Three Associating: Adventures in Relational Psychoanalytic Supervision

In this episode, Rachael struggles with her impulse to be castrating when she encounters what she experiences as an impenetrable patient, a Citadel.  She is irked by the patient constantly batting away her interventions and seemingly needing to know better than her.
In this episode, she and Gill discuss a stinging intervention that Rachael made. The problem was less the intervention itself than Rachael’s  desire to cut the patient down, a desire she recognised and asked for help to resist.  Through supervision Rachael was able to be more in touch with the patient’s vulnerability and developmental age and to move past the power struggle the patient evoked and to think about how to engage his vulnerability.

In this episode, Rachael plumbs the mysteries of the erotic, both in the transference and the countertransference; mysterious because it occurs in liminal or transitional space as Winnicott would say. It is a space of illusion and disillusion where it is not clear what belongs to who. Both Rachael and her patient playfully enjoy the experience, while both in their own way bring in a third to dilute the experience. Rachael becomes aware of her own loss in this and is able both to observe and experience it while also observing and experiencing her patient's change. Together with Gill, the associators conclude that sometimes it is better to settle the waters by not stirring them. The erotic is often beyond words, and thus leaving the erotic known but unarticulated is, in this instance, a good option.

In his therapy with Noor, Andrew comes to realise that he is inadvertently co-constructing an avoidance of grieving and mourning. Through a careful unpacking of enactments in the room, Andrew comes to see how mini separations and losses within the therapy caused by sessions ending and holidays taken influence both the content and process of therapy. Through modifications in the pace and rhythms of therapy, Noor unconsciously communicates her grief. Andrew initially struggles to recognise this as to do so involves him in accepting loss himself. Andrew is helped by his unconscious, which reveals itself in the session both through an enactment of a jet lagged state, and an understanding of what the words jet lag signify. Thus, an understanding of both the music and the the words of the session, as it developed in supervision, allowed a paradigm shift  from intellectual defence to emotional engagement.

In this episode, Rachael encounters the uncanny intelligence of the patient's unconscious. The patient, having criticised Rachael for her “messy” management of her clinical practice then adopts the same management style and surreptitiously benefits from it.  Feeling guilty, the patient has a dream revealing these dynamics but withholds her insights from Rachael. This produces a desire in Rachael to be mean and partake of the jouissance of revenge. By unpacking her own unconscious with Gill, it becomes clear to Rach that her countertransference wish is a clue to the patient's fear, which is preventing her from surrendering into the patient position.

In this episode, Andrew finds himself embodying traumas the patient has experienced but has placed an explicit prohibition on articulating. During his therapy sessions with Rob, Andrew respects this prohibition. There is much else to speak about and the session feels lively. However, after every session Andrew feels strangely dead, reflecting a limit on his capacity to comfortably process powerful affects when words are off limit and the patient wishes to screen off pain and to avoid facing into the void. 

Questions are raised about the perils of going along with the patient's wish not to speak the unspeakable as well the dangers of not doing so.  

All the while, the affective registration of Rob's screened off trauma persists at somatic and affective levels in Andew as an embodiment of Rob's traumatic memories. The power of this is barely tolerable and Andrew feels doomed if he does speak and doomed if he doesn’t, but in the supervision he explores the possibility of a third way and finds a way out of the binary.