Three Associating: Adventures in Relational Psychoanalytic Supervision

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. 

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.

In this episode, Andrew presents us with an insoluble ethical dilemma. Is it desirable or even possible for therapists to remain neutral when the patient lives by a value system very discrepant from their own and seems to do so comfortably and credits the therapy for this outcome?Andrew and Gill agree that therapists are not neutral as they have their own moral compasses, even if they believe it is incumbent on them to bracket them. They also agree it is fair to question the patient about the consequences of their new found comfort with problematic actions and to explore if the comfort is authentic or defensive. However, Andrew and Gill also accept that they may be defending themselves against accepting the patient's comfort with a lack of empathy for those in his ambit. They are left with the question 'Whose defensiveness is it anyway?'.

In this rich episode, Rachael grapples with a variety of complex nuanced issues such as an unexpected ending and the feat of balancing the therapist's self interest with the patient’s interest in a number of domains, including payment. Also on the table were inner conflicts around masochism and self care and the potential risks and rewards of playfulness and creativity and the inherent pleasures and perils that they engender.At the end of the session, Rachael and Gill concluded that whatever side we finally land on in the resolution of inner conflict, it is essential to own the outcome and to stay authentic and transparent.

In this episode, Andrew struggles with the power of splitting and projection as they close down thought, generate anger, and diminish compassion.He gets caught in these dynamics and struggles with his own reactivity as anger and defensive intellectualisation  masquerading as thinking emerge in the therapy space.Through supervision, Andrew realises the fear and existential threat that underpins these dynamics. He moves from a wish to confront binaries and from an appeal to both/and thinking to understanding the feelings underpinning either/or thinking, projection, and othering.Andrew comes to see how his own responses have been subverted by this extremely pressuring dynamic and returns to the capacity to go meta to himself and to the transference/counter-transference matrix

In this episode, Rachael works with a young woman who is desperate to find the right man and equally desperate to find a failsafe way to make a good choice. A prolific consumer of social media, she scours all the information about red flags that are meant to help someone spot a narcissist (e.g. lovebombing, gaslighting, self-centredness). She appeals to Rachael to assist in this endeavour of constructing and applying lists of red flags. Rachael tries to shift the agenda to fostering agency,  but to no avail.  In supervision, Gill asks a series of questions which leads Rachael to her own conclusion that her own narcissism constellated around the “need to know”. A common dynamic in therapists is implicated in this therapeutic impasse.

In this episode, Rachael is conflicted about performance artist Petra's wish for Rachael to watch a video of Petra engaging in human suspension.  Rachael has an immediate countertransference feeling that she doesn’t want to be “implicated". Rachael does not understand this feeling as she is aware of the mastery involved in this activity and also Petra's pride in her ability. However, Petra also speaks of her engagement in this practice as a means of regulating her affect. Rachael comes to understand that her reaction to Petra’s request was connected to wanting not to judge Petra’s engagement in human suspension and also wanting not to turn a blind eye to the trauma that could be "implicated” in Petra’s activity. Thus, Rachael comes to understand her own reaction as pointing to the need to integrate both the positives and the problems involved in Petra’s chosen mode of mastery and self soothing and to engage with both traumatophilia and traumatophobia (Saketopoulou, 2023).

In this session, Andrew is confused by why Amber, an anorexic adolescent woman, is so silent in session when she chats easily with other team members. Andrew is sidetracked both by his anxiety about his position in the team and his anxiety that he is getting it wrong.  In supervision, Andrew comes to understand that his different treatment by Amber may signal something positive including  Amber's emerging desires for male attention. He explores how safety for both him and Amber may lie in introducing material that can cut across the intensity of the therapeutic couple while, paradoxically and at the same time, detaching himself from his persecutory anxieties about the team which interfere with his focus on Amber.

In this episode, Andrew finds himself conflicted. His talented young patient reflects a contemporary set of values and ideas that Andrew wishes to honour, but he has a nagging sense that Jaxx is running ahead of himself. He is caught between admiring Jaxx’s resilience and wondering about the cost. But Andrew is not sure if his worry reflects a more conservative world view in himself or real potential danger for Jaxx.   In the session Andrew recognises that he needs to move to a both/and position, validating Jaxx's achievements while holding his vulnerabilities and being less cautious about moving closer.

