Group Analytic Supervision [1 ed.] 103245220X, 9781032452203

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Group Analytic Supervision

Group Analytic Supervision uses group analytic concepts to cast light on how group supervision works, covering history, theory and practice. Margaret Gallop and Margaret Smith illustrate the benefits that supervision can provide for post-qualification group supervision. This book offers a model of group analytic supervision, the clinical hexagon, to support supervisors of groups in thinking about their supervision group and its process. Gallop and Smith use vignettes to illustrate how supervision groups work together to broaden and deepen their understanding of their clients, including examples that demonstrate the benefits of this multi-perspective approach for therapists pro­ viding dyadic therapy. Group Analytic Supervision addresses several of the key tasks for supervisors of groups, including establishing and maintaining bound­ aries around the work, establishing good working relationships, working with parallel process, transference and countertransference. It describes using differ­ ence and diversity to enrich learning and it stresses the importance of self-care. Group Analytic Supervision will be essential reading for anyone who is providing group supervision, particularly therapists who undertake group analytic training. It will also be of great interest to counsellors and therapists, social workers, probation officers and healthcare staff who both provide and receive group supervision. Margaret Smith is a psychodynamic psychotherapist and group analyst working in private practice with a special interest in group supervision. She is an inde­ pendent member of the United Kingdom Council for Psychotherapy (UKCP) and a member of the Institute of Group Analysis (IGA) and the British Asso­ ciation for Psychoanalytic and Psychodynamic Supervision (BAPPS). Margaret Gallop is a group analytic psychotherapist in private practice with a special interest in supervision. She is a member of the IGA and the UKCP. She is a former co-convenor of the IGA Diploma in ‘Using the Group as a Medium for Supervision’.

“This long overdue book is thoughtful, intelligent, knowledgeable, kind and impeccably researched. With its impressive grasp of different theoretical approaches, clear structure and vivid vignettes, it illuminates the complex and rewarding task of offering supervision in a group. It will be invaluable for anyone supervising trainees or professionals alike.” Sara Perren, Group Analyst, Co-Director, IGA Diploma in Group Supervision, Group Supervisor at York Groupwork and Group Analysis North “I recommend this book whole-heartedly to experienced group analysts and newcomers to group analytic theory alike. At its most effective group super­ vision both reveals and dissolves blocks in and resistances to the therapeutic process; not by the use of expert knowledge but by enabling and encouraging free association and the consequent emergence of parallel process. This method and its historical context are carefully described and revealed in this wonderful book.” Leonie Hilliard, Group Analyst and Co-Director, IGA Diploma in Supervision

Group Analytic Supervision

Margaret Smith and Margaret Gallop

Designed cover image: Windy Wood © Carol Miller. First published 2024 by Routledge 4 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 605 Third Avenue, New York, NY 10158 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2024 Margaret Smith and Margaret Gallop The right of Margaret Smith and Margaret Gallop to be identified as authors of this work has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library ISBN: 978-1-032-45220-3 (hbk) ISBN: 978-1-032-45219-7 (pbk) ISBN: 978-1-003-37597-5 (ebk) DOI: 10.4324/9781003375975 Typeset in Times New Roman by Taylor & Francis Books

Contents

List of figures About the authors Acknowledgements Introduction

vii

viii

ix

1

PART I

A history of group analysis 1 History: S.H. Foulkes and the beginning of group analysis

5

7

PART II

Group analytic theory

17

2 To ‘supplement’ or ‘build anew’: Foulkes’s sociogenetic theory of

the mind

19

3 Some group analytic concepts

31

PART III

The history of group supervision

49

4 In the beginning: The roots of group analytic supervision

51

5 Group analytic supervision since 1970

62

PART IV

A group analytic model of supervision 6 The clinical hexagon: A group analytic model of supervision

79

81

vi Contents

7 Dynamic administration: Managing the boundaries of group supervision

97

PART V

Sustaining practice

113

8 The supervisory alliance: Creating sustaining relationships in group supervision

115

9 ‘To set the darkness echoing’: The experience of the supervisee in the supervision group

129

10 Enough and to spare: The function of supervision groups in supporting the psychological needs of staff working in demanding professions

160

PART VI

Using the group as the medium for supervision

171

11 Parallel process: Processing role responsiveness in group supervision

173

12 What am I missing? What is not being said, and what is not being heard? Making use of the multiple perspectives in the supervision group

186

13 Through a glass darkly: Using a reflecting team approach in the development of supervisory practice

202

Index

215

Figures

9.1 Pulteney Bridge (2022), by Carol Miller. Painting. Courtesy of

the artist. 9.2 The Garden of the Asylum at Saint-Rémy (May 1889), by

Vincent van Gogh (1853–90). Painting, oil on canvas.

Photographer: Peter Horree (2013). 9.3 Dew-Drenched Furze (1889–90), by John Everett Millais.

Painting, oil on canvas. Photographer: Ian Dagnall (2020). 9.4 Pinewood North West Gale (17 September 1945), by Michael

Ayrton (1921–75). Courtesy of Justine Hopkins and the Estate

of Michael Ayrton, and the Ashmolean Museum, Oxford. 9.5 Nocturne in Black and Gold: The Falling Rocket (1875), by

James McNeill Whistler (1834–1903). Painting, oil on panel.

Photographer: ICP (2020). 9.6 Houses + Lights + Sky (1912), by Luigi Russolo (1885–1947).

Abstract painting. Photographer: ICP (2021). 9.7 The Young Family (2002–2003), by Patricia Piccinini (1965–).

Sculpture using synthetic materials and human hair. Courtesy of

the artist and the Bendigo Art Gallery, Australia. 9.8 The Dance (1909–10), by Henri Matisse (1869–1954). Painting,

oil on canvas. Photographer: Peter Horree (2012). 9.9 A Rocking Chair (1950), by Henry Moore (1898–1986). Bronze

sculpture. Courtesy of the Joe Kitchen and Henry Moore

Foundation. 9.10 Mother and Child (2003), by Monika Celebi. Painting. Courtesy

of the artist.

136

137

138

139

140

145

146

146

147

148

About the authors

Margaret Smith is a psychodynamic psychotherapist and group analyst who has recently retired from working in private practice. She has provided indi­ vidual and group psychotherapy and individual and group supervision and she has convened the Mersey Psychotherapy Network Reading Group for Psychotherapists in the north west. She has a special interest in group supervision. She co-convened the Institute of Group Analysis (London) training in group supervision ‘Using the group as the medium for supervision’ between 2009 and 2018. She formerly worked in the NHS managing staff support services for a number of NHS trusts in the Liverpool area, offering staff counselling, group analytic psychotherapy, post trauma support, staff consultation groups, work­ place mediation, organisational consultancy and a range of training courses. She taught on the Tavistock Institute Liverpool D10 between 2004 and 2009. She is an independent member of the United Kingdom Council for Psychother­ apy (UKCP) and a member of the Institute of Group Analysis (IGA) and the British Association for Psychoanalytic and Psychodynamic Supervision (BAPPS). Margaret Gallop is a group analytic psychotherapist in private practice: a writer, tutor and supervisor. Her work includes providing individual and group super­ vision in the NHS, higher education, and in third sector organisations. Alongside work with clients suffering from workplace stress she supports a day retreat centre, offering group quiet days for those in need of reflection and meditative silence. A group combining times of discussion, silence and creative expression has run for many years. Early in her career she studied child development, and has extended this interest in the growing child, supervising volunteers working with young people and psychotherapists providing parent infant group work. Margaret has provided seminars and papers on group analytic supervision in Britain and abroad. As well as contributing to psychodynamic counselling training at Reading and Oxford Universities she has co-convened the Institute of Group Analysis Diploma in ‘Using the Group as a Medium for Supervision’. She is a member of the Institute of Group Analysis (IGA) and the United Kingdom Council for Psychotherapy (UKCP).

Acknowledgements

We would like to thank the following for their contribution to creating this book. First, all those who have provided supervision through our working life, whose wisdom has helped us develop our work. Thanks are also due to colleagues and members of supervision groups, from whom we have learned so much and who have so enriched our working life. We also thank Saloni Singhania and Susan­ nah Frearson for their help with preparing our work for publication. We thank the following for their permission to include the paintings used in the book: � � � � �

Carol Miller for the use of her painting Windy Wood for the front cover of the book and for the use of her painting Pulteney Bridge as an illustration for Chapter 9 of this book. Monika Celebi for the use of her painting Mother and Child as an illustration for Chapter 9 of this book. Joe Kitchen and the Henry Moore Foundation for use of The Rocking Chair. Patricia Piccinini and the Bendigo Art Gallery, Australia, for the use of the image of her sculpture The Young Family. Justine Hopkins and the estate of Michael Ayrton for Pinewood North West Gale, and the Ashmolean Museum, Oxford, for its permission to use its image.

We would also like to thank Alamy for their assistance with the use of the following paintings: � � �

The Garden of the Asylum at Saint-Rémy (May 1889), by Vincent van Gogh. Painting, oil on canvas. Photographer: Peter Horree (2013). Dew-Drenched Furze (1889–90), by John Everett Millais. Painting, oil on canvas. Photographer: Ian Dagnall (2020). Nocturne in Black and Gold: The Falling Rocket (1875), by James McNeill Whistler. Painting, oil on panel. Photographer: ICP (2020).

x Acknowledgements

� �

Houses + Lights + Sky (1912), by Luigi Russolo. Abstract painting. Photographer: ICP (2021). The Dance (1909–10), by Henri Matisse. Painting, oil on canvas. Photographer: Peter Horree (2012).

We thank Jane Williams for her encouragement and for her assistance and persistence in helping us source the illustrations we have used in the book. We would also like to thank Louise Smith for her support with the publication process. This book is a team effort, without which it would not have been written. Particular thanks are due to Margaret Gallop’s husband, Julian, for his clear thinking and technical and personal support, and our family members, for their technical support and sustained encouragement.

Introduction

Why we have written this book Our decision to write this book stems first and foremost from our belief in the value of group supervision for providing support for therapists and for safe­ guarding their clients. We would like to share some of our enthusiasm and experience in the hope that by doing so we can give supervisors of groups more confidence about offering supervision in groups and about the value of peers supporting and learning from each other. We believe that together we can each go further in our work than we could manage on our own. Group supervision provides sustenance and a safe haven for therapists who touch the lives of others. It provides a space for reflection for therapists under pressure. Engagement in a supervision group can be rewarding. During the time we were writing this, a friend put into words her view that the difference that one person can make when they take part in a group can be compared to the impact of a pebble dropped into water. One pebble creates ripples on a pond, and these circles radiate outwards. When you throw a pebble in the right way, the pebble can skim across the water before it falls. Each time it touches the surface, it creates a new set of ripples that radiate out, interacting with the others to create new patterns. Each therapist in the supervision group creates their own unique ripples. In this way, the group covers a much wider area of the pond, and the ripples intertwine to form new patterns. We may never know the number of people whose lives have been touched by insights from a supervision group as its members pool their insights, feelings and experience. We believe that group supervision has the potential to provide counsellors and therapists with an experience that feels collegial. It breaks isolation and provides a sense of being part of a team. It is heartening when group mem­ bers take insights from their colleagues’ work and use them for their own work. This is the economy of the supervision group. We enjoy it when col­ leagues who are feeling challenged by a current difficulty in their work leave feeling supported, more confident about their way ahead and re-energised by feeling part of a team of like-minded therapists. DOI: 10.4324/9781003375975-1

2 Introduction

What we are writing about has come from our training, our reading and our experience. The book is an attempt to distil our thoughts in order to lay some foundations for people who are new to, or feel inexperienced when, providing group supervision. We hope that the vignettes we use help the reader to mentally step inside the supervision groups we are writing about to get a feel from the inside of how the process of group analytic supervision works.

Synopsis The first part of the book, Chapters 1–3, provides a background for those new to group analytic thinking and a reminder for group analysts who plan to train as supervisors of groups. The book begins with a brief history of the emergence of group analysis. The two chapters on group analytic theory describe the way that it both differentiates itself from, and also uses, psycho­ analytic theory for its distinctive group analytic approach to therapy. Chapter 3 introduces some group analytic language. The group analyst seeks to engage a group of strangers in conversations that create insight and change. Chapters 4 and 5 focus on the emergence and development of group analytic super­ vision in the UK and across Europe. Chapter 6 examines in detail how the supervisor of a group holds the frame of the group, the dynamic administra­ tion. The chapter also reflects on the importance of the supervisory relation­ ship and the supervisory alliance. It continues with an overview of group supervision in practice. There are chapters on the group’s use of difference and its perspective on the needs of the supervisor and supervisee. It examines some specific supervisory concepts from a group analytic perspective, includ­ ing countertransference, parallel process and role responsiveness. The book introduces vignettes to illustrate how the supervision group works. The authors have not used case examples from their supervisory practice as vign­ ettes. In order to maintain confidentiality about clinical work, all the vignettes are fictional.

The current context Michel Foucault was the first to draw attention to the use of terminology about the mind as a tool of social control. For example, when someone is feeling low, they refer to their ‘poor mental health’. The language of mental illness and health is one that leaves the problem with the individual rather than seeing it as a symptom of a wider societal issue. Today, as in the time when Foucault was writing, the motivation for improving access to counsel­ ling and psychotherapy services is the economic one of getting people well enough to return to work. Short-term counselling and psychotherapy inter­ ventions have been shown to be more cost-effective than drug therapies. One of the distinctive features of the group analytic approach is that it places cli­ ents and their difficulties firmly in their social context. Both group analytic

Introduction

3

therapy and group analytic supervision lay emphasis on taking the social context into account. Similarly, they pay attention to the language that is used, especially about illness and health. The recent increase in the need for counselling and psychotherapy services, particularly since the pandemic, has meant that there is a shortage of afford­ able help available for people in distress. As a result of this, the provision of services, particularly for young people, has become ever more stretched. In a context where funding is limited, group supervision can be a cheaper option. When one supervisor meets with a group of practitioners to reflect on their work, this can save money while still providing a quality experience. This book offers a distinctive approach. It builds on a mounting body of evidence that group supervision has worked well for the past 50 years, for both students and experienced therapists alike.

The intended readership We have written this book for practitioners who are providing group super­ vision or are planning to do so. It will be of use to supervisors of groups working in different fields, including group analysis, counselling and psy­ chotherapy, nursing, social work, probation, education, clergy, music and drama therapy, and addresses dilemmas in a range of settings, stressing the importance of taking the context of the work into account. It will be of par­ ticular relevance to institutes who offer post-graduate training for therapists in group analytic supervision—first, the Institute of Group Analysis in London, but also institutes across Europe, Australia and America. It will be of interest to training institutions who provide group supervision to their students and to charities who offer counselling and therapy services.

Our purpose in writing the book Our book brings group analytic perspectives to bear on the theory and practice of providing supervision in groups. We have written it: � � �

�

To be applicable to the supervision of both dyadic work and the supervision of groups. To supplement the reading material available for the training of supervisors of groups. To provide some reference material for those who work in the health service, the charity sector, universities, social services and probation, and have been asked to provide group supervision. Many may have no back­ ground in providing group supervision. To acknowledge the importance of caring for the carers and the fact that therapists and their supervisors may also experience distress, depression and anxiety when under pressure.

4 Introduction

�

To give examples of how group supervision can work well: a b c d e

How the learning from group supervision can benefit clients. The value of learning from others in facilitating professional growth. Providing collegial, sustaining relationships with peers that can sometimes last over many years. The benefit of seeing others facing similar challenges. How the pace of supervision provides a change of gear, allowing group members to slow down and reflect on their work together.

The scope of the book We acknowledge that this book has only just skimmed the surface. In parti­ cular, we recognize that more is needed in the area of ethics, diversity and intersectionality, endings and retirements, the student perspective and organi­ zational issues. We would also like to see further writing about some of the themes that emerge in supervision groups—for example, the impact of the client group on the work when there is trauma or eating distress and where the work is with children and babies. With this in mind, we are beginning to collect chapters by other writers with the intention of publishing a second volume.

Part I

A history of group analysis

Chapter 1

History S.H. Foulkes and the beginning of group analysis

Introduction Group analytic supervision arose from the practice of group analysis as developed by S.H. Foulkes. This chapter gives an overview of group analysis in order to introduce the background that shaped group supervision. Group analysis recognises that new ways of working, such as providing therapy and supervision in a group, do not take place in a vacuum. Of importance is the specific historical context of those who were inspired to challenge the pre­ vailing ideas about human nature and society. Foulkes’s childhood Elizabeth Foulkes, S.H. Foulkes’s biographer, wrote a pen portrait of his life (Foulkes, 1990: 3–21). The framework of this chapter comes from her work. According to Elizabeth Foulkes, her husband came from a Jewish family and was the youngest of five children. He was born in Karlsruhe, in southern Germany, in 1898, and both his parents, Gustav and Sarah Fuchs, came from the merchant classes. For much of Siegmund Fuchs’s childhood, the family lived in the family house with his grandmother living upstairs. By co-incidence, this extended family group of seven or eight was the size Foulkes recommended for his therapy groups. Foulkes learned English at school, which must have been helpful to him when he and his family emigrated to England before the outbreak of the Second World War (Foulkes, 1990: 5). Elizabeth Foulkes says that Foulkes studied psychiatry in part because of his fascination with the striking differences in the way his brothers devel­ oped and the varied professions in which they chose to work. She records that Foulkes spent long periods on his own when he was young and was a reflective child. She suggests that his curiosity about his mind developed into an interest in philosophy (Foulkes, 1990: 5) She recalled him telling her that he enjoyed playing team games such as football and tennis with friends (Foulkes, 1990: 6). DOI: 10.4324/9781003375975-3

8 A history of group analysis

The First World War During the First World War, Foulkes served in the army, where he joined the telephone and telegraph section (Foulkes, 1990: 6). During the First World War, the German army used the most advanced phone technology of the day. As a member of this regiment, Foulkes would have been responsible for facilitating networking and communication between different battalions. It is striking that, when Foulkes wrote about his patients’ symptoms, he used imagery reminiscent of some of the difficulties his regiment may have faced as they were developing systems of communication on the battlefield. For example, difficulties that defence mechanisms can cause include ‘a dis­ turbance in communication … which prevent(s) a free flow of communica­ tions or their reception and thus the sharing of them’ (Foulkes, 1975: 131). It is worth noting here that group supervision often focuses on disturbances of communication in the therapy under consideration. One of the tasks of group supervision is to notice and name blocks in communication in the work being presented. Foulkes’s university studies After the war, Foulkes’s family encouraged him to go to university, where he studied medicine. During his two years of pre-clinical studies in Heidelberg, he read the work of some of the foremost German psychiatrists of the day. These included Jaspers and Gruhle (Foulkes, 1990: 6). Both of these thinkers had an influence on the development of Foulkes’s ideas. Karl Jaspers, a German-Swiss psychiatrist and philosopher, challenged some of the prevailing views on psychiatric diagnosis. Previously, the primary task of the psychiatrist was to list the contents of the patient’s thoughts as the basis for diagnosis. Jasper included biographical information about each patient and developed categories to describe their disorders. These categories are largely ones with which we would be familiar today. Hans Gruhle was critical of the genetic research methodology underpinning eugenics, one of the central ideological planks of the Weimar Republic. For example, Gruhle pointed out the lack of evidence for a link between genetic disposition and criminal behaviour. He hypothesised instead that poverty was a more likely cause (Wetzell, 2003: 178). Gruhle also challenged the sterilisation policy applied to criminals, who were viewed as feeble-minded (Wetzell, 2003: 171). Perhaps not surprisingly, Gruhle was eventually removed from one of his university posts in Germany during that period. According to Elizabeth Foulkes, it was as a result of reading a footnote in a book by Gruhle that Freud’s work came to Foulkes’s attention. He went on to read Freud’s New Introductory Lectures on Psychoanalysis, Studies in Hys­ teria and the Interpretation of Dreams (Foulkes, 1990: 6). Foulkes wrote of Freud that, ever since 1919, when he read Freud’s works, they:

History

9

have been the greatest influence in my professional life, and remain so at the present time. From then on I knew exactly what it was that I wanted to be, namely a psychoanalyst. (Foulkes, 1968: 117) Munich and Berlin Foulkes studied psychiatry in Munich. After the First World War there were thousands of soldiers who had returned from the front with life-changing inju­ ries to their heads. Foulkes studied psychosomatic medicine under Gustav von Bergmann, whose research subject was the impact of damage to the cerebral cortex in soldiers with brain injuries. While Foulkes was there, one of his col­ leagues, Karl Kleist, studied the impact of lesions in soldiers’ brains on their behaviour. Through studying their behaviour and then the location of their brain lesions after their death Kleist was able to form a picture of the function of different parts of the cerebral cortex. It was during his clinical year at Charité II in Berlin that Foulkes began to develop his approach to understanding mental disorders. He was interested in Paul Schilder’s research into the links between the body and the mind. He agreed with Schilder that there was no clear division between the two. His view was that our experience of the world and our inner experience were in a constant state of change as we project and introject our experience of ourselves (Foulkes, 1990: 74–75). He refers to the separation of these facets, the received wisdom of the day, as an unnecessary dualism (Foulkes, 1990: 109). For Foulkes, a patient’s current emotional difficulties are shaped by the social context in which the symptoms arose (Foulkes, 1990: 158). Foulkes’s medical studies Foulkes returned to Frankfurt for his postgraduate studies, focusing on neurology under Kurt Goldstein. Here, Foulkes continued to learn about brain functioning. It was from Goldstein that Foulkes developed his con­ cept of the individual as a ‘nodal point’ in a network. We are all, ‘part of a social network, a nodal point, as it were in this network, and can only artificially be thought about in isolation, like a fish out of water’ (Foulkes, 1948: 14–15). In describing the individual as a nodal point, Foulkes is saying that a person is just one part in a larger system, the whole being greater than its parts in the same way as a neuron is just one point in the larger functioning system of the brain. While Foulkes studied under Goldstein, he was given permission to challenge prevailing theories and to adopt a questioning approach. He also learned about the importance of critical self-reflection. Foulkes recognised the benefit of looking for ‘unacknowledged, hidden prejudices’ because it ‘sharpened one’s perception of concealed theories disguised as

10 A history of group analysis

facts’ (Foulkes, 1990: 8). It may be because of this that he was later interested in the work of Jane Abercrombie, who provided study groups to help trainee doctors explore their hidden prejudices. He refers to this in his writing on group supervision (Foulkes, 1964: 255). Foulkes acknowledged Goldstein’s holistic questioning approach as a for­ mative influence on his way of thinking and teaching (Foulkes, 1968: 118). Later, he would go on to apply this approach to the supervisory seminar when training his students. This capacity for questioning and self-reflection is central to the work of supervision. Foulkes also had a lifelong enthusiasm for research and he encouraged his supervisees to conduct research as an ongoing part of their learning (Foulkes, 1964: 254–255). Goldstein also lectured on gestalt psychology and he applied the con­ cept of the figure–ground principle to his organismic approach to treat­ ment. Foulkes adopted this approach, seeing the individual and the group as a figure and ground constellation. This concept is of importance in group supervision because one aspect of the supervisor’s role is to help their supervision group to hold in mind both the figure—the specifics being thought about—and the ground—the context in which the therapy is taking place, in their supervision group. This will be explored further in Chapter 6. Foulkes’s keen observation skills were already in evidence when he was working at the neurological institute. He used his time on wards observing the doctor–patient relationship as well as learning about psychiatric diagnosis. He recalled that F. Kino, a consultant, had an exchange that seemed to deepen his connection with one of his patients, after which Kino significantly chan­ ged his diagnosis. He had previously described her as hysterical. After their relationship had deepened, he diagnosed her as suffering from multiple sclerosis. Foulkes recalled that this gave him ‘much food for thought con­ cerning both doctors and patients’ (Foulkes, 1990: 9). Later, Foulkes wrote about the role that patients play in the mind of the therapist: The parts which patients play in a group … are also the result of uncon­ scious projections, expectations and provocations on the part of the therapist … in particular those of personification, a patient representing the unconscious part of the therapist of dramatisation, resonance and multiple representation. (Foulkes, 1964: 179) This insight is central to Foulkes’s practice as a supervisor. His focus was on uncovering countertransference in his trainees as a route to facilitating engagement and reducing the impact of the therapist’s projections on to members of their groups (Foulkes, 1964: 252).

History

11

Foulkes’s psychoanalytic training Foulkes moved to Vienna in 1928 to train as a Freudian psychoanalyst. He contacted Helene Deutsch, a colleague of Freud’s, and asked her to provide him with a training therapy. At that time, Deutsch was the head of the Vien­ nese training institute. Later, after she moved to America, Deutsch, a femin­ ist, worked as an analyst, specialising in treating women. She is known for identifying the ‘as if ’ personality. Foulkes’s training supervisors were Eduard Hitschmann and Herman Nunberg. Both these men were doctors and psychoanalysts and closely associated with Freud. Hitschmann was not just Freud’s friend, he was also the Freud family’s physician. He also became a member of Freud’s Wednesday Psycholo­ gical Society from 1905. Hitschmann went on to write the first concise pre­ sentation of psychoanalysis, Theories of Neurosis. He also became the director of Freud’s psychoanalytic outpatient clinic in Vienna in 1922. According to Dyer, writing on the Victorian Web, Freud himself described Hitschmann as orthodox. Nunberg, Foulkes’s other supervisor, was a Polish member of Freud’s Wednesday evening group. In his obituary, there was reference to Freud’s appreciation of Nunberg’s keen application of a rigorous scientific approach and his avoidance of speculation. Nunberg used observations from his patient practice to consolidate his theoretical approach at a time when this was not always the case within the field of psychoanalysis. His book Principles of Psy­ choanalysis was published in English in 1956 (Nunberg, 1956). The influence of both Hitschmann and Nunberg may have been reflected in the principles which Foulkes himself outlined when he set up the Group Analytic Society. For example, one of Foulkes’s aims was to base group analysis on ‘a body of theo­ retical constructs based on factual and clinical observations; particularly con­ cepts of use in the psychotherapeutic or sociotherapeutic field, and concepts linking up with the social sciences’ (Foulkes, 1990: 150). Foulkes and Elias Foulkes returned to Frankfurt in 1930 and set up his practice in the Frankfurt Psychoanalytic Institute (Foulkes, 1990: 10). It was in Frankfurt that he was introduced to the work of the Sociological Research Institute. Many of the ideas that underpin our modern thinking and our arguments about philoso­ phy and politics were emerging during this time and, as the situation in Ger­ many deteriorated, they were exported as successive waves of Jews and dissidents escaped from Nazi Germany. One of the threads in this debate was about how change happens, and the impact of culture and social factors on the individuals within a society (Pines, 1978: 10). The interchange between the Psychoanalytic Institute and the Department of Sociology, which included Karl Mannheim and Norbert Elias, had a powerful impact on Foulkes. He recalled that it was as a result of their influence that he came to ‘the insight

12 A history of group analysis

that biological and socio-cultural factors were of equal importance for a true understanding of the human mind’ (Foulkes, 1968: 121). Foulkes followed the Freudian model of the mind throughout his life. However, as a result of his contact with Elias, Foulkes laid greater emphasis than Freud on the importance of environmental influences in the development and maintenance of psychological disturbance (Foulkes, 1964: 148, 1990). In Foulkes’s more psychosocial model, he described an individual as: pre-conditioned to the core by his community, even before he is born, and his personality and character are imprinted vitally by the group in which he is raised, (Foulkes, 1990: 152) Foulkes’s move to England Foulkes and his family left Germany in April 1933, just before the new law came into force requiring Jews to surrender their passports. Foulkes received an invi­ tation from Ernest Jones to move to London, and the family arrived in London in May 1933. Between then and the outbreak of the Second World War in 1939, Foulkes completed British medical training and also became an active member of the British Psycho-Analytical Society, where he found himself more closely aligned with the Independents (Foulkes, 1990: 14). The Independents were the group of psychoanalysts who included Donald Winnicott, Michael Balint and Paula Heimann. Along with the Kleinians, they were all members of the British Psycho-Analytical Society, but the Independents’ research and writing fell out­ side the more strictly Kleinian approach to psychoanalysis. The development of group analytic theory and practice Foulkes describes his journey from psychoanalysis to group analysis as being a process that evolved over time and was the product of a variety of influences, beginning during his medical training in Germany. After watching a play by Maxim Gorki, he noted, ‘Here was a play without a hero, a leaderless group on the stage, driven by strong, anonymous forces. I pondered about the pathogenic and therapeutic power of the theatre and of everyday life’ (Foulkes, 1964: 13). Foulkes also refers to the influence of Tigrant Burrow (Foulkes, 1964: 13–14). Burrow was a controversial figure in his day, believing that the application of traditional medicine to human behaviour was flawed. According to Pertegato, Burrow shared a similar understanding of the interplay between the individual and society, believing that: society as a whole contains the same neurotic elements that Freud attributed to the individual mind, maintaining that so-called ‘normality’ is but a shared disease. (Pertegato, 1999: 276)

History

13

For Burrow too, the natural place for the study of human behaviour was the social context of the group. Following a challenge from one of his patients, he came to believe that psychoanalysis was itself oppressive. He wrote, ‘In its present unconscious social involvement, psychoanalysis is not the study of a neurosis; it is a neurosis’ (Burrow, 1927: 201). Burrow’s views were in opposition to psychoanalytic practice, and Freud and the psychoanalytic community ostracized him. Although Foulkes was influenced by some of Burrow’s ideas, he was also careful in the way he presented to them. It was important to him that his ideas were accepted by his psychoanalytic colleagues. Foulkes’s first therapy group took place in Exeter, where he moved after the outbreak of the Second World War. He initially saw individuals for analysis, but it occurred to him that he could put these patients into a group. Having read widely about this practice, Foulkes developed his own approach and its theore­ tical basis, publishing his first paper in 1942, before his move to Northfield (Foulkes, 1964: 33–34).

Establishing group analysis Foulkes moved back to London after the war, working at the Bethlem and Maudsley Hospitals, and was involved in training there until he retired in 1963 (Foulkes, 1990: 16). Foulkes’s group analysis thrived because of the combination of skills he brought to bear on his work. Firstly, he had an amazing ability to acquire and process new knowledge. Secondly, Foulkes’s success in establishing group analysis was due to the energy he put in to set­ ting up and establishing different vehicles for disseminating his ideas. Thirdly, he had an ability to spread his ideas within the many social networks he was in touch with and, fourthly, he was charismatic enough to persuade people to adopt and promote his ideas. These are the same skills that Malcolm Gladwell, an author and journalist, recognised as the core qualities necessary when establishing a new movement or selling a new product. Gladwell suggests that the spread of ideas arises because of a set of similar necessary ingredients that are needed in order to create a tipping point. A tipping point is a set of conditions that are needed in order to promote a new product or idea. Gladwell identifies a number of examples of past trends and events that hinged on the influence and involve­ ment of connectors—people in touch with a wide range of networks who can cross-fertilise ideas—mavens—people who are knowledgeable and seen as trustworthy—and salesmen—people who are good at persuading others. From Methodism (Gladwell, 2002: 173) to hush puppies (Gladwell, 2002: 67–68), the same qualities are involved. He describes people who cross-fertilise ideas and develop connections as Foulkes did, as connectors (Gladwell, 2002: 34–36). Foulkes and the colleagues who promoted and established group analysis shared these qualities.

14 A history of group analysis

Foulkes worked with colleagues to create a group analytic culture. Foulkes, James Anthony, Patrick de Maré and other colleagues who were also inter­ ested in developing and disseminating group analytic ideas founded the Group Analytic Society (London) in 1952. Their purpose was to put their informal weekly meetings on a more permanent footing. Since then, the society has become an international organisation, GASi, and is responsible for holding scientific meetings, workshops and the annual Foulkes lecture and study day. GASi holds a group analytic symposium every three years in dif­ ferent venues across Europe and is responsible for publishing Group Analysis, the group analytic journal. This was first launched in 1967. It was just under ten years later that the first papers on group analytic supervision started to appear, the first being published in 1975 by Barbara Dick. The Group Analytic Society was involved in setting up the Institute of Group Analysis (IGA) in 1971. Foulkes became involved in the training of future group analysts (Foulkes, 1990: 16). Two of the first graduates were Meg Sharpe and Liesel Hearst in 1975. Meg Sharpe edited and contributed to The Third Eye (Sharpe, 1994), the first book on group analytic supervision, with Liesel Hearst and Harold Behr as two of the contributors. Since then, the IGA has been involved in setting up other group analytic training programmes, both within the UK and in Europe.

Conclusion Foulkes was an able scholar, absorbing new ideas from others, firstly in Ger­ many and then in England. He was a teacher and a writer as well as a psy­ choanalyst and group analyst. He approached each activity with energy and enthusiasm that inspired others. He had the capacity to absorb a wide range of different perspectives and he was an able psychoanalyst, group analyst and supervisor. He had outstanding collaborative and organisational skills that allowed him to leave a legacy behind him that included the Group Analytic Society, now GASi, a training institution, the IGA, and a scientific journal to develop and disseminate group analytic ideas. The fact that Foulkes was not shunned by the psychoanalytic community, as Tigrant Burrow had been for his more social approach, may partly be because he first established himself as a mainstream psychoanalyst and trai­ ner. It may also be that Foulkes was successful in establishing group analysis because his thinking emerged from his practice (as did that of Melanie Klein). Also, Foulkes was careful to present group analysis as a development of Freudian principles rather than a challenge to them.

References Burrow, T. (1927) The Problem of Transference. The British Journal of Medical Psy­ chology 7: 193–202.

History

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Foulkes, S.H. (1948) Introduction to Group-Analytic Psychotherapy. London: Karnac Books. Foulkes, S.H. (1964) Therapeutic Group Analysis. London: George Allen & Unwin. Foulkes, S.H. (1968) On Interpretation in Group Analysis. International Journal of Group Psychotherapy 18 (4): 432–434. Foulkes, S.H. (1975) Some Personal Observations. International Journal of Group Psychotherapy 25 (2): 169–172. Foulkes, S.H. (1990) Selected Papers: Psychoanalysis and Group Analysis. Oxford: Routledge. Gladwell, M. (2002) The Tipping Point. New York: Back Bay Books. Nunberg, H. (1956) Principles of Psychoanalysis. Their Application to the Neuroses. Foreword by Sigmund Freud. Trans. by Madlyn Kahr and Sidney Kahr. New York: International Universities Press. Pertegato, E.G. (1999) Trigant Burrow and Unearthing the Origin of Group Analysis. Group Analysis 32 (2): 269–284. Pines, M. (1978) The Contributions of S. H. Foulkes to Group Analytic Psychotherapy. New York: Stratton. Sharpe, M. (1994) The Third Eye: Supervision of Analytic Groups. London: Routledge. Wetzell, R.F. (2003) Inventing the Criminal: A History of German Criminology, 1880– 1945. Chapel Hill, NC: University of North Carolina Press.

Part II

Group analytic theory

Chapter 2

To ‘supplement’ or ‘build anew’ Foulkes’s sociogenetic theory of the mind

Freud’s theory of mind Freud’s theory of the mind includes the conscious, the preconscious and the unconscious. Freud hypothesised that the unconscious is shaped by, firstly, our genetic makeup; and secondly, memory traces from prehistory that have become incorporated into the mind’s structure, as outlined in Totem and Taboo (Freud, 1912). He referred to these as the phylogenetic components of the mind. Freud’s third influence on the unconscious mind was from the internalisation of events from within our family, particularly childhood family experiences. The uncon­ scious contains repressed objects that the conscious mind wishes to avoid. This process can offer some initial relief from distress. However, the contents of our unconscious still have a powerful influence on the mind and can cause difficulty for us in the longer term. Psychoanalysis involved working with these layers of the unconscious mind using free association and the analysis of dreams. Freud saw the individual mind as a combination of our genetic makeup, developed in prehistory, and each person’s personal history. To this, Foulkes added a third component, the societal. This is the part of the personality that is shaped by the culture in which we live. These beliefs make up an aspect of our world view that we come to think of as ‘normal’. It comprises the societal norms and beliefs that permeate society as a result of powerful influencers, the elites of the day. These societal influences form what Foulkes refers to as the social unconscious. Foulkes called these three elements together the ‘socio­ genetic’ (Foulkes, 1990: 81). For Foulkes, this was the societal component, the third element, the contextualisation of the Freudian model of the mind.

Foulkes and Freudian theory Although Foulkes adhered to much of Freud’s model throughout his life, what changed was his understanding of the importance of the social nature of the person and its contribution to psychological disturbance. It was this insight that led him to develop a group approach to helping the people who came for help (Foulkes, 1990: 273). DOI: 10.4324/9781003375975-5

20 Group analytic theory

Foulkes was not attached to psychoanalysis in an uncritical way. Although he was a psychoanalyst: This does not mean that psychoanalysis is my bible. I consider Freud’s work like a great work of art, the great work of one person, not easy to build on without losing the essential ground. (Foulkes, 1990: 287) Foulkes undertook this revision of the Freudian model of the mind in an evidenced way. In his paper ‘On Group Analysis’, he stated that (a) a theory should treat each piece of evidence as of equal significance, (b) the theory should emerge as a consequence of the evidence and not the other way round and (c) the observer must take their own impact on what they are observing into account (Foulkes, 1990: 129–130). Foulkes developed his sociogenetic model from the available evidence from biology and social theory of his day.

Supplementing Freud’s theory of mind Some of Foulkes’s most important papers were published posthumously in the book Selected Papers of S.H. Foulkes: Psychoanalysis and Group Analysis (1990). Chapters 4–7, the main focus of this chapter, were originally published between 1936 and 1941 and they cover four areas. The first contains details from the biological and holistic approach he studied in his work with Kurt Goldstein (Chapter 4). The second is his paper ‘On Introjection’ (Chapter 5); this is a literature review describing a psychoanalytic understanding that combined conflicting understandings from English and Austrian theory. Its relevance here is that introjection, along with projection and identification, provides the psychological process underpinning the development of the ego and the superego. Thirdly, Foulkes’s review of a book by Norbert Elias (Chapter 6) focuses on some of the social mechanisms that shape the mind. Fourthly, Foulkes’s reflections on reading a book by Helen Keller are a review of his theory in the light of Keller’s memories, as a blind and deaf person, of her life before and after she learned to communicate with others in the out­ side world (Chapter 7). Each of these chapters is explored in more detail along with its contribution to Foulkes’s group analytic approach. These chapters each contributed to Foulkes’s understanding of both what separates the human mind from that of animals and the influence of the social on building the id, the ego and the superego, Freud’s model of the mind. Kurt Goldstein Foulkes drew on his training with Goldstein for his understanding of our biological, animal nature. At the beginning of his paper on Goldstein’s work, Foulkes says of his research both that it is modern, up-to-date science and

To ‘supplement’ or ‘build anew’

21

that his ‘conception is radical, uncompromising and consistent. He takes holism seriously, yet he remains a biologist’ (Foulkes, 1990: 40). This view of man was in contrast with the dominant approaches of the day that viewed the mind primarily as though it was a series of moving parts. Holism views the workings of each individual as a whole because holists believe that the study of different parts individually falls short of providing a full understanding. Holism also incorporates values and meanings when understanding the human mind. For Foulkes, this approach to the mind was central to his model. He said that: Though the mental and the physical sides are acknowledged to have specific characteristics, they are seen merely as different ways of looking at one and the same organism from two different points of observation. (Foulkes, 1990: 52) Goldstein’s holistic view was based on his detailed case histories. He recorded the location of his patient’s injuries and their impact on the way their mind now functioned. Foulkes’s interest was also on what went on within the mind and the way this was mediated through the body’s physiology. He was curious about the link between the symptoms brought to psychoanalysis, such as problems with body image and the denial of blindness, and Goldstein’s research. For example, soldiers who had amnesic aphasia had injuries to the area of the brain that affected language. Their injury made it difficult for them to symbolise, to name the things around them and the people they knew or to describe their feelings. Both Foulkes and Goldstein regarded this as regressing to a state that is in some ways similar to childhood (Foulkes, 1990: 49; Goldstein, 1934). Making links between the biology of the brain and psychoanalysis in this way provided Foulkes with the evidence he needed that the mind can only be truly understood from a holistic perspective. In summary, Foulkes described, firstly, the physical, biological part of our nature and the importance of understanding how physical limitations impact on the way the mind works. Secondly, Foulkes underlined the importance of seeing things from a holistic perspective. Whereas Freud held a dualist-interactionist view of man, maintaining a distinction between the material body and the mental, subjective world, Foulkes is asserting here that the mind cannot be understood as separate from the body, and that there is an inseparable interrelationship between the two. On introjection This section on Foulkes’s paper on introjection is included here because it shows the way he positioned himself as one of the many psychoanalysts who were developing Freudian thinking. His paper clarifies, expands on and sup­ ports Freud’s writing, largely agreeing with what he says. He affirms Freud’s model of the mind as comprising the id, the ego and the superego. His

22 Group analytic theory

endeavour was to transform Freud’s topological model by showing how its development is shaped by the social environment. For Foulkes, the id, the ego and the superego not only interact and are modified through their relation­ ships with others, but are also shaped by societal pressures from the wider society (Foulkes, 1990: 72). The concepts of introjection and identification are significant because they describe the mechanism that allows the outer world of our social environment to become incorporated into the mind and shapes the ego and the superego (Foulkes, 1990: 76, 77). Introjection was a term first used by Ferenzi and used by Freud in his Interpretation of Dreams. Foulkes’s paper brought together different uses of the term from the UK and Europe, linking diverse perspectives on introjection from British analysts such as Fairburn and Klein with those of Ferenczi, Freud and Abraham on the continent (Foulkes, 1990: 77). Foulkes named introjection as unconscious and a defence mechanism. He stressed the intimate connection between introjection and identification and their place in the formation of the ego and superego (Foulkes, 1990: 64). There are indica­ tions that he was continuing with his research on introjection and identification after his paper was published (Foulkes, 1990: 77 (footnote), 84). Foulkes distinguished between primary and secondary introjection. He noted that primary introjection involved incorporation of the object, that is it takes place through ‘an inclusion of object-representations into the ego [and] super­ ego’ (Foulkes, 1990: 76). He placed secondary introjection as taking place later, describing it as an unconscious vehicle for primary identification. It happens when a civilising aspect of one person is taken in by another and modifies their ego (Foulkes, 1990: 76). His critique of Freud is always respectful, showing himself to be faithful to the basic tenets of Freudian thinking. What excited Foulkes most about Freud’s writing about introjection was that it provided a mechanism for the way the ego and superego are modified by their environment. He described it as ‘ultimately the most astonishing of all’ the evidence he had found (Foulkes, 1990: 59). Although Freud was writ­ ing primarily about what happens in love relations, in mourning and in the way we relate to leadership, it became clear to Foulkes that he was implying that ‘our ego and super-ego can be understood, and understood only, as the outcome of a series of identifications taking place at all stages of our devel­ opment’ (Foulkes, 1990: 59). The development of the ego and superego involves giving up an earlier introjection in order to replace it with a later one (Foulkes, 1990: 71). This way of understanding the way the ego and the superego are modified forms a fundamental tenet of group analysis. Norbert Elias Foulkes acknowledged the debt he owed to Norbert Elias and his friend and colleague Franz Borkenau. He said of both these social theorists that ‘I had learned much from my sociological friends—especially Norbert Elias and

To ‘supplement’ or ‘build anew’

23

Franz Borkenau, they had been analysed—so we could learn from each other by exchange’ (Foulkes, 1973: 72). Borkenau is less well known. He was a friend and colleague of Elias, and their research was intertwined. Borkenau studied the societal changes that led to some of our modern views. Elias focused on the dissemination of societal attitudes. Foulkes’s short review of Elias’s book The Civilising Process provides a glimpse into the radical nature of this research and its significance for group analysis. Chapter 6, which contains the review, is important because Elias provided the mechanism that Foulkes was looking for. Elias’s work traced the way that language and societal norms are transmitted throughout a society. Elias provided detailed evidence that it is the leading fig­ ures of the day, the elites, who shape the current thinking and behaviours that become adopted and seen as normal. This civilising process changes over time, and variations in social norms vary between one country and another. Elias’s research also showed that social taboos arise in the same way, with sanctions against breaches increasing in severity as a result of the increasing complexity needed as societies grow larger. Here was the evidence Foulkes needed. Whereas Freud had attributed cultural behaviours such as the taboo against incest to memory traces from before the dawn of time, Elias’s research showed that taboos were learned rather than innate and were modified in response to societal change (Foulkes, 1990: 80). As Foulkes says, they: cannot be of a primarily psychological nature because that would mean that a tendency in a definite direction is inherent in the psyche itself, an assumption which we, as natural scientists, see no reason to make. On the contrary, what forms the content and object of our mental life (and, for that matter, of psychology) is of necessity being constantly modified by these ‘external’ circumstances. (Foulkes, 1990: 80) In Foulkes’s sociogenetic model, societal restrictions were transmitted to the growing child through their parents along with those of their family traditions. In his book The Civilising Process, Elias demonstrated to Foulkes’s satisfaction that ‘an external conflict (a real one) becomes an internal one’ (Foulkes, 1990: 81). These conflicts are internalised and passed on to succeeding generations through the process of socialisation. Foulkes noted that this socialisation is of benefit to society because the internalisation of aggressive behaviour by the individual is likely to reduce external violence. However, the price for this is that these fears and anxieties originating from daily life become repressed. In the unconscious, societal restrictions become entangled with the internalised patterns of behaviour individuals experienced from their family in childhood. Both shape the inner conflicts clients bring (Foulkes, 1990: 81). Foulkes was at pains to stress in this chapter that, although these views diverged from those of Freud, his intention was not to supersede but to sup­ plement his work. He also stressed that the line of sociological enquiry adopted

24 Group analytic theory

by Elias fits in well with psychoanalysis; both are approaches seeking to under­ stand the development of the mind of individuals. For Foulkes, Elias’s research provided a better understanding of the origins of conflict. This can enhance the analyst’s understanding of the nature of what is repressed in the unconscious (Foulkes, 1990: 82). Foulkes’s model of group analytic psychotherapy was significantly influenced by Elias’s work. Helen Keller Foulkes used Helen Keller’s book The World I Live In (Keller, 2012) as a case study, a living testimony to the way the mind develops. Her work was infor­ mative because she became blind and deaf at the age of 19 months, and her early childhood was spent unable to communicate with those around her. When she was six, her parents were able to find her a tutor who taught her to com­ municate through touch. As a result of the loss of her sight and hearing, her development was delayed. Reading Helen Keller’s book sparked Foulkes’s interest because of her developmental delay. As an adult, she was able to recall and reflect on her experience from before the age of six, the age she had learned the meaning of words and could communicate. Because of this, she was able to compare her current experience with the former period of her life and put this into words. Foulkes found Keller’s book a pointer to a number of issues. Of relevance here is that Helen Keller’s book confirmed that both the ‘ego and superego are socially conditioned institutions’ (Foulkes, 1990: 84). Firstly, Keller’s experience confirmed that, in order to have thoughts, she needed words. This depended on learning them from someone in the outside world. Secondly, she needed to become aware of herself as an ‘I’ that is distinct from the world. This development of her ego allowed her to have thoughts of her own. Foulkes noted the importance Keller attached to her hand as the organ that allowed her to communicate with the outside world. He also concluded that, with only smell, taste and touch available to her, her memory was a recollection based on this tactile experience (Foulkes, 1990: 86). Summary These four chapters between them form the base of the new theory that underpinned Foulkes’s analytic practice. They are where Foulkes most clearly evidenced his rationale for his approach to group analysis. Firstly, Goldstein’s understanding that the whole is greater than the sum of the parts led Foulkes to the holistic view that the body and mind can only be understood together. Secondly, Foulkes recognised the importance of words and the capacity to symbolise as essential for the development of the ego. Thirdly, the ego and superego emerge and change only as a result of ongoing introjection. Fourthly, it is not only family relationships that are introjected, it is also societal norms that become integrated in the ego and superego.

To ‘supplement’ or ‘build anew’

25

How Foulkes’s theory shaped his approach In his speech at the first European workshop on group analysis in London, in January 1973, Foulkes told his audience that two of his sociology colleagues, Norbert Elias and Franz Borkenau, had assured him that there was nothing useful obtained from sociological research that would contribute to the development of a theoretical base for group analysis (Foulkes, 1973: 72). As a result, he drew on the sources available to him that have been summarised here to develop his approach. He set out to rework Freudian theory to include the social in order to provide a framework for group analysis. This involved his detailed examina­ tion of Freud’s theory in the light of the latest research of the time. He introduced some new concepts that are specific to group analytic practice. Chapter 3 will introduce these concepts in more detail. Elias and Borkenau were both followers of Freud, both had been analysed and both were inter­ ested in the role emotions play in shaping the mind. Foulkes described their contribution as historicising Freud. They both took part in a historical ana­ lysis of the conduct of life and of the forms of thought, through a historical analysis of words, categories, concepts and texts, in order to apply these to the situation of their day (Szakolczai, 2000: 48–50). Elias studied the influence of elites on societal norms. Borkenau studied the processes taking place at lim­ inal periods of change, going back to the sixth and seventh centuries, identi­ fying the spirit of the age and the ingredients that shaped the shift in underlying attitudes of the day needed to sustain societal change. Foulkes accepted Freud’s first two influences on the ego, the innate genetic component and the influence of family. It was the origin of the taboos as hypo­ thesised by Freud that Foulkes believed could be replaced by his sociogenetic model (Foulkes, 1990: 81). Cultural norms serve a social function, avoiding undue external conflict but coming at a cost. Once external conflicts have become repressed, they do not disappear. They reside in the unconscious and can make individuals more fearful of the external world (Foulkes, 1990: 81). The rest of this chapter explores Foulkes’s understanding of the nature of the person when the societal context is taken into account as an important contributor to the formation of the personality. The ego and the superego Freud’s interest in the mind and what causes conflict led him to develop his topological model as a way of making sense of what he refers to as patholo­ gical conditions (Freud, 2018: 22). He sets this out in The Ego and the Id (Freud, 2018). Consciousness is the thoughts and feelings we are currently aware of, our conscious mind. Freud added two further layers, the pre­ conscious and the unconscious. The preconscious mind contains material that is not currently conscious but can be easily recalled. Other content is less

26 Group analytic theory

easily recalled, and Freud hypothesised that this was because of some force that prevented painful conflictual feelings resurfacing and becoming con­ scious. He called this force repression, and this repressed part of the mind the unconscious (Freud, 2018: 13–15). Content in the unconscious shows itself through symbols that can emerge in dreams and through free association. Whereas the conscious mind uses logic, the unconscious mind is dominated by primary process thinking. There is a different form of logic, and objects in the mind are not governed by time but by magical thinking and wish fulfil­ ment. These wishes can reappear in disguised form in dreams and through free association. The unconscious symbols have their origin in prehistory as a result of events that have become disconnected from the symbol itself. For example, in Totem and Taboo, Freud quoted Jung who hypothesised that, symbolically, man’s libido could be represented by the symbol of a god killing an animal, and that the origin of totemism lay in the need to avoid incest and early relationships between a young man and his mother-in-law (Freud, 1912: 14). Foulkes did not challenge the basic structure of Freud’s model of the mind: the id, ego, super­ ego, repression, the unconscious and primary process thinking. However, where he ‘supplements’ the model, the implications are far-reaching. Foulkes attributes Helen Keller’s capacity to become conscious, to think, to make choices and to symbolise to the input from her teacher, who taught her the meaning of words. It was through this process that she was able to sym­ bolise and to become aware of what was in her mind. His view is in contrast with that of Viennese psychoanalysts of the time who saw thinking about one’s own mind as only arising after a person had been analysed. He saw the learning of language as fundamental to the emergence of Keller’s ego and becoming aware of being an ‘I’. Keller’s experience also led Foulkes to ques­ tion the Kleinian view that the infant progresses from relating to people as part objects to relating to them as whole objects. Klein saw the capacity to hold good and bad experiences of the same person in one’s mind as a devel­ opmental achievement. Keller’s experience convinced Foulkes that in fact children see the people as whole objects from birth, and that part objects are a later development (Foulkes, 1990: 86). Mechanisms of defence Most of Foulkes’s focus on the unconscious was directed towards under­ standing the mechanisms behind the way the mind develops. Of particular interest to him were projection, introjection and identification. He agreed with Sándor Kovács that introjection and projection were defence mechanisms involved in the process of repression. The formation of the ego and superego takes place through the processes of identification and introjection (Foulkes, 1990: 62). In this process, both early relationships and societal norms are entwined in the unconscious and incorporated into the ego and superego

To ‘supplement’ or ‘build anew’

27

(Foulkes, 1990: 81). Foulkes treats Freud’s defence mechanisms as a given in the rest of his writing, normally referring to them in a list. For him, the defence mechanisms involved in psychological disturbance were mainly introjection, projection and identification. He confirmed that group analysts work with transference phenomena, resistances and other defence mechan­ isms in the same way that analysts work with their patients in dyadic therapy (Foulkes, 1990: 130). Seeing the person as a whole At the time that Foulkes was revising Freudian ideas and developing his approach to group analysis, the schools of neurobiology and sociology were opposed to that of the newly emerging field of psychoanalysis. Foulkes gave himself the task of finding a synthesis between these fields to form a holistic understanding of the mind. He described this as taking him ‘much hard thinking’. He agreed with Goldstein about the importance of taking the whole person into account, and that an examination of independent parts of a person in isolation does not do justice to describing them as a whole (Foulkes, 1990: 129). Our connection with the world is mediated through the body, and they need to be thought about together. Neither can be seen as separate from the other (Foulkes, 1990: 82). He also recommends group analysts be receptive to everything about their patients, their body and everything they say and do, as useful to their analysis (Foulkes, 1990: 274). Foulkes attributed his decision to develop an approach to treatment in groups in part to Kurt Goldstein. At the first European workshop in 1973, he said that: From training and insight acquired in neurobiology as seen by my tea­ cher Kurt Goldstein, I held the conviction that the situation in which one works, the situation as a whole really decides all part processes and their meaning, all part processes which one can observe. (Foulkes, 1973: 73) He also stated that the ideal situation for this is to see patients in groups. Anxiety Freud had recognised that, although it is normal to feel anxiety when experiencing something traumatic, some anxiety does not appear to have a cause. He attributed this to the Oedipus complex and castration anxiety, suggesting it was caused by the suppression of sexual libido. He also identi­ fied neurotic anxiety, a state triggered by repressed, unconscious conflict. Foulkes’s understanding of anxiety was influenced by Goldstein.

