Psychoanalytic treatment is an important therapy that explores the influence that unconscious mind has on thoughts and behavior. The goal of psychoanalytic therapy and treatment is to offer an insightful resolution to the patient. This form of treatment focuses on childhood experiences and aims at creating a correlation between the experiences in childhood and how they shape the behavior in adulthood. It is a long-term form of therapy and, therefore, requires constant supervision and consultation for reinforcement. The goal of psychotherapy is to impact a significant change in both personality and emotional development. Psychoanalytic therapy works with certain assumptions depending on the form of treatment required. One of the assumptions is that the psychological problems are deeply rooted in the unconscious, and the manifestations are as a result of disturbances that are latent. Another assumption of psychoanalytic therapy is that the psychological disorders are as a result of unresolved issues in the process of development or as a result of repressed trauma. The final assumption of the therapy is based on treatment aims at bringing the repressed conflicts on the surface to enable the patient to deal with them in an individual capacity. The following paper explores the similarities between supervision or consultation and psychoanalytic treatment process. The paper also evaluates various psychoanalytical models of supervision and consultation as well as the differences between individual and group supervision, ethical issues surrounding supervision and multicultural concerns.
Supervision and Psychoanalytical Treatment
According, the goal of monitoring is to understand the third person under psychoanalytic treatment. Similar conflicts and misunderstandings are prone to occur in a consultation relationship[ CITATION Bra08 \l 1033 ]. Therefore, appreciating these similarities enhances the understanding of the process of supervision in mental health consultation[ CITATION Bra08 \l 1033 ]. Hobson, (2013) categorizes psychoanalytic assessment as an interesting aspect of psychological therapy that is purely based on building relationships with a complete stranger. The process of accessing the mind of a stranger is exhilarating, relieving, frightening and enraging[ CITATION PHo13 \l 1033 ]. Psychoanalytic Supervision includes the capacity to combine teaching functions as well as evaluating them. The supervisor should interpret theory of technique based on the totality of the information gained through the processes of psychoanalytical consultation[ CITATION Ker10 \l 1033 ]. The supervisor should also aim at combining honest communication and collegiality with the client[ CITATION Ker10 \l 1033 ]. Moreover, the supervisor has a responsibility of reducing the influence of personal dynamics in creating a suitable environment for psychoanalytical therapy.
According to[ CITATION Sar101 \l 1033 ], psychological competencies that are required in the consultation process includes relationship building, self-reflection, intervention as well as assessment case conceptualization. Curative psychodynamic psychotherapy depends on relationship building during supervision[ CITATION Sar101 \l 1033 ]. Self-reflection is a complex process that involves close analysis of the background of the problem based on the present circumstances. In competent assessment and diagnosis, case conceptualization is a powerful tool when making inferences about the underlying unconscious processes in the client[ CITATION Sar101 \l 1033 ]. Based on the supervision experiences, it is important to integrate the unconscious processes observed in the client with a theory to come up with varied deductions. There is a difference between the supervision process and clinical setting in psychoanalytical treatment. However, integration of the concepts in supervisees is significant for their development[ CITATION Sar101 \l 1033 ].
In psychotherapy, supervised training has been known to influence the beliefs, attitudes and skills among psychotherapists. It also affects the interaction process events both in psychotherapy and supervision significantly. However, there are a few studies that have been done to establish a direct correlation between the performances of therapists and client change to supervision. Standardized training manuals that are analogous to the manuals in psychotherapy need to be developed to ensure uniformity of treatment. With treatment standardization manuals, supervision is bound to remain a core function of psychoanalytical therapy training. Supervision in psychoanalysis is more systematic compared to supervision in psychotherapy. In psychoanalysis, supervision concentrates on countertransference, diagnosis, transferences and resistance. The tendency to make brilliant interpretation is also necessary for psychoanalytical supervision. On the other hand, psychotherapy supervision is determined by the ability of the psychotherapist to understand the possible diagnosis of the client. Therefore, psychotherapists need to have heightened observational powers, intuitions and application of own unconscious. Supervision aims at differentiating the dumb and the blind spot in psychotherapists. Several factors can influence the relationship between the supervisor and the supervisee. Trust, competitiveness, accepting and belligerence shape the relationship.
Models of Supervision and Consultation
Defining and comparing supervision models is as crucial as analyzing the clinical models on psychoanalysis[ CITATION MFr12 \l 1033 ]. Based on the models in use, there is a technical overlap in practice between supervisors and practitioners although they all have a similar approach. The process of creating models of supervision that simplify the infinite variations in styles among individuals enables supervisors to identify the most suitable model that suit their personality. In supervision, it is paramount to capture the critical dimensions in order to describe the supervisory styles adequately.
The nature of the supervisor’s authority
In this dimension, the supervisor views himself/herself as an expert who is not directly involved with the psychological problems affecting the client. The authority is based on the knowledge to be taught. The supervisor has an absolute claim on what is correct for the patient, and his /her authority is observed in the supervisory relationship.
