Three Associating: Adventures in Relational Psychoanalytic Supervision

In this episode, Andrew gives new meaning to Winnicott's idea of “playing with reality” as he tries to help his patient into a more social reality through the medium of play. In the session, Andrew⁠ and Gill reflect together on the fact that in a long-term therapy both the patient and the therapist develop beyond where they started and that the match between them needs to be re-thought in the light of this. In the beginning of the supervision, Andrew⁠ finds himself making a division in his head between work and play but then comes to realise that while the play is the work, there nevertheless is still room to transform the mode of play. In this way, the possibility of thinking about elided topics such as sexuality opens up. In addition, there is an opening up to a more enlivened way of working in the transference.

In this episode, Rachael works with a young woman who is desperate to find the right man and equally desperate to find a failsafe way to make a good choice. A prolific consumer of social media, she scours all the information about red flags that are meant to help someone spot a narcissist (e.g. lovebombing, gaslighting, self-centredness). She appeals to Rachael to assist in this endeavour of constructing and applying lists of red flags. Rachael tries to shift the agenda to fostering agency, but to no avail. In supervision, Gill asks a series of questions which leads Rachael to her own conclusion that her own narcissism constellated around the “need to know”. A common dynamic in therapists is implicated in this therapeutic impasse.

In this session, Andrew is confused by why Amber, an anorexic adolescent woman, is so silent in session when she chats easily with other team members. Andrew is sidetracked both by his anxiety about his position in the team and his anxiety that he is getting it wrong. In supervision, Andrew comes to understand that his different treatment by Amber may signal something positive including Amber's emerging desires for male attention. He explores how safety for both him and Amber may lie in introducing material that can cut across the intensity of the therapeutic couple while, paradoxically and at the same time, detaching himself from his persecutory anxieties about the team which interfere with his focus on Amber.

In this episode, Rachael⁠ revisits the complex feelings that child sexual abuse evoke in both patient and therapist. Rachael discovers that her wish for magic powers has not disappeared and has reappeared in a different form. Beyond this, Rachael contacts both the magic and the terror of the therapeutic journey itself and the loneliness this sometimes produces in the therapist. Both Gill and Rachael conclude that while trauma itself is to be regretted, the person that we emerge as in the wake of trauma is to be embraced as a crucial and valuable aspect of our autobiography.

In this episode, Rachael approaches the taboo of sexual attraction in therapy and its tendency to lead to dysregulation, involuntary self-disclosure, and shame. Rachael's feelings unduly amplify her self-consciousness, complicating the ongoing therapeutic task of understanding her and her patient's contribution to the co-construction of their relational field. After engaging Rachael in a discussion of the reality/fantasy divide and the difference between voluntary and involuntary self disclosure, Gill invites a recourse to theory both as a stabilising force in the choppy waters of the embodied and as a way of retaining the boundaries of supervision versus therapy.

Rachael comes to realise that feeling provoked by the patient’s apparent self-centredness in enactments that occur in the waiting room and in the session has led to a wish to be provocative in return. She first enjoys then tussles with revenge fantasies. By talking through these fantasies and owning their pleasure, she recognises their meaning, and this opens up multiple perspectives.