J Contemp Psychother
DOI 10.1007/s10879-011-9201-5
ORIGINAL PAPER
Supervising Psychoanalytic Psychotherapy: Present Knowledge,
Pressing Needs, Future Possibilities
Joan E. Sarnat
! Springer Science+Business Media, LLC 2011
Abstract Existing research from the fields of education,
cognitive science, neuroscience, and psychoanalytic psy-
chotherapy points us toward possibilities for the future of
psychoanalytic supervision. This research suggests that we
need to go beyond communicating abstract knowledge and
make our supervisory relationships more experiential,
participatory, relationship-focused, and personal in order to
teach usable knowledge, develop complex psychothera-
peutic skills, and facilitate emotional and relational
development in our supervisees. The author concludes that
a relational model of supervision fits this pedagogical
profile. After grappling with our resistances to change, the
author hopes that more psychoanalytic supervisors will
make use of a relational model of supervision, as well as
drawing upon new technologies and neuroscience-based
teaching techniques.
Keywords Psychoanalytic supervision !
Psychodynamic supervision ! Relational model of
supervision ! Neuroscience ! Education research !
Cognitive science ! Psychoanalytic psychotherapy
I am grateful for this opportunity to step back from daily
practice and from my usual writing on the supervisory
relationship in order to reflect on the Big Picture questions
that Dr. Watkins has posed. My answers reflect my per-
sonal views as a clinical psychologist and psychoanalyst
who practices, writes and teaches about supervision from
an intersubjective/relational psychoanalytic perspective. In
J. E. Sarnat (&)
3030 Ashby Avenue, Suite 109B, Berkeley, CA 94705, USA
e-mail: jsarnat@post.harvard.edu
characterizing the field today, I draw upon my impressions
of the practices and attitudes that I have observed in
supervisors whom I have encountered in my own training
(at the University of Michigan 19701975 and the Psy-
choanalytic Institute of Northern California, 19972002);
in my professional life as a practicing psychologist, psy-
choanalyst, and teacher of psychoanalytic psychotherapy
and supervision in the San Francisco Bay Area; and, before
that, in Amherst, Massachusetts.
In all of my writing on supervision I have advocated for
moving beyond a didactic, patient-centered, one-person-
psychology model of psychoanalytic supervision to a more
experiential, intersubjective, and analytic approach which
I call a relational model of supervision. My responses to
Dr. Watkins questions reflect that commitment.
What We Already Know About How to Supervise
Psychoanalytic Psychotherapists
In reviewing the literature in preparation for writing this
paper, I was struck by how much empirical knowledge and
clinical understanding we already have that could help us
to become better psychoanalytic supervisors. Yet, in my
world, the world of psychoanalytic psychotherapists and
psychoanalysts outside of academia, much of the knowl-
edge contained in the literature remains unfamiliar, or has
at least failed to be integrated into our practice.
Core Competencies and How to Teach Them
in Supervision
A necessary first step in improving how effectively we
supervise our students is to define what we want our stu-
dents to learn. Clarity has been slow in coming both
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because of the complexity of the task of describing what
exactly a good psychoanalytic psychotherapist does; and
because of disagreements between psychoanalytic schools
about what effective therapeutic participation looks like.
However, recently progress has been made.
Within psychoanalysis proper, Tuckett (2005) estab-
lished common ground as to what psychoanalytic candi-
dates should learn. He defined three frames that any
psychoanalyst should be able to create and sustain during
treatment. First is the participantobservational frame,
which emphasizes the analysts capacity to bear and pro-
cess, rather than only acting upon, the emotional states that
the patient evokes within the analyst,1 while participating
in a relationship with the patient. Second is the conceptual
frame which concerns the specific ability to conceptualize
clinical experience (p. 41), by identifying the transference
and countertransference and the development of an analytic
process. Third is the interventional frame, which is the
ability to intervene in a way that is consistent with the
analysts participant-observational stance and his or her
conceptualization.
When I was asked to define the core competencies of the
psychodynamic psychotherapist by selecting from Rodolfa
et al.s (2005) list of competencies for professional
psychologists, I selected relationship, self-reflection,
assessment and diagnosis, and intervention (Sarnat
2010) as central for the psychodynamic psychotherapist. In
highlighting these particular competencies I drew upon
Tucketts work, relating these core competencies to his
frames.
Cabaniss (2008, 2011) has been working along similar
lines, defining learning objectives for psychodynamic
psychotherapists and analytic candidates. For example, she
breaks down the primary learning objectives for psycho-
analytic interventions into the skill series listen, reflect,
intervene and then tries to specify precisely what needs to
be learned for each of these skills.
All of these approaches to defining our pedagogical
goals in conducting psychoanalytic supervision suggest
that we need to help our supervisees to learn three rather
different kinds of things. First, we need to become effective
at transmitting knowledge about theory and technique in a
manner that is meaningful to our students and accessible
for use. Second, we need to train our supervisees to become
expert at a variety of complex psychotherapeutic skills.
Third, we must find ways to facilitate the development of
a variety of emotional and relational capacities in our
supervisees. Improving our supervisory methods in each of
these three areas should, in my view, be our goal for the
future of psychoanalytic supervision.
1
In my view, this is an ideal, since, from a relational perspective,
enactment is understood to be inevitable and universal.
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J Contemp Psychother
Insights from Education and Cognitive Science
Given the lamentable absence of process and outcome
research in psychoanalytic supervision itself (Watkins
2010), Cabaniss (2008) borrows relevant research from the
field of education to define best practices in teaching psy-
choanalytic psychotherapy skills. In particular she refers to
research conducted by Tyler which demonstrated the
effectiveness of specifying and operationalizing goals and
objectives, designing ones teaching strategy specifically to
accomplish them, and later using ones goals and objec-
tives to assess the effectiveness of the teaching process.
