Tuesday, 4 January 2011

Super Vision

We shall not cease from exploration
And the end of all our exploring
Will be to arrive where we started
And know the place for the first time.
(T.S. Eliot – ‘Little Gidding’)

Having received some very positive comments about my last piece, I thought I would risk another therapy-oriented posting. Several people have alluded to the emotional costs of being a therapist. ‘How do you cope,’ they have asked, ‘having to face other people’s distress day after day?’ It is a very pertinent question. How do we, as therapists, manage to survive our own feelings generated by our encounter with the other?

Of course, it is not only the other person’s despair that affects us. As living, breathing human beings therapists experience the whole gamut of feelings towards those who come to them with their problems. Every honest therapist will tell you that there are times when we dislike a patient, feel angry towards him or her, bored … or alternatively we feel sexually attracted towards him or her – even ‘falling in love’ with the person we are supposed to be helping.

As a therapist, feeling any of those feelings is fine – so long as we don’t act upon them. What we need to do is work them through with an experienced, impartial ‘other’ (usually a qualified therapist working within a similar field) within a confidential and supportive environment. In other words, we need to take our clinical issues to our supervisor, who we meet with on a regular basis in order to work out why we feel what we feel and how we can deal with those feelings in a way that is helpful both to ourselves and our patient.

What follows is an imaginary supervision session between myself (P) & my female supervisor (S) that, hopefully, illustrates how the supervisory process works. My imaginary patient is a woman named Riadne.

P. ‘I’m struggling … I think I may be falling in love with Riadne.’

As those words tumbled from my mouth I felt the fire of my shame burning me inside out.

S. You think?

P. ‘Yes!’

S. You are not sure?

P. ‘We are reaching the end of her therapy. She is ready to leave but the thought of her going really saddens me.’

S. And your reluctance to let her go … to bid her farewell … equates to being in love with her?

P. I do not answer. I am confused. I know that I am drawn to Riadne but I don’t understand why. Am I falling in love with her? Perhaps I am. There is just ‘something’ about her that is making it very difficult for me to tolerate the thought of never seeing her again.

S. I wonder if you are in love with me?

She turns in a pause of resonance to greet my eyes with her warm smile … a mother’s smile.

P. ‘No!’ I blurt out honestly.

S. Then … perhaps I should go?

P. ‘But …’

I resist and shudder to a halt. Her suggestion that she should, perhaps, go has panicked me … hurt me. I feel confused … frightened. What does she mean, 'perhaps she should go'?

I stay with the feelings … and slowly open my shutters to let in the daylight. Words, generated by my feelings, begin to form.

P. ‘I’m hurting … I feel tears. I feel … unneeded.’

S. Well … I do not need you … but I’m pleased I can be here for you.

Her kind features spoke softly, truthfully, lovingly.

P. ‘But I need you right now.’

S. And you clearly have me.

P. ‘Yes … yes!’

I look at my supervisor’s face. I feel her … I feel her loving me … and I love her. She is safeness, steadiness. She is ‘always’ … but if she went away … if she abandoned me …?

Tearfalls. ‘No! Stop them!’ I say to myself. ‘Tears are drips of failure … aren’t they? No … tears are … exposure!'

S. I sense … (pause) … I might be wrong … I do sense that you are holding something in … just here … (she touches her chest).

P. ‘Yes!’

A silent movie jerks onto my internal screen. I am back in my childhood, watching myself: a small boy sat on the bottom step of a staircase … alone … quivering, weeping with fear as the ghosts of my imagination bump and clatter around in my head. I am petrified. I have been abandoned forever.

Suddenly, I hear the key in the lock, the creak of the door, the random chatter of an oblivious woman.

Tearfloods: unspeakable salty torrents as I stand shakily in the presence of my mother and catch her puzzled concerns in the ‘oh my’ of her opening coat.

A ripple of anger pokes at my ribs … she has returned, yet she does not realize. She is here, now, yet she is absent.

S. Who are you tears for, I wonder (there is a requisition of silence wrapped in her tone)?

P. I rub my chest, as if soothing a physical pain and look up to face my supervisor as I speak.

‘For the absence of my mother … though she was never too far away … yet I did not always feel her, only the emptiness of her space.’

Warm ponders of cumuli waft by. I feel my screen closing. I am not in love with Riadne but I do love her … I love her enough to let her go.

The initial sense of loss that I experienced when faced with having to say 'goodbye' to Riadne was an unconscious reaction, triggered by a cluster of childhood 'losses' that I had never resolved. Discovering the origins of my anxiety (frequently being left on my own as a small child) enabled me to make sense of it and accept that Riadne would be ok. She had worked through her issues and felt ready to face the ending of her therapy. My reluctance to let her go - initially interpreted by myself as having begun to fall in love with her - was merely my unconscious projection onto her of my fear of being left on my own ... and 'falling in love with her' seemed the most effective (unconscious) strategy for preventing her from leaving. 


  1. OMG this is a master piece. I am so touched, felt every word you said. This is well written..Beautiful and sad - Thanks!


  2. Thank you for such a lovely, positive comment. Really pleased that you connected with it so deeply.

  3. Another great post - I wonder how often people transfer their fear of abandonment into 'falling in love' or into a sense that they are dependent on the support of a mentor or loved one?

    Again you have given me much food for thought - thank you

  4. Thank you for your lovely comment marousia. It is true that people do transfer such fears onto significant others, both inside & outside therapy. Yet, within a therapeutic context, it is certainly no bad thing at all. 'Patients' do tend to re-enact past relationships with their therapist, providing rich material for the therapist to work with and interpret. Eventually, the patient is enabled to develop insight into these transference reactions & work through the unresolved issues that have caused them.

  5. I really appreciate how poignantly you illustrated the process of clinical supervision. As a music psychotherapist I have had supervision for many years, and now I provide supervision for music therapists, but it's still uncommon enough within our particular field that having examples such as yours is truly a helpful reference. Thank you!