Kavanaugh - On Psychoanalytic Supervision: A Theoretical Perspective and Philosophy
On Psychoanalytic Supervision: A Theoretical Perspective and Philosophy ©
by Patrick B. Kavanaugh, Ph.D.
On Psychoanalytic Supervision... is premised on the idea that points of convergence and divergence between various perspectives on supervision ultimately derive from the similarities and differences between the various conceptions of psychoanalysis, itself. Thus, a conceptual framework, understanding, and synthesis of psychoanalysis is presented and contextualizes this perspective on psychoanalytic supervision. Situated in philosophy, the humanities, and the arts, this particular version of analysis is understood as a venture into communication via the associative method in a contextualizing metaphor from the arts. Each aspect of this conceptualization is considered from the perspective of supervision. Some thoughts on a philosophy of supervision are considered premised on the idea that the art of psychoanalysis can be learned but not taught.
Introduction and General Comments
It would seem that points of convergence and divergence between various psychoanalytic perspectives of supervision ultimately derive from the similarities and the differences between the various conceptualizations, understandings and syntheses of psychoanalysis itself. Thus, I would like to proceed this morning by briefly presenting a particular conceptual framework, understanding, and synthesis of psychoanalysis; and, from within that context, to present a particular perspective and understanding as to psychoanalytic supervision. As I proceed, I would like to consider, comment upon, and/or raise some questions regarding certain topics considered relevant to psychoanalytic supervision such as: the role of diagnosis and assessment, "free association", and "parallel process and directionality". Hopefully, the perspective 1’l1 be presenting might contribute to our discussion later on this morning as to points of convergence and divergence in psychoanalytic supervision.
As I begin, I would like to mention: (1) that all of my comments this morning will be in reference to the supervision of clinical work with adult individuals; (2) that my comments do not presume the objectives nor standards of the IPA nor those of institute training, and, (3) that all of my comments regarding psychoanalytic supervision will be from the conceptual framework being outlined unless otherwise noted.
An Understanding of Psychoanalysis: The Associative Method and Psychic Theatre
I would like to speak to an understanding and synthesis of psychoanalysis as being, first and last, a venture into communication via the associative method in the context of psychic theatre. Psychoanalytic supervision from this understanding and synthesis of psychoanalysis would be concerned with the teaching and the learning about the associative method about what is to be considered as communication, and about what is meant by "psychic theatre".
From this perspective, the purpose of supervision would be to contribute to the supervisee's development of a way of thinking, to their development of a body of knowledge about theory and technique, and to their integration of theory and technique in both understanding and working interpretively with the patient. Supervision would be "patient centered" in that it would be organized around the associations of the patient.
I would like to briefly elaborate upon the three essential elements with which supervision would be concerned: the associative method, communication and psychic theatre.
By the associative method, I am referring to a very inclusive definition of a methodology by which the therapist listens to all the patient's thoughts as being reflections of a continuous process of communication. The definition of this associative method would be the therapist's way of thinking and listening, the understanding of this communicative process, the dynamic formulation as derived from the patient's associations, and finally, the subsequent interpretations ---- which, in turn, become part of the associative process. The associative method from this perspective would consider the associations of the patient as the data for observation and clinical inference. All of the patient's thoughts would be viewed as "associations" which have been selected and organized on the basis of the "laws of association" as contrasted to the "laws of learning". The primary mode of interaction by the therapist with the patient is through interpretation; that is, through explanatory translations of that which is believed to be communicated via the patient's associations.
With this understanding of the associative method, there would be certain implications for psychoanalytic supervision in terms of: (1) that which would be taught, and (2) how it would be taught. For example, didactic teaching in the form of "talking about" and "discussing" such basic concepts relevant to theory and technique as the nature and characteristics of the unconscious, the dynamic significance of unconscious activity, the influence and centrality of unconscious fantasy in the organization of the facts of one's experiences; the laws of association and their influence upon thought organization, perception, and cognition; the principles and attributes by which the mind is believed to function such as the principle of psychic determinism, the genetic principle, and the principle of multiple functions.