Drawing upon these ideas Cabaniss et al. (2011), in their
manual for training psychodynamic psychotherapists, pro-
vide examples for how one might actively and intentionally
teach skills such as listening, understanding, and inter-
vening. A psychoanalytic supervisor who followed this
manual would, at least some of the time, shift from her
usual attitude of associative receptivity toward the pre-
sented clinical material, to a more focused effort to teach
specific skills which the supervisor feels that the supervisee
needs in order to help the patient in question at that
moment.
But skill-building manuals go only so far in teaching the
art of psychoanalytic psychotherapy. After creating a
manual for short-term psychodynamic psychotherapy,
Strupp and Anderson (1997) were struck by its limitations,
and pessimistic about manuals in general for teaching
psychodynamic psychotherapy. As Binder (1999) put it,
it appears that manuals are most beneficial for
promoting the simple use of prescribed technical
strategies and tactics. [But] manualized therapy
training appears no more successful than other forms
of therapy training in facilitating the skillful use of
techniques (Crits-Christoph and Luborsky, 1996;
Crits-Christoph, Cooper, and Luborsky, 1988: Piper,
Joyce, McCallum, and Azim, 1993)Interpersonal
skills in establishing and maintaining an alliance with
the patient are essential however interpersonal
skills are enormously difficult to teach (p. 707).
[italics added]
Binder (1999) and Cabaniss (2011) understand that
training psychoanalytic psychotherapists involves much
more than can be conveyed in a manual. Binder (1999),
drawing upon research from cognitive science, concluded
that the central training task is to help beginning psycho-
dynamic therapists to transform declarative knowledge
knowledge of facts and theories learned from books,
seminars, and didactically-oriented supervisioninto pro-
cedural knowledge. Procedural knowledge is knowledge
about how to do something, like in-your-bones knowledge
about how to ride a bike. Cabaniss (2011) reached similar
J Contemp Psychother
conclusions based on educational research that shows the
importance of relevant, problem-centered, interactive, and
affectively rich learning experiences for educating adult
learners. Safran and Muran (2000), too, believe that
experiential, relationship-based teaching methods are most
effective in facilitating the capacity of supervisees to apply
interpersonal psychotherapy technique in a skillful manner.
As Binder (1999) defines it, the task is therefore to help
beginner therapists, whose working models are rudi- Winnicott 1972; Safran and Muran 2000; Ogden 2003,
mentary and fragmented, to develop sophisticated and
flexible working models by connecting abstract knowledge
about theory and technique to phenomenal experiences. As
psychotherapists gain experience, they learn to more
readily identify relevant patterns in material, make appro-
priate judgments about those patterns, and take action
spontaneously. These capacities become increasingly
unconscious and automatic with practice. Eventually an
expert even adapts quickly and smoothly to sudden chan-
ges and unexpected conditions. This kind of expertise is
worlds away from what beginners learn when they develop
simple skills like identifying a resistance or practicing
accurate empathy.
Psychotherapy integrationists such as Goldfried (1980)
and Bordin (1979), who looked for therapeutic competen-
cies that divergent psychotherapeutic approaches agree
upon, have similarly contended that the capacity to create a
therapeutic relationship is an essential, and perhaps the
primary psychotherapeutic competence. Psychotherapy
outcome research confirms Binders (1999), Goldfrieds
and Bordins conclusions. For example, Orlinsky et al.s
(1994) meta-analysis of hundreds of psychotherapy process
and outcome studies concluded that a good psychothera-
peutic relationship was the strongest predictor of positive
outcome, stronger than any particular technical approach.
Orlinsky et al.s findings affirm the importance of the
psychotherapist becoming expert in conducting the thera-
peutic relationship so that new corrective experiences may
occur within it, and so that a strong working alliance
between patient and psychotherapist may be developed.
One need only consider the task of learning to work with
transference, a therapeutic skill that lies at the heart of
psychoanalytic psychotherapy, to appreciate the centrality
of developing relational capacities in our supervisees. Most
students can be readily taught the skill of identifying the
major transference dynamic in a given session by practic-
ing finding it when reading a transcript or tape of a clinical
hour, or in process notes that they present in supervision.
However, how do you teach a supervisee to decide whether
it will be more facilitative, with a given patient at a given
moment, to address the transference directly, or to stay
within the patients metaphor? Whether to speak from
within the transference or about the transference? Or per-
haps to say nothing because the patient seems unlikely to
be able to make use of such an intervention at that
moment? And how do you help a supervisee to develop the
capacity to think at all while in the presence of an attacking
or devaluing patient? Maintaining a self reflective stance
under pressure, being able to hear the patient deeply and
respond non-reactively while under attack or refinding that
capacity after losing it, are competencies that are essential
for the psychoanalytic psychotherapist (see Bion 1962;
2005; Sarnat 2008, 2010, 2011). These capacities are most
likely to develop in our supervisees when they are able to
connect theoretical knowledge to lived experience in an
engaged, attuned, and safe supervisory relationship.
Supervisees prefer supervisory relationships that they
experience as safe and secure, according to a study by
Riggs and Bretz (2006) that related attachment processes in
supervision to supervisee satisfaction. Using data from a
survey of doctoral level interns, they concluded that
supervisees who perceived their supervisors as having a
secure attachment style had significantly more positive
feelings about both the supervisory task and the supervi-
sory bond than those supervisees who did not perceive their
supervisor as securely attached. Remarkably, this finding
held true regardless of the supervisees own attachment
style.
How can supervisors be helped to create a secure
attachment, to provide a relationship that helps to make the
link between abstract knowledge and lived experience, and
to thus facilitate the development of emotional and rela-
tional capacities within their supervisees? A relational
model of psychoanalytic supervision provides guidance.
Developing Emotional and Relational Capacities
and Teaching Through Experience: Insights
from a Relational Model
The relational psychodynamic model of supervision, which
I developed with Mary Gail Frawley-ODea (Sarnat 1992;
Frawley-ODea 1997; Sarnat 1998, 2011; Frawley-ODea
and Sarnat 2001; Sarnat 2006; Burka et al. 2007; Beck
et al. 2008), explicitly prioritizes accomplishing those
tasks. I briefly describe that model here.
