Kacie Liput dissertation

Institute for Clinical Social Work

Candidates’ Honesty and Openness in the Supervision Relationship

A Dissertation Proposal Submitted to the Faculty of the Institute for Clinical Social Work in Partial Fulfillment for the Degree of Doctor of Philosophy

By Kacie Campbell-Liput

Chicago, Illinois September 15, 2022

Copyright © 2022 by Kacie Liput

All rights reserved

Abstract

This phenomenological study investigated the lived experience of 11 psychoanalytic candidates on how open and honest psychoanalytic candidates are with their training supervisors. This study offers deeper insight into what allows a candidate to be open and honest or guarded and reserved with a supervisor.

This study had eight major findings:

1. Regarding supervision, the concerns of discussing honesty made finding participants difficult.

2. The candidates in this study genuinely wanted to be open and honest

3 A supervisor’s approach towards a candidate depends on their level of openness.

4. The most effective intervention may not be understood in the supervision dyad.

5. Candidates are sensitive to institutional processes and turmoil.

6. Candidates are the most honest with the unseen guide behind the couch.

7. The power and influence of candidates increases with their numbers, as integral information is exchanged and provided, collectively, with their cohorts.

8. Candidates’ Achilles’ heel is honesty, which is the primary reason why they leave a supervisor

For my husband, John

Being entirely honest with oneself is a good exercise

~Sigmund Freud

Acknowledgements

I owe the fruition of this dissertation to the support of many people. To my dissertation chair, Dennis Shelby, PhD who understood the complication of the topic of “honesty” before I did and was able put language to the challenges of the project with enduring patients. To my dissertation committee, Jim Lampe, Sue Cebulko, and Connie Goldberg all of whom had also been invaluable supervisors in my training at ICSW. To the faculty at ICSW, who I was fortunate to learn from and augment my growth as a clinician and a researcher. To Rick Michael, Alana Spiwak, Jean Godwin, and Glen Gabbard, who served as my psychoanalytic supervisors at the Center for Psychoanalytic Studies in Houston. To Karen Strupp who listened to me for years “on the couch. ” To Rachel Brownlie who read through the document multiple times. To my 11 participants that sat for this study, I am ever-so-grateful.

KL

Table of Contents Continued

The 1950s-1960s and the American Pathological Supervision Model

De-New-Yorkating

1970-1980 Heinz Kohut

Who Should Be a Psychoanalyst? Return of the Lay Analysts

What is Therapeutic About Psychoanalysis

1990s to Present: Relational Psychoanalysis

Supervision Critique

Special Problems of Supervision

Teach or Treat? Parallel Process Issues in Supervision

Problems with Progression

Gatekeeping

The Candidates’ Unofficial Power

What We Know About Candidates

Supervisions from Candidates’ Perspective

Concluding the Topic of the Importance of Honesty

III. Methodology 52

Introduction

Rationale for Qualitative Research Design

Rationale for Phenomenological Research Methodology

The Research Sample

Table

of Contents Continued

Themes Across Cases

Limitations and Delimitations

The Role and Background of the Researcher

IV. Results

…………………………………………………………………........78

How Open and Honest Are Candidates? It’s Complicated

The Candidates in this Study Genuinely Wanted to Be Open and Honest

Not All Supervisors are Created Equal

Candidates’ Achilles Heel in Openness and Honesty

The Supervision Dyad Is an Open System

Candidates Are Sensitive to Institutional Processes and Turmoil

The Unseen Guide Behind the Couch

The Unseen Power of Cohorts

V. Discussion and Conclusion

Honesty is Complicated

……………………………………………......91

Most Candidates Genuinely Want to Be Open and Honest Not All Supervisors Are Created Equal

Candidates Leave Supervision over Conflicts with Openness and Honesty

The Supervision Dyad: The Open System

Candidates are Sensitive to Institutional Processes and Turmoil

The Unseen Guide Behind the Couch: The Candidates’ Analysts

Chapter I Introduction

General Purpose Statement

The purpose of this phenomenological study is to explore the experience of how open and honest psychoanalytic candidates feel they can be with their training supervisors. This is a complex relationship since (a) the candidates pay for the supervision (either privately or within their tuitions), (b) the supervisors must periodically report on the progress of the candidates and eventually give approval that the candidates are ready to be certified as psychoanalysts, (c) the evaluation process in supervision creates asymmetry in the system, so those involved cannot escape power imbalance issues, and (d) analytic training is a process that endures for 4 to 8 years, sometimes longer according to the APsaA head office (Wardell, 2016). The added time represents considerable expense, so candidates are motivated to complete their training in a timely manner.

As a candidate, as with all people, there will always be neurotic qualities one possesses. Hence, one will always be faced with the dilemmas of unconsciously presenting less than “the full truth” to avoid internal conflict. Thus, it may be that some extent of what might be called lying is unavoidable in psychoanalytic candidates, but that does not mean they are dishonest. For the purpose of this study honesty will be defined by Thompson (2001), in the article “The Enigma of Honesty: The Fundamental Rule of

Psychoanalysis,” as the individual being sincere, truthful, and candid. Thompson looked to Freud to determine the original intent of honesty in psychoanalysis. Hence, the word honesty in this proposal does not follow within the etymological roots derived from the Latin honestus, meaning “an honorable person” (from a moral perspective), deducing that the person neither lies, cheats, nor steals. Freud (1912/1973) believed only neurotic and obsessive people were analyzable. Hence, there will always be neurotic and obsessional influences in education in general and supervision in particular. Freud also believed in the repression barrier of the unconscious, so he believed neurotics would be incapable of honesty in the moralistic definition from an etymological perspective (Rieff, 1959). This study will examine whether psychoanalytic candidates are generally open and honest, the extent of their openness and honesty, and what impedes their openness and honesty.

Significance of the Study to Clinical Social Work

According to the American Board of Examiners in Clinical Social Work (ABECSW, 2004) clinical social workers make up the largest group of mental and emotional healthcare workers in the nation. Many professionals believe that social work is incompatible with psychoanalysis (Alperin & Hollman, 1992). Yet, in 1988 APsaA changed their policy so social workers could apply without waivers, making social workers the newest members of the psychoanalytic profession. A survey of New York psychoanalytic training programs showed that social workers made up 50% of the graduating classes (Rowe, 1975). Yet, despite the controversy, social workers now train in psychoanalysis more than ever before. In fact, social workers may dominate the field of psychoanalysis. Many social workers come into psychoanalytic training as seasoned

clinicians. They have already experienced what could be called clinical social work supervision; however, it is unclear how or if previous supervision prepares social workers for psychoanalytic supervision.

The rationale for a practice specialty in psychoanalysis, according to ABECSW, is that psychoanalysis is an effective method of treatment for those who experience disturbances in affect, thought, and behavior. Psychoanalysis is a psychotherapeutic application, by a trained analyst, to help ameliorate disorders that interfere with a patient’s functioning level. The analysis is conducted with a frequency and intensity that seeks out unconscious material to help one gain personal insight and awareness of self and others, increase their capacity to regulate emotions, and improve problem solving skills. Psychoanalytic training occurs as post-graduate training; as such, the analyst is well versed in a multitude of psychoanalytic theories, research, applied practice methodologies, and has a set of specialized clinical skills. Psychoanalysis involves the detailed exploration of the emotional, psychological, cognitive, and behavioral aspects of patients. It is reasonable to expect complications with candidates and supervisors, as the complex exploration will encounter a variety of pathological structures in the analysis under supervision.

Crayton Rowe, a social worker, surveyed New York Psychoanalytic training programs and found that social workers made up 50% of the graduating classes (1975). Despite the controversy, social workers are training in pscychoanalysis now more than ever. Traditionally, social work has been practiced in an institutional or clinical setting, typically involving a supervisor who performs administrative tasks, performance evaluations, and focuses on agency expectations (Hair, 2008); so work independence has

not been expected. Yet, potentially, there could be a great value in psychoanalytic therapeutic techniques and understanding, influencing a broad range of the mental health professions. For instance, people trained in clinical social work also serve as institutional presidents, deans, faculty, and curriculum chairs where their psychoanalytic training can allow them to understand, train, and mediate interpersonal issues (Perlman, 1995). While this study may reveal findings relevant to any psychoanalytic supervisory relationship, it specifically focuses on clinical social workers as the majority of the supervisees.

The psychoanalytic supervisory relationship is crucial, clinically, for numerous reasons. The supervisory relationship can dramatically impact the way psychoanalytic candidates learn to be analysts, and how they view themselves, since examples and techniques used in this relationship offer tools in learning how to be a psychoanalyst. What the supervisee internalizes from the supervisor will directly affect the supervisee’s patients, possibly over the span of the supervisee’s career. As many senior social workers become supervisors within the general profession of social work, as well as within psychoanalysis, their relationships could impact many people, not just the supervisee and their caseload during supervision. The results of this study hopefully will provide insight into how to improve the supervisory relationship. Knowledge about the day-to-day conduct of psychoanalysis often is handed down from generation to generation (R. D. Shelby, 2017).

Whether the supervisee goes on to private practice, private institutional settings, or publicly funded programs with clinical social work practice, the impact can persist. Psychoanalytic training has strict supervision guidelines, primarily to prevent someone not intellectually or emotionally prepared to practice (Hall, 1984). However, clinical

social workers independently work in institutional clinical settings that typically involve a supervisor who tends to administrative tasks, performance evaluations, and agency expectations (Hair, 2008).

Foregrounding

My own psychoanalysis has uncovered a new way of being in the world that allows me to be more honest with myself by working through defenses that are no longer helpful To omit information or lie directly to a supervisor is extremely distressing. This is the antithesis of who I am and the antithesis of what the practice of psychoanalysis is about. This is not defined as a moral stance, but as an internal experience. When a candidate is not open or honest with their intent, there may be a sense of dread or anxiety, even of failure. There is meaning in not being open and/or honest in supervision. This meaning cannot always be ascribed to the candidate’s issues alone. The issues could stem from the supervisors and their encounter with the emotional dynamics of the candidate and/or the candidate’s analysand. Using a more relational, or two-person school of thought, a supervisee’s issues should prompt a supervisor to examine their contribution to a dynamic of mistrust or other issues that may influence the supervisory encounter.

I became interested in researching the relationship of the supervision dyad due to my difficulties in a psychoanalytic supervision. In my first analytic case, I had many parallel processes with my analysand that played out with my supervisor, which took time to work out. At the time, how I identified with my patient had not been analyzed, resulting in blind spots. I needed to understand myself before I could understand my patient and my impasses that occurred in supervision. I had also lost my second control case due to

my patient’s intense trauma history that took over a year to discover. My second supervisor said the case was “unanalyzable” and stopped supervision promptly. I respected her but was disappointed when she chose, at her discretion, not to credit me with the training hours. I felt the money and time in supervision was wasted, and I never understood why she believed the case was not analyzable. Worse, because of my supervisor’s abandonment, my patient and I were left without any understanding of how to proceed “out of analysis.” The psychiatrist on the case was also an analyst, who did not agree with my supervisor’s assessment. At the same time, I had been resisting sitting for my first colloquium, since I felt I was not ready, despite the encouragement from my advisor and supervisors. As a candidate we sit for two colloquiums. The purpose of the first colloquium is to exam the candidate’s progress midway through the candidate’s training. The candidate will write up two cases and present their cases to their assigned colloquium committee. After the presentation and discussion of the cases, the members of the committee will give feedback and make recommendations for the candidates third case. The final colloquium is to determine if the candidate is ready to be a psychoanalyst and a part of the psychoanalytic community. Once I felt I was ready to sit for my first colloquium, my new supervisor felt I was not ready. In my experience, he thought I was ready until I resisted his feedback over a trivial issue: not removing a candy bowl at the office I shared with three other clinicians, which had been there 20 years before I joined the practice. Unfortunately, he raised the issue of my resistance to his feedback as part of the meeting that was evaluating my progress as an analyst. When I asked my advisor what happened, she directed me back to my new supervisor and requested that I ask him to reevaluate the situation. When I approached my new supervisor, he became defensive

saying that it was a team decision, and it was unfair that I was singling him out. Many candidates report these confusing group dynamics, often dominating their experience of their supervision and evaluation.

What sparked my curiosity about the relationship between the supervisor dyad was the advice I received from colleagues, not all of them candidates, during a time I experienced impasses in supervision. Between my PhD program and my analytic training, there was a period where, altogether, I had nine supervisors and consultants, either once a week or once every other week. Some of the recommendations I received were to have frank conversations with my supervisor, get a new supervisor, or not to be as transparent. Related to the recommendation to be less transparent, it was suggested I read Annie Rodger’s writing She struggled with mental health issues as a therapist in training and avoided straightforward conversations with her supervisor; in other words, she chose to appear more stable and prepared than she felt. These recommendations led me to wonder how honest psychoanalytic supervisees feel they can be with their supervisors. Can they really share their therapeutic mistakes and learn from them, without negative repercussions, such as having their careers delayed and incur additional financial burdens? Can they let their supervisors know their own challenges without discrediting themselves in their supervisors’ view? How much do and should supervisors know about the supervisees’ history? How much do the supervisees trust their supervisors? Are there ways in which imbalances in power can or should be ameliorated by appeal to a theoretically unbiased third party? While I formed these questions, I noticed that very few of my peers openly discussed their difficulties with their supervisors, though I expected they would. In my supervision to become a social worker, and when I became a

psychodynamic therapist before working with supervisors, I had not encountered these conflicts. The dynamics were shockingly different with my psychoanalytic supervisors, and I suspect that unchecked power differentials caused these difficulties, especially while learning and understanding the complexity of the analytic profession The literature that notes these tribulations, and their effects, repeatedly mentions the imbalances and difficulty as a global issue in psychoanalytic training starting from the 1950s.

Statement of the Problem and Specific Objectives to be Achieved

The relationship between candidates and their supervisors is complex as (a) the candidates pay for the supervision; (b) the supervisors must submit progress reports and eventually approve the certification as a psychoanalyst; (c) the evaluation process in supervision creates asymmetry, so the system cannot escape power dynamic issues; and (d) analytic training is a process that endures 4 to 8 years, sometimes longer according to the APsaA head office (Wardell, 2016). There is never a completely objective determination of a completed analysis (Rubens, 1992), which also would transfer to a “supervision” never truly being completed within the triad (patient, candidate, and supervisor). The determination of completed training is subjective.

Candidates pay their supervisors (either individually or in their tuition), while at the same time, supervisors have to report the candidates’ progression to their progression committee, which they serve on. The supervisor then determines if the candidate is ready to take on new cases to become certified. The problem is that there can be conflicts of interest that may not be formally acknowledged. The supervisor is being paid through the supervision process. When the supervisor deems that their training is complete, the

candidate is certified as an analyst and no longer needs supervision. At this point, the supervising analyst could be faced with loss of income or loss of intrinsic rewards from being in a supervisory relationship. Or the supervisor may be supervising the case for such a low fee that they could increase their income by quickly passing candidates In summation, either by promoting or delaying a candidate’s progression, a potential conflict of interest could arise.

Because of the real or perceived repercussions, few have said, out loud, that clinical supervisors may fail to give adequate support and subconsciously stifle their supervisee’s progress. Thus, this topic has not been explored in the literature, nor is there a mechanism to ameliorate the conflict Most literature has focused on the supervisors’ perspective of the co-created problem, leaving out the other half of the dyad. From a candidate’s perspective it may seem that the supervisors are “bullet proof,” since there is no outside system monitoring the process. Many in the psychoanalytic educational system have called for ongoing evaluations of training and supervising analysists, however this has not come to fruition. Because of this lack of oversight, candidates may, subconsciously or consciously, process whether it is worth being open or honest as omitting information, telling white lies, or outright lies could be safer

Statement of Objectives

The following questions will guide the study:

1. What is the meaning of honesty in supervision for psychoanalytic candidates?

2. How honest are candidates with their supervisors, given the complexities of the supervisory relationship and the need for approval from the supervisor to graduate?

3. To what extent do candidates feel they can talk about their mistakes or perceived mistakes openly with their supervisors?

4. To what extent do supervisors know their candidates’ histories or their current life circumstances?

5. To what extent do the candidates receive interpretations from their supervisors on a personal level?

6. To what extent do candidates trust and welcome interpretations from their supervisors?

7. To what extent do candidates trust their supervisors’ intentions?

8. How do candidates address difficulties with their supervisors through informal or formal mechanisms?

Statement of Assumptions

The following assumptions set a foundation for understanding the researcher’s perspective. To the extent possible, Chapter 2 provides evidence for these assumptions.