Teaching of the clinical utility and application of such principles would be accomplished through the detailed consideration of process recordings of the analytic sessions as recalled and as communicated by the therapist. Supervision would attempt to articulate certain principles and concepts and, then to illustrate the integration and relevancy of those principles and concepts basic to theory and technique in the specific (i.e. relevancy to the formulation of recommendations regarding treatment, the frequency of meetings, the setting of the fee, and so on).
Supervision would also address other issues that are related to be the treatment such as the question of "diagnosis" and "criteria for analyzabilty". These questions are crucial as it is how the supervisee eventually conceptualizes "diagnosis" and "criteria for analysis" which will determine who will and will not be seen in analysis. One of the more far reaching implications from this understanding of the associative method would be that "diagnosis" and "ego assessment" would achieve their conceptual significance and clinical utility only when the ongoing evaluation of dynamic process, structure, and content is for the purpose of determining how the therapist might best establish and maintain a treatment relationship with that person. One would forego the concept of diagnosis when it is used in the service of establishing who would be seen in analytic work rather than how to best work with a particular individual. The supervision would advance the concept of "therapeutic diagnosis" as the diagnostic criteria to determine whether one would be seen in analysis. Therapeutic diagnosis would rest upon two factors: (1) the patient's willingness to participate in the endeavor as illustrated by their being there at the agreed upon times, and (2) the anxiety tolerance of the therapist.
The supervisory consideration of detailed process recordings would also include tracing through the clinical material, emergent themes as would be reflected and suggested by the individual's associations in terms of similarities or common attributes or some other associative principle which would be reflected between or within the individual's associations. The supervisory focus would be continuously considering the multiplicity of conflictual meanings and significances of the clinical material in terms of transference and countertransference implications, as well as discussing with the supervisee issues of theory, dynamic formulation, and interpretive technique as would be suggested by the material.
It would be important to consider the other two elements in this synthesis of psychoanalysis: communication and psychic theatre. Specifically, the questions: What is it that constitutes "communication" in the analytic process? How might this be related to "psychic theatre"? and, What are some of the implications for psychoanalytic supervision?
By communication is meant that, from this understanding of the associative method, one would view all behavior as part of the associative process. All behavior would be viewed as having an expressive, protective, and communicative function or aspect; and, all behavior would be viewed as the consequence of a complex compromise of various internal psychic actions and conflicting and conflictually determined internal images of "self" and of "other". These communicative aspects of behavior are considered to be expressed through linguistics as in the spoken word, through pictorial representations as in dreams, and through body language as in gestures, movements, somatic expressions, experiences and processes. This understanding of "communication" reflects the associative method's assumption of a monistic view of mind and body. From such a conceptualization, mind, body, dreams, action and language all reflect an interwoven communication during a specific analytic hour. Also, this monistic view provides a context out of which meaning can be derived much like as is the case with a dream i.e. the meaning of a pictorial representation in the dream being derived from the associative context. All of these communicative aspects of the individual join together in the "conversation" during the analytic hour. Thus, the verbal associations of the individual are considered to be but one of the communicative avenues of the associative process.
T'here are certain implications for psychoanalytic supervision which follow from this understanding of communication and from the idea that all behavior has communicative aspects. Certainly, a primary focus of the supervision would be upon ways of conceptualizing as would be found in the Interpretation of Dreams and various theories of linguistics. Obviously, this would involve for the supervisor the examination and reexamination of such defining concepts of psychoanalysis as "free association" and what constitutes "free association". For example, "free association" from this theoretical position is something neither "special" nor "different" nor is it something that one has to learn to do or stop doing.
