On the Presence and Absence of Supervisors.

The presence or absence of another person, and the relationship between these two contradictory and complementary relational phenomena, significantly influence people's emotional experiences and developmental processes. These phenomena are often intertwined and in continuous dialectic with each other, thereby creating relational paradoxes in infant-parent, patient-therapist, and supervisee-supervisor relationships. Similar to other relational paradoxes, those created in supervision by supervisors' intermittent presence, cannot and should not be resolved, but have to be comprehended and accepted by both partners, preferably through negotiating their meanings. Negotiations help supervisees to contain contradictory supervisory realities, to internalize integrated aspects of their supervisors, and to include other identification figures, thereby creating durable and resilient "internal supervisors" that mold their clinical analytic selves. Negotiations of these paradoxes also help supervisors to renounce an omnipotent and potentially destructive fantasy of being ever-present for their supervisees.

Observations on the Centrality of Security in Psychoanalytic Supervision: A View from the Interpersonal Tradition and Attachment Perspective.

Using theoretical concepts from the Interpersonal tradition in psychoanalysis and supported by findings from the attachment literature, the utility of attending to the issue of psychological security in supervision is considered for its potential to enable increased capacities for conducting psychoanalytic treatment.

Reflections on Supervision.

This paper explores basic tasks involved in the supervisory process, and frequent problems in carrying out these tasks. Basic tasks include clarification of mutual expectations of supervisor and supervisee; the establishment of mutual trust as fundamental for countertransference analysis; "parallel process" exploration and clarification of explicit and implicit theoretical assumptions by both supervisor and supervisee. Frequent problems include the extent of initial evaluation of patients; problems of intervening "without memory or desire"; transference and countertransference diagnoses and interpretive consequences; clarification of affective dominance; interventive shifts with severe psychopathology, and realistic goals of patient, supervisee and supervisor. Limitations to supervision include specific psychopathologies, cognitive limitations, and a generally restricted capacity for empathy by the supervisee.

Supervision for our times: countertransference and the rich legacy of the Budapest School.

In this paper I ask what an investigation of the Budapest model of supervision may add to our psychoanalytic imagination. The Budapest model confronts us with a number of crucial questions for contemporary psychoanalysis, including the question of envisioning ways of working on the countertransference of the analyst. I discuss the lack of memory that surrounds the Budapest model, and I read it in relation to the unsettling issues it stirs up, including those of authority, horizontality, and the ethics of psychoanalysis. In the Budapest model, supervision can be seen as a form of "double dreaming" or of "dreaming up of a dream". In particular, in drawing on the writings of Sándor Ferenczi and Michael Balint, I point to some principles behind the Budapest model and to the epistemic, technical, and ethical implications of their ideas. I also work toward a Ferenczian "translation" of the idea of "parallel process".

Essential elements of the work of a supervisor.

The supervisor's prime task is to consider from the very beginning the analytic ability of the analyst presenting the case; this can be assessed by observing how the colleague transcribes the clinical material and describes what is meaningful in the session. It is extremely important to understand whether the patient's suffering is neurotic, or whether he suffers from an initial psychotic disorder. In this latter case, the analyst will know that he cannot employ the same tools that he uses for the neurotic patient. It is fundamental to draw careful attention to the importance of the patient's personal history. In the process of reconstructing the past, the patient's difficulties are gradually understood by the analyst, the patient and the supervisor. Given that a memory may be distorted by present emotions and conflicts, the analyst must form meaningful hypotheses that, through reconstructing interaction with the original objects, help to comprehend the precarious equilibrium of the present. Over the course of supervision, I consistently emphasize the construction of the analytic relationship, which is based on the analyst's mind and of the patient's ability to communicate emotionally, so as to promote the analysand's mental growth.

WHAT'S NEW IN PARALLEL PROCESS? THE EVOLUTION OF SUPERVISION'S SIGNATURE PHENOMENON.

The concept of parallel process has played a central role in psychoanalytic supervision for the last 60 years, generating continuing interest in the power of the unconscious to create unexpected intersections between the analytic and supervisory relationships. I track the evolution of the concept, starting with its invention by an interpersonalist psychoanalyst, adoption by two ego psychologists, enrichment by object relations theory, and, finally, redefinition as a multi-directional dynamic by relational psychoanalysts. I then further elaborate the relational view of parallel process, illustrating its complex, multidirectional nature with an extended vignette. I discuss the relationship of enactment to parallel process and illustrate the usefulness of supervisory consultation when enactments that parallel into the supervisory relationship lead to impasse. Finally, I point to educational and neuropsychological research that suggests that working with parallel process is good pedagogy.

