I thought this could be seen
at least twice. The Ž rst time was after he had spoken of his physical pain and his feeling
of crumbling. He immediately went on to say what a great salesman he was and how
wonderful people thought him to be in what was a manic denial or  ight. The same
pattern could be seen later in the session when the patient talked movingly about fearing
that he might not be wanted (and, as I said, there is very good reason to suppose that he
was really not wanted as an infant). He quickly moved on from this to talk about being
in a very privileged place, the London club, and had left the therapist feeling left out. I
did say at this point that I was surprised that she had not wondered whether his going to
 PATIENT ’S MATERIAL AIDS UNDERSTANDING OF COUNTERTRANSFERENCE FOR SUPERVISION 1497

London would mean that his therapy had to end. She was shocked by this and said that
it had not even occurred to her and that, of course, it might mean that. Thoughtfully, she
then said that she was probably so anxious about the possibility of this happening that
she had been unable to think about it.
I was not sure how to take this further and went back to elaborating what I thought
was the main theme of the session, that is, the patient’s difŽ culty in tolerating psychic
pain. I said I thought that he used his own means of trying to deal with his pain and that
there was an element of competition with the therapist about this. I thought that this could
be seen in the early material of the session in which he had described the competition
between the two companies. The therapist said that she thought this was right and that,
from the beginning of the therapy, there had been an unspoken rivalry between them
about what she offered and the way that the patient wanted to deal with his problems.
That is to say, she had felt that the patient, while asking for her help, also thought at the
same time that psychotherapy was a useless treatment compared to his way of dealing
with depression, even though that had so far failed.
We were now able to see how the material about the competition between the companies
was a metaphor for what was going on in the transference. I began to think more about this
and eventually said that I thought we needed to consider carefully the patient’s idea that
there was an unscrupulous Ž rm that was unethically trying to win business for itself. I then
suggested to the therapist that there was a way that this applied in the treatment situation,
and that I thought this was inhibiting her ability to interpret. I said that I thought she was
understandably very anxious that this patient might not be able to settle in treatment and
that she would lose him. Part of this anxiety was ethical, that is, she believed that this form
of treatment was right for him. But there were other feelings she had which did not have
the patient’s interests as central and were more concerned with her need to have a training
patient who stayed the course. I put this in a very careful way and tried to make it clear
that I thought this was absolutely normal and to be expected in her situation. However, I
thought that this need in her made it very difŽ cult to distinguish between trying to engage
the patient in treatment for his beneŽ t and trying to do so for hers. I suggested that this
dilemma had inhibited her in pursuing the right line of interpretation; she had got worried
that she would be trying to steal business in an unethical way.
The therapist reacted with relief to this and went on to say how she did need to be
able to own her need for the patient to attend, and that this was indeed a difŽ cult thing
to acknowledge. We went on to discuss how this might be made more difŽ cult by this
particular patient and his great sensitivity to whether his object really wanted him. We
then spoke about the patient’s wish to expose somebody as unethical and how the patient
in the transference would wish to bring into the open his anxiety that his therapist would
be trying to undo his defences in order to win business for herself. We concluded that
an effective interpretation would be that he feared that this was her aim and that she
would take retribution if he exposed this anxiety to her. Near the end of the session the
therapist told me that this was all connected with personal issues for her. I acknowledged
that this might be the case but I said that an ordinary and understandable professional
anxiety of keeping her training patient and the effect this had on her work was what we
could discuss. (When my supervisee read an earlier draft of this paper, she told me that
she thought she would have actually stopped herself telling me this personal material.
1498 VIC SEDLAK

I am sure that, in her case, this was accurate. Sometimes supervisees do communicate
personal issues in such a situation, and I attempt to Ž le them away in a mental space that
I try not to refer to either internally or in further supervisions. I believe that what I lose
in forgoing interesting and illuminating facts is more than made up for by the sense that
there is a proper distinction between the supervision and personal analysis.)
I have wanted to show that it can be possible at times in supervision to discuss
the dynamics of the patient as they manifest themselves in the session and also to
discuss the countertransferential difŽ culties that are raised during the work. In many
cases, of course, the two are connected in that the countertransferential difŽ culties are
a tremendous block to the therapist being able to see what the dynamics are. Thus, in
my example the therapist feared that if it were disclosed in any way that she needed
her patient for her own reasons then she would be revealed as unethical and would lose
her patient. This anxiety was so disabling that she turned a blind eye to the fact that
if the patient moved his work to London he would have to terminate his therapy. By
uncovering this anxiety in the supervision, the therapist was helped to become more
open inside herself to the fact that she needed her patient. This in turn enabled her to
distinguish between her selŽ sh wish for the patient to stay in the treatment and other
more concerned and reparative wishes. She then felt less guilty and was able to explore
more with the patient his phantasies about her.
I want to emphasise that it was not necessary to look at the particularly personal
reasons behind the supervisee’s anxiety. The patient’s material was quite sufŽ cient to
understand all that needed to be understood in order to clarify the atmosphere in the
session and to begin to resolve it so that something of an impasse could be overcome
and its dynamics understood. I also want to underline that the impasse was produced
by the patient’s pathology (of always wanting his object to want and desire him, rather
than vice versa). The fact that he was able to use a particular professional preoccupation
of his therapist (which would, of course, have had a more personal genesis) is entirely
incidental; if he had not managed to create this countertransference in this way he would
have done it by another means (indeed, in the following months he regularly did so). The
supervisor need not concern himself with the exact nature of the personal contribution
made by the supervisee to the analytic relationship; that is for her personal analysis. The
supervisor can content himself with only spelling out the nature of the actual relationship
in the therapy and this is adequately communicated by the patient’s material. I would
suggest that, when it is not so indicated, it is probably premature to take up with the
supervisee what the supervisor’s intuition about the relationship is. To my mind, this
is akin to the wild analysis that ensues when the analyst interprets on the basis of a
countertransferential feeling without supportive evidence from the patient’s material.