It would be important for the supervisory process to be consistently communicating and illustrating through the clinical material that the associative method from this perspective, does not refer simply to the interpretation of certain similarities or common attributes between or within the individual's sequence of associations nor does it refer simply to explanatory statements as to suggested motivational causalities for certain behaviors or affective states as would be suggested or derived from the patient's associations. This would be a rather reductionistic view of both the methodology and of person. There is something more. Psychoanalytic supervision would emphasize and attempt to illustrate via the process recordings that the associative method takes place within the context of "psychic theatre", the third element within this conceptualization.
By psychic theatre is meant "psychic theatre" as a contextual metaphor for the psychoanalysis and psychoanalytic supervision. It is readily recognized that one can travel only so far with any metaphor in speaking about mental life, psychic events, and/or psychoanalysis before that metaphor begins to prove to be inadequate in breadth and scope to encompass such phenomena. However, it seems that the metaphor of "psychic theatre" is particularly well suited to communicate and to reflect a particular perspective regarding psychoanalytic supervision and the teaching of the analytic attitude, the therapeutic task, and the psychoanalytic process. Further, it suggests some rather interesting implications for the understanding of the concept of "parallel process". Thus, "psychic theatre" as a rather comprehensive contextual metaphor for the analysis and supervision is not a matter of little consequence.
In considering "psychic theatre" as contextual metaphor, it might be helpful to begin by considering the dream and certain characteristics of the dream. This theoretical perspective would maintain that the same processes as are to be found in each and every analytic hour are the same processes as are to be found in dreams: condensations and displacements are to dreams as metaphors and metonyms are to language. In the dream, each character, each element, and each aspect of the dream image is representational of "self", even that which is experienced as "other" is considered to be an aspect of "self" which is experienced by the dreamer as being "other". For example, the sensory image in the dream of the frightening and terrifying monster is as representational of traits or aspects within "self" as are the more readily identifiable and preferred images of self. In this example, the present tense subjective experience of "self" is experienced in objectified form as the frightening "other", the monster.
As are images in the dream conceptualized as representational of "self" and "other", so, too, are associations conceptualized during the analytic hour. We are always and are only speaking about aspects of self; conflict is internal and is between different aspects of "self"; even though it might be experienced and reported, as in the dream, as external and experienced as between oneself and another person, for example, in the analytic hour between the therapist and patient.
Images of "other" are viewed as unconsciously selected to conform with and to confirm ingrained internal images of self and of other. The psychic drama which most times unfolds but gradually within the psychic theatre of the analytic setting is that which unfolds in each and every object relation in the individual's life; it is no different in analysis. It is not the presence of these same conflictual experiences between images of self and of other being repeated and relived in the analytic setting which distinguishes analysis as being analysis; it is how it is understood and worked with that determines if it is analysis.
The associations of the patient are viewed as being brought to mind for the purpose of communicating something about the patient's understanding and experience of what is going on at any particular moment in space and time in relationship to their experience of the therapist; all that transpires during the analytic hour is viewed as "transference". The patient's associations are conceptualized as having two major functions: to represent via symbols communications and to reflect via these same symbols ongoing, internal sensory and sensual mental representations of "images of self" and of "'images of other". The psychoanalytic situation as "psychic theatre" is conceptualized as providing the setting to which the individual comes, talks about, and, as they communicate, lives out and experiences an unfolding internal psychic drama made up of these internal sensory images of "self" and of "other". The ultimate reference point is always the "self". Translative statements are addressed to this experiencing definition of "self". One of the implications is that the thoughts brought to mind during the analytic hour in some way reflect the patient's intrapsychic experience of self and other, is communicated in an interpsychic context, and often is experienced in the form of an interpersonal relationship with the therapist.
Within this contextual metaphor of psychic theatre, the patient is viewed as the producer, director, and choreographer of all that transpires in the treatment: the director in the sense that they direct where the treatment will go, when it will proceed, at what pace, and the emotional context at the different times in the treatment; the producer in the sense that they produce through the associative process all that is necessary to be understood through the various avenues of communication, the communications of which are seen as part of an integrated "conversation"; the choreographer in the sense that there is an unconscious orchestration amazingly complex and yet quite precisely guided by the internal mental representations. The choreographic orchestration includes the recreation of the emotional ambience experienced as attached to the particular mental representations.