28 Group analytic theory

Foulkes mentions anxiety in his seminal paper ‘On Introjection’, where he links it with identification, suggesting that identifying with someone they love leaves people feeling protected from their own feelings of weakness and more secure (Foulkes, 1990: 68). Foulkes was influenced in his view by the work of Goldstein. Like Freud, Goldstein saw anxiety as a normal response to fear. Goldstein saw anxiety as ‘the patient’s effort to remain in the situation he can cope with’ (Foulkes, 1990: 50). Anxiety-provoking situations show themselves in the body, through changes in facial expression, pulse rate and the circulatory system. Goldstein had observed that, in states of high anxiety, people lose their capacity to think about themselves and others (Foulkes, 1990: 49–50). What interested Foulkes was that Goldstein’s research showed that, in states of anxiety, the physical and psychological responses are two sides of the same coin. In what Foulkes refers to as ‘a state of catastrophic anxiety’, a person’s fear has become dissociated from the specific environmental event that triggered it. Foulkes’s conclusion for practice was that: when describing the phenomena from both positions [physical and psy­ chological], separately, the meaning of the material only becomes man­ ifest when looking at its relevance for the whole. (Foulkes, 1990: 49–50) The person’s psychological response to a past event had become dissociated but still had the power to paralyse in the present. Its effect was to undermine the person’s ability either to draw on their own ego functioning to help them to self-sooth or to feel connected with others in their social network whom they could draw on for support. Foulkes understood that in order to trace the original meaning of the anxiety it was important to take account of both the physical and psychological aspects. Here again, Foulkes is challenging Freud’s theory that anxiety is triggered by the Oedipus complex, replacing it with the impact of the social context. He is saying that all anxiety is triggered by a traumatic event or events, and this re-emerges from the unconscious when past trauma reactions are triggered in the present. Libido theory Freud followed the traditional approach to understanding the person, which was to dissect it into its parts to understand it. For Freud, our libido, our life force, comes from psychic energy driven by Eros, our sex drive, and Thanatos, the death instinct. He believed these internal processes were largely inbuilt and originated in the mind. In thinking about this, Foulkes followed Goldstein and his holistic understanding of human development. From this perspective, the energy that is available to a person is not just dependent on internal processes within the person themself. Of equal importance is the interaction between an organism and its environment. Foulkes noted that anxiety and libido theory act

To ‘supplement’ or ‘build anew’

29

as figure or ground. If there is a change in the environment, it will affect the person’s mind. It is the interaction between the two that creates change (Foulkes, 1990: 50). Foulkes’s sociogenetic model of the mind It has been said that Foulkes had planned to write a book detailing the con­ tent of group analytic theory. Dahlin thinks that ‘Foulkes gave us little theory but very much in the form of praxis’ (Dahlin, 2003: 365). He saw group analysis as both effective and cost-effective. However, he concluded that, although Foulkes offered us a clear and effective praxis, it lacked the gravitas of other, more vigorously researched, methodologies (Dahlin, 2003: 365; Carter, 2002: 133). This chapter is suggesting that, although Foulkes did not complete his planned work on group analytic theory, he did contribute much. The chapters in Selected Papers referring to the work of Goldstein and Elias, along with Foulkes’s paper ‘On Introjection’ and his review of Helen Keller’s book The World I Live In, when taken together, show detailed attention to theory that both supplement and build anew Freud’s model of the mind. In reworking these aspects of Freudian ideas, Foulkes developed a theore­ tical underpinning for group analysis. This theory remains faithful to Freud’s model of the id, the ego and the superego. It was radical in its day in rejecting the idea that they included memory traces from the dawn of time to explain taboos. Instead, Foulkes laid out his sociogenetic model where the ego and superego are formed and modified through the processes of identification and introjection from their environment. In Foulkes’s model of the mind, the cur­ rent impact of our culture, shaped by the elites of the day, is sufficient to explain those aspects of the mind that Freud hypothesised in Totem and Taboo were memory traces laid down in ancient history (Foulkes, 1990: 80). Instead, Foulkes proposed that the mind is shaped by the influence of societal and cultural norms that are internalised in childhood. Traditions that were passed on by parents through their child rearing practices shape the way the mind sees the world in adulthood (Foulkes, 1990: 81). Foulkes took a holistic view of the individual, who cannot be understood without reference to their environment. He asserted the importance of the body, the physical object that mediates between the mind and the world. From this perspective, our life force is not only generated from within the mind, but also a product of forces from the outside world. This was confirmed to him in his study of Helen Keller’s account of learning to communicate and perceive the world using her hand as a replacement for her lost sight and hearing.

Conclusion At the beginning of his career, Foulkes followed Freud’s classical perspective of the mind. He then met colleagues from the Frankfurt school of sociology

30 Group analytic theory

who opened his eyes to other ways of understanding the way our minds work. His review of Elias’s book The Civilising Process captured Elias’s view that our societal mores are internalised in childhood and passed this way from generation to generation. His review of the psychoanalytic literature on the processes of projection, introjection and identification led him to build on Freud’s model to explain psychoanalytically the processes that socialise the mind. Foulkes’s emphasis on the importance of being aware of the societal context, alongside that of the family and biological makeup, has been adopted as mainstream within group analysis. Foulkes’s reworking of Freud’s model of the mind and the introduc­ tion of societal pressures are a fundamental shift in direction from Freud’s model. Towards the end of his life, he said that he felt liberated when he decided that he would no longer be constrained by what he saw as the limits of psychoanalytic theory. He wrote: I will, therefore, confess that for me it was an act of liberation to work in what I consider a new field, group analysis, where one could build anew without in the least losing one’s psychoanalytical foundation. (Foulkes, 1990: 287)

References Carter, D. (2002) Research and Survive? A Critical Question for Group Analysis. Group Analysis 35 (1): 119–134. Dahlin, O. (2003) Group Analysis Has No Theory! Foulkes Failed Us. Did He? Group Analysis 36 (3): 365–374. Foulkes, S.H. (1973) Address to the First European Workshop. Group Analysis 6 (2): 72–77. Foulkes, S.H. (1990) Selected Papers of S.H. Foulkes: Psychoanalysis and Group Analysis. Oxford: Routledge. Freud, S. (1912) Totem and Taboo. London: Hogarth Press. Freud, S. (2018) The Ego and the Id. Mineola, NY: Dover. Goldstein, K. (1934) Der Aufbau des Organisraus. Einfiihrung in die Biologie unter besonderer Berilcksichtigung der Erfahrungen am kranken Menschen Imago 22: 210–241. Keller, H. (2012) The World I Live In and Optimism: A Collection of Essays. Courier. Szakolczai, A. (2000) Norbert Elias and Franz Borkenau: Intertwined Life-Works. Theory, Culture & Society 17 (2): 45–69.

Chapter 3

Some group analytic concepts

Introduction This chapter will be of interest to those who may be new to group analytic thinking. It is intended to provide the concepts that underpin the practice of group supervision. It could also be useful for the more seasoned group analyst who is beginning to apply these concepts to their supervisory practice. It focuses exclusively on Foulkes, the language he used and his approach to therapy. Foulkes’s decision to develop a new approach to psychoanalysis was a result of having reviewed much of Freud’s writing and having extensively researched colleagues’ papers, both in Vienna and in the UK. Foulkes had hoped for inspiration from the social sciences to help him shape his approach to psychoanalysis in groups. Having been assured by Elias that the socio­ logical literature would not be of assistance, Foulkes needed to look else­ where. He was aware of American approaches—the work of Trigant Burrow, who was not following a purely psychoanalytic approach (Foulkes, 1990: 147), and Carl Rogers, who ran encounter groups that offered constructive support (Foulkes, 1990: 172). Foulkes wanted his groups to be analytic and he set out to develop his method using his knowledge of psychoanalysis, his own observations and his considerable experience (Foulkes, 1973: 72). The con­ cepts Foulkes introduced to supplement the psychoanalytic literature were evidenced where possible by research. Foulkes saw the therapy group as akin to a mini research project into the conditions supporting therapeutic change (Foulkes, 1964: 129). Foulkes regarded the move from a two-person relationship, such as psy­ choanalysis, to the three-person psychology of the group as changing the main focus of the therapy. This involved a move away from an analysis of transference towards an analysis of interpersonal relationships. This required some additional terminology to carry concepts that would capture what was happening. A concept is an abstract idea that can be used as an experimental model to test out something new to see if it works. A theory is arrived at by formulating a hypothesis and testing it to find scientific evidence to prove it. A theory has a predictive component, whereas a concept adds description and DOI: 10.4324/9781003375975-6

32 Group analytic theory

clarity but it does not predict. Foulkes understood this. The previous chap­ ter describes the way that Foulkes examined Freudian concepts and tested them against the most up-to-date research of his day. In effect he was hoping to test these concepts in order to prove or disprove their validity. This chapter shows that Foulkes did not regard himself as creating a new approach. He saw himself as combining concepts drawn from psycho­ analytic theory with the additional language needed to adapt to the threeperson psychology of analytic groups.

Group analytic theory What is a person? Foulkes’s theoretical stance arose from the addition of societal influences to Freudian theory, as described in the previous chapter. These societal influences on our minds play their role in generating the internal conflicts underlying indi­ vidual distress. He explained that ‘as group psychotherapists we study human beings and their problems in their full social context’ (Foulkes and Anthony, 1991: 29–30). Foulkes’s emphasis on the importance of environmental influences in the development and maintenance of psychological disturbance was reflected throughout his writing. He named the Freudian concepts of projection, intro­ jection and identification as the mechanisms underpinning his socially based approach to the mind. He referred to the societal norms that cause internal conflict as ‘these colossal forces’ that have tremendous power. Foulkes recognised that they shape our personality as much as our own innate potential, while at the same time we defend ourselves against the knowledge of their influence (Foulkes, 1964: 52). He concluded that the ‘so-called inner processes in the individual are inter­ nalisations of the forces operating in the group to which he belongs’ (Foulkes, 1990: 212). This placed the origin of psychological disturbance within the family, the community network and the underlying culture, rather than primarily located in an individual; ‘illness is interpersonal and involves the community’ (Foulkes, 1964: 296). This way of understanding inner conflict recognises that conflict as an inevitable outcome of societal living. Foulkes agreed with Elias that conflicts are shaped by the context. He asserted that conflicts from the current psy­ choanalytic literature arise in the context of the family. Although there are innate personality traits, the child’s inner and outer worlds cannot be sepa­ rated and they are ‘transmitted more than inherited’; even ‘the libidinal phases and reactions to bodily functions are culturally conditioned’ (Foulkes, 1990: 275–276). This perspective both was different from that of Freud and was in opposition to the contemporary language of disease and illness. He saw each person as ‘pre-conditioned to the core by his community, even before he is born, and his personality and character are imprinted vitally by

Some group analytic concepts

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the group in which he is raised’ (Foulkes, 1990: 152). Because we live in com­ munities, we share a common culture. This aspect of our culture is largely static and only changes slowly most of the time. Individuals come to accept as normal the way that things are done in their own culture and beliefs. Foulkes located the culture he was writing about as Western European. He contrasted this culture with the culture in Soviet Russia (Foulkes, 1990: 166) and with the culture of the area of Indiana that the Kinsey Report refers to (Foulkes, 1990: 205). Foulkes called areas that share a common culture the ‘foundation matrix’. It refers to the web of communication that takes place between people in a group. A group of strangers can meet together and communicate because they have a similar anatomy, physiology and genetic makeup and are immersed in the same culture. This is what he meant when he said that we are all a part of a common foundation matrix. This common inheritance allows us to interact and com­ municate. The foundation matrix is societal and is communicated to each person from infancy through the people who surround them, through introjec­ tion, projection and identification. The foundation matrix is slow to change, and each person comes to experience it as normal. We are not normally aware of our foundation matrix on a day-to-day basis unless we have cause to stand outside it. Foulkes himself did not directly address issues of diversity in groups. This was picked up later by Farhad Dalal in his book Taking the Group Ser­ iously: Towards a Post-Foulkesian Group Analytic Theory (Dalal, 1998). Each individual is also born into a family network and local community. Foulkes called this ‘the dynamic matrix’. This matrix changes more readily over time. Within this group, the infant learns about themself and others through the same process of projection, introjection and identification. The family and the local group where they live shape what each person learns about both social and family norms. Foulkes described each individual as both: helplessly compressed into a mere particle of social groups and masses … [and] at the same time left without any true companionship in regard to his inner mental life. The relative isolation and alienation of the indivi­ dual is thus a very real problem of our time. (Foulkes, 1990: 152) In this model, an individual person is shaped by the society they live in. Our culture and family norms are absorbed throughout life and shape the person we become. They are formed by the system and they also contribute to it (Foulkes, 1990: 184). Foulkes used an analogy to illustrate the way our culture permeates each individual without them being consciously aware of this. He said that individuals ‘can only artificially be considered in isolation, like a fish out of water’, but at the same time they are on their own (Foulkes, 1983: 14–15). It may be that Foulkes’s reference to only being able to see a culture for what it is as an outsider was drawn from his own experience. He was part of a Jewish

34 Group analytic theory

dynamic matrix, a sub-group within Germany. When the clash took place between this group and the large German foundation matrix, the intensity and inherent danger of the conflict led Foulkes to move country. Foulkes saw each individual as being a ‘nodal point’ in their social network: ‘Society’ is inside the individual, just as well as outside of him, and what is ‘intrapsychic’ is at the same time shared by the group, unconsciously most of the time in either sphere, except in the group analytic group. The borderline of what is ‘in’ or ‘outside’ is constantly moving, and the experience of these changes is of particular significance. Even objectively there is no clear-cut frontier between inside and outside, as little as between reality and phantasy. (Foulkes, 1990: 184) In Foulkes’s model of the individual, the triggers which bring people for therapy are present as symptoms such as anxiety, depression, stress or diffi­ culty sleeping. In order for therapy to take place, these symptoms need to be located in the conflicts created by the environment from which they arose. The causes of emotional distress During infancy, we learn to fit in with those around us because we need others to help us survive. At the same time, each of us also has our own needs and wishes, our id. There is inevitable tension between our individual needs and our need to fit in with the people we live and work with, creating inner conflict. We learn to defend ourselves from being aware of this inner conflict to protect us from feeling anxious because of threats to self-esteem and from thinking about painful issues. Freud referred to these as mechanisms of defence. For Foulkes, these defence mechanisms were absorbed in infancy from forces generated by the foundation matrix through the processes of introjection and identification. For him, defences in the individual were only to be understood within the context of the society and culture. As an illustration of this, he contrasted the way neurosis presented itself in Rus­ sian society with that in Western Europe. He concluded that one main difference between the two cultures is that, in Western societies, people are less aware of their conditioning, believing that they are free when this is not as much the case as they believe (Foulkes, 1990: 168). He concluded that, in Western society, ‘our culture throws a much greater burden on the individual. Conflicts are increased, internalized, dynamically unconscious’ (Foulkes, 1990: 169). He said that what he called ‘This modern sickness’ presented itself as ‘deep doubts and fears about integrity and identity’ (Foulkes, 1990: 152). Symptoms were caused when a person either no longer felt accepted by their group, or they did feel a part of the group but they also felt sufficiently constrained that

Some group analytic concepts

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they were no longer able to meet their own personal needs. At this point, symptoms were experienced as overwhelming. Stress, anxiety, depression and feelings of worthlessness infected their daily lives. People coming for therapy would usually present with a range of these symptoms. Often, these symptoms had become dissociated from their original triggers loca­ ted within their current relationships, breaking the connection between their interpersonal difficulties and their symptoms. Foulkes referred to one patient whose therapy led him to recognise his physical symptoms as mental communications about what he called ‘unconscious goings on’ in this man’s relationships with his wife and children. There will always be a tension between meeting an individual need and the strictures that arise from fitting in with societal pressures. The symptoms that bring people for therapy are caused by the tension between their own needs and those of people close to them who provide them with a sense of safety and belonging (Foulkes, 1964: 58). Foulkes describes the development of symptoms using the analogy of a three-dimensional jigsaw puzzle. Each individual is: in constant interaction with the other pieces … When you take this indi­ vidual fragment out of its context, it is shaped and formed, or deformed, according to the place it had and the experiences it received. (Foulkes, 1990: 275) This led him to the hypothesis that, because symptoms are caused by diffi­ culties in relationships, they can only be fully understood when located within the context from which they arose. Vignette: Jim, Part One When Jim came for help, he was off work and depressed. He said he couldn’t face the thought of going back to work after having been signed off with stress. His panic attacks were becoming more frequent and severe because his sick pay was about to run out. When the therapist asked him about his work context, he mentioned his new manager who he described as ‘always on my back’.

Because symptoms such as conflict or anxiety are relational, they need to be contextualised alongside other relationships. The current context for Jim’s anxiety was his imminent need to return to work and his experience of his manager as over-zealous in his attention. The therapist wondered about the roots of Jim’s difficulty, the original social context, his family. During the assessment process, Jim seemed unaware of there being any connection. He described himself as having had a happy childhood.

36 Group analytic theory

Vignette: Jim, Part Two When Jim joined a therapy group, he talked more about his family background. He came to recognise that in his large Catholic family, where he was the young­ est, he had learned that he could best get his needs met by looking helpless. He had indeed been happy as a child. However, using the strategy of appearing helpless with his boss created the impression that he needed more help than he did, hence his boss being on his back.

The ‘location of disturbance’ in the present was Jim’s relationship with his boss. It was an interpersonal difficulty, with its roots in childhood. Difficulties are to be located ‘between persons’ not in one individual alone. For Foulkes, location included both the foundation matrix—societal patterns of beha­ viour—and the dynamic matrix—both the past and the here and now of the group (Foulkes, 1990: 213). Jim was having a difficulty in the present that had roots in his past. These two locations were as a result of the influence of the Catholic church and its family values. Later, Foulkes extended the meaning of the term location to include the depth of the communication taking place at any one time. He referred to five levels of communication that emerge in psychotherapy groups: the current level, the transference level, the projective level, the body level and the pri­ mordial level (Foulkes, 1990: 183). In Jim’s case, the current level was his work situation. The original context, the transference level, was his family where he had his needs met by appearing helpless. He now projected on to others the power to give and withhold what he needed. He presented with stress, a body-level symptom. For Jim, the boss was symbolised as the strict father, the primordial level. Factors that maintain the symptoms of distress Foulkes was interested in why people resist change when their life is so pain­ ful. This was a more important question for him than what had contributed to their symptoms in the first place. ‘Group analysis is not so much concerned with the question of how people have become what they are as with the question: What changes them or prevents them changing?’ (Foulkes, 1964: 144). He recognised that tolerating suffering requires a significant amount of emotional energy, and that therefore the forces which keep a distressed person from changing must be powerful. Foulkes believed that these constraining forces arose from tensions in the dynamic matrix. Change is difficult because of the person’s dynamic matrix, the current group in which the person is living. The established relationships within this matrix exert a powerful influence on maintaining the status quo. The individual and their symptoms also serve a purpose for those around them. This means that, when any individual tries to adapt, they will be acting in opposition to the needs of their group. A change in one person affects the

Some group analytic concepts

37

positions of the others in the group, upsetting this balance. Groups largely act to maintain a sense of equilibrium (Foulkes, 1964: 144–145). He observed that ‘Often, if not always, improvement in the patient provokes active, if largely unconscious opposition on the part of others involved … at the very moment of a decisive change in the patient under treatment’ (italics in original). The indi­ vidual can be thought about as a symptom of disturbance in the group. When a person begins therapy, the wish to change can sit alongside resistance to change. In order for someone to be motivated enough to change, they needed to experience ‘a disequilibrium in the personality, an unbalance which demands change and can bring about that change’ (Foulkes and Anthony, 2018: 45–46). Initially, resistance can take the form of wanting help with symptoms rather than making changes in the way the person relates to others. Vignette: Belinda’s new partner Belinda joined a therapy group because she had bouts of debilitating depression and couldn’t form long-term relationships. She worked as a deputy head tea­ cher where she was well respected. However, there was concern about her peri­ ods of absence triggered by bouts of depression. Some months before she joined the group, Belinda went off sick again, and a colleague recommended that she sought therapy. When she told her story in the group, she was interested in how others coped with depression. The group were sympathetic but, instead of offering hints, they asked her questions about things that may have triggered her depression. Belinda had started a new relationship. As she and her boyfriend became closer, her underlying valency for anxiety and depression increased. The group were able to help her to see the connection between her symp­ toms, her relationship with her boyfriend and the responsibility she felt towards her father. It emerged that as she was getting closer to her boyfriend, her father was giving out subtle and sometimes not so subtle controlling messages. Belinda began to connect her depression with the constant feelings of guilt she felt. She described her anguish at having to choose between seeing her boy­ friend and ‘letting her father down’. Belinda was an only child, and her mother had died when she was four. Her father was understandably grief-stricken. She was both in the care of her father and increasingly the carer for him. Belinda and her father were very enmeshed and, except for a brief period when Belinda had a three-month work contract in Los Angeles, she had lived near him and taken care of him. One of the other group members called it ‘being at his beck and call’.

Belinda’s depression was a symptom of her inner conflict resulting from ten­ sions in the present between her own needs and her father’s expectations. A traumatic event in Belinda’s childhood, the untimely death of her mother, disrupted the family matrix. This event and her father’s controlling behaviour

38 Group analytic theory

shaped Belinda’s personality, leaving her feeling overly responsible for her father’s well-being. Her new relationship was pulling Belinda away from her father, who was competing to maintain their former relationship. It seemed that he was invested in keeping Belinda tied to him. The group had helped Belinda to understand the connection between her depression and her father’s behaviour. When inner conflicts are named, they become consciously under­ stood in the group, and this makes them more amenable to change. Change comes through individuals’ empowerment to take responsibility for their own suffering. How does change happen? The ultimate aim of group analysis is the dissolution of inner blocks, unlearning—as a result of which more choices become available to the individual, conflicts become amenable to solu­ tion, the whole mental life is raised to a level of greater freedom, liber­ ating it from compulsive conditioning and repetition. (Foulkes, 1990: 216) An analytic group provides a neutral situation outside the environment where symptoms developed. Relationships in the therapy group have not been pre­ determined by past events other than those which each person brings with them. Each person presents their symptoms in the group through the way they relate to each other and to the group analyst. Change takes place in the group conversa­ tion through the process of translation, making the unconscious conscious. Change in the group is an interpersonal process not isolated in the mind of one individual in the group, but rather ‘each change in each member of the network reacts on all the other members of the network’ (Foulkes, 1990: 72). Change in one person makes a difference to all of the members. The main drivers of change are ‘catharsis’—gaining relief by expressing powerful repressed emotions—and the analysis of transference. In group analysis, this means transference both to the group analyst and to the other members of the group. The group also uses identification and counter-identi­ fication as they take place between group members in response to each other. Communication in the group facilitates the process of dissolving resistances. A group also provides an opportunity for unlearning past patterns that shape interpersonal relationships. Group members learn about their valency for projection, misinterpreting what is ‘inside’ them as coming from ‘outside’— that is, from another member of the group. Change itself emerges from the group’s ‘free-floating discussion’. Free-float­ ing discussion provides a means for reaching the unconscious in a similar way to that of free association in dyadic analysis. All this is possible because individuals can communicate with each other at different levels, moving

Some group analytic concepts

39

between what is conscious and unconscious. These ‘quasi-associations’ come from members’ common understanding of each other (Foulkes, 1990: 157). In this process, the group shows ‘bursts of chain activity, each member con­ tributing an essential and idiosyncratic link to the chain … The event can deepen the level of communication in the group and lead to dynamic group developments’ (Foulkes and Anthony, 2018: 151). This is a description of the ‘chain phenomenon’. This process serves the same function as free association in dyadic therapy. Foulkes referred to this process as ‘translation’. Translation increases ‘the area of communication in depth as well as raising it to the level of conscious communication’. Over time, unconscious processes are brought into conscious awareness through the group conversation producing change and insight (Foulkes, 1990: 141). In a group analytic group, the process of interaction creates a new ‘matrix’ of meaning. This meaning is transpersonal and belongs to the group. As people get to know each other, their capacity for communication increases, and relationships deepen. In the process, ‘individuals become more clearly defined’ (Foulkes, 1990: 182). Each group member responds at both conscious and unconscious levels and has the capacity to translate and communicate between ‘unconscious, preconscious and conscious’ levels of the psyche, bringing what was unconscious in one person into consciousness within the group (Foulkes, 1990: 215). Change takes place because members’ free-floating conversation loosens resistances. There are times when ‘condenser phenomena’ release a sudden and deep discharge of primitive material through dreams and the naming of fears and fantasies. The condenser phenomena reveal something unexpected that seems on a conscious level to be disconnected from the previous conversation (Foulkes and Anthony, 2018: 151). Vignette: Belinda, Part Two Aisha, another member in Belinda’s group, was the carer for her elderly mother. Aisha was also married with two children and she had a part-time job at her local post office. Group members offered sympathy and support for her situation. Jacquie, another member of the group, asked her how far her situa­ tion was affected by her family’s cultural heritage. As Belinda heard Aisha talk about the pressure she felt under to give up her job and the guilt she felt at not being more available to help her mother, she found herself identifying with her. She could see elements of her own situation mirrored in Aisha’s dilemma. In what seemed at first a disconnected response, one of the other group members talked about grieving for their lost childhood. The tone of the group conversation shifted as each person talked about grief. Belinda got in touch with her grief about having so little memory of her mother, who had never been mentioned at home after her death. She also revealed that she used to have nightmares, thinking that she had somehow been responsible for her death.

40 Group analytic theory

The group conversation began with an exchange between Aisha and Belinda about their current situations. Foulkes referred to this as ‘exchange’. Exchange is one of the group-specific therapeutic factors and needs to be understood in the context of the group. It operates at different levels and so it can bring something that was previously unconscious into consciousness. This is as a result of what Foulkes referred to as a group’s ‘loosening and stimulating effects’. When one person talks about their problem, this makes it easier for others to talk about this too. As different members contribute to the theme, the group moves towards deeper, unconscious material, increasing the range and depth of what can be talked about in the group (Foulkes, 1990: 141). Foulkes named the experience of one person seeing an aspect of themself reflected in the way another member is behaving the ‘mirror reaction’. This mirror reaction offers them, or supplies them with, the opportunity to observe similar behaviour to their own from the outside. The mirror reaction involves the defences of projection and identification and it increases insight (Foulkes, 1964: 81). There can be distortions in the mirror reaction in groups. In Foulkes’s experience, these largely cancelled themselves out (Foulkes and Anthony, 2018: 151). Belinda had grown up to accept her close relationship with her father and her role of carer as being normal. Seeing the impact on Aisha of her mother’s demands and the group’s supportive comments served to help Belinda to take a step back from her own situation and to review her situation in a new light. After only a few weeks, Belinda told the group she felt less on her own with her difficulties. She had previously felt ashamed of feeling the resentment she did towards her father. Seeing Aisha struggle with the pressure from her mother and the support she had received from the group meant that she no longer felt so on her own. Foulkes mentioned ‘reducing isolation’ as another potent group-specific factor. When Belinda joined the group, she was brought into a different social situation, one where others had similar struggles and she could feel adequate. She was able to say things she had never revealed before. She felt understood as others responded. She also found out that others in the group whom she liked could feel as depressed as she did and shared similar feelings, such as anger and resentment, that she had previously tried to suppress. Facilitating change In the initial stages of therapy, the group helped Belinda and Jim to translate their physical and mental symptoms into relationship difficulties. The pro­ blems people bring to their group are more likely to be events that happen at home, at work or with their friends. When members also repeat the beha­ viours that arose in their families within the group they can be seen and thought about in vivo.

Some group analytic concepts

41

Vignette: Jim, Part Three Jim began the session by bringing up a development in his work situation. He was still off sick and particularly anxious because he had an occupational health appointment booked for three weeks’ time. He said he felt like a rabbit in the headlights. He knew he had to return to work to pay the bills, but he couldn’t face seeing his boss. Patrick, another member of Jim’s group, said he really felt for Jim and revealed that he had been in a similar position the previous year. Patrick described the way the group had helped him with an occupational health appointment to assess his readiness to return to work.

This is an example of ‘resonance’. Resonance is an interpersonal response to the emotional state of another. Foulkes described it as an instinctive and intuitive process. It takes place when the inner world of one person is in tune with the inner world of another. Resonance takes place spontaneously and is shaped by the person’s unique personality and past experience. Resonance also contains an unconscious interpretation on the part of the person who is resonating to what is being said (Foulkes, 1990: 218). The unconscious inter­ pretation contained in what Patrick was saying was that, like him, Jim found it difficult to take control and so felt at the mercy of others. In Jim’s work situation, he felt at the mercy of his boss and now he was experiencing the same feeling over his appointment with an occupational health (OH) nurse. Vignette: Jim, Part Three, Continued Jim could see that Patrick had struggled in a similar way to him and thanked him. The problem was, he said, that he genuinely didn’t know what he wanted. To Jim’s surprise, Yunexse, another group member, challenged him about this, saying that she thought he did know what he wanted. At this point, Jim became paralysed and was unable to speak. This brought Jim’s anxiety squarely into the group. After a pause, Patrick asked Jim whether what he was feeling now in the group was simi­ lar to the way he felt in work. Jim acknowledged that this was the case. At this point, the group analyst asked the group about times when they had felt paralysed, and what feelings this had aroused in them. Ryan said there had been times when he had felt shamed, Javi and Flora referred to times when they had felt angry in the group. The group analyst turned to Jim and asked him how he had felt when Yunexse had challenged him. Listening to other group members name their feel­ ings enabled him to recognise that he had felt both shamed and angry.

Seeing Jim’s reaction live in the group enabled the members to make sense of his behaviour and to help him connect this with feelings that had previously been repressed. The group helped him think about how he would take more control of his appointment rather than leaving the control with the OH nurse. As a result of thinking this through in the group, Jim planned to tell her that he was ready to return to work but that he needed to be managed by a different person.

42 Group analytic theory

Another benefit of being in a group is that it can provide a network of support as members make changes in their social context outside the group and also through the turbulence created as family and friends in turn adapt their behaviour to accommodate this change. The week before Jim’s appointment, the group helped him to develop strategies for managing his occupational health appointment the follow­ ing day, sharing strategies that they had found helpful in tight corners. Jim had also put some thought during the week into doing what Patrick had done and asking to be given a different boss. They wished him good luck as they left the group. While he acknowledged that there is nothing exceptional in exchange— sharing information and offering explanations—Foulkes regarded it as a therapeutic factor that has a beneficial effect. Jim learned from this exchange about new ways of dealing with difficult situations. A third benefit of group analysis is that it provides a forum for trying out new behaviours in the group context. Over the next few weeks, Jim both watched the way that others handled tensions in the group and began to take risks himself. This widened his range of potential behaviours. Differences between members can mean that where one person is heavily defended against, for example, being in touch with feelings of anger while others have a blind spot in this area, the group’s experience is enriched, extending the range of what can be felt in the group. Dissolving defences in this way can create new insight. When something is unconscious in one or more people, because of painful and traumatic experiences from the past, another person may be in touch with some of the missing pieces of the jigsaw. This could be, for example what is not being said. There may be feelings that resonate in one person while others seem unaware. For example, Yunexse was able to con­ front Jim with his helpless behaviour because she felt able to be in control and she was comfortable with confronting others. Processes that impede change It takes energy to maintain symptoms, and this causes distress. A change in one piece of a jigsaw puzzle will mean other pieces adapting to make the whole fit together. Foulkes’s social model of the person locates illness in blocks to commu­ nication in the group, and a person’s illness can be best understood as a symptom of this block. A change in one person will affect everyone. After an initial period of relief to family and friends who are pleased a ‘sick’ member is better, the consequences of this disruption to established patterns of relating may be resisted. This is because lasting change in one person involves some adjustment in the rest of the group. This can cause friction, and it may take

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43

time to adjust to a new homeostasis (Foulkes, 1990: 199). It can require con­ siderable energy on the part of the previously ‘sick’ person to maintain change because this will be in opposition to the current stasis. When treat­ ment is successful, and there is an adjustment in the dynamic matrix of the group to accommodate this, sometimes another member of the group may become ill (Foulkes, 1964: 149). Vignette: Belinda, Part Two, Continued With the support of the group and her new partner, Belinda was enabled to put some boundaries in place around her support for her father. She no longer called every day and, when she did call, she was letting her father know how long she was staying for. The group celebrated with her this huge shift in their relationship. Her relationship with her partner was thriving, and she said that he had told her how different she was, laughing and smiling more and looking less tense. A few weeks’ later, Belinda arrived in floods of tears. Her father had become very depressed. She and her partner had called to find him very confused and sleepy. They called the emergency services who took him to hospital. One of the doctors told them later that he had taken an overdose. It wasn’t enough to kill himself but serious enough to need treatment. Belinda felt dreadful and was speaking in the next group as though she was responsible for his actions. She said she was beginning to feel depressed again herself.

Although Belinda had been able to make significant changes herself in her therapy group, this is only a part of the story. The other half involved a determination to see things through. This is a demanding process, captured in Homer’s epic poem when Odysseus resists the sirens’ songs by having his ship’s crew tie him to the mast of their ship so he could hear them without being seduced. For Belinda to maintain her change, she will need to meta­ phorically ask the help of her partner and the group to tie her to the mast if she is to hold her course and resist being seduced into old patterns by her father’s alarming behaviour. Foulkes acknowledged that, although what he referred to as these difficul­ ties can be resolved in groups, there are limits to what can be achieved. Foulkes referred to deep Oedipal conflicts such as that between Belinda and her father as ‘operating in strength and in depth’. In some circumstances, he felt that the working through of the conflict may require some individual psychoanalysis (Foulkes, 1990: 240). The role of the therapist The group analyst is responsible for the ‘dynamic administration’ of the group. Group analysts use the term ‘dynamic administration’ to cover the tasks involved in managing both the internal and external boundaries of groups.

44 Group analytic theory

Dynamic administration of the external boundaries of the group will be shaped by the number and needs of members of the group. The group analyst sets the day and time for the group, decides on who to include and when they can join. They set dates and, if the group is run privately, any arrangement for fees. Running an analytic group involves organising a suitable room and appropriate furniture in a place where there will be no interruptions. Ideally, the group analyst will also have an appropriate room where group members can assemble if they arrive early. The group analyst will assess people before they join and prepare new members to join the group. When the group meets, the group analyst helps the group to communicate and encourages free-float­ ing discussion. This supports the process of moving material from uncon­ scious to conscious communication. It is this process that creates change and insight, widening and deepening what can be spoken about. Under these conditions, ‘the past can be reactivated under conditions which allow for change’ (Foulkes, 1964: 147). The group analyst is a fully engaged observer, aware that they will also have their own defences that will affect the group process. It is important for therapists to avoid being too active in order to encourage this group to begin to take an active part in their own therapy (Foulkes, 1990: 291). The therapist listens for the aspects that are causing distress in the group. Interventions involve helping the group members to find a new balance that meets their inner needs more adequately while also still fitting in with the pressures of everyday living with others. The group analyst pays free-floating attention to the group conversation, listening for unconscious group communication that reflects the conflict experienced by each member in their daily lives. When blocks emerge, they help the group to reflect on these exchanges in order to facilitate commu­ nication and insight. It is not only the group analyst who engages in this process. Foulkes recognised that the insights of others in the group could be of therapeutic value, because different group members will employ differing defences. Each member of the group may have helpful things to contribute. Sharing responsibility for change with the group democratises the process. When the group members’ interventions allow new material into conscious­ ness, this is called ‘translation’. Foulkes reserves the group analyst’s interven­ tions for Freud’s term, ‘interpretation’ (Foulkes, 1964: 111). In the same way, transference to the therapist was transference with a capital T, and transfer­ ence to other group members was transference with a lower-case t. He also sees countertransference in groups in a similar way (Foulkes, 1990: 143). Group free-floating discussion is akin to the free association which takes place in psychoanalysis. Group analytic therapy is described as ‘therapy of the group, by the group, including the conductor.’ Foulkes used the image of an orchestra as a metaphor, with the group analyst in the role of the conductor. As a conductor, the therapist trusts group members’ unconscious selection of what he presents. As each member contributes to this theme, the focus is on ‘the ongoing behaviour where it is “hot”’ (Foulkes, 1990: 173). The group

Some group analytic concepts

45

analyst uses their own resonance to what is being talked about as the compass that helps them to decide when to intervene and the depth of their interven­ tion (Foulkes, 1990: 154). When they find themselves drawn into an enact­ ment, Foulkes suggested pausing to reflect and formulate an interpretation of what was happening in the group (Foulkes, 1990: 291). He also acknowledged that he could get things wrong: one can be mistaken, but there will be special reasons why a mistake has been made. We can therefore never be completely mistaken—except in the ‘location’ of our experience. This is where observations such as ‘pro­ jection’, identification and projective identification come in. (Foulkes, 1990: 279) While taking a neutral stance and following the lead of the group are impor­ tant, they are not the whole picture. In order to achieve lasting change in the group, the conductor needs to engage in more active participation. This involves working through different phases, including using dreams and trans­ ference issues, progressively dissolving resistances and loosening defences (Foulkes, 1964: 17). Within this approach, the group conductor allows the group to arrive at the common areas where they all struggle and to help each other by bringing their different experiences, perspectives and insights. When the group reaches its own block and is not moving forward, it is the group analyst’s responsibility to intervene. The vignettes about Belinda and Jim below provide two examples of the group conductor being more active at a critical phase where the group became blocked. Vignette: Belinda, Part Two, Continued Having been more quiet than usual, one evening at the end of the group Belinda announced that she had decided to leave the group. She reassured them that the things they had said to her had all been helpful but she couldn’t see any way round the dilemma she was in and she felt she was going round in circles. The group’s suggestions were no longer helping. She had let her boy­ friend know that she couldn’t commit to the sort of relationship that he was looking for. The group were speechless at first and then frustrated on Belinda’s behalf that it had come to this as though her fate was inevitable. She agreed to give a month’s notice, naming a date that would be her last session. At this point it was the end of the group, and the group analyst suggested to her that the group would think more with her about her decision to leave the group and think it through in more detail the following week.

Group supervision The group analyst, Fred, took this to his supervision group the next time it met. Members of the supervision group offered their thoughts and shared similar

46 Group analytic theory

experiences. The supervisor, Tomas, asked him to sum up what he would take away to think about. Fred had found the reference to Oedipus really helpful. He could see that, without a second parent to mediate her father’s attention, Belinda would find it hard to separate out her own needs from those of her father, making it hard to hold on to them. Having a boyfriend introduced her to the third posi­ tion and this had put her in touch with her own needs and desires. Under pres­ sure, however, she did not yet have a firm enough capacity to verbalise and think about her own feelings and needs and she had given up. Fred decided that, if the group didn’t raise the issue, he would initiate a conversation about what Belinda had hoped for when she met her boyfriend. He would also ask what both she and the group saw her life as being like without him. He decided to tell her that it might be helpful to continue with the group rather than to ditch everything at the same time. If she stayed in the group, they could continue to support her. The group conductor, Fred, also thought that Belinda and her father could make the adjustments over time that could allow them to establish a new way of relating that took both of their needs into account. However, if Belinda still decided to leave the group, some of the supervision group’s suggestions about couple or family therapy might also be helpful. He could recommend a couple of colleagues who were both individual and family therapists. Vignette: Jim, Part Three, Continued The week after Jim’s occupational health appointment, he reported back to his therapy group. He said he thought the appointment started well. He managed to tell the nurse that he was ready to return to work and that he needed a change of man­ ager. But in his words, ‘after that, things went pear shaped!’ The nurse had asked him about his difficulty with his manager, and he had broken down in tears as he gave some examples of things he had been upset by. Seeing him in tears, she decided he wasn’t yet ready to return to work. She did agree though to liaise with human resources to see what could be done to move him to work under another boss. She signed him off work for a further two weeks and said that either she or someone from human resources would get in touch about options for changing his manager. The group congratulated him on managing to assert his needs. One of the group members thought that this was more important than getting upset. The group conductor had noticed that, in the weeks since Jim had been challenged by Yunexse, she had not spoken directly to Jim. When the group were giving him feedback, they were supportive but avoided challenging him. He gave this as feedback to the group and asked them what wasn’t being said. Yunexse asked Jim what the tears were about when he cried. Jim looked frozen, but this time Yunexse explained that she hadn’t asked him to get at him. She had in fact asked because the one thing that made her cry was when she was beside herself with rage. She had learned to explain to people that she wasn’t crying because she was upset, it was because she was angry. Jim was close to tears as he said that ‘the penny had dropped’ for him. He had started to cry when he told the nurse about incidents when his manager

Some group analytic concepts

47

had said things in front of the team that had left him feeling humiliated. In fact, the last time this had happened was the day before he went off sick, and yes, he had felt ‘beyond angry!’ Patrick commented that, when Jim had said that, his whole demeanour had changed. He had looked defeated when he arrived, but now he looked on fighting form.

The group analyst’s hypothesis was that Jim needed to get in touch with his anger, and that the group were reluctant to challenge him about it. He deci­ ded to engage the group rather than address the issue directly himself because, at this stage, he thought it likely that Jim would tolerate a challenge from a group member more easily than one from him. In these two examples of group supervision, the group analyst intervened to help the group when it had become blocked. In the first example, the group analyst firstly sought help for himself to think through what to do. He decided that, in this case, he would use his authority to encourage Belinda to stay longer in the group. This was because he felt concern about how she would cope if she did indeed end her relationship with her boyfriend. In the vignette about Jim, the group analyst chose to intervene because his intuition told him that the group was finding it difficult to challenge him. He saw it as a whole group issue. The group was not ready to challenge Jim, but it was helpful for Jim to experience the benefits of constructive challenge.

Conclusion At the heart of Foulkes’s writing is his revision of Freudian theory to emphasise the part that the community and the family play in the development of the mind. What he set out to show was that, by adding this social perspective, there was no need to adopt Freud’s model that complexes such as Oedipal tensions are due to memory traces in the brain laid down in prehistory. Instead, diffi­ culties are all relational and can be explained in social terms. The therapy group is another social group, standing outside the situations where conflicts arose. Foulkes recognised that this was an ideal place in which to see the tensions leading to their underlying conflict in their current situa­ tion through the eyes of others—for example, behaving in ways that were learned in childhood and are unhelpful in the present. This includes their current relationships, both inside and outside work. Foulkes’s approach to group analysis was to use the group to convert symptoms such as depression or anxiety into relationship issues. For Foulkes, the root of problems in the present lies in the individual’s inner conflict between doing what they wish and their need to curb their wishes to meet the needs of others. This tension will arise in the therapy when the needs of each conflict with their need to fit in in order to feel part of a group. In a therapy group, each individual can see how others behave, and at times this acts as a mirror, enabling them to see similar difficulties to theirs in

48 Group analytic theory

others, as an observer. Feeling a part of a group can help to relieve isolation, and exchange allows learning from other perspectives. The free-floating group discussion enables what is talked about to broaden and to deepen through condenser phenomena and chain reaction. These are features unique to groups and they allow unconscious conflicts to be translated into problems that can be worked with. The group is a useful place to support change when environmental pulls risk impeding change. It is rarely easy to sustain lasting change. The obser­ vation of one person’s progress in a relationship can be of benefit to all the members. Seeing the change at the end of one person’s journey in spite of the tensions and hurdles they faced on the way can be an inspiration to others who feel further behind on the path. Foulkes referred to the group analyst as the conductor of an orchestra. Like a conductor, they arrange the time and place for the group to meet and they are responsible for starting and finishing on time. Once the group has assem­ bled, their task is first and foremost to encourage the widening and deepening of what can be talked about in the group through fostering free-floating dis­ cussion. They manage the boundaries of the group and intervene when the group becomes blocked. They also use their authority at times of crisis in the group to contain the situation. The aim of group analytic therapy is to help individuals adjust in their current social environment while being more freely able to be and express themselves. It does this in the group through widening and deepening insight, enlarging the range of language that can be expressed to allow freer expression both in the group and outside.

References Dalal, F. (1998) Taking the Group Seriously: Towards a Post-Foulkesian Group Ana­ lytic Theory. International Library of Group Analysis 5. London and Philadelphia, PA: Jessica Kingsley. Foulkes, S.H. (1983) Introduction to Group-Analytic Psychotherapy. London: Karnac Books (London: Heinemann, 1948; New York: Grune & Stratton, 1949). Foulkes, S.H. (1964) Therapeutic Group Analysis. London: George Allen & Unwin. Foulkes, S.H. (1973) Address to the First European Workshop. Group Analysis 6 (2): 72–77. Foulkes, S.H. (1990) Selected Papers: Psychoanalysis and Group Analysis. Oxford: Routledge. Foulkes, S.H. and Anthony, E.J. (1991) Group Psychotherapy: The Psycho-Analytic Approach. London: Karnac. Foulkes, S.H. and Anthony, E.J. (2018) Group Psychotherapy: The Psychoanalytic Approach. London and New York: Routledge.

Part III

The history of group supervision

Chapter 4

In the beginning The roots of group analytic supervision

The influence of the psychoanalytic context on group analysis Psychoanalytic approaches to supervision in the UK have been influenced by Freud’s Wednesday evening case discussion group. The first meeting took place in November 1902. Members of the group presented papers on psy­ chology, neuropathology and the newly emerging field of psychoanalysis. According to Schwartz’s history of psychoanalysis, members were selected to contribute their discussion paper by names being drawn from an urn (Schwartz, 1999: 100). Each meeting included a case presentation followed by a discussion, with a final summary given by Freud. Freud’s Wednesday eve­ ning Psychological Society had a changing membership. It continued until 1939 and the outbreak of the Second World War. Over the course of its 36­ year existence, about 150 people had participated in the group, many of whom went on to become eminent analysts in their own right. When we look at the first literature that emerged from their discussions about cases such as Little Hans and Anna O through the lens of current supervisory practice, they seem very different from the sorts of case discussions that are typical of supervision groups today. Attention was focused on analytic theory, and little attention appears to have been given to ethics, power, authority and dynamic administration. Little Hans raises a number of boundary issues: ana­ lysts analysing members of their own family, therapists taking over cases from their supervisees and supervisors imposing their interpretations on the therapist’s cases. For example, it is highly unlikely that, today, a child who is afraid of horses would be treated as though this indicated that he wanted to marry his mother, as was the case with Little Hans. Now there are clear guidelines around boundary issues and regulatory bodies in place to uphold them. Early developments in psychoanalytic thinking came at cost to Anna O, whom Freud diagnosed as suffering from hysteria. She agreed to having psy­ choanalysis and was the first person to receive treatment using Freud’s new method of free association (Freud, 1895). There is some evidence that her difficulties were in fact neurological and exacerbated by drugs, rather than psychological, suggesting that Anna O’s case may not have been appropriate DOI: 10.4324/9781003375975-8

52 The history of group supervision

for psychoanalysis. This example is a reminder that supervisors have an important role in helping the supervision group to tolerate not knowing rather than basing therapy on a hasty diagnosis. Whatever limitations there may have been in the practices in Freud’s Wednesday evening group, the case study discussions gave birth to psychoanalysis as we know it today. Many of the ideas are still of relevance in supervision, and the weekly case discussions are the roots of our current supervisory practice.

The emergence of supervisory practice as a distinct discipline in psychoanalysis An increasing number of people, mainly psychiatrists, became interested in Freud’s new treatment. It was because of this that a number of the original members of Freud’s Wednesday evening group became involved in setting up training institutes in response to the need for training. Although they devel­ oped separately, each of the first institutes, in Budapest, Berlin and Vienna, included three components: theoretical seminars, a training analysis and supervised practice. The element of the training where there was some diver­ gence between institutes was the supervised practice. In Budapest, trainee therapists would begin offering psychoanalysis to patients and would take their work to their personal analyst for supervision. Martin Rock suggests that this was based on an understanding that ‘most problems trainees had with patients were countertransference problems and the belief that no one could help him more effectively than his own analyst’ (Rock, 1996: 6). There is some evidence that other training institutes too began by combining trainees’ personal analysis with case supervision. According to Jacobs, David and Meyer, the idea of separating trainees’ supervision from their therapy arose in Berlin when ‘Hans Sachs complained to his colleague Max Eitingon that he was tired of hearing his patients talk so much about their own patients in their analyses with him’ (Jacobs et al., 1995: 20). As a result of this conversation, Eitingon offered supervision to trainees, thus separating their analysis from that of their patients. The separation of therapy from supervised practice since then has devel­ oped from the tradition practised in Vienna and Berlin. Nevertheless, it is true that difficulties in an analysis are related to the therapist’s countertransference. It seems that, initially, training supervision often involved the supervisor teaching their supervisee by taking over the case, as Freud had when Hans’s father was unable to help his son with his phobia. This was done with a view to ‘demonstrating, more or less effectively how he would deal with the mate­ rial presented’ (Rock, 1996: 6; original italics). Rock saw the downside of this practice as making it more difficult for therapists to develop their own inde­ pendent identity. This model also did little to address transference and coun­ tertransference issues arising between therapist and patient or therapist and supervisor. It was also an approach that seems blind to the imbalance of

In the beginning

53

power in the supervisory relationship and the potential for acting out on the part of the supervisor. By the 1950s, there was a shift in thinking about the nature of counter­ transference as unconscious, the classical Freudian perspective. Paula Heimann widened the term countertransference to include ‘all the feelings which the ana­ lyst experiences towards his patient’, rather than restricting the term to only those aspects that are unconscious. Prior to this, the only approach to working with countertransference in supervision was for the supervisor to recognise what were termed ‘countertransference enactments’. Enactments arise when the therapist is drawn out of role, over- or under-reacting to what their patient is saying. The supervisory task was to analyse it in order to make the unconscious conscious in the therapist. The supervisor helped the supervisee recognise and reflect on the triggers, usually from their past, that led to the enactment. Heimann adopted a different perspective, focusing on the importance of the therapist’s emotional response. In her view, ‘The analyst’s emotional response to his patient within the analytic situation represents one of the most impor­ tant tools for his work’ (Heimann, 2018: 81). She saw that, when the analyst was able to harness their emotional response (that is, their conscious physical and emotional experience in the room with their patient), this could be a useful tool in understanding what was happening for their patients. Searles was the first to note that, when transference and counter­ transference processes emerge in supervision, they often reflect something of the therapist’s relationship with their client. When he experienced pulls from his role with his supervisee that were not there with other cases he was bringing, he realised that this could be viewed as potential information about what was unconscious in the patient therapy dyad. He referred to this as the reflection process. The supervisee, he said, made an unconscious identification with the client/patient which could extend to tone of voice and behaviour. The supervisee thus enacts the central pro­ blem of the therapy in the supervision, potentially opening up a process of containment and solution, first by the supervisor and then by the therapist. (Searles, 1955: 159) Searles also acknowledged the potential for this reflection process to adversely affect the therapy when it was the supervisor enacting something caused by a blind spot in them. When this happens, it can be transmitted from the supervisor, via the therapist, to the patient. There are ‘processes at work currently in the relationship between patient and therapist [that] are often reflected in the rela­ tionship between therapist and supervisor’ (Searles, 1955: 159). Ekstein and Wallerstein noted that, when supervisors were able to use their counter­ transference to name the parallel process, it could facilitate personal supervisees’ learning and growth as well as reducing the likelihood of the dynamic being enacted within the supervisory relationship (Ekstein and Wallerstein, 1958: 179).

