Integrating Psychodynamic and Systemic Supervision

Transcription

1 Integrating Psychodynamic and Systemic Supervision Peter Alan Reiner The potential value of integrating psychodynamic and systemic approaches cannot be underestimated; and increasingly, supervisors are called upon to facilitate and guide this process in their supervisees. Although the interweaving of the intrapsychic and the interpersonal has been slowly evolving for several decades (e.g., Scharff & Scharff, 2008), little has been written about the supervision of those learning to practice from this integrated perspective. The three major sections that follow describe resources available to systemic psychodynamic supervisors, both those to be recommended to supervisees and those to be perused by supervisors, themselves. The first section is chiefly for those supervisees often from countries other than the United States who have been trained in psychodynamic work with individuals and have had little, if any, exposure to systemic theory and therapy. The second is chiefly for systemically trained supervisees often those from the United States who have had virtually no exposure to mainstream psychodynamic concepts and practices. The final major section comprises key readings about the process and practice of psychodynamic supervision, which apply in the main to systemic psychodynamic supervision. Each major section begins with an introduction that describes it and its component parts. The Complete Systemic Supervisor: Context, Philosophy, and Pragmatics, Second Edition. Edited by Thomas C. Todd and Cheryl L. Storm John Wiley & Sons, Ltd. Published 2014 by John Wiley & Sons, Ltd.

2 2 Key Readings for Supervising Psychodynamically Trained Therapists Supervisors who are guiding psychodynamically trained supervisees in the transition from work with individuals to systemic work with couples and families would do well to recommend the following resources. The following list contains readings that are written from either an object relations or a self-psychology perspective, or from a perspective that incorporates concepts and interventions from both. Transitioning to systemic therapy practice A marvelous starting point is Scarf s easily digested two-part article that deftly interweaves the intrapsychic and the interpersonal. Gerson s book and the Scharffs (2008) chapter are excellent for supervisees seeking an in-depth read; the classic chapters by Lansky and Slipp provide quicker introductions to the systemic application of self psychology and object relations, respectively. The list ends with three excellent references that detail obstacles and constraints frequently encountered by therapists transitioning to systemic work. Scarf, M. (1986a, November). Intimate partners: Patterns in love and marriage (Part 1). Atlantic Monthly, 45 51, pp Scarf, M. (1986b, December). Intimate partners: Patterns in love and marriage (Part 2). Atlantic Monthly, pp This two-part article provides a superb, highly approachable introduction to the application of object relations theory, including projective identification, to clinical work with couples. Gerson, M. J. (2009). The embedded self: An integrative psychodynamic and systemic perspective on couples and family therapy (2nd ed.). New York: Routledge. This stellar book guides experienced psychodynamically oriented psychotherapists in incorporating systemic understandings and interventions. Gerson adeptly integrates the intrapsychic and the interpersonal, incorporating findings from neuroscience research and attachment theory. Lachkar, J. (2004). The narcissistic/borderline couple: New approaches to marital therapy (2nd ed.). New York: Brunner-Routledge. This sophisticated, clinically focused book applies foundational concepts from object relations and self-psychology to therapy with couples; Lachkar also provides commentary on types of narcissistic disturbance and on the dynamics of matches of other personality styles. Lansky, M. (1986). Marital therapy for narcissistic disorders. In N. Jacobson & A. Gurman (Eds.), Clinical handbook of couple therapy (pp ). New York: Guilford. This approachable, classic chapter elucidates key clinical principles in the treatment of narcissistically vulnerable couples. Slipp, S. (1995). Object relations marital therapy of personality disorders. In N. Jacobson & A. Gurman (Eds.), Clinical handbook of couple therapy (2nd ed.) (pp ). New York: Guilford.

