The COPE Study Group on Impasses in Supervision has been working together more than nine years, in tandem with a discussion group on impasses in psychoanalysis, which is open to registrants at each of the national meetings. A number of candidates or recent graduates who presented cases to our impasses in psychoanalysis discussion group, in the course of presenting, began to recognize supervision had played a role in the difficulties they were having with the cases. Some of these presenters then came to our COPE group to discuss with us what they had come to recognize as the part supervision had played in their difficulties.
In a number of instances, we found the engagement with the supervisor had become unproductive or, even worse, destructive, especially if it occurred early in the analyst's career. Presenting in both settings seemed to expand these young analysts' thinking. It helped them, and us, appreciate the complexity of a process in which issues of conflict and defense were being played out among the candidate, patient and supervisor. What additionally often became clear was that there were difficulties occurring within the organizational structure of the institute contributing to these problems. We thought of this as a supervisory “quartet” consisting of patient, analyst, supervisor and institutional setting. Really striking to us was that these complex situations, which had initially been perceived by the candidate as primarily an impasse in the analysis, became more layered and complicated as they described the work. The role of supervision and what was occurring at the institute newly arose in the candidates' awareness as they presented their cases. In the few situations when candidates were aware of difficulties in supervision, neither supervisor nor candidate had addressed the issue explicitly.
We thought of this as a supervisory “quartet” consisting of patient, analyst, supervisor and institutional setting.
When supervisors brought concerns about impasses in supervision to our COPE group, they were more likely to have tried to address their concerns with the candidates. The situations they presented had great variety, such as the candidate seemed unsuited for analytic work, instances where a specific conflict was being enacted in the supervision, and where the supervisor was able to find a way to work this out with the candidate, and instances when the interplay of the specific conflicts of the candidate, patient and supervisor led to the stalemate. In this latter situation, the supervisor sought consultation for herself to open up the impasse. Sometime the difficulties the candidates presented seemed so deeply rooted in their own conflicts and characters they were unable to productively engage in a supervisory process. This situation posed a specific challenge since the supervisor did not want, nor did it seem advisable, to take over any of the analyst's function. But this extreme example led us to discuss the more general, and less dramatic, instances in which impasses seem to arise when candidate's conflicts overlap with an area central to the patient's and/or the supervisor's difficulties. We began to explore ways in which we as supervisors could be helpful in addressing such situations.
We will continue both our discussion group on impasses in analysis and our COPE group on supervision. These presentations and discussions of supervisory impasses serve as an educational opportunity for both the presenter and the participants. We have learned a great deal in the process of these discussions. While we believe we can offer a consultative function, we are also impressed how much the presenter comes to learn in the process of preparing and presenting the impasse. In our impasse discussion group, what has been striking to us is the presenter begins to realize something new about him or herself that has contributed to the case being stalled. The nature of this difficulty is highly individual; it differs in each case and is related to the way this aspect of the analyst intersects with the patient. It is as if we are seeing “splits” within individuals played out in an interpersonal field.
Judy L. Kantrowitz, Ph.D., chair of the COPE Study Group on Impasses in Supervision, is a training and supervising analyst at the Boston Psychoanalytic Institute and an associate clinical professor of psychology in the Department of Psychiatry, Harvard Medical School.
Steven Goldberg, M.D., Study Group on Impasses in Supervision co-chair, is training and supervising analyst, San Francisco Center for Psychoanalysis; personal and supervising analyst, Psychoanalytic Institute of Northern California; in private practice of psychoanalysis and psychotherapy in San Francisco.
In supervision, we have examples of a similar pattern occurring, especially when supervisees present their dilemmas. But sometimes, supervisors describe a similar process, though they are less apt to make such discoveries in our presence. So we wonder whether these differences are primarily due to supervisors being more experienced and already much more familiar with their conflicts and vulnerabilities and/or less inclined to reveal their vulnerabilities to their peers, especially in a group setting. Our intent has been to try to help normalize the experiences of impasses, to see them as revealing important aspects of some difficulty in action when it has not yet been understood consciously. We hope supervisees and supervisors will view us as a resource to aid in making the nature of these impasses conscious and thereby loosening their hold.
We are writing a casebook using examples that have been presented to us. Three chapters are in the final stages. Another two are in process. Three are supervisors' accounts of impasses and two are by candidates. We hope our casebook, once completed, will aid our endeavor to better understand the nature of supervisory impasses, how they develop and how they can be resolved.