Creating and Elaborating the Cultural Third: A Doers-Doing with Perspective on Psychoanalytic Supervision.

Although recognized as highly crucial to supervision practice (e.g., Tummala-Narra, 2004), culture has been addressed minimally in the psychoanalytic supervision literature. Calls to remedy that limitation have been made and making culture matter has been identified as a most pressing need for psychoanalytic supervision. But how then do we as supervisors go about doing that? How might we better position culture in, and make culture central to, our psychoanalytic supervisory conceptualization and conduct? We subsequently take up those questions, expanding upon our earlier proposals about cultural humility and the Cultural Third (Watkins and Hook, 2016) by (a) proposing a tripartite multicultural perspective (i.e., cultural humility-cultural comfort-cultural opportunities) as supervision sine qua non; (b) using recognition theory as a way to better understand that very process of Third creation and elaboration; and (c) providing a rupture/repair case example that shows efforts to create and build the Cultural Third in supervision. The Cultural Third is conceptualized as a product of doers-doing with so as to culturally learn together through "not knowing".

Effects of Functional Analytic Psychotherapy Therapist Training on Therapist Factors Among Therapist Trainees in Singapore: A Randomized Controlled Trial.

Functional Analytic Psychotherapy (FAP) is a behavioral psychotherapy intervention that emphasizes the development of an intimate and intense therapeutic relationship as the vehicle of therapeutic change. Recently, research has provided preliminary support for a FAP therapist training (FAPTT) protocol in enhancing FAP competency. The present study aimed to expand on this research by examining the effects of FAPTT on FAP-specific skills and competencies and a set of broadly desirable therapist qualities (labelled awareness, courage and love in FAPTT) in a sample of therapist trainees in Singapore. The study also evaluated the feasibility and acceptability of FAP in the Singaporean context. Twenty-five students enrolled in a master's in clinical psychology program were recruited and randomly assigned to receive either eight weekly sessions of a FAPTT course or to a waitlist condition. All participants completed measures assessing empathy, compassionate love, trait mindfulness, authenticity and FAP-specific skills and competencies pre- and post-training, and at 2-month follow-up. A post-course evaluation was administered to obtain participants' qualitative feedback. Results indicated that compared with the waitlisted group, FAPTT participants reported significant increases in overall empathy, FAP skill and treatment acceptability from pre- to post-training. Improvements were observed on several outcome variables at 2-month follow-up. Participants reported finding the training to be both feasible and acceptable, although several raised issues related to the compatibility of the treatment with the local cultural context. Overall, the findings suggest that FAPTT is effective for improving specific FAP competencies and selected broadly desirable therapist qualities among therapist trainees. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Functional Analytic Therapy (FAP) therapist training protocol was effective in improving empathy and FAP skills among Singaporean therapist trainees. These improvements were maintained at 2-month follow-up. The training was found to be acceptable in the Singaporean context, although several adaptations were suggested to increase the compatibility between FAP principles and local cultural norms.

The evolution of psychoanalytic thought: a brief view through the lens of Western art and history: Freud and beyond.

OBJECTIVE: The aim of this paper is to explore the diversity and progress in psychoanalysis and psychotherapy post-Sigmund Freud from the perspective of Western art. Since 1900 the shift from one-person psychology to the more contemporary two-person psychology is reflected in the creativity of artists, particularly in their depiction of the mother-infant relationship. CONCLUSION: An alternative perspective in understanding the evolution of Man's nature can be drawn from a discourse between art, history and psychoanalytic thought. Using art as evidence that reflects concurrent changes in psychoanalytic thought is a stimulating way to engage trainee psychiatrists and psychiatrists in their exploration of human nature.

Practicing Psychoanalysis and Psychodynamic Psychotherapies in Developing Societies.