54 The history of group supervision

Summary Over the first half of the twentieth century, the nature and practice of super­ vision changed. Initially, when trainees took their supervision to their therapy, the task centred primarily on the analyst uncovering the trainee’s counter­ transference. The separate discipline of supervision emerged at the point where analysis of trainees’ cases became separated from their analysis. Initi­ ally, supervision was about passing down the wisdom from the founding fathers, as had been the practice in Freud’s Wednesday evening group. The next shift in practice followed the publication of papers, most notably by Paula Heimann, who recognised the potential value of conscious counter­ transference. This paved the way for Searles and Ekstein and Wallerstein, who recognised and used parallel process to enhance their supervisory work. The supervisor’s capacity to work in this way made the process available both to use as information about the therapy and to reduce enactments by the supervisor. The significant publications on the theory and practice of super­ vision within psychoanalysis from this period are almost exclusively based on a dyadic model and formed a significant part of the context within the UK from which group analysis and group supervision emerged.

S.H. Foulkes and group analytic supervision The context for the development of group analysis Group analysis arose after the Second World War, at a time of change and rebuilding. Foulkes was one of a number of immigrants who had come to the UK to escape persecution on the continent, bringing with them some of the new ideas about psychoanalysis from Austria, Germany and Hungary. A number of these people had met at the Maudsley Hospital where they had received group supervision for their casework. A number of these had been supervised by Foulkes. For example, Robin Skynner, who worked at the Maudsley during the time Foulkes was there, received supervision from him for his work. He is quoted as saying that, although his colleagues remained ‘puzzled about the nature of what they received from him’, ‘it proved to be of exceptional value to their lives. It was certainly not conveyed by intellectual means’. Skynner remembered Foulkes’s sense of curiosity, his belief that each person had something of value to contribute, and that the group could ‘find out more than any individual if its creative power could be harnessed’. Robin Skynner also said that Foulkes’s approach to supervision was like ‘a truly scientific study of human behaviour’ (Foulkes, 1990: 19–20). Foulkes was able to bring a wealth of expertise drawn from his training as a psychiatrist and a well-respected psychoanalyst, Freudian training analyst and teacher. He provided postgraduate training at the Maudsley Hospital. He had been a consultant psychiatrist at the Maudsley and one of the founders, with

In the beginning

55

Bion, of the Northfield Experiment and he had been on the BPS Council. All this experience gave him the background needed to establish both the Group Analytic Society and a new institute, the Institute of Group Analysis. He drew on his extensive experience and his deep understanding of the fundamentals of psychoanalysis, combining them with his more radical approach to group ana­ lysis that was drawn from social theorists from Europe, such as Kurt Goldstein. His friend Norbert Elias had also moved to England, and Foulkes wrote a review of his book The Civilising Process (Foulkes, 1990: 79–82). Foulkes’s approach to group supervision Foulkes followed the traditional psychoanalytic practice of including teaching, therapy and supervision in the training of group analysts. The practical differ­ ence was that all three were conducted in a group. Foulkes placed group supervision as on a continuum between teaching and therapy. In doing so, he is following the approach he experienced himself in Vienna. He adapted the dyadic approach to supervision, applying his group analytic method to group supervision. It is to be noted that, in Chapter 20 of his book Therapeutic Group Analysis (1964), Foulkes also includes research into the theory and practice of the group analytic method, along with his overview of the supervisory seminar. Where he differs from other psychoanalytic training is in aspects of the theory that focus on therapy in groups. The same is true for group analytic super­ vision, where he does not refer to writers offering dyadic supervision such as Searles, or Ekstein and Wallerstein who were writing at this time. His focus remained firmly on the work of those who had experience of creating learning in groups such as Jane Abercromby, R.C.M. Hunter and George Stroh. However, he was keen to show that his approach to group analysis fitted in well within the psychoanalytic tradition. Of particular interest to him was the case research of some of the first group analysts. This contains descriptions of their practice and reflection on their learning. In his section on the super­ visory seminar, Foulkes draws on some of this research, relating it to the practice of providing supervision in groups. He was interested in not only their research, their learning and their insights but also their ‘mistakes’ (Foulkes, 1964: 252). Foulkes was clear that appropriate boundaries were to be set for therapy, theory, research and supervision. They were to be defined according to the nature of each task. For example, when writing about group supervision, he wrote that the: supervisory seminar was not a therapeutic group; it could not be under the circumstances. We deliberately confined our discussion to the inter­ action between the doctor and his group of patients … On occasion we also took into account reaction within the seminar itself. (Foulkes, 1964: 251)

56 The history of group supervision

He acknowledges the importance of working with countertransference while further defining limits to the focus on the registrar’s personal material that was to be explored: in so far as—and only in so far as—it encroached on their function … in the role of therapist, with his patients, and the other as a participating member on the supervisory seminar or staff group. (Foulkes, 1964: 251) Countertransference in group supervision was a central focus. An advantage of this was that it created a learning opportunity for the whole group. The method Foulkes introduced as a way of achieving this was that advocated by Jane Abercrombie, who was interested herself in Foulkes’s approach to group analysis. She used group analytic principles to provide group learning for trainee doctors as a part of their medical training. Her research showed that group discussion of cases allowed the trainees to receive feedback from others that helped them to spot their own biases. This awareness helped to reduce misdiagnosis by individual doctors, and Foulkes advocated this approach as central to group supervision. He highlighted the benefit to group members of learning from the work of others. Each member can take up different roles, ‘conductor, observer and third person’, with the supervisor there to help them learn from the experience (Foulkes, 1964: 251). The aim of this was to help each person to receive feedback about their own biases in the same way that Abercrombie’s doctors had done. His approach encouraged active participa­ tion and the analysis of countertransference experienced by each of the supervision group members elicited from the patient material and not just the trainee presenting their group. He was confirming that group analytic super­ vision was within the mainstream of psychoanalytic practice, while high­ lighting the additional learning that supervision in a group can bring. Foulkes supplemented the description he gave us of his own approach to group supervision by referring to three scientific papers. Each highlights what he saw as important ingredients of group supervision. He used them to provide a deepening understanding about an important aspect of group supervision practice. Before introducing the first paper, Foulkes made it clear that, in order to help patients change, it is necessary first to help the therapist change. It was indeed very impressive to see how great and how deep going was the influence of the doctor’s personality and approach on their group of patients. Change in him in relation to his group, particularly change on unconscious levels, would alter the course of events in the group … Such problems of countertransference played a considerable part in our super­ visory conference and were the more impressive as they in turn were brought to light and analysed by all those present. (Foulkes, 1964: 251)

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In the first case, Foulkes used a paper by Stroh to illustrate the importance of analysing countertransference as a way of understanding a therapist’s enactment in his therapy group. This paper focused on one individual, Stroh, and his learning from his supervision group, his contemporaneous notes and his self-reflections. Stroh had been one of Foulkes’s supervisees. Stroh’s single case research paper was based on notes he had taken in preparation for his group supervision. Stroh argued that, because his group notes were primarily written as his free associations to his group, rather than representing a totally accurate record, they were likely to capture countertransference enactments and to identify the ‘unconscious motivations of the reporter’ (Stroh, 1958: 404). His focus was on himself primarily and, when he returned to them, he was looking for what he was doing that impacted negatively on his super­ visory work. In the process of re-analysing his supervisory notes, Stroh iden­ tified four themes reflecting what, with hindsight, he recognised as shaping his actions that were outside his conscious awareness at the time. Firstly, there was his countertransference to the supervisory seminar members, including the seminar leader. Secondly, there was his countertransference to one of his therapy group members, B, and his overreaction to what she was bringing. He recognised this when the link was made between a change in the material the patient was bringing and his use of language in recording the session. This enactment was seen both between himself and his patient and with the supervision group. He noted that this was ‘precipitated if not created, by the therapist’s transference to his own analyst’ (Stroh, 1958: 409). Thirdly, Stroh recorded his unconscious relationship to his therapy group where he had been previously unaware that he took up the role of their ‘master of cere­ monies’. Finally, Stroh commented on his identification with his patients and feeling like a patient himself in his supervisory seminar. This process where Stroh wrote a case report on his work, analysing the blocks in his work and presenting his work to the supervisory seminar, can be recognised as in the tradition practised within psychoanalysis. The difference was that Stroh was describing a supervision group rather than dyadic super­ vision. What was of significance in this individual case study was the focus on the therapist’s blind spots rather than the patient’s difficulties. Foulkes used Stroh’s paper and the change in his relationship with the patient B to illustrate the importance of the supervisor and each member of the supervision group engaging in keen observation of themselves, noticing changes in language and tone in order to identify their countertransference—that is, their unconscious enactments (Foulkes, 1964: 252). The second paper Foulkes referred to in this section on group supervision focuses on the dynamics of the supervision group itself. For this, Foulkes referred to an unpublished paper by R.C.M. Hunter. Hunter was working at McGill University in Montreal and was offering supervision groups, each lasting for a year. He provided four groups in all, three for trainee doctors and one for a group of nurses. He had studied the dynamics of his supervision

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groups over several years, keeping records and noting the different phases and resistances to the task of supervision that each seemed to show (Foulkes, 1964: 253). Hunter’s paper is no longer available, and we are reliant on Foulkes’s overview on Hunter’s paper. The second part of the title of Hunter’s paper, ‘A Natural History of a Supervision Group’, refers to Hunter’s use of the clinical notes of each session as the focus for his research. According to Foulkes, Hunter’s records allowed him to identify similar dynamics at the same phase in the life of each of the three supervision groups he was providing. Foulkes described the climate of Hunter’s supervision group as one where ‘Active participation was encouraged and an authoritarian atmosphere was avoided’ (Foulkes, 1964: 253). Foulkes then named the three phases Hunter identified. Participation during the first phase, lasting around two months, was characterised by ‘tentative questioning and altogether evidence of con­ siderable caution’ (Foulkes, 1964: 253). This sounds the sort of struggle that most supervision group members have when they first meet together to reflect jointly on each other’s work. Foulkes describes this phase as one of resistance. Hunter’s second phase, lasting from around two to eight months, showed a different form of resistance to the supervisory task: ‘The emphasis remained primarily on the trappings of the work rather than on the work itself ’ (Foulkes, 1964: 253). Hunter reported that, if he successfully addressed issues the group was raising, more would take their place. From the details of Hunter’s description, we might recognise the supervision group as being either in Bion’s fight/flight mode or in dependency mode (Bion, 1989: 63), depend­ ing on whether Hunter responded to the group dynamics mildly or sternly. Foulkes observed that it was only when Hunter was able to link the grum­ bling in the supervision group to a response to the projection of blame they were absorbing from their therapy work that there was a shift in the super­ vision group dynamic. Although Foulkes did not refer to the paper by Ekstein and Wallerstein on parallel process, or use the term, he recognised that feel­ ings from the therapy groups were being enacted in the supervision group discussion (Foulkes, 1964: 254). Hunter referred to a third form of defence arising once he had interpreted the group dynamics, which occurred in the second half of the life of the group. His supervision groups successfully deflected attention from their task by splitting into two camps. One side devalued and the other idealised the supervision group. Foulkes linked this example to the issue of boundary and task setting, both responsibilities that lie primarily with the supervisor. Foulkes expressed the view that the splitting might have been an indication that Hunter’s supervision groups had become too focused on personal mat­ ters. This raises the important issue of how much focus to allow on the supervisees’ own personal issues and relationships in the supervision group, including the supervisor’s, and how much on the dynamics of the therapy group, including the therapist. This is an important tightrope that all super­ visors negotiate.

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Hunter’s key contribution was that he described some of the defensive methods that supervision groups can employ to avoid having to reflect on their work with colleagues because the task can feel both daunting and exposing. It also raises some key questions for the practice of group super­ vision. How much structure is necessary? How does the supervisor find a balance between taking an anti-authoritarian stance and exercising their authority when the group is off task. And how far should personal issues come into the group supervision space? These issues will be returned to again in Chapter 7 on dynamic administration. The third author that Foulkes referred to in this section is Jane Aber­ crombie and her research methodology, briefly mentioned earlier. It is an interesting coincidence that it was Helene Deutsch, Foulkes’s analyst, who first suggested the use of free association in analytic supervision as a route to helping trainee psychoanalysts learn about their patients’ unconscious pro­ cesses. This was a marked change from the previous didactic style of super­ vision where supervisors taught technique based on their student’s case reporting (Burck and Daniel, 2019: 8–9). In her 1935 paper, Deutsch suggested that: The candidate’s unconscious actually absorbs the material given him [sic] by the patient at a time when he is still completely free from understanding its importance. If the candidate is allowed to reproduce the material in free association, one can see how much more wisdom his unconscious shows in the reproduction than does his conscious knowledge. (Deutsch, 1935: 62) Abercrombie also found free association of benefit when she used it in her research into the impact of prejudice on trainee doctors’ learning. She had noticed that, when doctors made observations on the material in front of them, ‘they did not distinguish sufficiently sharply between what was there and what they had been taught “ought” to be there’ (Abercrombie, 1960: 16). She identified distortions by encouraging the doctors to engage in free asso­ ciating in response to each other. She used this methodology to help trainee medical students observe more accurately and with minimum distortion (Abercrombie, 1960: 64) by learning from the group (Abercrombie, 1960: 76). In her trial of using free-floating discussion with doctors in small groups of peers, she found that, as a result of hearing others’ views of the same patient, it became clear to her that: each extracts something different. Discussion of the differences of their reactions involves discovering not only what factors influence the kind of selection they made from the information presented, but it also involved them exploring their own store of information. (Abercrombie, 1960: 79–80)

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Foulkes quoted the benefits of Abercrombie’s research: The tests in observation and reasoning showed a significant difference in favour of those who had taken the course against controls. The former made fewer inferences. Those they made, were based on better evidence. They also considered alternative inferences. They were less ‘set’. (Foulkes, 1964: 255) Foulkes adopted Abercrombie’s approach, encouraging free-floating discus­ sion in his supervisory seminars. He promoted this as fundamental to helping the doctor become aware of erroneous personal preconceptions of their own that were affecting their therapy group. In group supervision, the supervisee learns about the ‘interaction between information and attitudes’ and the need for self-examination to identify prejudices that may distort observation (Foulkes, 1990: 255). The use of free-floating discussion in group supervision will be explored further through the use of vignettes in Chapter 6.

Conclusion In this chapter on the supervisory seminar, Foulkes firstly described the way group analysts analysed their countertransference. Secondly, he explained how this was achieved in a supervisory group. In addition, Foulkes was clear that it was not just the supervisor who engaged in this task but the whole super­ vision group. The third aspect of this recurring theme was his recourse to research papers and his encouragement to others to do the same. Foulkes encouraged curiosity in the people he supervised about their unconscious motivations and supported them in recording their learning. He also read widely himself and maintained contact with colleagues both in the UK and abroad. Throughout his writing, he referred to areas where more research would benefit the development of group analytic practice. In particular, he cited the work of Stroh, Hunter, and Jane Abercrombie and her use of freefloating discussion in identifying distortions in observation, making it a truly scientific approach.

References Abercrombie, M.L.J. (1960) The Anatomy of Judgment: An Investigation into the Processes of Perception and Reasoning. New York: Basic Books. Bion, W.R. (1989) Experiences in Groups and Other Papers. Oxford: Routledge. Burck, C. and Daniel, G. (2019) Mirrors and Reflections: Processes of Systemic Supervision. London: Routledge. Deutsch, H. (1935) On Supervised Analysis. Contemporary Psychoanalysis 19: 167–181. Ekstein, R. and Wallerstein, R.S. (1958) The Teaching and Learning of Psychotherapy. New York: Basic Books.

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Foulkes, S.H. (1964) Therapeutic Group Analysis. London: George Allen & Unwin. Foulkes, S.H. (1990) Selected Papers: Psychoanalysis and Group Analysis. Oxford: Routledge. Freud, S. (1895) The Case Of Anna O. London: Hogarth Press. Heimann, P. (2018) On Counter-transference 1. In Influential Papers from the 1950s. London: Routledge, 27–34. Jacobs, D., David, P. and Meyer, D. (1995) The Supervisory Encounter: A Guide for Teachers of Psychodynamic Psychotherapy and Psychoanalysis. Newhaven, CT: Yale University Press. Rock, M.H. (1996) Psychodynamic Supervision: Perspectives for the Supervisor and the Supervisee. Northvale, NJ: Aronson. Schwartz, J. (1999) Cassandra’s Daughter: A History of Psychoanalysis. Oxford: Routledge. Searles, H.F. (1955) The Informational Value of the Supervisor’s Emotional Experiences. Psychiatry 18 (2): 135–146. Stroh, G. (1958) A Therapist’s Reactions as Reflected in His Reporting on a Psy­ chotherapeutic Group. International Journal of Group Psychotherapy 8 (4): 403–409.

Chapter 5

Group analytic supervision since 1970

Introduction This is an overview of the development of group supervision from 1970 to 2010. It traces the emergence and development of concepts used in group analytic supervision. The chapter is structured into blocks of ten years.

Group supervision in the 1970s In the 1970s, the role of group analytic supervision was to support students in training. The first supervisors were drawn from psychiatry, psychoanalysis and social work, three of the areas where supervision was widely practised. The Maudsley Hospital used group supervision as a part of its training pro­ gramme for psychiatry trainees. Junior staff observed experienced practitioners conducting their groups and their observations were discussed afterwards. In a similar way, when junior staff co-conducted their own groups, they were observed through the one-way screen and were subsequently supervised by their con­ sultants. Co-therapy was the model. (Behr, personal communication, 17 October 2017) During Harold Behr’s time at the Maudsley Hospital, the supervision groups each consisted of between six and eight supervisees and were conducted by Malcolm Pines, Heinz Wolff and Henry Rey. ‘Students took it in turns to pre­ sent group material, recalled as accurately as possible, with occasional pauses to reflect, discuss and analyse. The style of supervision reflected the personality of the supervisor’, some giving significantly more personal input than others. Students too developed their own personal styles as group conductors (Behr, personal communication, 17 October 2017). The first supervision (at the IGA) was for students training to be group ana­ lysts, and, just as at the Maudsley, the style of supervision provided was very much dependent on the personality of the supervisor. Harold Behr recalls that, DOI: 10.4324/9781003375975-9

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I was in the second cohort to qualify (1975) with Lionel Kreeger as my supervisor. There was no rotation of supervisors, which had its advantages and disadvantages. There were similarly advantages and disadvantages to offering supervision to a mix of novices and more senior colleagues. (Behr, personal communication, 17 October 2017) Most of Foulkes’s focus was on the group supervision of trainees. Liesel Hearst remembered that, once they had qualified, group analysts should ‘go it alone’—that is have a period of time without supervision, in order for them to feel free enough to develop their own separate style of practice. There was also little postgraduate supervision available, although Foulkes offered supervisory support for colleagues on an ad hoc basis. During the mid-1970s, several papers appeared in the journal Group Ana­ lysis. Barbara Dick expressed her view that there was a lack of clarity about how to conduct group supervision. In a monograph on a meeting with Foulkes, she recorded that he too ‘shared our dissatisfaction with the lack of understanding of the supervision of group psychotherapy’, suggesting that there was pressure on supervisors to fulfil the wishes of the supervisees rather than to help them think for themselves (Mance, 1975: 22–23). The year after Dick’s paper, Peter Bott, an Australian group analyst, published the first of two papers on supervision in group analysis. His first paper was about the benefits of providing a combination of supervision and personal therapy in training. He saw this combined approach as a way of helping supervisees to integrate both ‘professional and personal aspects of his total self ’ and ‘the external factors influencing the material that trainee therapists bring to supervision’ (Home, 1976: 43–44). The next paper on group supervision published in Group Analysis was by Napolitani, an Italian psychiatrist and group analyst who was responsible for training group ana­ lysts in Rome. It was the practice there for trainees to observe other trainees before co-conducting their own group. Napolitani encouraged the observing trainees to free-associate to the group material and to feed this back to the therapist afterwards in their supervision session. This helped the trainee who was running the therapy group to become less intellectual in their response to the group material. It also helped those observing to become aware of the benefits of this approach and of their own potential for distortions in their thinking about the group material presented. In order to prepare trainees to run their first group, they were also included in supervision groups with trainees who were already co-conducting a group. Napolitani suggested five potential benefits trainees could gain from this approach: it would help supervisees to deepen, expand and integrate insight; increase supervisees’ understanding of group dynamics and group processes; and increase trai­ nees’ self-awareness of unconscious motivations for their choice of work and reduce their resistance to using supervision. His last two aims were to help supervisees to reduce both under- and over-reliance on the supervision and

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to increase their interest in integrating underpinning theoretical aspects of their work (Napolitani, 1979: 53–54). Bott’s 1979 paper (written in response to Napolitani’s) reflects on the pro­ cess of supervision. Bott identifies five variables, or sub-systems, that the supervisor needs to hold in mind as having influence on the content and style of presentation of supervision material. Bott includes the therapist’s interac­ tions with the setting; their feelings in their role as a group conductor, including their countertransference; the therapy group dynamics; those of the supervision group; and the trainee’s personality. He recognised that ‘When the supervision group is stuck change of focus to one of the other subsystems often frees the discussion and results in further learning’ (Bott, 1979: 135). This model has four of the six ingredients used in the model of the clinical hexagon, the model used in the training of supervisors today (see Chapter 6). Bott’s and Napolitani’s papers both addressed some of the concerns raised by Dick. Their contributions to the aims and the process of group analytic supervision provided some clarity of approach underpinning the group ana­ lytic model. Bott provided a model to help supervisors navigate difficulties arising in the supervision group process. Free association, used by the group to increase awareness of less conscious processes and reduce members’ dependence on intellectual solutions, as in Napolitani’s paper, is also widely used in group analytic supervision today.

Developments during the 1980s There was an increase in the number of papers written on group supervision, from 4 between 1970 and 1979 to 17 listed in the cumulative index of Group Analysis between 1980 and 1989. Other papers on group supervision from Europe, America and Canada reflect some of the emerging practice within postgraduate supervision. Postgraduate supervision During the 1970s, supervision was mainly provided routinely for students, but the need for postgraduate supervision for newly qualified group analysts was increasingly recognised as important. Much of what was published in Group Analysis in the 1980s about postgraduate supervision was from Europe. Lansen, whose paper was published in 1980, gives the impression that at this point the importance and focus of postgraduate supervision were still in the process of development. Firstly, he expressed a wish that more space be given in workshops to supervision. He also suggested that, if the subject of super­ vision was precluded by time in these workshops, a separate supervision workshop could be arranged to focus on the specifics of group supervision. He also asked for clarity about whether the focus of supervision should be on the therapist or on their supervisory dilemmas (Lansen et al., 1980: 58).

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Martin Grotjahn was also concerned about potential dilemmas in post­ graduate supervision. One concern was about supervisors continuing to ‘teach’ supervisees how to work after they had graduated. He felt this approach did not always sufficiently respect the therapist’s developing exper­ tise and their need to develop their own style. Secondly, Grotjahn was clear that it is the therapist who has the greatest understanding of their patients, and that supervisors offering postgraduate supervision might unintentionally undermine the therapist’s own intuitions. His article encouraged graduates to allow themselves to ‘be themselves’, rather than needing to feel that they had to conform to the directions of their supervisor, with the proviso that they behave ethically. He advised therapists to have supervision when they feel they need it, rather than it be prescriptive (Grotjahn, 1984: 165). A different perspective, from North America, is reflected in an article in Group Analysis by Shultz and Stoeffler. They were colleagues and members of a team working in the same private practice in Michigan. Their supervisory practice was based on the accepted group analytic understanding that it is often the therapist who is blocking the group’s work when things are stuck. Their method was to meet with colleagues for a two-hour group supervision group each week to address countertransference issues. In addition, they and their colleagues went on an occasional ten-day retreat. During the retreat, they made a commitment to be as open as possible with each other. This involved thinking about their countertransference through the lens of the roles they adopted, both in the formal sessions devoted to case discussion and in their recreation with each other (Shultz and Stoeffler, 1986: 225–234). Training supervision Meg Sharpe, a Jungian analyst and group analyst, provided the first super­ vision of supervision for supervisors on the IGA Qualifying Course. In a seminal paper, co-authored with Dick Blackwell and published in Group Analysis in 1987, they addressed the issues raised by Lansen and Grotjahn. They described a way to foster active participation by group members by reducing the reliance on didactic teaching and encouraging ‘free-flowing involvement’. This approach was inspired by Meg Sharpe’s attendance at a congress in Sweden, and her motivation came from a ‘desire to develop a more flexible, effective and imaginative model of supervision’ less focused on a ‘teacher/student model’ (Sharpe and Blackwell, 1987: 195). It deserves more detailed attention because it has informed the way supervisory practice is widely practised today. Using imagery from gestalt psychology, Sharpe paints a picture of a wellfunctioning supervision group where each supervisee presents their work and receives multi-perspective feedback from members of the group. This feed­ back explored both the material that the therapist presented (the figure) and also what may be unconscious, mirroring feelings, mood and body language

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(the ground). This was very much in line with Foulkes’s practice, and it more clearly happened through using the whole group and not just the supervisor. The therapist’s increased awareness about themself allowed for potential to help them gain greater understanding and new insight into the dynamics of their therapeutic work. Sharpe suggested that this created an increased free­ dom to expand understanding through enlarging the range of interventions made available for thought (Sharpe and Blackwell, 1987: 197). Sharpe also emphasised the importance of the supervisor modelling open­ ness themself in order to encourage their students to do the same. ‘We sug­ gest … [this] leads to a higher degree of involvement and mutual support in the supervision group. This, in turn led to increased openness and sharing of both content of and process of students’ groups’ (Sharpe and Blackwell, 1987: 196). It also led to better ‘working through’ and learning for all the group within this supervision analogue of the group analytic process. This is a dif­ ferent approach to reaching what may be unconscious in the therapy from the traditional psychoanalytic model of supervision described by Langs, where the supervisor retains anonymity (Langs, 1994: 111). Sharpe suggested that the supervisor of groups also needed to take into account students’ increased vulnerability to feeling shamed in a supervision group. This could impede the disclosure of countertransference or other ‘mistakes’ in their practice. Sharpe recommended that supervisors foster a sense of mutuality and support between members (Sharpe and Blackwell, 1987: 196). Sharpe further suggests this can provide the group with a more holistic understanding of their therapeutic relationship with their therapy group. Drawing on her experience and her reading of the literature on group super­ vision, she lists a number of different methods of stimulating this level of engagement which are available to the supervisor. These include: role identi­ fication, a focus on group processes, following one particular patient, drama­ tisation, free association, exploring what is happening from a theoretical viewpoint and working through the presentation of a single issue of concern to the supervisee. She emphasised in particular the importance of contain­ ment through offering students reassurance and nurture. Sharpe also intro­ duced a more participative model for student evaluation where students assess each other and their supervisor as a part of the process. She suggested that these processes together create a climate for mutual learning that enhanced openness, which she recognised as necessary in order to increase students’ learning (Sharpe and Blackwell, 1987: 206). Training for supervisors During the 1980s, the IGA set up the first training for supervisors of groups, commissioned by the IGA and hosted at the North London Centre. It was open to group analysts and psychoanalytic psychotherapists with an interest in providing supervision in groups. The course was run by Harold Behr and

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Liesel Hearst who, along with Meg Sharpe, were some of the first IGA gradu­ ates. The course ran over three intensive bi-monthly block weekends. This model made it possible for people from across the UK and Europe to take part. The course comprised presentations, role-plays and skills development exercises. After successful completion of the training, group analysts could apply for training supervisor status. This made them eligible to apply for a supervisor position on the IGA training courses. This training, along with the additional supervision of supervision provided by Meg Sharpe, provided some standardi­ sation of the quality of supervision offered by supervisors on the IGA Qualifying Course. The course also served to create expertise in supervising in groups more widely, as supervisors who had completed the course were employed to provide group supervision in institutions. Other group analysts from across Europe who completed the course went on to develop group supervision within their own training institutes. By 2007, there was enough expertise in group supervision around Europe to create a special edition of Group Analysis on group supervision, written largely by contributors from the continent.

Group supervision in the 1990s The 1980s was a time of experimentation and development of ideas about the place and need for group supervision, and this laid the ground for group ana­ lytic supervision as it is practised today. The group analytic literature in the 1990s reflects a sense of consolidation of the group analytic approach. There was an increase in the number of papers published in Group Analysis, and The Third Eye: Supervision of Analytic Groups, the group analytic textbook on group supervision, was published in 1995 (Sharpe, 1995). Several themes emerged in the literature from the 1990s, particularly from The Third Eye and the 2007 special edition of Group Analysis. Parallel process When Kutter referred to mirroring and reversed mirroring in group super­ vision, he was using a group analytic term to describe what others have referred to as parallel process. Kutter was reminding therapists of the need to be mindful of their own transference to patients and the way this can be enacted in the supervision group (Kutter, 1993: 178–179). Voorhoeve and van Putte described parallel process in their organisation when an event occurring in one ward setting affected interactions in other settings within the institu­ tion. They also undertook a literature review where they evaluated the con­ cept of parallel process (Voorhoeve and van Putte, 1994: 178–179). The first paper in Group Analysis to use the term ‘parallel process’ (they call it process parallel) was by Schuman and Fulop in 1989. The term mirroring had pre­ viously been used synonymously with the term parallel process. Fulop and Schuman described their experience on a psychiatric ward where their group

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supervision enabled them to recognise the parallel process between the beha­ viour of the patients on their ward and the staff group’s subsequent behaviour in their ward group (Schuman and Fulop, 1989: 387). Rivalry and competition One of the challenges for supervisors of groups can arise when there are riv­ alry and competition between group members that adversely interfere with the supervisory task. Several authors reflect on some of the supervision group dynamics associated with rivalry and competition in group supervision. Mittwoch refers to rivalry in the group supervision of students as something to be expected. She emphasises the importance of bringing this out into the open so that it can be talked about to avoid tensions festering (Mittwoch, 1995: 54). Olivieri-Larsson draws on his own rivalrous feelings in group supervision and the tensions he felt between the wishes for autonomy and for someone to direct him (Olivieri-Larsson, 1993: 172). Sternberg described the important role that supervision played in processing rivalry in an organisational context where there were differing and conflicting approaches to treatment (Sternberg, 1994: 150–151). Shame Another important theme in the group analytic literature was that of shame. This is an important factor for the supervisor of groups to hold in mind because, in group supervision, a supervisee’s therapeutic work is presented in front of colleagues. Having an audience who witnesses the difficulties in their work can both cause shame and avoidance. Olivieri-Larsson identified the potential of group supervision to be exposing and he identifies some condi­ tions that arouse shame (Olivieri-Larsson, 1993: 170). Sternberg noted that, when supervisees feel that the work they are to present is too shameful to talk about in a supervision group, this can make for a climate which feels ‘hateful’ (Sternberg, 1994: 149). Mittwoch wondered whether fear of exposure in group supervision could at times be even more daunting for a therapist than engaging with their therapy group (Mittwoch, 1995: 51–52). The supervisory stance Within the field of psychoanalysis, writers such as Langs stress the impor­ tance of the supervisor observing the frame, acting as a teacher and avoiding self-revelation (Langs, 1994: 60). Other writers take a more intersubjective perspective and advocate adapting their supervisory style to the needs of their supervisees and ensuring that the process is experienced as collaborative and in tune with the supervisee’s need (Jacobs et al., 1995: 33). As a group ana­ lyst, Sternberg places emphasis on the supervisor’s role in promoting a climate

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of equality in order to create a space where therapists can think. In order to achieve this, supervisors need to avoid giving therapists the feeling of being pupils. Instead, they facilitate therapists’ thinking by asking questions about the therapeutic relationship. This allows the therapists to reflect for them­ selves on the impact of transference and countertransference issues (Stern­ berg, 1994: 154). The supervisory relationship In group supervision, it is not just the therapist’s relationship with their super­ visor which needs to be held in mind but also their relationships with peers in the group. Mittwoch reminded us that the supervisor of groups needs to pay attention to this in order to create a safe and effective supervision group (Mittwoch, 1995: 54) She acknowledged differences in the supervisor’s focus in group supervision. With trainees, she focused more on the teaching end of the spectrum in order to avoid touching on anything that might be better explored in the therapist’s own therapy. She advocated the use of supervision that focuses on blocks in the therapist as better suited for supervision of therapists who are no longer engaged in their own analysis (Mittwoch, 1995: 55–56). Supervision of student work This next section refers mainly to The Third Eye, the group analytic super­ vision textbook based on the practice of experienced training group super­ visors at the IGA. It is a useful ‘how to guide’ for supervising students, one of its primary purposes. It is referred to here in more detail because it covers some of the areas that are important for supervisors who work with students. Student assessment Cohen’s chapter in The Third Eye, on monitoring the supervisee, describes the assessment process by providing anonymised examples of reports supervisors had written about their students’ work (Cohen, 1995). One of Meg Sharpe’s chapters focuses on the effective presentation of group material. Her other chapter outlines some essential ingredients of supervision training. She includes the selection of suitable candidates and some of the ethical and dynamic administration issues specific to the group supervision of groups (Sharpe, 1995: 151–164). The student perspective The Third Eye is creative and continues the practice begun with Sharpe’s 1987 paper in that it takes account of students’ views. Three students, Corbett, Brown and Kasinski, each contributed their experience of supervision from

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when they were trainees. This is a valuable perspective that is less generally available in the supervision literature. Corbett used the concept of the matrix to describe the web of communication between his experience of therapy, supervision and theory while he was training. He highlighted the importance of supervision to his learning and development as a group analyst. This was because his experience of supervision had a significant impact on the inter­ relationship between his inner and outer world. Brown describes her experi­ ence on the course as providing her with an opportunity to explore the interface between the private and the professional. Brown refers to an earlier experience where she and Kasinski reflected on the way they adapted the presentation of their work to help their supervisor give them more of what they needed (Brown, 1995: 31–32). The inclusion of the student perspective in this book is a distinctive contribution to the field. Elsewhere, papers were and still are largely written by supervisors for supervisors. The group analytic supervision model The Third Eye makes it clear that group supervision involves multiple perspectives, and that group analytic supervision takes account of the free associations and countertransference experience of the whole group and not just the supervisor. The book covers a number of important aspects that fit together to form a model for group analytic supervision practice. This model addresses theory, technique and practice as well as capturing some of the essence of what is unique about group supervision. The book encompasses three differ­ ent approaches to providing group supervision. Firstly, there is the weekly face­ to-face supervision that was offered on the London qualifying course. Secondly, there is the block supervision with weekly telephone conference groups that was used in block training, both in the UK and in the rest of Europe. Thirdly, the Greek model of supervision was adopted in Athens by Yanis Tsegos, where the supervision process was adapted in order to provide effective supervision at a time when there was a dearth of experienced supervisors. Supervision on block training courses Stephen Cogill gave an overview of the then-new Manchester block training model of supervision. Initially, the block group supervision model pragmati­ cally included two face-to-face meetings at each block with a training group supervisor, supplemented by the supervision groups meeting together locally as a peer group without their supervisor. Cogill suggested that one of the benefits was having supervision alongside students’ therapy at each block. He also described some of the tensions inherent in the regional peer group supervision between blocks in the early years of the training. Cogill men­ tioned the initial anxiety expressed by students when telephone conference group supervision was introduced in 1993, allowing the supervisor to join

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with students from different parts of the country each week. This anxiety was short lived. Cogill noted that, because the group also met face-to-face at each of the blocks, this arrangement was very effective. There were some adjustments to the frame when on the phone: the supervisor needed to be more active and supervisees more focused in order to make best use of their time (Cogill, 1995: 113–114). This block training model of supervision is provided for courses out­ side London, in Russia, Europe and the UK. This was recognised as effective, and Behr and Hearst confirmed that the mirroring (parallel process) could equally well be processed in this block model (Behr and Hearst, 1995: 107–108). The Greek model of supervision By way of contrast to the London and regional models of supervision, Sharpe also included the chapter by Tsegos describing ‘the Greek model’ of super­ vision. In Greece, there was initially little access to an experienced supervisor. Originally developed for expediency and to make a virtue out of a crisis, Tsegos developed this model with the aim of empowering students in a way he had felt was lacking in his own more traditional experience of supervision. In this model, the supervisees, along with an ‘experienced observer’, work to a structure to help them focus on the supervisory task. Firstly, there is a pre­ sentation by one of the students to the rest of the group who sit in a horse­ shoe around a chart. Secondly, the group engages in and records an analysis of feelings, fantasies and perceived themes. Thirdly, in the synthesis stage, the supervision group processes their group’s input (Tsegos, 1995: 122). Each of these three approaches to group supervision is distinctive but effective in supporting students to develop as group analysts. A theoretical framework for group supervision Harold Behr introduced theory as a framework for helping the trainee therapist to survive some of the competing tensions within their role. He stressed the importance of ‘dynamic administration’, the tasks involved in managing both the internal and external boundaries in groups, creating a safe space for the therapy to take place and central to the learning for trainees setting up their first therapy group. Other important theoretical issues include, firstly, how to help therapists learning to balance the tension between thinking about whole group processes and not losing sight of the individuals. Secondly, theory provides trai­ nee supervisors with a theoretical perspective to help them guide their use of interpretation in their therapy groups. Thirdly, theory can add to reflections on how supervisors can engage supervisees who find it difficult to participate fully in the supervision group. Fourthly, theory can be useful when helping therapists find a balance between focusing on the past and the present. Behr also addressed the issue of how the supervisor of groups works with countertransference in group supervision (Behr, 1995: 11–12).

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Summary By the end of the 1990s, group supervision had established training and a growing literature base. It had a clear model and a distinctive and effective approach lying within the psychoanalytic tradition. With increasing regula­ tion within the UK and across Europe, this was important for the future development of the field. The IGA training at the North London Centre provided a pool of experienced supervisors who developed and flourished across Europe.

Group supervision since 2000 By the early 2000s, there was a growing group of group analytic supervisors responsible for training group analysts across Europe. From this has come a European-wide body of group analytic literature on group supervision. This has played an important part in the expansion of the literature available in group analysis. Group analytic supervision theory and practice continued to develop, drawing on established expertise in group approaches. For example, Scanlon used Schon’s model from higher education as a tool for separating two of the tasks of supervision. He used this to distinguish between reflecting on the dynamics of the therapy group—reflection on action—and reflecting on pro­ cess—reflection in action. Reflection on action is the focus on the therapy brought by the therapist. Reflection in action focuses on the supervision group dynamic as a way to highlight the parallel process being enacted by the super­ vision group (Scanlon, 2000: 196–197). Scani, reflecting on a supervision group he was conducting in Hungary, described the impact of class and power on this process. He noted that tensions in a changing cultural climate were mirrored in his supervision group (Scani, 2002: 390–405). Brunori, Magnani and Raggi published their research into the impact of the therapist’s increased capacity to reflect on their work as a result of their group supervision in a hospital setting in Modena in Italy (Brunori et al., 2007: 163–166). The special edition on group supervision was published in Group Analysis in 2007. In this edition, Berman and Berger explored the key ingredients necessary for safe and effective group supervision. They stressed the impor­ tance of the group supervision process for providing containment for the therapist, which in turn can help the therapist to provide containment for their therapy group (Berman and Berger, 2007: 262). Hanson suggested that group cohesion is the key necessary ingredient for the group to feel a safe enough place to take risks, including addressing the dynamics of the super­ vision group itself. ‘Given a high degree of group cohesion, the group will tend to show a greater range of risk-taking in new interactions’ (Hanson, 2007: 200). Berman and Berger used group reverie and free-floating associa­ tion as the route to access unconscious dynamics within their colleagues’ work. They propose that

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in a collective ‘group reverie’ that is co-created by the compiled personal associations (and association to the initial associations) that members contribute, in the process of sharing with each other the specific way in which the presented material resonates in their private world. (Berman and Berger, 2007: 241) Pisani et al. provide an overview of group analytic theory and practice and distinguish the differing positions of the conductor and the task of the mem­ bers in the small group from those of the median group. They then review median group supervision (Pisani et al., 2006: 537–548). Friedman suggests that supervisors can help their supervisees to focus on relation disorders in their groups. He suggests this focus on the interpersonal rather than the intra­ psychic is a more effective approach than relying on the use of interpretations (Friedman, 2007: 268). For postgraduate group supervision, it is the group as a whole that is the supervisor, and the members’ task is to translate what was unconscious in the therapy into the consciousness of the supervision group (Noack, 2009: 11). While Noack acknowledged the potential for sibling group rivalry to be destructive, she also underlined the potential for relationships with colleagues in group supervision to continue for years and suggested that they can often become ‘the closest personal attachments in the matrix of professional rela­ tionships’ (Noack, 2009: 8).

Applications of the group analytic model Group supervision, with its multi-perspective potential, can also be an ideal place for thinking about intrapsychic phenomena and the way they can be replicated when working with complex cases and with families. Kalai descri­ bed the benefits of group supervision for therapists working with families in difficulty, describing how the group’s reflection on their own dynamics helped the therapist to gain insight into the dynamics being enacted with the ‘pro­ blem’ child within the family, between the family and the school and between the family and the therapist (Kalai, 2007: 204–215). Urlic´ and Brunori high­ lighted the benefits of group supervision in hospital settings for containing staff teams affected by the dynamics of working with schizophrenic and psy­ chotic patients and their families. They emphasised the importance of super­ vision for both psychotherapists and other staff, to process transference and countertransference dynamics (Urlic´ and Brunori, 2007: 271). Two European Group Analytic Training Network (EGATIN) training days were held, in Athens in 2011, with presentations and discussion on models of supervision, and in Zagreb in 2017, where papers covered supervision of supervision, working with unconscious processes in group supervision and the use of internet technology and its impact on group supervision. In the UK, the British Association of Psychoanalytic and Psychodynamic Supervision

74 The history of group supervision

(BAPPS) publishes a twice-yearly journal Supervision Review. This has inclu­ ded articles by a number of group analysts writing about group supervision, and these have all been used to supplement the reading material from The Third Eye, the core group analytic text, to provide a further theory base for training supervisors of groups.

Regulation of therapists In the UK, developments in group analytic supervision since 2000 have taken place in a context where there has been a move to regulate psychological therapies and their associated training, such as the training of supervisors, in the name of protecting the public. UKCP (the United Kingdom Council for Psychotherapy), the regulating body to which the IGA belongs, states on its website that one of its tasks is ‘to protect the public by making sure everyone on our register meets our professional standards’.1 It was tasked by the UK government with the regulation of over 70 different psychotherapy training courses grouped into colleges. In practice, this means auditing therapists against standards every five years. The IGA’s training comes under the umbrella of the CPJA (Council for Psychoanalysis and Jungian Analysis). The supervision policy statement was largely a result of the standards pre­ viously set by GATS (later known as BAPPS), the professional body which had grown out of the supervision training developed at the Westminster Pastoral Foundation (now WPF Therapy) in the 1980s. As BAPPS, it had become an affiliate of the CPJA, of which the IGA is also a member. BAPPS had devel­ oped a set of minimum standards for its supervisor training, and, as it was the only body to have done so, these were adopted as the standards for all super­ vision training within CPJA. The IGA supervision training moved from the North London Centre when it closed, and new course guidelines were written with these standards in mind. Students now bring their group analytic super­ vision group to the course for 45 hours of supervision of supervision while they are training. It is no small task to put together a supervision group, and the training itself offers help with creating and maintaining a well-functioning group analytic supervision group. This has led to the expansion of group ana­ lytic supervision outside the training arena, and many supervision course par­ ticipants’ groups continue after the end of the training. In 2009, the IGA expanded its supervision training to five blocks from three, to increase the theoretical input and to allow time for a greater focus on the integration of theory with practice. This integration has been achieved through the use of reflecting team supervision (Smith, 2019), a process that has developed over the course of the training’s existence. It has also included weekly Skype supervision of supervision groups. More recently, these have moved to Zoom. Although there were initially numerous teething problems, this use of internet technology has allowed access to the course from countries from around Europe where no local training was available. This has seeded

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expertise with the potential for other countries to develop their own training, as, for example, has happened at the Polish institute. The course introduced two distinctive elements. The first was recommended by the advisory group tasked with establishing the course. This was to include a reflecting team experience. The second was to provide weekly supervision of supervision, an element of which is face-to-face, normally at the block weekend. It has also included two median groups in each block. Like group supervision, the median group pro­ vides an intimate space where some personal material is shared, but without the focus on issues becoming therapy. In this way, it mirrors some of the tensions contained within the group supervision process itself. The provision of group supervision via the medium of video conferencing initially received mixed responses. Although the quality of the calls has vastly improved recently, at the time of its first use there were many difficulties with staying connected, and deep feelings of helplessness, exclusion and isolation were stirred up in participants in response to dropping out of a Skype con­ ference. At the EGATIN training day on supervision in 2017, Gallop used a metaphor from The Tempest, ‘This rough magic’, to capture the tension between the benefits and challenges of using internet technology (Gallop, 2017; unpublished presentation at EGATIN conference, 22 April 2017). Video conferencing has also added a visual connection to the process. ‘In many ways, video conferencing brings people who may be miles apart into the room together although the separation is highlighted when someone is visibly distressed and no one can pass the tissues’ (Smith, 2018: 52). This curious mixture of intimacy and distance is a theme in all supervision, where the task is to focus on the therapeutic relationship but without it becoming therapy. The use of internet technology works well when it is combined with face-to-face days. The coffee and lunch breaks between supervision sessions on the day allow for more intimate connections to develop than arise over the task-centred video conferences. Postgraduate supervision Postgraduate supervision has become the norm since the development of regulation although many group analysts find it expedient to have dyadic supervision. As well as the traditional regular supervision groups that flourish in institutions and private supervision groups set up in major cities, there are also new approaches such as the supervision groups meeting once per seme­ ster described by Hanson (Hanson, 2007: 189–203) and the increased use of video technology to provide supervision groups for therapists in more isolated areas. Some of the benefits and drawbacks of telephone supervision were explored in a special edition of Supervision Review, the BAPPS journal, in the spring of 2005. Likewise, a special edition of Supervision Review in the autumn of 2018 included a range of perspectives on the use of video con­ ference supervision.

76 The history of group supervision

Summary The Third Eye and other group analytic literature available to support safe and supportive practice have emerged in Europe over the last 30 years. This has provided training material to draw on for supervisor training, and the two EGATIN conferences aimed at trainers have provided papers and reflective space for the continued professional development of experienced supervisors. The IGA has continued to provide training for supervisors, and, since 2009, this has included weekly group supervision of supervision. Postgraduate supervision of supervision has become more widely established, and some of the supervision groups formed on the supervision training course have con­ tinued for years afterwards as peer groups. Modern technologies, while not perfect, can allow the development of supportive and creative connections between colleagues separated by distance. Some supervision of supervision groups forged connections between colleagues from different parts of Europe. With concerns about pandemics and climate change, they may pave the way for the future.

Note 1 See www.psychotherapy.org.uk/about-ukcp/our-aims/

References Behr, H. (1995) The Integration of Theory and Practice. In: The Third Eye: Supervision of Analytic Groups. London and New York: Routledge. Behr, H. and Hearst, L. (1995) Supervision in Trans-Cultural Block Training Courses, Part 1: Supervisors. In: The Third Eye: Supervision of Analytic Groups. London and New York: Routledge. Berman, A. and Berger, M. (2007) Special Section: Matrix and Reverie in Supervision Groups. Group Analysis 40 (2): 236–250. Bott, P. (1979) A Systems Model for Group Psychotherapy Supervision. Group Ana­ lysis 12 (2): 134–136. Brown, R. (1995) Simultaneous Supervision and Analysis. In The Third Eye: Super­ vision of Analytic Groups. London and New York: Routledge. Brunori, L., Magnani, G. and Raggi, C. (2007) Special Section: Supervision between Rituals: Creativity and the Development of the Reflective Function. Group Analysis 40 (2): 216–235. Cogill, S. (1995) Supervision on the Manchester Block Course. In: The Third Eye: Supervision of Analytic Groups. London and New York: Routledge. Cohen, V. (1995) Monitoring the Supervisee. In: The Third Eye: Supervision of Ana­ lytic Groups. London and New York: Routledge. Friedman, R. (2007) Special Section: Where to Look? Supervising Group Analysis—A Relations Disorder Perspective. Group Analysis 40 (2): 251–268. Gallop, M. (2017) This Rough Magic. In: Vision: Supervision. Zagreb, Croatia. Grotjahn, M. (1984) Commentary. Group Analysis 17 (2): 166–174.

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Hanson, W. (2007) Special Section: Block Supervision: Helping to Overcome Potential Disengagement and Stimulate Development in Qualified Group Analysts. Group Analysis 40 (2): 189–203. Home, J. (1976) First Reflections on the London Workshop of 4–9th January, 1976: “Change and Understanding”. Group Analysis 9 (1): 43–45. Jacobs, D., David, P. and Meyer, D. (1995) The Supervisory Encounter: A Guide for Teachers of Psychodynamic Psychotherapy and Psychoanalysis. Newhaven, CT: Yale University Press. Kalai, S. (2007) Special Section: Group Supervision of Individual Therapy. Group Analysis 40 (2): 204–215. Kutter, P. (1993) Direct and Indirect (‘Reversed’) Mirror Phenomena in Group Supervision. Group Analysis 26 (2): 177–181. Langs, R. (1994) Doing Supervision and Being Supervised. London: Karnac. Lansen, J., Mallon, V., Schlapobersky, J., et al. (1980) Reports. Group Analysis 13 (1): 57–75. Mance, J.E. (1975) The Small Group Reports: Report on Dr. Foulkes’ Group (Rap­ porteur: Barbara Dick). Group Analysis 8 (1): 22–28. Mittwoch, A. (1995) Difficulties and Conflicts. In: The Third Eye: Supervision of Analytic Groups. London and New York: Routledge. Napolitani, F. (1979) Co-Therapy by Alternate Conduction and Reciprocal Super­ vision. Group Analysis 12 (1): 52–55. Noack, A. (2009) Using the Group as a Medium for Supervision. Supervision Review: The Journal of the British Association for Psychoanalytic and Psychodynamic Supervision (Groups) (Spring): 7–13. Olivieri-Larsson, R. (1993) Superego Conflicts in Supervision. Group Analysis 26 (2): 169–176. Pisani, R.A., Colangeli, G., Giordani, A., et al. (2006) The Median Group: Training and Supervision. Group Analysis 39 (4): 537–548. Scani, G. (2002) A Group of Group Conductors as Mirror of Social Stratification Conflicts. Group Analysis 35 (3): 390–405. Scanlon, C. (2000) The Place of Clinical Supervision in the Training of Group-Ana­ lytic Psychotherapists: Towards a Group-Dynamic Model for Professional Educa­ tion? Group Analysis 33: 193–207. Schuman, E.P. and Fulop, G. (1989) Experiential Group Supervision. Group Analysis 22 (4): 387–396. Sharpe, M. (1995) The Third Eye: Supervision of Analytic Groups. London and New York: Routledge. Sharpe, M. and Blackwell, D. (1987) Creative Supervision through Student Involve­ ment. Group Analysis 20 (3): 195–208. Shultz, P.P. and Stoeffler, V.R. (1986) Group Supervision in a Retreat Setting: The Continuing Process of Becoming a Psychotherapist. Group Analysis 19 (3): 223–234. Smith, M. (2018) Some Thoughts on Supervisory Boundaries and Digital Technology. The Journal of the British Association for Psychoanalytic and Psychodynamic Supervision Supervision in the Digital Age (Autumn): 50–54. Smith, M. (2019) Through a Glass Darkly: Using a Reflecting Team Approach in the Development of Supervisory Practice. Group Analysis 52 (3): 297–312. Sternberg, T. (1994) Love and Hate in Supervision Groups. Group Analysis 27 (2): 149–157.

78 The history of group supervision Tsegos, Y. (1995) A Greek Model of Supervision: The Matrix as Supervisor—A Ver­ sion of Peer Supervision Developed at IGA (Athens). In The Third Eye: Supervision of Analytic Groups. London and New York: Routledge. Urlic´, I. and Brunori, L. (2007) Special Section: Supervision: Editorial Introduction. Group Analysis 40 (2): 163–166. Voorhoeve, J.N. and van Putte, F.C.A. (1994) ‘Parallel Process’ in Supervision when Working with Psychotic Patients. Group Analysis 27 (4): 459–466.

Part IV

A group analytic model of supervision

Chapter 6

The clinical hexagon A group analytic model of supervision

Background The task of the supervisor of groups is to facilitate the work of the supervision group. They pay attention to the supervision group’s dynamic administration, providing some structure, and they foster a climate where each person feels safe enough to bring the areas of their work where they most feel in need of help. Once a piece of work has been presented, the members of the super­ vision group hold a free-floating discussion about what they have heard. While this can provide a rich source of insight and learning, at times there is so much to take in that it can be confusing. The clinical hexagon provides a compass, a model that can help to orientate the supervisor to aspects that may be less thought about. The term model is used here to denote the ele­ ments of theory and practice of supervision that form the structure for the supervisory task. They are intended to support the supervisor as they estab­ lish a space to offer support and insight and share experiences that develop their practice.