In this episode, Rachael⁠ revisits the complex feelings that child sexual abuse evoke in both patient and therapist. Rachael discovers that her wish for magic powers has not disappeared and has reappeared in a different form. Beyond this, Rachael contacts both the magic and the terror of the therapeutic journey itself and the loneliness this sometimes produces in the therapist. Both Gill and Rachael conclude that while trauma itself is to be regretted, the person that we emerge as in the wake of trauma is to be embraced as a crucial and valuable aspect of our autobiography.

In this episode, Andrew surprises himself by the degree to which his patient has led him into dissociating from his own inner subjectivity and into merging with the patient's agenda. This agenda, in turn, reflects the patient's merged state with his partner so that “two become one”. Andrew is able to use supervision to take up a third position and to take a perspective which frees him to use his own thoughts, thereby helping the patient shape his own subjectivity independently of his partner.

In this episode, Rachael approaches the taboo of sexual attraction in therapy and its tendency to lead to dysregulation, involuntary self-disclosure, and shame.  Rachael's feelings unduly amplify her self-consciousness, complicating the ongoing therapeutic task of understanding her and her patient's contribution to the co-construction of their relational field. After engaging Rachael in a discussion of the reality/fantasy divide and the difference between voluntary and involuntary self disclosure, Gill invites a recourse to theory both as a stabilising force in the choppy waters of the embodied and as a way of retaining the boundaries of supervision versus therapy.

In this episode it becomes clear that Andrew and his patient Manuela are unconsciously co-constructing a dynamic in which Manuela is under pressure to be cultured and cool in order to maintain Andrew's admiration, while Andrew is under pressure to take up a lesser position. As the supervision unfolds, Andrew becomes aware of how his envy is at the heart of this dynamic and how he is projecting certain longings onto Manuela. He becomes aware this leads to both an underplaying of Manuela’s limits and vulnerabilities and the overplaying of his own and keeps her stuck in a relational impasse. In the session, Andrew moves to a more balanced perception of Manuela’s plight and a greater recognition of his own contribution to her relational dynamic.

Rachael comes to realise that feeling provoked by the patient’s apparent self-centredness in enactments that occur in the waiting room and in the session has led to a wish to be provocative in return. She first enjoys then tussles with revenge fantasies. By talking through these fantasies and owning their pleasure, she recognises their meaning, and this opens up multiple perspectives.

In this episode, Rachael encounters a worthy adversary in the elegant and charismatic Iris. Beguiled by Iris charm and colourful stories Rachael can’t help feeling seduced.  However she also feels manipulated and is  irritated with herself and Iris.  Nevertheless she still feels the pull to captivation in the session. In the end, Rachael ⁠ realises that the most worthy adversary that she has is herself and in freeing herself contemplates helping Iris to be both her charismatic and her vulnerable self.

In this episode, Andrew struggles to disrupt his patient's rigid self-control, ever mindful of a psychotic potential that could be unleashed given the patient's history of experiencing a psychotic episode. Andrew experiences both the seductions of a meeting of minds and the potential tyranny of his patient's mind that fears the body, its appetites, and affects.

In this episode, Rachael is provoked by a disrupted patient. Power struggles and challenges emerge in the room as Rachael struggles to think and not enact in the face of the patient's enactments.  Technical questions of courageous speech versus disruptive challenges are engaged as Rachael shows great integrity and courage in taking in the challenges of supervision to come to an expanded understanding of trauma.

In this episode, Andy is frustratingly blocked by his patient's difficulty in listening and by her incessant talking, both of which reveal parts of her self and mask others. Ironically, Andy himself has to surrender into listening rather than talking and into only having recognised small snippets of his thoughts, if any at all. He becomes aware of the deprivation under his patient's excess and how this fuels the discrepancy between her subjective reality and his experience of her.

In this episode, we encounter Rachael's struggle with an avoidant patient who is fearful of closeness. Rachael is conflicted between her desire for the patient to make progress and to stay present to the work and to 'dine in', and her awareness that, for his desire to move forward to emerge, she needs to take a step back and let him continue with 'take away' for a while longer.

