My Experience as a Supervisor of Neuropsychoanalytic Psychotherapist Students (Part II )

The approach I take with the student supervisee that I spoke of in my earlier post, is basically the approach that I continue with all my students--one week of teaching and one week of supervision over the duration of their supervision experience. So instead of writing about how the supervision of all students is different and how I adjust the supervision process to each one's particular needs, etc., I am going to write about what their supervision processes had in common.

Let me start with the books I used to help me further learn how to supervise. The first one is Clinical Perspectives on the Supervision of Psychoanalysis and Psychotherapy (1984), edited by Leopold Caligor, Philip Bromberg, and James Meltzer. The second book is Learning Process in Psychoanalytic Supervision: Complexities and Challenges (1987) by Paul DeWald. The third text was written in 1995 by Daniel Jacobs, Paul David, and Donald Jay Meyer. It is  titled, The Supervisory Encounter. The fourth supervision book is  Glen Gabbard's Long Term Psychodynamic Psychotherapy( the last chapter on Supervision.) The final text I studied is  entitled, The Supervisory Relationship, written in 2001 by Mary Gail Frawley-O'Dea and Joan E. Sarnat. In addition to these books I have read various articles and papers on  supervision that came my way through journals, etc. One of those is  by Otto Kernberg, published in 2010, Psychoanalytic Supervision: The Supervisor's Task.  For neuropsychoanalytic supervision in particular, I used my Training Manual, An Introduction to Neuropsychoanalytic Psychotherapy, which includes a section  on how to present case material. 

All of theses sources are  helpful, but even more helpful is hearing cases presented at neuropsychoanalytic conferences, and further hearing how the analysts/therapists would supervise the person presenting the material. These are not formal ongoing supervision sessions, but I find them very helpful in seeing how the analysts/therapists doing the supervising  listen, formulate, and comment on the case material. As enriching as all of these readings and experiences have been in doing supervision, they do not specifically address how to teach neuropsychoanalytic theory, practice, and technique to students. For this task I also attend conferences and read articles on psychoanalytic teaching. Over time I have developed a notebook with my charts, notes, diagrams, etc., that helped me teach my students about theory and practice. 

Of course the main way a student learns how to do neuropsychoanalytic psychotherapy is by "actually doing it." Neuropsychoanalytic therapy  training is tripartite. It consists of didactic courses, supervision, and your own personal or training psychotherapy. Although I have  not required  personal psychotherapy for my students, I have strongly encouraged  it. But in the end it is the fourth element of training that teaches the students the most, and that is their experience with their patients in the room, week after week, in neuropsychoanalytic treatment. I will say more about that next time.

My Experience as a Neuropsychoanalytic Psychotherapy Supervisor ( Part III)

The beginning phase of neuropsychoanalytic  psychotherapy supervision is similar to but different from the beginning phase of neuropsychoanalytic psychotherapy. It is similar in that the primary goal of the beginning sessions is all about forming a relationship with the student. In psychotherapy we call this the forming of a therapeutic relationship or a therapeutic alliance. In supervision we call it forming a supervisory relationship or a learning alliance. The relationship building part of the beginning phase requires the same skills of the supervisor as it does of the therapist. And from the student side, it requires the same amount of trust that forming a relationship with their therapist requires.

The major difference is the goal and purpose of supervision verses therapy. Supervision is not a therapeutic experience. It is a learning experience. It is not a therapist to patient relationship. It is a teacher to student relationship. We call this the "teach versus treat" goal. It is very important that the supervisor and the supervisee know the difference in the two forms of encounter.

Now what is unique about psychotherapy supervision, unlike other teacher/student relationships, is there is an element of therapy in the teaching. Because the teacher is also a therapist, they use their understandings and skills to help the supervisee see some things about themselves that would be off base to share in any other teacher/student dyad. For instance, if the supervisee makes a huge mistake in treating one of their patients, and the therapist believes it is because the supervisee's own personal issues got in the way, then they will tactifully point that out to the student. But they will not go into depth about the student's personal issues as if it were a therapy session. Instead they will say something like, "If this personal issue continues to get in your way then you might want to bring it up with your therapist." This is why it is so important that the supervisee also have a therapist as well as a supervisor. In addition to forming a learning alliance with the student therapist, the supervisor will also want to learn as much about the student's history of learning psychotherapy as possible. So the supervisor asks all about how the student became interested in therapy, what types of therapy have they themselves been in, what courses have they taken, where do they feel are the gaps in their knowledge, how much therapy have they actually conducted and what types, etc? During this time of history gathering the student may tell the teacher many personal and private things about themselves as well. The teacher listens empathically to the student as if these were therapy sessions, but the teacher does not dwell on these more personal experiences. The focus remains educational and not therapeutic. When does the beginning phase of supervision end? When the supervisor and supervisee feel they are quite comfortable with each other, and their relationship is no longer something they are focused on.