The clinical hexagon S.H. Foulkes talked about the focus of our attention being like figure and ground. He said: Figure is that which we choose particularly to observe, that on which we focus, or what in impartial observation forces itself into the foreground. (Foulkes, 1990: 231) The model is a way of capturing both the figure and the ground in group supervision. It builds on the work of Ekstein and Wallerstein and their model of the clinical rhombus. They recognised that, although only the therapist may actually meet the client, the supervisor will be affected by them at second hand through the conversation they hold with the therapist. This triad—client, therapist and supervisor—will also be affected by the constraints of the DOI: 10.4324/9781003375975-11

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organisation in which the therapy takes place. Ekstein and Wallerstein’s model has four corners—the client, the therapist, the supervisor and the organisation (Ekstein and Wallerstein, 1958). The clinical hexagon adds two more dimensions—dynamic administration and the supervision group dynamics—and applies this model to group supervision. Each facet of the clinical hexagon will interact with and have an effect on the others. This chapter explores each of the corners of the clinical hexagon in turn, and each will be illustrated with a vignette. 1 Dynamic administration It is the supervisor’s role as manager to set internal and external boundaries appropriate to the task. This list includes time, length of session, fees and frequency of meetings, and provision of a private and adequate space. Internally, they begin and end each meeting, set breaks, organise time sharing and fix regular reviews of their supervision experience. There will be many similarities between the supervisor’s dynamic administrative task with their group and their supervisees’ dynamic administration of their therapy group. Supervisors are role models for the therapists they supervise. Good boundary management by the supervisor offers therapists a good model for their prac­ tice. Appropriate boundary management includes ensuring safe practice. When ethical issues such as safeguarding and risk are not addressed by the group, the supervisor uses their authority to focus on them. Managing boundary issues Boundary issues need to be dealt with thoughtfully and sensitively. There can be boundary issues internal to the supervision group itself that arise becoming known only after the work has begun. The group will think through the implications of boundary issues on a case-by-case basis. This is illustrated in the vignette below. Vignette 1: The shop workers A supervision group session of four counsellors from a charitable organisation, Andrew, Erin, Pedro and Tulip, had a boundary issue affecting Andrew and Erin. It had transpired that each was seeing a client who worked in the same shop. Their clients, Ahmed and Mel, not only knew each other, but their relationship had completely broken down. As soon as Erin talked about her client, Andrew recog­ nised that Mel, her new client, was the manager of the shop where Andrew’s client, Ahmed, worked. Andrew explained that Ahmed was receiving help because he experienced his manager, Mel, as a bully. Both Andrew and Erin asked the super­ visor what to do. The supervisor helped the group to think about how best to manage these boundaries within their supervision group.

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The supervisor encouraged the supervision group to think through possible responses. They considered both the option of excluding each of the counsellors when their clients were presented and that of them remaining, and any likely consequences of each.

This is an example of working through dilemmas such as this in the group on a case-by-case basis rather than relying on a rule or a guideline. However, when therapists work within an organisation, there may also be guidelines that need to be followed about boundary issues and how to manage them. The breaking of boundaries While organisations need to have policies and procedures in place for report­ ing abuse, it can generate distress for therapists working with clients who have not already disclosed previous abuse. There may be a statutory requirement for the therapist to break boundaries when there are risks, either to the person who is being seen or to someone they know, especially when this involves a child. Most organisations have a safeguarding officer who can be called on for advice and support when a therapist is uncertain about how to proceed. It is not uncommon for therapists who need to report abuse to feel as though they are being abusive themselves in doing so, and they may need support to process their feelings in their supervision. 2 The therapy The central task of supervision is to focus on the therapeutic work. As the group does so, the supervisor of the group takes a helicopter view, monitoring what is happening and noting when the group seems at an impasse. For example, the supervisor may notice that the supervision group is focusing exclusively on one specific aspect of the work to the exclusion of all others. The supervisor may wonder whether the focus has become too narrow. The same can be said for too broad a focus—for example, talking exclusively about the wider context in generalised terms without reference to the detail of the work. The supervision group can act as a mirror at times of confusion. In this next example, the supervision group acted as a mirror allowing Joan, the therapist, to see the confusion she was feeling. Vignette 2: Stuck in the swamp Joan, a newly qualified community nurse, described her work with her patient, Gordon, and the feelings she had as he talked about his chaotic life. There were times when she felt she was becoming overwhelmed by the flood of emotions being expressed. She listened to the kaleidoscope of feelings expressed by group members as they responded to her description of the work. Joan reported that

84 A group analytic model of supervision seeing their confusion was a relief. This was because it allowed her to meta­ phorically stand back and think about her client’s confusion rather than being caught up in it. She realised she needed to help him slow down and think, rather than feeling ‘stuck in the swamp’ with him, the phrase Gordon had used about his experience.

In this example, the supervision group’s reaction to Joan’s account of Gor­ don’s life was helpful. It allowed Joan to take up the observer position. She could see the confusion on colleagues’ faces. As an observer, she realised that her confusion was not because she was missing something. She could now see that, in Gordon’s inner world, life was confusing. This enabled Joan to slow down and take time to understand the causes of his confusion before making a decision about Gordon’s future needs. In the next example, the focus is on Anne’s therapy group. The supervision group members were each listening to what was being said through the lens of their own past experiences. Working effectively means being able to use this to advantage, as this vignette illustrates. Vignette 3: The only child Anne’s new therapy group often had long periods of silence when members were finding it hard to talk to each other. Anne found herself working ever harder to encourage them to speak to each other about what was on their minds. The supervision group members too were silent until the supervisor asked what was stirred up in them. Maureen, a supervisee who was an only child, reminded Anne that five of the six members in her group were the only child in their family. Maureen thought that Anne’s group members may not have had the same opportunity to learn to play as children as their classmates with siblings. Anne said she could identify with this because she too was an only child. Consequently, she had felt overwhelmed and lonely in the crowded playground when she started school. Another supervisee, Frank, remembered his fear of being criticised when he first joined his supervision group. Andrea talked about her own anxiety when she had started a group in a new context. Anne left having felt both supported and less drawn to rescue and more able to help the group talk about their family backgrounds and how this was shap­ ing their experience of talking to the others in the group.

The supervisor’s intervention was not to interpret the silence. Instead, it was an intervention to stimulate their conversation. Maureen’s insight about Anne’s group having so many only children was a first step for Anne in making sense of her group’s struggle to communicate their thoughts to the ‘siblings’ in their group. It also connected Anne with what it was from her past that played into this. The vignette illustrates the way that each member tuned in to their associations and put this into words. These insights helped Anne to connect with her own experience of loneliness, and she could then

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think about how this fitted with her group. This is an example of a super­ vision group taking in and digesting difficult feelings from the therapy and giving them back to Anne in a more manageable form (Bion, 1967: 114–115). 3 The therapist Foulkes’s interventions in his supervision group were intended to create change in the therapist, the common denominator between the therapy and the super­ vision. The example he gave was focused specifically on an enactment by naming changes in the trainee’s use of language. This led the trainee to recognise the link between his current identification with his patient, his transference to his new therapist and his relationship with his mother (Foulkes, 1964: 252). In the fol­ lowing example, the focus of the therapy group was initially on the dynamic between two of the therapy group members. Change emerged only when the supervision group refocused its attention from the therapy group to the therapist. The issue brought for the supervision group’s reflections was the difficulty the male therapist, Marcelle, had with a heated exchange between two of the women in his therapy group, Heidi and Jackie. Vignette 4: Conflict and group supervision In the therapy group: Marcel described a heated exchange that took place after Heidi had disclosed her past abortion. Heidi had explained that, even though her religious family had supported her decision at the time, afterwards the family behaved as though it hadn’t happened This had left Heidi feeling as though she was the black sheep of the family. Jackie, a woman who had been adopted, made it clear that she didn’t approve of Heidi having had the abortion, remarking that she wouldn’t be alive if her mother had aborted her. The rest of the therapy group, including Marcel, looked on uncomfortably but said nothing. Marcel took this incident to his group supervision. In the supervision group: Initially, the supervision group members offered moral support to Marcel and shared their thoughts and associations with his account. The supervisor noticed that Marcel was behaving like a bystander in the supervision group. She com­ mented aloud that this was the same role as Marcel had described taking in his therapy group. This led to an exploration in the supervision group about what Marcel was feeling. He reported feeling like a rabbit in the headlights with what he called ‘all this women’s talk’. Further questioning helped Marcel to mention an experience where his sister had caught him having sex with an early girl­ friend in his teens and had teased him mercilessly. He was now in touch with the overwhelming sense of shame he had felt. Reconnecting with this earlier shaming experience helped him to think about how it affected him in his

86 A group analytic model of supervision therapy group. The supervision group turned back to the different perspectives brought by Heidi and Jackie. They hypothesised that both may have been exposed to feelings of judgement and shame as children.

In this example, the conflict in the therapy group triggered Marcel’s fight-or­ flight response. The supervision group helped Marcel to reconnect with his teenage feelings of shame at being caught out. The supervision group named the common theme of shame, connecting it with both Heidi and Jackie and their past histories. Marcel recognised the need to further explore the theme of sex and shame in his therapy group. 4 The supervision group dynamics Each piece of work brought for supervision will have its own unique impact on the dynamics of the supervision group. This is because the therapist will bring something of the essence of their work, which will resonate with each person. The supervision group can learn to tune in to these often subtle changes in the climate of the supervision group that shape their conversation. Scanlon talks about the difference between ‘reflection on action’ and ‘reflection in action’. Reflection on action involves presenting a case and receiving feedback from the supervision group. Reflection in action takes place when the supervision group thinks about what is happening in the conversations taking place between them. In a well-functioning supervision group, the conversation can move between reflection on action and reflection in action. Reflection in action can deepen insight into what is happening unconsciously in the therapy that is mirrored in their conversation—the parallel process. Scanlon suggests that the skilful supervisor learns to facilitate reflection in action when they see that the supervision group has become blocked (Scanlon, 2000: 228). The supervisor’s task is to help the group move between the figure and ground of the work—what is in the forefront of their minds and what is in the back­ ground. An example would be monitoring how far their conversation focuses on the therapy and how far it may reflect their own process. Supervision group members’ conversations, feelings and behaviour are potential sources of informa­ tion as they reflect on their work. When things go well, one of the members of the supervision group can mentally stand back from what is being said and observe that the supervision group conversation is in some way caught in the same dynamic as the therapy they are talking about. However, it is a tool that needs to be used with caution. Once supervisees learn about parallel process, they can initially be inclined to see it everywhere. While they may sometimes reflect reso­ nance from the work under consideration, at other times, what is named as par­ allel process may be more of a reflection of dynamics from the relationships in the supervision group. It is likely anyway that there will be elements of each. It is at times such as these that the supervisor may need to use their countertransference to what is happening to help the group to think about what belongs where.

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‘The fog’ is an example of parallel process in action. A team of university counsellors were meeting for their monthly group supervision. Vignette 5: The fog Greg, one of the counsellors, expressed his frustration and concern about his client Joseph. Joseph had come to the service as an urgent referral. After having an additional assessment meeting, Greg was still unclear about what Joseph’s core issue was or how to proceed. There were a number of attempts by the supervision group members to ask Greg for more detail. Greg said this lack of detail to present about Joseph made him feel inadequate as a counsellor and ashamed he didn’t know more. After this, the conversation drifted into spec­ ulation. The supervisor observed that the supervision group conversation was now also lacking focus and asked for their associations. Ronan, one of the counsellors, had an association to the time he had seen someone who had a similar impact on him. He had referred the person to the local community psychiatric nurse (CPN) team for an assessment that had resulted in his client’s hospitalisation. Greg, Joseph’s counsellor, sounded shocked at first, but also relieved that the lack of detail might not be as a result of his inexperience. Having thought about it, he said he could see that, if Joseph couldn’t engage with him about his problems, counselling was not helpful at the moment. This was the first time he had seen someone in this state. As a result of Ronan’s input, Greg decided to take this to his manager and suggest a referral to the mental health team.

In this case, the lack of detail and the seeming confusion described by Greg may have reflected Joseph’s ‘foggy’ internal world. This was felt to be an indication of a breakdown in mental functioning, possibly as a result of trauma. Parallel process, where communication in the therapy becomes enacted in supervision, can affect the supervisee negatively when it is not recognised. The next vignette is an illustration of this happening. Vignette 6: Flooded with grief Wilf, a supervisee, presented his client Jamie’s experience of loss to his super­ vision group. His client had needed to identify their partner who drowned as a result of a flood. Wilf said he had felt flooded after listening to the details the client had described. He had found it difficult to focus on his other clients for the rest of the day. The supervision group expressed sympathy and support for Wilf before going on to give him a lot of useful feedback about the impact of trauma on patients, leaflets he could download and other general thoughts about how to proceed in the work. The supervisor paused the group conversa­ tion and asked Wilf what he had found helpful. He looked ashamed and admitted sheepishly that the only feedback he could recollect was one member’s empathic response to him about how awful it must have been for him to listen to this account first hand.

88 A group analytic model of supervision After this feedback, the supervisor wondered whether the supervision group too had been feeling traumatised by Wilf’s account. She asked them how they had felt after listening to Wilf. Their countertransference response was to the content being evacuated into them and to feeling sick. Getting in touch with feelings allowed them to acknowledge that the traumatic case had triggered their own emotional response to the trauma. Having all felt flooded by the details revealed in the case, they had unintentionally repeated Wilf’s experience and had overwhelmed the therapist with help he was not yet ready emotionally to hear.

In this example, the supervision group responses were given when the impact of listening to Wilf’s description of the trauma limited their capacity to tune in to what he needed. When supervision groups are engaged in reflection on traumatic incidents, it is especially important for the supervisor of groups to maintain a focus on the tone and pace of the supervision group dynamics as well as the content. In this case, the content of the contributions was appropriate. What the supervisor noticed, and what lead her to ask the presenter for feedback, was an increase in pace and the emotional tone of the contributions. It was as though they were evacuating their thoughts into Wilf in a similar way to the way they had experienced his account as being evacuated into them. 5 The supervisor’s countertransference In group supervision, it is both the supervisor and the group who monitor their own emotional response to the group’s work. The supervisor will intervene at times when the group is either off task or stuck. When the supervisor too feels at an impasse, they may need to take the work to their peer supervision group for further reflection. Elkind, a consultant who was contacted to help resolve ther­ apeutic impasses in the work of other therapists, noted that these impasses were often triggered as a result of one of two difficulties. Either underlying vulner­ ability triggered attachment responses in the therapist, or the therapist was restricting their range of interventions in order not to rock the boat with a patient they perceived as fragile (Elkind, 1996: 363–364). Elkind’s intervention involved working with her countertransference in order to identify and name the emotional trigger for an enactment of past trauma (Elkind, 1996: 379). The following vignette illustrates the need for additional help from outside the supervision group. In this case, Justine, the supervisor, turned to her peer supervision group for help. Vignette 7: Supervising a love–hate relationship Two marital therapists, Bertha and Peter, presented the case of a couple they had been seeing for the last few months. This couple that Bertha and Peter been seeing had a stormy relationship, seeming to go through a cycle of having a row, avoiding each other and then passionately making up. It didn’t take long for the next row to erupt. The couple kept talking to Bertha and Peter about

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their desire to separate but then failing to do anything they had agreed in their sessions to make this possible. In their supervision group, the other two therapists in the group saw the couple as wanting to stay together and needing some interpersonal skills input to help them communicate their needs more constructively. Bertha and Peter explained they had tried this and it hadn’t worked. They now felt that the couple’s best interests were served by separating. Each couple in the supervision group took turns to react, either by being more passionate in what they said or by saying very little. It became clear that the behaviour between the couple that Bertha and Peter were seeing was mirrored in the supervision group, although more mildly. The supervisor, Justine, named the parallel process between the two settings, the marital therapy and the supervision group. However, it was as though her interventions fell on deaf ears, and this dynamic persisted. Justine took this to her peer supervision group, where the members saw the couple playing out an extreme case of ambivalent attachment. They noted the super­ vision group’s focus was on what to do rather than on how things felt. When Bertha and Peter presented the case again, Justine encouraged the group to talk about their feelings. After her intervention, some of the super­ vision group expressed feelings of emptiness, fear and dread. This paved the way for Bertha and Peter to make a link between their countertransference feelings of inadequacy and the fear and dread of being abandoned. The threat of abandonment was a theme in the histories of both partners in this stormy relationship. In this case, the couple had each survived a childhood where they couldn’t live with and couldn’t live without the main attachment figures in their life. They both had parents who had threatened to abandon them at times. The members of the supervision group were then able to think, with Bertha and Peter, about the couple’s fear of both intimacy and abandonment in childhood, and how each was enacting this in their stormy relationship. They recom­ mended considering each having some individual therapy alongside their cou­ ples work together.

The supervision group had recognised that this couple’s pattern of rowing and repairing their relationship must serve a function for them both. It was only with hindsight that their supervisor Justine recognised that she had not been tuning in to her countertransference. 6 The organisation The supervision group and the therapist will be affected by whether super­ visees work within an organisation or independently. For example, a group located in a mental health setting will be likely to have access to psychiatry and CPN services that are not necessarily available to a therapist working privately in a community setting. Therapists working in an institutional con­ text may more usually offer a time-limited number of sessions and be expected to complete the institution’s preferred outcome measures. There may be standardised guidelines for practice. Therapists who work privately can be

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freer to make decisions but have less containing infrastructure to draw on when things go wrong. Therapists who work in an organisation may have had little or no choice in selecting their supervisor or the others in their supervision group. Likewise, therapists who work privately may not be able to fit in with the time of the group being run by their preferred supervisor. When the supervision is pro­ vided internally by the organisation, some of the therapists may have a pre­ existing relationship with the others in the group or with the supervisor. Some supervisees would prefer dyadic to group supervision and may be dis­ appointed to find themselves in a supervision group. Organisations also make changes to improve services or to reduce costs. All this will colour supervisory relationships and the supervision process. These are important areas to explore when the supervisor is initially contracting with the supervision group and at reviews of how the group is working. Sometimes, the full impact of changes made by the organisation is not immediately obvious. In the example below, Helen, the therapist, worked for an NHS service in the Midlands. She had been in her supervision group for more than two years at the time of this example. It illustrates the way organisational change impacted her work. Vignette 8: In the shadow of the organisation Helen, an experienced group analyst, described feeling disheartened when she presented her psychotherapy groups in her group supervision. She saw her therapy groups as lifeless and gave examples. The members of the supervision group engaged in free-floating discussion, offering reflections on their experi­ ences of feeling disappointed about their own work. They also made some suggestions about what Helen could do to enliven the group. She had tried them, but reported back that she found that, while her efforts had been effective in the moment, they hadn’t changed the overall picture. Helen had finally found herself giving up. The supervision group members too started to feel half­ hearted as they realised they were starting to repeat themselves when Helen brought up her groups. The supervisor drew on the model of the clinical hexagon. Five of the cor­ ners of the clinical hexagon had been explored in the supervision group’s recent reflections. She was left with the organisational context as the one that had not emerged in their conversation. It was when the supervisor asked about any changes at work that a lightbulb came on for Helen. She talked about the changes in her team resulting from a large cut in funding the previous year. A therapist colleague was retiring without being replaced, and the budget for supervision had been axed. Helen said her whole team was feeling demoralised. Their external supervision had been withdrawn, and they were now only meet­ ing for peer supervision. Helen was the only group analyst and often felt out­ numbered by the dyadic therapists and had to work hard not to lose her voice. She reminded the group that she had mentioned this eight months ago, when

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the funding for her external supervision had been withdrawn. In discussion with the group, she had taken the decision at that time to continue in the supervision group by paying for it herself, something she intended to continue. She said work had been a nightmare recently and she had focused on her three therapy groups as a respite from thinking about work. The group now realised that, although they had been aware of the changes, they had not thought about the impact they might have had on Helen. Long waiting lists and the privileging of shorter-term interventions had also left Helen feeling she didn’t fit with the organisation’s aims any more. She had been blaming herself for the difficulty she was having in recruiting new group mem­ bers. She was also feeling resentful that, while nothing was said, there were vibes that her work wasn’t being valued because she was not taking on new patients for her groups at the same pace as the others in her team who worked dyadically. The supervision group members were very supportive of Helen and highlighted some of the ways that the people in her groups had made progress. They helped her mourn what she had lost—the retirement of her colleague and the loss of working in an environment that valued her contribution. They also encouraged her to think about how she could argue her case for the benefit of groups in the current climate when conversations about throughput were dom­ inating the conversation.

In this example, the initial focus was on the therapy group being presented and Helen’s struggle to breathe life into it. It was when the supervisor refo­ cused the supervision group’s attention on the context that background issues affecting her work were brought to the fore. Although Helen had mentioned the previous changes in her work before, only the practical arrangements around payment had received attention at that time. Once Helen had made the supervision group aware of how the organisational change had affected her, the members also supported her in her mourning of the loss of her col­ league who valued groups. They also encouraged her to find her voice to argue her case, something she acknowledged she had often struggled to do when confronting authority figures. The supervisor’s use of the clinical hexagon allowed the supervision group’s focus to be reorientated to the unthought known. The focus on the recent changes in the organisational context highlighted their impingement on the work. The supervision group members were more fully aware of the impact of the changes in the organisation on Helen and her groups. Super­ vision is not therapy, and so the links between the organisational changes and Helen’s past were acknowledged but not explored. In his book The Shadow of the Object, Christopher Bollas suggested that, although we are affected by the relationships we have throughout our lives, much of the impact of our encounters is not thought about. This is in spite of some of these events having a lasting effect (Bollas, 1987). Diamond found that organisational defences are very powerful when issues such as change, loss and grief arise (Diamond, 2008: 362).

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The clinical hexagon model in practice The clinical hexagon offers a compass for the supervisor who can use it to think about where to focus. It provides a framework to support the supervisor of groups to work with the multi-perspective contributions of group super­ vision. Each of the corners of the clinical hexagon will bring a particular aspect into the foreground while leaving others less in focus. The movement between one corner and another can highlight new perspectives that were previously not the focus of the supervision group’s attention. A group analytic model of supervision combines each of the corners of the clinical hexagon to form a model for reflecting on the work that therapists bring. In this approach, the supervisor manages the boundaries of the supervision group, while the group works with the task. There are four stages to this model. The supervisor is active when managing the time boundaries and intervenes when the supervision group becomes stuck. 1 The presentation The supervisor is responsible for supervision group time boundaries. They oversee the group’s internal boundaries, including the allocation of time for each person. The supervisor invites each therapist in turn to present their work and brings this focus to a close after the agreed allocated time. They may help a therapist to become more specific about what they wish the supervision group to think about with them when other group members haven’t done so. The therapist will present their work to the supervision group. This can be done in a number of ways—for example, reading from notes, spontaneously recalling material or focusing on their own countertransference to an event in the group. There are occasions when sessions are recorded and played back to the supervision group. What is important in bringing the material is that something of the essence of the work is conveyed to the supervision group. The supervision group listens to the account of the therapy, including the way it is conveyed, the content, the language that is used, the body language of the presenter and the emotional temperature in the room. During this time, the other therapists are encouraged to notice their emotional responses and associations to the work. They may also note the emotional distance or engagement they experience, their feelings and bodily sensations, who they identify with in the account and what they are thinking. 2 The supervision group reflection Once the account has been given, the other supervisees are invited to respond. Initially, there may be requests for further detail. It is worth bearing in mind that, if this phase continues for too long, it may be defensive on the part of

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the group. The supervisor encourages the group to hold a free-floating discussion of their thoughts, feelings, hypotheses and associations about work the therapist presents. In a well-functioning supervision group, this process can be a vehicle for translating what was outside awareness into words. The group members may be offering their own thoughts, associa­ tions, suggestions and feelings or sharing similar experiences. These are examples of reflection on action. 3 The supervision group members reflect on their own process Sometimes, something from the therapy group conversation can be recognised through thinking about the supervision group conversation. This has the potential to illuminate what the members may have not been previously con­ sciously aware of but are tuned into at a less conscious level. When the members of the supervision group reflect on their own group dynamics, this is ‘reflection in action’. It is only when this process becomes blocked that the supervisor may draw on the clinical hexagon. 4 Presenter feedback Receiving feedback from the group can be both enriching and anxiety-pro­ voking. Sometimes, the quantity of feedback given may feel overwhelming. The supervisor invites the presenting therapist to review the feedback they have received from the supervision group. This can both help them to digest the different perspectives given from the other group members and provide an opportunity to clarify things when needed. It also allows the rest of the group to receive feedback about their contributions. It can also be a time when the supervisor of groups can review what areas of the clinical hexagon were cov­ ered and any that were not mentioned. This model is followed in the example below. Vignette 9: A group in mourning Zoran presented a therapy group where two members had just left, leaving four remaining members. Since then, there had been erratic attendance. Zoran’s group members were either too busy at work or had planned last-minute holi­ days. Zoran was anxious that his group might not survive. The supervision group asked Zoran about whether he had followed up on the people who were attending erratically. He said he had sent out a standard letter, and the group helped him to think about whether or not it would be appropriate to do more.

Reflection on action is where the supervision group focuses on either the action taking place in the therapy group or on what the therapist has done, or plans to do.

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Stage 1: Supervision group response – ‘reflection on action’ Group members sympathised with Zoran. They shared their feelings about the group, its previous ambience of warmth and support, and their previous envy of him for the group members’ ability to think about how their relationships showed themselves in the group. James, the supervisor, thought that the remaining members were still attached, even though they weren’t coming reg­ ularly. Ben and Anne, the other two members of the supervision group, thought with Zoran about bringing in new members.

This vignette is characteristic of ‘reflection on action’. Zoran talked about his concerns for his group. The supervision group drew on their memories of his group, reassuring him that it had been going well before the departures. They observed that the group in the room seemed to be attached to him and to each other. Stage 2: Supervision group response – ‘Reflection in action’ James invited the group to think about its own process. Initially, there was an awkward silence, after which there was recognition of how busy they had been with offering Zoran ideas and suggestions. The supervision group acknowledged their busyness as a means of avoiding the underlying feelings. At this point, the mood became more sombre, and the feeling of mourning surfaced. Ben commented on this, saying he felt as though he had arrived at a funeral.

Stage 3: Presenter feedback Zoran acknowledged the group’s reflections had helped him to get in touch with his sadness at the loss of the two people who had been in the group since the beginning. He recognised his feelings were also affected by two recent losses in his family. He now wondered if his personal losses had affected his capacity to tune in to the group’s sadness at the loss of two important group members.

When the supervision group engages in reflection in action, its members think about their experience in the here and now of their group. In this vignette, the switch to reflection in action took place when the supervision group members moved away from talking about the therapy group. Instead, they tuned in to what they were feeling in the here and now of the super­ vision group. In this case, some of their busyness was a deflection from being in touch with the therapy group’s loss and the wish to avoid the pain of mourning. This is the switch from what was conscious to what had been pre­ conscious, just outside conscious awareness. This switch facilitated the move from the behaviour to its unconscious function.

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Presenter feedback The supervisor invited Zoran to reflect on the supervision group feedback. Zoran said he had found it painful but helpful to have heard the feelings expressed by the other therapists in the supervision group. It had shifted him to a new place in his thinking about what might be being avoided in his therapy group. The supervision group had been focusing on two corners of the clinical hexagon, the therapy group and its recent absences and dynamic administra­ tion—his response to his absent group members. Refocusing on the super­ vision group, a third corner of the clinical hexagon, helped the group think about unconscious feelings they were avoiding.

Conclusion A group analytic model of supervision uses the supervision group as a medium for reflection on therapists’ work. The clinical hexagon provides a framework for the supervisor to assist group members in maintaining a reflective stance under pressure. The model of the clinical hexagon builds on group analytic practice in the tradition of S.H. Foulkes. It provides the supervisor with a map to assist them to notice what is in the foreground of the group’s attention and what may be missed because it has been in the background and unnoticed. Each corner of the clinical hexagon will have an impact on the content and shape of the supervision group discussion. The central focus of supervision is the clinical work. The supervisor pro­ vides dynamic administration of the group—arrangements, when and where to meet and how the supervision group is organised. While it is important to focus on the therapy, it is also important to think about other areas that may also have an impact. A focus on the therapist is a direct route to addressing countertransference issues. The supervision group will be encouraged to focus on its own process when it is recognised that members may be enacting something from the therapy. The supervisor uses their countertransference when the supervision group seems at an impasse. All this takes place within a social context, an organisation or in a private room setting that normally will provide an outer container for the therapy, although at times it may also impinge. Using the model of the clinical hexagon as a compass, supervisors can monitor the direction of travel of the supervision group. The supervisor can also use it to orientate themselves in order to think about what is missing from the supervision group conversation. The group analytic model of supervision offers a structure that can aid the supervisor in providing support and learning for therapists with the aim of enabling them to offer a safe and effective service for clients.

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References Bion, W.R. (1967) Second Thoughts: Selected Papers on Psycho-Analysis. Oxford: Routledge. Bollas, C. (1987) The Shadow of the Object: Psychoanalysis of the Unthought Known. Columbia University Press. Diamond, M. (2008) Telling Them What They Know: Organizational Change, Defensive Resistance, and the Unthought Known. The Journal of Applied Beha­ vioral Science 44 (3): 348–364. Ekstein, R. and Wallerstein, R.S. (1958) The Teaching and Learning of Psychotherapy. New York: Basic Books. Elkind, S.N. (1996) Resolving Impasses: Including Patients and Supervisees in Consultations. In: M.H. Rock (Ed.), Psychodynamic Supervision: Perspectives of the Supervisor and Supervisee. New Jersey: Jason Aronson. Foulkes, S.H. (1964) Therapeutic Group Analysis. London: George Allen & Unwin. Foulkes, S.H. (1990) Selected Papers: Psychoanalysis and Group Analysis. Oxford: Routledge. Scanlon, C. (2000) The Place of Clinical Supervision in the Training of Group-Analytic Psychotherapists: Towards a Group-Dynamic Model for Professional Education? Group Analysis 33 (2): 193–207.

Chapter 7

Dynamic administration Managing the boundaries of group supervision

Introduction This chapter begins by defining the group analytic term ‘dynamic adminis­ tration’. It then draws on Colin James’s chapter in The Psyche and the Social World on holding and containing in group psychotherapy in order to reflect on the nature and purpose of dynamic administration (James, 1994: 60–79). Winnicott’s theory of holding and Bion’s concept of containing are two con­ cepts referring to the role of the necessary conditions for promoting thinking. This theory is then applied to the practice of group supervision, and the pro­ cess of dynamic administration is illustrated through the use of vignettes. Foulkes almost certainly borrowed the term dynamic administration from the management consultant Mary Parker Follett. Dynamic administration is an active and ongoing process. Group analysts use the term ‘dynamic administration’ rather than the term ‘frame’ to cover the tasks involved in managing the boundaries of their groups. This is because a frame sits at the boundary, and the supervisor of groups needs to pay attention to both the inside and the outside of this frame because engaging more than one person at a time will require additional active, ongoing administration. The supervisor’s boundary management shapes the experience of the supervision group. The supervisor of groups needs to use their authority to maintain safe boundaries in order for supervision to fulfil its primary task of reflecting on the clinical work and ensuring safe practice. Group analysts recognise that working in groups requires attention to both the external boundaries—the impingements from outside the group—and the internal boundaries that impact on what happens between members inside the group.

The holding and containing functions of group supervision Colin James applied Winnicott’s term ‘the holding environment’ and Bion’s concept of ‘containment’ to the role of therapists offering analytic groups. It was his contention that these concepts could help group analysts to better understand patients’ experience within the matrix of the therapy group DOI: 10.4324/9781003375975-12

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(James, 1994: 75). The concepts of holding and containing are applied here to the dynamic administration of supervision of groups. This refers to the supervisor’s administrative role in creating and managing the supervision group environment. Donald Winnicott It was Donald Winnicott who emphasised the importance of a safe holding environment for children growing up. This is also needed throughout life in order to grow and mature. Three aspects of Winnicott’s thinking about par­ ental roles are of particular value in thinking about the supervisor’s role as dynamic administrator. Firstly, just as the mother creates a good enough holding environment for the infant, so the supervisor is responsible for the creation of the holding environment for the supervision group. Secondly, when all goes well, the mother gradually adapts her behaviour by following the infant’s needs as they mature (Winnicott, 1982: 138). In good enough supervision, the supervisor will also adapt their behaviour as their supervisees develop. The supervisor will be able to promote and encourage their super­ visees’ capacity to engage their own internal supervisor (Casement, 1985: 30– 31). Thirdly, Winnicott describes the parent–infant relationship as offering a shared transitional space. In good enough group supervision, the supervisor too creates an atmosphere akin to a shared transitional space. In this space, the supervision group members engage in reverie and share associations and emotional responses to the work under consideration. The supervisor’s dynamic task can be conceptualised as the creation of a holding environment in which clients are thought about in a shared potential space where the supervision group conversation moves between internal and external reality. Winnicott describes the infant’s journey from illusion towards reality as one where the infant becomes able to recognise ‘the boundary between internal and external reality from a position of shared reality’ (James, 1994: 70; italics in the original). It is this process that facilitates the growing child’s capacity both to contribute to and take from their relationships with others in a heal­ thy way. In group supervision, the reflection on supervisees’ case material takes place in the group’s transitional space, and change evolves from the movement of the group communications between internal and external reality. Wilfred Bion Bion based his concept of containment on the processes undertaken by a caregiver that allow a child to develop the capacity to think about their own mind and about the minds of others. This is a complex process that requires both parent and infant to be able to tolerate frustration. The right brain, the emotional brain, is wired during the first two years of life when the infant is most dependent on the others around them to regulate their feelings (Schore,

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2003: 39–40). Bion said that, when this process goes well, the caregiver uses their mind as a substitute for that of their infant, who does not yet have the psychic structures in place to do this for themselves. Caregivers do this through providing comfort when the baby is distressed. This involves picking up the signals of the baby’s distress, taking them in at a feeling level and digesting them in order to make an appropriate response to the baby. The attuned caregiver uses their reflection to detoxify and return distressing feel­ ings to the baby in a more manageable form. Bion described this as turning the infant’s ‘beta elements’—that is, the feelings and sensations that they experience as unbearable—and detoxifying them by changing them into ‘alpha elements’. These are more digestible for the infant (Bion, 1984: 36). This process can easily break down when the parent is unable to tolerate the infant’s distress or when either they or their infant are not sufficiently able to tolerate frustration. In Bion’s model, when this happens, the caregiver needs support with this task from outside. This process is what Bion referred to as ‘container-contained’ (Bion, 1984: 91). When the caretaker is unavailable as a container and there is no external containment to support them, this leaves the infant in a state of what Bion referred to as ‘nameless dread’, still caught up in painful feelings and without the resources to deal with them. When therapists engage in supervision, the supervision group provides the container to contain the therapist when they are finding aspects of their therapeutic work challenging. Holding and containing the supervision group The rest of this chapter explores the supervisor’s boundary management through the lens of the work of Bion and Winnicott and their concepts of holding and containing. The way the supervision group is held and contained will be affected by the supervisor’s attention to the supervision group bound­ aries. This will include attention to the context and setting, and putting the supervision group together. The supervision contract also includes the inter­ nal boundaries and how the members work together as a group. Both the internal and external boundaries are explored in this chapter. The supervisor of a group sits on the boundary of the group. Like Janus, the Roman god in mythology who is represented as having two heads, they face two ways. They face outwards, in their thinking about the context for the work. They also face inwards, managing the boundaries within the super­ vision group. Group supervision is a work group with set tasks, carried out within the supervisory frame. Supervisors of groups are responsible for ensuring that there is the transitional space needed for the emotional work undertaken. This work is akin to supporting the caregiver’s role in creating a safe space to process undigested experiences and their associated thoughts and feelings from their therapeutic work.

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In her paper on ‘Using the Group as a Medium for Supervision’, Noack underlines the importance of the supervisor’s responsibility for dynamic administration, which she refers to as ‘the bedrock’ of good practice. Echoing the words of Winnicott, she says: Dynamic administration creates an immutable division and clear boundaries between inside and outside the group, which in turn provides within the group a secure space for psychic exploration. (Noack, 2009: 8) Before the supervision group begins Dynamic administration of a supervision group starts in the mind of the supervisor with planning for the new group. They will need to give thought to the context and where the group members will come from. For example, they may be setting up supervision on a training course or providing supervision for a group within an organisation. Equally, they may also be planning to set up a private supervision group. Some private supervisors invite therapists to get in touch if they are looking for a supervisor. Some supervisors of groups may have the luxury of being able to consider how potential members will fit together. They can consider gender balance, the background and level of expertise of each person and the type of work each will bring. Supervisors working in private practice will need to make arrangements for payment, including when they will give out invoi­ ces and ways they can be paid. Each therapist will be joining the supervision group with their own needs and expectations. Some understanding of the supervisor’s approach to supervision will need to be included in the negotia­ tion process. When they are setting up a private group, a supervisor may choose to hold a pre-meeting with each person individually. This provides an opportunity to discuss needs and expectations and to check for any boundary issues with other potential members that may impinge on relationships before they meet for the first time. Sometimes, the supervisor will be given a super­ vision group put together by a counselling or psychotherapy service or staff on a training course, or they may take over a pre-existing group. When making arrangements for providing supervision within an institution, the details will normally need to be negotiated with the manager. The supervisory contract The contracting process for group supervision has elements in common with contracting for dyadic supervision. These include ensuring that there is a sui­ table room where the group can meet uninterrupted. Clarity is needed about the practicalities—for example, days and times, length and frequency of ses­ sions, and arrangements for breaks. Where supervisees are meeting physically,

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they may need specific instructions about entering and leaving the building. The boundaries around confidentiality will be familiar territory for therapists and supervisors. These may be shaped by the requirements of their profes­ sional body and the organisation the group members work for. With students, the supervisor cannot guarantee the normal levels of confidentiality because the institution will usually require a supervisor’s report. Instead, con­ fidentiality will be held within the boundaries of the training institution. The process can be transparent—for example, having an agreement that informa­ tion should not be shared by the supervisor without informing the therapist of what will be said. Once qualified, other organisations may require a report on the therapist’s progress. For example, university counselling services normally have a contract with the supervisor that requires them to provide an annual appraisal of their work. Professional bodies require enough information about their practice to allow them to include them on their register of members. The only other time when boundaries may be breached would be when unethical or illegal practice is not being addressed by the therapist themselves. Once the external practicalities have been agreed, the supervisor’s first task is to meet and agree a contract with their supervision group. The purpose of negotiating the contract is to provide clarity about the boundaries around the work, what the task is, and how the process will work. One of the differences in the way a contract is agreed in a supervision group is that it emerges from the group conversation. This is because, when contracting with a supervision group, it will take the agreement of the whole group to make the contract work effectively. Each supervision contract will need to be tailored to the needs of the group, their workload and the requirements of their work con­ text. The task is to provide a good enough space for the work to take place. In group supervision, the contract forms the boundaries around the space for reflection on the relationship between the therapist and their clients. When a supervision group is meeting virtually, they will need to know what platform is being used (Teams, Skype or Zoom) and that their equipment works well enough for them to hear and be heard. Supervisors will have little or no control over the varied environments from which each member of the group is joining. It is, however, important to think about them. For example, each person is expected to be somewhere where they cannot be overheard. The external boundaries of supervision groups Supervisory work can be conceived of as sitting within a series of circles, each shaping the work to some degree while also providing a measure of contain­ ment. At the outermost layer—the national level—the government commis­ sions all health and social care bodies and expects them to have stipulations about providing clinical supervision. The professional bodies regulating stan­ dards for counselling and psychotherapy have made supervision a mandatory requirement for maintaining registration. The intention is to both support staff

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and protect the public. Preceptorship supervision is also mandatory for health, probation and social care staff when they first qualify. Post preceptorship, the provision of supervision can vary widely. These two levels of containment for the supervisory work can be thought of as being a part of the foundation matrix (Foulkes, 1990: 212–213). The foundation matrix remains constant, changing only slowly. For example, the Health and Care Professions Council (HCPC) has set the mandatory requirement for clinical supervision for health and care staff. However, it is unlikely that it will become mandatory for post-qualification supervision to be provided for all health and social care professionals nationally without major social change. All this forms a part of the background, shaping beliefs and expectations that become thought of as normal. Trainees also come to see their work through particular theoretical lenses and methods of practice. This forms a part of the preconditioning that takes place during training. At a societal level, the holding environment for the work both creates constraints and also works well enough to keep most staff safe and contained enough to engage in the work while also providing protection for their clients. The third layer of the onion is the organisation. The task of organisations that provide therapeutic services is to deliver the best quality of care available within their allocated budget. This task is likely to be overseen by managers. The managers are constrained by the decisions made in the outer rings of the onion—government and professional bodies. These can include financial con­ straints, rules, systems and mandatory regulations. An organisation also allo­ cates space for the work and appoints middle managers to oversee the day-to­ day work of administrative staff and the healthcare practitioners themselves. Supervision that is provided within an organisation for its health and care staff sits within this layer of the onion. Each of the layers around it can be thought of as providing a containing function or, when not working well, as impinging on the therapeutic work. For example, psychiatrists in the UK are currently required to see two psychotherapy cases as a part of their mandatory learning about psychological therapies. Organisations are required to provide a super­ vision group for these trainees when they take on their training cases. There will be a set day and time for the supervision in line with the practice required for the provision of psychotherapy. At times, this will clash with another part of these trainees’ mandatory training—for example, when they are expected to be ‘on call’ to deal with emergencies. When this is the case, the supervisor does not have the authority to orchestrate change. Their role is to help the supervision group to manage these impingements the best way they can. Supervisory settings This next section looks at some of the settings in which group supervision takes place, some of the benefits of each setting and also some of the dynamic administration that can need attention in order to maximise the benefits of

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each one. There are a wide variety of settings for counselling and psy­ chotherapy services within health and social care settings. Clinical supervision can take place in hospital inpatient services, community services and GP practices. There may be dedicated counselling and psychotherapy depart­ ments with their own building or wing of a building, or the services may be provided by a charity in a community setting that is rented by the provider. There are a number of benefits to therapy services being provided by health and social care services. The organisation acts as a container when there are issues of risk, usually having a range of resources available to support a vul­ nerable client. Other benefits of working within an organisation are: the con­ taining structure surrounding the work, including access to the building itself, a manager, reception and administrative staff, and policies and procedures that form the holding environment, the ground for the work. In health and social care settings, there will normally be a receptionist to organise the room, and secretarial support. Supervisors working internally to the organisation will normally be paid automatically and will have pension rights. Supervisors who work externally will need to be put in touch with the staff member with responsibility for making arrangements for the supervisor to be paid. The rooms will usually be suitable for a group meeting and will have been cleaned and tidied. In an organisation, there will already be a group in need of super­ vision, more often than not, and so no need for the supervisor to find people to put together. There will often be a space where the therapists can assemble beforehand, and the receptionist will let them know when the room is free. There will usually be support from the manager and some understanding of the nature and purpose of supervision and its importance. In organisations dedicated to providing therapy, there will be policies and procedures in place that regulate the work and form part of the holding environment. Health and social care providers will usually have a system for notifying the supervisor of any absences and for letting the supervision group know if the supervisor is unable to attend. These background processes only come into the foreground when something changes or when something goes astray that has an impact on the supervisor and the supervision group. When all these things are in place, this reduces the supervisor’s dynamic administrative work because these basic requirements for safe supervision with boundaries are integral to the culture and working practices of the organisation. This is all a part of the containing process for group supervision. There can also be constraints. Financial constraints lead to decisions that shape practice—for example, setting a limit to the types of psychological therapy available (individual, group or modality)—within the service, the number of staff, administrative support and the maximum number of sessions in each service user’s care package. The benefits and challenges of some of the organisational settings used for supervision are explored in more detail in three settings: a day hospital, a ward-based service and a GP practice. There are also two community settings: a church that also serves as a suburban

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community centre and a university counselling service. Each of these has dif­ ferent boundary management areas to hold in mind. The hospital setting Outpatient services provide patients with assessment, treatment and rehabili­ tation. For example, day hospitals in a mental health trust typically provide a range of services, including occupational therapy and art and music therapy, as a part of their rehabilitation programme. The task of supervision in a day hospital setting is to contain the containers, to support the staff who are supporting their service users in staying well enough to avoid hospitalisation. In the vignette below, the art and music therapy staff met for fortnightly supervision for their work. Mary was their external supervisor. Vignette 1: Shame about the noise Mary was asked to work in the only room available in a day hospital setting. She began to provide group supervision in November on a Tuesday. It was only the following March that she discovered that her fortnightly supervision group coincided with the day the grass outside their window was cut. This meant that, over the summer months, the group had to shout to make themselves heard! Mary tried in vain to negotiate the use of a different room but was told that none was available at that time.

The supervisor saw the constant intrusion of loud noise as an impingement on the group and its work. Winnicott described impingement taking place when the mother’s needs are placed above those of her child. As a consequence, the child learns to adapt to the needs of their parent (Winnicott, 1992: 211–212). In this case, the group learned to shout over the noise of the grass cutter. When a supervisor is invited in to provide supervision in an organisation, they are effectively a guest. They are charged with responsibility, but are without authority within the organisational system. Consequently, they can only suggest and request rather than negotiate when problems in the arrangements for the supervision arise. This can make the process of enabling change challenging. Overcoming the challenges of making the practical arrangements for supervision of ward staff requires a manager who is willing to support its provision. It may be because of this that much of the supervision of wardbased staff is offered informally as and when it is needed. Arrangements that take account of rotas and having enough staff on the ward for a group to be released can be a challenge. The NHS is a hierarchical system, and having a manager with the authority to allocate funds for additional staffing costs and the authority to ring-fence the use of a room makes a big difference. When the task of setting up a new supervision group seems daunting, it can be helpful to be reminded of the benefits of providing supervision. Marcus

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Evans, who provided clinical supervision for mental health staff dealing with patients with severe personality problems, suggested that the benefits of supervision include staff understanding their patients better, providing time for processing some of the overwhelming feelings that emerge when working with very disturbed patients, providing insight into the meaning of patients’ symptoms and increasing the capacity of staff to work with their patients in a constructive way (Evans, 2016: xv, xvii). Private settings The potential settings for private supervision are extensive. This section explores some of the dynamic administration that particularly relates to con­ sulting rooms, church offices and community centres. It also includes a section on video conferencing supervision, where there can be a mix of settings—the NHS, social care, consulting rooms, church buildings, community centres and people’s homes. Some of the benefits and difficulties that emerge would be similar whether the therapist is providing therapy or supervision. Supervisors may be working from home or renting rooms in a variety of community spaces. When a group of therapists work together, they can create shared arrangements. For exam­ ple, they can employ a receptionist to manage the process of entry and exit from the building. When this is not possible, a therapist may rent a room from an owner who lets out areas of the building to a range of different businesses. The supervisor and the therapists who see clients in this type of setting are likely to be sharing communal routes for entering and exiting the building, stairs, kitchen area and toilet facilities. Sometimes, difficulties are outside the therapist’s control, as in this next vignette. Vignette 2: The fire alarm One therapist took a dilemma about a fire alarm to her supervision group. She rented a room in some city centre offices and ran her therapy group in the evening. Unfortunately, they regularly had the fire alarm going off when their supervision group was meeting there because someone from one of the other organisations using the building had burnt the toast they were making. This meant that they needed to evacuate the building until the fire brigade gave the all clear. The landlord said they were powerless to do anything about it. The supervision group helped the therapist to come to the decision that if, she wanted to avoid this, she would need to move premises.

The internal boundaries of group supervision In group supervision, attention to internal boundaries is particularly impor­ tant. This is because the group members have relationships with each other

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and not just with the supervisor. Relations between members can make or detract from the supervisory experience. When the group works well together, shared problems can help to detoxify some of the challenges the therapist is experiencing in their therapeutic work. This is described by James as holding and containing the work (James, 1994: 70–71). In supervision, holding and containing are being provided for the therapists rather than for clients. Bion describes containment as necessary in order for frustration to be tolerated, a necessary condition for learning to take place. Bion used the word learning in a relational sense, meaning the mating of a preconception with a realisation, where what was expected of someone is confronted with the way things are, creating a lightbulb moment (Bion, 1993: 113–114). The group members need to feel safe enough for therapists to bring their work and not so anxious that they are unable to take in what is being reflec­ ted back. It also needs to be a place where members can be helped to think from alternative perspectives, and this can be challenging. The supervisor models this in their interventions, and it can be helpful to encourage two-way feedback between the person presenting their work and the other therapists in the supervision group. Time allocation in group supervision will be shaped by, firstly, the number of members of the group and the time available. There should, however, be a fair distribution of time allocated to each member. Therapists will have dif­ fering needs to be fulfilled by their supervision and will also have differing skills to contribute. For the supervisor, this involves appreciating the differing strengths and life experiences of each group member, just as the good enough mother does with her children. One of the supervisor’s responsibilities for the internal dynamic administration of the group is to ensure that group supervision does not become therapy. Sometimes, this can require a fine judgement to be made: for example, a therapist who has been recently bereaved and who is not receiving their own personal therapy may need some time to talk about the impact it is having on them and their work. Others may, at times, contribute their own similar experiences. This is a part of the supportive function of group supervision. It should not, however, be taking over the whole of the time. The supervisor can help the therapists in their supervision group to think about alternative avenues of support when there is need. In group analysis, as in all analytic work, much of the focus will be on working with countertransference and parallel process, because change in the therapist, particularly at an unconscious level, is needed in order to change the course of the therapy. The supervisor is mindful that the conversation in the supervision group is the vehicle for translating what is unconscious into consciousness in order to unblock work that is stuck. At the same time, the group conversation needs to avoid supervision becoming therapy. Foulkes held the view that working with the supervisee’s countertransference was necessary, but that it should be circumscribed. Therapists’ countertransference

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should only be addressed because it is impeding their work with their therapy group or their supervision group (Foulkes, 1964: 251). Supervision group culture Supervision groups have their own culture, and their engagement shapes the group experience as they use the supervisory space for exploration of their responses to the therapy work. Winnicott described the move that the infant needs to make in order to use the ‘cultural space’ as the move from object relating through use of the projective processes to object usage. This involves aggression towards the object, and the person receiving this aggression needs to be robust enough to withstand this. In childhood, it is under these condi­ tions that the infant can give up their sense of omnipotent control and treat their caregiver as a separate person in their outside world (Winnicott, 1982: 101–102). This cultural space is located in the potential space between the individual and the environment (originally the object). The same can be said of playing. (Winnicott, 1982: 118; original italics) This is equally true at times in supervision, especially for trainees, who need to move through four stages to become competent, and this includes recog­ nising and tolerating areas of unconscious incompetence. The ‘good enough’ supervisor of groups provides a holding environment where the group can be genuine and honest and engage in serious and creative play revealing personal associations and experiences, phantasies and dreams. These are pooled with those of others and allow what was unconscious into consciousness. Change in the matrix of the supervision group affects everyone. As therapists change, they take this back to the matrix of their therapy group. Something of that change is introduced into the therapy group dynamic and changes the conversation. It is in this way that changes in one matrix that overlaps with others thereby have the potential to change those too. An addi­ tional benefit inherent in the process is that it is not only the therapist who presented their work who learns and changes from their experience. Therapists also learn vicariously from witnessing the learning of others. When things go well, members of the supervision group, with their differing backgrounds and experiences, can bring additional richness to the group. In the group situation, the supervisor needs to foster a climate of mutual respect through modelling supportive and respectful behaviour and managing any scapegoating or sibling rivalry effectively. When the supervisor pays close attention to their dynamic administrative responsibilities, and the supervision group feels safe enough, differences voiced by supervision group members can enrich rather than impede reflection on a broad range of learning. In responding to others’ work, supervisees will at different times share resonance

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(their own emotional responses) and recognise their countertransference responses (their over- or under-reaction to the material in their therapeutic work) unique to them. One may have a strong intellectual side and good grasp of theory, while another has greater capacity to translate counter­ transference feelings into imagery, and a third may be the group memory. Each can contribute their perspective to create greater insight. Berman and Berger suggest that the necessary conditions for using the transi­ tional space in supervision effectively require the supervisees to abstain from asking questions and from supporting or criticising the presenter. Instead, they advise: Pay attention to your inner world, to your sensations, feelings, fantasies, memories and thoughts. Take your time when listening to the presenter and vice versa. Later on, please share with us, something that occurs to you while listening. (Berman and Berger, 2007: 244) The following vignette illustrates the way the supervisor of groups uses her role on the supervision boundary to facilitate this free-floating communication. Vignette 3: The grim reaper Alex, the therapist, was struggling with Bee, a young patient with recent onset depression. Alex described their patient’s distress as clearly visible, but wordless. When Alex had given his account, the group said very little in response. The supervisor wondered if the group were in touch with their own sense of Bee’s wordless depression. She invited them to free-associate. The supervision group slowly began to voice feelings of deadness. One member commented, ‘We’ve become paralysed by this patient’s death anxiety!’ At this point, another member said, ‘yes, the last time I was in tune with feelings like this myself, was the day I had a diagnosis for a terminal illness and I thought I was going to die! My mind went totally numb’. Alex then mentioned for the first time in the supervision group that he was still mourning the loss of a close family member. The supervision group turned their attention to him and were very supportive. The group were then able to help Alex to see that his own recent bereavement had pre­ vented him from being in touch with Bee’s voiceless distress. Having acknowledged his own grief, he said he felt more able to explore his patient Bee’s distress.