Conclusion
I do not wish to claim that there is anything particularly original in my thesis. I believe
that most analysts will, in their daily work, listen to their patients’ material and employ
it as their major source of information about the dynamics of the therapeutic situation.
However, when this is written about, my impression is that there is a constant understating
of the importance of the patient’s unconscious observations about the state of mind of
 PATIENT ’S MATERIAL AIDS UNDERSTANDING OF COUNTERTRANSFERENCE FOR SUPERVISION 1499

the analyst, and it is this that I have tried to correct in this paper. I believe that this allows
the analyst to contain better the megalomania that is always a danger when the analyst
is giving primary consideration to his countertransference (Meltzer, 1978). I have also
tried to show that it can provide the supervisor with a disciplined distinction between
supervision and personal analysis.
Acknowledgements: I would like to thank John Churcher, Wojciech Hanbowksi, Graham
Ingham and Hilary Thornton for their comments on an earlier draft of this paper.

Translations of summary
Das Material des Patienten als Hilfe beim disziplinierten Durcharbeiten von Gegenübertragung und
Supervision. Der Autor vertritt die These, dass der Patient das, was er weitgehend unbewusst am Funktionieren
des Analytikers beobachtet, mitunter in seinem Material mitteilt. Dadurch erhält die Gegenübertragung klinische
Relevanz. Das Konzept der „Verstehensarbeit“ wird als psychoanalytisches Modell für dieses Phänomen
benutzt. Dies wird anhand eines klinischen Falls illustriert; der Autor vertritt die These, dass eine selektive
Berücksichtigung des Materials des Patienten eine Disziplin vermitteln kann, die es dem Analytiker erleichtert,
sich zwischen den beiden Gefahren der Megalomanie einerseits und der Verstrickung in eine symmetrische
Beziehung mit Selbstenthüllungen andererseits zu orientieren. Der Autor wendet diese Überlegungen im
Anschluß daran auch auf die Supervision an, um die psychoanalytische Supervision von einer Praxis zu
unterscheiden, die sich ebenfalls aus einem intersubjektiven Paradigma herleitet, aber sich der Meinung des
Verfassers zufolge von der persönlichen Analyse nicht deutlich genug unterscheidet.

El material del paciente como ayuda para la elaboración rigurosa de la contratransferencia y la

supervisión. El autor sostiene que las observaciones en buena medida inconscientes del paciente sobre el
funcionamiento del analista son, a veces, comunicadas en el material del paciente y que esto puede tener
relevancia clínica para la comprensión de la contratransferencia. A Ž n de aportar un modelo psicoanalítico
de este fenómeno el autor utiliza el concepto de ‘elaboración de la comprensión’ [‘understanding work’]
y lo ilustra mediante un caso clínico. Asimismo argumenta que una selección adecuada del material del
paciente puede aportar una disciplina apropiada que ayude a navegar al analista entre los peligros gemelos
de la megalomanía, por un lado, y la implicación en una relación simétrica y auto-reveladora, por el otro.
Luego el autor aplica estas ideas a la supervisión para distinguirla de una práctica que también proviene de un
paradigma intersubjetivo, pero la cual, según el autor, no se diferencia lo suŽ ciente del análisis personal.

Le matériel du patient comme une aide à la perlaboration rigoureuse du contre-transfert et de la

supervision. L’auteur considère que les observations, en grande partie inconscientes, du patient concernant
le fonctionnement de l’analyste sont, parfois, communiquées dans le matériel du patient, ce qui peut avoir
une pertinence clinique pour ce qui concerne le contre-transfert. Le concept de « travail de compréhension
» est utilisé pour fournir un modèle psychanalytique à ce phénomène. Un cas clinique illustre ce propos.
L’auteur soutient qu’une prise en considération sélective du matériel du patient peut constituer une discipline
propre à guider l’analyste à travers les deux écueils qui sont d’une part, la mégalomanie, d’autre part,
l’implication dans une relation symétrique d’auto-dévoilement. Par la suite, l’auteur applique ces idées
à la supervision et les utilise pour distinguer la supervision psychanalytique d’une pratique qui provient
également d’un paradigme intersubjectif, mais qui, selon l’auteur, n’est pas sufŽ samment distincte d’une
analyse personnelle.

Il materiale del paziente come aiuto per l’elaborazione disciplinata del controtransfert e della
supervisione. L’autore sostiene che, a volte, le osservazioni per lo più inconsce del paziente sul
funzionamento dello psicoanalista sono comunicate nel materiale del paziente stesso e che ciò può dare un
signiŽ cato di rilevanza clinica al controtrasfert. Per formulare un modello psicoanalitico di questo fenomeno
è qui utilizzato il concetto di “lavoro di comprensione”, illustrato in un caso clinico. L’autore sostiene
che una presa in considerazione selettiva del materiale del paziente può fornire una disciplina adeguata
per guidare lo psicoanalista tra i doppi pericoli della megalomania, da una parte, e del coinvolgimento in
un rapporto simmetrico e autorivelatorio dall’altra. L’autore applica poi queste idee alla supervisione e
le usa per distinguere la supervisione in psicoanalisi da una pratica anch’essa derivante da un paradigma
intrasoggettivo, ma che, secondo l’autore, non si distingue a sufŽ cienza dall’analisi personale.
1500 VIC SEDLAK

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