A relational psychodynamic model of supervision draws
on contemporary psychoanalytic ideas (Aron 1996; Hoffman
1998; Mitchell 1997; Pizer 1998) about the centrality of
relationships in structuring the mind. Patient, therapist, and
supervisor are viewed as co-creators of two reciprocally
influential dyads. Exploration of the supervisory relation-
ship, as it relates to the clinical relationship, is considered
central to accomplishing the tasks of supervision. In contrast
to non-relational models of psychodynamic supervision, in
relational models the emphasis is upon acknowledging what
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is mutual within the supervisory relationship. (See
Bergmann 2003 and Frawley-ODea 2003 for illustrations
that contrast non-relational and relational approaches). The
supervisor is mindful that she, as well as her supervisee, has
an unconscious, and that both members of the supervisory
dyad introduce their transferences, anxieties, and resistances
into the interaction. At the same time, the supervisory rela-
tionship is understood to be an asymmetrical one in which the
supervisor has greater power and carries primary responsi-
bility for establishing the frame, tending the boundaries of
the supervisory situation, and adapting to the supervisees
learning needs.
Attending to disruptions in the supervisory relationship
is necessary in order to strengthen the learning alliance
(Watkins 2010). Strong learning alliances are desirable, of
course, in all supervisory approaches, including CBT,
family therapy supervision, and others. However in a
relational model of psychoanalytic supervision, attending
to disruptions in the relationship is important for reasons
that go beyond protecting the learning alliance, and that go
beyond protecting a secure attachment relationship as well.
The relational supervisor uses tensions in the supervisory
relationship as opportunities to give the supervisee a first
hand experience of how one works in treatment. In my
experience, after a supervisory disruption has been worked
through, talking about what was helpful to the supervisee,
and why it was helpful, allows the supervisee to connect
abstract clinical concepts to lived experience, and to
develop more sophisticated working models. Frawley-
ODea and Sarnat (2001) put it this way:
So much of what supervisees need to learn is difficult
to make explicit in words, and they too often hear, I
cannot explain to you how to do this if you have not
experienced it yourself. And so as supervisors we
strive to supplement our technical advice, our theo-
retical conceptions of the patient and of technique,
with a relationship, a medium that is also the mes-
sage. We embed our teachings in our own way of
being and doing within the supervision. We do
not take the supervisory process for granted, or ignore
it, but rather recognize it as the carrier of so much we
want to teach. We endeavor to engage supervisees in
an experience that transmits, unconscious to uncon-
scious, what we can never communicate directly or in
words (p. 229230).
In a previous paper (Sarnat 2010) I offered a vignette to
illustrate how working with a beginners conflicts and
anxieties during the supervisory hour allowed her to
develop new emotional competencies in her relationship
with a difficult patient. I described how my supervisee,
Lisa, used our affectively intense, quasi-therapeutic
supervisory interaction to reflect upon and gain mastery
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over her feelings of shame and anxiety as she first began to
conduct psychodynamic psychotherapy. She left our
supervisory hour, in which I think she had found me to be
emotionally available and a source of needed security,
feeling relieved. When, in the next therapy session, her
patient exploded at her, she was able, for the first time, to
sit with the patients feelings, as well as her own, and then
to reach out to her patient. As a result of this moment of
connection, Lisa and her patient were able to begin to
create an alternative to the dismissive-of-attachment pat-
tern that this patient had established with Lisa, and that the
patient had apparently created in many prior relationships.
In trying to articulate the theory of pedagogy that was
implicit in my work with Lisa, I said:
I was working to create a supervisory relationship
into which Lisa could safely bring intense affective
states, and in which we could do psychological work
with those states. Creating this kind of supervisory
environment is essential to supporting the develop-
ment of a supervisees capacity to bear the emotional
intensity of the psychotherapeutic relationship and to
learn from that experienceI often use experiences
in supervision to teach clinical theory, but only after
the crisis has passedIn this case we might discuss
such concepts as unconscious transference/counter-
transference enactment, resistance, defense, parallel
process, holding, and Bions (1962) concept of con-
tainer/contained. We would discuss each concept as it
had come alive in our shared experience. By inte-
grating theory with experience in supervision, my
hope is that my supervisee will feel that theorizing
can provide containment in the midst of turbulent
relational events, rather than being primarily an
intellectual activity. (2010, pp. 2526)
Working with parallel process is another way of helping
a supervisee to connect an abstract conceptualization to
lived experience. Sometimes a supervisees relationship
problem with the patient parallels into the supervisory
relationship, and comes alive there. The supervisor then
has an opportunity to address the issue in the here-and-now
of the supervisory relationship. When a supervisor does so,
and in the process acknowledges her own participation in
the difficulties, powerful experiential learning can occur.
(For examples see Frawley-ODea and Sarnat 2001; Filho
and Pires 2010; Sarnat 2011).
The relational model of supervision rejects the myth of
the supervisor as an objective expert who is more or less
immune to countertransference reactions (Frawley-ODea
and Sarnat 2001; Sarnat 2006). This shift in how we
understand the nature of the supervisors authority opens
the way for supervisors to seek consultation early and
often. I recently had an experience in supervising a
J Contemp Psychother
psychoanalytic candidate that brought home to me both the
power of recognizing parallel processes and the value of
consultation (Sarnat 2011). After a year of supervising my
candidates work with a severely traumatized patient, dis-
sociative defenses overwhelmed all three of us, causing
both the supervised analysis and the supervision to go dead.
I requested consultation from my peer group. Within this
supportive group, I was able to become aware of anxiety
and feelings of failure that had been triggered in me by the
supervision, as well as becoming more fully aware of my
emotional withdrawal from my supervisee and her patient.
In the course of the consultation, I was able to recontact
both my self-confidence and a feeling of emotional con-
nection to my supervisee and her patient. In our next
supervisory hour, as I told my supervisee about the con-
sultation, and about my understanding of what had hap-
pened to us all, her dissociative fog began to lift as well. In
that moment my supervisee got the value of using
another mind to process overwhelming affect. She also had
a first hand exposure to an experienced analyst, her
supervisor, getting help with her anxieties and defenses. As
a result her feelings of shame about her work decreased and
she was able to move ahead with her patient.