1. The supervisory process and relationship are central to the training of future psychoanalysts.

2. The literature and pilot study indicate that the supervision process is complex, and the experience fluctuates.

3. Most literature on the topic is approached from the supervisor’s point of view

4. The literature promotes the idea of an honest exchange between the candidate and supervisor regarding a range of feelings, fantasies, and details of the analysis under supervision.

5. An initial query into this topic indicates that candidates are not always honest with supervisors for a range of reasons.

6. Honesty in supervision can be approached as a phenomenon amenable to close exploration and study.

7. The methodology will allow access to the complexity of supervision from the candidates’ point of view with an emphasis on the phenomenon of honesty.

8. Candidates will be able to articulate the complexity of the supervisory relationship coherently.

9. Analysis of interview data will lead to a greater understanding of the complex phenomenon of honesty in the supervisory relationship and process.

Epistemological Foundation of Project

Freud found his beginnings as a neurologist. His attempt was to make psychoanalysis into a “hard” science or a “pure psychology,” which he failed to do. Still, psychoanalysis had its beginnings in the positivist stance, and remained so for decades (Palombo, Bendicsen, & Koch, 2009). Derrida found that one’s resistance to Freud, resistance being defined as the point at which analysis stopped, was in contradiction to Freud’s earlier work (Derrida, 1998; Schechter, 2014). Here lies an example of the difficulty of understanding Freud as his theories were being developed, redefined, or changed. His followers would share ideas that he did not approve of, to mitigate the differences of opinion, he created a closed system of information into psychoanalysis. He

controlled new ideas from his followers, carefully to make sure their ideas were in coherence with the theories he was developing (Grosskurth, 1991). Many of Freud’s descendants had hoped to leave the theory in the natural sciences. The underpinnings of positivism are found with the drive theorist, ego psychologist, and the object relational theorist schools of thought (Palombo et al., 2009). These analysts, in the positivist or objective realm, believe they can stand outside their interactions with patients and have an objective view. This model is one in which analysts are perceived to be in an allknowing position where countertransference is avoided (Hoffman, 1991), though this discernment was not considered an important objective. As Pine (1990) stated, the positivist does not ensure a certain kind of openness. If one type of intervention did not work, then another was tried without necessarily understanding the reasons.

From 1938 until 1989, psychoanalysis in the United States remained under the oversight of the medical profession. This was because the American Psychoanalytic Association (APsaA) felt they needed to keep the profession respectable, and held firm to keep its practices within proscriptions defined by the medical model (Reeder, 2004). Yet, the International Psychoanalytic Association (IPA) granted the so-called franchise of the United States a separate functioning agent; doing so created the question of whether the United States would oversee itself or be beholden to IPA. IPA, social workers, and psychologists were still allowed to become psychoanalysts, causing much tension in the mental health field and added to the arrogance and sense of superiority of the privileged medical doctors (Ponder, 2007). Freud had a concern that psychoanalysis, in coming to the United States, would follow psychiatry into the medical model, which it ultimately did (Schechter, 2014). Psychotherapy was reserved for those not trained in

psychoanalysis. This included social workers and psychologists and their division of tasks in the mental health field. If someone was not analyzable, they were referred to psychotherapy.

Hermeneutic and social constructivist approaches emerged as psychoanalysts were unable to hold on to the underpinnings of the profession being a science (Palombo et al., 2009). Several authors (Palombo et al., 2009; Schechter 2014) discussed the epistemological tensions of psychoanalysis since there was much criticism of Freud’s classical model. In response to these disagreements, other schools of thought were formed, such as attachment theory, self-psychology, and relational theories. These theories allowed psychoanalysis to have other philosophical underpinnings in hermeneutics and constructivist viewpoints (Palombo et al., 2009). From a positivist standpoint, the supervisor can declare the truth. From a hermeneutics perspective, the meaning is found in the interchange between the patient, the candidate, and the supervisor. Inevitably, these epistemological differences would influence and inform supervision differently. Do these new schools of thought and their epistemological differences filter down into supervision today?

In this research, hermeneutics is used, with a phenomenological approach, to investigate the study. The etymology of the word hermeneutics is grounded in Greek with Hermes, who interpreted what the gods wanted to humans (Mueller-Vollmer, 1985). Edmond Husserl was a philosopher was born in Prossnitz, Moravia under the AustroHungarian Empire. Husserl brought the understanding of meaning to problems, which clearly transcended the realm of simple logical deductions (Mueller-Vollmer, 1985). Positivism, on the other hand, has allowed a detached and objective third person point of

view, whereas phenomenology is the study of structures of consciousness as experienced from the first-person point of view. As such, phenomenology, in the current study, is used less as a philosophy yet more of a mode of inquiry, though some theorists align it with a relativistic viewpoint, which does not agree with the current study’s theoretical basis

Phenomenological studies are used describe what an experience means for those who have had the experience and rely on the subjects’ ability to provide a comprehensive description of their experience. The researcher sets aside their views, accepts participants’ statements as valid from the participants’ perspective and interpretation, known as the process of bracketing, and provides an interpretation of the perceptions that appear to be most useful in understanding the phenomenon.

Fundamentally, the present inquiry fits with the empirical theory of knowledge, as it focused on the role of experience, especially experience based on perceptual observations by the senses, and interpreted logically. The epistemological foundation of this project is not; however, positivist, because the mode of inquiry is planned as a method that cannot be replicated, with the same result, within a small margin of error. The epistemological foundation of this project relies on objectivism, the philosophical position that what you know about an object exists independently of your mind, and philosophical realism, the position that truth consists of the mind’s ability to perceive a non-relativistic nature of the physical world, with its perceptions having a correspondence to a reality that is independent of its prior conceptual schemes (Objectivism, n.d.; Realism, n.d.).

Chapter II

Literature Review

Introduction

The goal, aim, and hope of this phenomenological study is to understand how open and honest psychoanalytic candidates are in psychoanalytic supervision. Specifically, the researcher seeks to understand, from the candidates’ perspective, how psychoanalytic candidates determine how open and honest they can be with their supervisors. Prior to implementing this study, a critical review of the literature is required. This review was purposeful, meaning that themes specifically related to the purpose statement were examined. Topics include a historical examination of the terms psychoanalytic supervision, psychoanalytic institutional education, and psychoanalytic education in order to ground readers in the theoretical underpinnings of the study, as well as its primary focus.

Keywords used to search for relevant literature included psychoanalytic honesty, clinical supervision, tripartite psychoanalytic model, supervisor dyad, progression committee, psychoanalytic supervision, psychoanalytic education, and psychoanalytic institutions To conduct this selected literature review, multiple resources were utilized including books, dissertations, peer reviewed professional journals, internet sources, and periodicals. A variety of search engines and databases were utilized to conduct this literature review including, PEP-web, Google Scholar, PsycINFO, EBSCO, Academic Search Premier, Tandfonline, and PsycNET. Original attempts were made to utilize a top-

down approach, but it became apparent that a scarce amount of literature was available, specifically about a candidate’s perspective of psychoanalytic supervision; hence a bottom-up approach was employed.

Supervision Through Psychoanalytic Schools of Thought

Psychoanalysis draws from a century-long history of multifaceted traditions, both in clinical technique and theoretical concepts. All the various schools of thought and concept draw on some theoretical map of Freud’s (Mitchell & Aron, 1999). There is always some form of thinking about the unconscious process, exploring the present and the past, unconscious processes between the patient’s associations to reality and fantasy, or the transference and resistance from the patient. As Mitchell and Aron (1999) point out, some of the ideas and concepts can be fully formed by a theorist into a school of thought, such as Freud’s drive theory or Kleinian’s object relations. These are more circumscribed traditions. Other schools of thoughts are not as easily categorized. Sometimes traditions in psychoanalysis arise in less formal and systemic fashion, centering around a particular author’s concepts or writing (1999), such as the relational school of thought.

This literature review will start from a historical evolution of psychoanalysis and the tradition of supervision starting with Freud. The conflict between Klein and Freud bypasses the Americans. The Berlin Institute and its frame for supervision was uprooted by American tradition (Reeder, 2004), and became the American ego psychology model that solidified a pathological supervision in the 1950s, where the candidate is a subservient and passive recipient of imposed authoritarian formulations (Ponder, 2007).

Kohut changed this by abandoning the drive theory of the pathological model to promote a deficit model. Kohut’s developments provided an important basis for the emergence of a relational approach (Kernberg, 1997). The relational school of thought is arguably more precarious, as there is no central figure as an organizing theorist (Mitchell & Aron, 1999)

All of the theories of psychoanalytic thinking, in chronological order, will unfold through the history in this literature review, but not in ridged, well-defined schools of thought.

The Beginning with Freud and Supervision

Supervision was first implemented by Freud (1910/1973) in 1902 (Frawley-O’Dea & Sarnat, 2001; Gay, 1988). Freud was his own analyst, supervisor, and wrote his own academic papers. Freud believed that the ability to encounter self-evaluation was necessary to help others intra-psychically and obtain knowledge. Freud’s supervision initially involved reading a paper, then smoking and drinking in his waiting room with his colleagues (Jacobs, 2002). These meetings were called the Psychological Wednesday Night Meetings (Wallerstein, 1998) and membership was not limited to the medical field, instead they consisted of an array of intellectuals. Freud (1926), in his paper on lay analysis, was an avid advocate for lay analysis stating, “I stress on the demand that no one should practice analysis who has not acquired the right to do so by a particular training. Whether such a person is a doctor or not seems to me immaterial” (p. 233).

When psychoanalytic training began, supervision lacked structure, resulting in broadly defined roles and scenarios where one’s analyst would also be one’s supervisor. Frawley-O’Dea and Sarnat (2001) pointed out, in their historical evaluation of the literature, that the so-called classical analyst was a single-person model. The analyst in

this model had all the authority, knowledge, and power, because his patient was less psychically healthy than the analyst. The main currency in this model was the ability of the analyst to give interpretations. The analyst was a blank slate, and the patient who questioned the analyst was seen as resisting knowledge the analyst had to give. Supervisees who questioned their supervisors were then considered problematic, since they too were resisting what the supervisor had to offer (Ekstein & Wallerstein, 1958).

The Initial Loss of a Two-Person Supervision Model

By the 1930s there were two schools of thought about how to handle the education of psychoanalytic candidates, the Hungarian school, and the Berlin school. The Hungarian school members were Ferenzi and Rank who initially examined psychoanalytic training. In 1924, Ferenzi and Rank published Die Entwicklungsziele der Psychoanalyse, which stressed that the training analysis needed to be deeper and more thorough than therapeutic analysis. Ferenzi and Rank did not believe that the training analysis was enough to prepare the student to practice analysis. Hence, they recommended controlled analysis (Fleming & Benedek, 1966). Ferenzi and Rank thought that the best way for a candidate to have supervision was with one’s own analyst. They argued that psychoanalysis was a two-person experience. They also pointed out that training analysts were taxed on their availability to treat patients and to train future analysts. This school of thought did not win favor for training due to multiple reasons, including World War II. Another reason Ferenzi and Rank’s system was lost to Eitingon’s Berlin model was that Freud had learned he had throat cancer (as cited in Fleming & Benedek, 1966). Cognizant of his intellectual legacy, he was more focused on

his ideas and theories being purer, which deviated from the way he practiced himself.

Bernfeld (1962) believed the introductions of rigidness into the system of training was due to Freud’s anxiety and the threat of the eventual “loss of self.” Bernfeld concluded, “Irrational motives of xenophobia introduced melancholy traits into our training” (p. 467). Freud was enraged by Ferenzi’s reintroduction of Freud’s long forgotten (forbidden) seduction theory, as well as the boundaries Ferenzi crossed with his female patients, writing about them in Confusion of Tongues (Berman, 2014). Freud expressed concerns with what he coined “wild analysis, ” targeted towards Ferenzi. This is when a “wild psychoanalyst” had not been following the rules of psychoanalysis or the prescribed techniques (Berman, 2014; Phillips, 2002). All this made the alternate training in Berlin much more appealing to Freud.

How Eitingon Syndrome Began

Eitingon felt that it was necessary to teach psychoanalysis through a different method than the Hungarian model, believing that supervising analysts could detect beginner’s mistakes even if the supervisor did not know the candidate (Fleming & Benedek, 1966; Reeder, 2004).

Eitingon set up the institute in Berlin entirely at his own expense. As Ferenczi lost favor with Freud, Eitingon did not deviate from Freud’s theories. Zusman (1988) pointed out that Eitingon had never written a scientific paper because he believed everything had already been discovered. His relationship with Freud was based on idealization, submissiveness, and inhibiting new scientific discoveries in psychoanalysis. Eitingon believed what was needed was a more formal structure for psychoanalytic training.

Zusman argued that the model set up was based on Eitingon’s personality and his relationship to Freud. Eitingon’s offering was a tripartite model, which is now the model that is carried out for supervision today under the American Psychoanalytic Association (APsaA). The tripartite system involves a personal analysis, didactic learning, and supervision (Ekstein & Wallerstein, 1958; Fleming & Bendick, 1966; Reeder, 2004).

Ironically, Freud viewed Eitingon as being compliant and lacking ideas, but had deep pockets for his cause. Reuben Fine (1979) wrote that Eitingon was an unlikely person to have established the first training institute. Eitingon had no formal analysis, except for a few conversations about himself with Freud. Although Eitingon trained as a medical doctor, he never completed the final exams necessary, due to his stuttering ailments. Thus, Eitingon himself was a layman in the field and was untrained.

In the tripartite system (i.e., the Berlin school), countertransference issues were to be handled in one’s own analysis (Wolstein, 1984; Rock, 1997). The supervision was not to include supervisees’ personal problems, but to focus on the patient and technique (Frawley-O’Dea & Sarnat, 2001). Ferenzi felt that Eitingon’s model separated the supervised analytic work from the training analysis and would divide psychoanalytic training into separate entities, instead of offering the candidates a continuous development through various methods of teaching (Fleming & Benedek, 1966).

Since it was considered that the Berlin Polikinik offered the most rigorous training in psychoanalysis (Makari, 2008), the best and the brightest students made their way to the Berlin Society to train under Eitingon. Due to this arduous training system, the days of the “wild analyst” were numbered. Balint wrote, in 1948, that there were only three published papers on psychoanalytic training, this included Freud’s (1937) paper,

“Analysis Terminable and Interminable.” Balint (1948) discovered that there were 10 papers read at various meetings between 1927-1938, but most papers focused on the complications of psychoanalytic training rather than laying a groundwork for training procedures.

Freud established the International Psychoanalysis Association (IPA) in 1910 to advance his ideas and promote a commitment to shared standards of professional practice (Wallerstein, 1998). By 1928 the International Training Commission (ITC) was established under IPA (Reeder, 2004). It became the central agent for psychoanalytic training. The IPA almost had total control of all training activities. Reeder (2004) stated, “For known historical reasons, Americans do not easily take instructions from Europe, and in a long run they could not accept what they perceived as overpowering ukases [authoritarian edicts or arbitrary commands] from the IPA and the ITC” (p. 65). At the time, there was an active power struggle between Europe’s psychoanalysis and the American analysts. World War II displaced many analysts in Europe. Both the Hungarian and Berlin Societies vanished as they were known. On March 11, 1938, Austria fell to Adolph Hitler, and Freud left Vienna on the Orient Express, never to return home to the birthplace of his legacy of psychoanalysis (Makari, 2008). The common belief was that the IPA had no reason to think it would be in any jeopardy as a governing body, but the Americans had different ideas, and as the European psychoanalytic community was in shambles, the American Psychoanalytic Association demanded that the ITC (training body) cease to exist (Makari, 2008). Ignoring the Americans was no longer an option. Jones was the president of the IPA at the time. He was also known to have saved many of the Jewish psychoanalysts’ lives by extraditing them out from under the totalitarian

regimes. There were nearly 100 Viennese analysts that went to English-speaking countries, except for four analysts. If the lay analysts went to the states, they no longer could practice, because the IPA could no longer protect them. The American system had other ideas and other conflicts (Makari, 2008). As Reeder (2004) pointed out, the American’s imposed an even stricter regime for training. The initial development of psychoanalytic training was based on what Zusman formulated as the Eitingon syndrome, which is based on rigidity, sectarianism, and an abuse of power that plagues many psychoanalytic institutions today (Berman, 1998; Zusman, 1988). Hence, the foundation of training candidates was based on idealization. As Kernberg (1986) stated, “Idealization processes and an ambience of persecution are practically universal in psychoanalytic institutes” (p. 815).