Vital to the contemporary exercise of psychiatry is the biopsychosocial approach, with psychotherapy as its well-defined, and requisite, constituent. The key objectives of psychoanalysis and other related therapies are the amelioration of symptoms and modification of character by probing the unconscious. But the practice of psychoanalysis and similar insight-oriented techniques is in developing nations is different from developed countries due to cultural and educational reasons, along with a shortage of required facilities. The result often is ignorance of exploratory techniques and the substitution of approaches, such cognitive and behavior therapies, which operate at the conscious and subconscious levels of mind. Additionally, decreased implementation of psychotherapy by psychiatrists in industrialized countries may discourage its use by therapists in developing societies. This article is devoted to developing, traditional, or conservative societies and the obstacles confronted in the progression of applied (clinical) psychoanalysis and related methods in the classroom and practice. Possible solutions also are discussed briefly.

A SPECIAL LEARNING EXPERIENCE ABOUT TRANSFERENCE AND COUNTERTRANSFERENCE DYNAMICS AT THE BEGINNING OF MY PSYCHOANALYTIC TRAINING(.).

Drawing upon his description of the early phases of the analysis of the second case of official supervision, the author illustrates in his work why this experience became a foundational moment in his formative trajectory as a psychoanalyst. Three important aspects are discussed: (1) the significant role his supervisor played in helping to manage and to confront the difficult dynamics of transference and countertransference that characterized the author's early years of analytic work with patients; (2) the transformative factors that opened up new avenues in the repetition and the original traumatic pathology put forward at great length by the patient; and (3) the making contact for the first time with that area of inter/intrapsychic phenomena that the author has since then explored widely and theorized about, under the name of relational dynamics governed by role-reversal.

Neuroscience in the residency curriculum: the psychoanalytic psychotherapy perspective.

Educators of future psychiatrists tend to teach an array of approaches to the mind and brain, including among them the neurobiologic perspective and the psychoanalytic perspective. These may be considered at opposite ends of many spectra, including the fact that psychoanalysis takes a large-scale and treatment-oriented perspective and has helped countless patients over the years, while neuroscience has tended to be reductionistic, focused on understanding, and has helped very few people. A tension, therefore, exists for the educator in teaching neuroscience: is it wise to spend valuable time and energy teaching this interesting but, thus far, impractical field to future practitioners? Here, we argue that neuroscience is re-orienting itself towards more psychoanalytically relevant questions and is likely, in future years, to give new insights into the nature of basic drives and social relations. We additionally argue for balance on the part of providers in both acknowledging biologic underpinnings for clinical phenomena and yet continuing to take a stance oriented towards appropriate change. Given the burgeoning new focus within neuroscience on topics directly relating to the human internal experience and the novel challenges in both understanding those advances and appropriately using them, we encourage educators to continue to give future psychiatrists the educational foundation they need to follow neuroscientific discoveries into the future.

Toward a Psychoanalytic Way-of-Being in the Game of Life: Discussion of a Paper by Steven Ablon.

There are no clinical techniques not always already embedded within a psychoanalyst's way-of-being-in-the-world. This claim, grounded in the author's reading of Steven Ablon's "What Child Analysis Can Teach Us about Psychoanalytic Technique" (in this volume), takes us to Ablon's exemplary psychoanalytic comportment, with a particular focus on poetics, playfulness, practicality, and pluralism. These complex, intertwined features of child psychoanalysis have had a broad and deep impact on contemporary adult psychoanalysis, influencing praxis, conceptions of therapeutic action, ethics, and workaday worldview.

What Child Analysis Can Teach Us about Psychoanalytic Technique.

Child analysis has much to teach us about analytic technique. Children have an innate, developmentally driven sense of analytic process. Children in analysis underscore the importance of an understanding and belief in the therapeutic action of play, the provisional aspects of play, and that not all play will be understood. Each analysis requires learning a new play signature that is constantly reorganized. Child analysis emphasizes the emergence and integration of dissociated states, the negotiation of self-other relationships, the importance of co-creation, and the child's awareness of the analyst's sensibility. Child analysis highlights the robust nature of transference and how working through and repairing is related to the initiation of coordinated patterns of high predictability in the context of deep attachments. I will illustrate these and other ideas in the description of the analysis of a nine-year-old boy.

Being with the patient: the use of "clinical evidence," reconsidered.

Our objective was to review the use in psychiatry of data arising from interaction with the patient, here called "clinical evidence." We conducted a clinical and historical review. Data from interactions with patients are increasingly marginalized in psychiatry, even as interactional data have an increasing role elsewhere in healthcare. Recommendations for training, clinical care, and administration are made.

[Initial training in psychotherapy for psychiatrists in France: results of a national survey]. / La formation aux psychothérapies des internes de psychiatrie en France : résultats d'une enquête nationale.