The relational models extensive focus on the imbedd-
edness of the individual mind in networks of relationships
provides supervisors with a powerful tool for thinking
about the impact of the organizations and cultures in which
they and their supervisees are imbedded. The impact of the
organization on the supervisory dyad is an area that Ekstein
and Wallerstein brought to supervisors attention over fifty
years ago with their concept of the clinical rhombus
(Ekstein and Wallerstein 1972, p. 11), although their the-
ory, ego psychology, did not allow as full an understanding
of the impact on individuals of the organizations in
which they work as does relational theory (Berman 2004;
Frawley-ODea and Sarnat 2001). Because supervisees
often unconsciously carry the unresolved organizational
issues of their agencies and/or training institutions into
their supervisory and clinical relationships, a supervisor
who is able to become aware of such conflicts and put them
into words can free the supervisee to learn and to grow.
This is similar to how a family therapy intervention can
free up the development of a child who has been a symp-
tom carrier for a family.
Finally, the relational model highlights the perspectival
nature of the individual supervisors take on the super-
visee, and the value of collaborating with other supervisors
who work with the same supervisee who inevitably see the
supervisee somewhat differently. Team meetings provide
an opportunity to address unconscious splitting dynamics,
and help each supervisor to better understand her own
relationship to the supervisee (Ebbert 2011). In all of these
ways a relational approach facilitates the emotional and
interpersonal development of the supervisee and facilitates
the linking of abstract knowledge and direct experience.
Although, admittedly, complex boundary issues must be
negotiated by supervisors who work in this way, the
supervisors capacity to maintain a clear focus on the
learning task, as opposed to a therapeutic task (Burns and
Holloway 1989; Ekstein and Wallerstein 1972; Frawley-
ODea and Sarnat 2001), provides one safeguard. The
relational supervisors commitment to accepting the inev-
itability of her own areas of unconscious participation also
offers some protection from the supervisee becoming the
container for the supervisors unconscious conflicts (Sarnat
1992). The models emphasis on supervisory consultation
and collaborating with other team members provides a final
check on boundary crossing.
Facilitating the Development of Emotional Capacities
in Supervision: Insights from Neuroscience
Research in neuroscience provides further guidance as to
how we can help our supervisees develop the emotional
capacities they need to become effective psychoanalytic
psychotherapists. This research also provides neurophysi-
ological correlates for many of the convergent insights
from cognitive science, education, and the relational
model. Divino and Moore (2010) summarized this litera-
ture and described how they made use of it to improve
their classroom teaching of psychoanalytic psychotherapy.
Specifically, they looked at research documenting the
neuroplasticity of the brain; the importance of affect
regulation to attachment processes; the impact of trauma
on brain development, especially in terms of the role
played by implicit/procedural memory; and the function
of mirror neurons. Divino and Moores understanding of
this research caused them to create a classroom environ-
ment in which the medium is the message and students
have an opportunity to learn from direct experience. For
example, Divino and Moore consciously strive to make
their theoretical lectures personally relevant to their stu-
dents in order to engage more parts of their students
brains, and thus increase retention; they return a second
time to material that they have perceived to be anxiety
provoking so that their students can have a chance to
absorb the material when in a calmer state of mind; they
bring into the discussion the performance pressures and
competitive anxieties that students generally experience
but dont talk about, as they teach about the reduced brain
processing capacity of brains that are highly anxious; they
co-lecture and use the instructor relationship to provide an
in vivo model of working with interpersonal disruption,
thinking out loud about the unconscious process that may
have triggered a tense or irritable interaction between
them.
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Divino and Moore (2010) concluded from their review
of the neuroscience research that experiential, emotionally
engaged, relationship-based approaches to teaching and
learning are most effective. This kind of learning situation
provides a combination of activation of the left hemisphere
of the brain, the part of the brain that deals with cognition
and language; and moderate activation of the right hemi-
sphere, midbrain, and limbic areas, the parts of the brain
that deal with impressions and affects.
Divino and Moores (2010) conclusions apply not only
to classroom teaching but to supervision as well. Take, for
example, a moment when a supervisees affectively intense
here-and-now experience is received by a supervisor who is
able to remain present for that intensity and helpfully
regulate it. Under these conditions, an activated supervisee
can be helped to hold on to some measure of reflective
capacity, or to regain it after losing it, thus integrating the
functioning of the left brain with the right brain and the
limbic system. This might describe what happened in
Lisas brain in the vignette referred to above. Such
moments not only facilitate emotional development in the
supervisee, but also model for the supervisee how to
facilitate psychological growth with the patient.
Schore (2011), also citing neuroscience research, urged
psychotherapists who regard interpretation and other verbal
communication with the patient as the central curative
factor in treatment to reconsider. He, too, recommended
paying attention to the patients non-verbal right brain,
since it is the site of the infantile self. When a therapist
communicates right brain to right brain a more complete
connection is made with the patient, a connection that goes
beyond words. Lobbying for the importance of developing
competence in making right brain to right brain contact,
Schore said:
At the most fundamental level, the work of psycho-
therapy is not defined by what the therapist explicitly,
objectively does for the patient, or says to the patient.
Rather the key mechanism is how to implicitly and
subjectively be with the patient, especially during
affectively stressful moments when the going-on-
being of the patients implicit self is dis-integrating
in real time (pp. 9495).
In supervision, too, this reordering of priorities makes
sense. Supervisors are most effective when they take seri-
ously the importance of attending to the relationship and
the nonverbal, affective, unconscious-to-unconscious bond
between supervisee and supervisor.
Neuroscience research also highlights the therapeutic
value of a person coming into contact with the contem-
plative state of mind that we most often associate with
meditators. As Ulmer (2011) pointed out, many psycho-
analytic thinkers have emphasized the beneficial impact of
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the analyst sustaining something akin to this state of mind.