The beginning phase ends when both participants are caught up in the treatment of the supervisee's patients and the patient becomes the major focus of the sessions. Then the dyad has moved into the middle phase. The middle phase in psychotherapy is called the "working through phase." I would call the middle phase in supervision the "working on" phase, meaning the student and the teacher are both now working on the student's provision of therapy for the patient. The student is "working on doing it." The teacher is "working on teaching it." Learning is taking place. The supervisee is learning how to do psychotherapy. It is during this middle phase that the major problems of supervision come up. The student's personality sometimes helps the therapy process and sometimes gets in the way of it. It is the same with the supervisor. Their personality sometimes enhances their teaching and sometimes hinders it. These learning difficulties, problems, conflicts, and misunderstandings have to be worked on in the supervision, just as they have to be worked through in psychotherapy. It may be that both teacher and student have to consult a third party to clear up some problems in the supervisory work together. Sometimes the supervision problems cannot be worked out and the supervision ends before completion. Hopefully that does not occur and the supervisory dyad moves into the third and final phase of supervision, the ending or termination phase.

The termination phase is marked by the time in supervision when both the supervisor and the supervisee believe that the supervisee has learned all they can learn from the supervisor, and they are now feeling that they can function independently of the supervisor as a junior colleague or beginning independent therapist. Sometimes this ending is determined by a set number of supervision sessions required for licensure. At other times it is a free decision between the supervisor and the student therapist. No matter how the ending is determinded, ending supervision is not unlike ending therapy. It is all about wrapping things up, summarizing gains, celebrating victories, accepting failures, and ending the supervisory relationship. Like in therapy this ending needs not to be rushed. I would say it takes three to six months to successfully end five years of supervision. A major part of supervision termination, like in therapy termination, is grief. Both the student and the teacher will hopefully grieve the loss of the relationship, and this grief needs to be acknowledged and talked about. Of course both members of the dyad will also be celebrating as the student comes to "graduate" from supervision and becomes an independent therapist. For the supervisor it is not unlike having a child transition from young adulthood to mature adulthood. The student may indeed feel the same type of growth process and outcome. It should be a happy day when the former supervisor and the former student celebrate together the former student's receiving of their license to practice psychotherapy on their own! Ask a question!! Make a comment !! Tell me who you are !!

My Experience as a Neuropsychoanalytic Psychotherapy Supervisor ( Part I )

Let's begin this post with the books/papers/lectures  I use in  teaching and supervising neuropsychoanalytically oriented students. For an introduction to psychoanalytic structural theory ( Ego, Id, and Superego), I request they read Sigmund Freud ( 1912, 1913, 1923, 1926.) I further added for a theory introduction, Brenner (1973.) For theory and technique in both insight and supportive therapy, I assigned DeWald (1973.) From these classics I add the following books to their reading assignments: Luborsky, 1984. Viorst, 1986. Wallerstein, 1993. Gabbard, 1994, 2004. Rockland, 1989. McWilliams,1992, 2004. Goldstein, 2001. And from  neuropsychoanalytic psychotherapy I assign Mark Solms books, papers, and lectures and my own Introductory Lectures on Neuropsychoanalytic Therapy. 

These texts introduce the trainees to the major analytic theories of ego psychology, object relations, self psychology, and relational analysis, and neuropsychoanalysis as well as the psychotherapeutic techniques of insight and supportive therapy. Every other week in didactic session we discuss these readings and how they apply to their patients. The weeks we are not discussing their readings, we explore their cases in neuropsychoanalytic therapy supervision. In supervision sessions the student trainees present their cases utilizing process notes and videos of their sessions. I was trained in process note presentations in my own supervision, and I also presented with audio sessions, but video presentations were new to me. The various schools my supervisees attend may now require reviewing video sessions. There are strengths and weaknesses in all of these ways of presenting case material. I will not go into those in this post. In a future post I will write in more detail about the three phases of neuropsychoanalytic psychotherapy supervision-- beginning, middle, and ending.

My Retirement Speech from the Valley Pastoral Counseling Center

I first want to thank and recognize my most personal supporters and encouragers, my family, for being here this afternoon and caring for me through the years. I next want to recognize my therapist brother who started out as a pastoral counselor. I am further happy to have here today two groups of our life long friends.

