Search

The supervision agreement (also referred to as a contract), while long mentioned as an important part of psychoanalytic supervision, has yet to be addressed in any substantive or concrete way in the psychoanalytic supervision literature. What exactly is a psychoanalytic supervision agreement? Why does it matter? What are its components? How do you implement such an agreement? We consider these questions subsequently, our purpose being to accentuate the written (as opposed to verbal) psychoanalytic supervision agreement as central to (a) making increasingly probable a good supervision beginning and (b) providing a facilitative framework and anchoring container within which the work of supervision can be enabled. We propose that the written supervision agreement, while conceivably valuable at any stage of supervisee development, can be of greatest value to those beginning to provide psychoanalytic treatment services and receive psychoanalytic supervision (i.e. Novice phase supervisees). [ABSTRACT FROM AUTHOR]

When Covid-19 was declared a pandemic, most people felt helpless, fearful, and demoralized while health care workers put their own lives at risk to support and heal others. The uncertainties expressed by experts and the ambiguous and protracted nature of the pandemic compounded the sense of frustration caused by the scarcity of protective equipment and effective medications. This combination of factors led to exhaustion, burnout, and moral injury. As a result, mental health practitioners worldwide realized that health care staff needed to stay motivated and resilient. Our contribution in this regard was to start Balint groups throughout Iran, online, for a full year. We learned some lessons worth sharing. Our insights were wrapped around challenges but proved helpful to preserve the integrity of delivering medical services in times of crisis. [ABSTRACT FROM AUTHOR]

This special issue on community mental health focuses on the ways in which several innovative mental health programs across the United States have risen to the challenge of incorporating psychodynamic principles into their clinical practice. Contrasted with these domestic programs are reports from a number of countries in Europe, Latin America, and the Middle East in which local clinicians describe how community mental health programs in their countries are tackling these issues. In this introduction, we emphasize factors common to the populations these authors serve, the organizational challenges they face, and the successes they achieve by way of their skill, creativity, and perseverance. We underscore the ways in which they articulate how psychoanalytic thinking, training, and practices have evolved in response to lessons learned and changing political, economic and cultural climates. We conclude that applied psychoanalysis, and particularly psychoanalysis applied to community mental health has, in some ways, been at the forefront of change in psychoanalytic practice in general. The modifications made by those in community mental health are viewed as necessary accommodations for both the communities served and for the psychoanalytic enterprise itself. [ABSTRACT FROM AUTHOR]

I subsequently summarize the quintessentials of my talk, "Core Quintessentials of Psychoanalytic/Psychodynamic Supervisory Thought and Action: In Three Parts", presented to the British Association for Psychoanalytic/Psychodynamic Supervision, 8 October 2022. I give focus to three ever fundamental, foundational areas: (a) the anchoring convictions that ground my supervisory perspective (the supervision foundation upon which I stand); (b1) my search to identify the crucial commonalities that animate my own supervisory practice and perhaps bind us all together as supervisors (a common factors, common processes, common practices perspective); and (b2) my complementary effort to accordingly propose an explanatory framework within which those binding commonalities could be situated (the Contextual Psychoanalytic/Psychodynamic Supervision Relationship Model); and (c) my struggle to work at forever making culture an integral part of who I am, how I think, and how I act as a supervisor (striving to incorporate a multicultural orientation into my practice and bring the Cultural Third to life). I offer these personal sharings, my personal perspective (along with perspective-consistent references), in hopes of stimulating further reader reflection, dialogue, and conversation about these core matters of quintessential psychoanalytic/psychodynamic supervisory importance. [ABSTRACT FROM AUTHOR]