Freud (1912) in his Recommendations to Physicians
Practicing Psycho-Analysis emphasized the value of the
analyst sustaining evenly hovering attention. Schafer
devoted an entire book of essays to something similar,
which he called the analytic attitude (1983). Bion (1962,
1970) spoke of the importance of the analyst sustaining a
state of reverie and entering an analytic hour without
memory, desire, or understanding.
Ulmer (2011) notes that Ogden foregrounds a contem-
plative state of mind in his paper on psychoanalytic
supervision. Ogden (2005) referred to the supervisory
relationship as guided dreaming, and in explaining a
successful supervisory encounter, he observed:
It was only because we were in a frame of mind akin
to the analysts state of reverie (Ogden 1997a, 1997b)
that we could use the supervisory hour in the utterly
unexpected way we did [talking about a novel]. This
sense of having all the time in the world, of having
time to waste,2 to my mind, is a necessary element of
the emotional background for an important kind of
associative thinking in the analytic supervisory set-
ting (pp. 12721273).
Here Ogden seems to be appealing to the supervisor and
supervisee to mobilize their right brains to share in a
contemplative state of mind.3
According to Ulmer (2011), neuropsychological studies
of meditation demonstrate that entering a state of con-
templation contributes to the development of five cogni-
tive/emotional capacities that are important for the
psychoanalytic supervisor.4 First, a state of contemplation
strengthens the connections between the parts of the brain
that generate intuitive feelings and the parts of the brain
that generate executive thinking and creative ideas (Holzel
2
Note that Ogdens article is about supervising psychoanalysis rather
than psychoanalytic psychotherapy. A supervisor who works in a
clinic setting, where multiple cases must be discussed in a given
supervisory hour, may not feel she has the luxury of relaxing into the
state of mind he describes. Yet I believe that the value of supervisor
and supervisee being able to enter the state of reverie that Ogden
describes applies to all psychoanalytic supervision, no matter how
time-pressured the setting.
3
For a discussion of how more structured mindfulness exercises may
be utilized in a relational approach to supervision, see Safran and
Muran (2000).
4
Research in this area has been complex and my discussion is
necessarily simplified. In reality there are multiple subtly different
contemplative states of mind that involve different parts of the
brain and that are developed by different forms of meditative practice
(Goleman 2003). For example, focused meditation strengthens
ones ability to focus on a single thing, while open-monitoring
meditation fosters an open awareness of the full range of experi-
ences, without privileging one over another. These different contem-
plative states of mind support different functions of the supervisor.
J Contemp Psychother
et al. 2010). Such connections could be helpful to a
supervisor who is trying to draw upon her unsymbolized
countertransference experience to formulate what is going
on between herself and her supervisee, as well as what is
going on between the supervisee and his patient. Second,
maintaining a contemplative state of mind increases ones
capacity to read micro-emotions (Ekman 2003) and thus
increases ones capacity to accurately empathize with the
other. Third, being in such a state allows one to maintain a
physiological state of calm while in the presence of intense
affective activation of another person (Ekman 2003).
Fourth, a person in a contemplative state of mind is more
alert, positive, open, flexible, and compassionate (Ekman
2003; Davidson 2003; Lutz et al. 2004), all excellent
qualities in a supervisor. Fifth, being in a contemplative
state of mind increases ones mentalizing capacities
(Fonagy and Target 1998) that is, ones capacity to reflect
upon both ones own state of mind and the state of mind of
another person. In summary, being with a person who is in
a contemplative state of mind increases in both parties the
capacity for accurate empathy, positive and open states of
mind, and integration between gut feeling and executive
thinking.
The implication of this research is that the atmosphere
one creates in the supervisory houran atmosphere of
spaciousness, emotional receptivity, and calmnesscan
have a profound impact on the supervisees ability to feel
secure in supervision, to settle down emotionally, and to
think and feel deeply and creatively. This then translates
into the supervisees increased ability to offer both secure
attachment and a containing, analytic attitude to his
patients, essential capacities for sustaining the participant-
observational frame that Tuckett (2005) described as a
primary psychoanalytic competency.
The pedagogical importance of a supervisor sustaining a
contemplative state of mind seems clear. But to prioritize
achieving such a state of mind, a supervisor would need to
value the stillness of reverie as much as more active forms
of teaching. Clearly a single supervisory stance doesnt
optimally facilitate the development of all therapist com-
petencies, and a variety of supervisor states of mind and
activities must be given place within the supervisory
relationship.
Pressing Needs and Future Possibilities
In summary, as I reviewed the literature in preparation for
writing this paper, I was amazed to realize how much we
already know about the art of teaching psychoanalytic
psychotherapy, how much consensus there is about what
works best in supervision, and how much research from
related fields backs those conclusions up. Whether one
draws upon the meta-analyses of the outcome literature on
psychoanalytic psychotherapy, upon cognitive science,
upon educational theory, or upon neuroscience, all arrows
point toward experiential, actively engaging, emotionally
rich, secure, and well-regulated relationship-based teaching
methods. A pressing need, in my view, is to encourage
psychoanalytic supervisors to make better use of this
knowledge. In order for more of us to integrate this
knowledge into our way of working, we will need to
understand our resistances.
Pressing Needs: Confronting Resistances to Working
Relationally in Supervision
Watkins (2011) observed that psychoanalysis has led the
way in the transition from patient-focused to supervisory-
relationship-focused supervision. However, in my experi-
ence, many psychoanalytic supervisors continue to work
from a non-relational, patient-centered, didactic model.
There are undoubtedly many reasons for this: commitment
to a particular clinical theory; comfort with supervising the
way one had been supervised, and a feeling of disloyalty
about changing ones approach; uncertainty about how to
engage relationally without crossing the teach/treat
boundary; anxiety about meeting the supervisee on the
more level playing field created by a relational view of the
supervisors authority (Frawley-ODea and Sarnat 2001;
Sarnat 2006).
