Supervision in Psychotherapy : Jenny Hill

I have been invited by my yoga teacher to write something about supervision, from the point of view of a Psychoanalytic psychotherapist (which is what I am). As supervision is given in my profession I have several years behind me of the process, both the receiving and the giving of supervision, of supervision groups and seminars and other quasi-supervision situations (e.g. supervising therapists in other fields).

The aim of supervision is to allow the practitioner to think with an experienced colleague (or qualified person) who is outside the intense atmosphere of the therapeutic session about what goes on in it, as remembered by the supervisee and paying particular attention to the levels of interaction that occur between therapist and patient. Such thinking about – which inevitably brings in feelings, emotions and reactions that are not necessarily rational or easy to understand – allows for reflection on the therapist’s own psychic input and affects in a non-judgemental way. It can be a very good learning situation (for both parties) as well as helping to free the therapist from projected material that the client may be, as it were, putting into him/her, usually unconsciously, and thereby to return to the next therapy session with at least a clearer mind and, with any luck, enhanced insight.

Yoga teachers, like doctors, (parents, teachers, etc) experience a good deal of such ‘transference’ from their clients. Without the capacity to take a longer view of the intimate work with patients the potential for burn-out and stress is ever present.

Having given this warm-up, I am going to talk, briefly, about a particular sort of ‘supervision’ situation: the Balint Group. This was a system initiated by Michael Balint, a psychoanalyst in the 1950’s and used by him and his wife for small groups of Gps. it continues to be used to this day.

Balint’s starting point was that at the centre of a Dr/patient consultation there is always a human relationship. Drs (you can read yoga therapist/teacher for Dr) are as variable as their patients; no two consultations are ever the same. Making a diagnosis is a small part of the work – a lot else occurs alongside. I should think that the everyday work of a yoga teacher, like that of a GP, is carried out at an interpersonal level where what the patient says and does is taken at face value and responded to in a pragmatic and straightforward way. At times this straightforward level of interaction is complicated by irrational and unconscious forces, which intrude into the relationship. The practitioner can be left feeling puzzled and uncertain what to do whilst the patient feels not helped or unsatisfied.

A Balint Group concentrates on the emotions aroused by a patient/ practitioner encounter and includes the practitioner within the view. Clinical observation, emotional response and the gaining and giving of therapeutic satisfaction are all mutual processes, the importance of which is understood by a good practitioner. There is also the recognition that, for a patient in distress, the very act of being in relationship with the therapist can in itself promote healing and change. The simple recognition and acceptance of the distress offered by the patient is felt by the practitioner.

The Balint Group provides a regular forum for thinking about such dynamics amongst a few colleagues. It relies on the inclusion of one member/facilitator who is trained in this way of thinking (probably psychoanalytically trained), with an awareness of unconscious processes. He/she is not in a ‘teacher’ role but is offering herself and her skills as facilitator, listener and commentator on the events in the consulting room that are brought to share with the group, by one member each time. Important conditions for the functioning of a group are: 1) the acceptance by all members of not knowing; willingness to stay with an idea without jumping to quick conclusions; toleration of uncertainty. 2) A personal narrative, whether by patient in the consulting room or practitioner in the group, is not necessarily ordered or sequential. Group members are asked to speak from memory rather than from written notes. 3) A willingness for self-exploration and to give all members in the context of discussion the time and encouragement to reflect on what things mean for them at their own depth and pace.

The benefits can be many: the opportunity to stand back from the consultation experience; increased tolerance of feelings of inadequacy, incoherence and not knowing; a cross-fertilisation of psychoanalytic ways of thinking with those of other practitioners about the patient/practitioner relationship; the stimulation of careful observation within the therapeutic consultation; the increased appreciation of the psychological dimension through observation of apparently trivial, meaningless phenomena; etc, etc …. To be a regular contributor to this sort of a work-group can be extremely rewarding and enriching as well as supporting with obvious consequences for the patient/practitioner work as well as personal benefits.

Jenny Hill. October, 2006