Our COPE Study Group on Supervision in Child and Adolescent Analysis has been meeting regularly for several years at the National and Annual Meetings of the American Psychoanalytic Association. Our COPE group membership is representative of institutes from various parts of the country; this diversity enriches the sharing of our experiences.
Our discussions of theoretical questions and clinical material are rich and lively as we talk over the particular issues that confront the supervisor of the candidate who is learning how to conduct child and adolescent analysis.
Special tasks for the child and adolescent supervisor that are not present in the supervision of candidates in adult training require particular attention. First, there is the development of multiple transferences and countertransferences, not only to the child but also to his or her parents and others in the child's life. Second is the impact of the child/adolescent's developmental process on the unfolding of the analysis. Third are the complex issues of confidentiality, secrecy and privacy that arise as the candidate works with family members, teachers and pediatricians. As our discussions developed, we found that many perplexing issues arose around ethical dilemmas encountered by the nature of child/adolescent analysis. We wanted to share our thinking with supervisors beyond our study group. To achieve this, we published a book in 2011, Ethical Practice in Child and Adolescent Analysis and Psychotherapy: Protecting Safety in a Therapeutic Environment.
As we realized that the principles of supervision and the education of supervisors are not formally taught in many institutes, we thought it would be helpful to develop a book directed toward the teaching of supervision that might serve as a starting point for the study of supervision within institutes. To this end we have a second book in press titled The Supervision of Child and Adolescent Analysis: Enriching the Candidate's Clinical Experience.
The chapters in this book are directed toward helping new and experienced supervisors develop their capacities to supervise candidates in their work with child and adolescent patients. The chapters in this book include supervision of assessment, of transferences and countertransferences, of work with parents, of ethical issues, of working with play, fantasies and dreams, and the challenges of termination.
The intent of the new book is to help supervisors develop their own approach to and style of supervision. It is also intended to call attention to the multiple unconscious processes that can potentially interfere with a supervisor's recognition of issues in clinical material and the invaluable benefit of study groups and consultations for supervisors. Thus, we included chapters on several models of supervision and the special challenges in child and adolescent supervision, which include supervising the widening scope of children and adolescents who seek help.
We supervisors tend to supervise our candidates the way we were supervised as candidates using the supervisory approach we experienced without considering what alternative approaches might also be useful. In the supervision of child and adolescent cases we find there are many dilemmas that confront the supervisor. The children and adolescents who enter analysis today are often more challenging than in the past when candidates tended to treat children and adolescents with neurotic conflicts. Today, the children and adolescents who come for treatment present with more severe difficulties, including organic and developmental issues, such as autism and physical delays, requiring speech, hearing and occupational therapies. They often have problems with executive function and self-regulation. These children are often receiving help with multiple problems. Parents also present with severe difficulties in parenting and in their lives.
These cases confront the supervisor and candidate with the task of considering a “widening scope” of techniques that encompass the particular needs of that child or adolescent. It is important that the supervisor help the candidate not only on the practical level of how to intervene and interpret but also to conceptualize why an interpretation or intervention is chosen at any particular moment in the treatment. This learning includes maintaining an analytic frame while meeting the treatment needs of the child and adolescent. Supervisors and supervisees can learn together in this challenging task of child and adolescent analytic work.
Paula G Atkeson, Ph.D., is training and supervising analyst, supervisor in child analysis at the Baltimore Washington Institute for Psychoanalysis, co-chair, COPE Workshop/Study Group on Supervision in Child Analysis, co-editor of Teaching Effective Supervision in Child and Adolescent Analysis (in press).
Anita G. Schmukler, D.O., is a training and supervising analyst and supervisor in child analysis at the Philadelphia Center for Psychoanalysis; president of the Association for Child Psychoanalysis and a co-editor of Teaching Effective Supervision in Child and Adolescent Analysis.
We hope that by reaching a wider readership we are helping the supervisors, new and experienced, in the supervision of candidates in their work with child and adolescent analytic cases. We also hope that we have contributed to making the art and science of supervision a subject that will be taught and discussed within the institutes of the American Psychoanalytic Association and other training institutes as well.
While our work is under the general heading of child analysis, many of the areas of study we address are applicable to the work of supervisors of the analysis of adults as well. The study of finding ways to help supervisors work more effectively is clearly not intended exclusively for analysts who treat children and adolescents.