Avoiding tensions in relationships is also a universal
human tendency, and as such knows no theoretical
boundaries. Even the most interpersonally oriented of
psychoanalytic supervisors sometimes do so, and we are
not motivated to change if we dont fully appreciate the
ways in which such avoidance undermines supervisory
effectiveness. For example, psychoanalyst Irwin Hirsh,
when asked under what circumstances he would explore
the relationship between himself and a supervisee, asserted
that he would not do so unless there is a problem
(Frawley-ODea and Sarnat 2001, p. 112). In my view, this
statement overlooks the possibility that unexpressed ten-
sion may exist, as well as showing a lack of appreciation of
the power differential between supervisor and supervisee
and how this discourages supervisees from bringing up
problems unless directly or indirectly invited by their
supervisors to do so. This attitude, held, I believe, by many
psychoanalytic supervisors, creates an atmosphere in which
dynamics in the supervisory relationship, which need to be
explored in order to help the supervisee develop in his or
her work with the patient, go unaddressed, and the super-
vised treatment flounders (Frawley-ODea 1997; Hirsch
1997).
As another example of the avoidance of tension in the
supervisory relationship, consider the transcript in
123

Chapter 8 of Ladany et al.s (2005) interpersonally-ori-
ented book on supervision. The transcript shows a super-
visor thoughtfully but persistently confronting a supervisee
who has a serious blind spot, and who is unwilling or
unable to face her difficulties. When the supervisee
becomes upset by the confrontation, the supervisor sug-
gests that the supervisee leave the room for a few minutes
and take a break. This otherwise skillful supervisor the working through of this interpretation is far from
believed that it was pedagogically necessary to interrupt
the supervisory hour because the supervisee was upset. But
in my view, the supervisor who does not sit with a super-
visee, and help him or her to calm down, misses an
opportunity to teach in the here-and-now how emotional
distress can be tolerated, worked with, and transformed in a
helping relationship. The supervisor misses an opportunity
to provide an experience of containment that might con-
tribute to the development of the supervisees capacity to
contain his patients distress (Burka et al. 2007). It is no
easy task to stay in emotional contact with a supervisee
during moments of intense distress, and to process ones
own responses sufficiently to provide affect regulation.
Doing so requires comfort with the idea of making use of
ones clinical capacities to facilitate supervisee develop-
ment. When supervisors dont sufficiently value such
moments as pedagogical opportunities, or cant imagine
how to work with such moments in a way that maintains
appropriate boundaries, they will naturally avoid them.
Binder (2011) cautions that we may use our clinical
skills in supervision as a rationalization for avoiding the
challenge of learning new supervisory methods:
clinical theories have been stretched to accommo-
date explanations of the components of therapist
performance, of the supervisory process, and as a
guide to teaching and supervising strategies. The
theory of parallel-process in the supervisory rela-
tionship is a prominent example of how applying
clinical theory to the understanding of the supervisory
process allows therapy teachers to rely on their
clinical skills when training therapy students. The
reliance on clinical theory as a substitute for a gen-
uine pedagogy for psychotherapy training may have
contributed to the relatively slow adoption by psy-
chodynamic therapy teachers of new technologies.
(p. 1)
While Binders point about why psychodynamic teach-
ers have been slow to adopt new technologies may be
valid, drawing upon clinical theory in supervision does
not have to stand in opposition to genuine pedagogy. freedom to organize in their own way what they bring to
Clinical-model-based approaches can actually contribute
to effective pedagogy and, as I will discuss in the
next section, need not contribute to avoidance of new
technologies.
123
J Contemp Psychother
It seems to me that much of the literature cited has made
an implicit interpretation to psychoanalytic supervisors:
Didactic teaching and skill development in supervision
are not enough. It is important to engage directly with our
supervisees and to reflect upon the difficulties that emerge
within our supervisory relationships, if we are to effec-
tively teach the art of psychoanalytic psychotherapy. But
complete. Continuing that working through is a pressing
need.
More Pressing Needs: Confronting Resistances to Other
New Methods Including New Technologies
Traditional supervisory methods, which require the
supervisee to see a patient before getting help, are not the
best way to train novices. We should, therefore, add
Binders (2011) fourth elementlearn-by-doing delib-
erate practice models that make use of interactive com-
puter programs and videotapes to the tripartite model. In
these analogue therapy situations the novice therapist can
practice responding to a progressively graded series of
situations, such as working with an angry or demeaning
client. Along similar lines, Cabaniss et al. (2011) and
Safran and Muran (2000) point the way to integrating
many skill-developing activities not only into the class-
room but also into the supervisory situation. These peda-
gogical strategies have been adopted by too few
psychodynamic training settings, at least among those with
which I am familiar.
Similarly, while it is considered standard practice by most
non-psychoanalytic supervisors and by many psychodyna-
mically-oriented supervisors in graduate school settings,
video and audio taping of clinical hours continues to be
rejected by many psychoanalytic supervisors. Kernberg
(2010) has recently called psychoanalysts to task for this
attitude. To me the exclusive focus on recording devices as
intrusions that are to be kept out of the sanctity of the psy-
chotherapy hour is myopic. This attitude brings to mind
classical psychoanalysts fantasies of being able to protect
their patients from their personalities and unconscious
conflicts if they try hard enough to be anonymous and
neutral (Mitchell 1998).
Some psychoanalytic supervisors reluctance to use
recording technology, however, comes not from concern
about the taping itself but from a worry about how the tapes
will affect the supervisory process. They fear that viewing
a tape in supervision will take away their supervisees
the supervisory hour. Yet if the supervisor allows the
supervisee to decide what in the tape to focus on, and
the supervisor pays attention to both what is avoided and to
the supervisees anxieties and conflicts in discussing the
J Contemp Psychother
tape, this concern becomes a non-issue. (Safran and Muran
2000). The supervisor can refer to avoided aspects of the
video tape as the supervisee becomes able to tolerate this,
in order to begin to work with the supervisees blind spots
and the anxieties that motivated those blind spots.