3 3 This short chapter, with helpful clinical examples, is a fine introduction to the application of object relations principles to work with couples. Scharff, J., & Scharff, D. (2008). Object relations couple therapy. In A. Gurman (Ed.), Clinical handbook of couple therapy (4th ed., pp ). New York: Guilford. This invaluable, though dense, chapter includes extremely helpful figures and tables such as these: projective and introjective identification, goals and tasks of object relations couple therapy, and criteria for termination. It is the best relatively short resource on the topic. Scharff, J. (Ed.) (1989). Foundations of object relations family therapy. Northvale, NJ: Jason Aronson. Scharff s thoughtful compilation contains the seminal papers that underpin the object relations approach to systemic therapy. Solomon, M. (1989). Narcissism and intimacy: Love and marriage in an age of confusion. New York: Norton. This important resource clearly explicates the application of self-psychology (with additions from the object relations and relational models) to clinical work with couples. Leone, C. (2008). Couple therapy from the perspective of self-psychology and intersubjectivity theory. Psychoanalytic Psychology, 25, Leone s thoughtful article provides a shorter alternative to the previous resource and is, perforce, a less inclusive read. Obstacles and constraints supervisees face in transitioning to systemic practice Wachtel, E. (1979). Learning family therapy: The dilemmas of an individual therapist. Journal of Contemporary Psychotherapy, 10, This superb, candid article provides an excellent overview of the obstacles faced by psychodynamically oriented therapists in incorporating systemic principles and interventions. Scharff, D., & Scharff, J. (1987). Resistance to beginning object relations family therapy. In D. Scharff & J. Scharff (Eds.), Object relations family therapy (pp ). Northvale, NJ: J. Aronson. This rich chapter includes detailed commentary on anxieties, countertransferences, and other uncomfortable emotions that frequently arise in therapists transitioning from individual work to family work or from family systems work to psychodynamic family systems work. Institutional resistances are also noted. Zietner, R. (2006). Obstacles for the psychoanalyst in the practice of couple therapy. In J. Scharff & D. Scharff (Eds.), New paradigms for treating relationships (pp ). Lanham, MD: J. Aronson. This sophisticated chapter details theoretical and emotional constraints faced by inveterate psychodynamically oriented clinicians in shifting to clinical work with couples.

4 4 Key Readings for Supervising Systemically Trained Therapists Supervisors who are guiding systemically trained supervisees in learning and incorporating psychodynamic principles and techniques would do well to recommend introductory books that provide surveys of psychodynamically oriented psychotherapy. While such books concern psychotherapy with individuals, they define and illustrate the basic building blocks of the theory, the general strategies for treatment, and the associated methods of intervention. Thus, they have considerable applicability to couples and families. The following list begins with resources that provide an overview of key psychodynamic theories and techniques, continues with resources that elucidate particular psychodynamic theoretical models, and ends with recommendations for readings about important concepts or issues. Overviews of psychodynamic approaches Mitchell, S., & Black, M. (1995). Freud and beyond: A history of modern psychoanalytic thought. New York: Basic Books. This approachable, introductory book provides clear explanations of key psychodynamic orientations with detailed clinical illustrations. Berzoff, J., Flanagan, L., & Hertz, P. (Eds.) (2011). Inside out and outside in: Psychodynamic clinical theory and psychopathology in contemporary multicultural contexts (3rd ed.). Lanham, MD: Rowman & Littlefield. This edited book provides a rich discussion of the principles and the evolution of key psychodynamic theories and their clinical applications, with particular sensitivity to myriad contextual variables. Fonagy, P., & Target, M. (2009). Theoretical models of psychodynamic psychotherapy. In G. Gabbard (Ed.), Textbook of psychotherapeutic treatments (pp. 3 42). Arlington, VA: American Psychiatric Publishing. This chapter and the one that follows it are brief, highly readable basic introductions to psychodynamic theory and technique, respectively. Gabbard, G. (2009). Techniques of psychodynamic psychotherapy. In G. Gabbard (Ed.), Textbook of psychotherapeutic treatments (pp ). Arlington, VA: American Psychiatric Publishing. McWilliams, N. (2004). Psychoanalytic psychotherapy: A practitioner s guide. New York: Guilford. This is a highly informative introduction to psychoanalytic clinical practice, which is written in a candid, down-to-earth, personable style. Model specific resources: contemporary classical drive theory Auld, F., Hyman, M., & Rudzinsky, D. (2005). Resolution of inner conflict: An introduction to psychoanalytic therapy (2nd ed.). Washington, DC: American Psychological Association.