The American Struggle with Elitism

The Americans had released the Flexner report in 1909, it was one of the most influential documents in higher education, greatly affecting the medical community. The report evaluated 155 medical schools in the United States and found only a handful had met certain standards (Chapman, 1974). It was the beginning of the American’s claim to medical superiority with reforms and regularizations. At that time, psychoanalysis was unknown in the United States. In 1909, when Freud came to America to give a lecture at Clark University, psychoanalysis was introduced. It made its way into the states by two routes up until World War II: through the medical community and intellectuals (Burnham, 2012). The American analysts allied with the medical profession in the 1920s and discarded the eclecticism that marked the early years (Coser, 1984; Ponder, 2007).

The Americans were focused on standards of care and outcomes as medical schools were closing or merging. The American Psychoanalytic Association reported that a bitter 38minute debate established the “1938 rule,” which barred membership to nonmedical analysts who were trained in the United States (Wallerstein, 1998). The reason was that the Americans believed that analysis was a science and the best way to protect the profession was to ensure that lay analysts could not be trained. Only medical doctors were permitted to practice because they believed that the standard of care needed to be from a scientific perspective. This echoed in the era of America’s race to claim superiority in education. Hence, psychoanalysis became exclusive for medical doctors only in America, creating elitism. Gatekeeping in psychoanalysis began as a political maneuver starting at the inception of APsaA in 1946 (Mosher & Richards, 2005). This new elitism held, despite the contributions of many great minds, such as Erik Erickson, Anna Freud, Otto Rank, Theodor Reik, Ernst Kris, and Karen Horney who were all lay analysts. The question most relevant to this elitism was posed by Hawkins and Shohet (1989): “Quis custodiet ipsos custodies?” or “Who will guard the guards?”

The 1950s-1960s and the American Pathological Supervision Model

To create the professional authority of psychoanalysis, the American authorities wove two strands together from two very different sources which, in the end, were essentially incompatible. First, they took the professional authority of medicine as a guide, which was based on experimental investigation and strict standards of training and certification. With the second, they took the charismatic authority of Freud as the founder and decisive thinker of the psychoanalytic movement (Eisold, 2004).

The war did not slow the development of psychoanalytic training in America; rather, the social situation accelerated its progression in several ways. First was the influx of trained analysts from Europe who were qualified teachers. Many training analysts, both Americans and the Europeans, who had immigrated into the states seeking refuge from war, joined the armed forces and went into the medical corps, which brought new views of diagnosis and treatment. The focus on war neurosis using an analytic lens brought more interest to the field, increasing applications to become psychoanalysts (Flemming & Benedik, 1966).

By the 1950s and 1960s, psychoanalysis was in its prime in America, whereas European psychoanalysis struggled as a profession after the social upheaval brought by war. While Anna Freud and Melanie Klein fought over theory in England, the Americans predominately bypassed the Kleinian movement of object relations, favoring the egopsychology model. The ego psychology model is considered a conflict model and a oneperson system, one-person psychology being constructed according to the natural science model (Thoma & Kachele, 1987). Having chosen this path, the American system sealed its fate in authoritarian training. American ego psychology was brought to life by the works of Hartmann, Kris, Loewenstein, Rapaport, Jacobson, Waelder, Fenichel, and others, through Freud to Anna, and the immigration of analysts from Vienna to America. This was the rise of the “classical ego psychological metapsychology.” Unlike Ferenzi and Rank, who suggested the interpersonal model, between two people, the egopsychology model was an intrapsychic model, and the central locus was the individual mind (Mitchell, 1988). Ross (1999) described training during this time: “At almost every stage of their progression, candidates and younger analysts found themselves subject to

pathologizing interpretations and sever rites of passage in manifest form of successive certification of competence” (p. 66). He also mentioned that “candidacy became a purgatory at its worst; a period of probation at best” (p. 67).

De-New-Yorkating

Although psychoanalysis rose in popularity, it was too expensive for the masses and not everyone was analyzable, increasing the need for psychologists and psychiatric social workers to help the difference. This then raised the psychoanalysis versus psychotherapy debate. Unique to America, but not invented in America, was the psychodynamic therapeutic model (Reeder, 2004). Psychoanalysis focused on transference, interpretation, analyzing the defenses, and techniques from the ego psychology model. Psychodynamic therapy was used to treat patients that were deemed unanalyzable, allowing them some benefits from treatment. Also, not everyone could be trained in psychoanalysis, including some medical psychiatrists that either were not accepted into psychoanalytic training or could not afford the extra training. The debate between psychoanalytic therapy and psychodynamic therapy was hotly contested. The psychodynamic model did not have the same prestige nor the same demands for training. It is important to understand why there are marked differences between psychoanalytic and psychotherapy supervision (Wallerstein, 1995). The two are very different; psychoanalytic supervision and training was rigorous and came with great expense, demanding multiple supervisors overseeing each candidate, individually, through progression committees (gatekeepers).

One of the pioneers for psychotherapy was Franz Alexander. Freud referred to him as his most promising American student (Schechter, 2014; Soul, 1964). He was the first

graduate of the Berlin Institute. At the University of Chicago, he was also the first professor of psychoanalysis in the United States, although he left a year later. In 1932, he helped found the Chicago Institute of Psychoanalysis (Pollock, 1977). Although grounded in classical Freudian theory, he was very flexible in modifying his thinking to newer knowledge. He is most known for bringing psychoanalysis out of isolation from under medicine. He produced a seminal book on psychoanalytic therapy, co-authored with Thomas French in 1946 (Marmor, 2002). Alexander contributed to the study of psychoanalytic technique through investigation of the value of brief psychotherapy (Alexander & French, 1946). He explored the relationship dyad and the curative properties of the therapeutic relationship itself as a “corrective emotional experience,” moving towards a two-person system (p. 66). Additionally, Alexander helped create an empirically based psychoanalysis. He became one of the first to undertake laboratory style, controlled, empirical research, propelling psychoanalysis away from its longstanding reliance on single case history towards a more broad-based study of larger sample sizes” (Alexander, 2015, p. XV). While Alexander was important in spreading psychodynamic therapy, he was also one of the seminal historical figures in the “relational” school of thought.

Alexander gave his blessing to his analysand, Lionel Blitzsten, to lecture in Chicago on psychoanalysis. This flamboyant character was known to attract intellectuals and philanthropists to his Monday night meetings. William Menninger was said to coin the phrase “de-New Yorkating psychoanalysis.” Blitzsten was the first training analyst with the IPA west of New York until the arrival of Alexander. Blitzsten founded the Chicago Psychoanalytic Society the same year Alexander became the professor of psychoanalysis

(Schechter, 2014). As other institutions continued to debate and split over the subject of lay analysts, Chicago was the birthplace of another training topic, the question of defining and differentiating psychotherapy and psychoanalysis.

Alexander set up the Chicago Institute of Psychoanalysis after the Berlin model for training. He set it up with private funding and provided a place where researchers, academics, and scholars could have a place to mingle, collaborate, debate, and live amicably together (Pollock, 1977). Alexander brought new people with him to help collaborate research and training. The department of medicine was more interested in treating more severe cases in psychiatry seen in mental hospitals versus patients seen in Blitzsten and Alexander’s private practices (Grinker, 1975; Schechter, 2014). Grinker stated that psychoanalysis encountered a formal defeat, unsuccessful in its attempt to create its own place in the university, or within psychiatry in Chicago. At the institute, Alexander had the funding to carry out research and train candidates (Schechter, 2014). He led the front in research on psychosomatic disorders, propelling the interest in psychoanalysis. He wanted to bring psychoanalysis as a tool to psychiatry, yet his analysand sought to make psychoanalysis its own entity, creating a divide in the aims of its training. In her book, Schechter mentioned that Blitzsten would have someone in for supervision, but due to his issues with the “purity of analysis,” he would start to “treat” the candidate to make sure they knew the differences between psychotherapy and psychoanalysis. This added yet another issue that candidates have been faced with historically, the “treat or teach” concept in psychoanalysis.

Schechter (2014) wrote that Alexander was lecturing, publishing, and traveling across the nation, showing how psychoanalysis was a tool for psychiatry. It was his

stance on a “corrective emotional experience” that seemed to fire up controversy, as some analysts did not see this as analysis, believing that symptoms were manipulated while the interior personality core was being missed. As Alexander’s public popularity grew, Blitzsten strategically used his professional and personal relationships to broaden his position within the analytic community nationwide. It was through his relationships that his debate flourished. His disciples went to run the Menninger Clinic, Austin Riggs, Chestnut Lodge, and Shepherd and Pratt Hospitals, along with leaders who were founders of institutes in Los Angeles, Seattle, and New York (Rubins, 1978; Schechter, 2014). Blitzsten, unlike Alexander, had no interest in research of psychoanalysis or integrating into social sciences through the community (Schechter, 2014).

Though the debate on psychoanalysis and psychotherapy has continued, there are distinct training differences (Watkins, 2016). Since the training of psychoanalytic supervision candidates is unique, the current, predominant literature on psychotherapy supervision is not applicable.

1970-1980 Heinz Kohut

Chicago was the bedrock of change. Following soon after Alexander there was Heinz Kohut. Kohut was originally denied training in psychoanalysis due to his strong homosexual streak (Strozier, 2004). Though Kohut was caught in the gatekeeper trap that riddles psychoanalysis, he persevered and deviated from Freud’s view of narcissism. Kohut abandoned drive theory and interpretations focused on the person’s inner subjective experience by understanding the self as the central agent. He introduced the idea of empathy as the curative factor. This was a major break from traditional

psychoanalysis. Kohut felt that parental failures of empathy created deficits. Empathy allows the creation of a relationship between the patient and analyst to help the patient develop a sense of self (Strozier, 2004).

From the supervision standpoint we see the literature expand to the need of mirroring. Dewald (1987) sees the need for praise and reward when the supervisees do well, which is a self-object function. He suggested that a supervisor functions like a master to an apprentice to think aloud to illustrate the therapist’s mode of functioning, translating into idealizing self-object. In self-psychology, admirations facilitate selfmastery (J. Palombo, personal communication, December 13, 2016). Muslin and Val (1989) wrote about supervision from a self-psychology perspective. The supervisee creates a self-structure, their own psychoanalytic identity, by finding their own voice through the process of supervision. Muslin and Val believe that optimally there is enough frustration so one can internalize the supervisor. Paula Faqua (1994) stated in her paper that it is common for supervisees to need praise for their success as much as they need direction when they err, which are self-object functions. According to Martino (2001), disruption-restoration events are essential apparatuses of the often painful, yet necessary, learning regression that is a prerequisite for the candidate to experience to have their own analytic identity. Alonso and Ruttan (1988) pointed out the vulnerability trainees expose themselves to in supervision. The narcissistic equilibrium must be exposed by showing the lack of knowledge, producing self-doubt, and having their “flaws” eliminated. In selfpsychology terms, this constitutes the building of self-structures where there was a prior deficit.

Watkins (2016) did an extensive review of self-psychology supervision over the last 35 years. He found, reviewed and summarized 33 articles, all with the common theme of self-psychology supervision. He organized the material around the supervisory dyad and the supervisor as a self-object. The trend in the ego psychology literature review was that the supervisee was pathological. In self-psychology, a different trend was seen in the literature, introducing the idea of supervisors’ “empathic failures” in supervision. This literature discusses trainees’ feeling self-blame, the training process evoking feelings of low self-worth, and the individuation process of the trainees (Watkins, 2016; Yerushalmi, 1994). Watkins approached the literature from a self-psychology perspective as if it was assumed that there would be supervisor failures from the onset. Teicholz (2007) wrote that supervisors have invited corrections from their supervisees of their empathetic failures.

Who Should be a Psychoanalyst? Return of Lay Analysts

In 1984 the American Psychological Association (APA) won an anti-trust lawsuit against APsaA. APsaA was forced to admit psychologists, social workers, and licensed counselors for training and certification (Wallerstein, 1998). Opponents of the exclusion of non-physicians from APsaA contended that elitism, arrogance, prejudice, and financial interest were factors in the physicians’ monopoly (Reeder, 2004; Welch & Stockhamer, 2003). Expanding training to other mental health treaters ended up saving APsaA institutions, which were declining due to the prevalence of medication and short-term therapy (Ponder, 2007). The non-physician analyst trainees augmented theoretical concepts, brought vitality, and increased diversity (Cooper, 1991; Ponder, 2007)

What is Therapeutic About Psychoanalysis?

Tessman wrote “The Analyst’s Analyst Within” to tackle the question “What is therapeutic about psychoanalysis anyway?” She also explored the question, “What is it about the process that works?” She tackled the idea of therapeutic action, or how the analysand internalized their analyst following termination. Tessman did her research at the Boston Institute. An open-ended questionnaire allowed the participants to structure and reflect on how the analyst continued in the mind of the analyst. She contributed a finding that the most satisfying relationships come from two-person (relational) psychology, and a more egalitarian attitude. The most dissatisfying analyses were from 1965-1975, when the Boston Institute was steeped in an authoritarian attitude, and largely consisted of male-to-male pairings and one-person psychology. Although Tessman acknowledged that the research was not generalizable, she believed that the relational approach skewed towards more satisfaction with one’s analysis by the 1980s, compared to the amount of dissatisfaction there was during the era more focused on the authoritarian model. Also, she pointed out that the idea that a “completed analysis” is only really an abstract idea and a subjective judgment (Gollad, 2004; Tessman, 2003). The more gratifying the analytic relationship was, the greater the analytic successes were Gollad made the connection that the satisfied subjects were more open, reflective, flexible, and resilient. Gollad leaped into implications for training, supervision dyads, curriculum, and how important this would be for training candidates.

1990s to Present: Relational Psychoanalysis

Kernberg (1997) wrote that the swing away from the classical analytic concepts is mainly due to Kohut’s emphasis on the self-object transferences as the focus of treatment. Kohut’s developments provided an important basis for the emergence of a relational approach. Goldberg (2002) noted how self-psychology’s evolution played a role in “other psychoanalytic excursions such as seen in interpersonal and social constructivist concepts” (p. 2). Relational psychoanalysis has emerged in the last 20 years as an important school of thought in psychoanalytic theory (Beebe & Lachmann, 2003).

Greenberg and Mitchell (1983) originally created the term relational to describe a group of psychoanalytic approaches where the mind is believed to constitute internalization of interpersonal relationships. This was a fundamental shift away from the drive and structure models, where relationships with others are believed to be the primary building blocks (Fosshage, 2003). Atwood and Stolorow (1984) introduced the concept of intersubjectivity, in which two or more intersubjective experiences intersect, forming a matrix of self with another or others. As the relational approaches weave together the intrapsychic and interpersonal levels, the intrapsychic life accepts the private, inner life that focuses on the internal process of fantasy, desires, repression, and unconscious motivation. The interpersonal model has explained the transaction with others and our participation in the social realm (Mascialino, 2008). Unlike other psychoanalytic schools, relational psychoanalysis does not have a founding theorist (Mitchell & Aron, 1999).

Berman (1997) stated that the relational psychoanalysis is not a new school of thought, but rather a broad, integrative, orientation focusing on the self and other.

The integration of relational and intersubjective perspectives into supervision lagged

behind the development of the theory and practice for patient treatment (Mollon, 1989).

The intersubjective perspective for supervision needed the supervisor and supervisee to create a mutual space for thinking and feeling, both allowing tolerance for not knowing.

Ogden (2004) named this space of intersubjectivity the “analytic third.” Aron (2006) explains that this is a two-person psychological model, which each gave meaning to the transference-countertransference events created in the transformative relationship. This interpersonal phenomenon in the supervisory space also communicated the therapeutic process. The entire power structure between the dyad changed in this model by allowing more equality and mutuality (Frawley-O’Dea, 2003). This approach, according to Wolstein (1997), claimed greater mutuality and partnership. Spreading the power dynamics in supervision allowed for the supervisor and supervisee to co-construct the meaning ascribed to the material of analytic therapy and the supervisory process (Yerushalmi, 1999). Yerushalmi (2012) pointed out that although there is a power shift towards more mutuality in this model; however, this does not mean that there is symmetry in the relationship. Parallel processes are not one-sided. The intersubjective approach gave a unique model to explore the mutual influences between the supervisor and supervisee. Frawley-O’Dea (2003) expanded the supervision model to a threedimensional system: supervisor, supervisee, and patient. This author also looked at the transference and countertransference of the supervised treatment and focused on the shared responsibility of the relationship. Barsness (2003) remained mindful of the relational model in supervision because supervisor relationships differ from analytic relationships. The supervisory relationship is limited in time, confidentiality is not guaranteed, and its primary purpose is not therapeutic.