Unstructured reporting of a clinical hour, requesting
help with specific clinical or diagnostic questions, reading
of detailed process notes, playing of tapes, or engaging in
specific skill-building activities, computer-assisted or
otherwiseall are modes of participation that make sense
for teaching certain supervisees in certain situations. One
size fits all doesnt take into account the diversity of
learning styles of different supervisees and of a single
supervisee at different developmental stages. Just as we
individualize clinical technique with patients, we need to
individualize pedagogical technique with supervisees.
Overcoming our resistances to making use of all of these
possibilities, whether motivated by a lack of information
and resources, anxiety about trying something new, or
loyalty to orthodoxy, is therefore a second pressing need.
Future Possibilities
Once we address our resistances to change, exciting new
possibilities emerge. For me, first among these possibilities
is that more psychoanalytic supervisors will come to value
and make use of a their own construction of a relational
model of supervision. Viewing the supervisory relationship
as a tool for developing emotional and relational capacities,
and as a means of facilitating learning-through-experience,
seems to me to open up one of psychoanalytic supervi-
sions most exciting potentials.
The creative challenge of devising focused, participa-
tory teaching exercises that are sophisticated enough to
develop complex clinical skills also beckons us. Safran and
Muran (2000) as well as Cabaniss et al. (2011) have
already begun to forge a trail in this direction in training
psychodynamic psychotherapists. Even at the meetings of
the International Psychoanalytic Association, change is
afoot. Listening-To-Listening workshops, developed by Berman, E. (2004). Impossible training. New York: Routledge.
Haydee Faimberg, demonstrate how a well-designed quasi-
experiential training activity can attract even seasoned
psychoanalysts. In her workshops, transcripts of analytic
sessions are divided up into units of 5 or 10 min of clinical
process and distributed sequentially for discussion in a
small group of psychoanalysts. Participants thus have the
opportunity to experience the unfolding of the hour just as
the analyst did. During discussion, three senior analysts
listen for how each analysts inferences about the clinical
material stem from their unique implicit theoretical
assumptions, and how one analysts assumptions differ
from others. These groups strive to create a setting where
differences are safe to acknowledge, and growth in self-
awareness becomes possible.
Another exciting future possibility would be for
departments of psychology, in collaboration with computer
science departments in our universities, to create and dis-
seminate interactive computer programs, and other tech-
nological innovations, for use in clinical training programs
that are in the community as well as within academia. Not
only our supervisees but also their patients will be grateful
if we provide trainees with laboratory experiences for skill
development.
The neuroscience-based teaching techniques of Divino
and Moore (2010) and Ulmer (2011) also beckon us,
promising the possibility of broadening and deepening the
educational experience of the therapist-in-training. In
future we might, as Safran and Muran (2000) have already
done, supplement psychotherapy supervision with mind-
fulness training in order to help trainees to develop their
capacity for reverie and for tolerating disturbing feelings
stirred by their patients and the treatment process.
I hope that in future we can also expand the quantity of
empirical research studying the process and outcome of
psychoanalytic supervision. When and if this happens, I
look forward to discovering more about how best to teach
useful knowledge, hone psychotherapeutic therapeutic
skills, and develop emotional and relational capacities
within our supervisees.
References
Aron, L. (1996). A meeting of minds. Hillsdale, NJ: The Analytic
Press.
Beck, J., Sarnat, J., & Barenstein, V. (2008). Chapter 4, Psychother-
apy-based approaches to supervision. In Shafranske. Falendar
(Ed.), Casebook for clinical supervision: A competency-based
approach (pp. 5796). Wasahington: American Psychological
Association.
Bergmann, M. S. (2003). A contribution to the supervisory panel.
Psychoanalytic Dialogues, 13, 327339.
Binder, J. (1999). Issues in teaching and learning time-limited
psychodynamic psychotherapy. Clinical Psychology Review,
19(6), 705719.
Binder, J. (2011). Teaching and supervising psychodynamic psycho-
therapy. Paper abstract from C. E. Watkins, Jr. (Chair), Teaching
and Supervising Psychotherapies in the 21st Century: Pressing
Needs, Impressing Possibilities. Symposium presented at the
Annual Meeting of the American Psychological Association,
Washington, DC.
Bion, W. R. (1962). Learning from experience. London: Tavistock.
Bion, W. R. (1970). Attention and interpretation. London: Karnac.
Bordin, E. (1979). The generalizability of the psychoanalytic concept
of the working alliance. Psychotherapy, 16, 252260.
Burka, J., Sarnat, J., & St. John, C. (2007). Learning from experience
in case conference: A Bionian approach to teaching and
123

consulting. The International Journal of Psychoanalysis, 88(4),
9811000.
Burns, C., & Holloway, E. (1989). Therapy in supervision: An
unresolved issue. The Clinical Supervisor, 7(4), 4760.
Cabaniss, D. L. (2008). Becoming a school: Developing learning
objectives for psychoanalytic education. Psychoanalytic Inquiry,
28, 262277.
Cabaniss, D. L. (2011). Teaching psychodynamics in the 21st century.
San Francisco, CA: Lecture at the Meetings of the American
Psychoanalytic Association.
Cabaniss, D. L., Cherry, S., Douglas, C. J., & Schwartz, A. R. (2011).
Psychodynamic psychotherapy: A clinical manual. West Sussex:
Wiley.
Davidson, R. (2003). Chapter 8, The neuroscience of emotion. In D.
Goldman (Ed.), Destructive emotions (pp. 179204). New York:
Bantam Dell.
Divino, C., & Moore, M. S. (2010). Integrating neurobiological
findings into psychodynamic psychotherapy training and prac-
tice. Psychoanalytic Dialogues, 20, 337355.
Ebbert, N. (2011). Learning from experience together: Perils and
pleasures of collaborative supervision. Oakland, CA: Presenta-
tion at the Psychotherapy Institute Supervisors Conclave.
Ekman, P. (2003). The universality of emotion, 119156. In D.
Goleman (Ed.), Destructive emotions. New York: Bantam Dell.
Ekstein, R., & Wallerstein, R. (1972). The teaching and learning of
psychotherapy (2nd ed.). New York: International Universities
Press.