Abstract Background Little is known about the influence on outcome of exploration of the patient-therapist relationship (that is, transference work) in psychoanalytic psychotherapy. We hypothesized that depressed adolescents would have better long-term effects from psychoanalytic psychotherapy with than without transference work. Methods Depressed adolescent (16 to 18 years) were recruited in health authority funded out-patient clinics in Oslo and Vestfold County, Norway. They were randomized to 28 weeks of treatment with psychoanalytic psychotherapy with or without transference work. Change was assessed using linear-mixed models. The primary outcome measure was the Psychodynamic Functioning Scale (pre- post-, and 1-year post-treatment). Level of depression was measured at the same time points and during therapy (week 12, and 20). Results 69 adolescents were treated with (N = 39) or without (N = 31) transference work. The mean number of sessions was 18.6 (SD = 8,6) in the transference work group and 18.0 (SD = 10.9) in the non-transference work group. Both groups showed large and significant improvement on Psychodynamic Functioning Scale during the whole study period. The difference between the two groups was not significant during the treatment period (95% CI −.79 to 1.2, p = .674, F = .18), or from post-treatment to one-year follow-up (95% CI −.13 to .96; p = .134; F = 2.3). For the secondary outcome measures the transference work group had significantly better outcomes from 12 weeks in treatment to one-year follow-up (Beck Depression Inventory, 95% CI − 1.7 to −.14, p = .022; Montgomery and Åsberg Depression Rating Scale, 95% CI − 1.6 to −.23, p = .009). Conclusion The findings suggest that exploration of the adolescents’ relations to the therapist amplify the effects of short-term psychoanalytic psychotherapy on their depressive symptoms for adolescents with a Major Depressive Disorder. Trial registration ClinicalTrials.gov . Id: NCT01531101 . Registered 8 February 2012.

Background: Little is known about the influence on outcome of exploration of the patient-therapist relationship (that is, transference work) in psychoanalytic psychotherapy. We hypothesized that depressed adolescents would have better long-term effects from psychoanalytic psychotherapy with than without transference work. Methods: Depressed adolescent (16 to 18 years) were recruited in health authority funded out-patient clinics in Oslo and Vestfold County, Norway. They were randomized to 28 weeks of treatment with psychoanalytic psychotherapy with or without transference work. Change was assessed using linear-mixed models. The primary outcome measure was the Psychodynamic Functioning Scale (pre- post-, and 1-year post-treatment). Level of depression was measured at the same time points and during therapy (week 12, and 20). Results: 69 adolescents were treated with (N = 39) or without (N = 31) transference work. The mean number of sessions was 18.6 (SD = 8,6) in the transference work group and 18.0 (SD = 10.9) in the non-transference work group. Both groups showed large and significant improvement on Psychodynamic Functioning Scale during the whole study period. The difference between the two groups was not significant during the treatment period (95% CI −.79 to 1.2, p =.674, F =.18), or from post-treatment to one-year follow-up (95% CI −.13 to.96; p =.134; F = 2.3). For the secondary outcome measures the transference work group had significantly better outcomes from 12 weeks in treatment to one-year follow-up (Beck Depression Inventory, 95% CI − 1.7 to −.14, p =.022; Montgomery and Åsberg Depression Rating Scale, 95% CI − 1.6 to −.23, p =.009). Conclusion: The findings suggest that exploration of the adolescents' relations to the therapist amplify the effects of short-term psychoanalytic psychotherapy on their depressive symptoms for adolescents with a Major Depressive Disorder. Trial registration: ClinicalTrials.gov. Id: NCT01531101. Registered 8 February 2012. [ABSTRACT FROM AUTHOR]

What are the binding commonalities that demark and define any and all psychoanalytic supervision perspectives? What do we all do as psychoanalytic supervisors that practically matters? Furthermore, might there be a unifying model that anchors those binding commonalities together into a supervision meaning-making, explanatory framework? In this two-part paper, I take up those questions. In Part I, based on a century-spanning literature review, I identify 50 (non-exhaustive) common Support and Learning factors that appear present across the panoply of psychoanalytic supervision perspectives. Relational, educational, and interventional, these 50 factors reflect the very stuff of which psychoanalytic supervision is made. In Part II, I present and elaborate upon the Contextual Psychoanalytic Supervision Relationship Model (CPSRM) – a theoretically-grounded model that anchors and contextualizes those common Support and Learning factors. Because common factors can be seen as nothing more than atheoretical amalgamation (i.e., lists of desirable characteristics endlessly strung together), the CPSRM is proposed as a theoretically-based antidote. A supervisory extrapolation of Wampold's contextual psychotherapy relationship model, the CPSRM accentuates relational connection, expectations/goals, and educational action as preeminently supervisee change inducing and learner affecting. [ABSTRACT FROM AUTHOR]