Supervision Critique

Despite Balint’s (1948) initial, critical review of supervision in the 1940s, the changes to the triparte model have been slow and tentative (Berman, 2004). Balint said that candidates were far too respectful and submissive to the authoritarian treatment. He believed that Freud thought that the new generation needed to relinquish their independence and self-assertion to be educated. Lachmann (2003) pointed out that Ralph Greenson, in 1967, observed that students came to train with enthusiasm and creativity, but were depleted by the duration of the training process.

Ross (1999) went as far as to say that training was riddled with sadomasochism. He said that trade schools had switched from individual power to educational committees that compromised education. He believed that the analytic organizations were run by selfappointed caucuses of party bosses that functioned like mini politburos. Ross also said that candidates were subject to pathologized interpretations and severe rites of passage for certification. He cited Lifton’s 1961 work, stating that training was an exploration into covert brainwashing and reform. Ross wrote that any challenges to teachers and supervisors would be muted and could have unfortunate consequences. The candidates might even be considered unanalyzable if they asserted their own ideas and did not comply with the authoritative dictates. Even if such candidates graduated, the doors to power, through becoming a training analyst, were closed to them. The process allowed silent obedience and produced shame due to uncourageous submission. Since its inception, candidates have succumbed to new neurotic ways to deal with the professional challenges due to submission and sadomasochism. Ross believed that understanding our own historical beginnings is imperative to break the sadistic structure in training.

Kernberg (1996, 2000, 2008, 2015, 2017) wrote, extensively and critically, about supervision. He expressed concerns about indoctrination, uncritical discussions of Freud, and the reluctance of teachers to present their work. He felt that there was an unrealistic idealization of psychoanalytic technique in psychoanalytic institutions. He believed that psychoanalytic education had become a trade school in which defined skills were taught with religiosity and lacked creativity. Kernberg (1996) wrote a humoristic study titled, “Thirty methods to destroy the creativity of psychoanalytic candidates.” Kernberg (1986) wrote that supervisors focused on the limitations, shortcomings, inadequacies, and mistakes of the candidate, all the while keeping their own personality shortcomings shrouded in secrecy. Kernberg (1996) pointed out that Szarsz, in 1958, said that there was a paranoid atmosphere that pervaded psychoanalytic institutes and impeded the quality of psychoanalytic educational life, slowing down the progression of the candidates. Kernberg (1986) discussed an important aspect of unidirectional evaluations on the student since there are no evaluations of the supervisors.

Lachman (2003) noted that there is a balance between individuality and compliance. If the supervisor is critical about multiple details, then the supervisee can feel criticized, outclassed, constricted, and shamed. Yet, if there is not enough feedback then the supervisee can feel abandoned and deprived.

Berman (2004), using a relational perspective, discussed the dangers of utopian fantasy of a “new person,” in that training somehow idealizes the analyst and analytic training as producing some improved, purified individual, casting aside any personal needs in a communal upbringing of the educational process. By producing an analytic false self, the candidates get seduced into compliance as they emerge into the

profession’s demands. There is an allure to belong and be accepted by the senior members. Arlow (1972) suggested that candidates maybe propelled by their anxieties to identify with the aggressor. In this fantasy of a new person there is an idea that there is a formula for standardizing behavior, giving standard interpretations, and how to deal with patients. This expectation that there is correct technique creates a judgmental focus that may inhibit a candidate from paying full attention to the actual impact of each intervention and how it is experienced by the analysand in the context of his or her inner reality.

Spence (1998) spoke of honesty in case presentations. He said that there is a concordance among candidates to appear normative, such that candidates will focus on getting a case that will not cause trouble. Candidates will then censor their interventions that may seem non-analytic. The result is the perception of a well-ironed-out case with orderly inner structure. The analysis will follow the developmental stages too neatly and there will be impressive fits between association and interpretations. These cases will have unobjectionable counter-transferences and optimistic conclusions.

Special Problems of Supervision

As this literature review has shown, conflict around training and power is woven throughout the history of psychoanalysis. Conflicts continue to grow around how to supervise candidates, and the conflicts are complicated by the evolution of theory and schools of thought around supervision (Bass, 2014). On APsaA’s (2015) website, there was a document titled “Standards for Education and Training in psychoanalysis” that was revised, in January 2015, at the time this researcher was writing her proposal The Board

of Professional Standards (BOPs) approved the document which included the goals of psychoanalytic education, the responsibilities of training, components of education, the clinical training, assessment of the education, etc On March 16, 2017, an email was sent out from Tina Faison with APsaA that called for a vote to implement the sunsetting (phasing something out of a business) of the Boards on Professional Standards (BOPs), and its removal from the APsaA bylaws. In this instance, power was changing hands and history was being made. The importance of these changes demonstrated that there has been little stability for candidates in their training from the historical and current perspective. The standards have continued to change so much that it is unlikely that they will be the same by the time just-beginning candidates graduate. In this regard, the only guarantee candidates have is that APsaA will continue changing training standards, leading to unpredictable expectations.

Educational inconsistency between institutions: Different standards.

Deborah Cabaniss wrote “Becoming a School: Developing Learning Objectives for Psychoanalytic Education,” a primer to the general problems facing the education of psychoanalysts today (Cabaniss, 2008; Kernberg, 2008). She noted that guidelines and assessment apparatuses for the progression and graduation of candidates lacked clarity and advocated for a psychoanalytic educational curriculum with clear learning objectives. Cabaniss drew from Tyler (1949) and added that these learning objectives must include behavioral and content aspects. Cabaniss (2008) wrote of the importance of the application with her work on the Columbia Task Force on Progression and Graduation. She did a unique study on what goes on in psychoanalytic supervision from the

candidates’ perspective. Her research led her to advocate for further training of faculty members.

Institutes should have policies and procedures designed to encourage and develop individual talents of faculty members, especially recently appointed faculty. This may be a system of mentoring, study groups, or post-graduate seminars. Faculty should be encouraged to deepen their own individual interests, which may result in publications or development of courses in a chosen area (American Psychoanalytic Association, 2015, p. 10).

Attention must be given to the word “should” as it pertains to the supervisors of psychoanalytic candidates. There are only recommendations, and each institute governs their own candidates and their education APsaA has created recommendations for their constituents, but not every institute follows the APsaA bylaws; the researcher has listed a few examples of standard differences. Deborah Cabiness’s institute is The Columbia Center, which has only allowed PhD social workers to train to become psychoanalysts, according to their website. The Center for Psychoanalytic Training in Houston states, on their website, that they accept master’s degree social workers to train, but they do not accept psychiatric nurses. The Columbia Center; however, has accepted other affiliated fields/occupations to train. There are distinct differences of training between the original APsaA model that candidates should follow and the requirements for the William Alanson White Institute for Psychiatry, Psychoanalysis, and Psychology (WAWI). In the WAWI model, candidates are required to work in the Institute’s Psychotherapy Service, providing 80 hours of clinical service under supervision, which is not required in the original APsaA model. Not all candidates have the same requirements to graduate within

APsaA as each institution has different criteria. Learning objectives have lacked cohesion and have made it impossible to standardize, allowing institutes to further the problem by setting their own standards, making training, on a national and local level, unpredictable.

Repeating history? From the candidates’ perspective?

Is the United States repeating history by creating more regulations? Only time will tell. What is known, from the points made above, is that training is not only inconsistent within regulatory institutions’ guidelines, but between institutions, and within the global arena. How candidates are trained is anything but standardized, leaving a lot of chaos in the system. Brodbeck’s (2008) article, “Anxiety in Psychoanalytic Training from the Candidates’ Point of View,” from the German Psychoanalytic Association from 19972003, dealt directly with the fear that candidates have within their cohort, a fear intertwined with the lack of educational expectation and procedures. Brodbeck uses examples of authoritarian treatment of recent graduates. Wiegand-Grefe, in “The Destructiveness in Psychoanalytic Training,” stated that there is a need for institutions to reflect upon the organizational problems of training and called for active participation from candidates about the conflicts within the training system (Brodbeck, 2008).

Teach or Treat and Parallel Process Issues in Supervision

Glen Gabbard (2016) addressed the teach or treat issues in supervision in his book, Boundaries and Boundary Violation in Psychoanalysis. Gabbard pointed out that the treat or teach issue with candidates has been usually addressed as a dichotomy in the literature. This is when the supervisor will put their teaching aside to work with the candidate’s

internal self. Gabbard wrote that the literature states that the two functions should not overlap, and the supervisor should only teach. When the candidate shows signs of countertransference reaction, the supervisor should refer the candidate back to their own analyst. Treating the candidate leads to educational boundary violations. Lawner (1989) addressed the current controversial issue of the dichotomy dilemmas are based in historical divide between the Vienna model and the Budapest model. The Vienna supervision model is known as an intellectual endeavor where the candidate is referred back to their own analyst. In the Budapest model, supervisors are known to use vivid experiences of counter-identification to help develop candidates’ understanding of their countertransference.

Yet, Gabbard wrote that Grinberg (1970) has distinguished that when projective counter-identification takes place, the supervision that the supervisor would speak about is a teachable moment. When candidates experience emotions belonging to patients that are projected onto them, the candidates can unconsciously identify with that aspect of an internal object with aspects of the patient’s self. These issues become blurry when candidates enter an enactment, where their unconsciousness played something out with their patient’s projection. Since these types of communications have a deeper origin, they require analytic observation on the couch. Lawner believed that these counteridentifications become stalemates within the therapy and supervisors have a unique perspective to help candidates unblock these impasses.

Gabbard (2016) noted that candidates may project conflicting pieces of themselves into their supervisor, which could make their supervisors enact aspects of the treatment out with their candidate, this is called a parallel process. These affects are evoked because

the supervisee is struggling with these countertransferences or counter-identifications and the supervisor identifies with these conflicting pieces. Gabbard also explored the idea that dealing with teach or treat issues in supervision are not easy to divide, and that the supervisor should not make linkages to childhood issues. He discussed that if the supervisor translated the affects into words that were useful to the supervisee, then the self-disclosure or teach/treat efforts that can be helpful, may not be boundary issues. Gabbard also expressed that there must be sufficient levels of trust and acceptance in the dyad for a candidate to be willing to self-disclose internal vulnerabilities that would be necessary to understand enactments and parallel processes. As candidates are vulnerable to fears of retaliation or punishments after from receiving a negative evaluation in their progression, they may sensor relevant affects, not to mention other information, during supervision. Gabbard (2016) also pointed out that two or more supervisors could be competing for the loyalty of the candidate and cause the candidate anxiety. Gabbard reported that, in private consultation, candidates have acknowledged that supervisors have made inappropriate sexual comments to them, or even made physical advances, but that these incidents go unreported because their advancement in training could be jeopardized. Despite the difficulties and complexities of supervision, Gabbard noted that supervision is not often taught in institutes, or anywhere, allowing the idea that supervisors magically know how to supervise.

Problems with Progression

Casement (2005) pointed out in her article “The Emperor’s Clothes: Some Serious Problems in Psychoanalytic Training,” that when something goes wrong with the candidate’s training, the progression committees often pathologize a student. She stated that these actions are wild analytic speculation, and that this type of analyzing should not be allowed. Casement noted that many of these issues are due to the candidate’s fear of a misuse of power, often due to habit rather than from an intent to deter a student’s progress. Kernberg (2000) argued that the vagueness and lack of criteria in evaluations of candidates bolsters the misuse of power in training analysts, which can induce fear, passivity, and paranoia in candidates (Tuckett, 2005). Casement reported that even if a training committee made a serious mistake regarding a candidate, they are reluctant to admit any injustice. The members would rather support another training committee member than admit that a candidate suffered professionally, and unjustly, due to a supervisor’s decisions. Casement advocated that although some students do deserve and need to be failed, students also need to be protected, and training analysts should be watchful of themselves. Casement pointed out that these decisions are usually made without the candidate being present, and without anyone adequately checking in with the candidate about their experience, begging the question why do progression meetings happen behind closed doors? Sometimes these decisions are made as if the candidate is the committee’s patient. Casement stated that the student should always be permitted to participate in their progression to ward off the risk of “wild analysis,” which could

become a basis for decision-making. Casement continued, mentioning that any interpretation outside of the consulting room is an act of aggression. Ward, Gibson, and Miqueu-Baz (2010) stated that there is a movement towards more openness and involvement with candidates. These authors also expressed similar concerns of Casement, that the candidate’s character could become the target if there are not objective criteria for evaluations. Although Ward et al. (2010) would state that this is a problem that needs to be addressed, they seem to see the problem as consisting of isolated and infrequent incidents. Though they have opined that candidates being hurt in their institutional structures is not a systemic problem, they have advocated for competency-based curriculum and training. Concern should be raised then, if candidates harmed in supervision are not an institutional problem, the harm occurring would indicate the candidate is under a “wild-supervision,” as the supervisor would be in a reactive mode/acting out. This process of “wild-supervision” would be unconscious and unchecked. Yet, a competency-based curriculum that advocated for students’ inclusion in their progression committees, would allow candidates to raise concerns and express their evaluations of their supervisors in a more transparent evaluation process.

Gatekeeping

The practice of gatekeeping begins with Freud, as Arnold Richards (2015) pointed out in Psychoanalysis in Crisis: The Danger of Ideology. Expressing dissent with Freud instigated the expulsion of many analysts, including Jung, Tausk, Groddeck, Adler, Reik, Ferenczi, and Reich. After this, in the literature review, gatekeeping occurred in the United States, eliminating lay analysts. Karen Horney and her fellow neo-Freudian

culturalists exemplified gate keeping as a tradition (Chodorow, 2005). People who did not stifle their dissent, especially during the ego psychology era, were at risk of expulsion.

Later, this would trickle into the articles around candidates. Who is allowed in and who is not is a function of the gatekeeping. Lidmila (1990) pointed out that supervisory positions are gatekeeping positions. In Berman’s book Impossible Training, even candidates have been aggrieved by a peer in their cohort and wondered why they were allowed to train (i.e., wondering what failed in the gatekeeping process). Casement (2005) pointed out the dangers of gatekeeping with candidates within their progression committees. Cabaniss, Glick, and Roose’s (2001) study of the dyad gave some indication of the fears candidates have about expressing discontent in supervision. The paper theorized that some of the reasons are intrapsychic on the candidate’s perspective, yet also juxtaposed the issue of real, authoritarian problems carried out by supervisors.

The Candidate’s Unofficial Power

Although there is little knowledge about what candidates find helpful in supervision (Cabaniss et al., 2001), there are unilateral evaluations (Kernberg, 2000), so candidates are not totally powerless. A candidate maybe bullied within the system (Berman, 2013), but they may not be explicitly powerless. In fact, Berman pointed out that candidates can be quite aggressive in case conferences and have harsh opinions. As Davidson (1974) illustrated, candidates sometimes take their issues “underground.” This is a positive function, Davidson stated, of evaluating teachers. Candidates, in the middle phase of their training, often enter a more independent stance. During the beginning

phase of training there might be idealization of analysts and supervisors. Due to “inbreeding,” there has been endless gossip at institutes, Davidson explained. The problems that are seldom discussed openly happen underground to validate the individuals’ and groups’ experience of the faculty, teacher, institute, and policies. Having a difficult supervisor and being treated unfairly whether real or perceived does not mean that evaluations are not happening. More than likely, they are happening underground.

What We Know About Candidates

Katz, Kaplan, and Stromberg (2012) did a national survey of U.S. psychoanalytic candidates, with a 40% response rate. The respondents were mostly women 45 to 65 years of age. Most of them were married, with doctoral degrees, in private practice, with an annual income of over $100,000 per year. More than half of them waited 4 years to matriculate due to financial concerns. Most candidates devoted 30 hours a week to their training, and 80% of candidates were happy with their training. Few studies have been done on the perceptions of the candidates’ training experience (Bosworth, Aizaga, & Cabaniss, 2009; Cabaniss et al., 2001; Ward et al., 2010). Ward et al. (2010) also found that most candidates were happy with their training in the British Psychoanalytic Society. Their results showed appreciation with a small mix of concerns. Although strong criticisms were expressed by a minority of candidates, it directly impacted their peer group.

