Group Supervision
Supervision Group
Working analytically with a client without supervisory support is very unwise. Every psychoanalytically oriented professional eventually faces the need to seek supervisory assistance. If they fail to do so, they risk losing either the client, their own well-being, or their profession—or all three.
Understanding this compels one to seek out and explore possible forms of such assistance. In this regard, group supervision holds a special place, as it offers certain additional advantages compared to individual supervision—for example, by providing the supervisee with clearer insight into hidden or problematic aspects of the analytic relationship.
The root of a psychoanalyst’s difficulties in working with clients lies in the inability to contain those aspects of countertransference that, for whatever reason, cannot be transformed into a form suitable for containment. Such content tends to be unconsciously projected outward from the therapeutic setting by the psychoanalyst. The task of supervision is to transform these contents into an acceptable form that is accessible for further processing by the psychoanalyst.
In the process of group supervision, the contents that are not contained by the psychoanalyst are projected onto the members of the supervision group. These contents manifest differently among various group members, due to their particular sensitivity to specific aspects of these contents. The presence of “blind spots” and the participant’s own unresolved issues amplifies this differentiation. However, they manifest in a form transformed by the group members’ defense mechanisms. At the same time, aspects of countertransference that have not been worked through by the supervisor are amplified in their private and unbalanced manifestations due to splitting among group members.
The group’s efforts and the distribution within it of countertransference content that is not contained by the psychoanalyst ensure its manifestation in participants as feelings (successful containment), sensations (conversion, somatization, etc.) and extraneous thoughts, as well as personal memories (intellectualization, displacement of affect, etc.). Due to the setting of supervisory groups, these reactions become accessible to group members for recognition as countertransference and can be brought back into the context of the supervisor’s interaction with their client. With the help of group members, these contents are then reworked until they are successfully transformed into a containing form.
This reprocessing occurs by linking countertransference contents in a new way through the objectification of the affects they evoke.
As the supervisor accumulates individual aspects of countertransference contents that were not previously contained, these aspects are gradually integrated with one another.
As the coherence of the objects of these mental contents increases, they—through the technical rules of supervision—begin to be retained by the supervisor in the reconstruction of the interaction with the client.
The other aspect of the process is the gradual suppression of the supervisor’s ego functions and the formation of the client’s introject. The supervisory setting facilitates the supervisor, at a certain point, projecting their own mature ego functions onto the supervisor figure and onto that part of the group that has already returned countertransference content.
Thus, as feelings are returned, a gradual transformation of countertransference occurs within the supervision group. After the return of non-contained countertransference content to the interaction between the psychoanalyst and his client, the group represents the healthy aspects of the client’s and the psychoanalyst’s personalities. The psychoanalyst finds himself in a situation where he contains aspects of the client’s psyche that were previously uncontained, while his observing self is projected onto the group and represented by it. In doing so, he contains—in a contained form—those aspects that he previously could not contain and had projected outside the therapeutic process.
In other words, a role reversal takes place during supervision. At the beginning of group supervision, the group experiences in various ways those aspects of the client’s psyche that the psychoanalyst is unable to empathically experience on their own, while the psychoanalyst experiences their own state of mind that arises when working with this particular client. During supervision, the specialist has the opportunity to personally experience the content projected onto the group.
The entire situation of group supervision involves the containment—in the form of a single introject—of the pathological aspects of the client’s mental functioning. This introject completely dominates the supervisee’s psyche but is contained by the supervisee’s own “I,” projected onto the group and reinforced by it.
This situation prompts the supervisee to introject both their own observing “I”—as realized by the group—and the observing part of the client’s “I.” Once this process has taken place, the supervision session concludes. Quite often, the process of the supervisor’s full recovery of mature ego functions is completed after the end of supervision.
The number of group participants is 7–10 people. With fewer participants, the return of countertransference reactions is hindered due to their limited distribution among group members. With a larger number of participants, the time required for the return of these feelings increases significantly.
The format of the report is flexible and includes: a query, a brief client history, information about transference and countertransference, the dynamics of the process, diagnostic criteria, and the supervisor’s query. Most often, the supervisor reports on their difficulties in the work and shares information about the client that they consider significant. Even a report that is chaotic and confusing can be perfectly acceptable for this work. When problems in the work cannot be articulated or identified, this is just as normal for supervision as clearly articulating them.