Having now completed its first century, psychoanalytic supervision has been and continues to be regarded as the cornerstone of psychoanalytic education; it is the primary means by which (1) psychoanalytic ideology becomes translated into practical product, and (2) budding analytic practitioners develop and grow in their therapeutic skills and professional identity. The supreme significance of supervision in contributing to the “making” of the competent psychoanalytic practitioner now seems a widely accepted given, even axiomatic. But as its second century gets underway, what have we learned from psychoanalytic supervision's first 100 years? What are its most pressing needs and, in turn, impressing possibilities at this time? And what needs to most change if psychoanalytic supervision is to most profitably advance in the years and decades ahead? In this paper, I would like to consider those questions, giving focus to five needs that seem to most require attention now: (1) making the practice of psychoanalytic treatment an increasingly competency-based, concretized learning affair; (2) enhancing the efficacy of supervisors through competency-based practice and training in psychoanalytic supervision; (3) more effectively incorporating existing technology and emerging technological advances into supervision and using them to enhance the psychoanalytic learning process; (4) better attending to matters of difference and diversity, and striving to seamlessly integrate them into the conceptualization and conduct of the psychoanalytic supervision experience; and (5) vigorously researching the psychoanalytic supervision process and working to establish an evidence base for supervisory practice. [ABSTRACT FROM PUBLISHER]

In this brief communication, we offer one perspective - the contextual psychoanalytic supervision model (CPSM) - on how psychoanalytic supervision works. The CPSM, a supervisory extrapolation of Wampold's contextual psychotherapy relationship model, accentuates four psychoanalytic supervisor-supervisee relationship variables as crucial and change inducing: the learning alliance bond, supervisor-supervisee real relationship, creating supervision expectations/providing an expectation-consistent form of supervision, and the supervisee's engagement in facilitative educational actions. The CPSM is presented in hopes of stimulating further discussion about what makes psychoanalytic supervision work. [ABSTRACT FROM AUTHOR]

Although establishing an evidence base for psychoanalytic practice has become a matter of increasing practical and accountability concern, the establishment of an evidence base for psychoanalytic supervision has yet to be given any consideration. In establishing a more comprehensive evidence-informed approach to treatment and training, the corollary need to build an evidence base for psychoanalytic treatment supervision would accordingly seem an important next step to address. What research supports the use of psychoanalytically informed constructs in supervision? With that research base considered, is there any sort of an evidence base for psychoanalytic supervision practice itself? In this paper, I would like to examine those two questions, giving particular attention to two psychoanalytically derived variables of supervision import: the supervisory alliance and parallel process. Based on research review, data thus far provide a high degree of empirical support for the supervisory alliance as perhaps being the crucial fundamental and foundational variable in making supervision work or not. While comparatively far more limited and less robust in nature, data about parallel process offer a tentative degree of support for that construct's importance in supervision as well. While still only in its most formative period, we at least appear to have an informed and informing evidence base for psychoanalytic supervision beginning to take more substantial shape. [ABSTRACT FROM AUTHOR]

The initial reactions to a bipolar disorder diagnosis of research participants in a small, qualitative study consisted of astonishment, dread of being mad, and extremely negative associations. All had prior mental health diagnoses, including episodes of severe depression (all but one) and alcoholism (one). All participants reported mental health histories prediagnosis and most had spent years contending with mental health labels, medications, symptoms, and hospitalizations. In addition, most participants were highly educated health professionals, quite familiar with the behaviors that the medical system considered to comprise bipolar disorder. Their negative associations to the initial bipolar disorder diagnosis, therefore, appeared inconsistent with their mental health histories and professional knowledge. This article contextualizes these initial reactions of shock and distress and proposes interpretations of these findings from societal and psychodynamic group relations perspectives. The participants’ initial negative reactions are conceptualized as involving the terror of being transported from the group of normal people into the group of mad or crazy people, i.e., people with mental illnesses, who may constitute a societal denigrated other.