The Columbia University Center for Psychoanalytic Training and Research identified that their candidates graduated on an average of 5.7 years, 5.1 graduates per

year, 98.3 months of clinical immersion, and 6.7 years of training analysis. Cabaniss et al. (2001) studied supervision dyads within Columbia University, with over 85% return rate of questionnaires. In general, satisfaction with supervision was high. The dyad agreed on issues of teach-or-treat as well as technical and theoretical frames of reference of the supervisor. Here it appeared that the issues of treat-or-treat are being resolved in the literature, with the conclusion that teaching is the role of the supervisor, while observations of the countertransference are valued. There were, though, striking differences regarding what the role of the supervisor was, what candidates found useful in supervision, the correlation between supervision and progression to graduation, and the evaluation function. Most candidates were unaware of the evaluation process of the supervisor, despite guidelines. Many supervisors have chosen not to share their written evaluations with their candidates, and many candidates are unaware they should be shown their evaluations. Supervisors were unaware of the desire for candidates to have more theory included in their case write-ups. Also, important to this study, despite a 75% satisfaction rate from candidates in supervision, 25% wished they had a different supervisor, and 50% of the dyads reported they did not discuss their relationship. Of the 25% of unhappy supervisees, 75% believed that if they switched supervisors, they would be labeled problematic. Yet, 75% of supervisors felt that there was no stigma if a candidate switched supervisors. In a follow-up survey about switching supervisors, candidates feared reprisals for switching, some reported that their training analysts advised against switching. Interesting enough, candidates felt that participating in the study enabled them to think more openly about their supervision. To be noted for this proposal, many candidates remained uncomfortable in revealing their personal issues in

supervision. The researchers suspected that unconscious processes played a significant role in the supervisory relationship. Interestingly, when the researchers hypothesized about the candidate’s difficulties in communicating their difficulties in supervision, it was because “candidates’ intrapsychic conflicts can contribute to a fear that bringing up difficulties in supervision will invite retaliation” (p. 261), and that the supervisor took on the transference in the relationship. Yet, the authors acknowledged that these candidates’ fears could not be explained away simply as intrapsychic conflicts, indicating the reality of dangers within the institution’s evaluation system.

Supervision From a Candidate’s Perspective

In 2015, I wrote an article, “Supervision from a Candidate’s Perspective,” Candidates Connection Newsletter (Liput, 2015). In the article, I was perplexed about how “honest” or transparent I should be in supervision. I naively divulged that I was extremely honest and shared my mistakes and anxieties from the beginning of my training to my supervisor so I could learn. In hindsight, I did not interchange these “learning” sessions with sessions that demonstrated my mastery. This extreme honesty and openness backfired. With one of my cases I had a lot of anxiety due to countertransference feelings wrapped up with my own history of trauma. I wrote about the complexities of being in treatment and dealing with my own trauma while on the analytic couch, then I would be sitting behind a difficult patient in the same day. I handled many of these highly charged affective states in my analysis with the difficult patient and not in supervision. I then disagreed with one of my supervisors, in the article I did not mention what the disagreement was about, because the supervisor was perplexed

that there was a candy bowl in my office reception area. My supervisor felt I was warding off the aggression I didn’t want to handle. My three suitemates who shared the reception area were not practicing analysis, and the candy bowl had been on the premises for 22 years before I joined the practice. Still, the supervisor wanted this bowl to be taken out of the office. I then stopped mentioning the candy bowl. I would discuss the problems I incurred with my supervision to my PhD mentor at ICSW, Dr. R, who I did not name in the article, was Dennis Shelby. I wrote that I started to bringing processing notes to my psychoanalytic training supervisors that also showed my competencies, and stopped disagreeing with the other supervisor, sure enough, I was advanced by the next progression committee meeting.

I had also done a mock phenomenological study for a class at ICSW with Dr. James Lampe. I interviewed candidates that were colleagues in Houston and found similarities in themes that started to arise in the interviews. One theme candidates wondered about was how much of their personal lives they should disclose their supervisors. Many candidates discussed their frustrations in the beginning of supervision due to lack of a psychoanalytic language to explain what w, as happening in the room. All the interviews showed the need for encouragement and positive feedback, which need is supported by Cabaniss et al. (2001) A few candidates revealed that they did not disclose as much information on cases that the supervisor felt were critical. Similarly, a few candidates withheld mistakes from their supervisors to appear to “have it together.” For the most part, everyone valued supervision. Most had difficult feelings at one point in training, but for various reasons. Of the five interviews, there was one outlier. This subject passionately communicated they were “always transparent,” purely honest, never had

difficulties in supervision, and found the experience “just magical.” I admitted, in my article, that I was envious of such an extremely wonderful experience. I also wrote about a lecture we had at an APsaA conference, where a training analyst recommended to candidates that we “spoon feed our supervisors sugar,” to get through progression. The most difficult part of the study was that I could not disclose all the findings, I worried that the local Houston supervisors would read the article. I was afraid of opening Pandora’s box since the results were “localized,” even though most of the findings seemed innocuous. After the article was released, I noticed some of my supervisors asked, and have continued to ask, on some continuum, how open and honest I felt I could be with them. Maybe this was just coincidental.

Concluding the Topic of the Importance of Honesty

In summary, as this literature review has shown, conflict around training and the authoritarian power dynamics is woven throughout the history of training candidates in psychoanalysis. From the onset of supervision there has been an authoritarian system around Freud that was passed down through the ego psychology model. From the literature, the self-psychology and relational school of thoughts have brought supervision into a two-person psychology, shifting into a problem in the dyad. Yet, from the very few articles around research on candidates, there have been differences in what candidates think of the supervision experience and what training supervisors have reported, such as in the Cabaniss et al. (2001) article. There are a lot of ideas on how to impose supervision onto candidates, but there is little research or input from candidates themselves to demonstrate whether these ideas are helpful. Plus, there is a plethora of ideas of what to

do in training, as demonstrated from a historical review and the current literature. APsaA has created a new department, the Department of Psychoanalytic Education, under Alan Sugarman, PhD., to demonstrate another educational climate change for candidates, BOPs being dismantled Now, training has changed, and may continue to do so, with uncertainty and a lack of predictability. With the sunsetting of BOPs, their functions have been turned back to the institutes, so there is still a lack of due process and consistencies in becoming a psychoanalyst.

As Gabbard pointed out, there is no formal process for supervisors to learn how to be supervisors; it is expected that it will be handled in an innate way. Also, no formal process for the ongoing evaluation of supervisors has been defined Since there is little information or research on how candidates make sense of their experience of supervision, it would be important to know, for the candidates, how open and honest they feel they can be in supervision. Since there is also recent literature showing that for the most part candidates are happy with their supervision, what are they happy with and does their satisfaction contribute to being open and honest? And, for those few candidates that are complaining (from the literature review) what are their grievances? Also, are they any less open and honest? By asking open-ended questions, analyzing the data may reveal recurring patterns and themes across individual interviews. Using a bottom-up approach to the phenomenon of supervision from the candidates’ perspective has allowed these patterns and themes to emerge organically. Questioning how open and honest psychoanalytic candidates are with their supervisors will hopefully reveal the many different complexities of how safe they feel or how much they can discuss difficult topics in supervision and in their training. The phenomena of how open and honest candidates

feel they can be in supervision may bring important findings to help policymakers, analytic supervisors, and supervisees understand psychoanalytic supervision more fully from the candidates’ perspective.

Chapter III Methodology

Introduction

The purpose of this phenomenological study was to explore the following overarching research question: How open and honest do psychoanalytic candidates feel they can be with their training supervisors? The supervision dyad is a complex relationship since (a) the supervisors must periodically report on progress and, eventually, give approval that the candidates are ready to be certified as a psychoanalyst; (b) the evaluation process in supervision creates asymmetry in the system, so those involved cannot escape power dynamic issues; and (c) the supervision process endures for 4 to 8 years, sometimes longer according to the APsaA head office (D.S. Wardell, personal communication, May 4, 2016). The study used interpretative phenomenological analysis (IPA), a form of phenomenological inquiry, which focuses on how individuals make meaning of their life’s experiences (Pietkiewicz & Smith, 2014).

For the purpose of this study, honesty was defined in the way Thompson (2001), in the article “The Enigma of Honesty: The Fundamental Rule of Psychoanalysis,” described it, as the individual being sincere, truthful, and candid. Thompson looked to Freud to determine the original intent of honesty in psychoanalysis. Hence, the word honesty, in this proposal, does not follow within the etymological roots of the term derived from the Latin honestus, meaning an honorable person, from a moral perspective,

deducing that the person neither lies, cheats, nor steals. Freud believed only neurotic people were analyzable (i.e., people with the diagnosed with hysteria were not considered analyzable), in the repression barrier of the unconscious, he believed neurotics would be incapable of honesty in the moralistic definition from an etymological perspective (Reiff, 1959). This study examined whether psychoanalytic candidates are generally open and honest and if so why. This study also examined what impedes candidates’ openness and honesty.

This phenomenon was explored by asking the following, initial, research questions: (1) What is the meaning of being open and honest in supervision for psychoanalytic candidates? (2) How open and honest are candidates with their supervisors, given the complexities of the supervisory relationship and the need for approval from the supervisor to graduate? (3) To what extent do the candidates feel they can talk about their mistakes openly with their supervisors? (4) To what extent do the supervisors know their candidates’ histories or their current life circumstances? (5) How much do the supervisors ask about the candidates’ countertransference? (6) To what extent do the candidates receive interpretations from their supervisors on a personal level? (7) To what extent do candidates’ welcome interpretations from their supervisors? (8) To what extent do the candidates feel trusting of their supervisors? (9) To what extent do candidates experience parallel processes? (10) To what extent do candidates believe the supervisors manage parallel processes in a professional and effective manner? (11) And, how do the candidates address difficulties with their supervisors through informal or formal mechanisms? After the interviews it had become apparent that some questions were relevant, and some were not. Since this was a phenomenological study, it was more

important to let the phenomenon of the candidate’s stories arise which led to insightful findings.

Rationale for Qualitative Research Design

There was difficulty in finding literature on psychoanalytic supervision from the candidates’ perspective because supervision has been mainly written about from the supervisors’ standpoint; very little research has examined what happens with the candidate, the candidate’s experience, or the supervisory dyad. Since there was a scarcity of prior research, qualitative research methods seemed appropriate. In addition, I sought a deeper understanding of the participants’ (co-researchers’) lived experience. Based on the IPA approach, the participants in this study were treated as pseudo co-researchers, who shared equal footing from the perspective of making meaning of their experiences. In other words, the phenomenological researcher accepted all assertions of participants as true from their frame of reference and as worthy of consideration, rather than discounting, diminishing, or discarding statements that are not in agreement with the researcher’s frame of reference. Moustakas (1994) stated that qualitative researchers are looking for the deeper understanding of human meaning. Phenomenology has engaged the total self from an ontological perspective. It has tried to illustrate the total accurate situation from the participants’ perspective. Accordingly, I sought comprehensive stories from the co-researchers regarding their experience of supervision. IPA is specifically used when there is a major event that has happened in in people’s lives, about which they start to reflect on the process, then make meaning of the experience. IPA reached to engage these reflections or lifeworlds (Smith, Flower, & Larkin, 2009).

Rationale for Phenomenological Research Methodology

Epistemology has examined the question, “What is the relationship between the knower and the object to be known?” (Fortune, Reid, & Miller, 2013, p. 63). Hermeneutic and social constructivist approaches emerged as psychoanalysts were unable to hold on to the underpinnings of the profession being a science (Palombo, Bendicsen, & Koch, 2009). Derrida traced Freud’s work to the hermeneutic (Schechter, 2014). There was much criticism of Freud’s classical model. In response to these disagreements, other schools of thoughts were formed, such as attachment theory, selfpsychology, relational theories, among other theories. These other schools of thought opened the door for psychoanalysis to have other philosophical underpinnings in hermeneutics and constructivist viewpoints (Palombo et al., 2009).

IPA has been known to consist three basic principles: (a) hermeneutics, (b) phenomenology, and (c) ideography. This research used a double hermeneutic viewpoint to investigate the study using a phenomenological approach. Fundamentally, this inquiry fit with the empirical theory of knowledge, as it focused on the role of experience, especially experience based on perceptual observations by the senses. The epistemological foundation of this project was not, however, positivist, because the mode of inquiry was planned as a method that cannot be exactly replicated with a surety of producing the same result within a small margin of error. The epistemological foundation of this project relied, instead, on (a) objectivism, the philosophical position that the characteristics you can perceive about an object exist independently of one’s mind; and (b) philosophical realism, the position that truth consists of the mind’s ability to perceive

a non-relativistic nature of the physical world, with its perceptions having a correspondence to a reality that is independent of its prior conceptual schemes (Objectivism, n.d.; Realism, n.d.).

Hermeneutics has been one of the three principles of IPA. “The etymology of the word hermeneutics is grounded in Greek with Hermes, who had to interpret what the gods wanted of the humans” (Mueller-Vollmer, 1985, p. 1). Edmond Husserl (18591938) was a philosopher born in Prossnitz, Moravia under the Austro-Hungarian Empire. Husserl brought the understanding of meaning to problems, which clearly transcended the realm of simple logical deductions (pp. 165-166). Then IPA examined how people make sense of these reflections, which is an interpretive endeavor that is informed by Heidegger’s double hermeneutic process. This is “double” because the IPA researcher was dependent on the account of the participants, but then the researcher needs to interpret the account (Smith et al., 2009).

Another principle of IPA has been phenomenology. Phenomenology has been defined as the study of structures of consciousness as experienced from the first-person point of view. In the current study, phenomenology was used as a mode of inquiry. Phenomenological studies have often (a) described what an experience means for those who have had the experience, (b) relied on their ability to provide a comprehensive description of their experience, and (c) focused on the participants’ reflective process with IPA.

Phenomenology allowed the researcher to find meanings related to the research question. This study looked at the meaning of honesty, and related concepts such as candidness or openness, in the context of psychoanalytic candidates with their

supervisors in supervision of cases. Phenomenology investigated perceptions of lived experiences in relation to specific contexts. This study investigated psychoanalytic candidates’ experience of how open and honest they can be in supervision. It is a careful, reflexive, and contemplative examination of how it is to be in the context of psychoanalytic training. Phenomenology helped to uncover participants’ experience of decision making and how it affected them after supervision. This study allowed the participants to reveal how open and honesty they are with their supervisors. The hope was it would reveal answers to other questions such as, to what extent does the supervision process leave candidates in pain and confusion? To what extend did it give candidates clarity and hope? Did it leave them feeling close to or distant from their supervisors? Did they feel guarded and vulnerable, or did they feel confident? Did they feel shame or pride? Did the decision-making process around being open and honest make them angry at themselves or their supervisors if the process does not go well? Did the decision-making around honesty make them feel they need their supervisors and find them irreplaceable? The results did not disappoint, themes that had not been anticipated arose, which is why IPA was ideal for this study.

The phenomenological study did allow us to look at the lifeworld, as Husserl termed it. Phenomenology is about the lived experience, not the world as it is measured, transformed, represented, correlated, categorized, compared, or broken down (Vagle, 2014). We were not interested in the present study in how the individuals construct concepts, but how they made meaning of their experiences. The philosophical assumption is that the individual is being, becoming, and moving through the lifeworld in an intersubjective relationship with others and with intentional relationships with other

things. In this case, I wondered how the candidates maneuvered through their supervision in training and being in a relationship with their supervisors, how they made certain decisions about their supervision that affected their experience of being candidates, and how candidates connected with their supervisors Using the ideas of Vagle (2014) and Smith, Flower, and Larkin (2009), I also wondered what the intentionality of the relationship was. This study examined the meanings candidates assigned to the psychoanalytic world they found themselves in and explored the notion of the interconnectedness and unity.

In this mode of research, the researcher set aside their view, accepting the participants’ statements as valid from the participants’ perspective and interpretation, known as the process of bracketing. The researcher provided an interpretation of the perceptions that appeared to be most useful in understanding the phenomenon. The researcher brackets ideas from these individuals and provided an interpretation of the perceptions that is useful in understanding the phenomenon. Patton (2002) stated that, “There is one final dimension that differentiates a phenomenological approach: the assumption that there is an essence or essences to shared experience. These essences are the core meanings mutually understood through a phenomenon commonly experienced” (p. 106).