The supervisor’s focus and relevant data
In most supervisory relationships, supervisors do not choose on what they are focusing on or ignoring. However, the decisions made non-reflectively in supervision have profound outcomes on the supervisees. For instance, supervision that focuses exclusively on the resistance of the client denies the supervisor and the supervisee an opportunity to discuss diagnosis, dynamics, and the anxieties addressed by the client[ CITATION MFr12 \l 1033 ]. Moreover, focusing primarily on the patient as the source of main data excludes the supervisees’ opinion about the state of the patient. However, some models leave out the supervisory relationship to focus on the attention.
The supervisor’s primary mode of participation
Supervisors exhibit diverse roles in the relationship. While some are didactic teachers, others are psychodynamic experts in the relationship. Other supervisors are Socratic askers who consistently pose questions to supervisees in the process while others offer interactive collegial support to supervisees. All the three dimensions above are imperative in discussing the models of supervision since they provide insights on the existing supervisory relationships.
The Primary Models of Supervision
The Patient-Centered (Classical) Model
The patient-centered model is also known as the classical model, and it was described by Freud[ CITATION MFr12 \l 1033 ]. The model is still being applied by some supervisors currently despite the evolution of their views on treatment that has taken more contemporary direction. In this model, the supervisor’s authority is based on the fact that they are experts who are not involved in the therapy process. However, they have both theoretical and technical expertise that transcends beyond that of the students. The difficulties facing the supervisee are assessed base on the patient’s dynamics as well as the technical limitations of the supervisee. In cases of countertransference problems, the supervisor advice the supervisee to take the issues of his treatment[ CITATION MFr12 \l 1033 ]. Therefore, in a patient-centered supervisory model, the supervisor is the determinant of the good theory and technique regarding the patient’s mental status. The psychology of the patient is the primary reference in the supervisory process. The key aspect in classical model is that little attention is paid to the supervisory relationship or supervisee’s psychology[ CITATION MFr12 \l 1033 ]. The primary purpose of the classical model is to ensure that all the interventions are based on the patient’s condition. However, conflict resolution in this supervisory model usually distracts the didactic focus. The mode of participation in a patient-centered model is didactic[ CITATION MFr12 \l 1033 ]. The goal is to help the supervisee in understanding the patient and the most appropriate response to give.
Advantage of the patient-centered model
Most supervisors who utilize the patient-centered model learn it from their own supervisors and, therefore, it is easier to apply. Moreover, the model is safer for the supervisors, and it minimizes any anxiety forthcoming. In a patient-centered model, the rules are well defined. The view of the patient’s mind is also well explained and therefore both the supervisor and the supervisee are relatively secure from any anxieties accruing from the clinical relationship. When working with a supervisor who applies the classical model, it is easier for the supervisee to be skilled in specifics of resistance. Since the focus of the supervision is outside the therapy session, the patient-centered model tends to keep the supervisory session calm. The model also offers a low-stress supervisory approach, and there is more attention to learning. The patient-centered model also provides supervisors who are unwilling to expose themselves personally an opportunity to instill concrete techniques to supervisees.
Shortcomings of the patient-centered model
The primary limitation of the patient-centered model is that it is not flexible to the vicissitude of human relationships[ CITATION MFr12 \l 1033 ]. The patient-centered model does not offer a more applicable approach to conflictual supervisory relationships. Therefore, when conflicts arise in the supervisory relationship, the supervisor either blames it on the patient’s psychology or the supervisee’s countertransference that is not workable. In this supervisory model, there is a possibility of occurrence of an interaction that is not open since the supervisee or the supervisor may not be willing to acknowledge their feelings on the issues emanating from the supervisory process. In a patient-centered model of supervision, there is no much contribution on the learning outcomes of the supervisee[ CITATION MFr12 \l 1033 ]. Moreover, it is possible for a supervisor to find the needs of the supervisee and the patient as competing.
The Supervisee-Centered Models
In a supervisee-centered model, the attention of the supervisory session is focused on the psychology of the supervisee. Similar to the patient-centered model, the supervisor’s authority is highly dependent on a lack of involvement despite being both theoretical and technical experts. Response to supervisee’s difficulties during the session highly depends on the supervisor’s expertise. In selecting relevant data, the supervisor focuses both on the patient’s and the supervisee’s psychology. There are three models under the supervisee-centered model.
Supervisee-centered learning problem model
The learning problem model is centered on the need to value the clinical model so as to enhance therapeutic change. The model also focuses on the resistance in understanding the supervisee’s psychology. In cases of resistance such as an inability to interpret the supervisor’s materials effectively or the failure to empathize with the patient, the supervisor takes an authoritative stance, and he/she shifts from didactic teaching to interpreting the resistance.
Strengths of the learning problem model
The model is effective in addressing the psychology of the psychotherapist. The model also allows the supervisor to participate in more ways other than the didactic approach. The model is cognitively engaging compared to the patient-centered model. The supervisor can demonstrate to the supervisee on how to work with resistance in a supervisory situation[ CITATION MFr12 \l 1033 ].