In this vignette, the supervisor’s intervention focused the members of the supervision group on their feelings, and this unblocked the flow of commu­ nication in the group. In the shared transitional space of the supervision group, members got in touch with their own painful feelings and put them into words. Foulkes called this translation because it translated something that he had not been aware of into words that could be thought about. Once Alex had expressed his own grief, he was able to use feeling to help in his work with Bee.

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Boundary challenges affecting group supervision It is not always possible to have the ideal balance of gender, age, ethnicity, experience and similarity of work in a supervision group. In group analytic therapy groups, this would be regarded as creating a ‘suboptimal group’ (Zelaskowski, 1998: 492). However, Zelaskowski found that, as long as he worked within his groups’ limitations, they were still effective. The supervisor of groups will be responsible for holding the limitations of the supervision group mix in mind as part of the task of managing the internal boundaries of the supervision group. Gender balance and group supervision When gender issues emerge within the therapeutic work, the supervisor will ideally be alert to the way this will affect the supervision group conversation. Vignette 4: The ‘odd man out’ Ingo, a male therapist, brought a new client, Seb, aged 36, whose presenting problem was his relationship breakdown following his partner Esme’s hyster­ ectomy. They had two lovely children and had no plans for more. Seb had always believed that he and Esme had been close until her operation. He was hurt and felt rejected because Esme had been increasingly irritable with him, not wanting him near her and frequently telling him that he wouldn’t under­ stand how she felt. In the supervision group, there was animated discussion between the three older female supervisees about the challenges for women of gynaecological problems and the menopause, each bringing relevant personal experience to bear on how it might affect this couple’s sexual relationship. The supervisor asked Ingo how he was feeling about the feedback, and he said he had felt the odd man out. This refocused the supervision group conversation. The women in the group were able to acknowledge their part in leaving their male colleague out in the cold. They recognised how unhelpful they had been, enjoying their sense of superiority in having expertise about ‘women’s issues’ that had excluded him. This allowed Ingo to acknowledge his part in allowing the women in the supervision group to marginalise him rather than using his sense of potency to find his way into the conversation. This in turn allowed him to think with Seb about his feeling of impotence in the face of a powerful gang of women who were still ‘helpfully’ surrounding Esme but leaving him out in the cold.

Change often takes place when the supervision group members can think about dynamics from the therapy that have been mirrored in the supervision group conversation, the parallel process. This is bringing together the verbal, the reflective and the emotional experience of the supervision group in the interest of the therapy under consideration. It also illustrates the importance of the container being contained. In this example, it was the supervisor who

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was holding the gender balance of the supervision group in mind. She took on the role of the father who helped Ingo, the male therapist, to find his voice in the supervision group. This was a learning experience for each member of the supervision group. The women were able to own their part in the mar­ ginalisation of their male colleague, and he was able to reflect on his sense of potency. In this example, this was enough to create change in the therapy and to refocus their work in a constructive way.

Supervision of trainees One of the aspects of the supervisory work is the supervisor’s use of their authority. The word authority is a term used in psychoanalytic supervision and it is implicit in the supervisor’s role as dynamic administrator. It is in supervising trainees that supervisors confront some of the most challenging supervisory boundary management issues, requiring the use of their authority. Supervisors may also need to take a more active role in the key tasks of supervision when they are supervising a student group. They will need to offer support to anxious students who are seeing their first clients; they need to educate students both about how best to use the supervision group and also, through helping them, about how to apply their theoretical learning to their practice. Most daunting of all for the students is the supervisor’s role of assessment of their potential as future therapists. There can be a tension between this role and the creation of the safe space needed for the student group to participate in the shared serious play involved in supervision. Just as, according to Winnicott, ‘psychotherapy is done in the overlap of the two play areas, that of the patient and that of the analyst’ (Winnicott, 1971: 54), the work of supervision is done through the supervision group’s ability and will­ ingness to engage in play areas of the therapy and the supervision. Super­ visors themselves do well to have their own consultative support in order to help them contain the high levels of anxiety which can be generated in supervision groups of trainees—including, at times, their own. Students invest a huge amount in their training, both financially and emo­ tionally. From the trainee supervisee’s perspective, the supervisor is being asked to take decisions about their competence, and their feeling of vulner­ ability may be captured in the words of Yeats: I have spread my dreams under your feet;

Tread softly because you tread on my dreams!

(Yeats, 1964, 150)

Issues of power arise in all supervision groups, but nowhere more so than when students’ practice is being assessed by their supervisor who has the responsibility of making a decision about whether they pass or fail. This does not, however, mean that assessment should not take place. It is important to

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protect the public by ensuring that students meet minimum standards of competency. It also protects the student from working in an area for which they are unsuitable. In this context, the supervisor’s task of simultaneously containing the therapists’ anxiety in a way that allows them to think and learn while they are also assessing their competence is especially challenging. Sharpe describes a method of assessment that involves the whole supervision group, and it includes the students’ assessment of the supervisor. She notes that learning is a two-way process, and that the students can also help the supervisor learn (Sharpe and Blackwell, 1987: 207). This egalitarian approach gives everyone a voice, and this can be more containing.

Conclusion The supervisor has multiple boundaries to attend to in their supervisory work. Winnicott’s writing on the holding environment can be useful to the supervisor when managing the boundary between the supervision group and the external context in which it takes place. In this, their role may be seen as providing the maternal holding environment and, as far as possible, preventing and managing impingements from outside the group that may affect the ‘transitional space’ which allows for movement between internal and external reality. Bion’s writing on containment is useful when thinking about the internal boundaries. This is because they contain the therapist and create a space for reverie. This is needed to work with and translate unconscious processes and to bring them into consciousness. Once they are conscious, they can be named and thought about. One of the differences between group analytic therapy and group analytic supervision is that it is the group that undertakes the supervisory work, with the supervisor as conductor. This mirrors Foulkes’s approach to group analysis. Both the external and internal boundaries are important aspects of dynamic administration for the supervisor, whose task is to provide a transitional space where learning and change are focused on the therapist’s work. The concepts of holding and containing provide a theoretical perspective to help the supervisor in thinking about their task of dynamic administration in group supervision.

References Berman, A. and Berger, M. (2007) Special Section: Matrix and Reverie in Supervision Groups. Group Analysis 40 (2): 236–250. Bion, W.R. (1984) Learning from Experience. London: Karnac. Bion, W.R. (1993) Second Thoughts. Aberdeen: Karnac Books. Casement, P. (1985) On Learning from the Patient. London: Routledge. Evans, M. (2016) Making Room for Madness in Mental Health: The Psychoanalytic Understanding of Psychotic Communication. The Tavistock Clinic Series. London: Karnac.

112 A group analytic model of supervision Foulkes, S.H. (1964) Therapeutic Group Analysis. London: George Allen & Unwin. Foulkes, S.H. (1990) Selected Papers: Psychoanalysis and Group Analysis. London: Routledge. James, C. (1994) Holding and Containing in the Group and in Society. London and New York: Routledge. Noack, A. (2009) Using the Group as a Medium for Supervision. Supervision Review: The Journal of the British Association for Psychoanalytic and Psychodynamic Supervision (Groups) (Spring): 7–13. Schore, A.N. (2003) Affect Regulation and the Repair of the Self. New York and London: W.W. Norton. Sharpe, M. and Blackwell, D. (1987) Creative Supervision through Student Involve­ ment. Group Analysis 20 (3): 195–208. Winnicott, D. (1982) Playing and Reality. London: Penguin Books. Winnicott, D.W. (1971) Playing and Reality. London: Penguin Books. Winnicott, D.W. (1992) Aggression in Relation to Emotional Development. Through Paediatrics to Psycho-Analysis. Karnac Books and the Institute of Psycho-Analysis. Yeats, W.B. (1964) He Wishes for the Cloths of Heaven. In: R.T. O’Malley (ed.), Rhyme and Reason (1964 ed.). London: Chatto & Windus. Zelaskowski, P. (1998) The Sub-optimal Group. Group Analysis 31: 491–504.

Part V

Sustaining practice

Chapter 8

The supervisory alliance Creating sustaining relationships in group supervision

Introduction The chapter sets the scene by introducing attachment theory. The language of attachment provides a way of talking and thinking about the importance of the relationships that form in supervision. Terms such as ‘secure base’, and ‘working alliance’—the necessary condition for play—capture a sense of the importance of having a safe haven from which to explore some of the chal­ lenges of the therapeutic work. The relationship between the therapist and their client is a key ingredient affecting the outcome of the therapy. In a similar way, the term ‘supervisory alliance’ has been applied to the relation­ ship between therapist and supervisor. There is a growing body of research from dyadic psychotherapy and supervision suggesting that effective super­ vision depends on there being a good working relationship between the therapist and the supervisor—the supervisory alliance. Some of this evidence is presented here.

Attachment theory Attachment theory proposes that the child’s relationships with their early care­ givers play a key role in influencing their personality and their future relation­ ships. Infants need a secure base in order to play and explore their environment. This is significantly affected by how securely attached they feel to their caregivers. Parental responses to their child lead over time to the devel­ opment of patterns of attachment. The child comes to expect that the parent will behave towards them in the same way they have done previously. Over time, the child develops internal working models of how they expect others to treat them. Once established, these internal working models will shape their adult relationships. Internal working models operate largely outside conscious awareness and so, once established, they are not readily amenable to change. In adulthood, people who formed secure attachments in childhood feel more confident about, and are more able to enjoy, their relationships with others. People with preoccupied, insecure attachment styles are more likely to DOI: 10.4324/9781003375975-14

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be anxious and dependent on the approval of others. People who are dis­ missive of others or display avoidant attachment patterns often give the impression that they can manage without the help of others. They tend to suppress and hide their feelings and to deal with perceived criticism by with­ drawing. People with a fearful style of avoidant attachment long for emo­ tionally close relationships but find it difficult to trust others, fearing that they will be hurt. They also have a negative view of themselves, seeing themselves as not deserving of others’ attention. Feeney and Collins point out that it is not only children who need a secure attachment figure in order to feel safe enough to go off and explore, but that it is also true for adults (Feeney and Collins, 2004). Most therapists have had their own therapy, and those who were previously avoidant or preoccupied may have gained ‘earned attachment’ as a result. However, under stress, pre­ vious patterns can re-emerge, sometimes creating difficulties in previously stable relationships (Ainsworth et al., 1978). Therapists come to supervision for support from someone with whom they feel safe to explore some of the challenges in their work. For this, they need to find someone with whom they can form a good working relationship.

The ingredients of a positive working therapeutic alliance Research into the therapeutic alliance in psychotherapy suggests that thera­ pists who create a good working relationship with their clients regularly ask for feedback. They are particularly interested in what is not helpful. They also ask their clients for suggestions about what could be done to improve things. They then practise harder than their peers at improving their per­ formance (Miller, Hubble and Duncan, 2008: 32). Attention to the ther­ apeutic alliance was shown to be a key ingredient in creating effective therapy. Effective therapy is defined as clients’ self-reported increased selfesteem and an increased ability to function effectively in their day-to-day life. Along with this, the research indicated that there was a reduction in clients’ risk score and in how overwhelmed they felt by their day-to-day problems. Miller called the most effective therapists ‘supershrinks’. These therapists also consistently had far fewer dropouts than their colleagues (Miller et al., 2007: 20). This research suggests that a good therapeutic alli­ ance is a key ingredient underpinning clients’ capacity to change. Other therapists, who may be just as insightful and helpful in other ways but do not maintain this focus, have more dropouts and are less effective in helping their clients to change. Foster studied the attachment styles of counsellors and how these affected their ability to use supervision. He found that it was the supervisor–supervisee relationship, rather than the student’s general attachment style, that predicted the outcome of their development as counsellors. He also found that, while supervisors tended to rate their relationship with their supervisees as secure,

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their supervisees often rated their relationship as insecure (Foster, 2003: 99). This finding highlights the central importance of both the supervisor’s capa­ city to ask for regular, honest feedback from the therapists they are working with and the need for the supervisor to be willing to adapt to make the experience a better fit. Sharpe advocated a two-way feedback process when supervising trainees (Sharpe and Blackwell, 1987), allowing therapists and supervisors to learn from each other. Watkins’s research into therapists’ experience of supervision found that those who responded positively about their supervisory relationship were more likely to feel confident, satisfied and secure in their work with their clients. They were more willing to risk self-disclosure and they developed a wider range of skills. Supervisors who related to their supervisees in ways that complemented their supervisees’ interaction style, were perceived as more effective. These supervisors were more likely to address the issues of race and gender, were perceived as behaving ethically and were generous in offering appropriate self-disclosure, all of which were found to be nor­ malising, memorable, facilitative, helpful and to deepen the supervisory alliance. Helpful self-disclosure focused on personal reactions to their own or the supervisees’ client material. Less favourable ratings were also more likely when the supervisees experienced a high level of role conflict, role ambiguity and what Watkins recorded as negative supervision events (Watkins et al., 2016: 41). Ratings were less favourable too when super­ visees had an avoidant attachment style or were experiencing high levels of stress, exhaustion and burnout. A key ingredient for providing a positive experience of supervision was humility. Supervisors who were open and acknowledged and remedied their mistakes helped to maintain a positive working alliance. Watkins also noted that effective supervisors privileged the therapist’s experience of their relationship with their clients over their own. The benefits of behaving with humility mitigated the inherent power differentials in their relation­ ship (Watkins et al., 2016: 30–31). The literature on the rupture and repair process in supervision over the last 50 years studied the necessary condi­ tions for maintaining positive supervisory relationships over time. Firstly, the supervisor actively monitors for signs of breakdown in the relationship with their supervisees. Secondly, when there is a rupture, the effective super­ visor works to repair their relationship (Watkins et al., 2019: 281–282). The most important ingredient when addressing a rupture in supervision is the supervisor’s capacity to behave with humility (Watkins et al., 2016: 23). Watkins highlighted the need for further ongoing research into the alliance in supervision. He stresses the importance of the role of supervision, ‘the medium by which that teaching, transmission, and perpetuation process occurs’ in therapists’ development, particularly for students in training (Wat­ kins, 2014: 48).

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Attachment styles This next section looks at attachment style and its impact on supervisory relationships. The supervisor’s attachment style The supervisor will be the person who is in the most powerful position in supervision. Watkins and Riggs found that supervisors’ attachment styles significantly influence their perception of their supervisees. Supervisors who are able to form secure attachments generally enter into a supervisory rela­ tionship with more favourable, optimistic, positive and realistic expectations of their supervisees. Secure supervisors are more likely to promote the devel­ opment of a positive representation through ‘encouraging/affirming, stimu­ lating/motivating, and safety securing behaviours’ throughout the supervisory relationship (Watkins and Riggs, 2012: 280–281). More worryingly, Watkins and Riggs found that preoccupied, ambivalent supervisors enter new supervisory relationships with hopeful expectations. As supervision proceeds, however, their perceptions may become increas­ ingly coloured by ambivalence, and initially positive views of the supervisee can suddenly shift to disappointment and impatience. Alternatively, super­ visors prone to doubting their own competence are apt to engage in role reversal, eliciting caregiving and positive feedback from their supervisees. Avoidant-dismissing supervisors may view their supervisees with less favourable, more pessimistic, less positive, and more unrealistic expectations throughout (Watkins and Riggs, 2012: 271). The therapist’s attachment style Renfro-Michel and Sheperis found that the counsellor’s attachment style affec­ ted their perception of their supervisory experience. Securely attached counsel­ lors were more likely to view their supervisory experience positively. Counsellors who were more dismissing, fearful or preoccupied were more likely to rate their experience negatively They concluded that supervisors need to pay particular attention to building a positive working relationship with counsellors who are fearful, dismissing or preoccupied. They reminded supervisors that being careful about the way they phrase feedback and building counsellor selfefficacy are important at every stage of the counsellor’s development, regardless of attachment style (Renfro-Michel and Sheperis, 2009: 150–151). Discussion Supervisory self-disclosure can be normalising, memorable, facilitative and helpful and it can deepen the supervisory alliance. Helpful self-disclosure

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focused on personal reactions to their own or the supervisees’ patient material has been found to be appreciated (Clevinger, Albert and Raiche, 2019: 222). Supervisors can regularly ask for feedback about what the supervision group finds helpful and what less so. Where this is built in as a regular event and asked in a way that is humble, the supervisor can learn from their supervisees. It will also be important for supervisors to look after themselves, particularly by look­ ing for colleagues’ support in their own supervision for their supervision.

Attachment theory and group analysis Although there has not been as extensive research into the supervisory alli­ ance in group analysis as in other approaches, there have been an increasing number of papers written about this. Powell linked a positive working alliance with neuroscience research and the growing evidence that the right brain develops before language and connects with the world of feelings. He noted that, in adulthood, the left brain works to suppress much of this experience. He suggested that, in order to create a positive working alliance, the super­ visor needs to learn to tune back into their right brain (Powell, 1990: 232). Valbak suggested that one way of developing a positive working relationship with clients is to restrict the selection of clients the therapist works with to those where they can understand their problems and they can empathise with them (Valbak, 2018: 173). This is not always possible for therapists working in busy departments with long waiting lists. Under these circumstances, group supervision may be an ideal place to bring clients to whom they feel less attuned because others in the group may see them differently. Brunori, Mag­ nani and Raggi applied the concept of the therapeutic alliance to the training alliance between teacher and student in group psychotherapy training (Bru­ nori et al., 2007: 218). They found that a good working alliance between the teachers and the students conducting their groups had a positive impact on their therapeutic work. A positive supervisory alliance allowed for more expression of both negative and positive feelings in their therapy groups. Their findings also showed increased client self-efficacy. This was particularly significant with psychotic clients who normally find it difficult to develop selfefficacy in their relationships with others (Brunori et al., 2007: 231). Marrone recognised the benefit of using attachment theory as a tool for helping therapy groups to improve the quality of their relationships. He found that a group analytic group can explore, challenge and modify internal working models because these models can be seen in action in the conversa­ tions that emerge in the group. Once recognised, negative expectations of self and others can be challenged and, when this is done sensitively, they can change over time. This process can facilitate change and improve the quality of relationships. Marrone suggested that the therapist can provide four essential ingredients for facilitating change. Firstly, the therapist fosters group cohesiveness to provide a secure base for group members to explore their

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inner worlds. Secondly, they facilitate an exploration of relationships as they emerge in the group setting. Thirdly, the therapist encourages group members to explore the ways they interpret the behaviour of others in the group and the responses they expect from each other. Fourthly, they encourage group members to make links between their relationships now and the significant early relationships that may have shaped their internal working models (Marrone, 1994: 156–157).

Attachment theory and the supervisory setting In this section, Marrone’s four steps are offered as a model for supervisors of groups to use when thinking about the supervisory alliance and the develop­ ment and maintenance of good working relationships in their supervision groups. The supervisor needs, firstly, to create a positive working alliance in order to create a secure base. Secondly, the supervisor invites therapists to share their free associations to the supervisory material under discussion. Thirdly, the supervision group members hold a conversation about the ways they have interpreted what they have heard from each other. Fourthly, group members may sometimes share the personal links they make between their relationships now and the significant early relationships that may have shaped their internal working models. Each of these stages is now visited in turn. The positive working alliance in supervision groups Firstly, the supervisor of groups needs to build and maintain a space where the therapists in the group feel safe enough to talk about their work. When this goes well, they will establish positive working relationships and respond in ways that are respectful of others’ feelings, even when they are offering differing perspectives. This means both establishing positive working rela­ tionships with each therapist in their supervision group and encouraging the therapists in the group to respect each other’s contributions. While the central focus of supervision is on thinking about their therapeutic work, it is also important to be mindful of other events in their lives that may have an impact. For example, when someone is going through a divorce or a bereavement, the supervision group can offer support and understanding. Taking care of the caregivers is an important contribution that group super­ vision can make, the theme of Chapter 10. Creating this secure base begins at the group’s first meeting, with the initial contracting process where the boundaries are agreed between the supervisor and the supervision group members. This includes agreeing to address tensions and difficulties as they arise over time to prevent feelings from festering. They can also be addressed when the group members hold regular reviews about their work together. In a supervision group, where colleagues are hearing about difficulties in their work, this has the potential to elicit feelings of shame and anxiety.

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Bennett has suggested that, when people feel under pressure, even individuals with secure attachment patterns may become preoccupied (Bennett, 2008: 99). The work of a supervision group to create a secure base for a new member of the supervision group is illustrated in the vignette below. Vignette 1: Creating a secure base The supervisor, Mo, is a group analyst who works part-time in the NHS run­ ning groups and offering supervision within her service. She also runs a group privately. As a part of her private work, she is facilitating a supervision group for three students who are also training to run groups. The supervision group has three members, John, Janine and Aisle. Aisle had recently joined the supervision group and was just starting to assess people for her training group. She presented the first session with Eric, a man she was hoping would join her group. She went into great detail, checking out with the group whether she was presenting the assessment appropriately and seeking reassurance that Eric was someone who could benefit from joining a group. She seemed particularly anxious to receive reassurance from Mo, the supervisor. Mo could see from Aisle’s body language that she was feeling highly anxious. She recognised that the supervision group was not yet a secure enough base for Aisle. In order to help her feel less intimidated, she invited Janine and John to talk about their experience of presenting their first group assessment when they had begun to put their group together. They both talked about how anxious they had felt at the time. John also asked Aisle about whether her client, Eric, had been anxious. He confided in her that he had noticed that anxious clients still make him feel anxious. Before the focus moved on from Aisle, Mo asked her what had helped her most from the feedback. Aisle said it was her experience of being supported in supervision and John’s and Janine’s willingness to share their similar experi­ ences. She had also found it helpful to hear about how they had conducted their assessments. This had made her feel more comfortable about assessing two new people for her group the following week.

In this example, the supervisor initiated a shift of focus, turning the spotlight on the other two members in order to reduce Aisle’s anxiety. Both John and Janine were generous in sharing their first assessment experiences. This inter­ vention used exchange, creating a sense of them all being in the same boat. Diamond and Marrone quoted Bowlby as saying that, in supervision, when therapists are anxious, this will trigger attachment needs that may inhibit their participation (Diamond and Marrone, 2003: 14). The supervisor who monitors the emotional temperature of the group may recognise that a therapist’s response to feeling challenged leaves them feeling less securely attached. Supervisors who regularly ask for feedback about how the therapists in their supervision group heard what was said are more likely to identify potential ruptures. They can both model this behaviour and they can encourage the

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others in their group to do the same. Feedback does not need to be intended as negative in order for it to be experienced that way. Each person’s internal working model will be a lens through which what is said is filtered. Sharpe found that, in her experience, when the supervisor modelled openness, this encouraged students to do the same. It also led to supervision group members offering more mutual support and it increased engagement (Sharpe and Blackwell, 1987: 196). Exploring relationships between group members Marrone’s second task when working with attachment dynamics in group ana­ lysis is to facilitate an exploration of the group members’ relationships as they arise within the group setting. In group supervision, therapists use themselves as the instrument when giving feedback to colleagues. While the relationships between members are not the main focus of group supervision, good working relationships are needed in order to provide support and develop practice. Responses to the work presented will be interpreted through the internal working models of the supervision group members. They will also be heard through the lens of the therapist who presented the work. When this works well, different perspectives can provide a rich and fertile discussion. Lasky, writing about the therapist’s countertransference, used an analogy from music. He sug­ gested that ‘peoples’ personalities are like a harp, an instrument with dozens of strings, some of which stand for conflicts and some of which do not’ (Lasky, 2002: 15). When the instrument has a string missing, or a string is plucked that resonates with a conflict, this can block the therapy. The missing and faulty strings will also shape the account brought to the group for reflection. The account will impact emotionally on the other therapists in the group who may hear some strings differently. The task in group supervision is to help the thera­ pist tune in to strings that they did not hear and witness the reactions of other group members who may be less triggered by strings that cause them pain. Vignette 2: The earthquake dream This vignette is from the same supervision group as in Vignette 1. Janine was a final-year trainee and had been in the supervision group for the last 18 months. She asked for the group’s help in thinking about a disturbing dream brought by one of her group members. The dream was about being trapped in a building after an earthquake. Her client could hear other people nearby, some of whom were injured, and all of them were thirsty. What distressed her most was that, although she could hear people crying out, she could not reach them. Janine had encouraged her therapy group to work with this metaphor. She had made an interpretation that this was a group dream, capturing their feelings in the group of being trapped, injured and thirsty, knowing that she was nearby but

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that she was not able to reach them. The group denied this, saying that she was a wonderful therapist, and they all agreed how helpful the group was. Mo, the supervisor, invited Aisle and John to say what they were thinking. John thought it might be connected to the summer break. Aisle commented that Janine had been running the group for nearly three years now and she asked Janine when she was planning to close the group. Janine revealed for the first time that she had just started thinking about when she would end the group herself. She thought it was likely to be in around nine months’ time. John reminded Janine that four of the seven members had been there since the group started. The supervision group then linked the earthquake in the dream to the group’s anticipated earthquake of the group coming to an end. Janine was then able to think about when to tell the group the group would end. The supervision group also acknowledged that Janine would also be leaving the course soon, possibly even before she closed the group. Both John and Aisle expressed their sadness at the prospect of her leaving the group. Janine looked tearful and acknowledged that, as a daughter in a family that had moved around every year or so, she still found it hard to believe that people would miss her.

In this example, it was when the supervision group focused on their relationship with Janine that they helped her get in touch with an aspect of her internal working model that linked to her past. It was not overtly stated that this may have been why she had not made the connection with the dream brought to her therapy group. However, she was able to let her colleagues know that their sadness at the prospect of her leaving had helped her to voice her tendency to minimise the impact of her leaving on others. This raises the issue of how a supervision group can hold attachment issues in mind and addresses them without it turning into a therapy group. Internal working models in group supervision The third task of Marrone’s model is to explore the ways in which therapy group members interpret the reactions of the therapist and their peers to what is said to them. When this works well, it can feel very supportive; at other times, it can also be exposing and shaming. Sharing work may sometimes expose past attachment patterns that still feel raw. When feedback is given with openness, empathy, understanding and the sharing of similar difficulties, feedback is more likely to be perceived as helpful. This involves everyone in the supervision group behaving in ways that are humble and respectful. Vignette 3: A student under pressure, Part 1 John, a second-year student in the supervision group, was the last to present his therapy group. He began by saying that everything was going well. It was notice­ able that he talked quite generally about his group and seemed preoccupied. Janine

124 Sustaining practice asked him to tell them about who was there and what had happened in his last group. John checked his notes. He acknowledged that attendance in his group had not been good recently, but he explained that this was due to a high level of sickness and people taking holi­ days. The group’s focus had been around emotionally absent parents. Two group members shared their sadness that they had never really felt they had known, or been known by, their parents. John said that he had felt that they were doing good work on this as a group and that he had not felt the need to say much. Mo, the supervisor, asked Aisle and Janine about what was in their minds. Janine said she saw the way he’d presented today as more like he used to be in the group last year, when his group had just started and he was struggling to keep members in the group. She was aware that he was presenting a theory paper in the seminar later that day on dropouts in groups and she wondered if he was pre­ occupied with that. He acknowledged that he had been struggling to stay present in the supervision group and that his mind had been elsewhere, thinking about his presentation. Aisle said that the title of his paper sounded really interesting. Now, she had actively started putting her therapy group together, and it was due to start later in the month. She too was anxious about the prospect of people dropping out. Janine wondered what presenting the paper had done to jolt John’s con­ fidence. He said he had re-read some of the feedback he had received from the supervision group during the time he had struggled to hold new members. He had been particularly stirred up by feedback that he was coming across as distant. He confessed that he was envious of Janine’s ability to hold on to her group members, and that there were times when he felt quite inadequate. Janine reminded him of some of the ways he had moved on since she had first known him. She thought this was also reflected by the fact that he did now have a thriving group. She saw it as a compliment that his group was talking about people who weren’t available last week, rather than leaving, and she thought his group were attached enough to work through this.

This vignette describes the way stress and anxiety can reveal itself through the material that is presented in group supervision. As this was supervision, Janine did not offer an interpretation of John’s behaviour. She made a straightforward observation about what she had noticed. It was John who made links between his preoccupied behaviour and the trigger in the present. This touches on John’s internal working model. His response to Janine’s feedback was to acknowledge that he felt inadequate. Janine’s response was to provide support, underlining the positive changes he had made while he was on the course. Attachment dynamics in the supervision group Marrone’s fourth task in working with attachment issues in therapy groups is to help therapy group members make sense of their expectations of others through making links between their relationships now and their significant early relationships. In group analytic supervision, this takes place in a mod­ ified form because the primary task of supervision is not therapy. There are

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three ways that may lead to therapists reflecting on how their current reac­ tions have been influenced by their past relationships. Firstly, this may arise because of a blind spot caused by an emotional response in the present arising from a relationship in the past. A second reason for focusing on supervisory relationships arises when the supervision group itself becomes blocked. A third difficulty may require the supervision group to address sibling rivalry taking place between them. 1

In the first case, the task of the supervision group is to provide insight for the therapist about what is blocking their work. This is likely to be due to their countertransference, the emotional strings that have either been dulled or sound too loudly and affect their capacity to help their clients when they are stuck. While past issues may be identified and linked with the block, they are not the focus of the work. This is illustrated in the following vignette. Vignette 3: A student under pressure, Part 2 Mo asked John for feedback about where the supervision group feedback had left him. He acknowledged that Janine’s feedback had felt like a jolt at the time. He had been aware that he had been struggling to keep his mind on the task, but he hadn’t realised that this was so obvious to others. He said he appreciated Janine giving him the feedback even though it was hard to hear. He knows that he has a tendency to withdraw, like his father. He expressed the hope that presenting his paper on dropouts would help him revisit this painful area in a new way.

Mo’s question to John about where the group feedback had left him allowed him to do some working through, processing and reflecting on, and starting to digest, the experience. 2

3

The second reason to focus on relationships between supervision group members arises when the supervision group itself becomes blocked. This is often as a result of someone recognising that they are engaged in par­ allel process—that is, repeating ways of relating in the group that parallel those taking place in the therapy. Reflection on the therapists’ links between past experiences and the present can be a way of gaining insight into what is happening in the therapy. This is using the thoughts and feelings in the present to understand what is happening in the therapy. An example of this is described in the following example on sibling rivalry. There can also be times when what is being paralleled from the therapy is experienced as wounding by one or more of the supervision group mem­ bers. When this happens, it can lead to a rupture in relationships. A third reason for focusing on supervisory relationships arises in response to sibling rivalry. Gautier generously described an experience she had

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when she was providing group supervision on a supervision course. One of the trainees had taken offence at a supervision group member’s sug­ gestion that she might have felt angry with one of her clients for their poor attendance. She angrily denied this and behaved in ways that Gau­ tier felt were potentially shaming of the person who suggested this. What followed was a heated discussion between the supervision group members (Gautier, 2009: 5–6). This is an example of where relationships have broken down. A supervision group cannot work effectively when this happens. Under these circumstances, the supervisor is responsible for what Tsegos refers to as ‘closing the circle’ (Tsegos, 1995: 123). This involves temporarily suspending the supervisory focus on client work to concentrate on repairing the relationships within the supervision group. In Gautier’s example, the triggering incident was the suggestion that the therapist presenting a client with poor attendance might have been angry. The trainee’s response was to say ‘of course not, I would never feel anger towards any client, I may feel confused, but never angry’ (Gautier, 2009: 5). This example as Gautier describes it may not have been repairable. It is rare for a supervisor to write honestly about incidents such as these. Because of this, it is being used here to show how the use of attachment theory and group analytic technique in the supervision group might possibly have made a difference. Firstly, the supervisor could have invited others in the group to contribute their differing perspectives on how they had heard what was said. This would need to have happened before things became too heated and attachment behaviour was further fuelled. Under these circumstances, it might just have been possible for this trainee to have been soothed enough by the focus being turned to others for them to hear what was being said. With enough of an adjustment to their internal working model, they may even have heard the intention behind the question as being helpful. Using attachment theory can help supervisors who are aware of their underlying anxious, preoccupied, dismissive or preoccupied attachment styles to reflect on how these may affect their supervision group. When necessary, this can be done by using their own supervision of supervision to think about their part in supervisory difficulties as they arise.

Conclusion In their supervisory work, it is important for supervisors of groups to ask for regular feedback about how the group is experiencing them as a part of the regular review process. They need to take what is said on board, with humility, and encourage the therapists in their supervision group to do the same. Creat­ ing a positive working alliance between group members is a fundamental part of the supervisor’s task. This is needed for the therapists in the group to feel safe enough to reveal past links to blocks in their work as therapists.

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This chapter has looked at some of the benefits of holding attachment issues in mind in group supervision. Marrone’s model can be used to work with attachment dynamics in a modified way, provided this focus is serving the interest of clients. His approach has been adapted here to help the super­ visor of groups to work with their supervision group members’ internal working models because, when they are shared, they can contribute to the understanding of the supervision process.

References Ainsworth, M.D.S., Blehar, M.C., Waters, E. and Wall, S. (1978) Patterns of Attach­ ment: A Psychological Study of the Strange Situation. New York: Lawrence Erlbaum. Bennett, S. (2008) Attachment-Informed Supervision for Social Work Field Education. Clinical Social Work Journal 36 (1): 97–107. Brunori, L., Magnani, G. and Raggi, C. (2007) Special Section: Supervision between Rituals: Creativity and the Development of the Reflective Function. Group Analysis 40 (2): 216–235. Clevinger, K., Albert, E. and Raiche, E. (2019) Supervisor Self-disclosure: Super­ visees’ Perceptions of Positive Supervision Experiences. Training and Education in Professional Psychology 13 (3): 222–226. Diamond, N. and Marrone, M. (2003) Attachment and Intersubjectivity. London and Philadelphia: Whurr. Feeney, B. and Collins, N. (2004) Interpersonal Safe Haven and Secure Base Caregiving Processes in Adulthood. New York: Guilford Press. Foster, J. (2003) Attachment Behavior and Psychotherapy Supervision, thesis, UMI no. 3082649. Gautier, D. (2009) The Impact of Sibling Rivalry in Group Supervision. The Journal of the

British Association for Psychoanalytic and Psychodynamic Supervision (Spring): 5–7.

Lasky, R. (2002) Countertransference and the Analytic Instrument. Psychoanalytic

Psychology 19 (1): 65. Marrone, M (1994) Attachment Theory and Group Analysis. London and New York: Routledge. Miller, S.D., Hubble, M.A. and Duncan, B.L. (2007). Supershrinks: Learning from the Field’s Most Effective Practitioners. The Psychotherapy Networker 31 (6), 26–35, 56. Miller, S.D., Hubble, M.A. and Duncan, B.L. (2008) Supershrinks: What’s the Secret of Their Success? Psychotherapy in Australia 14 (4): 14–22. Powell, A. (1990) Words and Music: An Unsung Therapeutic Alliance. Group Analysis 23 (3): 225–235. Renfro-Michel, E. and Sheperis, C. (2009) The Relationship between Counseling Supervisee Attachment Orientation and Perceived Bond with Supervisor. The Clinical Supervisor 28 (2): 141–154. Sharpe, M. and Blackwell, D. (1987) Creative Supervision through Student Involvement. Group Analysis 20 (3): 195–208. Tsegos, Y. (1995) A Greek Model of Supervision: The Matrix as Supervisor—a Ver­ sion of Peer Supervision Developed at IGA (Athens). In The Third Eye: Supervision of Analytic Groups. London and New York: Routledge.

128 Sustaining practice Valbak, K. (2018) Preparing for Group Analytic Psychotherapy: Meeting the New Patient. Group Analysis 51 (2): 159–174. Watkins, C.E. (2014) The Supervisory Alliance: A Half Century of Theory, Practice, and Research in Critical Perspective. American Journal of Psychotherapy 68 (1): 19–55. Watkins, C.E., Hook, J.N., Ramaeker, J., et al. (2016) Repairing the Ruptured Supervisory Alliance: Humility as a Foundational Virtue in Clinical Supervision. The Clinical Supervisor 35 (1): 22–41. Watkins, E. and Riggs, S. (2012) Psychotherapy Supervision and Attachment Theory: Review, Reflections, and Recommendations. The Clinical Supervisor 31: 256–289. Watkins, J.C., Hook, J., Deblaere, C., et al. (2019) Humility, Ruptures, and Rupture Repair in Clinical Supervision: A Simple Conceptual Clarification and Extension. The Clinical Supervisor 38 (2): 281–300.

Chapter 9

‘To set the darkness echoing’1 The experience of the supervisee in the supervision group

Introduction This chapter describes a small qualitative research project exploring the existential experience of members of two supervision groups, both working dynamically. This was an opportunistic study which arose out of the supervisor’s sense that the process would enhance the work of supervision. Supervisees were asked to be active members in supervision groups, bringing their counter­ transference responses to their work so they could be expressed and explored and further understanding gained to promote safe and effective work. The title comes from Seamus Heaney’s poem, Personal Helicon (1966), from his poetry collection Death of a Naturalist. In the poem, he compares his childhood fascination with looking into wells with his adult experience of looking deep into himself to find inspiration for his poetry. ‘I rhyme/To see myself, to set the darkness echoing’ (Heaney, 1966). Sometimes he would catch a reflection of himself in the water at the bottom of a well. Group supervision asks the supervisees to look into themselves to understand them­ selves better in order to clear blocks which may be impeding the therapeutic relationship. The phrase ‘to set the darkness echoing’ is reminiscent of Foulkes’s concept of resonance (Foulkes, 1964: 179). Of supervision he wrote, ‘One has reactions of one’s own (to the client work) which one can only find out by thinking about oneself ’. It may be that a gain in self-understanding both makes sense of an impasse for the client work and also in some way frees the therapist (Foulkes, 1975: 259). Foulkes wrote about group supervision as a place where counter­ transference reactions can be put into words and explored to clear away any prejudgements by the therapist (Foulkes, 1964: 179). By looking together at what is presented, a clearer image or pattern emerges. As group members exchange perceptions (Foulkes, 1964: 34) and pool their associations, understanding of the work develops. The research sought to find out how the group supervision process was experienced. The supervision group members were asked to choose a work of art to describe their experience of their supervision group and put into words DOI: 10.4324/9781003375975-15

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their choice of image. The aim was to gain an understanding of both con­ scious and unconscious needs and motivations in supervision. From this, the supervisor hoped to learn more about her role and what was required of her. This could in turn contribute to the quality of the client work, as the super­ visees became more fluent in expressing their countertransference experiences, deepening their engagement and creating a richer experience for practitioner and client group. When the group is described as a mirror in which dynamics are reflected, one imagines a still, unrippled pool. In reality, a human group rarely provides this smooth surface in which the work can be mirrored. In asking the question, the supervisor was drawing attention to the group dynamics and encouraging observation of this. This was an attempt to find a baseline from which the changing emotional dynamic from the supervisee’s presented work could be calibrated and seen in its uniqueness. Where the supervisor’s ability to picture the patient fails her, her questions to the supervisee often begin. It is in the fluid ‘potential space’ between super­ visor and supervisee—that space of contained imagination and observation, understanding and confusion, objectivity and subjectivity—that meaning is forged through the act of creating and discovering the patient. (Jacobs, David and Meyer, 1995: 10) The project aimed to open this potential space.

The rationale for the research Supervisees come to a supervision group with expectations. It is useful to know whether what they are getting matches what they had pictured. Supervision is a formal working relationship and a process that comprises regular meetings for maintaining standards of good practice. The practitioner is required to seek appropriate support and guidance and learn how to work more effectively with clients. The supervisor ensures safe and competent practice through regular meetings that underpin and promote reflective and informed practice. The con­ tract for work will be transparent and make clear the mode of work and the assumptions that it embodies. The supervision seeks to ensure that individuals are meeting and maintaining these standards. It will underpin and support best practice in a way that is beneficial to both the practitioner and the service user.2 The supervisee’s active process and personal learning experience Supervision is an active process, designed to ensure efficacy for the work and safety for the client group, and makes demands on the supervisee. Supervisees have their own presuppositions, conscious or unconscious, about what they want, need and seek to find in the supervision group, both from other mem­ bers and from the supervisor. Their expectations derive consciously from their

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particular professional group, the nature of their training and their work set­ tings, and unconsciously from countertransference responses to the work and from their individual backgrounds and personalities. Supervision is a personal learning experience, requiring the counter­ transference to be shared. This could be shame-inducing, particularly in a group, and the supervision group will optimally develop an emotional climate that encourages sharing without shaming, where missteps can be explored, and an element of play allows a lively process. When the presentation of the client is repetitive and has little sense of growth, the supervisee may be asking for a left-brain solution (McGilchrist, 2009: 98), a model or technique, to find an answer for the client. A direct response from the supervisor may create dependency rather than development of the practitioner’s own perceptions and autonomy. Asking for an image or metaphor encouraged use of the right brain. The right brain, which develops before the left, is more in touch with relating to others, bringing in a more lively emotional response. The rationale for using images Art depends on what is symbolically expressed, not what is literally represented. (Kaplan, 2007: 137) The duty of the painter is to study nature in depth and use all his intel­ ligence, to put his feelings into his work so that it becomes comprehen­ sible to others. (Van Gogh, 1997: 252) The task of selecting an image engaged the supervisees in a different way. In 1962, Abraham Kaplan wrote in The New World of Philosophy that The response to a work of art cannot be a purely intellectual reconstruc­ tion, of a fixed context/content which the art imaginatively conveys … it must in some measure be a recreation of the artist’s achievement, of sharing with him the process of inspiration—a work of art speaks only to those who make it their own. (Kaplan, 2022: 153) By joining the research project, the supervisees were offering a personal crea­ tive response. For the writer, the seminal experience in the use of art images in super­ vision was membership in training of a mature supervision group facilitated by a group analyst where cultural references were part of the currency of the discussion. As well as being playful, she experienced this as deepening her understanding of her practice by providing a range of mirrors in which what

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she was trying to describe could be seen, extending the language of super­ vision by means of metaphor. The structure of the group analytic supervision session encourages fluidity in group discussion. Napolitani, in setting up peer supervision, asked members to use free-floating attention to attend to their inner world, to notice their sensations, feelings, fantasies, memories and thoughts (Napolitani, 1979: 52). These may be cultural: literary, from poetry, film, music or works of art. In the process of exchange or a chain of association, an image may illuminate an impasse, acces­ sing what is not available to conscious attention. Amplified by group discussion, this can help with meaning and understanding. ‘Mutative metaphors’ can facil­ itate communication and change in therapeutic work (Cox, 1987: xxviii). By selecting an image, the supervisees were offering a creative response. An image can resonate with both the conscious and unconscious mind and give insights into the undercurrents of the group dynamics of both the supervision group and the therapeutic group. It provides a ‘metaphor’, a conveyor of meaning or a way of connecting one thing with another. The image choices contributed to free association and added to the supervision group’s creativity and sense of play. Winnicott states that ‘psychoanalysis has been developed as a highly specialized form of playing in the service of communication with oneself and others’. Play promotes authenticity and the autonomy of the therapist (Winnicott, 1971: 145) and facilitates professional development, moving away from dependency on the supervisor as the therapist finds ways of looking at their own countertransference and identifying their own projec­ tions. This contributes to the group process: ‘playing facilitates growth and therefore health: playing leads into group relationships’ (Winnicott, 1971: 56). Foulkes encouraged non-verbal symptoms expressed by the body to be under­ stood by ‘an intricate sequence of steps leading to verbalisation’, a shift from ‘from primitive levels to articulate modes of conscious expression’ (Foulkes, 1964: 111). The images provided steps for the unspoken to find metaphorical expression. In exploring the images, the following does not look further into individual supervision group members but concentrates on what the images tell about the settings, the nature of the therapeutic work, how the supervision group reflects the dynamics of the work setting and the group’s expectations of the supervisor.

Method The supervisees were asked to choose an image of a painting or sculpture that reflected their experience of being a member of their particular supervision group. They were then asked to find words to explain their choice. The images accessed an unconscious, right-brain response; the words engaged the more verbal, left brain as well, bringing both sides of the mind into a conscious perception of what they were describing. The method encouraged communica­ tion in the group, with the members expressing what the supervision group was providing or not providing for them, and gave pointers to the supervisor for

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facilitating a secure base for supervision. Members were free to opt out of the exercise. When supervisees suggested further images or brought their own, these were welcomed as a spontaneous gesture and a sign of engagement. In one setting, the supervisor took in art books and a large collection of postcards with paintings of a wide range of subjects. In the second setting, the parent–infant therapists chose images for themselves and spoke the words or wrote a passage. Caveat: limitations of the research The images in the first setting were from the supervisor’s own collection. In the second setting, the supervisees made their own choice. The therapists were culturally aware. Owing to the power differential, the supervisor can be thought to have influenced the choices. The images captured a particular moment in the groups’ development. The supervisor is aware of the danger of projecting her own responses into the images. Although this is to some extent unavoidable, as artists aim to find expression of universal feelings and the social unconscious, she has aimed to keep this to a minimum. Theoretical understandings Group analytic theory, as well as concepts from attachment theory, object relations theory, attachment neuroscience and the concept of the primary task are used in the following. The supervisory primary task The supervisor’s role is to support the provision of safe, effective therapy for those who seek it. The research project looked at the needs and motivations of the supervisees using Lawrence’s concept of the primary task. He drew attention to the three aspects. The normative task is the formal or official task, putting into operation the broad aims of the organisation. The phenomenological primary task is the task that can be inferred from people’s behaviour and of which they may not be consciously aware. The existential primary task is the task which the people within the organisation—the practitioners, in this case—believe they are carrying out, and the meaning or interpretations they put on their roles and activities (Lawrence, 1977, cited in Roberts, 1994: 30). The research here seeks to focus on the existential experience of group supervision, the members’ felt subjective experience, how they understand their task and the meaning they give to it. The group members’ and super­ visor’s contribution to the emotional climate is inescapable and is worthy of examination. The research begins to explore this area.

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The supervision group as a secure base The supervisor, with the co-operation of the members, can co-create a base for secure attachment and a safe space to play with ideas and explore further thinking. Early attachment research shows that children with secure attach­ ment to caregivers were more able to form secure attachments, which under­ pin the development of sufficient self-esteem, emotional health and ego resilience, initiative and social competence, and concentration in play (Wallin, 2007: 23). When mothers and babies enjoyed each other’s company, there were good outcomes for the baby. These attachment patterns can persist into adulthood and support working relationships where the right conditions are available. A secure base can create a suitable emotional climate in which members can bring what is concerning them, to recover and return to explore with their clients. What could the supervisor learn about providing this? The two different settings of the supervision groups The supervision groups were in two different settings, facilitated by an external supervisor. The first was an adult community mental health orga­ nisation where a weekly supervision group supported weekly individual work provided by trainees and volunteers with counselling training. The second was a fortnightly supervision group for professional parent–infant therapists working with short-term, weekly groups of parents—usually mothers—and babies who met in community settings. The mother–infant dyads were referred by medical professionals and Children’s Centre workers who were concerned about difficulties in the development of a bond between the mother and infant. Both supervision groups changed slowly in size and membership over time.

Results from the community mental health setting The primary task of supervision: the normative and phenomenological primary task The primary task of the supervision group in this setting was to support safe and effective work for clients in this low-cost service. There was a continuous learning aspect as student and qualified counsellors worked with a small caseload who self-referred to address their anxiety, depression and relationship difficulties. The supervision group met weekly with, usually, three or four members. The phenomenological task, what was observable, was good attendance, a respectful approach to the client group and care of each other’s feelings. The counsellors had been unused to the request to describe their feeling responses in previous employment outside this field. Clients attended well for openended work and were presented regularly. The existential aspect—the beliefs,

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meanings and interpretations of their work, how it felt to work there with this client group—is explored in the images. The images give an impression of the therapists’ existential experience. Observing and making use of the reactive dynamic of the supervision group as a feature of the presentation of the material were largely absent. The images provided a way for this group to begin to observe the group dynamic and look for parallel process. Method used in the adult community setting A selection of art books and postcards were presented, with depictions of a wide range of subjects including landscapes, portraits and family groups, and the therapists were asked to choose one that matched their experience of the supervision group and find words to explain their choice. More than one choice was accepted. A selection of them are described below. The images from the adult community setting Pulteney Bridge seen from the Rivers Edge (2004), by William Belshazzar Rose (1961–; not illustrated): ‘calm’, ‘unrushed’, ‘space’. Figure 9.2, The Garden of the Asylum at Saint-Rémy (May 1889), by Vincent van Gogh (1853–90): ‘an oasis’, ‘tranquil’, ‘reassuring’, ‘a beautiful garden’. Figure 9.3, Dew-Drenched Furze (1889–90), by John Everett Millais (1829–96): ‘the group feels like a misty wood’, ‘we go from dimness to light’. Figure 9.4, Pinewood North West Gale (17 September 1945), by Michael Ayrton (1921–75): ‘tossing around ideas’. Figure 9.5, Nocturne in Black and Gold: The Falling Rocket (1875), by James McNeill Whistler (1834–1903): ‘points of light in darkness’. Discussion of how the images and words relate in the adult community setting In the image Pulteney Bridge seen from the Rivers Edge, Rose’s painting shows two figures relaxing in a quiet riverside place next to the river. Behind them, the sturdy bridge holds up the unseen city life. A path leads to steps up to the busy shopping street. The river is safely fenced off. The late summer sun and leafy shade give the impression of a safe, relaxing space. The words chosen were ‘calm’, ‘unrushed’ and ‘space’, meaning ‘space to think’.

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Figure 9.1 shows a painting of the same place, by Carol Miller, illustrating the structure of the bridge.

Figure 9.1 Pulteney Bridge (2022), by Carol Miller. Painting. Courtesy of the artist.

Figure 9.2 depicts a ‘tranquil’ place in the hospital that gave asylum to van Gogh during his illness in May 1889, where he produced some of his most famous paintings with their lively brush-strokes. The courtyard provides a protected space separate from surrounding distress— an ‘oasis’ of calm, like water in a dry place. The ‘beautiful garden’ shows the flourishing of May growth.

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Figure 9.2 The Garden of the Asylum at Saint-Rémy (May 1889), by Vincent van Gogh (1853–90). Painting, oil on canvas. Photographer: Peter Horree (2013).

Figure 9.3 shows Millais’s early morning painting, Dew-Drenched Furze, depicting a dazzling sun rise.

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Figure 9.3 Dew-Drenched Furze (1889–90), by John Everett Millais. Painting, oil on canvas. Photographer: Ian Dagnall (2020).

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The supervisee explained ‘the group feels like a misty wood’. There is no visible path, but uncertainty as the therapists stays with ‘not knowing’, as she accompanies her client in their journey of self-understanding. Their dynamic model encouraged the therapist to wait until the client made their own crea­ tive move (Winnicott, 1971: 116). ‘We go from dimness to light’, as the supervision group process casts light on the work she brings. The sketch Pinewood North West Gale (Figure 9.4) was chosen to show the group ‘tossing around ideas’ in the free discussion stage. Another member added ‘things move quickly’. Michael Ayrton’s sketch was penned just at the end of the Second World War, a time of change and uncertainty. A writer and sculptor, he had an interest in mythology, particularly in mazes and the Minotaur. The swaying trees and dark interior of the wood suggest unpredictability.

Figure 9.4 Pinewood North West Gale (17 September 1945), by Michael Ayrton (1921–75). Courtesy of Justine Hopkins and the Estate of Michael Ayrton, and the Ash­ molean Museum, Oxford.

Nocturne in Black and Gold: The Falling Rocket (Figure 9.5) was chosen to convey ‘points of light in darkness’ in the supervision process. New insights and understanding allow change in the therapist as well as the client and can feel ‘explosive’ as well as requiring ‘vulnerability’ in experien­ cing a new way of seeing things (Felman, 1991: 68).

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Figure 9.5 Nocturne in Black and Gold: The Falling Rocket (1875), by James McNeill Whistler (1834–1903). Painting, oil on panel. Photographer: ICP (2020).

