The PANY Bulletin

Psychoanalytic Association of New York
Vol. 40, #2, Summer 2002

Some Reflections on Supervision of
Training Analysts

After many personal and professional experiences gathered over quite some time, I have recognized now more than ever the need for ongoing peer supervision for training analysts and graduate analysts in the psychoanalyses they conduct. Yet there seems to be no system in place for this at psychoanalytic institutes, and I only once heard of a training analyst arranging a consultation for peer input. The Institute’s Faculty Manual (March, 2002, page 7) states, “any training analyst is free to seek out consultation at any time”. That is hardly a strong endorsement of ongoing consultation for all analyses. One might call upon a large body of literature to support the idea that supervision or consultation in analytic practice should not come to an end, but for this brief note, let us look at just two current pieces.

In the PANY Bulletin (Volume 40, Number 1, Spring 2002, 11-14) Alice Maher wrote of the dangers inherent in this “potent medical treatment.” She said that “lack of benefit”, side effects and death rates of psychoanalysis are rarely examined, and, she gave a few examples of treatments gone terribly awry. Dr. Maher suggested a more detailed informed consent, and, the need for a mechanism for addressing side effects that may emerge during treatment.

In the April, 2002 issue of the International Journal of Psychoanalysis (Volume 83, Part 2, 339-350), Judy Kantrowitz wrote that

"After formal training ends, there is no built-in expectation that analyses will be discussed. Analyses then may remain totally private communications between patient and analyst, subject to the strengths and limitations of the particular pair. Unless analysts find a format to discuss their cases, such as a peer supervision group, a mutual supervision with a colleague on a regular basis or an ongoing consultative relationship, there are likely to be areas of blind spots in some aspect of their analytic work."

These recently published words of Maher and Kantrowitz resonate with me because of my own experience with my training analyst, anecdotal evidence I have heard about others’ analyses and my experience as a psychoanalyst.

I myself worked with my training analyst’s aggressive style as best I could, and did make great progress in our work together. A lot of this work actually entailed analyzing the rage I felt towards him/her. I felt much gratitude for the gains I achieved, which had a positive impact on my life. However, I interrupted my personal analysis when I recognized that the tactlessness and emotional distancing in my analyst would interfere with our freedom to do further work together. It is difficult to fully trust someone with a punitive or authoritarian style. Later I began hearing through the grapevine of other candidates dropping out of treatments. I found this deeply disturbing, for it forced me to put my profound personal disappointment into a much broader context of the missed opportunities of many hopeful analysands. Would a steady stream of candidates be referred to psychoanalysts who cannot connect deeply enough to allow a full analytic process to unfold, without having this limitation addressed through further supervision? Supervision might have adequately addressed the issues that ultimately led to these interruptions. It seems this is a systemic problem of grave consequence, unidentified by psychoanalytic institutes, and not addressed in any way.

In the same article, Kantrowitz wrote,

"Many analysts have always maintained some form of ongoing dialogues with other analysts. These discussions take place in many different formats. Some analysts have peer groups that have met for years. Other analysts engage in a mutual supervision which, over time, may have many similarities to mutual analysis in that they focus on each others blind spots. Many other analysts prefer to maintain a more formal consultation relationship; this may be a planned, ongoing arrangement or a more infrequently initiated contact."

The consultant offers a perspective on the analytic process from outside the dyad. Some aspects of the transference-countertransference interplay can best be understood from that position. The supervisor then plays an active role in discussing this viewpoint with the analyst. The analyst will only see other aspects when describing the case and attempting to look at the treatment through the eyes of the supervisor. The supervisor’s presence is the significant factor then, even as she/he is less active.

One reason that this need has not been addressed adequately to date is that we are loath to interfere in any way with the complete confidentiality of our patients, particularly our patients in the psychoanalytic field. This concern applies particularly to candidates, who must feel their privacy is protected, and who may be known to potential supervisors. Therefore, our patients who work in the field should know that we, as responsible psychoanalysts, would be seeking peer review from time to time, and that this will be done with discretion, in disguised form, with the consultant abiding by the strictest standards of confidentiality.

Upon considerable reflection, and taking into account confidentiality concerns, I would like to add to Dr. Kantrowitz’s and Dr. Maher’s recent observations in the following conclusion. Ongoing peer supervision of some sort needs to become a mandatory expectation for all graduates of the Institute, including training analysts. I personally have found such consultation to be extremely helpful. This supervision can be informal or formal, regularly or irregularly scheduled, individual or group, according to the preferences of the analyst. The expectation that there must be “checking in” with trusted colleagues from time to time on how things are going in all analytic cases should be instilled within the culture of this professional community. We have an obligation to acknowledge our accountability in this matter, for we must recognize that within the human heart, the impulse to control, intrude, seduce or enact, without the outside observer’s influence, can be great and, sometimes, unfettered.

Editor: The author preferred to publish this anonymously to prevent any possible identification of the analyst described.