Limitations of the learning problem model
The model does not give attention to the supervisor’s contributions in the supervisory relationship. In this model, difficulties in the supervisory relationship are attributed to the psychology of the supervisee. The model may lead to feelings of shame, failure and anxiety for the supervisee in the case of occurrence of problems in the supervisory relationship.
Supervisee-centered empathic model
The model was developed in the 1970s by self-psychologists based on their clinical approach. In this model, the supervisor’s authority is not much and is viewed as a less objective expert. The supervisor explores his /her empathetic errors as pointed by the supervisee rather than viewing them as resistance. The primary focus is based on the self-state of the supervisee. The supervisor listens and addresses the developmental needs of the supervisee.
Strength of the empathic model
The empathic model presents a shift in the attitude of the supervisor towards the supervisee. The model is appropriate to supervisees dealing with high levels of shame, despair, failure and anxiety. The supervisees develop more confidence with the application of the model.
Limitations of the empathic model
The model fails to consider the supervisor’s point of view since it is based on self-reflective efforts from the supervisee’s point of view. Factors such as aggression and countertransference constellations are neglected in an empathetic model since the model focuses on self-object.
The Supervisee-Centered Anxiety-Focused Model
The model was developed in the 1990s. In the anxiety-focused model, the supervisor’s authority is highly dependent on her role in helping the supervisee in his/her work as a result of anxieties caused by the patient in the clinical setup. The relevant data for the supervisory in this model includes the supervisee’s unconscious anxieties as well as the solutions that the supervisee suggests to the patient. The mode of participation of the supervisor is containment and interpretation of the anxieties and enactments displayed by the supervisor. The basis of this model is to create a suitable environment for the supervisee to be comfortable with the client.
Strengths of the Anxiety-focused model
The model is important in showing the supervisee how emotional holding works in a clinical relationship. Important supervisory relations develop in this model. The supervisees are comfortable with the supervisor’s sensitivity in the relationship.
Limitations of the Anxiety-focused model
If the supervisor addressed the supervisee’s anxiety during the supervisory relationship, the supervisee might feel exposed. This is tough for the supervisee if the supervisor is not aware of his/her own concerns.
The Supervisory-Matrix-Centered (Relational) Model
In this model, the supervisor’s authority derives from her capacity to participate, reflect and process the enactments emanating from the supervisory relationship. The supervisor has limited authority, and the expertise only unfolds as a result of participation. The relevant data for supervisory processing in this model include the relational themes in the supervisory dyad.
Difference between Group and Individual Supervision
Individual supervision is where the supervisor has a one-to-one relationship with the supervisee. Individual supervision is an imperative cornerstone in professional skill development[ CITATION Wor07 \l 1033 ]. It is both time-consuming, and labor intensive since the supervisor has to deal with a single supervisee at a time. On the other hand, group supervision refers to the development of professional skills among peer groups of supervisees. It is an efficient method for team building and growth of supervisees. Groups of four to six supervisees are recommended in this form of supervision foe easier case presentation among all the supervisees. Group supervision is cost effective compared to individual supervision. It also allows for testing of conceptual skills through peer validation unlike in individual supervision. The diversity among the participants improves the learning process. Group supervision also provides a microcosm of group process that improves the learning outcomes[ CITATION Wor07 \l 1033 ].
Ethical Issues of concern in Supervision/Consultation
In the professional supervision of psychoanalysts, it is important to observe the ethical issues of concern related to training and professional practice[ CITATION RGo12 \l 1033 ]. Ethical issues in supervision include transference, dual relationships, dependency, supervisory relationship, and the imposition of supervisor’s beliefs to the supervisee[ CITATION RGo12 \l 1033 ]. The supervisor should aim at minimizing all the ethical violations to ensure a mutual relationship with the supervisee during the supervisory process. The supervisor should also balance the rights of the client with the competence displayed. It is also prudent to maintain the confidentiality of both the supervisor and supervisee’s personal information emanating from the supervisory relationship. Supervisors are also required to teach the supervisees on how to make ethical decisions especially when faced with a dilemma in a clinical set-up[ CITATION Psy99 \l 1033 ]. The supervisor should also create a safe supervisory relationship with the supervisee to avoid any sexual attractions that can severely affect the supervisory outcomes.
Multicultural concerns in Supervision
Multicultural supervision is a form of supervision process amid difference between the supervisor and the supervisee such as race, age difference, gender, sexual orientation, religion and socio-economic status. Both the supervisor and the supervisee should be aware of the biases and cultural assumptions that surround counseling sessions[ CITATION Mur10 \l 1033 ]. There should be a mutual understanding of the existing cultural differences between groups of individuals. Both the supervisor and the supervisee should avoid stereotyping, racist comments and assumptions, other unethical considerations. For example, racism has adverse outcomes in a supervisory relationship if persons from a given race feel marginalized or being required to make comments on race during therapy sessions[ CITATION MCo07 \l 1033 ]. Supervisors who are ethnically mixed exhibit multicultural competence in supervision. Raising the topics on cultural differences during the supervisory relationships makes the supervisor more comfortable[ CITATION MCo07 \l 1033 ].