INTRODUCTION: According to a recent change in the French legislation (2010) regarding the regulation of the use of the title of "psychotherapist", psychiatrists are now allowed to use this title at the end of their training, without any additional training. However, various publications from 2000 have shown that there is no specific training in psychotherapy at a professional level during the training of psychiatrists. GOALS: To study the current situation of the Academic training of French psychiatrists in psychotherapy during their residency, their interest for these therapies, their level of satisfaction regarding their training, and the importance of additional private training programs. METHODOLOGY: A survey was carried out among residents in psychiatry from October 2010 until January 2011. An anonymous questionnaire covering five domains (academic teaching, psychoanalysis, extra-academic training, interest in a more developed model of training, supervision) was sent by the French Federative Association of Psychiatrists Trainees (AFFEP) to all French psychiatrist trainees, through their local trainee associations (n=26). RESULTS: The questionnaire was answered by 869 of the 1334 psychiatry residents (65%). The vast majority of the trainees reported being interested in psychotherapy, but 75% thought that their training in psychotherapy (psychoanalysis, cognitive-behavioral therapy [CBT] and systemic therapy) is insufficient. In 20 of the 26 universities, more than half of the trainees reported that their training was insufficient in the three fields; in four universities, more than half of the trainees were satisfied with at least one field. Yet, satisfaction rates were very different among universities: for example, 27% were satisfied with their psychoanalytic training in Paris and 87% in Strasbourg; 7% were satisfied with their CBT training in Strasbourg, but 65% in Nice. The vast majority (97%) believes that supervision about therapeutic relationship is necessary during residency rotations in the hospital. More than three quarters (78%) would like to have supervision at least twice a month. Yet, only 51% of respondents have such supervision. Once again, large disparities were observed between different Academies: for example 74% had supervision in Montpellier, but only 29% in Marseille. The vast majority (95%) of trainees would like a two-phase model of training (general theoretical teaching plus in-depth training in one or more methods), which is different to the current training model. CONCLUSION: Our results show a clear discrepancy between the importance of training in psychotherapy for psychiatrists, the interest of psychiatry students for these therapies, and the very high rate of dissatisfaction for the training received, as well as the rate of students supervised during their training period at the hospital. These results differ from what is observed in other countries, where satisfaction rates are much higher among students, and various psychotherapy training methods are proposed in a much more homogeneous manner. More research is required to understand the reasons for these difficulties with the psychotherapy training of psychiatrists in France, and to propose new models of training to improve this situation.

The analyst's hatred of analysis.

Analytic work is loved and hated. Both attitudes deserve scrutiny, but the analyst's hatred of analysis, which transcends countertransference responses to individual patients, represents an impediment to gratifying analytic work whose recognition and conceptualization has been resisted. The author suggests that antipathy among analysts toward analysis and the analytic situation is normative and expectable, yet commonly experienced as shameful. He speculates that it is sometimes disavowed and projected. Training institutes might inadvertently foster this sense of shame rather than promote its working through. The recognition that analytic identity functions as both a loving and a persecutory internal object has implications for psychoanalytic education and practice.

The deleterious impact of idealization and fanaticism and their underlying causes in psychoanalytic education.

Acrimony, dissension, and controversy have characterized psychoanalytic education from the beginning. The usual scapegoat for this situation has been the training analyst system. But this system is seen as just a symptom of deeper, underlying conflicts about our field and preparing for it. In particular, the tendency toward authoritarian dogmatism amongst psychoanalysts is a prime contributor. This inclination derives from the defensive idealization and fanaticism characterizing many psychoanalysts. Such idealization helps us to manage the many uncertainties that characterize our theory, our practice, and our pedagogical efforts. Various methods to address these uncertainties more directly are suggested as a way to counteract the negative effects of fanaticism.

The reluctance to self-disclose: reflexive or reasoned?

Despite a growing body of clinical literature advocating the thoughtful and judicious use of self-disclosure in psychoanalysis, there remains a reflexive reluctance to intervene in this way by many analysts of various theoretical persuasions. Why is this the case? Four motives for this reflexive reluctance to self-disclose are discussed: (1) theoretical reasons; (2) psychoanalytic authoritarianism; (3) fears of influencing the patient through suggestion; and (4) the analyst's personality characteristics. Examining the reasons for this state of affairs should help to reduce the rigidity or orthodoxy with which clinical psychoanalysis is practiced.