Ideography has been known to be the third principle of IPA, “Ideography is concerned with the particular” (p. 29). IPA is committed to the study of (a) the details of the experience on a case-by-case basis; and (b) how people understand the experienced phenomena, the particulars of the experience, and how these particulars have been understood and internalized (Smith et al., 2009). In this case, the topic of interest

included the particular details of supervision and the way the different particulars of the experiences were internalized by each candidate. It was a way to expand generalizations more cautiously. Looking at the particular experiences of supervision allowed this researcher to see if descriptions were a disparate, individual phenomena or if the particulars showed reoccurrences among the participants. This was a detailed study of individuals and their distinctive situations and conditions.

The Research Sample

Initially demographics were to be used. Due to the relatively small population of candidates in psychoanalytic training, the IRB requested that the candidates’ demographic information remained private Hence, no typical type demographics were taken, including age, gender identification, location of institute, or race; because of this, Appendix D was not used in this study. This author was relieved when the IRB made this mandatory, once I started the interviews and saw how personal each story was.

What can be said about this population is that the participants range from the west coast to the east coast, from the northern states to the far-reaching southern states of the United States. Seven institutes were represented that are a part of APsaA.

Inclusion and exclusion criteria.

One of the primary qualifying criteria for participants in this study was that individuals were actively sought certification from the American Psychoanalytic Association (APsaA), as it has been the oldest national psychoanalytic organization in the

nation and served as a scientific and professional organization (American Psychoanalytic Association, 2017).

To allow for the phenomenon of honesty in supervision to be explored by psychoanalytic candidates in a meaningful way, candidates must have had sufficient time in the supervision process. Thus, participants had to have had second year to advanced standing in their candidacy, meaning advanced standing candidates must have completed all the didactic training and were finishing up their cases “on the couch,” and had not yet sat for their second set of their colloquium at the American Analytic Conference. As it turned out, some of the participants had multiple interviews over a range of their training, many research participants have now graduated. With psychoanalytic candidates as participants, it was assumed that the participants had the required knowledge to some degree to self-assess their interactions with their supervisors. They were able to identify transference, countertransference, and defense-formation issues that arise in the supervision relationship.

No racial or gender group was excluded or purposely selected for this study. Initially, the aim was to find 12 participants, yet saturation was achieved at nine candidates I interviewed two more candidates for a sum of 11 participants to ensure the themes were repetitive Currently, there are more female candidates than males in training. Candidates would have been excluded from this study if they were under investigation for ethical violations or had their license revoked. Also, any psychoanalytic candidates not within the American Psychoanalytic training parameters were excluded since there would have been even more deviations to training.

Sample size.

McMillan and Schumacher (2001) stated that a phenomenological study usually has a smaller sample size because “insights generated from qualitative inquiry depend more on the information-richness of the cases and the analytical inquiry capabilities of the researcher than on the sample size” (p. 404), with a recommendation of at least six participants. This study had 11 participants based on Smith et al.’s (2009) citing that for dissertations there are sometimes grants attached that need more participants. This number allowed for more re-occurrences through the participants’ accounts and for more themes to arise, which could increase validity. Although there is no exact framework set up for capping the number of participants, these authors stated that some of the subtler data may not be focused if greater numbers are included.

Sampling method.

Purposeful sampling was used (Creswell, 2012). Smith et al. (2009) advocated for an homogeneous sample, because the research participants allowed insight into a particular experience. In this study, the focus was on psychoanalytic candidates in supervision. The participants were referred to me by my consultants from the Institute of Clinical Social Work (ICSW), from psychoanalytic candidate colleagues, and from supervisors from APsaA. I also used a convenience sample from sponsored candidate APsaA events, because the initial contact group consisted of people whose contact information I had from national conferences, and/or the persons they forward my contact information to. I targeted participants from east coast to west coast, from the northern states to the southern states. Fliers were distributed (see Appendix F) at national meeting events for

candidates, and an announcement in the Candidates’ Newsletter was distributed. I spoke at national conferences to the candidate’s counsel about my research to attract potential research participants.

Research Design and Procedures Outline

After the Institutional Review Board had approved the study and the proposal hearing was completed, I carried out the research. The following steps are summarized:

1. At the beginning of this study, I went to two professional conferences that focused on Interpretive Phenomenological Analysis.

2. I conducted one pilot interview with a colleague who was a psychoanalytic candidate.

3. I kept an ongoing journal of my own knowledge and biases. I answered my own preliminary questions. I journaled my thoughts after each interview, using the research method known as “bracketing,” which allowed the researcher to set aside theirownbiases and knowledgeto adopt an attitudeof “conscious ignorance”about the topic under investigation (Chan et. al., 2013)

4. I obtained my participant list from attending APsaA conferences and meeting candidates. I also had colleagues and supervisors refer candidates.

5. Recruitment: I called people who were referred to me, or from the potential participant list, using the script in Appendix C.

6. Scheduled interviews: Individuals who meet the predetermined criteria list and were willing to participate in two 45-minute interviews, including member checking procedures, I scheduled for their first interview. Prior to their scheduled

interviews, participants were sent, by email, the interview invitation and the follow-up to participate in the study (see Appendix A), as well as the recruitment flyer (Appendix F) Participants were asked to provide me with a fictitious name they wished to be identified by for all the various forms of data collection, including the interviews.

7. Interviews: The first semi-structured interviews were in person. Due to COVID, this step was altered, and interviews were conducted on a HIPAA regulated video conference for mental health professionals.

8. Originally, the first semi-structured interviews were to be submitted for transcription. Yet, this step was altered, and this researcher transcribed all the interviews herself. This ensured I was familiar with all the material that was collected to help with coding. I then hired my initial editor to make sure the interviews were transcribed correctly to ensure accuracy of the data. I sent copies of the interviews to my dissertation chair to review.

9. I follow-up by phone calls and/or email and/or text messages to clarify responses when needed.

8. Member checking: I sent each participant their own transcript to allow for corrections or volunteered additions.

9. Coding and preliminary analysis of the first interview transcripts were conducted.

10. The second interviews were conducted by a HIPAA complaint video conference or via a telephone call. This interview mainly focused on if the participants had any additional thoughts about honesty and openness in supervision. In some

instances, additional interviews were scheduled when helpful to add or validate the findings.

11. Transcription, coding, and preliminary analysis of the second interview transcripts were conducted as needed

12. I sent my dissertation chair all the results and findings as the research unfolded. Data collection.

The dataset came from primarily one source: the semi-structured, open-ended interviews. Researcher’s memos were a secondary source. The memos contained impressions during interviews, such as body language, that helped in interpretations of the meanings in a transcript. This researcher was trained in attachment interview that helped this researcher understand when a participant was in distress, and I coded those interviews accordingly. Appendix E contains the initial interview questions and prompts that were utilized.

Recruitment

and scheduling.

After having received IRB approval for the use of human subjects, I called my potential participants. Unfortunately, I was basically “ghosted” by most of the candidates on my original list. I continued to recruit for this study by attending APsaA meetings and discussed my research. Becoming more aware of how sensitive this topic was, I approached candidates more cautiously, which helped with recruitment. I then turned to my supervisors from ICSW, my psychoanalytic APsaA supervisors, and psychoanalytic colleagues for referrals. After I interviewed participants, then I was referred other

participants from other institutes. This method is known as “snowballing” (Smith et. al., 2009). I called each candidate that was referred to me and ask if he or she would participate (see Appendix C). I followed up with an email (see Appendix A), with an attached consent form (see Appendix B), and a recruitment flyer (Appendix F). When a potential candidate dropped out by being non-responsive in the study I continued my recruitment. I also wrote emails to each candidate on the listserve of APsaA. This process took over three years to find 11 participants.

I informed all candidates of the research questions to make sure they were understood. Initially I offered to meet the candidates in their offices, homes, or let the participants name a place convenient for them for an interview, if confidentiality could be upheld Covid changed these initial steps and, ironically, at the beginning of COVID, I scheduled the remaining participants via Doxy.me, a secure HIPAA compliant video conference system.

Interviews.

I confirmed that each participant had signed their consent forms and given me a pseudonym before each interview. I disclosed my own interest in the topic and shared my own struggles based on my recruitment script (see Appendix C). The self-disclosure for this study helped build rapport with participants and opened them up to sharing their own struggles and their processes.

I prepared open-ended interview questions for a semi-structured format, anticipating that part of the interviews would be led by the participants’ concerns, as outlined by Smith et al. (2009). This allowed participants to address topics and concerns that were not

scheduled for. These were the most valuable aspects of interviewing, since they revealed information, I did not expect or prepare for. The participants were the experts of their own experiences. The goal was to enter the lifeworld of the participant. Unfortunately, this study required I do an extensive literature review per ICSW’s requirement beforehand to receive IRB approval. Ideally, the literature review would have been done after the interviews. Some of the preliminary questions formulated were useful and some were not based on my biases of the literature. Yet, I was aware of the design flaw and, as a psychoanalyst, was trained to have “no memory” of previous sessions. I took this stance into the interviews as much as my mind allowed.

Follow-up.

The follow-up interviews were predominantly by phone, per request of the participants. I sent a copy of the participants’ interviews to the candidate, which is also known as “member checking” (Creswell, 2012). In the second interviews I discussed the candidates’ thoughts on their initial interviews to make sure their views were represented accurately. Then I had a discussion of preliminary results and requested feedback.

Data analysis.

I utilized qualitative interpretive phenomenological analysis (IPA), based on Smith et al.’s (2009) methodology framework, this entailed analyzing the meanings that particular experiences, events, and states hold for participants.

Bracketing.

During analysis, the researcher set aside their preconceived biases and ideas to understand the meaning of the participants in the study. This is known as bracketing (Creswell, 2012; Smith et al., 2009). I asked myself questions to be aware of my own bias. I kept a reflective journal, which was utilized as a form of independent audit. I used the reflective journal following the interviews and during the data analysis, which I considered to be a critical contribution to the quality and validity of the IPA process, encouraging the use of a notebook to write down initial impressions of the interviews, especially any strong feelings, to bracket one’s own experience. “It can help to reduce the level of this noise by recording it somewhere, thus allowing your focus to remain with the data” (Smith et al., 2009, p. 82).

Transcription.

IPA has required a verbatim recording of the interview. During the transcription process, significant statements, quotes, and sentences were highlighted and reflected upon. I used Horizontalization, which means that all data was treated as having equal value, not subject to the researcher’s bias of what might be important (Patton, 2002). This process helped to provide a deep understanding of how participants’ experience the phenomena of openness and honesty in supervision.

Reading, re-reading, and listening.

It was recommended that the researcher read and re-read the transcripts and re-listen to the recordings at least once to enter the participants’ world, and to enter a phase of

active engagement with the data, as individual narratives could bind certain sections together. This researcher found that being able to relisten to the interviews multiple times was invaluable, allowing me to hear “meaning units” and “themes” that I had initially missed.

Initial noting

.

The initial noting is known to be one of the most tedious processes of the data analysis (Smith et al., 2009), which this researcher has confirmed. I wrote notes on the transcripts, a process known as free textual analysis. The text was divided into meaning units, and comments were assigned to the preliminary themes that arose “Your aim is to produce a comprehensive and detailed set of notes and comments on the data” (p. 83). This process allowed for key themes to emerge from the data.

Developing emergent themes.

From rereading the notes, themes emerged, not only from the participants’ original words, but also the researcher’s reflections and interpretations (Smith et al., 2009). This step meant applying a theme label to related clusters of the invariant constituents identified in the previous step (Moustakas, 1994; Patton, 2002). As part of this step, these constituents were examined and labeled as themes, which became core themes of the experience.

Searching for connections across emergent themes.

Smith et al. (2009) stated that after the transcripts’ themes emerged, within a chronological order, the next step for the researcher (analyst) was to “think the themes fit together you are looking for a means of drawing together the emergent themes and producing a structure that allows you to point to all the most interesting and important aspects of your participant’s account” (p. 96). This happened through the process of charting and/or mapping. Moustakas described this step as an imaginative variation and theme validation. This step meant examining each theme from various perspectives to see the theme from differing views (Patton, 2002). This helped the researcher develop enhanced or expanded versions of the themes. The themes are then re-checked to make confirm that they are explicitly stated or compatible with their participants’ records. Incompatible views are removed (Moustakas, 1994). This researcher followed Smith et al.’s (2009) suggestion to find specific ways to look for patterns and connections between the themes:

• Abstraction: identifying patterns between emergent themes though super-ordinate themes by putting together “like with like and developing a new name for the cluster” (p. 96)

• Subsumption: combining related themes.

• Polarization: putting themes together of oppositional relationships by looking at the differences.

• Contextualization: looking at the connections between the emerging themes.

• Numeration: considering the frequency with which a theme emerges.

• Function: examining the function of the themes being examined.

• Bringing it together: documenting the strategies above that were used (not all may be used) while the analyst (researcher) puts together a graphic representation of the structure of the emergent themes.

Themes Across Cases

The graphic representation of each case is taken, patterns are sought after across cases, then the parts are put back into a whole (Smith et al., 2009), by measuring the emergent themes for the whole group. Moustakas referred to this as the structural synthesis. Having searched for themes, the researcher tried to understand how participants experience rather than what they experienced (Patton, 2002). This was done to depict a broader view of how participants, as a group, experience what they experience.

Ethical considerations.

IRB approval was imperative before the study could begin. All the respondents were volunteers. There was no physical risk to the participants in this study. The participants knew there would be a high probability of emotional distress as they reflected upon their personal experiences, as I learned during the mock study on the same topic. This researcher used clinical skills to help the participants process unexpected emotions, in addition to their own analysis, so they were able to process their feelings relatively smoothly. With the participants being psychoanalytic candidates, they were able to selfassess their reactions. The participants were allowed to discontinue the interview at any time. I was also prepared to suggest a break from the interview if I felt the process was overwhelming.

Precautions for protecting the identity of participants was important, as identifying either a participant or a supervisor could have jeopardized their respective studentsupervisor relationship, or even the candidate’s standing towards becoming a faculty member; thus, pseudonyms were used. In addition, descriptions of the sample were aggregated, no participant was described in a way would allow a reader to identify them.

The researcher was careful to avoid any presentation of text that could identify a candidate. At times, I mixed up genders in the text and disguised the story to keep the content of meaning in place. I crossed out any identifying information in the transcripts before I sent them to my dissertation chair, so he knew what information was protected.

Consent forms were read and reviewed at the start of each interview I used the Institute for Clinical Social Work Individual Consent for Participation in Research form. The form described the purpose, procedure, costs and benefits, and potential risks or side effects of the study. Issues of privacy and confidentiality were also covered. All digital recordings of the interview will be destroyed immediately after the completion of the study. The transcripts of the interviews will be kept on a flash drive, in my own fireproof safe, for three years following the completion of the study, and then will be destroyed. Study respondents reviewed their portion of the study after the preliminary data analysis to ensure they felt properly represented in the study. Respondents were all notified of the initial result and will be given a copy of the study, if they request the results, as they are invited to do in the informed consent statement.

Issues of trustworthiness.

In qualitative research, the focus on trustworthiness is based on how well the researcher has provided evidence that their description and analysis represent the reality of the participants interviewed. Member checking was used make sure that the participants had, and agreed, that their reality was represented to the fullest extent possible.

Credibility.

Credibility paralleled the criterion of validity in quantitative research. I brought credibility to this study by having interviewed myself first. Credibility was strengthened by (a) having monitored my own subjective perspectives and biases by having kept a journal throughout the research process; (b) having interviewed multiple candidates and comparing their transcripts; and (c) having confirmed the standard protocols of supervision, with supervisors, when questions arose as to what supervisory practices are considered ethical and necessary. I reported any variations from the planned data collection procedures. I utilized my dissertation chair to help with “peer debriefing” to enhance the accuracy of my accounts. I discussed my field notes and interpretations to help me examine any assumptions as well.

Dependability.

Dependability was established by providing an audit trail. I shared my dataset with my dissertation chair and my editor, who trained as a social worker and worked for the Center for Psychoanalysis Center in Houston. The need for dependability emphasized the

need for this research to account for any changes that occurred within the study setting and how these changes affected the way I approach the study.

Transferability.