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Common themes in the images from this setting Structure and containment The park by the river and the asylum garden suggest enclosed, protected spaces, made safe for supervision. The structure of the group, the of time and place, lower anxiety. Here, time has been allocated for each member so that the group can feel unrushed. The bridge crosses a river, and the riverbanks are engineered to prevent flooding, or the fear of over­ whelming feelings. Within the boundaried space of the asylum, the artist was able to work creatively and productively, ‘putting his feelings into his work’, so that others could understand him. The supervisee described his painting as showing an ‘oasis’, a place of refreshment and restoration, which was ‘tranquil’ and ‘reassuring’. These pictures suggest places of restoration. Nature and the outdoors: finding a way The images are set in the outdoor world, each with trees, giving shade by the river, growing in the asylum garden, as dark shadows in the Cre­ morne Gardens in Figure 9.5, a still presence in the misty morning light or as pine trees rocked by the north-west gale. Any people depicted seem small and secondary. The writer was reminded of the poet Dante who, sent into exile by his home city when 42, started to write The Divine Comedy with the words ‘In the middle of the journey of our life, I found myself in a dark wood, for the straight way was lost’ (from Dante’s Inferno, quoted in Hasse, 1990: 1). The clients at this agency were often people in midlife seeking a way forward, as were the therapists, finding a new pathway for themselves in their training. Each painting has a path­ way, except Dew-Drenched Furze, where the dawn light appears to sug­ gest one through the undergrowth. There are deep rivers and a stream, providing reflections. The rivers are contained in embankments, both held back from flooding, perhaps reminding the viewer of the depth and power of unrestrained water. Obscured vision Many of the images share a block to seeing clearly. Vision is obscured by mistiness, smoke, darkness, or the dazzling morning light. The therapist is in the position of ‘not knowing’. To extend this metaphor, they sometimes feel in the dark or not clear about their clients’ possible ways forward. Perhaps there is a fear of being ineffective, of not getting anywhere. Through the supervision group process they were ‘moving from dimness to light’; new thoughts are dawning providing ‘points of light in darkness’. New insights

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burst into view, like fireworks in the dark of the Nocturne, reflected in the river. The member may see something of themselves and what is slowing the therapy reflected in the group. Jane Abercrombie noticed that ‘free group discussion in group supervision raises students’ prejudices which can then be examined’ (Jane Abercrombie, quoted in Foulkes, 1964: 255). When the therapist works with their countertransference in the group, this can be an agent of change (Foulkes, 1964: 251). What was unconscious comes into view. Foulkes described the ‘explosive’ strength of group work when con­ nections are made (1964: 172). Fireworks require a safe framework from which to be set off or a cleared safe space where the audience can stand well back. Within established, secure relationships, ‘surprises’ (Schore, 2012: 204) can be more easily tolerated. Schore suggests that, in therapy, the ‘inter­ active regulation and resonance’ can release inhibition and generate energy, a shift out of dissociated states and a burst of feelings, allowing dormant parts of the person to ‘wake up’ and ‘become alive’ (Sands, 1995, quoted in Schore, 2012: 205). The secure base of the group provides a safe place for surprises as the therapist is challenged to explore new ways of thinking about her clients’ lives and perhaps, sometimes, her own. Summary of how the images relate to this setting Finding an image provided a step in learning to identify and name the reactive dynamic of the supervision group, the symbolism and resonance of the images revealing something of the dynamic process visible and translatable into language and thought. The images provided a playful path to a glimpse of how the work was impacting on the supervisees and a chance to notice and put into words their thoughts and feelings, furthering self-awareness. The images illustrated the sense of uncertainty, of ‘not knowing’ and how it feels to stay with their clients as they sought to find a way to a more fulfilling life. ‘Where there is trust and reliability … there is the possibility of potential space’, which, in this case, the adult ‘can fill with playing’ (Winnicott, 2005: 146). The supervision group, through free asso­ ciation and discussion, consistently found new ways to look at the material and allow the clients to find their own solutions. Vignette Sylvia (60 years) had retired to care for her husband with a deteriorating condition. She felt restricted, isolated and mildly depressed and couldn’t see a way out. In the mirror of the supervision group, it was hard to avoid a feeling of helplessness, but the group thought about her regularly, aiming not to pre-judge the hopelessness of her situation. As Sylvia’s relationship with her counsellor began to feel safer, she was able to reflect on her

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isolated and neglected childhood, with little chance to play, and she realised that her current situation mirrored her deprived childhood. As she became more able to reflect on her feelings and think about what she needed, Sylvia started to access the help available. She then surprised the supervision group by finding a welcoming weekly social group and she left having added a new dimension to her life.

Facing Sylvia’s painful situation, the supervision group mirrored her sense of helplessness. The inevitability of the group members’ own ageing and possible illness, including the supervisor’s, was difficult to think about and easy to put out of mind. Nevertheless, with the continuous holding of her counselling and the supervision space, she began to find her own ways forward.

Results from the parent–infant group setting The supervision group was made up of therapists from backgrounds in social work, psychology, nursing and art psychotherapy who had continued their professional training to work as parent–infant therapists. The primary task in this setting The supervision group supported the therapists in setting up and running parent–infant groups, usually attended by the mothers, who were referred by professionals who noticed a difficulty in bonding. The mothers came willingly as the groups had a reputation for helping them to communicate with their babies. The work was assessed for outcomes and showed that the mothers reported having benefitted. The therapists reported a visible improvement as the mothers and babies were seen to reconnect with each other. The referrers provided good outcome feedback. Mothers who needed more support could be referred on within the organisation. The supervision groups were largely well attended, with good timekeeping. The supervisor noted that the work was demanding and sometimes disturbing, as the babies were at a critical point in their development of a vital bond with their primary caregivers. Method used in the parent–infant group setting The supervisor extended the idea of conceptualising the supervision group to this second group. She asked the members to suggest an image which descri­ bed their experience of the supervision group. The members chose to offer the images directly as individual offerings, echoing the dyadic nature of the focus of the work.

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Images and words chosen in the parent–infant group work setting Houses + Lights + Sky (1912), by Luigi Russolo (1885–1947): the supervisee chose this to convey ‘dark feelings’ to be ‘illuminated by supervision’. ‘The white disc of light in the foreground is like the supervisor’ who is to ‘shine a light on the process of the group, its past and its future, to support the therapists in their work’. ‘The forward light is making sense of thoughts, feelings and emotions’ and providing a ‘beacon of hope, insight and a way forward’. The Young Family (2002–2003), by Patricia Piccinini (1965–): ‘the mother looks fed up with having to be always available’, ‘wonderful and sometimes disgusting’, ‘one rolling over is trying to entertain the mother’. The Dance (1909–10), by Henri Matisse (1869–1954): ‘flow, connectedness, fun, delight, pleasure, life’. A Rocking Chair (1950), by Henry Moore (1898–1986): ‘beauty, ordinariness, flexibility, creativity’, ‘secure holding while allowing flexibility of movement’, ‘the supervision group as a playful space’, ‘sometimes competition for space’, ‘being able to look at things from different angles’, ‘the mother’s moulding to the baby’. Mother and Child (2003), by Monika Celebi: ‘stillness, nurture and containment’. Discussion of the images and the choice of words in this setting Houses + Lights + Sky (Figure 9.6) is described as a Futurist painting. Lights penetrate the darkness as if driving out of a city. It was chosen to show the ‘dark feelings’ to be ‘illuminated by supervision’. Futurism, an early twen­ tieth-century art movement, sought to convey speed, power, energy and dynamism. It was self-proclaimed to be a ‘roaring motorcar which runs like a machine gun’ (Marinetti, 1909). The source of light and the beams of light contrast with the background; ‘the white disc of light in the foreground is like the supervisor’ who is to ‘shine a light on the process of the group, its past and its future, to support the therapists in their work’. ‘The forward light is making sense of thoughts, feelings and emotions’ and providing a ‘beacon of hope, insight and a path, way forward’. The supervisee emphasised the importance of her supervisor’s ‘faith in her potential’. As in some of the fol­ lowing images in this setting, there is reference to the physical presence of the supervisor, echoing the vital presence of the mother and the dyadic relation­ ships in the work groups. It picks up the excitement of the new, but not without anxiety. New babies bring excitement into the family and their own hyperarousal, for the parent to contain and calm.

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Figure 9.6 Houses + Lights + Sky (1912), by Luigi Russolo (1885–1947). Abstract painting. Photographer: ICP (2021).

In the The Young Family (Figure 9.7), the sculpture has a disturbing initial impact, both ‘wonderful’ and ‘disgusting’. It looks lifelike, but not recognisable. The sculptor used modern materials to replicate the textures of skin and hair. The artist’s intention was to show ‘a mother creature with her babies’ and to question animals being used for human organ harvesting. The image conveys ambivalent feelings relating to mothering, the unrelieved exhaustion of looking after a baby, having to be ‘always available’, the ‘wonder’ of the new baby and the demands of the task. Disgust in the countertransference may be picking up something disturbing in the material. The Dance (Figure 9.8) was chosen to represent the supervision group when it was going well: ‘flow, connectedness, fun, delight, pleasure, life’, describing the sense of the rewarding nature of working together and perhaps the fluency of the

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Figure 9.7 The Young Family (2002–2003), by Patricia Piccinini (1965–). Sculpture using synthetic materials and human hair. Courtesy of the artist and the Bendigo Art Gallery, Australia.

Figure 9.8 The Dance (1909–10), by Henri Matisse (1869–1954). Painting, oil on canvas. Photographer: Peter Horree (2012).

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free-floating discussion as members bring their own associations and identify the resonances of the work. The painting is admired for its fluency of movement, its sense of rhythm and its celebration of life. There is a sense of excitement, although, with closer attention, one figure may be losing her balance, perhaps represent­ ing the high arousal and sense of danger in the supervision group as members risk sharing with each other. This precariousness may also echo the therapists’ attention to the infants’ welfare and safety. The choice of A Rocking Chair (Figure 9.9) presented the ‘beauty, ordinariness, flexibility, creativity’ in the supervisee’s mother–infant work. She valued the multi­ ple perspectives of group supervision—the small statuette could be passed around and seen from different angles—but noticed the ‘competition for space’, a cause of

Figure 9.9 A Rocking Chair (1950), by Henry Moore (1898–1986). Bronze sculpture. Cour­ tesy of the Joe Kitchen and Henry Moore Foundation.

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ambivalence. She suggests that when this is contained by the supervisor the group can become a ‘playful space’. The supervision group can be seen as Winnicott’s transitional space, where play encourages creativity and autonomy. Free associa­ tion encourages playful spontaneity and authentic responses, as the therapist grows her sense of security in her role as a professional (Winnicott, 1971: 56). The super­ visee describes the mother as holding the child ‘securely’ while allowing ‘fluidity of movement’. She points to the moulding quality of bronze, as a mother seeks to mould to the needs of her child. This is a hint to the supervisor to adjust to the needs of each supervisee, the supervisory alliance. Schore draws attention to how a mother and the therapist learn the ‘non-verbal rhythmic structures of the clients’ internal states’, ‘flexibly and fluidly modifying (their) own behaviour to synchro­ nize’ and thereby ‘co-creating a growth facilitating context’ (Schore, 2012: 42). However, the pose of the mother in the statue conveys ambivalence about her role: her mouth is open in what could be a silent protest. Mother and Child (Figure 9.10) shows the mother and child in repose, safe in each other’s company, showing ‘stillness’, ‘nurture’ and ‘containment’. The containment allows reverie, as the supervision group members quietly mull over their work together. The cycle of supervision becomes restorative, allowing the group member to complete the process and feel refreshed,

Figure 9.10 Mother and Child (2003), by Monika Celebi. Painting. Courtesy of the artist.

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suggesting the restorative function of the supervision group resourcing and supporting the supervisee (Proctor, 2000: 7). Themes in common in the parent–infant setting The images contrasted with the adult setting. They register a different resonance in the material brought to supervision. In contrast to the obscured vision of many of the former images, these are highly coloured, bright and clear. Houses + Lights + Sky is the darkest, representing ‘dark feelings’, and implies speed, per­ haps the rapid changes of early motherhood, and may give a glimpse of the therapist’s rapid learning experience. There may be a hint to the supervisor to slow the pace in the supervision group so that no one gets tripped up. The Dance also suggests speed, excitement, perhaps hyperarousal. Although mother and baby groups can give vital support, they can be competitive, perhaps as a defence against the unthinkable fear of failing as mothers. This dynamic can be mirrored in the supervision group, and the supervisor may need to address the dynamic of sibling rivalry. That mothers may have ambivalent feelings towards their babies is acknowledged in the Rocking Chair bronze statuette and The Young Family, just as therapists may sometimes become weary of their demanding work. Proximity Other images are close-ups, homing in on the mother–child relationship expli­ citly. There is an emphasis on the body and a sense of the skin-to-skin intimacy and proximity of early mothering. There is contact and excitement in the dance, the fun and delight of mother–baby interactions and the contrasting stillness of the containing and nurturing mother. All mirror aspects of the work with mother–infant bonding. The mother–infant relationship is described as a dance as the pair respond to and mirror each other’s rhythms and synchronise their movements as they attune to each other. The non-verbal right brain develops first, and communication is non-verbal but bodily and empathic. Misattunement between mother and baby has been described as ‘mis-steps in the dance’ (Stern, 2018: 133). Recent research suggests that the baby is trying to understand and mould itself to the mother as much as the mother is to the child. The delight the mother and baby take in each other is shown in The Dance as the group aims to build up attachment relationships and mutual support. Nakedness, shame and exposure The nakedness may, by contrast, imply a sense of exposure, shame or access to disturbing feelings. The Rocking Chair (Figure 9.9) shows the mother’s cry, perhaps at not being able to settle the child, and The Young Family (Figure 9.7) shows the weariness of the exhausted mother, perhaps a source of shame. The images mirror the hyperarousal of the baby, which the mother seeks to

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regulate. The therapists sometimes offer a sense of containment for the mother, before she is able to provide it herself. As the mother becomes more able to calm her infant when he is over-excited or distressed, or to recover her child from flatness, gaze aversion and withdrawal, she forms a valuable bond, a safe attachment for the infant. From this secure base the growing infant becomes open to new experiences and can accept ‘safe surprises’ (Schore, 2012: 204). This prepares the child for interactions with others, to adjust to their environment and ultimately to learn to live in society. The language of movement The Rocking Chair shows rhythmic rocking, The Dance requires co-operation and shared rhythm, and, in The Young Family, the mother is watching one of the babies rolling playfully on its back—to attract its weary mother’s atten­ tion, the supervisee suggests. The parent–infant therapist has an acute awareness of bodily interactions; the baby has not yet developed the verbal capacity of the left brain, which is key to language. She watches for non­ verbal communication between the mother and child and is keenly attuned to rhythm and patterns of movement. A therapist is ‘gaining information about the patient from the bodily presentation, tone of voice, rhythm of speech, agitation or lethargy in presentation of material’ (Schore, 2012: 4; Keenan and Gorman, 2007). In the supervision group, the supervisee, resonating to her group’s material, may present something of the mother and baby by her own bodily posture and movements. As the vocabulary of movement is mir­ rored and reproduced in the supervision group, the group can understand more about what is happening in the working groups. Mirroring the parents, the supervision group members could arrive unset­ tled and leave calm and reflective. This mirrors how the mothers and babies could arrive flustered and anxious and need help to stow baby equipment and find their place in the circle of cushions. Members sometimes chose to sit on floor cushions around the supervisor’s feet, mirroring the groups and echoing the babies’ need for proximity in early secure attachment. Restoring the parent–infant bond The images of The Dance, the Rocking Chair bronze and The Young Family refer directly to the threatened mother–child bond and the therapists’ work to repair this. As parts of the supervisee’s self are challenged in the work, the supervision group provides a growth-facilitating environment where repressed feelings, dissociated aspects and ‘dead spots’ (Schore, 2012: 205) can come to back to life, a catharsis, where feelings are fully felt and expressed. As their communications are understood, the therapists can be revitalized in their work. This enlivenment frees the work to move on.

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Stillness The simple water-colour painting of the Mother and Child shows the ‘stillness, nurture and containment’ of a settled baby with its mother. Perhaps this represents a quiet, reflective phase in the supervision group, a reverie. Bion describes how the infant’s difficult feelings are taken in by the containing mother and given back in a palatable form. The group or supervisor is seen as a living container, like the mother who can experience the baby’s difficult feelings and reflect on them (Bion, 1993: 114–115). This reflective part of the process is now needed to fully understand what has been accessed. This image may show the process of the supervision group responding to the resonances of what is presented and making sense of them, sometimes described as a ‘collective group reverie’ (Berman and Berger, 2007: 241). Self-reflective function in this setting Foulkes points out how the group is sometimes seen as a mother (Foulkes 1964: 115) when primitive feelings are aroused. Parents who are able to reflect on their own childhoods are more able to provide a sense of security for their children. Beginning to notice the child’s communications helps the parents to begin to reflect on their own experience of being parented. In the same way, therapists use a self-reflective function and are able to reflect on their coun­ tertransference responses, and this contributes to their effectiveness. Thera­ pists may also reflect on their choice of this work and their valency to the work setting. Vignette Amara brought a young mother, Leila, and Noah to supervision. Leila was distressed by her baby Noah’s aversion to eye contact with her. As Amara described Leila, she noticed other supervision group members’ faces becoming serious, perhaps mirroring her own. Amara remembered her own mother’s taut face when she became anxious and how she sometimes caught her own ‘stony’ face in the mirror, when she was tired. Another member said, ‘Remember Noah isn’t depressed’, and the group relaxed and smiled. Amara remembered her mother’s warm smile and thought again about Leila. As Leila settled into the group, where others shared experiences of motherhood, she was able to reflect on her own experiences of being parented. Leila caught the eye of another baby and smiled. Her own baby, Noah, seeing Leila’s more relaxed expression, smiled too. As Noah found a less anxious response in other mothers, he was encouraged to look again into his mother’s face. As eye contact was refound, Leila and Noah’s communication was restored.

It can be hard to sustain empathy with strained mothers, but, by being reminded of still faces in the supervision group and remembering her own experience of

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this, Amara was able to lower her own anxiety about this mother and baby and show a warm, compassionate face to the anxious mother.

Common themes in both groups: theoretical perspectives Is the supervision group fulfilling its primary task? The phenomenological primary task is the task that can be inferred from people’s behaviour, of which they may not be consciously aware. The groups were seen to be valued, were well attended and were conscientiously used. Members were observed to become more confident in sharing their experi­ ences and joining in the process of supervision. This implied that they both respected and took appropriate responsibility for their clients and the therapy process. The groups were in increasing demand, with a low drop-out rate. The existential primary task, what the practitioners believed they were carrying out, is seen in the images. They imply that the adult group provided stability and structure within which to work and to find a way forward, both in the therapy and in their clients’ lives. In the parent–infant setting, the images focus on the mother–infant bond they were working to restore. The images illustrate the existential experience, how it felt to be a member of their group. Perhaps there was a sense of too rapid a pace of change, and rivalry for time and attention, but also an increasing sense of attachment to a secure base. The systems approach supervision model: formative, normative and restorative The systems approach supervision model, quoted by Proctor (2008: 7), points to the responsibilities of both supervisor and supervisee. The formative, learning tasks have been mentioned earlier in the illustrations of light; the normative here refers to ‘standards and ethics’, which need to be monitored both in the therapist themself and in their colleagues. Perhaps this appears in the images of paths and ways through. Formative themes The formative function, the learning and personal and professional development, is symbolized most clearly by the frequent references to light and darkness. Light is often used as a symbol of learning. In Houses + Lights + Sky, a supervisee pointed out the disc of light in the foreground as the ‘group supervisor’s role to shine a light’ on the process in the supervision group and provide a ‘beacon of hope, insight and a path, a way forward’ to ‘make sense of thoughts, feelings and emotions’ and to find a direction that supports the therapeutic work. There is a journey from ‘dimness to light’ and ‘points of light in darkness’, a ‘beacon’ and headlights on a road, a falling blazing firework. The dance of working together

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offers movement instead of impasse, ‘flow, connectedness, fun, delight, pleasure, life’. This is in contrast to obscured vision. The group’s free association frees up inflexible or predictable thinking. It amplifies an issue like a microscope, so it can be seen more clearly. Like play, it allows learning, and new revelations burst forth like fireworks. Curiosity is stimulated, ideas are ‘tossed around’, and new links and connections are made. The human pups are greedily feeding or playing. The lively growth of the trees suggests development. New understandings can emerge as ‘we go from dimness to light’. There can be a ‘dawning’ understanding. New insights condense like ‘points of light in darkness’. The restorative function of supervision The structure can be seen as restorative in supplying sufficient time and space, ‘calm, unrushed,’ the ‘tranquil’ garden. The mother provides ‘nurture’ and ‘stillness’. The formal structure and process could be seen as a well-learned dance, avoiding ‘rush’ and tripping. Learning the shape of the process, the steps and repetition can be both formative and restorative. The supervisor pays attention to the time boundaries, giving regularity and rhythm to a group with a pre-existing contracted timetable. The idea of the ‘proper time’ provides the opportunity to access unconscious responses (Bradbury, 2001). This facilitates a sense of stillness and reverie and time to reflect on the supervisees’ observations and responses to their work. The restorative function is seen in the stillness and sense of quiet reverie and reflection of the contented mother attuned to her baby in Figure 9.10. The opportunity to be listened to as opposed to being the listener is restorative in itself. As the therapist shares feelings aroused by the work, the speaker can feel accepted and acceptable. That this is reciprocal adds to the safety of the pro­ cess, within time boundaries. Perhaps this links to the rhythms of the rocking chair. Feeling safe enough to be a little playful is restorative. Being accepted as a whole person, with feelings as well as skills, helps the process of repair. Group members are learning continuously from each other, becoming pro­ fessionally more acute in their observations and more in touch with what in themselves may limit their work. As the groups listen to the music of the countertransference, its rhythm and beat, its different levels, members can become more self-aware of what sparks their particular feelings, what calls on their empathy and what trips them. Alongside is the conscious process of peers sharing experience and suggestions—for example, recounting a personal or cultural experience others may not have had. The structure and process allow the group to maintain each other’s balance, avoiding shaming and disorienting others and maintaining respect for each member’s contribution. Repeatedly listening to accounts of trauma, depression and anxiety can have an impact on therapists; uncomfortable feelings can be stirred up, and there is a possibility that these may cast a pall over other parts of the therapists’ lives.

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Protectively closing down empathy means becoming less open to what is being expressed. The restorative aspects of supervision can alleviate this. Schore sug­ gests that forming a right-brain-to-right-brain link extends the possibility of connection and can move the individual ‘from dissociation to re-enlivenment. There can be a burst of vitality and a sense of coming alive’ (Schore, 2012: 205). Forming good relationships with the supervisor and their fellow group members creates a secure base for the group. The therapist can feel freer to explore. The supervision group as a secure base As the group builds up trust, the members are more able to express ambivalence. Over time, the supervision group builds more secure and trusting relationships between members, and the group can become a secure base, a safe haven to come back to as they go out to explore the world of their patients and sustain practice. In infants, a secure base is invoked by a caregiver who provides ‘responsiveness, sensitivity, consistency, reliability, attunement’ and ‘the capacity to absorb pro­ test’ (Holmes, 2001: 9). Adults too need to talk through the frustrations of their work. A mature group can, like a therapy group, optimally provide a sense of acceptance and belonging, mutual nurture and support and create a basis for the ‘installation of hope’ (Lorentzen, 2014: 48). As the group members gain trust and understand each other, insights and understandings emerge with more fluidity. Building relationships as close colleagues adds the possibility of monitoring each other’s mental health and providing emotional support. Ambivalence towards the supervision group A feeling of ambivalence towards supervision is best expressed in the small statu­ ette, where the mother turns her face up in what may be a wail of frustration with her baby. There may be fear among the Houses + Lights + Sky. The interior of the Pinewood looks dark and dangerous. When ideas are ‘tossed around’, uncomfor­ table feelings can be stirred. The Dance looks exciting but may sweep you off your feet. In The Young Family, the mother creature’s face expresses exhaustion; she is ‘fed up’ with needing to be ‘always available’. Meanwhile, her lively youngsters appear to be getting the nurture they need. Was it the supervisor themself seen in the face of the weary mother creature, the anguished mother rocking her baby? Was the process they facilitated too fast? Was there sufficient containment? Mutual support As the group matures, the therapist can express herself more freely, be more spontaneous, test out ideas and insights with her peers and be more playful and creative. Free association can shed light on aspects of the work not yet fully understood, allowing the supervision group to tune into and sometimes recre­ ate the therapist’s unconscious experience. Seeing this mirrored in the group,

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the therapist can use her self-reflectiveness to make sense of what is happening in her relationships with patient and group.

Learning for the supervisor’s role The supervision group as a living container The images give clues as to what the supervision group members are looking for: what raises anxiety and therefore inhibits thinking, and what gives secure holding and the possibility of generating new thoughts. The choice of images suggests the importance of the supervision group as a container. In the adult group, which met consistently in an old building, three buildings emerge in the images, providing a safe haven, a boundar­ ied, protected space. The second group often suggests the mother’s body, something that can hold and yet be flexible. The secure base of the group attachments provides the unrushed space to think, an oasis of tranquillity and nurturing stillness. The containment includes the sequence of events which give everyone a fair share of the space. A dance can be described as a sequence of movements; in the past, one name for a dance was a ‘measure’, describing a clear, regular, rhythmic structure (McIntosh, 1964). Timing is key, and everyone must have learned the pattern of the dance, ‘got the measure of it’, the rhythm of it, the sequence of the dance. Trust in the supervisor to mind this process is impor­ tant, so that no one gets tripped up, and flow is possible. Reducing the possibilities of shame and exposure Shame is used by cultures to inhibit their members and echoes the toddler’s early experiences of learning to walk, when they feel vulnerable to criticism, humiliation and shame. A well-functioning supervision group seeks to develop a culture in which the sharing of difficult feelings is accepted and tolerated, allowing a continuous process of learning. Timing contributes to shame reduc­ tion in the reciprocal process of sharing. This facilitating of unrushed time and space to think is the supervisor’s responsibility. Supervisory alliance Ideally, the group supervisor has a chance to meet each group member indi­ vidually before the group starts, providing a chance for the supervisor to begin to understand their motivation for their work and setting up the supervisory alliance. The supervisee hopes to build a relationship where the supervisor can adjust a little to accommodate their needs. This understanding provides some protection against rivalry and competition in the group.

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The supervisor is responsible for allocating time and attention. The supervisor’s faith in the therapists’ work is important. Supervisees want to feel they can sometimes express ambivalence about the work, allowing a free expression of strong feelings, a catharsis that may add to the restorative experience of the group. Supervisory group alliance In the mother–infant setting, the supervisor may have a parental or grandparental presence, helping to contain the wash of feelings. The group, too, will continue, like a child, to teach the supervisee how best to supervise it. The group itself can provide something of what a mother provides to create secure attachment, this time within the supervisory alliance. Schore describes what a child—and perhaps, too, a therapist in supervision—needs: a ‘predictable, trustworthy, growth-facilitating emotional environment’ that allows a reduc­ tion in the ‘dissociative defence and vigilance’ and ‘raise[s] the stress response threshold’ (Schore, 2012: 203). The supervisees become more able to tolerate the flood of feelings coming from the work and feel more able to join in the dance and trust in the process, the flow of combined effort. Becoming attuned to each other provides the chance to make connections and further the client work. Optimally, they will develop a keen sense of each other’s well-being, able to monitor the impact of the work on themselves and each other.

Completing the process of the session Asking the presenting supervisee to make the final statement on what they have gained restores a sense of balance to the supervisee, The dance is completed, and they are helped back on to both feet; the way through the woods has been indicated. It returns personal control to the supervisee as they let the group know what they have gained. The asylum has a predictable routine, and the plants are flowering in due season. There is containment, predictability, process and pattern. The Mother and Child sketch celebrates a return to ‘stillness’.

A reflection on the use of imagery and cultural references in supervision Using images or objects is not new in supervision. Wakeman writes about ‘Building Imaginative Bridges’ (Wakeman, 2014: 109) when supervising work with children. In the research mentioned above, use was made of works of art specifically. If, as Kaplan suggests, as quoted earlier, the viewer’s response is in some way a recreation of the artist’s achievement, a sharing of the process of inspiration in making it their own, their engagement in the process can be seen to deepen their response and engage what is not yet available to the conscious mind. This creative engagement may help to integrate insight and, perhaps, to lessen resistance to supervision.

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The images in the project had the ability to ‘set the darkness echoing’. An image not only captures conscious resonances of the work and setting but hints at the unconscious reverberations of the supervision group as well as individual responses, what the supervisees are themselves bringing to the work. Sharing the images gave a glimpse of the impact on the therapists of working with their client group. In selecting an image, they are finding reso­ nances and feelings that have not yet been put into words and expressing them in a form which can be shared (Foulkes, 1975: 295). This expression of the unconscious mirroring opened the possibility of change in the supervisees and could change the course of their work.

Conclusion This chapter has explored the experience of the role of the supervisee. The images chosen by supervision group members provide a glimpse of how supervisees experience the groups and how they saw them working. They illustrate how the structure and boundaries of the group provide a frame within which a sense of professional and personal trust and secure attachment can be generated. By asking therapists to find a work of art, the project asked the members to reach into themselves to find a way of mirroring processes that may be pre­ conscious and bringing them into conscious awareness and to become more aware of their projections into their work and understandings of the group supervision process. It offered the chance to deepen, expand and integrate insight and perhaps to lessen resistance to supervision. The supervision group is a place for professional development, to explore countertransference feelings and reveal processes that may be blocking the therapy. The group becomes a place both for self-reflection and for more effective work. As the group builds secure attachments, the therapist can build trust that their work is acknowledged and recognised and can gain confidence in the value and quality of their work. The images offered a rare glimpse into the supervisees’ experience, with the possibility of improving the efficacy of the therapy and supervision offered. There is scope for more exploration in the area of the supervisees’ experience that will add to the developing literature on understanding the process of supervision.

Acknowledgement This chapter was first prepared as a paper for the Lisbon GAS Symposium ‘Art Meets Science: Exploring Challenges and Changes’ in 2014. I am grateful to the colleagues who have helped put together these thoughts.

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Notes 1 Quote from Seamus Heaney’s poem Personal Helicon (Heaney, 1966). 2 UKCP Supervision Statement (2018): www.psychotherapy.org.uk/ukcp-members/sta ndards-guidance-and-policies/

References Berman, A. and Berger, M. (2007) Matrix and Reverie in Supervision Groups. Group Analysis 40 (2): 236–250. Bion, W.R. (1993) Second Thoughts: Selected Papers on Psycho-Analysis. Maresfield Library. London: Karnac. Bradbury, S. (2001) Proper Time in the Matrix. Group Analysis 34 (2): 241–248. Cox, M. (1987) Mutative Metaphors in Psychotherapy. London and New York: Tavistock. Felman, S. (1991) Education and Crisis: Or the Vicissitudes of Teaching. American Imago (48): 13–74. Foulkes, S.H. (1964) Therapeutic Group Analysis. London: George Allen & Unwin. Foulkes, S.H. (1975) Group-Analytic Psychotherapy, Method and Principles. New York: Gordon & Breach. Hasse, H.S. (1990) In a Dark Wood Wandering (Trans. from Dutch by Edith Kaplan in 1989). London: Arrow Books. Heaney, S. (1966) Death of a Naturalist. London: Faber & Faber. Holmes, J. (2001) The Search for the Secure Base: Attachment Theory and Psychotherapy. Hove: Brunner Routledge. Jacobs, D., David, P. and Meyer, D. (1995) The Supervisory Encounter: A Guide for Teachers of Psychodynamic Psychotherapy and Psychoanalysis. New Have, CT: Yale University Press. Kaplan, A. (2022) The New World of Philosophy. New York: Vintage Books. Kaplan, B.A. (2007) Unwanted Beauty: Aesthetic Pleasure in Holocaust Representa­ tion. Chicago: University of Illinois Press. Keenan, J.P. and Gorman, J. (2007) The Causal Role of the Right Hemisphere in Selfawareness: It Is the Brain That Is Selective. Cortex 43 (8): 1074–1082. Lorentzen, S. (2014) Group Analytic Psychotherapy: Working with Affective, Anxiety and Personality Disorders. Oxford: Routledge. Marinetti, F.T. (1909) The Futurist Manifesto. Le Figaro 20: 39–44. McGilchrist, I. (2009) The Master and His Emissary: The Divided Brain and the Making of the Western World. Newhaven, CT: Yale University Press. McIntosh, E. (1964) The Concise Oxford Dictionary. London: Oxford University Press. Napolitani, F. (1979) Co-therapy by Alternate Conduction and Reciprocal Super­ vision. Group Analysis 12 (1): 52–55. Proctor, B. (2000) Group Supervision: A Guide to Creative Practice. Thousand Oaks, CA: Sage. Proctor, B. (2008) Group Supervision: A Guide to Creative Practice (2nd ed.). Los Angeles and London: Sage. Roberts, V.Z. (1994) The Organisation of Work. Oxford: Routledge. Schore, A.N. (2012) The Science of the Art of Psychotherapy. New York and London: Norton.

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Stern, D.N. (2018) The Interpersonal World of the Infant: A View from Psychoanalysis and Developmental Psychology. Oxford: Routledge. Van Gogh, V. (1997) The Letters of Vincent van Gogh. London: Penguin. Wakeman, C. (2014) Building Imaginative Bridges: Creating Art Supervision and Therapeutic Work with Children. London and Philadelphia: Jessica Kingsley. Wallin, D.J. (2007) Attachment in Psychotherapy. Guilford Press. Winnicott, D.W. (1971) Playing and Reality. London: Penguin Books. Winnicott, D.W. (2005) Playing and Reality. Abingdon: Routledge.

Chapter 10

Enough and to spare The function of supervision groups in supporting the psychological needs of staff working in demanding professions

There has long been debate as to what draws therapists into their profes­ sion. Lawton, in The Myth of Altruism (Lawton, 1982), wrote that workers were in fact meeting their own needs in offering to help others and implied that this could be to the disadvantage of clients. Altruism is defined in the Shorter Oxford English Dictionary as a ‘regard for others, as a principle of action; as opposed to egoism or selfishness’ (Little, 1959: 51). Lawton implied that those professionally engaged to help others were doing the exact opposite: fulfilling their own needs rather than those of their clients. This chapter suggests that, although therapists can be seen as ‘wounded healers’, in that their early experience in their family of origin did not give them the emotional support they needed, with sufficient professional backing they can provide something valuable. If they can learn to ask for the support they need by accessing their own therapy, training and super­ vision, they have something particular to offer. With sufficient training, CPD and adequate supervision, practitioners can flourish in their chosen profession of providing help to others. In 1991, Robin Skynner wrote, in response to Lawton, ‘Make Sure to Feed the Goose That Lays the Golden Eggs: A Discussion on the Myth of Altru­ ism’ (Skynner, 1991). He supervised groups of social workers, helping them to use their past experiences to the advantage of their professional work and at the same time, in so doing, helping them meet the needs they were expressing by joining the caring workforce. Through their unconscious needs being brought into conscious reflection, both they and their clients could have some of their needs met. Lawton warned that the agency the worker chose could become a place where the familiar dynamic of unmet needs was re-experienced, but with the worker, now an adult, having a greater sense of control. He drew attention to how the structure and processes were similar to, or mirrored in some way, the worker’s family of origin where those very needs were formed and the sense of deprivation acquired (Lawton, 1982). He suggested that the place and nature of the work were chosen unconsciously because of the psychological rela­ tionship required in that institution and its nature. DOI: 10.4324/9781003375975-16

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Vignette 1: The passing on of deprivation A counselling trainee brought to her therapy group her emotional deprivation as a child by parents who were often absent. Six weeks later she told them that, having established her first group of clients, she was proposing to leave them for an extended break. Her own therapy group pointed out that she was uncon­ sciously replicating her own experience and asking her group members to suffer what she had suffered. It was as if she was unconsciously saying to them, ‘This is what I had to suffer, so toughen up. That is what I had to do’. Rather than giving them an experience of secure attachment, she was asking them to adopt the same defences as herself. She was encouraged to take her plan for a break to supervision, where the best interests of her clients could be the focus.

Providing enough Skynner proposed, by way of contrast, that the therapist and the institution could work towards establishing a ‘Philosophy of plenty’ (Skynner, 1991: 156), accepting the premise that those in the helping professions tend to come from a background of deprivation and scarcity, a recognition hidden by the way helping organisations are structured. He encouraged the move­ ment from the ‘vicious cycle of deprivation’ to ‘the virtuous circle [sic] of mutual nurture’ (Skynner, 1991: 167). He called for staff well-being to be prioritised, with realistic workloads and training and supervision made accessible. He suggested that the commonalities between practitioners and their clients, when explored, can become a source of strength, freeing them from the need for repetitive re-enactment (Skynner, 1991). It can be satisfy­ ing to help someone. A sense of mutual satisfaction, he suggests, can ensure the therapy will work. The supervision group provides a setting in which the therapist can explore this. Karen Maroda emphasises the importance of this being a theme of supervision. ‘Working with therapists who understand their own counter­ transference repetitions and who are eager to explore them in their work makes for both a better therapeutic outcome and a better supervisory experi­ ence’ (Maroda, 2022: 7).

Who works as a therapist, and how are they best supported? Workers may seek an environment in which the particular skills learned as a child become useful, ‘specifically valued, an advantage rather than a handi­ cap’ (Skynner, 1991: 163). Adults who, as children, have learned the ability to wait, have patience, hesitate, pause for thought, reflect and not retaliate under provocation may have developed tact, resourcefulness or courage to enter places that others avoid. With therapy, they may have developed a sense of being good enough by their own reckoning to survive and gain perspective.

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Understanding your own story A secure child can, by the age of five, tell a coherent story about their lives. For adults too, the process of putting together a narrative helps the individual to make sense of themself. The story will change, as new pieces are put into the puzzle. Therapy and training add to the spiral of increasing self-knowl­ edge. ‘Accepting that our own motivations and needs play a major role in our professional identity and daily clinical work has the potential for changing the narrative in a profound way’ (Maroda, 2022: 9).

Early attachment and internal working models (IWMs) This chapter uses an attachment perspective. Jeremy Holmes describes John Bowlby’s idea of internal working models as ‘maps of the self and its relationship to others, constantly checked and updated in relationship to others. […] The constantly updated narrative is essential for creative living’ (Holmes, 2001: 72). These narratives change in the light of new experience, and therapy and supervision provide opportunities for this. If the IWM is of a secure family where the child’s feelings were attended to, they are more likely to have secure attachment. A key aspect of this, Holmes suggests, is that they can distinguish between themselves and others. Secure attachment allows therapists to step outside their feelings in relationship to the client and describe them. This facilitates finding ways of expressing their feelings about a client and the relationships they are forming, and what is blocking them, in the supervisory process. Each relationship is different and may also cast light on their own story (Holmes, 2001: 72). An anxiously attached person may not be able to do this. An ambivalently attached person may find it difficult to step back. An avoidant person, Holmes suggests, would cling to a stereotyped version of themselves: ‘Nobody is ever going to listen to me’. An anxious person may feel ‘threatened by the idea of a constantly updated narrative’ (Holmes, 2001: 72).

How can the supervision group support the supervisee? When a therapist has grown up in a family that failed to recognise their emotional needs or provide a chance to express them, a supervision group can become a secure base where recognition and expression of feelings can sup­ port their professional work. Holmes suggests that the sign of a secure attachment is the ability to protest. In a secure setting, the protest can be heard and taken seriously. ‘The capacity of the care giver to recognize and accept protest is as much a foundation of psychological health as the absence of major separation’ (Holmes, 1993: 6). Mature supervision groups where trust in other members has developed may allow the supervisee to articulate strong feelings that may not otherwise find a place for expression. These feelings may give vital clues.

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A well-trained and well-supported therapist can find a secure identity in their job role, and anxiety is raised when the role is not clear. There may be times when they feel anxious about a particular client, group or work situa­ tion and, in discussion with others, listening and reflecting, they can avoid withdrawal from what they find confusing, concerning or distressing and be able to think more clearly. In the following vignettes, this chapter gives examples of how a supervision group may be able to support members by providing a secure base, a place where difficulties can be expressed and listened to productively. Vignette 2: The therapist’s familiarity with her own story when shared in supervision frees an impasse in the work In a mature supervision group Jan presented her concerns about a therapy group member, Jamie, whom she had brought to her supervision group several times before. He didn’t seem to be making any progress, and she had begun to feel she and the group were failing him. Although in his mid-20s, he seemed to claim a child role in the group, and this mirrored his living situation as he had returned to live with his wider family. Although not being able to leave home is increas­ ingly common, his living situation seemed to symbolise his inability to move on. The youngest group member, he showed no signs of a change of attitude, taking responsibility or wanting to become more independent. Although he had aired in the therapy group his feelings of anger and helplessness at home and at his workplace, he seemed unable to move on emotionally or practically. The supervisor, Nick, asked for other members’ countertransference reac­ tions—how they were feeling about what Jan had brought. This gave permis­ sion for Meara to ask ‘Why is the group not challenging him?’ Ellie asked if Jan was protecting him in some way. She wondered if there was any resonance between Jan’s background and Jamie’s. Jan said she noticed that both she and the group member had grown up as the oldest child in single-parent families where the remaining parent had asked them to step up and be co-partner in bringing up the younger children. She felt sensitive to how a child can temporarily step up but know underneath how easily they could be cut down to size. Lack of attention to the oldest child’s emotional needs may make them vulnerable to criticism. Jamie spoke of the cutting remarks from his wider family, and Jan realised she felt protective of him in the group. Following this ses­ sion, Jan changed her behaviour subtly, and an older man gently challenged Jamie.

On subsequent reflection, Jan was not totally sure in what way she had changed her approach—perhaps it was her body language—but discussing her protec­ tiveness in the supervision group brought about change in her therapy group. In the above example, the supervision group challenged Jan’s approach with more robust but insightful suggestions. Jan, on reflection, wondered whether she had repressed her sense of anger at her own needs not being met as a child and this had led to her being passive. Her ability to reflect on her

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own story and see overlaps with her client’s let her become aware of her pro­ tective feelings, which inhibited the work of her therapy group. The super­ vision group, in a parallel process, had previously hesitated to challenge Jan. Here, the therapist’s own background not only gave her insight into her group member’s difficulties, but also led to an identification that, if unconscious, could inhibit the work. As the therapy group began to ask more of Jamie, Jan watched his progress and felt rewarded. Regarding her younger self with compassion extended what she could give in her work and made it more enriching and rewarding. Allan Schore suggests that a mutual regression in individual work, where therapist and client work together on what is restrict­ ing them, can be valuable. ‘The predictable, trustworthy, growth-facilitating emotional environment allows the patient, over time to reduce their dis­ sociative defence’ (Schore, 2012: 203). Jan’s secure attachment in her supervision group allowed her to bring this to her supervision group and think about being less passive. Research suggests that practitioners with an insecure attachment style find supervision more difficult until they are clear about what is being expected of them.

Insecure attachment in supervision Bennett’s research sought to find a link between a practitioner’s insecure attachment to a particular supervisor and their overall attachment style (Ben­ nett et al., 2008). Bennett looked at field supervisors in social work to find whether the general attachment status of trainee workers predicted their anxi­ ety around supervision. They found that their attachment style didn’t necessa­ rily predict outcomes, but was likely to be linked to a poor supervisory alliance. Students who were described as ‘secure’ were defined as having a high level of trust and being able to accept interpersonal comfort, with low anxiety in regard to the supervisory relationship and low fear of abandonment or rejection. These students were able to work on the bond with their supervisors and their working alliance. Insecure students needed clarity and information about the supervisory contract in order to form a good supervisory alliance (Bennett et al., 2008). The student and supervisor benefitted from time to clarify the goals and tasks of supervision and to nurture the supervisory bond. Similarly with the sustained support of the group supervisory alliance, the therapist can bring their feelings of protest to the group. In the following vignette, the pressure on a staff member from lack of resources threatens to interfere with communication within the organisation. Vignette 3: A supervision group supports a member with organisational change Fatima came to the supervision group angry with her third-sector organisation, which worked with refugees. The group was made up of group therapists working

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in different settings. Because of a rush of new referrals, the agency had withdrawn the possibility of group therapists seeing new groups for open-ended work. New protocols also discouraged any meeting of the therapists with clients prior to the first group meeting and, thereby, any chance of building a therapeutic alliance prior to the first session or selecting a group with a mixture of presentations. Fatima used the supervision group to protest about these radical changes. She told the group that she had fudged a request from her manager to meet up with her about implementing the changes, saying that she was too busy to meet her. The group roundly supported her, citing examples of how, in their own set­ tings, their professional training, expertise and judgement had been overridden and dismissed. Angela said she often wondered if management had forgotten what it was like to work in the organisation. Ahmed said that he had begun to feel constrained in his previous job, and this is what had led him to further training. Carol added that she had found previous reorganisations stressful, particularly if she had to implement them. There were strong feelings in the air, but, as the free group dialogue con­ tinued, the group entered a more reflective phase, and Fatima began to think how she could discuss the issues she felt so strongly about with her manager, who, she realised, might also be perplexed by the sudden demands on the organisation. After sharing her shock and frustrations in the group, she decided to go and see her manager and suggest that they offer to study the outcomes connected with groups run with and without assessments and also monitor the outcomes of short-term groups. At the following session, she was able to report a productive meeting with her manager, and, between them, they had con­ sidered the possibility of letting certain group members enter subsequent groups to continue their therapy while also seeding the next group with members who had some understanding of how the groups might work. The group noticed that she now used her manager’s first name.

Staying in relationship In the above, Fatima’s chance to express her reactions to changes was of value. Hearing fellow feelings from others, she felt understood, and this allowed her to think more reflectively. The trust and secure attachment to the other mem­ bers permitted this, along with the expression of ambivalent feelings, which can arise when working in an organisation. Fatima also heard from someone who had been in the position of her manager. This helped her to notice that she had projected her sense of helplessness on to the manager. Intolerable feelings can be projected on to the manager or organisation (Hirschhorn, 1988: 4). By being able to express strong feelings in the group, Fatima was able to regulate her feelings and find a way of expressing her concerns more effectively. She began to experience some shame at having blamed the manager. Now, she felt able to listen and retain her relationship with her manager. Personal material can interfere with the work, and sometimes it can be helpful to reflect on this in the supervision group. In the following, the supervisor, Mary, became aware of her own tendency to being the family

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peacemaker. Then, she could stand back and think about the impact of this on her work (Skynner, 1991). She began to notice her passivity may be slow­ ing the supervision group’s work. Vignette 4: Idealisation of the caring role Grace brought a client, Constanza, repeatedly to her supervision group in which Mary was the supervisor. Constanza had dropped out of work when challenged to learn new systems. Constanza’s husband had left after many arguments, taking the older children and leaving Constanza with their youngest son. Constanza told of her own neglected childhood as the youngest, overlooked child. Constanza emphasised her care of her son, walking him into school everyday hand in hand. As he grew older, the school began to tactfully query this, to Constanza’s annoyance. Grace listened to her with great care and kindness and, in supervision, repeatedly referred back to Constanza’s feeling abandoned by her mother at the school gate. Grace ‘stood by’ her client in the supervision sessions. Mary, the supervisor, began to wonder if Grace was overprotective. Constanza began to share how, at home, she would lose her temper and shout at her new partner and son. Grace continued to listen with patience to the small child in her client. The supervisor, Mary, noticed the work was going very slowly. On one occasion, she wondered aloud whether her own caution was having a delaying impact on Grace’s work with Constanza. This was denied. Then, one day, Grace said proudly that Constanza had offered to go in and help at the school. Mary surprised herself by losing her patience with Constanza. Grace was shocked. Mary felt ashamed; had she abandoned her role? Another member, Bill, suggested that this anger and impatience was part of the constellation the client was presenting. Winny said she, too, had long been impatient with this client. Bill added that he felt for Constanza’s son. ‘It is not cool to arrive at school hand in hand with your mother at his age.’ Had the group created, in a parallel process, the outburst of anger that Constanza expressed at home? The idealisation of the perfect mother, counsellor and supervisor was broken, something shifted, and shortly after this Constanza returned to work and accepted the more challenging job she had avoided at the start of her sessions.

The client was presenting herself as the idealised mother, the therapist as forever patient. There was a split between idealisation and shamefulness. Constanza wanted to give her child what she hadn’t had, not necessarily what the child himself needed. There was a sense of control and rigidity, rather than flexibility, spontaneity and creativity. Perhaps because the therapist was protecting the client, it was the supervisor who experienced the sense of shame that the client felt, fearing to fail as a mother and seeking to repair her sense of being a good mother. Maroda suggests that a move from empathy to an adult-to-adult approach later in the therapy may be more respectful and avoid infantilisation: ‘once an atmosphere of safety has been established it no longer needs to be the main focus of treatment’ (Maroda, 2022: 197).

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On reflection, Mary became aware of her desire to keep the peace in her family of origin, which perhaps inhibited her in challenging the therapist, who may have had a similar motivation, leading to passivity. Mary reflected that the therapist may be ambivalently attached to the client but could not articulate her negative feelings. Did this unconscious pattern mirror the therapist’s stance in supporting her client who couldn’t bear to be a robust mother, one who could leave her child at the school gate? With this in mind, what is needed to support the work? While maintaining clinical abstinence and keeping the needs of the client as the focus, how can the therapist retain their creativity, spontaneity and freedom to form ther­ apeutic relationships that are enlivening?

Work as reparation If the therapist is reliving early deprivations in their work, unconsciously trying to restore the parent, there is a danger of relying on the client’s pro­ gress as their reward. Splitting into idealised therapist and shutting away dif­ ficult feelings can make the therapist less effective. It is important to value what the therapist is giving in itself, and the supervision group can play a part in this. Writing about working in organisations, Hirschhorn emphasises that workers need to ‘understand the purpose of their work and can link the value they create to their wish to restore others symbolically by meeting the real needs of customers and clients’ (Hirschhorn, 1988: 229). The therapist can then experience the value of their work consciously. He stressed that the organisation best allows this to happen when it ‘does not deny the pain and injury of working with others’. This way, ‘people feel relatively whole and contain their propensity to scape-goat co-workers or clients’. The ‘work can act as a transitional object’ (Hirschhorn, 1988: 236), allowing a continuous cycle of reparation. He suggests that a reparative culture respects workers’ commitment, accepts occasional failure and provides containment for the pain of the difficulties of working with people.

Feeding the goose: sustaining practice The fairy story does not suggest that the goose that laid the golden eggs ate anything but normal goose food—grass, roots and so on. She needed no more than other geese. However, she did need as much as other geese. There may be a superstition that the therapist can keep going while others fall by the wayside. Of course, this is grandiose thinking. They need what others need.

Therapeutic abstinence and a flexible persona The therapist presents part of their personality to their clients, maintaining boundaries. Jung identified the concept of the persona, a word derived from

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ancient Greek theatrical masks. ‘It is the role we characteristically play, the face we put on, when relating to others’ (Stevens, 1990: 42). This abstinence is in the interests of the client. ‘Difficulty can … arise when one identifies with the persona, for this means sacrificing the rest of the personality and imposes a harmful degree of constraint on the realisation of one’s unutilised potential’ (Stevens, 1990: 42).

The supervisees’ care of themselves A high degree of self-sacrifice and constraint is not sustainable. It can be helpful for the supervision group to respect the need for therapists to nurture a life out­ side work. Finding ways of replenishing themselves as therapists is part of their commitment as they attend their supervision, nurturing different aspects of their life (Skovholt and Trotter-Mathison, 2016: 161). Finding complementary activ­ ities can nourish other aspects of their personalities, providing ‘balance’ to their working lives (Ross and Altmaier, 1996). Anne Holmes calls this ‘creative repair’ (Holmes, 2015: 95). A psychotherapist colleague working in a secondary school sustains her practice by spending time alone, developing her skill as a sculptor; a colleague who specialises in relationship counselling enjoys circle dance with its structure, form and co-operation. Others enjoy relinquishing responsibility and following another’s lead in a choir or orchestra, or finding their own voice in a small singing group. In a setting where you need to follow protocols, some find it restorative to protest and campaign for change.

The supervisory task There is an inevitable tension between the needs of the organisation, the inner needs of the supervisee and the limits of what can be achieved in training. When it is acknowledged that people choose their professions in part because of their inner needs, this provides a basis from which to work. The motivation from their own background experience can work well when the therapist feels their work is being appreciated, but can lead to difficulties during periods when their work is stalling or not recognised or acknowledged for its value. The supervisor needs to hold in mind the tasks of monitoring and sometimes challenging the supervisee while avoiding the potential for blame, shame and splitting. Gaining sufficient validation for their work builds a foundation from which the therapist can approach times when their work is stuck or not going well or is being questioned. The development of a secure base in the supervision group allows the supervisee to explore their countertransference feelings with a measure of confidence that they will not be actively blamed or shamed. In this way, they can permit themself to feel shame where appropriate and explore it in a way that becomes helpful to the client work. Accepting the shame can release new possibilities for exploration in supervision. Without this safety net, there could be a build-up of stress leading to projection on to the wider frame.

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Conclusion A mature supervision group can provide a secure base within which the therapists can share their countertransference reactions to their work, some­ times taking risks in making sense of these, and understand more about their own commitment to their work and its rewarding qualities. A commitment to finding nourishment for themselves in their wider lives contributes to sus­ taining their effectiveness. The therapist needs to value what they are offering to clients and sense that it is valued. Developing the supervision group as a secure base supports the supervisory process, in the best interests of the therapist and of their clients.