5 5 This basic, comprehensive book includes crisp definitions of key building blocks and postulates of classical drive theory and therapy, including resistance, transference, unconscious communication, and interpretation. Model specific resources: object relations and self-psychology Scharff, D. (1996). Object relations theory and practice: An introduction. Northvale, NJ: Jason Aronson. For this book, Scharff carefully selected, excerpted, and integrated key papers on object relations, with a particular emphasis on the models of the mind proposed by Klein, Fairbairn, and Winnicott. (Please also see Scarf s two-part article referenced in the section on key readings for supervisors of psychodynamically trained therapists.) Elson, M. (1986). Self psychology in clinical social work. New York: W. W. Norton. Writing for psychotherapists of all disciplines, Elson a friend and colleague of Kohut clearly explicates key theoretical and treatment principles of self psychology, highlighting a developmental perspective. Wolf, E. (1988). Treating the self: Elements of clinical self psychology. New York: Guilford. This clinically focused book, written by one of Kohut s collaborators, details central elements of the theory of self-psychology and illustrates disorders of the self with clinical vignettes. Model specific resources: relational and intersubjective psychodynamic approaches Hoffman, I. (2001). Sixteen principles of dialectical constructivism. Paper presented at the American Psychoanalytic Association meeting, New York, Retrieved from freudreloaded.wordpress.com/author/kokkiniammos/ (accessed September 29, 2014). In a succinct and clear manner that makes this a highly useful starting point, Hoffman abstracts eight principles of the relational model (or of models with relational leanings ). Mitchell, S. (1988). Relational concepts in psychoanalysis: An introduction. Cambridge, MA: Harvard University Press. This approachable classic contains clearly written explanations of the foundational principles of the relational model. Stern, D. (2005). Intersubjectivity. In E. Person, A. Cooper, & G. Gabbard (Eds.), Textbook of psychoanalysis (pp ). Washington, DC: American Psychiatric Publishing. This brief chapter is a useful introduction to the intersubjective sensibility that highlights its differences from classical drive theory. Wachtel, P. (2008). Relational theory and the practice of psychotherapy. New York: Guilford Press. This excellent, clinically oriented book illustrates the mutual influence of intrapsychic and interpersonal phenomena, with an explicit emphasis on social and cultural contexts.

6 6 Selected concepts or issues: attachment theory Shilkret, R., & Shilkret, C. (2011). Attachment theory. In J. Berzoff, L. Flanagan, & P. Hertz, P. (Eds.), Inside out and outside in: Psychodynamic clinical theory and psychopathology in contemporary multicultural contexts (3rd ed., pp ). Lanham, MD: Rowman & Littlefield. This chapter is an easy read that provides a solid introduction to the topic. Target, M. (2005). Attachment theory and research. In E. Person, A. Cooper, & G. Gabbard (Eds.), Textbook of psychoanalysis (pp ). Washington, DC: American Psychiatric Publishing. This succinct chapter provides a quick overview of key concepts and issues. Selected concepts or issues: projective identification Ogden, T. (1979). On projective identification. International Journal of Psycho-analysis, 60, In this thoughtful classic, Ogden defines and illustrates the concept and discusses its relationship to a group of related processes, namely projection, introjection, identification, and externalization. Racker, H. (1968). Transference and countertransference. New York: International Universities Press. In his classic book, Racker an Argentinian psychoanalyst influenced by Klein explicates concordant and complementary projective identification and the inextricable relationship between transference and countertransference. Selected concepts or issues: psychodynamic formulation McWilliams, N. (2011). Psychoanalytic diagnosis: Understanding personality structure in the clinical process (2nd ed.). New York: Guilford. This rich, approachable, and highly recommended classic has been updated to reflect the influence of the relational turn and findings from neuroscience research. Peebles, M. J. (2012). Beginnings: The art and science of planning psychotherapy (2nd ed.). New York: Routledge. This excellent, jargon-free book focuses not only on the therapist s formulation but also on its nuanced implications for enhancing the emergent therapeutic alliance. Cabaniss, D., Cherry, S., Douglas, C., Graver, R., & Schwartz, A. (2013). Psychodynamic formulation. Hoboken, NJ: Wiley-Blackwell. Cabaniss, D., Cherry, S., Douglas, C., & Schwartz, A. (2011). Psychodynamic psychotherapy: A clinical manual. Hoboken, NJ: Wiley-Blackwell. These two are companion volumes that are how to books that succeed in explaining psychodynamic formulation and treatment in easily understood terms.