Transferability will be judged by the reader. If the descriptions and interpretations match their own experiences and endeavors in the same context, then transferability will have been achieved. The aim was to provide a “thick description,” as discussed by Bloomberg and Volpe, and to give a holistic and realistic picture describing the meaning of the experience. I brought my own experience to the interpretation of the results, as my familiarity with the context enabled me to understand the descriptions and challenges of being a psychoanalytic candidate I used Yardley’s principles to assess the quality of the research, this entailed demonstrating sensitivity to context in the early stages of the research (Smith & Osborn, 2003). In IPA research, one must be able to show empathy, put the participants at ease, recognize participants’ distress tolerance, and understand the role of being the interviewer. My mock study enabled me to practice interviewing skills, and my work as a therapist has given me extensive practice in showing empathy, putting participants at ease even while discussing emotionally challenging material, and recognizing distress tolerance.

Limitations and Delimitations

The main limitation of this study was that it could not be generalized Although qualitative research is not generalized the same way quantitative research is, valuable insights has been gained from the implications, especially when considering the general population being studied. Due to time constraints, it was unrealistic for this researcher to interview more than 12 people. Other limitations of this study were the typical challenges to validity, due to the nature of qualitative research, such as the potential for personal bias to enter interpretations. In addition, in qualitative research, freedom is given to make each study unique; as such, replicating even the exact procedure, would produce different results. There is also concern that information could be distorted through an overimposition of subjectivity (Langdridge, 2007). Also, since they did not know me, there was no guarantee that those interviewed would feel comfortable enough to divulge their true feelings and experiences. I did mock interviews with people who I had a previously established camaraderie with. Thus, I could help remind them of stories they had told me about supervision. In contrast, I had no psychoanalytic history with the participants for the present study and found it more difficult to elicit relevant descriptions of their experiences.

The Role and Background of the Researcher

“The role of the researcher is recognized through the way in which the analyst interprets a participant’s understanding” (Smith et al., 2009, p. 107). Smith and Osborn (2003) referred to this as the double hermeneutic approach This researcher was trying to make sense of the sense-making activities of the participants. Studies are inductive and grounded in data rather than pre-existing theory. Descriptions are invariably idiographic, focusing initially on a single case before moving on to other cases and more generalknowing claims.

My background and interest in researching the relationship of the supervision dyad was due to my difficulties in supervision. This is known as “foregrounding” in IPA (Smith et. al, 2009). In my first analytic case, I had many parallel processes with my own analysand that further played out with parallel processes that occurred during my supervision. This was a complication that took time for my supervisor and me to recognize. My psychic structure, that identified with my patient, had not been analyzed, which led to blind spots. I had to be able to understand myself before I could understand my patient, and my impasses that occurred in supervision.

What sparked my curiosity about the relationship between the supervisor dyad was the advice I received from colleagues, not all of them candidates, during a time when I experienced an impasse in supervision. Some of the recommendations I received were to have a frank conversation with my supervisor, get a new supervisor, to try not to be as transparent, and to read Annie Rodger’s writing, whom struggled with her mental health and avoided straightforward conversations with her supervisor; in other words, she faked her conversations to look good. This led me to wonder how honest supervisees could be

with their supervisors. Could they really share therapeutic mistakes without negative repercussions? Could they let their supervisors know their own challenges without discrediting themselves in their supervisor’s view? How much do and should supervisors know about supervisees’ history? How much do supervisees trust their supervisors? Also, few people seemed to discuss their supervision difficulties openly during my candidacy. I had not encountered difficulties in my supervision to attain my License in Clinical Social Work, or when I went to attain certification in psychodynamic supervision, before my psychoanalytic training, including my PhD program. Thus, another question arose: what was so different about psychoanalytic training supervision?

My experiences had been one of unique challenges within the psychoanalytic training supervision process. In the Spring of 2014, I conducted a mock qualitative phenomenological study for a class on qualitative studies at ICSW. Using the same research question posed for the present study, exploring how honest psychoanalytic candidates felt they could be with their training analyst, I interviewed four candidates for the study. In the mock study, I explored useful research techniques, doing so served as a pilot study for the present study, and enabled me to refine my procedures.

During the time of writing this proposal, I was sitting for my last colloquium to become a psychoanalyst, defining strategies to progress my training. I also listened more intently to fellow candidates talk about struggles that we shared, together, at APsaA meetings for candidates. Yet, I also felt that I had been properly trained to be an analyst then. My training allowed me to enter these interviews without judgement and put my biases aside, as much as my mind would allow. Reflecting, I acknowledge that I have

crossed to the other side and seen things through the progression committees’ lens. I have felt the best of both worlds, being a candidate and having become an analyst.

Chapter IV Results

How Open and Honest Are Candidates? It’s Complicated

Most literature on supervision was written from the supervisors’ perspective and wisdom. This study focused on the other side of the story, the voices of the candidates, where the voices have remained predominantly silent. How open and honest are psychoanalytic candidates with their training supervisors? It is complicated. Through the study, I discovered that asking for honesty was dangerous. 10 out of 11 candidates appeared anxious, scared, or nervous over at least one topic discussed. Consistently, the candidates needed reassurance about their privacy. The word honesty stirred up strong emotions with candidates, administrators, scholastic professors, and psychoanalytic supervisors. I had a scholastic professor refuse to be on my dissertation committee because he felt, ethically, if I had found out that the candidates were not being completely honest that I needed to report them to their institutions and respective boards. Honesty needed more reverence, respect, and space to hold candidates’ anxiety. I had to revamp and eliminate the word “honest” from my flyers. I had open, informal conversations with candidates on honesty when we discussed their challenges. Sadly, I was ghosted most of the time when I reached out to record their experiences. It took me three years to find 11 brave participants.

The candidates’ feelings and their relationship with their supervisors have been complex, complicated, and multidimensional. The candidates have caring feelings, ambivalent feelings, protective feelings, feelings of loyalty, disappointed feelings, angry feelings, and feelings of being scared. Most of these feelings are hidden from the supervisors when reading the interviews.

The Candidates in this Study Genuinely Wanted to Be Open and Honest

Every candidate in this study genuinely wanted to be honest and open with their supervisors. The candidates found honesty important in their training and were perplexed and disappointed when they had to filter what they said to certain supervisors. Each candidate felt like that they had at least two supervisors they could be completely open and honest with the intricacies of their cases. Nine candidates had at least one supervisor they were not as open with, this sometimes led to changing supervisors, filtering the material to the supervisors’ ear, and/or mustering through supervision, not bringing attention to themselves.

Some candidates were more open, whereas other candidates were, naturally, more private. Hence, certain candidates found it necessary for their supervisor to know about their personal lives and, sometimes, gave their supervisors keynotes on their childhoods to help their supervisors understand the candidates’ countertransference with their patients.

The candidates that were more open about their personal lives and past reported transparency was imperative for the supervisors “to be in it with them” and “know” them. These candidates reported very rich experiences and had a “heartfelt path” with a mentor

to guide them. The supervisors were more aware of the countertransference issues and would redirect them to their analysts for deeper issues. It required a certain level of trust and vulnerability with their supervisors. Juxtaposed, candidates who kept personal information private between themselves and their analysts separate from their supervisors were more guarded. These candidates turned to their analysts to navigate their turbulent emotions and the difficulties of training. Their supervisors had less information about their candidates’ anxieties, their personal lives, and were kept from having a full view of the “whole” candidate, including their potential blind spots, and countertransference issues. Curiously, supervisions went smooth for some candidates, it appeared, by taking their anxieties elsewhere, depending on the supervisors. Some supervisors appeared to be able to hold more of the candidates’ anxieties in training than others. Although this was still an open and honest process, where the supervisees shared their mistakes and impasses, they relied on their analyst to validate and process the difficulties of their patients privately. This appeared to allow a more collegial type of relationship since little containment or support appeared to be needed. The experience with these supervisors was more cerebral. The difference was that candidates had to figure out what worked for them personally, and their needs were met differently. Even the guarded candidates could be more vulnerable, depending on the supervisor with time. None of the candidates reported any treat or teach issues in this study, their supervisors redirected them to their own analysis.

Some candidates gave me feedback believing that “not all candidates are honest.” They gave stories from their institutes with more “narcissistic candidates” that seemed to “con,” “seduce,” or “flatter,” the faculty, or use “academic banter.” The candidates gave

examples of how they knew the candidates were not giving full stories on their cases.

They reported that these candidates often did not have the same graduation requirements, only had done a few years of their own analysis, or that one candidate had only been seen twice a week until they graduated. These candidates were “special” and “gifted,” and had some talent such as writing or having prestigious employment or research. These types of students were easily pushed through the system. Two of the interviewed candidates believed these candidates would be committing ethical violations in the future and were resentful that the faculty turned a blind eye to these dynamics. The interviewed candidates reported that they did not want to be on faculty or on the same committees with the other candidates, they felt that they would only be disruptive to them and/or their institutions in the future. Again, all candidates in this study wanted to be open and honest, but not all candidates are necessarily open and honest according to the experiences of these candidates.

Not All Supervisors Are Created Equal

Despite every candidate in this study having reported that openness and honesty was essential, they filtered information with some supervisors more than others. One candidate reported that supervisors come with different strengths and aptitudes, while other supervisors have more deficits. There were themes that arose in the interviews that demonstrated some supervisors’ methods helped generate more openness and honesty than others. The key ingredient that stood out was the candidates’ need, along with their patients, to feel respected, fully open and honest, and that their supervisors held their best interest. Candidates were clear that they were equals as human beings, but that their roles

were not equal. Each wanted to develop their own minds and analytic voices, even if they were different from their supervisors. Overall, the candidates felt they could trust these supervisors for feedback and not feel criticized. They felt their supervisors were invested in their success to become analysts, yet the candidates also expressed a need for the supervisor’s “authority” and “expertise” to turn to when they were stuck, like a strong, wise, mentor that could guide them through rocky territory.

Themes of supervisors’ approaches emerged, which impeded the process of learning, collaboration, and transparency in candidates’ cases. These supervisors were referred to as “authoritarian” or “archaic.” Some candidates felt that the supervisors may have been following by example, “what was done to them they do to us.” These supervisors were described as needing their candidates to be empty vessels that they could be filled with their knowledge and instruction, that needed to be followed. Once “filled,” these supervisors would circle back, with their supervisee’s analysand, to see if and how their suggestions were used. Some candidates noted, at the beginning of their training, that this approach was helpful at first, borrowing the authority and confidence of their supervisors gave them self-assurance. Yet, if this technique persisted, the candidates were unable to find their own analytic style, and things became problematic, since the supervisors appeared to prefer strict obedience to their style and technique. The candidates with these supervisors felt criticized as opposed to being given helpful feedback or different approaches. These supervisors quizzed their supervisees regularly, demanding they answer theoretical questions “right,” off-balancing them. The candidates felt these supervisors could only have one smart person, or one “all-knower,” in the room leaving the candidates feeling “less smart,” versus being ambitious learners. There was no room

to hear if the candidates’ approaches worked or “how it all turned out.” Their own finesse and sense of their patients was disregarded for the supervisors’ technique and theory, and/or being extensions of their supervisors. Candidates really do not like “spoon feeding their supervisors sugar” to get through training.

Candidates did not respond well to “push-over” supervisors either. They yearned to have constructive feedback on how to be more effective, to hear how the supervisor was formulating the case, and what interventions/interpretations the supervisor might have used. Candidates do not mind augmenting their knowledge or thinking of how their supervisors think differently. The candidates wanted a peer to think with them on how to improve the analysis for their patients. This set of candidates expressed little desire for cheerleaders or indulgent praise. Although, they did want positive feedback, and mirroring that was genuine. This helped the candidates feel more confident in their work and themselves.

Candidates have also needed supervisors to contain more aggressive material from patients. The candidates pointed out that none of them really knew what was in store for them until the patient revealed more pieces of themselves. The candidates with patients that had aggressive or violent content were unable to foresee these challenges until some time had passed within the analysis. Candidates with self-destructive patients tended to have more anxiety; they felt ineffective, belittled, and wanted to be validated and given tools on how to carry forward. Candidates reported that not all supervisors are equipped to handle trauma, or destructive forces analysands bring. If the opportunity arose, candidates would switch to supervisors who were better containers, ones able to validate the unwanted feelings their analysands left them with. We had one candidate say he

“two-timed” on his supervisor to not make waves with his institute, we heard other candidates seek extra-supervision when they felt they were in a parallel process with their supervisor being “stuck.”

Not all candidates are created equal, they come with different personality structures, and different strategies to navigate training. The candidates reported that not all supervisors are created equal, and they come with different strengths, aptitudes, and deficits. Complicated relationships, with authoritative and critical supervisors, were more at risk, and the candidates had to filter how open and honest could be due to their experiences with their supervisor.

Candidates’ Achilles Heel in Openness and Honesty

The candidates’ Achilles heel in openness and honesty in supervision came when they decide to switch supervisors. They discovered that supervisors rarely received the whole story of why the candidate decided to switch supervisors. The candidates tended to give part of the story and were cautious while terminating the relationship. Candidates have turned to others for extra-supervision and kept their supervisors uninformed about the cases and/or the supervision they were struggling. Candidates have left supervision because of the supervisors’ style, feeling criticized, disrespected, not allowed to have their own minds, or because they were stuck, but ultimately, they left because their current supervision was not helpful. This appeared to be a blind spot for the candidates themselves, they would find themselves omitting key factors with the supervisor that were not working. Even though the candidates were clear with this researcher why they left certain supervisions, their stories indicated that they were uncomfortable letting their

supervisors know why they really left the relationship, except for one candidate, who was an anomaly; they were very clear why they terminated supervision: the supervisor committed ethical violations and the candidate felt betrayed.

Candidates only terminated with supervisors after a long, contemplative, agonizing process. It took a team of people to help the candidates terminate the relationship. Candidates that switched, in general, were worried about “hurting” or “upsetting” their supervisors. They worried with thoughts and questions like, “Will the supervisor retaliate?”, “Will the progression committee frown upon me switching?”, and “I feel guilty since they are a good person, but not the supervisor for the case.”

Although many of the candidates denied that they had loyalty issues, in the interviews, their distress can be heard in their voices and through the attachments they had with these supervisors. The candidates that seemed to have caring feelings were attached to their supervisors and, simultaneously, were aware of the difficulties in their supervision. Candidates that held their positive, negative, and ambivalent feelings conflicted at times. Interestingly, candidates with difficult supervisions would share their stories and would want me to know that their supervisors were lovely humans dedicated to psychoanalysis, and the candidate would protect the positive attributes the supervisor had. A year later, when I followed up with the candidates, none of the candidates regretted leaving their supervisor, and most seemed to have no memory of the difficulty in leaving when I would discuss my conversations with them a year prior.

Candidates also were not fully transparent when writing up reports. Some supervisors helped candidates leave out information based on progression committee members and their biases, to help the candidate progress smoother. This information is

guided by their supervisors. The most common theme that came up was if the patient was sitting up on the couch. At other times, candidates may also not be as transparent or open when they are feeling stuck on a case, are feeling overwhelmed, or when they have ineffective supervisors with authoritative and archaic attributes. Some candidates did not inform their supervisors when they were seeking consultation elsewhere.

The Supervision Dyad Is an Open System

The candidates that used extra supervision and did not necessarily inform their supervisors. Some candidates openly discussed different facets of their feelings or complications of their cases with other colleagues, cohort members, and other supervisors. 9 of the 11 candidates usually shared more, privately, with their analysts for mentorship and guidance through complicated training challenges. Unbeknownst to supervisors, these complex feelings or possible challenges in the cases, are being shared elsewhere. Some candidates take advantage of presenting at conferences or visiting teachers to have a different perspective. Rarely does supervision happen in the bubble of the dyad. When candidates are stuck, injured, or scared, they are reaching out to other colleagues in their cohorts, their analysts, or another trusted supervisor. Hence, no one really knows where the most helpful interventions will come from.

Candidates are Sensitive to Institutional Processes and Turmoil

Candidates have continued to watch and listen to administrators, faculty, and supervisors and how they handle conflict and perceived aggressions. 8 of the 11 candidates reported being sensitive to disturbances in functioning within their institution.

Seven candidates reported that they would not be graduating with the same standards they started with. This angered the candidates, and temporarily interfered with the relationship with their supervisor, but this appeared to be short lived.

