Supervision and Consultation

I would identify my current thinking about the process of psychotherapy as existing within the complexity theory/nonlinear dynamics system theory worlds. These names for theory are a meaningless mouthful for those who aren’t familiar so I’ll do my best to explain what I mean.

In sharp contrast to Freud’s initial proposition of the therapist analyst as objective observer—a “one person,” the patient, model of therapy—more contemporary and especially “two-person” relational, interpersonal, and intersubjective propositions suggest that the consultation room contains two subjectivities—that is, people—interacting with one another. Furthermore, their interaction is its own third thing that can be observed through the prism of each one’s subjectivity by each person involved. If Freud’s suggestion was for the analyst to watch the patient sail a boat and point out ways the patient could improve their sailing, two person models suggest we are both sailing the boat and we’re building the boat while we’re sailing.

Complexity theory takes this a step further and suggests that not only are we building the boat while we’re sailing, but maybe it’s not a boat at all, maybe we’d get there faster if we swam, and how do we know we’re not already where we’re trying to get to? Systems, such as the system of the patient or the system of the consultation dyad, can change through perturbations of many sizes that are non-linear and not necessarily predictable by theories of technique. Retrospect helps us organize our ideas about what created change, but those ideas might be neither generalizable nor right. The choice to take a case to supervision or consultation is something that inherently changes the system and is indicative of something within the system. Novelty, spontaneity, agency, and shifts between steady states and chaos are of central focus in this theory.

What does this mean for supervision and consultation? Well once we’ve established a level of interpersonal comfort with exposing your work and relationship to your patient with me, I think consultation can go best when we can be the most open with our experiences of our patients and genuine reactions in the consulting room. More technically, I think that countertransference is a part of the field of the therapy system. That means that something within and about the therapy can take place in the affective experience of the therapist. The feeling states of the therapist are information about not only what the patient is bringing, but how that information or energy is interacting with the person of the therapist. Countertransference reactions that tend to be confusing, intense, or troublesome to us are oftentimes reasons for seeking another’s mind on the matter at hand as it can have an effect of widening the field. Supervision is no substitute for a therapist’s own analysis or psychotherapy, where the therapist can safely explore confusions around self-other conflicts, ethical dilemmas, erotic transferences, value judgements, shame, and other vulnerabilities. However, supervision or consultation can be a nice complementary experience to one’s own good therapy.

We all have our blind spots, personalities, defenses, and limitations. Coming into greater awareness of them can help us do our work to our own ethical standards and equip our patients them to better articulate their experience with us in a way that fosters their growth and, if we’re lucky, ours too. Any strong or obvious phenomena in our work that we’d like to have a better understanding of can be a good reason to seek consultation or supervision.