7 7 Training Resources for Systemic Psychodynamic Supervisors The following selections assist psychodynamic, systemic, and integrative supervisors in enhancing their understanding and practice of psychodynamically oriented supervision, which is largely applicable to systemic psychodynamic supervision. The first article an excellent starting point details key psychodynamic contributions to the theory and practice of supervision. Sarnat s important article (2010) about doing psychodynamic supervision follows. The next two references illustrate the increasing systematization in training psychodynamic supervisors to supervise therapists who work with individuals. Several approachable books are then listed that illustrate the range of theory and practice of psychodynamic supervision. Finally, Watkins (2010) article provides a psychodynamic developmental perspective on the supervision of supervision. Watkins, C. (2011). Celebrating psychoanalytic supervision: Considering a century of seminal contribution. Psychoanalytic Review, 98, This useful, easily digested article provides an overview of foundational psychodynamic contributions to the supervisory process; it is valuable reading for all supervisors, regardless of theoretical orientation. Sarnat, J. (2010). Key competences of the psychodynamic psychotherapist and how to teach them in supervision. Psychotherapy theory, research, practice, training, 47, Sarnat, J. (2012). Supervising psychoanalytic psychotherapy: Present knowledge, pressing needs, future possibilities. Journal of Contemporary Psychotherapy, 42, Both these approachable articles are a must read for psychodynamic and integrative supervisors alike. Riess, H., & Herman, J. (2008). Teaching the teachers: A model course for psychodynamic psychotherapy supervisors. Academic Psychiatry, 32, Publications such as this and the succeeding one attest to the increasing number of postgraduate courses or certificate programs offered in psychoanalytic supervision of individual psychotherapy (e.g., Adelphi University, NYU). This useful article details the curriculum of one such course. Pegeron, J. (2008). A course on the supervisory process for candidates and supervisors: An attempt to address inconsistencies in psychoanalytic education and the fundamental paradox of psychoanalytic training. Psychoanalytic Inquiry, 28, Pegeron describes another course on the supervisory process and includes an appendix replete with key readings about psychodynamic supervision. Frawley-O Dea, M., & Sarnat, J. (2001). The supervisory relationship: A contemporary psychodynamic approach. New York: Guilford. This highly readable, seminal book explains and illustrates psychodynamic supervision from the relational perspective. Jacobs, D., David, P., & Meyer, D. (1995). The supervisory encounter: A guide for teachers of psychodynamic psychotherapy and psychoanalysis. New Haven, CT: Yale University Press.

8 8 This is a thoughtful and stimulating work that provides guidance to psychodynamic supervisors striving for greater depth in supervision. Rock, M. (Ed.) (1997). Psychodynamic supervision: Perspectives of the supervisor and supervisee. Northvale, NJ: Jason Aronson. This edited book and the one that follows provide multiple theoretical and clinical perspectives on supervision from within the psychodynamic paradigm. This book s authors are acknowledged experts. Gill, S. (Ed.) (2001). The supervisory alliance: Facilitating the psychotherapist s learning experience. Northvale, NJ: Jason Aronson. Gill s compilation addresses a wide array of clinical issues that may arise in supervision. Watkins, C. (2010). Psychoanalytic developmental psychology and the supervision of psychotherapy supervisor trainees. Psychodynamic Practice, 16, This thoughtful article promotes a psychodynamic developmental framework for considering processes intrinsic to the psychodynamic supervision of supervision. Call for Attending to Systemic Psychodynamic Supervision I hope that this extensive list of excellent readings will not only provide resources for those interested in learning more about the integration of psychodynamic theory and systems theory but also stimulate attention to the practice of systemic psychodynamic supervision. Aside from Chapter 9 in the accompanying book, there is a surprising lack of literature on systemic psychodynamic supervision, per se. Hopefully, then, this list will assist supervisors in applying these key ideas in the context of supervision and will spark additional literature to lessen the paucity on this topic. Reference Scharff, J., & Scharff, D. (2008). Object relations couple therapy. In A. Gurman (Ed.), Clinical handbook of couple therapy (4th ed., pp ). New York: Guilford.