Within this contextual metaphor of psychic theatre what would be the role of the therapist and the implications for psychoanalytic supervision?
The therapist is to the patient as is the understudy in the theatre is to the central figure or the lead character in a play. However, there are several defining and noteworthy characteristics to this role of the therapist as an understudy: (1) the status of the therapist as an understudy is a permanent one, and (2) the understudy serves in a "role of complimentarity" to that of the patient's.
As an understudy of permanent status, the therapist is not there to replace nor to eventually fill in for the patient. As an understudy, the therapist attempts to continuously understand the developing themes and multiple transference paradigms which includes the accompanying emotional context of the particular internal mental representation. The therapist comes to eventually understand that the choreography of the play also includes the patient's system of logic with its assumptions and premises, the stylistic aspects of thought organization, the unique associative language of meaning and significance in terms of content, structure, and functions served. Indeed, part of the play might be the evolution of the frame as a consequence of the treatment rather dm as a prerequisite for the treatment. Thus, from this perspective of the therapist as an understudy in the psychic theatre of the mind, the therapist is one hundred percent detached and observing and attempting to understand conceptually the psychic play as it unfolds.
The appreciation and recognition of the second of these two defining characteristics of the understudy i.e. the role of complimentarity, carries with it further implications in terms of one's understanding of analytic attitude, therapeutic task, analytic process, and for the concept of "parallel process".
In everyday life, the internal representation of "self" many times has found an object relationship within which the internal representation of "other" can be concretized outside of self and the Other can provide at least partially the longed for and desired gratifications through the living out of a complimentary role with the patient. One of the major differences between everyday life and the analytic hour, however, is that in the analytic hour the therapist does not attempt to live out and behaviorally enact these internal experiences of the desired "other" with the patient even though the therapist might be at times rather intensely experiencing the object hungers which could or would lead to such behavioral enactments.
As the patient comes to recreate, relive, and to repeat certain archaic patterns of "self" and "other" with the therapist, the complimentarity of role of the patient's internal "other" evocatively and continuously plays on the object hungers of the therapist. As an understudy, the therapist attempts to translate into words, to interpret into words that which unfolds; to explain from the individual's world of significance, meaning, purpose, and internal adaptation which would be important to be understood. In a sense, the therapist would be enacting the transference in translative and explanative thinkng and words rather than in other forms of action.
Thus, the therapist is not there to simply observe the unfolding psychic play. The therapist's task in this psychic theatre is to be there to attempt to understand what "is", and why it might be, and to work interpretively with these internal mental representations as they come to define the experience of the treatment. The therapist is not there to critique the play, nor to correct, nor to improve, nor to change the production in the service of making it better through the encouragement of a more adaptive posture to "reality", or to "society", or to some theoretically anticipated expectation, or to some other fictive standard. The intrapsychic conflict between the internal "self " and "other" is given expression and experience in the context of the interpsychic i.e. an interpersonal experience. The therapist as the external concretization or embodiment of the internal sensory image of "other" is required to be one hundred per cent immersed in the psychic play in the role of complementarity to the patient's "self "; in a very real sense (figuratively speaking, of course) the therapist is to "become" the character of the "other"; to "become" includes to think like, feel like, to be like, that particular "other" as an actor/actress would become a particular character in the theatre. Thus, as an understudy, the therapist is to be one hundred per cent detached and observing of the psychic play as it unfolds while, at the same time, one hundred per cent immersed in the psychic play as it unfolds.