References Bennett, S., Mohr, J., Brintzenhofeszoc, K., et al. (2008) General and SupervisionSpecific Attachment Styles: Relations to Student Perceptions of Field Supervisors. Journal of Social Work Education 44: 75–94. Hirschhorn, L. (1988) The Workplace Within: The Psychodynamics of Organisational Life. Cambridge, MA: MIT Press. Holmes, A.C. (2015) The Role of the Creative Arts in Initial Ministerial Education. Holiness & Education 1: 89–98. Holmes, J. (1993) John Bowlby and Attachment Theory. Oxford: Routledge. Holmes, J. (2001) The Search for the Secure Base: Attachment Theory and Psychotherapy. Hove: Brunner Routledge. Lawton, H. (1982) The Myth of Altruism: A Psychohistory of Public Agency Social Work. The Journal of Psychohistory 9: 265–308. Little, W. (Ed.) (1959) The Shorter Oxford Dictionary. Oxford: Oxford Clarendon Press. Maroda, K. (2022) The Analyst’s Vulnerability: Impact on Theory and Practice. New York: Routledge. Ross, R.R. and Altmaier, E.M. (1996) Intervention in Occupational Stress: A Hand­ book of Counselling for Stress at Work. Sage. DOI:doi:1996-97118-000 Schore, A.N. (2012) The Science of the Art of Psychotherapy. New York and London: Norton. Skovholt, T.M. and Trotter-Mathison, M. (2016) The Resilient Practitioner: Burnout and Compassion Fatigue Prevention and Self-Care Strategies for the Helping Pro­ fessions. Oxford: Routledge. Skynner. R. (1991) Make Sure to Feed the Goose That Lays the Golden Eggs: A Dis­ cussion on the Myth of Altruism. In: J.R. Schlapobersky (ed.), Institutes and How to Survive Them—Mental Health Training and Consultation. London: Routledge. Stevens, A. (1990) On Jung. London: Routledge.

Part VI

Using the group as the medium for supervision

Chapter 11

Parallel process Processing role responsiveness in group supervision

Introduction The word ‘parallel’ is used to describe the resemblance and relationship between one object and another. Although parallels are similar, they never meet. Parallel process is used in psychoanalytic supervision to describe the similarities of events taking place in two different contexts. Something of the therapeutic relationship is reflected in the exchanges between the therapist and their supervisor or supervision group. This can come into focus when therapist and supervisor reflect on their conversation.

Review of parallel process in the psychoanalytic literature In Freud’s view, to be an effective analyst or supervisor, a person needed to have been analysed to the extent that they were fully aware of their defence mechanisms and were no longer likely to enact them. Therefore, Freud believed, experienced analysts were able to offer support to their supervisees from the position of a dispassionate teacher or mentor, unaffected by their countertransference. Searles challenged this prevailing view of the analyst as only a ‘dispassionate mentor’. He recognised that the supervisor’s personal responses to their super­ visory work have informational value. He argued that the supervisor’s transfer­ ence could reflect ‘processes at work currently in the relationship between patient and therapist … [that are] reflected in the relationship between therapist and supervisor’ (Searles, 1955: 135). This is using countertransference as an infor­ mational tool. Doehrman, in her paper about the impact of parallel process on students, recognised that parallel process can be a two-way process: prejudices from the supervisor can adversely affect the therapist’s client (Doehrman, 1976: 10). She was saying that supervisors too can enact powerful dynamics from the therapy and that there are potential dangers for the therapist and the client when these are not recognised. Caligor’s detailed case report illustrates Doehrman’s point. His peer super­ vision group helped him to recognise a parallel he was enacting in his DOI: 10.4324/9781003375975-18

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supervision group. They observed that he had become frustrated with the one of the two therapists in his supervision group in a similar way to that enacted by his supervisee in the therapy with his patient (Caligor, 1984: 26–27). Cali­ gor’s paper highlights the important role his peer supervision of the super­ vision group had in shedding light on the parallel process he was enacting in his supervisory work (Caligor, 1984: 12). Some researchers are sceptical about the validity of the concept of parallel process. Watkins’s definition of parallel process is that there is some shared identification between the parties, possibly because they share a similar con­ flict (Watkins, 2020: 50). He suggests that, ‘since our primary “evidence” for parallel process remains the clinical anecdote’, this is not real evidence (Wat­ kins, 2020: 40). Watkins is implying not that parallel process does not exist, but rather that many accounts of parallel process are anecdotal and, there­ fore, not verifiable. Others, such as Tracey, see parallel process in supervision as an important factor in the outcome of successful therapy. Tracey and colleagues assembled an expert panel to look at the impact of parallel process on the therapeutic outcome. Although the study was small, involving only 17 students, it found convincing evidence not only of the presence of parallel process, but also that it significantly affected the client change process (Tracey, Bludworth and Glidden-Tracey, 2012: 330–343). The results showed there was a definite pull for the trainee therapists to behave differently towards their supervisor depending on the patient they brought. Each enacted something different, depending on the specific client they were bringing. They noticed as well that this pull was reflected in the supervisor’s behaviour towards their trainee. They ‘would act somewhat like the therapists in the previous therapy sessions with those particular clients [although] … the behavior changes are more subtle and nuanced, a matter of degree only’ (Tracey, Bludworth et al., 2012: 339). Their research suggests that parallel process involves an enactment on the part of both the therapist and their supervisor. Each will have work to do in order to recognise what has happened and adapt their behaviour. Effective therapeutic outcomes were most likely when there was a positive supervisory alliance, the relationship between therapist and supervisor was more equal, and therapist and supervisor followed a similar pattern: 1

2 3

At first, the therapist presented their client in a way that reflected their relationship, but usually with behaviour reversed. (For example, a client who was dismissing towards their therapist would elicit dismissing beha­ viour by the therapist towards their supervisor). This pulled the supervisor to behave differently, but in a way that was less marked than that of their supervisee. As the supervision sessions progressed, the supervisor increasingly responded more in role with the therapist, offering new avenues of approach for the therapist to take with their client.

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The change in the conversation between the supervisor and the trainee led to a change in the trainee’s responses to their clients, modelling those from the supervision session. The more the supervisor was able to modify their behaviour over time, to avoid engaging in the parallel process, the better the outcome (Tracey, Bludworth et al., 2012: 340).

How broad a term is parallel process? Tracey and colleagues used the term parallel process in a ‘totalistic’ way (Tracey, Bludworth et al., 2012; Tracey, Glidden-Tracey and Bludworth, 2012). The term ‘totalistic’ describes the expansion of the meaning of the words parallel process to include both conscious and unconscious elements. Kernberg, writing about countertransference, distinguished between this inclusive, ‘totalistic’ meaning and the ‘classical’ meaning that included only those elements that are enacted unconsciously (Kernberg, 1965: 38). Tracey and colleagues are suggesting that the term parallel process can be used to encompass both conscious and unconscious aspects in the same way. They refer to this as taking an interpersonal view. In his 1976 paper on countertransference and role responsiveness, Sandler described the impact of the expectations patients have on their therapist: the role-relationship of the patient in analysis at any particular time consists of a role in which he casts himself, and a complementary role in which he casts the analyst at that particular time. The patient’s transference would thus represent an attempt by him to impose an interaction, an interrelationship (in the broadest sense of the word) between himself and the analyst. (Sandler, 1976: 43) When, as therapists, we exhibit defences that fit with those of our clients, we may not notice that we are being pulled into a complementary role, fitting in with a relationship that is familiar for our clients. To a certain extent, this is inevitable. When it becomes clear that the work is stuck, supervision can help to bring this role responsiveness to light. When changes in behaviour in the supervision are replicated in the therapeutic relationship, this can create change in the client. Summary Parallel process involves a relationship and takes place as a result of role responsiveness. There is some controversy about the use of the term parallel process, what it means and how widely it can be applied in supervision. This is because examples are often anecdotal, and further research is needed. However, the two papers by Tracey and colleagues provide a first step in

176 Using the group as the medium for supervision

demonstrating that parallel process takes place, and that when this is recog­ nised it can be used to aid client change. This change takes place when the supervisor is able to modify their behaviour with the therapist. When the therapist mirrors the supervisor’s change in their work with the client, the supervision provides a catalyst for change in the client. There has recently been a widening of the concept of parallel process to include both conscious and unconscious aspects.

Working with parallel process in group analysis Introduction This part of the chapter begins with a literature review of the terms mirroring and parallel process, focusing on their meaning and the way they are used. It offers a six-stage model for working with parallel process in group supervision and illustrates its use with vignettes that display some of the range and inten­ sity of the experience of working with parallel process in a supervision group. Mirroring and parallel process in the group analytic literature Mirroring and parallel process are two similar terms. Both are used to describe a projective process, but each has a slightly different focus. Mirroring Foulkes referred to mirroring as happening when one person in a group was able to observe behaviour in another person that either resonated for them or reflected a part of themselves that they wished to deny. He linked the term to personification, seeing attributes in others that reflect something in themselves (Foulkes, 1964: 27). Foulkes saw mirror reactions as responses to seeing dis­ owned parts of the self in the behaviour of others (Foulkes, 1964: 77). The term mirroring has also been used to describe what is happening between the therapists in group supervision. This is how Cohen used the word mirroring when referring to a student’s projections towards their therapy group: Another kind of mirroring that occurs in supervision is where the stu­ dent’s reporting of his or her training group more accurately mirrors the student’s own inner life than that of the group … and of course a stu­ dent’s personal difficulties may distort his presentation of the training group, or even be projected on to the training group, especially if the student is in a ‘stuck’ phase. (Cohen, 1995: 69)

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Mirroring is being used here to describe a projective process that is distorting their representation of the group. Although Cohen refers to this as happening to trainees, it is inevitable for us all that both past and current experiences shape our view of what is taking place in the present. This use of the term mirroring reflects the way that what is unconscious in one person’s inner world resonates with another and distorts what they hear. This is consistent with the way Foulkes used the term. Knowles used the term mirror to describe parallel process, something ori­ ginating in one arena being reflected in another. The therapeutic community where Knowles worked was an open system where the supervision group acted as a mirror for the community. This mirroring was reflected in each of the ‘circles of activity moving from small group, to large group, to community and back again in the course of a week’ (Knowles, 1995: 85–87). What hap­ pened in the therapeutic work created ripples affecting the groups around it in a two-way process. In the example she gave, Knowles focused on both what was happening in the supervision group and her countertransference. This allowed the groups to think about their feelings of listlessness and it led to insight about their failure to mourn. This is an example of ‘reflection on action’: seeing what is happening in the dynamics of the supervision group as potential information about the therapeutic situation (Scanlon, 2000: 228). Tsegos alerts us to the danger of what Zinkin refers to as malignant mir­ roring (Zinkin, 1983: 117). This is where conflicts are enacted in the dynamics of the supervision group. Tsegos recommended that, when the ‘senior obser­ ver’ sees conflict in the supervision group, they should ‘close the circle’ to think about the here-and-now of their supervision group relationships. In the Greek model, supervisees normally sit in a horseshoe configuration in front of a flip chart where notes are recorded by the presenter. When there is a diffi­ cult dynamic in the group, they literally pick up their chairs and move them to form a circle. This is in order to reflect on the here-and-now of the super­ vision group. Once the issue is resolved, they return to the horseshoe config­ uration (Tsegos, 1995: 123). Conflicts can often (but not always) be traced to parallel process. This is when conflicts from the therapy are enacted in the supervision group. This is not always the case though, as the example given by Gautier about conflict in Chapter 8 illustrates. Parallel process Parallel process is a two-way process. This is more like being in a dance where partners complement each other as they move, one partner taking the lead and the other following in a complementary way. Malcolm Pines defines parallel process as ‘the emergence in supervision of phenomena that parallel those in the treatment situation’ (Pines, 1995: 2). He thought that, while par­ allel process in individual supervision can feel a little artificial, examples drawn from supervision groups are ‘very convincing because the group

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situation itself acts as an amplifier, increasing the range and intensity of the supervisee’s response’ (Pines, 1995: 2). Although Foulkes didn’t use the term parallel process, he recognised it and described its negative impact on the supervision group. He suggested that it was less likely to impinge on the work when the group focused on the task, and it was more likely to happen when the supervision group members were relating more like those in a therapy group (Foulkes, 1964: 253–254). Sproul-Bolton gave a detailed description of parallel process in his group supervision, although he referred to it as mirroring. It is presented here in full because it describes very clearly the way that he worked with parallel process. He said: While I am listening to a supervisee, I am also watching the other supervisees in order to see if, in any way, the group is mirroring unconsciously what is unfolding in the narrative … much can be learned from this process. Equally important is my own reaction to what is going on. I monitor my own countertransference responses just as carefully as I observe the group. So often this is significant. The other day, I became bored in a supervision session. Normally this group is lively and holds my interest, but on this occasion people seemed distracted. Interaction between members of the group had died away. I caught myself wishing that the session would end. Now thor­ oughly aware of the situation, I asked members of the group what they were feeling at the moment. There was a pause and then the group began cautiously to admit to feelings of disconnection. Further exploration of this revealed the fact that the group under discussion had failed to acknowledge the anniversary of the leaving of a cher­ ished therapist. In fact, the group had never properly mourned this loss. The present therapist was then able to disclose feelings of con­ siderable hostility towards the other therapist, hitherto hidden. (Sproul-Bolton, 1995: 74) Sproul-Bolton’s description of the process accurately captures the way that what was unconscious in the therapy group was recognised in the supervision group by members paying attention to their emotional response to the thera­ pist’s account of their work. In a supervision group, what may be unconscious in one person may be conscious in another. Once something has been named, others can become aware of their block, including the supervisor, as long as they are not too overwhelmed by their countertransference response (Moss, 1995: 538–539). Recognising that parallel process has taken place can reduce the risk of amplifying something unhelpful with the danger that this could adversely affect the therapy. It can also lead to an outcome that is of benefit to the client.

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A six-stage model for working with parallel process in supervision groups The supervision group’s capacity to work with parallel process is dependent on the members having established good enough working relationships to allow for ‘critical’ self-reflection. This is most likely when members show respect, warmth and humility in their work with each other (see Chapter 8). This can help feedback to be given thoughtfully and received in a nondefensive way. It can be tempting to think that, once parallel process has been recognised, this is all that is needed. However, it needs working through in a similar way to that needed when working with countertransference. This is because par­ allel process arises because of similarities between the client and their thera­ pist in what is being defended against from earlier experiences. The example provided by Sproul-Bolton showed the way that boredom and listlessness in the supervision group were signs that mourning and hostility following the loss of a previous therapist were being avoided in the therapy group. In group supervision, it is the group members who recognise and work with parallel process. Although it is likely that this will be the supervisor when they are working with students, more experienced therapists also take on this role. There are a number of stages to work through when working with parallel process. This model has six stages. These stages include: 1 2 3 4 5 6

Encouraging each supervision group member to maintain an active ‘third ear’ tuned in to their own emotional pulls and pushes and to the group’s dynamics. Recognising that parallel process has taken place. Tolerating and containing uncomfortable feelings. Recovering emotional equilibrium. Reflectively processing the experience in the group in a non-defensive way. Ensuring that the supervisee who presented their work has been able to hear what has been said in a way that is helpful to their work.

The following explores each step in this process in more detail. Encouraging each supervision group member to maintain an active ‘third ear’ tuned in to their own emotional pulls and pushes and to the group’s dynamics Billow suggests that we keep what he calls ‘a “third ear” acutely attuned to “me”’ (Billow, 2011: 299). He notes that as therapists (and supervisors) we have limited knowledge of our own unconscious, and all the interventions we make are filtered through our own subjectivity. Supervision group members tune in to the group process while listening to how the account of work being given is affecting them.

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Recognising that parallel process has taken place In group supervision, parallel process will involve the group being pulled into behaving in ways that fit with one or both of the roles that were taking place in the therapy. This can be identified when group members recognise that they are feeling differently or being pulled into a reciprocal role. Scanlon called this ‘reflection in action’. This takes place when the group reflects on the conversation between the members of the group (Scanlon, 2000: 200). When the group conversation has been affected by parallel process, the members will be experiencing at first hand something of the flavour of what was happening in the therapy group that was not able to be thought about. Understanding what took place live in the supervision group can help in thinking about what was happening in the therapy group. Tolerating and containing uncomfortable feelings According to Kernberg, the therapist’s ability to recognise and reflect on their contribution to what is taking place in the therapy depends on their capacity to maintain concern—in particular, a willingness to engage in ongoing self-criticism on behalf of the patient, an unwillingness to accept impossible situations in a passive way and a continuous search for new ways of handling a prolonged crisis. It implies the active involvement of the therapist as opposed to narcissistic withdrawal. This active involvement includes accepting the ongoing need for consultation with and help from one’s colleagues (Kernberg, 1965: 38–39). Foulkes said something very similar about therapists and their capacity for concern for the patient. The therapist: can never emerge untouched as he goes through this process with his patients. At the same time, he must be free enough from personal pro­ blems not to be drawn into the emotional whirlpools of his patient. If occasionally this should threaten him, we can expect that he would take heed of fine and early signals, and take counter-measures. … These are problems of counter-transference. Its influence on the therapeutic group, quite particularly from unconscious sources, is hard to overestimate. (Foulkes, 1964: 179) Billow demonstrates this capacity to maintain concern in his description of the experience of receiving feedback about the impact that he had on the group’s dynamic. He says: In the group under discussion, I asked for help, and achieved insight, which inspired me to develop the thoughts in this article. And also, I received several jolts of pain; their effects linger. (Billow, 2011: 311)

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This experience of discomfort on gaining insight is not often referred to in the group analytic literature, but it is important that this is taken into account in group supervision where supervisees can feel exposed and shamed. Recovering emotional equilibrium Once parallel process has been named and it has entered into the therapist’s conscious awareness, it will need to be processed as a part of the recovery process. In group supervision, it is the group that has been pulled to behave differently. It will be group members who need to regain equilibrium. Therapists need to recover themselves first in order to continue thinking about their work. It can be easy to imagine that sharing insights automatically leads to change in the therapeutic work. Jacobs et al. note that, when the therapist’s self-awareness is deepened, this will have an impact on self-esteem, especially among students. He lists some of the negative effects on self-esteem that can arise as being regression, helplessness and other narcissistic imbalances. He notes the importance of maintaining a balance between deepening explora­ tion and undermining self-esteem (Jacobs, David and Meyer, 1995: 207). Reflectively processing the experience in the group in a non-defensive way Reflective processing involves understanding the way the material that led to the enactment of parallel process fits in with members’ own inner world and wishes. It means acknowledging their valency for fitting in to the relationship pattern in the way they did. It is through this process that the therapist changes. This needs to take place before the therapist is likely to notice the ways their client behaves with them that trigger them to fit in with them. Once this has been observed, and they are able to stand back before responding and think about how to respond differently, this can lead to change. Ensuring that the therapist who presented their work has been able to hear what has been said in a way that is helpful to their work It is helpful for the supervisor to invite the therapist who presented their work to give feedback about what they have heard before moving on. This is partly because, like Billow, insight can be experienced as a jolt of pain, and it may take time for them to recover from the experience. When feedback is given in a supervision group, the different perspectives provided can feel like a lot to digest. Giving feedback to the group involves the therapist putting into words their understanding of the exchanges, associations and interpretations as they heard them. The feedback also gives useful feedback to the other supervision group members about how they have been heard.

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Using parallel process in action in group supervision The following vignette, ‘The double bind’, illustrates the way the six stages help when working with parallel process in group supervision. The supervisor was Alex, and the therapists in the supervision group were Naomi, Ana and Brian. This supervision group had been working together for a number of years, and there was a collegial spirit evident both in their willingness to share more personal material and in their concern for each other. Vignette 1: The double bind Naomi brought her severely depressed client, Jen, to her supervision group. She described her difficulty in engaging Jen, finding herself swinging between waiting patiently for her to speak and working too hard to engage her. When Jen eventually told Naomi she wasn’t helping, she started to doubt her capacity as a therapist. The supervision group was silent for a long time. Eventually, Ana asked Naomi for more detail, saying she didn’t feel she knew enough about Jen to be helpful. Naomi struggled to answer. Brian asked Ana what was going on for her when she was asking Naomi her questions. Ana reacted a little defensively, saying that she was just trying to be helpful. Brian’s voice sounded apologetic as he said he realised that, in trying to be helpful to Naomi, he had found himself unintentionally exposing Ana. Alex, the supervisor, noticed that she was feeling anxious. She expressed her curiosity about what others in the group were feeling. This refocused them from what was happening in the therapy to what was happening in the supervision group. Brian observed that the two positions that Naomi had described herself adopting with Jen in the therapy were now apparent in the supervision group. Both he and Ana had tried to be helpful but just made things feel uncomfortable. Observing these interactions, Naomi said she could see that both Brian and Ana had tried to help, but both had been left feeling wrong footed. She could see that they were left feeling the way she felt at the end of each therapy session with Jen. Seeing others try and fail as she had felt she had allowed her an opportunity to think about what happened in her therapeutic relationship with Jen from a different perspective. Naomi said she could now see that, because Jen had said so little about herself, it was almost impossible for her to know how to get things right for her. She came to see that, like Ana and Brian, she had been trying to be helpful but it had been experienced by Jen as being mis-attuned. Naomi had been aware that Jen found it excruciating when she stayed silent and mis-attuned when she tried to say something to break the silence. The supervision group checked in with Naomi about what feedback had been helpful to her. She said that she had arrived with a narrative in her head that was about banging her head against a brick wall. She had felt a failure, and this had been confirmed by her patient who had said she wasn’t helping. She said she would hold on to her experience of watching Ana and Brian trying to be helpful. She felt that what she would take back into her work with Jen was a better understanding of her part, her valency for self-blame.

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The new narrative Naomi was leaving with was that, as the youngest child in her strict family, she had often felt inadequate. In the present, this tendency lingered on and was enacted with Jen, her client. This had prevented her from thinking about Jen’s withholding behaviour and what lay behind it. She could now see that Jen was probably frightened of exposing herself to others and, in avoiding doing so, she kept others at bay. This meant that Jen was also unable to take in anything that was good. It was this, and the feelings that Jen was avoiding, that would need to be thought about in a sensitive way with Jen before they could make useful progress.

Reflections The exchange between Brian and Ana is an example of parallel process— in this case, being caught in a double bind. Alex, the supervisor, encour­ aged the supervision group to put their emotional experience of what had happened in the supervision group into words. The emotional pulls and pushes revealed themselves in the conversation between Ana and Brian. Brian recognised that he had engaged in parallel process, leaving Ana feeling attacked by a question he had asked with the intention of being helpful. Both Brian and Ana had to tolerate and contain feelings of shame stirred up by their exchange. Naomi’s response to what she had witnessed from the observer position was to let them know that this was what she had been engaged in doing in the therapy. This was a valuable insight for her, and her acknowledgement may also have been helpful to Brian and Ana in helping them regain a sense of emotional equilibrium because it was letting them know that she too was caught in the same trap. As experienced therapists, with good working relationships, they were able to process the experience in the group in a way that helped them all gain insight. Naomi reflected on her learning from this experience and the way it would help her to disengage from the difficulties she had with Jen. She left feeling more confident about her capacity as a therapist and with the intention of talking with Jen about what made it so difficult for her to talk about herself. She would also let Jen know that her fear of talking about herself made it hard for her to reach out to her.

Conclusion The dynamic involved in parallel process fits well with what Sandler called role responsiveness—the expectations patients have of their therapist that the therapist may then feel pulled towards fulfilling (Sandler, 1976: 43). Tracey and colleagues found evidence that supervisors who can recognise their part in enacting parallel process and progressively manage to stay in role help their students to do the same. They act as a role model for the student, who learns by copying their supervisor’s behaviour.

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Parallel process can be easier to recognise in group supervision, where conversations can amplify the effect. Working with parallel process in super­ vision involves working through sometimes painful feelings. The supervisor of groups can be helped to think about this in terms of working through a number of stages. In the example with Naomi and Jen, the parallel that was unconscious in the therapy was recognised and processed in the supervision group using this six-stage model.

References Billow, R.M. (2011) It’s All About ‘Me’: On the Group Leader’s Psychology. Group Analysis 44 (3): 296–314. Caligor, L. (1984) Parallel and Reciprocal Processes in Psychoanalytic Supervision. In: L. Caligor, P.M. Bromberg and J.D. Meltzer (Eds), Clinical Perspectives on the Supervision of Psychoanalysis and Psychotherapy. Boston, MA: Springer US, 1–28. Cohen, V. (1995) Monitoring the Supervisee. In: M. Sharpe (Ed.), The Third Eye: Supervision of Analytic Groups. London: Routledge, 174. Doehrman, M.J.G. (1976) Parallel Processes in Supervision and Psychotherapy. Bulle­ tin of the Menninger Clinic 40 (1): 1–104. Foulkes, S.H. (1964) Therapeutic Group Analysis. London: George Allen & Unwin. Jacobs, D., David, P. and Meyer, D.J. (1995) A Brief History of Supervision. In: The Supervisory Encounter: A Guide for Teachers of Psychodynamic Psychotherapy and Psychoanalysis. New Haven, CT: Yale University Press, 9–33. Kernberg, O. (1965) Notes on Countertransference. Journal of the American Psycho­ analytic Association 13 (1): 38–56. Knowles, J. (1995) Supervision in the National Health Service. In: M. Sharpe (Ed.), The Third Eye: Supervision of Analytic Groups. London: Routledge, 85–87. Moss, E. (1995) Group Supervision: Focus on Countertransference. International Journal of Group Psychotherapy 45 (4): 537–548. Pines, M. (1995) Introduction. In Sharpe, M., The Third Eye: Supervision of Analytic Groups. London and New York: Routledge. Sandler, J. (1976) Countertransference and Role-Responsiveness. The International Review of Psycho-analysis 3 (1): 43–47. Scanlon, C. (2000) The Place of Clinical Supervision in the Training of Group-Ana­ lytic Psychotherapists: Towards a Group-Dynamic Model for Professional Educa­ tion? Group Analysis 33 (2): 193–207. Searles, H.F. (1955) The Informational Value of the Supervisor’s Emotional Experi­ ences. Psychiatry 18 (2): 135–146. Sproul-Bolton, R. (1995) Supervision in the National Health Service, Part I: Group Supervision in an Acute Psychiatric Unit. Oxford: Routledge. Tracey, T., Bludworth, J. and Glidden-Tracey, C. (2012) Are There Parallel Processes in Psychotherapy Supervision? An Empirical Examination. Psychotherapy 49: 330–343. Tracey, T.J.G., Glidden-Tracey, C.E. and Bludworth, J. (2012) Parallel Process: When Does a Parallel Occurrence Carry Meaning? Psychotherapy 49 (3): 347–348.

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Tsegos, Y. (1995) A Greek Model of Supervision: The Matrix as Supervisor—A Version of Peer Supervision Developed at IGA (Athens). London: Routledge. Watkins, J.C. (2020) The Problem of Parallel Process: Wild Analysis in Psychotherapy Supervision? International Journal of Psychotherapy 24: 47–67. Zinkin, L. (1983) Malignant Mirroring. Group Analysis 16 (2): 113–126.

Chapter 12

What am I missing? What is not being said, and what is not being heard? Making use of the multiple perspectives in the supervision group

Introduction Facial recognition techniques have validated how different human beings are, even in appearance, one from another. Each individual is a unique combina­ tion of biological and social factors. We have differences in age, degree of health or disability, ethnicity, culture, class, creed, social status, sexual iden­ tity, financial security and family configuration. All these factors tune my perception as a therapist or a supervisor. I may have access to privileges I may not even be aware of, privileges that at the same time may filter out enriching perceptions and possibilities. My age, for example, could give me an acute understanding of the latest sensibilities or, if I am older, access to pre­ vailing issues over decades. I need to listen for what I am missing, what is not being said. Group supervision provides other listeners to help with this task. Foulkes’s work illustrates how a ‘network of interacting circumstances and persons is the real operational field for effective and radical therapy’. Foulkes worked as an army communications officer in his early life, where he could have become acutely alert to silences and blocks in communication. These might indicate a failure of communication equipment or the loss of an out­ post in the operational field. Foulkes pointed out how the ‘all important process of communication’ in the group ‘with its ever-growing understanding of unconscious processes and for repressed material’ enables ‘a common enterprise of mutuality’ (Foulkes, 1964: 169). The presenting difficulties that derive from an unspoken inner conflict come to light as they are articulated. ‘The benefit which each individual derives from working towards a free expression of his conflict in the group is intimately linked with the levels of communication which such a group can grasp’ (Foulkes, 1964: 74). Group analysis values the multiple perspectives of the group, and group supervision provides this multiplicity. A diversity of members is critically valuable where the difference in members’ various experience can be har­ nessed to give a range of perceptions. Supervision research stresses the importance of the supervisor’s awareness of supervisees’ individual differences and cultures. Some differences convey DOI: 10.4324/9781003375975-19

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practical disadvantages, limiting access. The experience of feeling different may inhibit contributions to the group, in particular if a sense of inferiority has been internalised. When differences that convey disadvantage intersect, they can compound or interlock to restrict opportunities. A diverse group analytic supervision group can reflect society and culture in a fuller way and overcome blind spots by harnessing the different perspectives of its members. The supervisor’s task is to create a structure and emotional climate within which varying perspectives can be heard and acknowledged and can con­ tribute to the supervisory process. In free group association, the conscious and unconscious meaning can be put to work to enhance insight and under­ standing. What was put out of mind, forgotten or barely perceived can become tangible and thought about. The combination of the social and cultural experience of an individual comprises the social unconscious, which is embedded from an early age by the way the individual has been raised. Transgenerational trauma may be part of the family foundation matrix, whether conscious in the family narrative or a silence. The recognition and acceptance of each member’s individual identity contribute to the well-functioning supervision group. The therapist brings to supervision their countertransference responses, their personal perceptions of an individual or group seeking to put into words what they are finding difficult (Foulkes, 1964: 255) and trusting that the wider group may perceive and express what is impeding their work. The group analytic supervision group makes use of free group association to explore this. Members learn vicariously too, by exploring their countertransference in response to other members’ work. This can be effective learning, as super­ visees may be less anxious when listening to each other’s work than when presenting their own.

Language and the unexpressed How the client expresses their distress can vary depending on culture and language. Urgent information may be missed. It may be hard to understand if expressed in body language or another language or dialect. The therapist’s own life experience may impede understanding. If a client presents talking about adoption, divorce or living alone, for example—issues that raise con­ trasting feelings—different therapists may have different understandings of what these life events have meant to their client. In therapy, there are actual unspoken professional power dynamics that potentially limit the therapeutic relationship. As well as the therapist’s role, there can be unearned power that derives from their social status, including race, gender and sexual orientation. Over time, within the structure, process and content of the group, different aspects of diversity may come into focus (Schlapobersky, 2016: 223).

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The training of therapists ‘Group analysis shows people not only how much they have—often quite unexpectedly—… in common with other people but also how they differ as individual personalities’ (Foulkes, 1964: 74). Therapists, in their training and personal therapy—both individual and group—have the opportunity to become aware of their potential blind spots as dissociated parts of themselves come to light. Experiences that have been quieted or unspoken find expression. Gaps in the family narra­ tive may become apparent as therapy allows access to what has been suppressed, repressed or disassociated. Training groups may first look for what members have in common, but, as a group progresses, members can gain a stronger sense of themselves and become more aware of their dif­ ferences, what is particular to the individual. Insights from their own cul­ ture and those of others can be re-evaluated as they explore their sense of identity. How the trainee is seen by others becomes apparent, and projec­ tions can be explored. The context provides a chance to identify dis­ crepancies between self-perception and how they are seen by others. The social unconscious can come into conscious awareness bringing with it any sense of internalised discrimination. These findings prepare the therapist for professional work as they learn how they may seem to others and how, as an integrated individual, they can use themself as an instrument in the work in hand. The following vignettes are written to illustrate specific points.

Difference is present at many levels in the supervision group Difference is present in: (1) (2) (3)

The supervision group members’ own sense of themselves. The understanding of other members’ identity. The understanding of countertransference responses arising from work with clients, including manifestations of the social unconscious and what is not immediately available to the conscious perception.

All these issues also arise in and for the supervisor.

The practical impact of difference In setting up the supervision group, the supervisor’s task includes matters sur­ rounding access as part of the dynamic administration—the choice of location, transport availability and so on. Clear travel instructions lower anxiety levels. This is paying attention to the everyday level of the group matrix.

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Vignette A: Hearing Hannah, a member of a supervision group in an agency working with bereaved young people, had a hearing impediment that disadvantaged her in group meetings. Her hearing aid, with a microphone and loop, could be positioned for her to hear her individual clients. This was less effective in a group, especially in a seat near the window with loud traffic noise. Her colleagues seemed to ‘forget’ this. One day, Hannah arrived last and had to take the chair by the window. Having previously asked to sit away from the window, she felt embarrassed to ask others to move. She had to choose between causing annoyance and feeling shame or missing out on hearing critical dialogue. She stayed silent. The supervisor, Ted, asked Hannah if she would like to change seats. Hannah thanked him and moved.

The group member was being excluded and disempowered by the group’s neglect of her practical and necessary needs: an enactment at the boundary that literally blocked free communication. There seemed to be an undertow of annoyance and impatience with Hannah, perhaps unconscious, who didn’t comply with other members’ level of ability. There was a dynamic of exclusion and a danger of Hannah being tacitly expected to internalise her disadvantaged status. Later in the session, Ted mentioned that a new client, with limited mobility, had been referred. How could the agency respond? Amy asked if there wasn’t special provision for people with his problems. Ted said there wasn’t. There was a moment of silence. Amy then said she was feeling guilty about forgetting Han­ nah’s request. How had she let herself forget? Then Bob agreed, admitting that he sometimes felt there was more provision made for the disabled than the nondisabled: disabled parking spaces always seemed empty. Claire said it was easy to feel, misguidedly, that the disabled always seemed to be asking for more and getting special status, like the youngest child in the family. Bob said that, on reflection, his disabled cousin hardly got out at all, there were too many obsta­ cles. Amy said she was glad the group had stopped and thought about this, as Hannah needed equal access to the group, not anything extra. Hannah said that she didn’t feel confident in joining in unless she had heard what was said. Ted noticed that, after this rather embarrassing conversation, in future meetings a suitable seat was left for Hannah.

In the above, free-floating discussion gave rise to a chain reaction of responses (Foulkes, 1964: 117) that expressed the feelings in the room and clarified the situation. The silence was translated by the group as they articulated their con­ flicted feelings about provision for the disabled and also shame about their pro­ jections and negligence of Hannah’s reasonable requirements. This bereavement agency, set up to break the silence around loss, had found words for Hannah’s hearing loss.

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Ted wondered in his own supervision whether other members’ concerns of inadequacy in the group were being unconsciously projected on to the dis­ abled member. She was a competent and experienced member—perhaps there was some envy.

Asking for what is needed Haben Girma, a human rights lawyer, experienced severe practical difficulties owing to the multiple barriers she had to overcome and suggests that ‘Disabled people and their communities succeed when the community decides to dis­ mantle digital, attitudinal and physical barriers’ (Girma, 2019: 266). The daughter of US immigrants from Ethiopia, Girma experienced many barriers, including very limited sight and hearing. She writes about her secondary school experience where she was only alerted to academic work she had not done by failing her exams. The teacher had given the class tasks by writing them on the board or speaking them, although neither of those means of communication were accessible to her. Low expectations of a disabled and immigrant scholar were in danger of being fulfilled. Haben spoke out and was provided with the technical support she needed. Without her communicating her needs, her intersecting disempowerments could have blocked her education.

Intersectionality Differences interact with each other. Having more than one source of differ­ ence from what is regarded as the norm can compound the difficulties and provide more obstacles in the way of personal fulfilment. The concept of intersectionality draws attention to the tendency of disadvantages to com­ pound and generate further difficulties. Altman points to this complexity of how these dimensions interact and how difficult this can be in lived experience (Altman, 2020: 219). Further, therapists and clients may ‘unconsciously reproduce interlocking oppressions in their work’ (Layton, 2020: 173). Bringing these possibilities to light allows clarification, exploration and con­ sideration in the supervision group. Differences of culture and creed In the following example, a clash of cultures and creed creates a dilemma. Vignette B: Culture and creed Tom, a group therapist, brings to his supervision group Anisa, who is querying her group attendance during a religious practice important in her culture, requiring fasting in the hours of daylight. The set time of the group in a com­ munity setting includes the hour when Anisa would normally break her fast.

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Could she bring a small snack into the group or should she stay at home? Anisa works in a school and has a family to care for before attending the eve­ ning group so will have had a tiring day. Tom asks if he would be breaking boundaries by allowing the member to eat at the time of day she is free to do so. Should he expect her to extend her fast and wait to eat and drink until the end of the group? Tom has to decide how he uses his discretion and power as the group facil­ itator, which includes the power of inclusion and exclusion. Members of Tom’s supervision group take up different positions in relation to the material coming from their own diverse perspectives. The supervision group is torn. Diana finds herself irritated that Anisa should even ask. She has committed to the group and, surely, she can wait a bit longer—or eat before she comes. Elizabeth says that that is a bit harsh as the formal aspects of her religious practice may be helping her through a difficult time. Diana remarks that she wonders whether, conversely, Anisa’s patriarchal religion could be putting too much pressure on her. Kingsley says that asking Tom what she should do makes her therapy into an alternative patriarchal religion. Diana holds her ground that therapy should help Anisa to be con­ scious of her individual choices as a woman. Elizabeth says that that can include following her own creed. Freda says she is now feeling physically exhausted at the thought of what Anisa has to do. Elizabeth shares that she herself has benefitted from a silent retreat. In fact, when the silence was over, she felt overwhelmed by all the talking; it almost gave her a headache. Diana says that this session is getting to be a bit of a headache. Kingsley wonders if all these different points of view are going on in Anisa’s mind. Diana concedes that Anisa needs Tom’s understanding and support. Tom thanks the group for throwing light on different aspects of Anisa’s clash of commitments. He understands more about how conflicted Anisa may be feeling. Navigating through this will be an important part of Anisa’s therapy.

Culture and creed in Anisa’s foundation matrix, compounded by social expectations of a working mother, could impede her access to therapy. The location of the disturbance was the clash of commitments. Tom began to see this as an example of intersectionality. Anisa belonged to a cultural and reli­ gious minority, as well as being a woman and a mother. Tom took his thoughts back to the therapy group, and a way was found to support Anisa. How her creed was talked about in the supervision group illustrates the power embedded in the language of how clients are discussed. The words chosen may give a clue to unspoken thoughts in the minds of other therapy group members and in Anisa’s own mind. Members’ different reactions and the language they used reveal their own embedded social unconscious. Language derives from the complexities of upbringing in a particular culture and includes an associated power dynamic (Dalal, 2001: 548). Free group association can bring unconscious prejudices to light and into conscious consideration. Oriel Brooks writes of the dangers of a traditional psychoanalytical model paying insufficient attention to race and culture or the social and political.

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She argues that these factors are ‘evaded’, ‘neglected’ or ‘obscured’ (Brooks, 2021: 14). She suggests there is a danger of denying someone’s real experience while looking for accepted concepts and emphasises the importance of look­ ing for the ‘foreign’ or ‘potentially unsettling’ when we meet someone from a different background (Brooks, 2021: 15). Layton argues that the ‘claim that psychic reality can be understood without reference to social location’ derives from the ‘race and class privilege enjoyed by the dominant social groups to which our theory makers belong’ (Layton, 2020: 172). She raises the question of the assumption of a norm from which other social patterns differ. Differences of class and culture In the following example, the wider cultural experience of the group within the same country helped in the understanding of a client. Difference in the supervision group contributes to self-awareness in the therapist. Vignette C: Language, class and culture In a youth counselling agency staffed by volunteers, Amanda presents a member of the parents’ group, run to promote understanding of their teenage children. She is concerned about George, a civil servant in his late 50s and a parent who is off work with exhaustion. His early energetic efforts in the group have waned to silence. In describing his background in the North East, George talks of a lack of connection with his father, who worked as a heavy manual worker. His father had been a talented musician in his youth but wasn’t able to progress with this. ‘As I grew older, he went silent. He would just say he was “jiggered”.’ George had explained that he was born to older parents, an unplanned last baby in a large family. It had always been said that his late birth meant that his father couldn’t retire. He had died of a heart attack ‘still in harness’. Amanda, his therapist, says she knew ‘exactly’ what it was like to be ignored by a father. Hers was never off the phone, a busy sales executive Peter, the supervisor, opened the idea of looking at the wider cultural context to explore the fuller meaning of what George brought. Another member, Hetty, who had grown up in a mining community, was alerted. She recognised the word ‘jiggered’—her father would say it, but she hesitated to say so as it came from dialect she had left behind when she moved south. She felt conflicted about revealing her social class background. But she was moved by hearing about Amanda’s client and overcame her hesitance. She drew attention to the physically exhausting nature of this father’s work. ‘Perhaps George’s father was too tired to speak.’ John said ‘I can see why he has trouble talking to his teen­ agers, if he couldn’t talk to his own father in his teens.’ Hetty said ‘It must feel as if his own children are growing up in a completely different world.’ John said ‘Parents can be envious of their own children—so many opportunities.’ Hetty said ‘George’s father must have felt like that, it’s so sad about the music. George could go places he never could.’ John said ‘And he did, didn’t you say George had a good job?’ Hetty said ‘But now he’s jiggered.’ John continued, ‘I

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wonder if George felt that his own late birth somehow led to his father’s pre­ mature death. Just by being born he had somehow finished him off. That must be a terrible responsibility to carry.’ Hetty said ‘Perhaps he is afraid of an early death too.’ Amanda said she had got a sense of that at the initial session, when she had wondered if jiggered was a punishment. ‘I don’t know the word, but it sounded like a gibbet.’ Hetty said ‘I wonder if he sees you, or even the group as privileged southerners who can’t possibly understand. Now he’s jiggered in the group.’ John wondered if there was similar tension and rivalry at work with younger work colleagues. ‘Does he see Amanda or the group as like his privi­ leged children?’ Amanda thanked the group for giving her a fuller understanding of George’s family context as he grew up. She said she was surprised how animated the group had become. This helped her understand his present exhaustion, his powerful feelings about his deceased father and how this complicates his feel­ ings about his own children.

The group dynamic of envy and perhaps rivalry between generations and parts of the country in the supervision group gave clues to what might be happening in the therapy group, and perhaps in George’s family and work­ place, which had exhausted him. The group explored the resonances of the slang or dialect word ‘jiggered’, meaning exhausted and broken. A jigger stretches cloth. When the fabric was taken off the frame, it would collapse. Dialect is defined as a form of language peculiar to a specific region or social group. It has also been described as a language without an army behind it, so there is reference to power and lack of it at work here. Hetty had learned not to talk about her working-class origins, which she started to ‘hide rather than expose to humiliation and ridicule’ (Dalal, 2001: 552). The dialect word vividly symbolized and contained feelings at the heart of George’s experience. Dialect words can add a vivid onomatopoeic communication that may give clues to feelings held in the body. ‘Acceptable language is in the code of the dominant culture. The rejection of dialect words, a person’s own language, can be seen as undermining the sense of self of the speaker’ (Fanon, 2008: 4). The above session could be understood as an example of the condenser phenomenon at work, a process Foulkes noticed in therapy groups. A chain of associations climaxes in an image that renders the nub of the matter more tangible, more accessible to the senses (Foulkes, 1964: 34). What emerges could be described as an example of the social unconscious, symbolized here by the dialect word, translated by a group member who felt in herself the conflict of shame about class and was able to throw light on the power dynamic of class (Dalal, 1998: 212). Vignette D: What can be spoken about? What can be heard? Hazel, a group analyst, brought her shock and disbelief to her supervision group. In an agency supporting immigrants, a therapy group member, Gazala,

194 Using the group as the medium for supervision a first-generation French Algerian migrant, had talked about her present con­ ditions of work, including being locked into the premises. Hazel found this hard to believe in her own country and in modern times and felt disturbed by the information. Meanwhile, the therapy group, after a slight pause, had veered away from what Gazala had said. After a slight hesitation, Hazel had drawn the group’s attention back to what Gazala had said. Was it too uncomfortable to hear? Hazel herself was shocked. There was a dissonance between Hazel’s understanding of her own country and what Gazala had described, Hazel’s supervision group took her sense of disturbance and Gazala’s account seriously and confirmed that what she had heard about was modern slavery. Arun had experienced something similar in an earlier stage of his employment. The supervision group then queried why the therapy group veered away from what Gazala had said. What else were other members keeping quiet about? Was it too shameful? Had Gazala grown up in a society where it seemed safer to maintain silence? Were the therapy group protecting Hazel from uncomfortable truths about her own society?

After discussing this in supervision, Hazel was able to listen more closely to Gazala and other group members. Was there something in their own histories that meant that slavery, or poor working conditions, were hidden beneath the overt dialogue of the group, while at another level these issues resonated? Had Gazala been testing what could be said here? Perhaps there was a dynamic of avoidance and denial in the group. Franz Fanon, of whom more later, wrote from his own experience that ‘Moving countries means taking on a new set of values, even if you realise they are not realistic’ (Fanon, 2008: 149).

The social unconscious Hazel had found Gazala’s account difficult to believe because of her own social unconscious. Modern slavery didn’t fit into the picture of her own country that she had grown up with. Foulkes felt strongly that ‘culture and values’ are ‘inescapably transferred’ to the growing child by their specific parents and their community, region, country and religious group. They are passed on ‘verbally and non-verbally, instructively and emotionally 24 hours a day. Even movements, gestures, and accents are determined in this way by these representatives of the cultural group’ (Foulkes, 1990: 155). Bringing the social unconscious, embedded from an early age, into con­ sciousness is an important process in supervision. Dalal draws attention to the need for the therapist to become aware of the deep cultural influences to which they are subject, bringing these to consciousness. The social and cul­ tural unconscious and the power relations that are part of this become visible in the language and symbolism they use (Dalal, 1998: 210). By their putting their uncomfortable thoughts and feelings into words, the unconscious can

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become accessible, and the supervision group can hear and challenge the therapist’s perceptions. This might bring to awareness preconceptions, power relationships and ideologies they may not consciously accept. Becoming aware of their own culture’s particular parameters allows the thera­ pist to reflect further on the opinions, norms and values they espouse. Group analysis derived partly from the Frankfurt School, where critical theory was developed (Foulkes, 1990: 11). The psychoanalysts of the Frankfurt School drew attention to the importance of social and cultural factors impacting psycho­ analytical practice and theory. They were alert to the norms and values of society and how they influence thinking, including the implications of the class and cul­ ture the therapist belongs to, both in their origins and in their current life. They were concerned that the therapist become aware of particular social pressures and cultural views. Supervision, in its formative and educative role, continues the process of learning to think critically about one’s own society and its prejudices. Vignette E: Awareness of the social unconscious in the supervisor Clara facilitated a supervision group for mother–infant group therapists in a community setting. Referrals came from professionals concerned about mother– baby bonding. The therapists brought their concern when a mother, Rhoda, and her baby from the travelling community joined a group they co-facilitated. The other mothers seemed nervous of Rhoda. How could the therapists help the mother be accepted into the group? They were aware of their own anxiety about not knowing enough about Rhoda’s culture. In a parallel process, Clara attempted to introduce the topic of cultural difference in the supervision group, but this was met with a sense of unease. In discussion, the supervision group decided that their own anxiety would neither help Rhoda’s integration into the group nor help her to relax in her care for the baby, and there was no valid reason to focus a dispropor­ tionate amount of attention on Rhoda other than to integrate her into the group.

The travelling communities have lived alongside the majority populations of Britain for centuries, but there remains unease owing to different ways of living. The resonance of alert and alarm here was perhaps amplified by the new mothers’ sense of protectiveness. It is a common experience that joining any non-specialist community mother and toddler group can be painful for the first few sessions as the new mother is gradually accepted into the pro­ tected space. Recent concerns with infection perhaps make sense of an evo­ lutionary aspect of protectiveness among parents of young children. Diverse community mother and baby groups are valuable community makers, but need first to overcome conscious and unconscious bias.

The supervisor’s self-awareness On reflection, Clara, the supervisor, realised she had not thought of her own family’s stories of Romani ancestry during the supervision session. She reflected

196 Using the group as the medium for supervision that this revealed a dynamic in the supervision group of splitting and projec­ tion, of expelling some unwanted feelings into the ‘other’ group. This gave her a clue about the dynamic among the mothers’ group. Clara reflected on her sense of shame, exposure and fear of exclusion, as well as pride, which comes from identifying with a minority group. She realised that she must be carrying a transgenerational echo of feeling excluded from mainstream society.

Layton writes about the tendency to split off what is socially unacceptable and behave in a ‘proper’ manner, projecting what is felt to be shameful and humiliating and seeking to avoid feeling unacceptable, unloved or treated with ‘indifference’ (Layton, 2020: 178). This perhaps resonated with other aspects of the parent–infant group. New parents can become separated from their usual social activities by their task and can feel anxious about their parenting. Seeing this anxiety mirrored in other parents can give a temporary sense of relief. Parents’ insecurity about doing a good job was echoed, in the parallel process, among the therapists who brought their anxiety to supervision, asking ‘Are we getting this right?’ The group therapists are primed to reassure the parents they are not unique and watch out for signals when support is being requested.

Internalised disadvantage and self-discrimination People with disabilities can sense they are required by society to take on the ‘burden’ of ‘reaching into’ the non-disabled world (Girma, 2019: 14). Perhaps this is also pertinent to anyone moving cultures, including that of joining the profession of group psychotherapist. There is a need to be politically aware as a supervisor, to avoid being swept along by systems that perpetuate dis­ advantage. In this sense, response to difference can be seen as a dynamic force, which can move in different directions over time. Frantz Fanon, a French West Indian psychiatrist from Martinique who worked in Algeria in the 1950s, highlighted how an ethnic group disempowered by slavery over centuries can internalise a sense of inferiority that is hard to overcome. It is a transgenerational trauma that continues to oper­ ate. He too found himself subjected to an unconscious cultural bias. He describes the social unconscious as ‘the repository of prejudices, myths, and collective attitudes of a particular group’ (Fanon, 2021: 165) and wrote about the human, social and cultural consequences of colonisation, which he describes as leading to the internalisation of poor self-image, a loss of selfworth. The sense of being unacceptable is corroding to mental health and the capacity to lead a full life. Fanon asked individuals to look at the full humanity of the other person. ‘I acknowledge one right for myself: the right to demand human behaviour of the other’ (Fanon, 2021: 204). The power of the supervisor can feel greater to the supervisee than the supervisor realises.

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Vignette F: The supervisor becomes aware of unearned social power Barbara offers a supervision group from her home in a pleasant suburb. Leila, a supervision group member, repeatedly cancels her attendance. There is a grow­ ing impatience with her non-attendance, which appears to be casual and showing lack of commitment to supervision, the group and the supervisor. Maria, another group member, expresses concern about Leila and her inter­ secting difficulties. Leila is a first-generation South Asian immigrant, recently trained and with family responsibilities. Although Barbara and Leila had explored some of these issues at their original meeting, she decides to offer her a meeting or phone call so that Leila can readdress her situation and they can consider together whether Leila wishes to continue and what they can do to make this possible. Barbara wonders if the supervisory alliance may need strengthening to cross the social divide.

Barbara realises she may have missed the urgency of Leila’s difficulties, and the hints from the group help to piece together a greater understanding of the pressures on the supervisee. In her own supervision group, Barbara brings to her conscious mind irritation that had allowed her to miss communications from Leila which other members had received. When they meet, Barbara becomes aware of not only Leila’s practical difficul­ ties but also her internalised self-discrimination and overvaluing of Barbara because of her social as well as her professional status. Leila says she is deter­ mined to see the ‘best person’, although it is hard for her. Barbara encourages her to value her own professionalism. The second interview allowed a better supervisory alliance, as Barbara became aware of Leila’s discrimination against herself.

B.-C. Wright has written about how, as a second-generation immigrant, she had been encouraged by her parents to ‘fit in’, but in doing so she now felt she had hidden her true, ‘intrinsic’ self (Wright, Clarke and Taverner, 2020: 22). Wright emphasised the need for race and culture to be addressed in training and has written about how her therapist challenged her tendency to undervalue her own culture and professional value. Group supervision requires a building of trust. When people come from a culture where deference is the norm, they may need to learn to hold their ground professionally, being given permission to disagree with others (Parker, 2020: 33). In contrast, if you have been encouraged from an early age to argue, you may need to find ways of working more co-operatively, joining in the shared reverie of the supervision group.

Building an identity Kwame Anthony Appiah, who has dual Ghanaian–British heritage, suggests that the ways humans divide themselves into sub-groups have more to do with

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a personal sense of identity and belonging than ‘essential’ differences. In The Lies That Bind, he suggests that identities of race, creed, sexuality and culture, although vital in giving us a sense of who we are, when looked at closer are full of contradictions. Looking to biology for ‘essential’ differences, he argues—between ethnic groups, for example—has failed. But the surrounding culture and society are also critical to knowing who you are. As well as giving a sense of personal identity, social and cultural group identities matter to others too, as they provide clues that others can read. ‘Social identities con­ nect the small scale’ personal experience with ‘larger movements, causes and concerns’. He points to the danger of being confined by the identity others allocate, whether those within or those without the group you identify with. But, ‘If you do not care for the shapes your identities have taken, you cannot refuse them, they are not yours alone’ (Appiah, 2018: 218). One’s identity must be negotiated with others and oneself. Further, he advocates working with others in a larger concern. Changing the understanding of these iden­ tities, he suggests, cannot be done by the individual alone, but that collective work must be done in the interests of others too. ‘Women negotiating inter­ sectionality have worked together across class, and language and religion and nation in the global struggle against oppression and inequality’ (Appiah, 2018: 218). A personal identity is also part of the community’s understanding of itself. Bringing these factors to conscious awareness allows further under­ standing to be part of the dialogue in supervision. The therapist has the dual task of finding a shared humanity, the common foundation matrix, while at the same time investigating what feels strange, foreign or unsettling to their comprehension. Group supervision breaks the isolation of the therapist and brings more minds to their aid. Overcoming shame and embarrassment, or fear of raising this in others, may be a part of what inhibits the work of a group in being able to bring differences and the social unconscious into conscious awareness. When difficult things are put into words, the fuller implications of these insights can be considered.