Others who have been great supporters through the years are here as well:

My psychiatrist friend and colleague who also studied psychoanalysis.

And my long time friend and colleague who has traveled a similar path to mine. He began in pastoral ministry. Moved to pastoral counseling, then psychoanalysis, and finally neuropsychoanalysis.

I thank you all for being here today to celebrate with me and for our long and continued history together!

The next groups I wish to recognize and thank for being here are first: My fellow therapists at the pastoral counseling center. I have known some of you for almost twenty years. Second: The Interns and Residents I supervised over the years. You taught me as I taught you. Third: The Boards of Directors over the years. We could have not accomplished the mission of the pastoral counseling center without your oversight and fundraising. Fourth: Office staff and volunteers. You worked behind the scenes to keep the Counseling Center functioning smoothly from within which allowed us to reach out to the community as well. 

As I thought about what I might say today, two questions came to my mind. The first one was, " Why did I come to the Valley Pastoral Counseling Center?" That one was pretty easy to answer. I needed a job! Which was true, but more seriously, I had just graduated from a Pastoral Counseling Institute which including training to become a LPC. And, at the age of 40 I was wanting to transition out of the pastorate and into the pastoral psychoanalytic psychotherapy. My long time friend who was then the executive director here at Valley Pastoral, was kind enough to create a position for me as a staff psychotherapist. I was very grateful to be here!

The second question I asked myself was, "Why did I stay at Valley Pastoral until retirement?" ( Note that I retired from Valley Pastoral but subsequently  continued a small private practice in psychoanalytic psychotherapy). That question was a little harder to answer. One reason I stayed so long was the work itself. Thanks to our expanded mission statement, staff therapists could do not only therapy, but also supervision, education and consultation. So , I got to do here much of what I loved doing! I got to do psychoanalytic psychotherapy--1100 patients for whom I am most grateful. I got to do supervision--14 students who taught me almost as much as I taught them. I got to write--two books, several articles,  100 Blog posts," The History of the Pastoral Counseling Center", and many newsletter articles. I further got to give numerous talks/lectures in the community. I got to lead the counseling center through 12 years as the Executive Director  and a number of years as clinical director and training director. I got to continue my education through the American Association of Pastoral Counselors, the American Psychoanalytic Association, and the International Neuropsychoanalytic Society. And I also got to travel-- one trip being to the Sigmund Freud Museum in Vienna, Austria.

And, through all of these various roles, I was fortunate to be able to help many different patients, supervisees, and others in so many different ways. So I now had to ask," Why would I have NOT stayed here until retirement?"

But I stayed for another reason as well. And that was because of you all here today-- the Valley Pastoral community-- the historical community of the Valley Pastoral Counseling Center. You have been my community throughout all these years. You as therapists, residents, interns, supervisees, Board Members, office staff, and volunteers. It is our relationships that kept me here. Our relationships we forged as we worked side by side fulfilling the mission of the Center. I have valued our relationships, both past and present. And it those relationships with you in this room that I will take with me into this next chapter retirement from VPCC. 

Holiday Sadness

Some of us will be sad during the Holidays, especially if we have lost a loved one in the past year. I have heard many patients say, "This first Christmas without my spouse (or child, etc) will be the hardest." Grief is hard enough when there is not a Holiday coming. It is even harder once the Holiday arrives.

I once told a client that "the reality of losing someone takes the mind a year to accept." I believe that is true--at least a year--sometimes longer. Our minds are not prepared for the harsh reality of death. It takes time for the reality to sink in and become real to us. The time that it takes, no matter how long, is what we call grief or mourning. Most often we underestimate how long grief will take to heal. I have used one year as an average, but many feel it takes several years to work through some losses. That is why we call the process "Grief Work." It is hard work. Unfortunately the general population is not always aware of just how long such a process takes.

Our friends and family members often give us about 3 months to grieve and then they want us to be done with it. Why? Because they find it difficult to be around someone who is grieving. It is like being around someone who is depressed. It brings others down as well and they do not like that feeling. This is why we sometimes need to enter counseling to deal with our grief. A trained therapist is better able to bear our suffering and hear our pain--and for a longer period of time. When you go to therapy for your grief you may find you have a host of feelings to work through.

