Anxiety, supervision and a space for thinking: Some narcissistic perils for clinical psychologists in learning psychotherapy*

Abstract

The process of learning psychotherapy involves narcissistic dangers--there may be injuries to self-esteem and self-image, especially when working with certain kinds of disturbed and hostile patients. Some patients will unconsciously recreate, in the transference, representations of early damaging experiences with parents, but now reversed with the therapist as the victim. It is vital for the trainee to be helped to understand these powerful interactional pressures. There are aspects of the professional culture and ideals of clinical psychologists (and possibly of some psychiatrists and social workers as well) which may make them particularly vulnerable in work with the hostile patient. It is argued that the function of supervision is not to teach a technique directly, but to create a 'space for thinking'--a kind of thinking which is more akin to maternal reverie, as described by Bion, than problem solving.

The reflective meta-dialogue in psychodynamic supervision

“…Here binder & Strupp describes that supervisees must be able to do "… self-reflection, emotional and interpersonal self-monitoring …" and supervisors have the ability to do "… self-reflection and self-monitoring of the emotional / interpersonal processes associated with supervisor-trainee interactions, along with the ability to oscillate between identifying with and observing the experiences of the trainee and the trainee's patient" (binder & Strupp;In Watkins 1997, p. 46-47 Ogden takes a radical stance, basing reflectivity on the supervisee´s perception of the client: "… 'dreaming up the patient' in the supervisory setting represents the combined effort of the analyst and the supervisor to bring to life in the supervision what is true to the analyst's experience …" (p. 1268), corresponding to Mollon (1989). In Ogden's view, the reflection processes between supervisor and supervisee is a non-linear and non-logic process focusing on the interpersonal unconscious in supervision (berman, 2000;brown & Miller, 2002).…”

Play and metaphor in clinical supervision: Keeping creativity alive

“…When activated in supervision through play or image making in response to the supervisees' experience of working with clients it can be immensely helpful in bringing into consciousness issues of which the they may previously have been unaware (Edwards, 1993, p. 219). This has particular relevance to therapists at the beginning of their careers, and I am inclined to agree with Mollon (1989) who argues that, The aim of supervision... should not be to teach a technique directly and didactically, but rather to facilitate the trainee's capacity to think about the process of therapy on the assumption that technique grows out of this understanding (p. 114).…”

Rites of Passage: Identity and the Training of Clinical Psychologists in the Current South African Context

“…The inevitable comparisons make trainees particularly cautious about sharing their creativity, for fear of being narcissistically injured or shamed. They are likely to protect themselves by negotiating around obstacles rather than addressing them (Mollon, 1989), particularly if the space does not feel safe enough, as is surely the case, given what we have said above.…”