Three Associating: Adventures in Relational Psychoanalytic Supervision

In this episode, Rachael gets tangled up in her own anger and hostility towards her patient on behalf of the patient’s daughter. While trying to distance herself from the patient's enmeshment with the daughter she inadvertently gets enmeshed herself in the patient’s dynamic. 
By more fully accessing her anger with the patient and realising that in her mind she has been treating the daughter rather than the patient, she is able to recenter herself more clearly with the patient in the room.
The importance of feeling into the therapy and not only thinking into the therapy is emphasised, with the end point of integrating both. Rachael⁠ must own her murderous rage towards the mother/patient and to reflect on its meaning and beyond that have the capacity to articulate it in a form which can be heard by the patient.  By the end of the session, Rachael⁠ is able to achieve this.

In this episode, Andrew struggles with the question of therapy terminable and interminable. He faces an ethical dilemma as to whether continuing therapy with a particular patient who has made considerable gains would be in some way unethical.

Andrew⁠ is thoughtful about the issue of fostering dependence which is an important issue to consider. However, he finds through supervision that he has unconsciously stepped into enacting the role of the patient's authoritarian father who imposed separations on the patient as a child.

Andrew⁠ comes to see he has engaged in a subtle power struggle and has unconsciously used psychoanalytic premises as an anti analytical third that blocks thought rather than facilitates it. Interestingly, Andrew⁠’s awareness of the enactments in therapy are discovered through a parallel process that emerges in the supervisory relational field.

In this episode, Rachael struggles with her own feelings about her therapy being cut across by a psychiatrist who seems to be opposed to long term therapy. 

She feels activated especially as the patient has asked her to intervene and contact the psychiatrist. 
In supervision, she engages with her frustration at the interference in her treatment and her therapeutic relationship and also her anger in relation to the zeitgeist that opposes in-depth therapy. 
Rachael⁠ recognises that in her activation she gets pulled into focusing more on the zeitgeist and less on the patient and is hooked by the emergence of her own sibling rivalry . 

These are not enacted with the patient but they interfere with Rachael⁠’s ability to think about the analytic meaning of the patient’s request. Through supervision, she is able to see that she is inadvertently being invited into a split and while activated is loosing the opportunity to explore the psychodynamic meaning of the patient’s request. Through this understanding she returns to her analytic position.

In this episode, Andrew presents an unusual situation where a patient requires his partner to be present in his therapy not to work on couple dynamics, but as a benign observer. 
Andrew finds himself unable to resist this demand both because Andrew is ideologically opposed to imposing his will on the patient and because he can’t in the moment think why the patient’s preference should be resisted. 
Andrew consciously accepts the patient’s narrative that therapy should take place in the threesome but unconsciously resists it. This resistance manifests in an insistent thought that the therapy will be short term. 
In supervision, he realises that the thought is a wish covering over his frustration at being manoeuvred into working in a way that is restrictive and recognises that he is in the presence of a merger.  
Andrew comes to see this merger as less sweet and more problematic than he had thought and he determines to use his frustration to challenge the merger and negotiate a different therapeutic frame.

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.