You may be shocked at first and in a state of disbelief and numbness. You may feel overwhelmed with deep sadness. You may feel guilty and blame yourself somehow for the loss. You may have even been angry at the person you lost and fear that they left this earth not knowing that you loved them. No matter what your feelings are, a caring therapist will help you face those feelings and express them. Our natural tendency is to suppress our feeligs rather than attend to them. This is exactly the opposite of what we need to do. Matter of fact the only way you can grive wrongly is to not grieve at all. The key is to let the feelings come and to bear them--regardless of the amount of hurt or pain they cause. An empathic therapist knows this and will be with you throughout the process. If you can allow yoursef such an experience in therapy, over time, your painful feelings of sadness will begin to heal.

Holiday sadness is often about grief--especially the first Holiday Season without a loved one. But as I shared in the"Christmas as an Anniversary Reaction" post, Holiday sadness can also be due to left over grief from many year's past. If you have any unresolved grief in your life, you can be pretty sure it will come to the surface during the Holidays. So whether your grief is fresh or is left over from the past, if you will let the grief come to your heart and mind, you will eventually feel better. You can process your grief with family and friends or you can seek therapy if it is just too much to bear. Either way remember," the only wrong way to grieve is not to grieve." I hope your Holiday can be as good as it can be even as you continue your grief work..... Make a comment!! Ask a question!! Tell me who you are !!!

Christmas as an Anniversary Reaction

Like many, I have often wondered why Christmas is so powerful. Over the years I have heard it is because of our overly high expectations or our idealized notions of what a perfect holiday is supposed to be. Of course these are true but I have wondered if there might be something more--something deeper.

So I starting thinking about Christmas as an anniversary reaction. Anniversary reactions occur when we experience a significant anniversary and the memories and feelings associated with the original event come pouring forth from our unconscious into consciousness. Maybe this is what happens at Christmas. The Holiday is an anniversary. We have celebrated this day every year from the time we can remember. As a result all kinds of feelings get stirred up around it. Each year when this day rolls around we remember all the other years we have celebrated it--the good ones, the bad ones, and the in between ones. All kinds of feelings come gushing forth. One popular Christmas song says,"Christmas makes me feel emotional." That is true.

I believe it is true because we experience Christmas as an anniversary reaction. So this year I would encourage you, when you are feeling all kinds of emotions at Christmas, to think of them as an anniversary reaction. May we all let the varied feelings of love, joy, dread, anxiety, depression, etc come to the forefront of our minds. May we embrace them. Attend to them. Let them come. And also try to understand them. If your feelings get too uncomfortable during the Christmas holidays then you might consider seeking out a therapist to help you work through them. Therapy can help when the anniversary reaction of Christmas becomes too emotionally overwhelming and the negative feelings come to predominate. I hope your Christmas emotional anniversary reaction this year is more pleasant than not, and that the positive feelings of this season much outweigh those that are more painful. Happy Holiday!

Our Psychopath President and His Ardent Followers Explained

A friend asked me recently what makes Trump's most ardent followers so irrational, so out of touch with reality, that they would blindly follow a psychopath and elect him twice as President of the United States? In researching an answer for him I returned to Bandy Lee, MD forensic psychiatrist. She edited the premier text on Trump's mental health entitled , The Dangerous Case of Donald Trump, where 27 psychiatrists and psychoanalysts described Trump as a highly narcissistic delusional psychopath. In her follow up text, Profile of a Nation, she went a step further to also assess the illness of Trump's most ardent followers. 

 She believes their disturbed view of reality is a direct outcome of his disturbance. She lists two phenomenon behind such behavior: First is Narcissistic Symbiosis. Narcissistic symbiosis happens this way: A highly disturbed leader hungry for admiration to compensate for severe low self worth, projects omnipotence to his followers. This type of extremely narcissistic leader believes his own lies and thus they become more than strategic lies, they become delusions. Trump himself believes them and in parallel fashion so do his followers. 

The second phenomenon that explains the delusions of the leader becoming the delusions of the followers is Shared Psychosis. This occurs when those in an emotional bond with a delusional psychotic become delusional themselves. These persons were previously disturbed to some degree and the disturbed leader such as Trump takes them over the edge. They come to share his paranoid delusions and propensity for violence. 

Dr. Lee believes the solution to both of the above phenomenon is Removal of the Disturbed Leader, followed by removal of his policies and then rational and pragmatic solving of the socioeconomic and psychological stress of the followers. She shares this perspective and these solutions in her follow up second book entitled, Profile of a Nation: Trump's Mind, America's Soul. I recommend both of these texts for a thorough understanding of Donald Trump and those who ardently follow him. ..... Ask a question? Make a comment !! Tell me who you are !!!!

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