Our COPE Study Group on Impasses and Failures in Analysis has been working together for the past five years. It was initially formed to complement an APsaA discussion group on the same topic that we created somewhat earlier. As we had hoped, the two groups have functioned synergistically in offering somewhat different vantage points on our areas of interest. In the COPE group, in particular, we have wondered about the impact of impasses and failed cases, especially on candidates and on analysts early in their careers. How could supervisors and faculty best help younger colleagues not only to weather such experiences but also to learn and to grow from them? To what extent could supervision contribute to the problem, and what was the relationship between clinical and supervisory impasses? How could supervisors, faculty, and the overall institute structure best foster an atmosphere of openness in which these clinical outcomes and derailments of supervision could be constructively discussed?
In the early meetings of both groups, we focused on impasses in treatment with a view to unraveling patient and analyst overlaps and disjunctures. In the COPE group, we increasingly found ourselves studying the role of supervision in these processes, often studying clinical material presented first in the Thursday discussion group. The presenters in this discussion group have most often been candidates or recent graduates, and the cases they have presented have been supervised. In the course of their presentations, many of these new analysts have discovered that their thinking in the discussion group begins to expand. They realize, as people often do while presenting, that something has been limiting the scope of their awareness.
The effect of supervision frequently emerged as more central to the impasse than these analysts had previously considered. Often it came up as something of a surprise. When this was the case, we invited the analyst to come back to meet with our COPE group to explore in greater depth the role of supervision and its contribution to the impasse. Other analysts, who had not previously presented at the Thursday discussion group, also brought us similar situations for us to try to help them explore. In general, these cases were not ones in which the analyst initially believed that the supervision had contributed significantly to the impasse. In fact, most often the analysts had positive things to relate about their supervisory experience, and did not focus on the contribution of the supervisory experience to the clinical impasse.
To what extent could supervision contribute to the problem, and what was the relationship between clinical and supervisory impasses?
Nonetheless, their exploration of what occurred began to reveal previously unrecognized effects of the supervision. Sometimes there were overlaps in character or blind spots in the candidate that the supervisor shared. These became apparent when the study group was able to offer a new perspective on the case and sometimes on the supervision. Other times it became more clear in the course of the presentation and discussion that transference to authority by the analyst/supervisee, combined with a supervisor's critical tone, led to inhibitions in the clinical work. Sometimes the group could discern and demonstrate to the analyst how institutional conflicts and institute history were played out in the supervision, resulting in a constriction of the candidate's thoughts and creativity.
In most, if not all, cases it emerged that problems in the supervision, if they were within the awareness of supervisee, supervisor, or both, were not explicitly discussed. Understanding why this occurs so consistently in a learning and professional environment that emphasizes open inquiry is a problem we plan to continue to explore.
Having heard dilemmas brought to us both by supervisors and by supervisee/analysts over these past five years, in a variety
Judy L. Kantrowitz, Ph.D., is a training and supervising analyst at Boston Psychoanalytic Institute, clinical associate professor at Harvard Medical School, and the author of The Patient's Impact on the Analyst and Writing about Patients: Responsibilities, Risks, and Ramifications.
Steven H. Goldberg, M.D., is a training and supervising analyst at San Francisco Center for Psychoanalysis, where he is currently serving as dean of students. He is also a personal and supervising analyst at Psychoanalytic Institute of Northern California.
of educational and institutional contexts, the supervisory process and the impact on supervision of other factors in institutional life is appearing to us as ever more intricate and complex. The impact on both treatment and supervision of institutional conflict and dysfunction is an area to which we have only recently focused our attention and which we hope to study further. To what extent might an impasse represent not only a co-construction between analyst and patient but also a more complicated construction involving the institute itself?
As we continue to gather case material, we are beginning to consider writing a casebook to communicate some of our experience and what we have learned from it to colleagues. We continue to invite colleagues to present cases involving impasse or failure at our Thursday discussion group, and we will continue in our COPE group to study analyses in which supervision itself is an issue and has played a significant role in the impasse or failure. We welcome supervisors and supervisees to contact us about bringing such situations to our Friday morning COPE group. Situations in which a candidate has been supervised by an analyst who is known to have been involved in a boundary violation or boundary crossing, and where the case has foundered or ended prematurely, would be welcomed as we try to understand some of the possible ripples and collateral damage from these events. Please contact or .