Three Associating: Adventures in Relational Psychoanalytic Supervision

In this rich episode, Rachael grapples with a variety of complex nuanced issues such as an unexpected ending and the feat of balancing the therapist's self interest with the patient’s interest in a number of domains, including payment. Also on the table were inner conflicts around masochism and self care and the potential risks and rewards of playfulness and creativity and the inherent pleasures and perils that they engender.At the end of the session, Rachael and Gill concluded that whatever side we finally land on in the resolution of inner conflict, it is essential to own the outcome and to stay authentic and transparent.

In this episode, Andrew struggles with the power of splitting and projection as they close down thought, generate anger, and diminish compassion.He gets caught in these dynamics and struggles with his own reactivity as anger and defensive intellectualisation  masquerading as thinking emerge in the therapy space.Through supervision, Andrew realises the fear and existential threat that underpins these dynamics. He moves from a wish to confront binaries and from an appeal to both/and thinking to understanding the feelings underpinning either/or thinking, projection, and othering.Andrew comes to see how his own responses have been subverted by this extremely pressuring dynamic and returns to the capacity to go meta to himself and to the transference/counter-transference matrix

In this episode, Rachael works with a young woman who is desperate to find the right man and equally desperate to find a failsafe way to make a good choice. A prolific consumer of social media, she scours all the information about red flags that are meant to help someone spot a narcissist (e.g. lovebombing, gaslighting, self-centredness). She appeals to Rachael to assist in this endeavour of constructing and applying lists of red flags. Rachael tries to shift the agenda to fostering agency,  but to no avail.  In supervision, Gill asks a series of questions which leads Rachael to her own conclusion that her own narcissism constellated around the “need to know”. A common dynamic in therapists is implicated in this therapeutic impasse.

In this episode, Rachael is conflicted about performance artist Petra's wish for Rachael to watch a video of Petra engaging in human suspension.  Rachael has an immediate countertransference feeling that she doesn’t want to be “implicated". Rachael does not understand this feeling as she is aware of the mastery involved in this activity and also Petra's pride in her ability. However, Petra also speaks of her engagement in this practice as a means of regulating her affect. Rachael comes to understand that her reaction to Petra’s request was connected to wanting not to judge Petra’s engagement in human suspension and also wanting not to turn a blind eye to the trauma that could be "implicated” in Petra’s activity. Thus, Rachael comes to understand her own reaction as pointing to the need to integrate both the positives and the problems involved in Petra’s chosen mode of mastery and self soothing and to engage with both traumatophilia and traumatophobia (Saketopoulou, 2023).

In this session, Andrew is confused by why Amber, an anorexic adolescent woman, is so silent in session when she chats easily with other team members. Andrew is sidetracked both by his anxiety about his position in the team and his anxiety that he is getting it wrong.  In supervision, Andrew comes to understand that his different treatment by Amber may signal something positive including  Amber's emerging desires for male attention. He explores how safety for both him and Amber may lie in introducing material that can cut across the intensity of the therapeutic couple while, paradoxically and at the same time, detaching himself from his persecutory anxieties about the team which interfere with his focus on Amber.

In this episode, Andrew finds himself conflicted. His talented young patient reflects a contemporary set of values and ideas that Andrew wishes to honour, but he has a nagging sense that Jaxx is running ahead of himself. He is caught between admiring Jaxx’s resilience and wondering about the cost. But Andrew is not sure if his worry reflects a more conservative world view in himself or real potential danger for Jaxx.   In the session Andrew recognises that he needs to move to a both/and position, validating Jaxx's achievements while holding his vulnerabilities and being less cautious about moving closer.

In this episode, Rachael⁠ revisits the complex feelings that child sexual abuse evoke in both patient and therapist. Rachael discovers that her wish for magic powers has not disappeared and has reappeared in a different form. Beyond this, Rachael contacts both the magic and the terror of the therapeutic journey itself and the loneliness this sometimes produces in the therapist. Both Gill and Rachael conclude that while trauma itself is to be regretted, the person that we emerge as in the wake of trauma is to be embraced as a crucial and valuable aspect of our autobiography.

In this episode, Rachael approaches the taboo of sexual attraction in therapy and its tendency to lead to dysregulation, involuntary self-disclosure, and shame.  Rachael's feelings unduly amplify her self-consciousness, complicating the ongoing therapeutic task of understanding her and her patient's contribution to the co-construction of their relational field. After engaging Rachael in a discussion of the reality/fantasy divide and the difference between voluntary and involuntary self disclosure, Gill invites a recourse to theory both as a stabilising force in the choppy waters of the embodied and as a way of retaining the boundaries of supervision versus therapy.

In this episode it becomes clear that Andrew and his patient Manuela are unconsciously co-constructing a dynamic in which Manuela is under pressure to be cultured and cool in order to maintain Andrew's admiration, while Andrew is under pressure to take up a lesser position. As the supervision unfolds, Andrew becomes aware of how his envy is at the heart of this dynamic and how he is projecting certain longings onto Manuela. He becomes aware this leads to both an underplaying of Manuela’s limits and vulnerabilities and the overplaying of his own and keeps her stuck in a relational impasse. In the session, Andrew moves to a more balanced perception of Manuela’s plight and a greater recognition of his own contribution to her relational dynamic.

Rachael comes to realise that feeling provoked by the patient’s apparent self-centredness in enactments that occur in the waiting room and in the session has led to a wish to be provocative in return. She first enjoys then tussles with revenge fantasies. By talking through these fantasies and owning their pleasure, she recognises their meaning, and this opens up multiple perspectives.

In this episode, Rachael encounters a worthy adversary in the elegant and charismatic Iris. Beguiled by Iris charm and colourful stories Rachael can’t help feeling seduced.  However she also feels manipulated and is  irritated with herself and Iris.  Nevertheless she still feels the pull to captivation in the session. In the end, Rachael ⁠ realises that the most worthy adversary that she has is herself and in freeing herself contemplates helping Iris to be both her charismatic and her vulnerable self.

In this episode, Andrew struggles to disrupt his patient's rigid self-control, ever mindful of a psychotic potential that could be unleashed given the patient's history of experiencing a psychotic episode. Andrew experiences both the seductions of a meeting of minds and the potential tyranny of his patient's mind that fears the body, its appetites, and affects.

In this episode, Rachael is provoked by a disrupted patient. Power struggles and challenges emerge in the room as Rachael struggles to think and not enact in the face of the patient's enactments.  Technical questions of courageous speech versus disruptive challenges are engaged as Rachael shows great integrity and courage in taking in the challenges of supervision to come to an expanded understanding of trauma.

In this episode, Andy is frustratingly blocked by his patient's difficulty in listening and by her incessant talking, both of which reveal parts of her self and mask others. Ironically, Andy himself has to surrender into listening rather than talking and into only having recognised small snippets of his thoughts, if any at all. He becomes aware of the deprivation under his patient's excess and how this fuels the discrepancy between her subjective reality and his experience of her.

In this episode, we encounter Rachael's struggle with an avoidant patient who is fearful of closeness. Rachael is conflicted between her desire for the patient to make progress and to stay present to the work and to 'dine in', and her awareness that, for his desire to move forward to emerge, she needs to take a step back and let him continue with 'take away' for a while longer.