The COPE Study Group on Supervision in Child and Adolescent Analysis was formed in 2003, following the participation of several of our members in the discussion groups of the COPE Workshop on Supervision in Adult Analysis. Exploration of crucial issues in the ongoing workshop led to the perspective that there are distinctive features of supervision of child/adolescent analysis that might bear further examination and study. Since one mission of COPE is to provide further opportunities of study to psychoanalytic educators, clinicians, and theory builders, our study group was formed with two considerations: to include members of a wide range of institutes (therefore we included only one member from each institute represented) and limitation of the group to a workable size, in order to facilitate depth of discussion.
The intent of the study group is to learn more about the process of supervision of child/adolescent cases. A variety of issues have emerged, several appearing consistently, that seem to involve the candidate analyst's impulses towards regression, for which there are multiple opportunities in child/adolescent analytic work and defenses against these impulses.
For example, the challenge of effective work with parents is one descriptive area that appeared frequently in case material presented. In the context of the candidate's difficulties in working with parents, grandparents, nannies, teachers, and clergy, the candidate analyst's tendency to regress, impulses to reenact unresolved transferences, and defenses against these impulses were frequently among the underlying issues observed.
The candidate's identification with the child patient, overdetermined at times, was one source of conflictual responses to parents/caretakers. Simultaneously, unconscious identification with the parent may lead to difficulties in maintaining an analytic stance with the child patient. Supervisors can attempt to help the candidate maintain an equidistant stance in the family so that each family member can be heard in depth, with empathy and tact.
The second issue, helping the candidate to analyze the child patient's proclivity for action, also involves issues of regressions and defenses against regression for the candidate analyst. The child tends to communicate through actions and candidates find themselves confronted with challenges that are not usually encountered in the analysis of adult patients. The engagement in action with the child (a necessary activity) may blind the inexperienced candidate to her/his analytic task of thinking, analyzing, and assessing the modes of communication. We have seen that thoughtful and supportive supervision in this facet of the work can expand the candidate's understanding of the subtle meanings of action and lead to introspection so the candidate may develop more flexibility in thinking about the material.
A third issue appears, phenomenologically, as specific learning problems in candidates. Such apparent learning blocks may serve as defenses against newly aroused personal conflicts (and new regressive potential) that arise because of the special nature of working with children/parents. Working with adolescents when the candidate analyst is dealing (or failing to do so) with his/her own specific conflicts and developmental issues associated with the phase at which the patient is struggling can be particularly problematic. When the candidate in child analysis is no longer in personal analysis, the supervisory work in this context may be especially difficult.
Our study group members have wrestled with how best to work with issues that present themselves as “learning problems,” so that personal awareness may be expanded without the supervisor taking the role of analyst/therapist to the candidate. We are examining supervisory techniques which are helpful in facilitating the candidate's reaching meaningful understanding of their difficulties in analysis of children. The candidate's transferences to the supervisor present yet another instance in which impulses toward regression and defenses against these impulses are subjected to study by our group.
After several years of meeting, our study group felt ready to develop a COPE Workshop on Supervision in Child and Adolescent Analysis open to all child/adolescent supervisors and associate child supervisors. We plan to involve a wider group of supervisors in the process of studying this field. This workshop, at its first two meetings, has presented live supervisions of child analysis, and each presentation was followed by rich and lively discussions. We welcome all child/adolescent supervisors and associate child supervisors to attend this workshop, which is held on the Wednesdays of the APsaA meetings from 12:15 p.m. to 1:45 p.m.
Paula G. Atkeson, Ph.D., is training and supervising analyst, supervisor of child analysis, at the Baltimore Washington Institute for Psychoanalysis and faculty at The Clinical Social Work Institute, Washington, D.C.
Anita G. Schmukler, D.O., is training and supervising analyst, supervisor of child analysis, at the Psychoanalytic Center of Philadelphia. She is faculty at the University of Pennsylvania and the New York University Psychoanalytic Institute.
Eslee Samberg, M.D., is editor of the COPE column. She is training and supervising analyst at the New York Psychoanalytic Institute and clinical associate professor of psychiatry at Weill Cornell Medical College.