"Parallel process" becomes an absolutely indispensable concept with this understanding of the associative method within the contextual metaphor of psychic theatre, particularly with this view of the therapist as a detached and yet immersed understudy. Parallel process achieves its conceptual significance not because of its occurrence, as its occurrence is continuous and reflected within the evocative transference. Rather, its significance derives from how it is understood in the supervision and how it serves to further the treatment. There are two occurrences of "parallel process" which are particularly deserving of elaboration when considering psychoanalytic supervision: parallel process within the therapist, and between supervisor and supervisee. A brief clinical example of parallel process as reflected within the therapist, and between the therapist and supervisor, might be illustrative of process as well as directionality. With the mind seen as inherently dichotomous, conceptual definition and meaning takes place when something is defined in terms of its binary opposite. That is, one’s experiencing internal definition and meaning of "life" is achieved in contrast to that which it is not, "death". The same would hold for night/day, black/white, parent/child, self/other, man/woman, health/sickness, and patient/therapist. According to this position, it is necessary for one's experiencing definition of "self" to have and to maintain the antithesis in one's mind i.e. self as "other", in order to maintain that fictive sense of identity of "self".
The setting for this hypothetical situation which follows is that of a locked, adult inpatient unit. The therapist is an individual in a psychoanalytic predoctoral or postdoctoral program working with actively psychotic adult inpatients.
The supervisee: "I, the supervisee, have an image of self which is healthy, is normal, and thinks rationally, whatever idiosyncratic meaning and significance these terms might have for me. This very preferred image of self is maintained in binary opposition to that part of my mind called the patient, that part of self experienced as "other". As I meet with my actively psychotic patient on the inpatient unit, I come to experience certain very intense, excitedly frightening stimulations and unconscious fantasies of an oral incorporative and mutilative nature. I do not recognize that the associative chain of communications from my patient suggest that these experiences and feelings are related to primitive transference experiences associated with breast feeding. To that degree that it is important to maintain these aspects of self as "other" as in external to "self", then to that degree do I experience unbeknownst to self a "parallel process" within self, and go to supervision with the recommendation to have the patient medicated, in a psychoanalytically informed way, of course. Put another way: I wish to medicate that part of my mind called the disturbing "other", that part of my mind which, indeed, "understands" these transference experiences. By medicating my patient, I will feel better as in being less anxious and less guilty. Assuming that the repetition of archaic patterns of self and other and that the complimentarily of role has been playing on the object hungers of myself, the supervisee, then medicating my patient results in me feeling better. I go and speak to my supervisor to communicate that the patient is "regressing" and that "medication is indicated".
The Supervisor: I, the supervisor, can proceed, essentially, in one of several ways. I as the supervisor, also have been unconsciously stimulated via the process recordings of that which has been transpiring in the treatment. As supervisor, one way that I could proceed is to depart from the position of psychoanalysis as a venture into communication via the associative method in the context of psychic theatre. Instead of adhering to those principles and conceptualizations guiding the treatment thus far, I prescribe to the supervisee how to: reassure the patient, to structure reality for the patient, to reduce environmental stressors on the ward for the patient, and to have medication initiated. This prescription for me as supervisee stops my listening to the patient, stops the patient from talking or acting in such personally disturbing ways, and stops me from reporting such disturbing material to my supervisor. Further, as supervisor, I could cite to the supervisee how these therapeutic actions are supported by theory and are performed for the most humane and ethical of reasons.
Indeed, this "prescription" to be administered by the supervisee might not only illustrate multidirectionality of parallel process, it might also represent an ingeniously collusive compromise formation between supervisor and supervisee while at the same tome meeting JCAH requirements for individualized treatment planning.
As supervisor: A second way I could proceed would be to keep consistent with those principles and concepts integral with the associative method in the context of psychic theatre. Thus, it could be communicated to the supervisee that perhaps the "regressive behavior" is something being relived and behaviorally enacted in the treatment and is to be understood as part of the psychic theatre. Supervision would focus upon understanding the meanings and significances of that being communicated and how one might interpretively translate into words the idiosyncratic meanings to the patient. Supervision might also attend to the disturbing "parallel processes" prompting the urgency of medication. The recognition and appreciation by the supervisee that these psychological processes are from within self is something that would be one of the major functions and discoveries of the supervision; to that degree it is realized that it is within self then to that degree does the therapist come to see that they themselves and the patient are more alike than otherwise. Indeed, one could seriously question how far understanding could proceed if one could not see themselves in their patient via this role of complementarity.