The difficulties in conducting psychodynamic psychotherapy research are well documented. More recent meta-analyses have demonstrated clear benefits; however, it has been argued that naturalistic studies are of more direct relevance to clinical services. UK National Health Services ( NHS) provide psychodynamic psychotherapy within psychiatric settings for heterogeneous and generally complex patient populations. Much of the psychodynamic psychotherapy is provided by trainee psychiatrists who rarely have prior experience of delivering such therapy, but who are supervised by senior staff. Our naturalistic outcome study uses both quantitative and qualitative methodology, and describes a symptomatically and functionally impaired patient group (n = 384) deriving significant and clinically meaningful benefit from their therapy. Patient satisfaction and perceived change were positively correlated with each other and with symptomatic improvement. Patients' descriptive comments provided additional rich information, most commonly describing a positive outcome for therapy and the belief that therapy was too short. This study complements more formal research showing that psychodynamic psychotherapy is efficacious in outpatient settings. [ABSTRACT FROM AUTHOR]

This article explores the concomitant change in one client's object relations and his image of God that occurred in the context of psychoanalytically oriented psychotherapy. The case demonstrates the benefit of long-term psychoanalytically oriented treatment to help an individual with major mental illness to heal emotionally, mentally, and spiritually. The client, who suffers from bipolar I disorder, experienced significant developmental mastery as he moved from the paranoid/schizoid position to the depressive position (developmental stages conceptualized by theorists Melanie Klein and Douglas Fairbairn). In addition, the psychotherapy mitigated the effects of homonegativity on M's self-image and his experience of his homosexuality. Through our work, the client began to see and interact with this clinical social worker, others, and the God of his understanding, in a more realistic and healthy manner. M's participation in a 12-Step group and his adherence to its beliefs augmented changes he made through psychotherapy. Through a long-term psychoanalytically oriented psychotherapy and involvement in Al-Anon meetings, the client's belief in a punishing God shifted toward a more benevolent one-a God who had a plan for his life that was revealed through the transformation of his suffering. In summary, M's object relations changed toward a greater balance of emotions and development of more textured relationships, including his relationship toward himself and God. [ABSTRACT FROM AUTHOR]

This paper outlines the use of weekly psychodynamically-informed groups on inpatient acute wards. The authors run inpatient groups with nurses as co-therapists. The structure of such psychodynamic groups is outlined along with the use of 'here and now' interpretations and enactments. Psychodynamic concepts such as projection, denial and counter-transference are described and their use in working with paranoia and grandiosity. The authors illustrate the use of these concepts within their groupwork and provide case material that shows how these concepts can be applied in the inpatient setting. [ABSTRACT FROM AUTHOR]

Failure to establish or sustain intimacy is a major reason most patients give for entering therapy, and this is especially so for group therapy. Their hope is that through the here-and-now nature of the group, the peer feedback from the group, and the development of interpersonal dynamics within the group, an atmosphere will be created in which issues of trust and intimacy can be safely explored and worked through. After a brief review of the literature on the subject, case material will be used from the presenter's practice, notably excerpts from a session of a long-term (25 years) analytic therapy group illustrating members' attempts to establish and foster intimacy on the one hand, and to defend against and avoid it, on the other. Discussion will focus on the identification of mechanisms that encourage or deter the development of intimacy. [ABSTRACT FROM PUBLISHER]