The duration of the report should be up to 20 minutes. If it lasts longer, the burden on the supervision group members caused by countertransference content projected onto them severely impairs the functioning of their observing self.
The role of the group supervisor is central throughout the supervision session. The supervisor serves as the focal point for the projection of the supervisee’s ego functions, and the success of the supervision depends on how effectively the supervisor engages other group members and sustains the process of projecting the supervisee’s mature ego functions onto the group. The supervisee’s task is to refrain from attempting to understand what is happening and to focus on maximum accuracy in their responses.
Group members must refrain from any evaluative reactions toward the supervisee or one another. All reactions from participants that do not reflect the supervisor’s feelings should be regarded as manifestations of fragments of the supervisee’s introjects. Reactions from participants that do reflect the supervisor’s feelings can be regarded as manifestations of the integration of the mature ego functions of the psychoanalyst and the supervisee.
The return of feelings is complete when the participant leading the process feels that their countertransference feelings have disappeared or have significantly changed. If the feelings have changed, it is necessary to begin the return process again from the initial stage in its new form.
Sometimes, after a participant has completed the return of countertransference content, the supervisor or other group members may be tempted to continue exploring the feelings returned by that participant. This should not be done, as in this case virtually the entire group is faced with a difficult task—within the limited time frame of the supervision session—namely, working through the supervisor’s deficient ego functions. The need for such clarifications stems from the supervisor’s pre-existing, mature ego functions—formed through the projective identification described above.
Group Supervision Technique.
The supervisor invites the supervisee to present a case. At the same time, the supervisor asks all participants to become aware of their own state and well-being, and reminds them of the need to monitor how these change throughout the presentation. While the supervisee is presenting their case, the supervisor monitors the supervisee’s reactions, the reactions of group members, and their own reactions to what is happening. The supervisor’s own reactions are the most important. Their ability to accurately recognize and verbalize their own feelings proves to be critically important. The moment the supervisor’s state begins to lose clarity, the sharing of information about the client must be stopped.
In other words, it is unacceptable for the content of the supervisee’s uncontained countertransference—which the supervisee projects onto the group—to overwhelm the supervisor’s observing ego functions.
Another situation in which the session must be halted involves the emergence of powerful primitive defenses in other group members. These most often manifest as direct or veiled attacks on the supervisor or on one another. Sometimes, in cases of somatization, various types of vegetative somatic reactions may occur. If these reactions become strong and pronounced, the presentation must also be stopped.
The third scenario, which is the most common, is the increasing suppression of the supervisor’s ego functioning. This may manifest as a growing loss of coherence in the presentation or an increase in primitive defensive efforts, most often aimed at establishing boundaries.
After the communication is complete, the supervisor invites group members to ask questions clarifying the client’s history or related to the course of psychotherapy. This is necessary for several reasons. Group members must somehow adapt to their changed situation and, if possible, restore the observing part of their self by formulating a preliminary interpretation.
The supervisor should allow those participants whose ego functioning has been disrupted to use questions as a means of expressing their defensive efforts. Finally, the supervisor must, when necessary, demonstrate their reliability to the supervisee as a supporting “I.” This is achieved through active group facilitation, recognizing and identifying any forms of attack on the supervisor, and providing effective and calm defense against them.
The return of projected countertransference begins with the supervisor. A participant who begins to return projected countertransference feelings to the supervisor first briefly describes changes in their state and well-being. The degree of coherence in their report is irrelevant. The purpose of the report is symbolization. This is not limited to verbal symbolization but also includes nonverbal components, including unconscious ones. The only requirement is that the supervisor pay attention to the report.
The Theoretical Part of Supervision This involves group members expressing their judgments about the case. By the time the discussion of countertransference content is concluded, the difficulties experienced by the psychoanalyst in the specific case become clear, as does the perspective from which the problems are examined—one that makes them understandable and useful to the supervisee. Quite often, there is simply no need for a detailed theoretical analysis, or it turns out to be so clear to the group members that its discussion takes only a few minutes.
In other cases, differences in the theoretical perspectives of the participants and the supervisor hinder theoretical understanding. In these cases, a theoretical analysis is often undesirable, as it disrupts the containment of introjects.
As in all other forms of group supervision, the possibility of a gradual accumulation of unresolved countertransference reactions remains here.