Filho, G. V., & Pires, A. C. (2010). Benign and disruptive
disturbances of the supervisory field. International Journal of
Psycho-Analysis, 91, 895913.
Fonagy, P., & Target, M. (1998). Mentalization and the changing
aims of psychoanalysis. Psychoanalytic Dialogues, 8, 87114.
Frawley-ODea, M. G. (1997). Whos doing what to whom?
Supervision and sexual abuse. Contemporary Psychoanalysis,
33(1), 518.
Frawley-ODea, M. G. (2003). Supervision is a relationship too: A
contemporary approach to psychoanalytic supervision. Sympo-
sium on psychoanalytic training and education. Psychoanalytic
Dialogues, 13, 355366.
Frawley-ODea, M. G., & Sarnat, J. (2001). The supervisory
relationship: A contemporary psychodynamic approach. New
York: Guilford Press.
Freud, S. (1912). Recommendations to physicians practicing psycho-
analysis. Standard Edition, 12 (pp. 111120).
Goldfried, M. (1980). Toward the delineation of therapeutic change
principles. American Psychologist, 35, 991999.
Goleman, D. (2003). Destructive emotions. New York: Bantam
Publishing.
Hirsch, I. (1997). Supervision amidst abuse: The supervisors
perspective. In M. H. Rock (Ed.), Psychodynamic supervision
(pp. 339360). Northvale: Jason Aronson.
Hoffman, I. Z. (1998). Ritual and spontaneity in the psychoanalytic
process. Hillsdale, NJ: The Analytic Press.
Holzel, B., Carmody, J., Evans, K., Hoge, E., Dusek, J., Morgan, L.,
et al. (2010). Stress reduction correlates with structural changes
in the amygdala. Social Cognitive and Affective Neuroscience,
5(1), 1117.
Kernberg, O. (2010). Psychoanalytic supervision: The supervisors
tasks. Psychoanalytic Quarterly, 79, 603627.
Ladany, N., Nelson, M. L., & Friedlander, M. L. (2005). Critical
events in psychotherapy supervision: An interpersonal approach.
Washington, DC: American Psychological Association.
Lutz, A., Greischar, L., Rawlings, N., Ricard, M., & Davidson, R.
(2004). Long-term meditators self-induce high-amplitude
123
J Contemp Psychother
gamma synchrony during mental practice. Proceedings for the
National Academy of Sciences, 101(46), 16,36916373.
Mitchell, S. A. (1997). Influence and autonomy in psychoanalysis.
Hillsdale, NJ: The Analytic Press.
Mitchell, S. A. (1998). The analysts knowledge and authority.
Psychoanalytic Quarterly, 67, 12.
Ogden, T. (2003). On not being able to dream. International Journal
of Psychoanalysis, 84, 1730.
Ogden, T. (2005). On psychoanalytic supervision. International
Journal of Psychoanalysis, 86, 12651280.
Orlinsky, D., Grawe, K., & Parks, B. (1994). Process and outcome in
psychotherapy. In A. D. Bergin & S. L. Garfield (Eds.),
Handbook of psychotherapy and behavior change (4th ed.,
pp. 270376). New York: Wiley.
Pizer, S. A. (1998). Building bridges: The negotiation of paradox in
psychoanalysis. Hillsdale, NJ: The Analytic Press.
Riggs, S. A., & Bretz, K. M. (2006). Attachment processes in the
supervisory relationship: An exploratory investigation. Profes-
sional Psychology: Research and Practice, 37(5), 558566.
Rodolfa, E., Bent, R., Eisman, E., Nelson, P., Rehm, L., & Ritchie, P.
(2005). A cube model for competency development: Implica-
tions for psychology educators and regulators. Professional
Psychology: Research and Practice, 36, 347354.
Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic
alliance: A relational treatment guide. New York: Guilford
Press.
Sarnat, J. (1992). Supervision in relationship: Resolving the teach/
treat dilemma in psychoanalytic supervision. Psychoanalytic
Psychology, 9, 387403.
Sarnat, J. (1998). Rethinking the role of regressive experience in
psychoanalytic supervision. Journal of the American Academy of
Psychoanalysis, 26(4), 529543.
Sarnat, J. (2006). Authority relations in psychodynamic supervision:
A contemporary view. In R. Raubolt (Ed.), Power games:
Influence persuasion, and indoctrination in psychotherapy
training. New York: Other Press.
Sarnat, J. (2008). Reuniting the psychic couple in analytic training
and practice: A candidates experience. Psychoanalytic Psychol-
ogy, 25(1), 110121.
Sarnat, J. (2010). Key competencies of the psychodynamic psycho-
therapist and how to teach them in supervision. Psychotherapy:
Research, Practice, Training, 47(1), 2027.
Sarnat, J. (2011). Disruption and working through in the supervisory
process. Paper delivered at the 47th Congress of the International
Psychoanalytic Association, Congress of the International Psy-
choanalytic Association, Mexico City.
Schafer, R. (1983). The analytic attitude. London: Hogarth Press.
Schore, A. (2011). The right brain implicit self lies at the core of
psychoanalysis. Psychoanalytic Dialogues, 21(1), 75100.
Strupp, H. H., & Anderson, T. (1997). On the limitations of therapy
manuals. Clinical Psychology: Science and Practice, 4, 7682.
Tuckett, D. (2005). Does anything go?: Towards a framework for the
more transparent assessment of psychoanalytic competence.
International Journal of Psycho-Analysis, 86, 3149.
Ulmer, N. (2011). Contemplating supervision: A neuropsychoanalytic
relational perspective. Lecture for the Supervision Study
Program. Berkeley: The Psychotherapy Institute.
Watkins, C. (2010). Psychoanalytic constructs. American Journal of
Psychotherapy, 64, 393416.
Watkins, C. (2011). Celebrating psychoanalytic supervision. The
Psychoanalytic Review, 98, 401418.
Winnicott, D. W. (1972). Holding and interpretation. New York:
Grove Press.