Three Associating: Adventures in Relational Psychoanalytic Supervision

In this episode, Rachael takes on a number of important questions including when is it appropriate to bypass defences by uniting with the patient’s perspective and when to try to get under the defences and how to do this . Similarly, Rachael explores the question of when to push against resistance and when to work around  resistance or go to a third option of analysing the resistance. 

Rachael also comes up against the fact that her memory of the patient in a previous phase of therapy is affecting her ability to simply be present with the patient in the current moment.

Following Bion's dictum to try to be without memory or desire, Rachael is able to reappropriate the value of working in the transference-countertransference matrix as it is unfolding in the room. She is also able to share with the patient the load of reflection and thought by asking questions and directing the treatment rather than doing all the work herself.

In this episode, Andrew encounters a patient whose stated objective is to own her own competence and self assuredness and to be more like him. Andrew anticipates encountering a people pleaser and is surprised when he encounters a lack of it. The patient stonewalls him in particular moments  She resists his attempts to move closer by masking her anger and collapsing into tears and shutting him down. 

In response, Andrew⁠ consciously carries her denied anger but denies his own unconscious envy of her freedom to collapse. This leads him to subtly undercut her anger while consciously intending to invite it. 

In this interplay of the patient’s and therapist’s joint unconscious denials, affect heightens and thought decreases. Through supervision, a better balance between feeling and thought is achieved and Andrew⁠⁠ moves forward taking ownership of his own envy in the gender wars.

In this episode, Rachael gets tangled up in her own anger and hostility towards her patient on behalf of the patient’s daughter. While trying to distance herself from the patient's enmeshment with the daughter she inadvertently gets enmeshed herself in the patient’s dynamic. 
By more fully accessing her anger with the patient and realising that in her mind she has been treating the daughter rather than the patient, she is able to recenter herself more clearly with the patient in the room.
The importance of feeling into the therapy and not only thinking into the therapy is emphasised, with the end point of integrating both. Rachael⁠ must own her murderous rage towards the mother/patient and to reflect on its meaning and beyond that have the capacity to articulate it in a form which can be heard by the patient.  By the end of the session, Rachael⁠ is able to achieve this.

In this episode, Andrew struggles with the question of therapy terminable and interminable. He faces an ethical dilemma as to whether continuing therapy with a particular patient who has made considerable gains would be in some way unethical.

Andrew⁠ is thoughtful about the issue of fostering dependence which is an important issue to consider. However, he finds through supervision that he has unconsciously stepped into enacting the role of the patient's authoritarian father who imposed separations on the patient as a child.

Andrew⁠ comes to see he has engaged in a subtle power struggle and has unconsciously used psychoanalytic premises as an anti analytical third that blocks thought rather than facilitates it. Interestingly, Andrew⁠’s awareness of the enactments in therapy are discovered through a parallel process that emerges in the supervisory relational field.

In this episode, Rachael struggles with her own feelings about her therapy being cut across by a psychiatrist who seems to be opposed to long term therapy. 

She feels activated especially as the patient has asked her to intervene and contact the psychiatrist. 
In supervision, she engages with her frustration at the interference in her treatment and her therapeutic relationship and also her anger in relation to the zeitgeist that opposes in-depth therapy. 
Rachael⁠ recognises that in her activation she gets pulled into focusing more on the zeitgeist and less on the patient and is hooked by the emergence of her own sibling rivalry . 

These are not enacted with the patient but they interfere with Rachael⁠’s ability to think about the analytic meaning of the patient’s request. Through supervision, she is able to see that she is inadvertently being invited into a split and while activated is loosing the opportunity to explore the psychodynamic meaning of the patient’s request. Through this understanding she returns to her analytic position.