How "parallel process" is understood in supervision and how one proceeds can represent the difference between a silent collusion between supervisor and supervisee resting upon a pathologizing of the patient, or, as an opportunity to understand more about the patient through the associative method within the context of psychic theatre. Psychoanalytic supervision is not psychoanalysis of the supervisee; the processes of the parallel phenomena are to be understood within the context of the patient's associations, assuming that they are reflected in the associations of the patient.
From this understanding of psychoanalysis there comes a perspective and philosophy of supervision. The supervisor speaks and teaches from within their understanding and conceptual framework of psychoanalysis. The particular conceptualization of psychoanalysis determines the specific body of theoretical knowledge to be taught and the particular focus on those technical skills to be developed. From this perspective, however, it is a way of thinking and a way of conceptualizing about theory and technique which are considered to be most crucial as it is these two factors which will determine the parameters within which analysis takes place and beyond which the analysis simply will not proceed.
The supervisory process proceeds with the recognition that the patient is the giver of the truth, the source of the ultimate system of signification and that which has meaning. To act as if the supervisor is the Knower could create and contribute to the illusion that the supervisee is the Knower or the ultimate Signifier of meaning "in the process of becoming" if only they think, act, formulate, and intervene like the supervisor. Such an unspoken agreement in the supervisory process can ultimately lead to this system of expectations being reproduced in the analytic hour resulting in a psychoanalysis of conformity as contrasted with a psychoanalysis of individuality.
There is much that can be taught and much that can be learned. However, if the essence and the art of analysis is a "way of thinking" to be developed, a way of thinking which involves seeing ourselves and the patient as being more alike than otherwise, involves "becoming" one of the characters of complimentarity in the psychic theatre of the mind, and involves interpretively translating in a meaningful way to the patient, then it can be said that the art of psychoanalysis can be learned but it can not be taught. Psychoanalysis as a "way of thinking" can be described, talked about, illustrated via vignettes or via process recordings but, eventually, it is to be the supervisee’s understanding and interweaving of basic analytic concepts and clinical material which will reflect the supervisee’s synthesis of psychoanalysis.
Dr. Kavanaugh received his doctorate in philosophy (psychology) from the University of Windsor in Ontario, Canada. Since the completion of his doctoral studies, he has been active in the academic, organizational, and practice areas of the psychoanalytic-psychological community. In the academic area, he has served as Director of Clinical Training and member of the core teaching and supervisory faculty in the doctoral program in psychoanalytic psychology at the University of Detroit; as a member of the teaching and supervisory faculty in the Program for Advanced Studies in Psychoanalysis in Wyandotte, Michigan, an interdisciplinary program for the study of the analytic discourse; and, as a member of the teaching and supervisory faculty in the pre-and post doctoral educational programs at the Detroit Psychiatric Institute, the Wyandotte General Hospital, and the V.A. Medical Center in Detroit. In the organizational area, he is the founding and current president of the Academy for the Study of the Psychoanalytic Arts; past president of the International Federation for Psychoanalytic Education; the Michigan Psychological Association, and the Michigan Society of Clinical Psychologists. In the practice area, many of his professional interests during the past 35 years are directly related to experiences in the discourses of various residential treatment facilities.
Dr. Kavanaugh is a recipient of The Distinguished Psychologist Award from the Michigan Psychological Association and the Master Lecturer Award from the doctoral students at the University of Detroit.
Currently Dr. Kavanaugh is in the private practice of psychoanalysis in Farmington Hills, Michigan:
Office: 31805 Middlebelt, Suite #305
Farmington Hills, Michigan, USA 48334
Phone: (248) 626-6460
Fax: (248) 626-4808