In this episode, Andrew finds himself challenging his patient's perception of him as an internet dinosaur, too old to be familiar with youth culture. In engaging this challenge, Andrew finds both a way to connect with his patient, but also a way to collude to avoid an underlying grief which needs to be addressed.

In this episode, Rachael⁠ struggles with exasperation and grief as she writes a court report for a patient who has relapsed. To be both truthful and helpful is no mean feat, and nor is accepting the limits of her responsibility while still grappling with how to move the therapy forward.

In this episode, Andrew⁠, ⁠Gill⁠, and ⁠Rachael⁠ explore the hot topic of neurodiversity. We conclude that whatever the political and ideological controversies, our main focus needs to be on the person in the room.

Misrecognition and the projection of others are a perennial problem, but perhaps more so for those who are queer identified. But whoever is at the receiving end of mistaken identity, the effects are very unpleasant as Gill, Andrew, and Rachael come to know first hand in this episode. www.threeassociating.com

In this episode, Gill, Rachael, and Andrew grapple with feelings of exposure as Rachael becomes aware that her private and professional lives have collided, but the exact nature of this is unknown. www.threeassociating.com

Rachael, Gill, and Andrew work together to understand how the presence of subtle power dynamics, unconsciously enacted in the therapeutic relationship, are signalled by the therapist’s destructive fantasy. www.threeassociating.com

In this episode, Gill, Andrew, and Rachael are confronted with how intense feelings can muddy the waters and produce confusion about which feelings belong to the therapist and which to the patient. www.threeassociating.com

In this episode, Rachael, Andrew, and Gill discuss the proverbial notion that the road to hell is paved with good intentions as Rachael's wish to protect the patient reveals hidden difficulties. www.threeassociating.com

In this episode, Andrew, Rachael and Gill tussle together over ethical and therapeutic issues as they wonder where self help ends and where helping oneself to what belongs to the other begins. www.threeassociating.com

Rachael, Gill, and Andrew struggle hard to resist the all-too-human desire for magical solutions to truly awful problems. www.threeassociating.com

In the first episode of season two, Gill, Andrew and Rachael plunge into the pleasures and perils of toxic masculinity and the allure of trading intimacy and authenticity for the exercise of power. www.threeassociating.com

In this last episode of season one, Gill, Rachael, and Andrew grapple with the challenges of staying awake when it seems that the other person is exaggerating wildly or, even worse, is somewhat out of touch with reality. Faced with the seemingly impossible task of finding a constructive way to express one’s thoughts to the person, it is easy to unconsciously zone out instead. www.threeassociating.com

Gill, Andrew, and Rachael wrestle with the thorny issues of rivalry and competition. They show how, ironically, being caught in rivalry can lead one to give away one’s authority, as the focus comes to be placed on competing rather than on occupying one’s own personal power. www.threeassociating.com

Gill, Andrew, and Rachael encounter the common problem of when we are drawn in by charisma, fail to set firm boundaries and then experience guilt and anxiety about hurting the other person when we feel our boundaries have been transgressed. www.threeassociating.com

Gill, Rachael, and Andrew dive into the heady brew of sex and aggression, showing how these issues can be unconsciously provoked and can then easily lead to shame and overwhelm. www.threeassociating.com

Gill, Andrew and Rachael uncover some unexpected disadvantages of friendliness, delving into how affability can cover up an unconscious fear of difference and otherness, and also mask a desire to be mirrored back positively to oneself. www.threeassociating.com

Gill, Andrew and Rachael discover how unconscious disapproval can be communicated with ill effect and provoke bullying and verbal intimidation in return, resulting in overwhelm, dissociation, and an inability to think. www.threeassociating.com

Gill, Andrew and Rachael come to understand how an unconscious bias towards over-identifying with a person's trauma story inadvertently deprives the person of agency and disallows a more nuanced perception of the person. www.threeassociating.com

Gill, Rachael, and Andrew explore the common problem of feeling conflicted between a wish to be accepting and the desire to be confronting of offensive stances and statements. They come to recognise how understanding one's own unconscious biases contributes to the solution. www.threeassociating.com