Overcoming prejudgements Haben Girma was mentioned earlier in the chapter as she sought to combat social expectations about her disability at school. Her memoir describes how she persisted in maintaining her ambition and trying things disabled people were discouraged from attempting. With family and special needs support and through her own hard work, she entered Harvard University to study law, but still found everyday practical situations required her to speak out. In a canteen designed for those with hearing and sight, she had no means of knowing what food she could choose and had to strongly protest to be sup­ plied with a menu she could access. She now lobbies for better equipment to allow inclusion. Girma emphasises that disability is not something individuals ‘overcome’: they are still disabled. Her acquisition and development of digital

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and technical skills have been her side of a reciprocal process but are not enough without the community removing barriers, at both a practical and technical level. This first requires an ‘attitudinal’ shift to ‘choose inclusion’ (Girma, 2019: 266). Although her disabilities interlocked with race and gender to impede her professional prospects, by demanding appropriate support, she succeeded educationally, finding a role as a human rights lawyer supporting others facing discrimination. Haben Girma received the Helen Keller Achievement Award in 2018.

Reflections on the supervisory relationship Foulkes stressed the value of the group offering acceptance and respect for its members, so that they can share and fully participate in a constructive experience (Foulkes, 1990: 115–116). In the supervision group, a task group, this can pass on value to others. Recent research has reiterated the paramount importance of the nature of the relationship between the supervisor and the supervisee (Rothwell et al., 2019: 1). An effective relationship requires a level of trust. Interviewed supervisees valued a warm, empathic relationship with a supervisor who is motivated to work with them as an individual, while able to provide con­ structive feedback without hesitation when this is needed. They are approachable and respectful and bear the interests of the supervisee’s welfare at heart. They understand the setting and its policies and keep good records. They respect the confidentiality of supervision in relation to what the super­ visee shared. In this way, the supervisee is more able to understand and identify their own emotional experiences and relate these back to clinical practice. In group supervision, the supervisor’s role is to provide a context within which members can build professional relationships that create a mature group with an optimal level of respect. Here, trust can grow; where a sense of acceptance and belonging is created, members can share unsettling feelings and explore what may be inhibiting their work. Difference: what does the supervisor need to bear in mind? 1 Access for group members in as many ways as possible—location; trans­ port; building and room facilities; technical equipment for mobility, hearing and sight—providing for the realistic and practical needs of the group. Disadvantage is not shared out equally. 2 A diverse supervision group can offer a wider range of cultural experience to enhance perception. Expressive language may render further insight. 3 Self-awareness in the group members in relation to difference and diver­ sity is encouraged.

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4 A developing self-awareness in the supervisor of their power, which may be more evident to others than to themself. They have professional power from their training, experience and role. They may be seen as a role model. 5 In addition, they may have further perceived power from their social status, race and position of privilege in the surrounding society. 6 The supervisor has a continuing task to detect what in their social

unconscious could get in the way of providing appropriate supervision.

7 Sibling rivalry and hidden tensions may need to be brought to conscious

attention. 8 The supervisor’s faith in the supervisee is important to the supervisee. This includes believing in their capacity to receive constructive feedback when needed. Crucial too is the recognition of the member’s personal identity. 9 The supervisor’s trust in the group supervision process is central. 10 Basic modesty is required by therapist and supervisor.

Conclusion This chapter has started to explore what may be missed or unspoken, what may be being denied, avoided, projected or misunderstood. The answers are infinite. When trying to understand the practical, social and cultural impacts on one of the planet’s 7.8 billion people, it makes sense to make use of the diversity of the supervision group members and their combined experience. Each practitioner’s developing self-awareness contributes to a group mind, larger than the individual mind, which can catch in its web more of the nuances of language and apprehend the silences of power. Like an Aeolian harp, the group can be an instrument to catch the resonance of spoken and unspoken messages brought to the supervision group for translation. Free association can bring the unconscious into expression; a chain of associations can allow breakthroughs into conscious communication as an idea is captured and expressed. The supervision group contributes to growing the professional. A mature, well-functioning supervision group can recognise, acknowledge and value each therapist’s unique contribution, both as an individual and in the practice of their work.

References Altman, N. (2020) Intersectionality: From Politics to Identity. In: M. Belkin and C. White (Eds), Intersectionality and Relational Psychoanalysis: New Perspectives on Race, Gender, and Sexuality. Oxford: Routledge. Appiah, K.A. (2018) The Lies That Bind: Rethinking Identity. Profile Books. Brooks, O. (2021) Looking Like a Foreigner: Foreignness, Conformity and Com­ pliance in Psychoanalysis. In: Loewenthal, D. (Ed.), Critical Existential-Analytic Psychotherapy. Abingdon, UK: Routledge, 10–28.

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Dalal, F. (1998) Taking the Group Seriously: Towards a Post-Foulkesian Group Analytic Theory. London and Philadelphia, PA: Jessica Kingsley. Dalal, F. (2001) The Social Unconscious: A Post-Foulkesian Perspective. Group Analysis 34: 539–555. Fanon, F. (2008) Black Skin, White Masks. Grove Press. Fanon, F. (2021) Black Skin, White Masks. New York: Penguin Classics (Modern Classics). Foulkes, S.H. (1964) Therapeutic Group Analysis. London: George Allen & Unwin. Foulkes, S.H. (1990) Selected Papers: Psychoanalysis and Group Analysis. London: Routledge. Girma, H. (2019) Haben: The Deafblind Woman Who Conquered Harvard Law: A Memoir. New York: Hatchett Book Group. Layton, L. (2020) Intersectionality, Normative Unconscious Processes, and Racialized Enactments of Distinction. In: M. Belkin and C. White (Eds), Intersectionality and Relational Psychoanalysis: New Perspectives on Race, Gender, and Sexuality. Oxford: Routledge. Parker, V. (2020) A Group-Analytic Exploration of the Sibling Matrix: How Siblings Shape our Lives. Oxford: Routledge. Rothwell, C., Kehoe, A., Farook, S.F., et al. (2019) Enablers and Barriers to Effective Clinical Supervision in the Workplace: A Rapid Evidence Review. BMJ Open 11 (9): e052929. https://bmjopen.bmj.com/content/11/9/e052929.abstract Schlapobersky, J. (2016) From the Couch to the Circle: Group-Analytic Psychotherapy in Practice. Oxford: Routledge. Wright, B.-C., Clarke, D. and Taverner, K. (2020) Black Matters. Therapy Today 31 (7).

Chapter 13

Through a glass darkly Using a reflecting team approach in the development of supervisory practice

Introduction In the Christian Bible, the Apostle Paul uses the phrase ‘through a glass darkly’ to capture the difference between seeing a shadowy reflection on a piece of glass and the full impact it has on us when we see something ‘face to face’ (1 Corinthians 13:12). The use of this image as the title of the chapter is intended to acknowledge the shadowy image of the therapy being described when we see it through the lens of the reflecting team supervision. Reflecting team supervision involves one team of therapists observing another from behind a two-way mirror. The two groups then change places, and the super­ vision group observes the reflecting team’s feedback. This process draws on resonance (Foulkes, 1990: 173), the emotional impact that one person’s com­ munication has on another, and free-floating associations. These can only capture something of the essence of what may be unconscious. This is a dilemma for all supervision; Zinkin pointed out that supervision can be of enormous benefit, provided participants remember that ‘what they are jointly imagining is not true’ (Zinkin, 1983: 247). From Foulkes’s writing on the supervisory seminar, we know that he recognised the importance of addressing countertransference and parallel process in group supervision (Foulkes, 1990: 251–253). The term counter­ transference is used here to mean any response to the patient’s transference that reduces the therapist’s capacity to reflect on the therapeutic relationship. This is differentiated from resonance, which normally does not have the same negative effect on the therapist’s capacity to think and can, therefore, be more readily used to aid the therapy. Parallel process is where an unconscious dynamic from the therapy is enacted in the supervision group. The task of the supervisor is to recognise this and to help supervision group members to use the experience to gain insight into the therapeutic relationship. Foulkes also recognised the value of the conductor’s conscious resonance to their group members in understanding what was happening, provided that they were also reflecting on how much of their resonance reflects the patients’ issues and how much their own (Foulkes, 1975: 295). DOI: 10.4324/9781003375975-20

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In a well-functioning supervision group, supervisees’ resonance to a collea­ gue’s work can be a resource, and their free-floating associations can have the potential to deepen understanding. However, the group, including the super­ visor, may at times mirror the unconscious dynamics from the supervisee’s presentation, rather than uncovering them: the parallel process. The reflecting team approach described in this chapter was originally developed for use in the IGA London Diploma in Supervision training to provide experiential learning about working with countertransference, resonance and parallel process in group supervision. The chapter introduces two new concepts: firstly, reflecting team supervision. Reflecting teams have traditionally been used in family therapy to help families change. This approach involves two teams. One consists of the family and their therapists, and the other is an observing group who watch the interactions between them and provide feed­ back. In reflecting team supervision, a reflecting team observes another group engaging in supervision. They exchange places, and the observing group offers hypotheses about what they saw. The second concept, ‘scenic understanding’, is drawn from the work of Albert Lorenzer. ‘Scenic understanding’ focuses on a ‘snapshot’ from a patient’s story. There are two key ingredients of this snapshot: firstly, there is the patient’s ‘scene’, usually from their childhood and experienced as trau­ matic. This is often presented without any apparent emotional connection on the part of the patient. The second ingredient of this snapshot is the thera­ pist’s physical and emotional response. In this approach, the therapist’s reso­ nance is made available to the patient in order to help them to reconnect with the feelings and make sense of the scene. The therapist’s tasks are to allow themselves to stay with the pain that their patient’s account stirs up in them and to find the words to return the feelings to their patient in a way that is manageable for them and that does not result in their re-traumatisation. Therapists may find this difficult when a patient’s trauma resonates with a similar one of their own.

Reflecting team supervision The model used in this chapter originally emerged from the Milan school of family therapy and the work of Tom Anderson. He hypothesised that family systems can change when presented with new perspectives that are big enough for the family to notice, but not so big or so different that they cannot be integrated into the family’s communication system. In the reflecting team experience, a family talk with one or more family therapists while being observed by a reflecting team sitting behind a two-way mirror. Then they change places, and the family watches the observers (referred to as the reflecting team) hold a conversation about what they have observed. Anderson hypothesised that the reflecting team’s feedback needed to be presented in a sensitive way to the family system to minimise the risk of

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difference being heard as criticism. He further hypothesised that reflecting teams also need to foster a climate that promotes a sense of equality between the family and the therapists to ensure that their input does not have a destabilising effect (Andersen, 1988: 416). Prest and colleagues developed this model to make it appropriate for use in the group supervision of marital and family therapists. When it worked well, this was because the different contributions offered different perspectives, the ‘difference which makes a difference’ (Bateson, 1972: 459). In the reflecting team process: a group of therapists observe part of a therapy session (usually from behind a two-way mirror). During a break, the therapist–client system switches places with them. The members of the reflecting team discuss their ideas and perceptions about the session while the therapists and clients watch. Following this, they resume the therapy session, discussing what they have heard. (Prest, Darden and Keller, 1990: 26) In this reflecting team approach, the therapists and family receive feedback from outside their group in order to gain new perspectives on what happened in their communications.

Reflecting teams and group supervision In group supervision training, it is the therapist who is invited to stand back to observe communication between the other supervision group members. They do this in order to receive feedback about the dynamics of the work they have presented from the perspective of their colleagues. To be effective, this process requires complex skills for both supervisors and supervisees. The supervision group itself is also observed by a reflecting team, which gives feedback about parallel process. Being observed by colleagues can be challenging, but it also has the potential to provide a rich learning opportunity that all the members of the reflecting team can learn from and integrate into their ongoing work. Reflecting team supervision develops supervisors’ abilities to help their supervision groups recognise and name unconscious dynamics from the ther­ apy as they are repeated in the supervision group. This can both provide an indication of what was unconscious in the therapy group, including in the therapist, and limit any negative impact. It is normally easier to recognise parallel process as an observer. This makes the reflecting team process an ideal way of developing the skill of recognising parallel process. Scenic understanding ‘Scenes’ that stir up powerful emotional responses in the therapist are viewed as indications of countertransference. Alfred Lorenzer, like Foulkes, thought

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that problematic responses to current events had their origins in the earliest phases of life, and that the difficulties people have in relationships begin to make sense when their current behaviour is linked with the original social context, the ‘scene’ from which they developed. These scenic moments from the patients’ pasts are relationship episodes where bodily and emotional responses were not translated into language. What has not been thought about is likely to be repeated in relationships in the here and now, including in the relationship with the analyst (Lorenzer, 1974: 283). Lorenzer used his own strong emotional responses and bodily sensations evoked by his patient’s narratives (that were often devoid of affect) as an indication of what was being excluded from the patient’s consciousness. These were used as a route to make connections with the original ‘scene’. They would be conveyed to his patient as a way of linking the past with the present, making the unconscious conscious. Schaffrik, writing about this approach, suggested that, when experiences were repressed, this was because they were not given words by caregivers when their child’s behaviour was disapproved of in the cultural climate at that time. It was because of this that they lacked the words to express their feelings verbally, and so they were registered in the body (Schaffrik, 2002). Therapists can recognise these scenic experiences and help their patients to connect them with the original scene by paying attention to both their own reactions and the way their patient presents. When listening to their patient, they may notice that: 1 2 3 4 5

The narrative is being given without any feeling attached. There are indications about feelings from their body language. The patient seems more vulnerable to suggestion. There is a sense that something in the person’s narrative remains unspoken. The patient seems unable to think and struggles to give a coherent account.

The key to this approach is to let the data speak for themselves. Rather than engaging in formulating an interpretation, the focus is on putting into words what the interaction provokes in the therapist, thus allowing something to be expressed and thought about that was originally outside the patient’s con­ scious awareness in the original scene. According to Rohr, there are three aspects to understanding that need to be linked in order for unconscious messages to be recognised and reconnected with the original feelings: 1 2 3

The logical: being clear that we understand the language being used. Psychological: attending to conflicting messages—for example, someone whose body posture suggests they are feeling sad, but who is laughing. Gaining a scenic understanding: that is, recognising the context and background of the event. (Rohr, 2014)

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The therapist needs to have listened at each of these three levels in order to help the patient. They need to take in both the verbal and non-verbal com­ munication, as well as any disconnections between messages from body lan­ guage and feelings. Feelings that have become disconnected from the patient’s original distressing early event, and of which the patient seems unaware, need to be reconnected with the appropriate part of the scene. The painful work of the therapist is to bear the feelings that seemed unbearable to the patient, and to help the patient bear them too. The task is also to link the patient’s scenes to the missing feelings and to recognise the unconscious messages that caused them to be repressed. This needs to be done in a way that is digestible. Bion described this process as taking place when a therapist listens to their client’s distressing feelings, takes them in, reflects on them and offers them back in a way that the other person can hear in a more helpful way (Bion, 1993: 114– 115). When the therapy itself becomes blocked, it is likely that this is because of what is stirred up in the therapist by their patient’s often traumatic scenes. Scenes that trigger reactions in the therapist that block the therapy can be usefully thought about in group supervision. The supervisor encourages the supervision group members to offer their own feelings and associations as a route to helping the therapist to process their countertransference reaction to the patient’s scene. The supervisor also encourages the group to recognise and work with parallel process—that is, to work with the supervision group’s own blind spots in so far as they can be recognised.

Reflecting teams and group supervision Prest’s reflecting team approach has been adapted to provide experiential learning about aspects of supervision theory in the training of supervisors of groups. A group of supervisors meet to discuss the work of one of its mem­ bers and are observed from behind a two-way mirror. A therapist presents a ‘scene’ (a snapshot) from their work, selected either because it stirred up strong feelings in them or because they had a bodily reaction to what their patient was saying. It will normally be something that affected their capacity to think and respond at the time, indicators of a countertransference response. The ‘snapshot’ should be brief and include an interchange with the patient or group and the therapist’s emotional and bodily response. They may also bring their lack of response if they were left feeling numb when they might have expected to have had an emotional reaction. At an agreed time, the two groups change places, and the reflecting team members have a conversation about the dynamics they have observed and offer hypotheses about how this might relate to the therapy under discussion. Then, the two groups meet together to reflect on their experience and exchange learning. The following example of a ‘scene’ is one where there was a lack of feeling on the part of the therapist.

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Vignette 1: The absent parent Ernest talked about his childhood in response to a question from his therapy group. He described the day his mother left home, suitcase in hand and with tears in her eyes, when he was aged five. He and his sister were shouted at by their father because they didn’t eat the fish and chips he had bought for tea and they were sent to bed early. The therapist noticed that she was picking her fin­ gernail as Ernest spoke and she was shamefully aware of thinking about her next meal. No one in the supervision group spoke in response.

The supervision group members slowly began to put into words their distress at hearing this account. In response to this, the therapist thought her lack of emotional response was because of this scene’s connection with an early painful loss she had experienced. She realised that it resonated with Ernest’s account of his parents’ separation. As therapists, our own trauma affects our normal capacity to take in and respond to our clients’ painful stories. In the reflecting team supervision that followed, the group was able to make links between Ernest’s memory and the therapist’s reaction. They wondered whe­ ther the therapist’s hunger may have linked with the experience of the client’s emotional hunger caused by his mother’s desertion and loss of emotional feeding from his father. The therapist’s shame may have been echoing some­ thing in her that resonated with his shame and self-blaming about his mother’s desertion and being shouted at and punished by his father. In the next example, the therapist brought a ‘scene’ where a therapist had a bodily response to their patient’s narrative. Vignette 2: Megan’s earliest memory When Megan was asked about her childhood, her only memory from before the age of 11 was of being on an outing from her children’s home at around the age of 6 with her two older brothers. She remembered one of her brothers drowning while they were all swimming in the sea. Megan spoke slowly and seemed emotionally unmoved, her eyes looking vacant. However, listening to this, the therapist found herself having difficulty breathing and she felt physically sick. The therapy group members were fidgety but didn’t respond, and almost immediately one of them refocused the group on a different issue.

After presenting the scene in group supervision, the therapist listened to the supervision group’s associations, both to Megan’s brother drowning and to her own difficulty breathing. The therapist saw the same shocked look on the faces of the other supervision group members as she had seen on the faces of her therapy group members and the same struggle to find the words to respond to Megan’s story. She then watched the reflecting team’s conversation. The reflecting team commented on the supervision group’s difficulty responding to the therapist’s description of her difficulty breathing. They generated a hypothesis that death was something that adults felt

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uncomfortable talking about, particularly when it involved children and when it involved someone choking. This allowed the therapist to make a link between her patient’s story and an experience she had as a small child. She remembered being made to breathe in gas and air at the dentist, in order to have some teeth out. This terrified her at the time, but she didn’t feel able to talk about it, and it subsequently gave her nightmares about death and dying. In this reflecting team process, what was unconscious in both the patient and the therapy group was also missed by the therapist. It was witnessed and named by the reflecting team in response to the therapist’s account. There are times in group supervision when the glass is too dark or distorted for it to be seen through clearly enough by the supervision group on its own. It needs some input from outside, such as the reflecting team situation described here, or supervision of supervision to help make the unconscious conscious. Foulkes said that, although supervision is not therapy, uncovering counter­ transference does include a therapeutic element (Foulkes, 1964: 250). This is particularly the case when the therapist’s feelings need to be made conscious in order for them to help their patients with a similar issue. In the third vignette, which is described in more detail below, the therapist brought her strong emotional response to an incident at the end of her group. These incidents often happen around the boundary, perhaps because they are repetitions of disturbing episodes from patients’ lives, where the patient both wants something to be brought to light in the therapy and fears it. The timing of the incident, being outside the session, precludes immediate thoughtful response and often leaves the therapist feeling caught off balance, perhaps in a similar way to the impact of the original scene on the patient. Vignette 3: Wrong-footed The context Two facilitators ran a training day that incorporated a reflecting team experience into the programme. Emily was in a supervision group with other colleagues, all of whom had volunteered to be observed by the reflecting team. This team was made up of the rest of the participants, who were watching from behind a two-way mirror. May, the supervisor, was responsible for managing the time boundaries and keeping the group to its task. Emily was asked to give a brief snapshot of some therapy where she had experienced a strong emotional and/or bodily response. The supervision group were to listen to Emily’s snapshot without interrupting her, noting their own emotional and bodily responses. When Emily had finished, the supervision group members were asked to offer their feelings about and associa­ tions to what they had heard. Both Emily and May were to listen but not con­ tribute. After this, the supervision group changed places with the reflecting team whose members offered their observations about parallel process and counter­ transference. After this, the two groups then met to reflect on this experience.

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The snapshot The scene Emily presented was from her psychotherapy group. The incident took place when she had told them that she would be raising her fee from January. There was little comment in the group at the time but, as they were walking down the corridor of the surgery where Emily rented a room, she heard the two newest members talking about her. One of them was saying to the other that she was only interested in their money. The other one started to sing some words from Fiddler on the Roof, ‘In this life, one thing counts, In the bank, large amounts’. She said she felt enraged and shamed because she knew that her colleagues elsewhere in the building would have heard this. She had been so angry that she had been almost completely unable to recall the content of that group session and had struggled to record anything in her notes.

The supervision group Responses from the supervision group were sympathetic. It reminded Alan of a time when he had spent one afternoon in work last year trying to hide the fact that his trousers had split after he had bent down to pick his pen up. Joan remembered sneezing and wetting herself when she was out shop­ ping soon after the difficult birth of her second child. David said it reminded him of the TV programme The Weakest Link and that to be so publicly attacking of her was cruel. Madge found herself preoccupied about how difficult she would have found bringing something back into the next session that she had only overheard. She would have felt stitched up.

The reflecting team After the supervisor had called time, the two groups exchanged places. Observations made by the reflecting team included the warm way that supervision group members empathised with Emily’s experience, their rage on Emily’s behalf at the cruelty of what they had heard and the mirroring of what they perceived as the sense of Emily’s powerlessness. June offered the hypothesis that the supervision group had lost the therapy group, and that their conversation too was in danger of repeating this. This observation refocused them, and they began to think about what this corridor con­ versation might be holding for the group. Anne saw money as connected with power and control and hypothesised that this might be what couldn’t be talked about in Emily’s group. Jo commented on the power of the two new members to humiliate Emily after the group and hypothesised that this may be in contrast to where they saw themselves in the group’s ‘pecking order’. Ivor picked up the theme of shame and rage. He hypothesised that their seemingly deliberate shaming behaviour needed to be understood in terms of their transference to Emily. The trainers indicated that it was time for the two groups to join together to reflect on their experience.

210 Using the group as the medium for supervision

Joint reflection on the experience One of the trainers invited comments from the presenting supervisee first. Emily said she had felt supported by the supervision group and the associations from other members reduced the intensity of the shame she felt. It was also helpful to hear Madge mirror back her sense of powerlessness. She acknowl­ edged her anxiety about presenting the snapshot and thought the supervision group’s support had brought this down to a level that allowed her to listen and take in much of what was said. Naming the shame had taken her back to infant school and the humiliation of being publicly punished in front of the whole school for stealing an extra helping of ‘spotted dick’ (a winter pudding) from the school canteen when she was seven. She had hated the canteen staff after that and she still hated spotted dick to this day. She thanked Joan for what she had said and was tearful as she mentioned that she had never spoken before about the humiliation she had felt because she was so frightened when she was being punished that she had wet herself in front of the whole school. The trainers asked May, the supervisor, to respond. She said it was interest­ ing being there just to manage the boundaries and not to feel under pressure to contribute. It had been frustrating at first, because she had wanted to jump in and identify some of the dynamics that she had noticed. She had learned from listening to Emily’s feedback that her past interventions in her supervisory work may have been given too early. She had also learned that, when strong feelings are elicited, support is needed first in order to allow the supervisee to regulate their emotions. They need to feel on an even keel before they are able to take in comments from others. The trainers opened the discussion up to the whole group. New thoughts had emerged, and Emily highlighted several as helpful in the feedback she had been given. The ones she particularly identified were around working with boundary issues, reconnecting with the absent group and holding people’s differing feel­ ings and perspectives in mind. Both groups acknowledged how little attention they had given to what it would be like for the two therapy group members if and when they returned the following week. Emily now thought the other therapy group members might also have been as preoccupied as Madge was by whether they could voice what they had heard on their way out in their next group. She wondered whether they would feel obliged to turn a blind eye. The two facilitators brought the experience to a close.

Reflections Although reflecting team supervision may feel exposing, this can be mini­ mised when the supervisor helps the supervision group to stay focused on their own associations and emotional reactions rather than asking questions, commenting on the work or offering advice. Supervisees too are human and, just as in family therapy the reflecting team’s feedback needs to be presented in a sensitive way to the family system, so the feedback given to the super­ visor, supervisee and the supervision group by the reflecting team needs to be given sensitively to minimise the risk of difference being heard as criticism. It

Through a glass darkly

211

can also increase the likelihood of feedback being heard as helpful, a pre­ requisite for successfully learning from experience. This approach both views countertransference as being inevitable and acknowledges that all therapists have blind spots that require attention. Sandler recognised that, where countertransference is unconscious, it is only possible to process it after the event (Sandler, 1976: 69). Relationship entan­ glements between patient and analyst can also be viewed as potentially useful information. They will often reflect difficulties that are characteristic of the patient or patients outside the therapy room. Using ‘scenes’ from the thera­ pist’s work offers a different way of working with this in group supervision.

Some group-specific factors This more collegial and participative approach to working with counter­ transference can provide a safer experience for supervisees who may feel vul­ nerable presenting their work. Although there is very little research into the benefits of group supervision, evidence from the field of education suggests that, in reflective practice groups, learning is valued most when peers exchange similar feelings and experiences rather than offering help or solu­ tions. Brookfield noticed that, in a reflective practice group with teachers, what we thought were idiosyncratic features of our own critically reflective efforts are paralleled in the experiences of many of our colleagues. We dis­ cover that what we thought was our own idiosyncratic difficulty is actually an example of a wider structural problem or cultural contradiction. (Brookfield, 1995: 291) In group supervision, exchange also works through utilising the chain reac­ tion whereby group free association reduces resistances and allows a release of material from a deeper, unconscious level. Offering associations also uses what Foulkes referred to as the ‘condenser phenomenon’, because it taps into symbolic material such as dreams and images as a way of reaching what is unconscious (Foulkes, 1964: 34). This is particularly useful when working with experiences that may not have been previously put into words. This process draws on Foulkes’s concept of the mirror reaction when therapists identify with others in their group and put this into words. What was unconscious within the therapy can also be brought into consciousness through reflection on the dynamics of the supervision group, the parallel process. Supervisors too can get caught up in parallel process in the case under consideration. Caligor gives a detailed description of parallel process where a patient’s dynamics were mirrored in his supervision group. It was only in supervision of the supervision group that he was able to gain enough distance to recognise that he was behaving in the same ‘stuporous-depressed,

212 Using the group as the medium for supervision

unduly silent’ way towards his supervisee as the supervisee was in response to his patient (Caligor, 1984: 26).

Some benefits and drawbacks of this reflecting team model Encouraging supervisees to contribute their feelings, similar experiences and differing perspectives, rather than suggestions and questions about the work under consideration, may reduce the fear of shame and exposure in the supervisee presenting their work. If supervisees are to benefit from these opportunities for learning, this is essential when they are being observed by a reflecting team and feeling vulnerable. The reflecting team experience can help participants to value their emotional responses and learn about their blind spots from those of others. Sharing emotional responses in a work context carries a risk of feeling shamed. While therapists may be comfortable using their countertransference in their therapeutic work, they are using it to make observations and hypotheses about their patients, and so not exposing their own feelings in the same way. It may take more than one experience of reflecting team super­ vision for colleagues to become accustomed to articulating this more private part of themselves. It also requires skill on the part of the supervisor in creating a climate of trust that makes it safe enough for the reflecting team experience to work effectively. It is helpful for supervisors to have a taste of this experience themselves in order for them to appreciate the powerful impact it can have on their supervision group. Presenting the supervisee’s reaction to a ‘scene’ from their patient work is one way of identifying and working with countertransference. Learning from colleagues’ emotional responses and associations can provide insights for everyone in the group into the triggers of their reaction to these scenes. When it goes unrecognised, countertransference can lead the therapist to under- or overidentify with the patient, and this can block effective therapy. Parallel process can be named, and countertransference can be addressed, through other participants’ collegial responses. It can be easier for the therapist to learn from colleagues who are going through the same process. Receiving a range of feedback from a group can be hard to absorb and it can feel overwhelming at times. It is often only after supportive comments have been given that the therapist’s emotional equilibrium is restored enough for them to take in further feedback. Research also shows that what is most helpful is the sharing of their peers’ experiences offered in a supportive and encouraging way. Conversely, if the presenting therapist feels attacked, this invariably shuts down their capacity to learn. It is important for both the supervision group and the reflecting team to have the presenting therapist’s feedback about their experience. This can facilitate group members learning about how to match their contributions with the therapist’s level of arousal.

Through a glass darkly

213

Conclusion Lorenzer’s approach to the unconscious through the use of ‘scenes’ offers an approach that can help therapists to gain insight into triggers from their past that elicited their countertransference response to their patient’s narrative. Once the therapist has been able to process their own blocks in their work, they may be more able to verbalise feelings from the patient’s past that were not put into words in the original scene. As a method of working with coun­ tertransference, this focus on a ‘scene’ avoids some of the strategies that can be used defensively in supervision groups, such as providing more detail about the story at the expense of allowing time for reflection. It also avoids group members becoming like detectives, wanting more detail or rushing in to offer their own solutions, although these approaches have their place. Instead, it focuses supervisees’ contributions on their own associations and emotional responses to the scene. Coming from this place of equality, ‘we are all in this together’, difference is less likely to be heard as criticism by the therapist whose work is being supervised. Working with a scene helps supervisees recognise triggers that elicit a countertransference response. When this approach is used over a number of meetings in the training of supervisors, each participant may also increase their learning about their own countertransference ‘valencies’. Responses from colleagues may include reactions that are both different from, and simi­ lar to, their own. Although group analytic supervision normally uses a dif­ ferent approach from that of family therapy, this model separates out some of the useful processes that can contribute to effective work in supervision groups. It may also help supervisors recognise the limitations of working with resonance and free association, especially when acknowledging that, at best, we see through a glass darkly.

References Andersen, T. (1988) The Reflecting Team: Dialogue and Meta-Dialogue in Clinical Work. Family Process 26: 415–428. Bateson, G. (1972) Steps to an Ecology of Mind: Collected Essays in Anthropology, Psychiatry, Evolution, and Epistemology. Northvale, NJ: Jason Aronson. Bion, W.R. (1993) Second Thoughts: Selected Papers on Psycho-Analysis. Maresfield Library. London: Karnac. Brookfield, S.D. (1995) Becoming a Critically Reflective Teacher. San Francisco: Jossey-Bass. Caligor, L. (1984) Parallel and Reciprocal Processes in Psychoanalytic Supervision. In: L. Caligor, P.M. Bromberg and J.D. Meltzer (Eds), Clinical Perspectives on the Supervision of Psychoanalysis and Psychotherapy. Boston, MA: Springer US, 1–28. Foulkes, S.H. (1964) Therapeutic Group Analysis. London: George Allen & Unwin. Foulkes, S.H. (1975) Group-Analytic Psychotherapy, Method and Principles. New York: Gordon & Breach.

214 Using the group as the medium for supervision Foulkes, S.H. (1990) Selected Papers: Psychoanalysis and Group Analysis. London: Routledge. Lorenzer, A. (1974) Die Wahrheit der Psychoanalytischen Erkennthis: Ein HistorischMaterialistischer Entwurf. Suhrkamp. Prest, L.A., Darden, E.C. and Keller, J.F. (1990) ‘The Fly on the Wall’ Reflecting Team Supervision. Journal of Marital and Family Therapy 16 (3): 265–273. Rohr, E. (2014) From Logical to Psychological to Scenic Understanding in Super­ vision Groups. Workshop, Lisbon Conference ‘Art Meets Science’. Sandler, J. (1976) Countertransference and Role-Responsiveness. The International Review of Psycho-analysis 3 (1): 43–47. Schaffrik, T. (2002) The Work of Alfred Lorenzer: An Introduction. http://bidok.uibk. ac.at/library/schaffrik-lorenzer-work-e.html, accessed 30 April 2010. Zinkin, L. (1983) Malignant Mirroring. Group Analysis 16 (2): 113–126.

Index

Ainsworth, M.D.S., 116, 127 alliance, 115–119, 155, 156, 164; forming, 119, 120; supervisory, 2, 115–121, 123, 125, 127, 148, 155, 156, 164, 174, 197; therapeutic, 116, 119, 165; working, 115, 117, 119, 120, 126, 164 alpha element, 99 ambivalent attachment, 89 Andersen, T., 204, 213 anecdote, 174 Anna O, 51, 61 anonymity, 66 anxiety: and group supervision, 70, 141, 155; and patients, 35, 124, 134; and students, 70; anxieties, 23; death, 108; Foulkes and, 28; Freud and, 27; mother's, 144, 196; supervisor's, 110, 111; therapist's, 111, 152, 153, 155, 163, 188 anxious attachment, 121 attachment: ambivalent, 89; anxious, 121; avoidant, 116, 117; insecure, 115, 164; internal working model, 115, 119–127, 162; relationship, 149; secure, 115, 116, 118, 121, 134, 150, 156, 157, 161, 162, 164, 165 attachment perspective, 162 attachment theory, 115, 119, 122, 126, 127, 133 attitude, 163 authority, 47, 48, 51, 59, 82, 91, 97, 102, 104, 110 autonomy, 68, 132 avoidant, 116, 117, 162 avoidant attachment, 116, 117

Behr, Harold, 14, 62, 71 beliefs, 19, 33, 102, 134 Berlin, 9, 52 beta element, 99 Bion, W.R., 55, 58, 60, 85, 96, 97, 98, 99, 106, 111, 151, 158, 206, 213 blame, 58, 168, 182 body: and mind, 9, 21, 24, 27, 28, 29; bodily, 32, 92, 149, 150, 205–208; feelings held within, 193; image, 21; language, 65, 92, 121, 163, 187, 205; level, one of five levels of communication in a group, 36; mother child bond, 149, 155 bonding, 143, 149, 195 Borkenau, Franz, 22, 23, 25, 30 boundaries, 11, 43, 82, 83, 92, 97–103, 111, 153, 157, 210; and disability, 189; and group supervision, 58, 82, 92, 97; Bion and, 99; breaking of, 83, 191; dynamic administration, 43, 48, 71, 82, 100, 108, 109; external, 82, 97, 99, 101; Foulkes and, 55, 58; Freud and, 51; in therapy groups, 167, 208, 210; internal, 92, 97, 105, 109, 111; Noack and, 100; of a space, 141; of supervision groups, 101; of time, 92, 153, 208; secure base, 120; supervision, 110; Winnicott and, 98, 99 boundary, 51, 82, 83, 97–100, 104, 111, 189 Bowlby, J, 121, 162, 169 brain injuries, 9 Brown, R., 69, 70, 76 Budapest, 52 burnout, 117

Balint, M., 12 BAPPS, 14, 74, 75

case discussion, 51, 52, 65 catharsis, 38, 150, 156

216 Index chain reaction, 48, 189 change: and attachment, 116, 119; facilitating change, 40; family and therapy, 203; how change happens, 11, 36–38, 44, 132; in group supervision, 64, 86, 98, 152, 157; in the therapist, 85, 106, 107, 139, 142; maintaining, 43, 45, 48; organisational, 90, 91, 164; parallel process and, 174–176, 181; resistance to change, 36, 42, 115; societal change, 23, 25, 29, 33, 54, 76, 139; therapy and, 31, 57, 110, 132; therapy group, 163 childhood, 7, 203; and Freud's theory, 19; and therapy, 35, 39, 47, 89, 143, 166; influences, 23, 29, 30, 107, 129, 207; regressing to, 21 civilising, 22, 23 clinical rhombus, 81 co-conduct, 62, 63 communication: between internal and external reality, 98; conscious and unconscious group, 44, 200; family, 203, 204; Foulkes as army communications officer, 8, 186; lack of, due to disability, 190; language and dialect, 193; levels of, 36, 186; metaphorical, 132; non-verbal, 150; of repressed feelings, 150; on battlefield, 8, 186; parallel process enactment as, 87; parent infant, 151; play as, 148; translation, effect on, 39; web of, 33, 70; within the organisation, 164 community, 12–14, 32, 33, 47, 83, 87, 89, 103–105, 134, 135, 177, 190–195, 198, 199 competition, 68, 144, 147, 155 concept, 10, 31, 70, 97, 98, 119, 129, 133, 167, 174, 176, 190, 203, 211 condenser phenomenon, 193, 211 conditioning, 34, 38 conducting, 62, 63, 72, 119 conductor, 44–48, 56, 64, 73, 111, 202 containing, 73, 97–99, 102, 103, 106, 111, 149, 151, 179, 180 containment: and work, 167; Bion and, 98, 106, 111; containing, settings, 90; dynamic administration, 97; mothers and, 144, 148, 151; provided by the supervision group, 101, 102, 141, 148, 154, 155, 156; supervisor's role in, 53; therapist offers, 150; with students, 72

context,; family, 193; group, 83, 84, 99, 100; historical, 7, 36, 54; of the group, 40; of the therapy, 10; organisational, 35, 90, 91, 212; psychoanalytic, 51; regulatory, 74; rivalry in, 68; social, 13, 25, 28, 30, 32, 34, 35, 42, 95, 192, 205; supervisor's task, 111; training, 208 contextualisation, 19 contract, 37, 99, 101 Corbett, 69, 70 counselling, 87, 100, 101, 103, 104, 134, 143, 161, 168, 192 countertransference: and parallel process, 173, 175, 177, 203; Foulkes and, 10; in group supervision, 56, 70–73, 106, 108, 125, 130, 132, 163, 203, 213; in groups, 44; Lorenzer, 204; supervisor's, 86–89, 92, 168, 178; theory and, 53, 56, 60, 64, 65, 69, 145; therapist's, 95, 122, 142, 187, 211; trainees, 52 creative repair, 168 creativity, 132, 144, 147, 166, 167 cultural, 23, 29, 39, 72, 107, 131, 132, 153, 156, 187, 191–198, 199, 200, 205, 211 culture, 11, 14, 19, 29, 32–34, 103, 107, 186, 187, 191–195, 198; and difference, 190–198; and group supervision, 195; supervision group, 107, 155; therapists and, 190–192, 197; work, 167 curiosity, 7, 54, 60, 182 dependency, 58, 131, 132 depression, 3, 34–38, 47, 108, 134, 153 Deutsch, H., 11, 59, 60 Dick, Barbara, 14, 63, 77 dissociated, 28, 35, 142, 150, 188 distress, 3, 4, 19, 32, 34, 36, 42, 44, 83, 99, 108, 136, 187, 207 disturbance, 36, 37, 191, 194 diversity, 4, 33, 186, 187, 200 drama therapy, 3 dramatisation, 10 dreams, 19, 26, 39, 45, 107, 110, 211 dyadic, 3, 27, 38, 39, 54–57, 75, 90, 100, 115, 119, 143, 144 dynamic administration, 43, 51, 59, 69, 71, 81, 82, 95–98, 102, 111, 188; group therapist's role, 43, 44, 97; supervisor's role, 95, 100, 102, 105, 106, 111 dynamic matrix, 33–36, 43

Index 217 education, 3, 72, 190, 211 EGATIN, 73, 75, 76 ego, 20–29, 134 Ekstein, R., 53–55, 58, 60, 81, 82, 96 Elias, Norbert, 11, 12, 20–25, 29, 30–32, 55 emotional climate, 133, 134, 187 empathy, 123, 151, 153, 154, 166 enactment, 53, 57, 88, 161, 174, 181, 189 encounter groups, 31 enlivening, 167 environment, 22, 28, 29, 34, 38, 91, 98, 115, 150, 156, 161, 164; environmental, 12, 28, 32, 48; holding environment, 97, 98, 102, 103, 107, 111 ethics, 4, 152 Europe, 2, 3, 14, 22, 34, 55, 64, 67, 70–76 evidence, 3, 8, 10, 20–23, 31, 51, 52, 58, 60, 115, 119, 174, 183, 211 exclusion, 75, 83, 189, 191, 196 existential primary task, 133, 152 expertise, 54, 67, 72, 75, 100, 109, 165 faith, 144, 156, 200 family narrative, 187 formative, 152, 153, 195 Foucault, Michel, 2 Foulkes, Elizabeth, 7, 8 Foulkes, S.H.: childhood, 7; culture and values, 194; dynamic administration, 97; establishing group analysis, 13–15, 48; First World War, 8; foundation matrix, 102; group analysis, early development, 12; group analysis, his approach, 24, 27, 47, 55, 56, 111; group analytic practice, 95; group analytic, his role in its origins, 2, 20, 24, 25, 29, 34, 48, 67; group as mother, 151; group supervision, 142, 211; group supervision, 54, 63, 66, 106, 129; group supervision, countertransfer in, 202; group supervision, origins of, 10; group supervision, parallel process in, 202; group, multiple perspectives of the, 186; group, offering acceptance and respect, 199; influenced by Elias, 11; influenced by Goldstein, 27; influenced by Gruhle, Jasper and Freud, 8; medical studies, 10; mirroring, 157, 176; move to England, 12; non-verbal,

132; non-verbal, 132; parallel process, attitude to, 178; psychoanalyst, wanting to be, 9; psychoanalytic studies, 11; resonance, 129; resonance in a group, 202; supervision group, 85; therapy groups, 193; university studies, 9; value of the group, 199; whole person, 27 foundation matrix, 33–36, 102, 187, 191, 198 frame, 2, 68, 71, 97, 99, 157, 168, 193 Frankfurt, 9, 11, 29, 195 free association, 8, 19, 26, 38, 39, 44, 51, 57, 59, 66, 70, 120, 132, 153, 211, 213 free group association, 187 Freud, S., 8, 11–15, 19, 20, 21, 22, 23–34, 44, 47, 51, 52, 54, 61, 173 Freudian theory, 19, 25, 32, 47 GASi, 14 gender, 100, 109, 110, 117, 187, 199 Gorki, 12 ground, 3, 10, 20, 29, 36, 66, 67, 81, 86, 103, 191, 197 group analytic supervision, 14, 51, 54, 62, 64, 70, 74, 111, 124, 132, 187, 213 group supervisory, 164 Gruhle, 8 healthcare, 7, 102 Hearst, Liesel, 14, 63, 67 Heimann, 12, 53, 54, 61 Hitschmann, 11 holding environment, 97, 98, 102, 103, 107, 111 holism, 21 holistic, 10, 20, 21, 24, 28, 29, 66 human mind, 12, 20, 21 humility, 117, 126, 179 Hunter, R.C.M., 55–59, 60 id, 20–22, 26, 29, 34 idealisation, 166 identity, 34, 52, 162, 163, 187, 188, 197, 198, 200 IGA, 14, 55, 62, 65–69, 72, 74, 76, 78, 127, 185, 203 illusion, 98 impasse, 83, 88, 95, 129, 132, 153, 163 injury, 21, 167 insecure attachment, 115, 164 Institute of Group Analysis, see IGA

218 Index internal working model, 115, 119–127, 162 internal world, 87 internalised discrimination, 188 internet, 73, 74, 75 Interpretation, 8, 15, 22 Intersectionality, 190, 200, 201 intervention, 84, 88, 89, 108 introjection, 20–30, 33, 34 isolation, 1, 9, 27, 33, 40, 48, 75, 198 Kasinski, 69, 70 Keller, Helen, 20, 24, 26, 29, 199 Klein, M., 22, 26 language: and power, 191, 193, 194, 200; body, 65, 92, 121, 163, 187, 205; difference of dialect and, 187, 193; emergence of ego, 26; group analysis, 2, 48; in supervision, 3, 57, 92, 132; of attachment theory, 115; of group analysis, 31, 32; right brain, 119; trainee's use of, 85; used of illness and health, 3, 32 language and religion and nation, 198 libido theory, 28 loneliness, 84 lonely, 84 matrix, 33, 36–39, 70, 73, 97, 107, 188 Maudsley Hospital, 13, 54, 62 memory traces, 19, 23, 29, 47 metaphor, 44, 75, 122, 131, 132, 141 mirroring, 65, 67, 71, 150, 151, 157, 176–178, 209 model of the mind, 20, 21, 26, 29, 30; Foulkes, 29, 30; Freudian, 12, 19–21, 26 monitoring, 69, 83, 86, 154, 168 Montreal, 57 motivation, 2, 65, 155, 167, 168 mourning, 22, 91–94, 108, 179 multiple perspective, 12, 186 multiple perspectives, 70, 73, 126, 186, 187, 191 mutuality, 66, 186 narrative, 162, 178, 182, 183, 205, 207, 213 neglect, 189 network, 9, 28, 32–34, 38, 42, 186 NHS, 90, 104, 105, 121 nodal point, 9, 34 normative, 133, 134, 152

norms, 19, 23–26, 29, 33, 195 Nunberg, H., 11, 15 nurse, 41, 46, 83, 87; nursing, 3, 143 nursing, 3, 143 nurture, 144, 151, 154, 164, 168 Oedipus complex, 27, 28 organisation, 67, 83, 89, 90, 95, 102, 103, 104, 133, 143; charitable, 82; organisational, 14, 90, 91, 103, 164; professional body, 101, 102; setting, 105, 143; supervisor and, 100, 101, 133, 168 outsider, 33 parallel process: and group analysis, 177; and group supervision, 86–89, 109, 125, 164, 166, 178, 179; history of, 53, 54, 58, 67, 68, 71, 72; research and, 173, 174, 175; six stage model for working with, 176, 179–184; working with, 195, 196, 202, 208, 211 peer supervision, 88–90, 132, 174 perception, 9, 118, 132, 186, 188, 199 persona, 167, 168 perspective: attachment, 162; environment, 29; group analytic, 45, 48; group supervision, 70, 73, 122, 126, 186, 187, 191; multi-, 70, 73, 186, 187, 191; social, 47; theoretical, 29, 53, 71, 111, 152; trainee, 70 perspectives, of the group, multiple, 186 phantasy, 34 phenomenological, 133, 134, 152 phylogenetic, 19 play: benefits of, 134; childhood, 84, 115; group relationships promoted by, 132; in supervision, 110, 131; potential space and, 98, 107, 130, 142; psychoanalysis and, 132; transitional space and, 148 power: and early psychoanalytic practice, 51, 53; and group therapy, 187, 191, 193, 209; and projection, 36; expressed through art, 144; in group supervision, 72, 117, 133, 191, 194, 195; of group supervisor, 196, 197, 200; of nature, 141; of social norms, 32; of the therapy group, 54; of the unconscious, 28; with trainees, 110 practitioners, 3, 62, 102, 133, 152, 160, 161, 164

Index 219 pre-conditioned, 12, 32 preconscious, 19, 25 prejudice, 59 primary process, 26 primordial, 36 privilege, 192, 200 probation, 7, 3, 102 projection, 20, 26, 27, 30, 32, 33, 38, 40, 58, 168 proximity, 149, 150 Psychiatry, 61, 184, 213 psychoanalysis, 43, 57; and Elias, 24; and Freud, 51; and group analysis, 20, 31, 62; and group supervision, 68; and playing, 132; history of, 11; holistic understanding, 27; Kleinian, 14; psychoanalyst, 11, 14, 20, 54; seeing the person as a whole, 27 psychological, 162; disturbance, 12, 19, 27, 32; nature, 23; process, 20; relationship, 160; responses, 28; therapist, 74, 102, 103 psychosomatic, 9 psychotherapy, 74, 100–102, 110, 115; effectiveness, 2; group analytic, 14, 36, 63, 90, 97, 119, 209; need for, 3; training, 119 reality, 34, 98, 111, 130, 192 reflecting team supervision, 74, 202–204, 207, 210 repair, 117, 150, 153, 166 reparation, 167 reparative, 167 repressed, 19, 25, 26, 38, 41, 163, 186, 188, 205, 206 resilience, 134 resistance, 37, 58, 63, 156, 157 resonance, 10, 41, 45, 107, 142, 149, 163, 195, 200–203, 213 restoration, 141 restorative, 148, 149, 152–154, 156, 168 retirement, 91 reverie, 72, 73, 98, 111, 151, 153, 197 rivalry, 68, 73, 107, 125, 149, 152, 155, 193, 200 Rogers, Carl, 31 role responsiveness, 173, 175, 183 role reversal, 118 rupture, 117, 125

scenic understanding, 203, 205 Schilder, Paul, 9 secure attachment, 115–118, 121, 134, 150, 156, 157, 161–165 secure base, 115, 119–121, 133, 134, 142, 150–155, 162, 163, 168, 169 self-awareness, 63, 142, 181, 192, 195, 200 self-esteem, 34, 134, 181 setting: boundaries and, 99; community mental health, 103, 134; hospital, 72, 73, 103, 104; in children's centres, 143; institution, 67; organisational, 103; private, 105; social care, 103; supervision groups in a, 102, 103, 162; therapist’s interactions with, 64 sexual orientation, 187 shame, 68; and class, 193; and the therapist, 198, 209, 210; culture and, 149, 155; in group supervision, 66, 68, 85, 86, 120, 183, 189, 194, 196, 212; in therapy, 165, 166; reduction, 131, 155, 210; supervisor's role in managing, 168 Sharpe, Meg, 14, 65, 67, 69 siblings, 84 Skynner, R., 54, 160, 161, 166, 169 social context, 13, 28, 32, 35, 42, 95, 205 social environment, 22, 48 social status, 186, 187, 200 social unconscious, 19, 133, 187, 188, 191–200 social worker, 3, 143, 160, 164 socialisation, 23 socio-cultural, 12 sociogenetic, 11, 19, 20, 23, 25, 29 splitting, 58, 168, 196 spontaneity, 148, 166, 167 stability, 152 stress, 23, 34–36, 68, 116, 117, 124, 156, 168 Stroh, George, 55, 57, 60, 61 structure, 19, 59, 71, 81, 95, 103, 132, 136, 141, 152–157, 160, 168, 187 student, students, see also trainees, 3, 4, 10, 59, 62–71, 101, 110, 111, 116–125, 134, 142, 164, 173–176, 179, 181, 183 subjective experience, 133 superego, 20–26, 29 supervision group dynamics, 68, 82, 86, 88 supervisory alliance, 2, 115, 117–121, 123, 125, 127, 148, 155, 156, 164, 174, 197 supervisory contract, 100, 164

220 Index supervisory relationship, 53, 69, 90, 117, 118, 125, 164, 199 supervisory stance, 68 supplement, 19, 21, 23, 25, 27, 29, 31, 74 sustaining practice, 167 symbols, 26 symptom, 2, 36, 37, 42 taboo, 23 teaching, 10, 52, 55, 65, 69, 117 theories, 9 timing, 208 topological, 22, 25 trainees, see also student: and mirroring, 177; and supervision, 8, 52, 54, 62, 64, 69, 70, 107, 110, 117, 134; competing demands, 102; student perspective, 70; theoretical framework, 102 transgenerational trauma, 196 transitional object, 167; transitional space, 98, 99, 108, 111, 148 translation, 39, 44, 108, 200 transmission, 117 trauma, 4, 87, 88, 153, 187, 203, 207 trust, 104, 116, 142, 154–157, 162, 164, 165, 199, 200, 212 uncertainty, 139 unconscious: and repression, 23; and the ego, 22, 26; and the superego, 22, 26; and trauma, 42; association, 107; attention by therapist, 44; bias, 195; conflict, 27, 48, 189; cultural norms,

25; defence mechanisms and, 26; dreams, 26; dynamics, 72, 203, 204; enactment, 57; exchange, 40; Foulkes and the, 22–28, 34, 37–44, 205; free association, 26, 202; free floating discussion, 38, 44; free group association, 187; Freud and the, 19; images, 132; levels, 39; levels, conscious, preconscious and, 39; meaning, 187; messages, 205, 206; mirroring, 65, 157; motivation, therapist, 57, 60, 63, 130; needs, therapist, 130, 160, 167; parallel process relation to, 175–180; physical symptoms, 35; presuppositions, 130, 191; processes, 39, 44, 59, 66, 73, 178, 204; repressed by culture, 34; resonance, 41, 177; reverberations, 157; role, 57; symbols, 26; time, 153; translate, 73; translation, in the group, 38, 111 unearned power, 187 values, 21, 36, 186, 194, 195 video conferencing, 75, 105 Vienna, 11, 31, 52, 55 vocabulary of movement, 150 Wallerstein, R.S., 53–55, 58, 60, 81, 82, 96 Winnicott, D.W., 12, 97–99, 100, 104, 107–111, 132, 139, 148 wounded healer, 160