Yet, if there are institutional splits and fractures that threaten the functioning level of the institute itself, this does interfere with openness and honesty. Depending on what side of the split the supervisor is on will determine how much information is filtered to that supervisor. One candidate had to go to another institution to finish her training, another had their graduation delayed due to in-fighting in their institutions. The candidates reported that the splits seemed to have to do with the pedagogical differences and more archaic standards. In-fighting has affected candidates, especially since colleagues, friends on faculty, and their supervisors pass this information on to the candidates. Four candidates felt that their institutes were better at keeping these differences away from the candidates, others thought they knew, only to find out they only knew parts of the conflict. Either way, increasing standards for candidates to graduate has continued to temporarily affect openness, while more severe conflicts have interfered with openness and honesty longer, with particular supervisors if conflicts persist.

The Unseen Guide Behind the Couch

Candidates are most open and honest with their analyst. 7 of the 11 candidates volunteered that their analysts were the most important person in their training. Some analysts weighed in on the candidates’ options for supervisors, while some gave suggestions. Other candidates chose supervisors who only reflected their decision processes. A few candidates report their analyst recommended supervisors that were their

own analyst, or supervisors, or people they analyzed or supervised. Some analysts helped guide candidates through the politics of training when it felt impossible. Some of the more private candidates took their countertransference issues to their analyst first, to process, before bringing the challenges of the case to their supervisors, presenting in a more regulated and contained manner. If their cases were stuck, the analyst would step in and offer suggestions, or offer “off-handed supervision,” suggest the candidate get a second opinion, or encourage the candidate to change supervisors. One candidate’s analyst validated that his supervisors needed more compliance and less thinking.

Three candidates reported that their analysts did not help with their cases, did not weigh in on their choices for supervisors, or help to navigate the political terrain of their institutes. They expressed that their analysts helped make meaning of the issues for themselves and connected their affect/feelings to their histories. Or, their analyst empathized with the difficulties of training, difficult patients, and reflected back their preferences. In every instance, the analysts were important to these candidates, in different ways. The candidates felt the most honest and open behind these closed doors, away from supervisors and progression committees. Hence, the unseen guide is at the center of the candidates training.

The Unseen Power of Cohorts

Integral information has been exchanged between candidates during meetings with their cohort. This set of candidates demonstrated that there is power in numbers. Cohorts, with seven or more candidates, seemed to be able to address their grievances directly with their administrators, as a group. These candidates intimately shared the difficulties

of training and normalized the regressive process. They also openly evaluated faculty courses and brought levity by making fun of faculty members between classes. Four of the larger cohorts met for drinks or went to each other’s homes. The more time they spent with each other, the more they shared unedited evaluations and experiences of their supervisors and administrators.

The smaller cohorts did not demonstrate the same openness of evaluations, or intimate relationships as a group. Yet, three candidates from smaller cohorts had at least one good friend, either in other training or classes, to share their inner worlds with. However, they were not able to commiserate and strategize on how to collectively approach their difficulties. Through their surrogate cohort, they would get unofficial evaluations of their supervisors and decide which to work with or avoid. One candidate, in a large, online class felt more vulnerable and did not openly share with her cohort members. This more isolated candidate appeared very scared in the interview with me, came with a script, and disappeared after the first interview. During the pandemic, in a progression meeting I was in, the supervisors expressed that it was hard for the candidates to truly share and be vulnerable online; a similar topic suited for investigation.

There is an informal evaluation of supervisors that does happen amongst candidates. Evaluations of administrators and supervisors can happen in unfiltered ways. Hence, supervisors have evaluations and receive reputations in unstructured settings. Candidates have shared with other colleagues outside and within their institutes. In the larger cohorts, there appeared to be less filtering and more opportunity for “gossip” to flow. If a supervisor was difficult or helpful, in time, the candidates would know.

In summary, there were many themes that emerged in this study:

1. The difficulty in finding participants to sit for this study and how scared most of the participants were.

2 Candidates in this study genuinely wanted to be open and honest.

3. Candidates reported that not all supervisors are created equal.

4. The supervision dyad is an open system, one lacking the understanding of where the most effective intervention will come from.

5. Candidates are sensitive to institutional processes and turmoil.

6. The unseen guide behind the couch is whom the candidates are the most open and honest with.

7 This set of candidates demonstrated that power came with numbers, influence and integral information was exchanged and provided, collectively, through their cohort.

Discussions and Conclusions

Honesty Is Complicated

It was very difficult to find psychoanalytic candidates to sit for this study. The endeavor provided important data unfolded with unexpected stories and became unusually complicated. Early in my search, I realized the difficulty in finding candidates was part of this research story, and a significant theme that arose in this research. The question of how open and honest psychoanalytic candidates are with their training supervisors was clearly complicated. The word honesty stirred up emotions in many candidates, supervisors, professional academics, and institutions. Many candidates and other professionals, through their responses and actions, confirmed how difficult honesty was to discuss and how many meanings the word had for the different individuals I encountered. I experienced honest conversations during spontaneous exchanges when I could freely think out loud with other candidates that shared their thoughts, freeing and healing the storyteller, sadly, in those conversations, the recorder was off limits. I had honest conversations with the participants that chose to sit for my study; however, it was difficult to find them, and trust had to be established. Considering honesty is a fundamental rule for psychoanalysis (Freud, 1912), candidates themselves have important information about honesty in supervision and about the word “honesty” itself.

Honesty, in this study, was defined by Thompson (2001) in the article “The Enigma of Honesty: The Fundamental Rule of Psychoanalysis” as the individual being sincere, truthful, and candid. The word honesty in this study was not defined by the Latin roots honestus, meaning “an honorable person from a moral perspective” (2001). The Latin word for honesty has a moralistic view, with distinctions between good and bad and right and wrong. Honesty, as defined in Latin, could impinge on one to be an observer keeping shame at bay, because honesty, with that definition, would evoke judgment resulting in shame and stop the observer from reflecting. Although honesty was not defined by the etymologically Latin roots in terms of this study, the research showed that many candidates and professionals think of honesty through the Latin lens of judgment.

Freud used the Greek’s meaning of honesty as an ethic. Honesty was “derived from the Greek ethike tekhne, meaning ‘the moral art,’ ethike is in turn derived from the Greek ethos, meaning “character.” (Thompson, 2001). Honesty was used in the pursuit of happiness, which produced equanimity by obtaining freedom from mental agony. Thompson pointed out that Freud differentiated honesty having ethical values that differed from moral values.

The fundamental rule of psychoanalysis, according to Freud (1913), in his collection of essays, “In the Beginning of Treatment,” as stated to his patients, is “ never forget that you have promised to be absolutely honest, and never leave anything out because, for some reason or other, it is unpleasant to tell it” (p 135). What Freud understood was that neurotic patients had resistances, inner conflicts, and repression barriers that would make it impossible for anyone to be totally honest. Hans Sachs (1947) said there were essentially no differences between training candidates and neurotic patients, and that

candidates would inevitably have neurotic problems. Freud understood his patient had inner conflicts that were unconscious and things the patients’ themselves did not want to know about themselves (Thompson, 2001). From this, Freud understood that psychoanalysis could never be reduced to a conventional standard of morality by the etymological roots in the Latin language. Freud knew that free association was the vehicle that allowed honesty to arise; in other words, it allowed patients to self-reflect. Freud knew that according to the Greek definition of honesty that patients would be freed from their mental anguish through non-judgmental observations, self-reflection, and honesty with another. This study has been an example of how difficult it is to separate the Greek and Latin meanings of the word honesty and how entrenched the Latin moralistic word is in our culture in psychoanalysis. Because of the complication of the word “honesty,” it became a phenomenological theme in this research and appeared to impede participants from sitting for this study.

The research showed that honesty was a dangerous topic for candidates to discuss, 10 of the 11 candidates were initially scared to talk to me. Ten candidates wanted to know how I intended to keep their identities confidential. Six candidates called me later to ask if I would wait to publish any articles about my study until after they graduated. One candidate was so scared they stopped all communication after the first interview. Another candidate told me he felt I was like Child Protective Services, and that he was telling on the parents (his supervisors), which was a very powerful comment about how scared he was to be honest about his supervisors. The topic not only scared candidates, but also two scholastic professors. One was a beloved professor, who I asked to be on my committee, and he declined. He told me that if I found out a candidate lied, I had to report

them to their respective boards. This professor obviously was using the word honesty with moral judgment and not from a place of freedom from defenses, judgment, and fears. He could not see that most candidates would have inevitable neurotic qualities “with repression barriers” that Freud had identified (1912).

I wrote six institutes and sent flyers without a response. I wrote a published author I had met, who wrote on supervision, asking if she could introduce me to any candidates that might be willing to sit for my study. I was passed off to their institute president who responded that they could not burden their candidates during COVID with my study. Hence, this president stopped candidates in their institute from even knowing about my study or having the choice to participate. Ironically, it was due to COVID that I was able to find candidates that had extra time to sit for this study that helped me finish my research. I could not help but notice, in October of 2021, that an APsaA nationwide survey was sent out asking for participants to participate in the Holmes Commission on Racial Equity Survey Study, during the midst of COVID. There seemed to be something powerful being acted out in my search for research participants. I found four supervisors willing to help me find candidates and provided names I could contact. I went through the APsaA list server, identified every “analyst in training,” and contacted them personally to sit for my study I received one response, who agreed to participate. Hindsight, using the APsaA head office to figure out how to reach people, as Michael Russell did for the Holmes Commission on Racial Equity Survey Study survey, might have been more effective. Or, maybe a more quantitative study would have been easier, since the answers would not have to be recorded.

As I started this study, I found the difficulty in finding candidates confusing to me, which now is understandable. In 2016, I attended the 105th annual meeting in Chicago. I had attended a candidate meeting on the rooftop of a swanky restaurant. I had the privilege to share my dissertation topic with eight professional candidates Many of the candidates knew each other through various projects they had worked on together. They had become comrades and trusted each other. I met some of these candidates through friends, sat with them at lunches, and went to some of the same lectures and conferences. The conversation that night was important and there seemed to be a lot of themes and commonalities that arose about how everyone survived training. In full disclosure, alcohol was involved No one seemed intoxicated, which might have lowered the repression barrier. Yet, the topic of how open and honest candidates are with their supervisors flowed openly that evening. I heard uncensored, unabated stories, and dilemmas that had similar themes. I heard stories that made the group laugh and other stories that had us silently reflect, mindful of the real, difficult challenges of being a candidate. What I heard was no matter how honest candidates wanted to be, honesty came with challenges that would be helpful to identify from the candidates’ perspective. There was a sense of freedom, and a burden was lifted as we told our stories to each other. I left feeling excited about my topic. I had taken all the participants’ numbers, and everyone seemed eager to support my dissertation. Yet, surprisingly, only one person in that group sat for this study. I was ghosted, I was given honest reasons why people would not sit for my study, some people dismissed me at future conferences, and some treated me as if I had the plague.

I realized the candidates on the rooftop were using Freud’s adaptation of the word honesty from the Greek system. The candidates were honest, produced equanimity, and trust, which allowed us to obtain freedom from mental agony as we discussed honesty in supervision so freely. As the days past and people returned to their institutes, I concluded that the Latin word of moral judgment crept in, the fear of being recorded, under the eyes of supervisors, progression committees, institutional administrators that were judging their work and their characters to determine who would advance and who would be hindered by their progression committees. Plus, the complicated feelings of loyalty towards some supervisors. Judgment is in the psychoanalytic system and at times is necessary. As Thompson said “jurisprudence” is necessary in training, where the patient is the “inquisitor” and juror of his own free associations, and the analyst holds the frame and knows the rules, but allows the patient to have their own ethical code they choose to live by.

I started this study with a lot of bravado, embarrassing omnipotence, and darn right naivety. I understood the psychoanalytic intellectual map of honesty in the papers I read, yet I had no clue about the terrain of the map. Now that I have finished this study and have slogged through the terrain with the candidates that participated in the study, I realized there was so much in Thompson’s paper, “The Enigma of Honesty,” that I did not absorb or comprehend. As I have mentioned, I had to eventually eliminate the word honesty from my flier and emphasized the word openness. Ironically, after rereading “The Enigma of Honesty” after the interviews, I found that Freud had his own difficulties with the word honesty with his patients. He too was challenged by talking to his patients and getting them to pledge honesty in their analysis with him. He was fascinated by the

censorship his patients had with free associating to say whatever came to mind. Thompson would refer to this as disclosure anxiety. Freud observed how difficult it was for his patients to comply with the rule to be honest, so he amended his pledge for his patients to be “candid,” which allowed more active cooperation (Thompson, 2001). The parallel “candid” is similar in this study as “openness” was emphasized to help recruit candidates and to help them discuss how open and honest they could be with their supervisors. Ramzy (1965) demonstrated the confusion of honesty from a moral perspective in his article “The Place of Values in Psychoanalysis.” He states, “Candidates must have moral integrity, honesty . . .” (p. 97). Candidates are double bound, caught between the Greek and Latin meanings of the word honesty. Candidates are in analysis, in a regressed process that will activate regression, being asked to be honest and say anything that comes to mind, while simultaneously being asked the same of their analysands. Afterwards, they will be met by progression committees and supervisors, who assess their work, placing judgements and assessments on the candidate’s ability to analyze another. Honesty is complicated. Hence, the literature itself in understanding the complexity of the word honesty has supported the difficulty in finding participants for this study. Along with my lack of understanding at the beginning of this study, about how much reverence and respect the topic needed, I failed to fully comprehend how scared most candidates were to be recorded, and their fear of being identified, or of retaliation. I had to learn to take time to create trust between myself and the candidates that participated. It is understandable that candidates, given their vulnerable position as students, would reluctant to speak publicly about their educational experience.

Most

Candidates

Genuinely Want to be Open and Honest

This study revealed that every candidate that participated in this study genuinely wanted to be open and honest in their training. Candidates have continued to desire supervisors that they can share the complexities of their cases, their mistakes, challenges of not knowing, fears, and anxieties. In addition, most candidates have continued to examine their blind spots from their personal lives so their deficits would not affect their cases. The candidates have expressed their want to be vulnerable, in a safe place, with someone who they could truly trust, to contain all of their training anxieties, when they too are in a regressive process of their own. 7 out of 11 candidates said that openness and honesty was essential in their training. The four candidates that did not volunteer the importance of being open and honest with their supervisors still demonstrated in their need to be open and honest through their stories. Candidates that had reservations with their supervisors, due to their own personality structures, gave stories of challenging cases that needed complete transparency to receive the help they needed from their supervisors. These more reserved candidates were open with the interviewer, discussing openly their own mistakes, which they had already shared with their supervisors.

One candidate said that she, “[Picked supervisors] that I could be totally honest with.” Paula was open with her ambivalence in her training. The difficulty of finding a male case, and being told multiple times that her cases were not analyzable, created a significant challenge towards being totally honest. Eventually, she chose to fulfill her requirements instead of having a true and fulfilling learning experience. She spoke of her disappointment, upset that her seemingly analyzable case lacked depth. She described an “as if” patient that she was able to complete the requirements of graduation with, that she

knew lacked real learning. She was totally honest with her supervisor and her analyst about the guilt she had about the case having counted without gaining the depth of learning desired. She shared less about her personal life with her supervisors, but she was open with her analyst about her own ambivalence and conflicts with wanting to finish her training. Having followed up with this candidate, I learned that she has finished her requirements for her training, and is dealing with her ambivalence about writing up her cases to graduate.

Michelle said, What works for me is if I can be honest. I am too established to hold things back, that doesn’t work for me. I fired a supervisor I didn’t like during training last year because I didn’t feel I could be fully present and talk about my cases adequately with him. I really tried to pick people who I could be honest with or could bring my whole self to.

. . . I wanted to go deeper into my own self, because I think the reaction in our self is so important to talk about and sort through with our supervisors . . . I feel like if I am not honest, I am going to miss something.

Kay stated, “The alliance with the supervisor is imperative. It needs to feel safe, collaborative, the supervisor needs to be transparent, so you base the safety in the personal relationship.”

Allen expressed more internal conflict, regarding what he shared about being open and honest: “My superego would have me tell, but I have to figure out ways around that. My strategy is to not be totally open. Not to be human. . . . (I’m) caught in a conflict

internally.” Yet, his stories showed his superego was prevailing and his desire to lack humanness was clearly losing.

Melinda said,

My superego demands I be honest. From the beginning, I felt that it was essential that my supervisors know about me. I provide information as needed. I had a case that involved substance abuse, so I let my supervisor know my father was an alcoholic. I wouldn’t pick a supervisor I couldn’t tell them important things. If I couldn’t say important things, it would be an exclusion for me.

Aron was in a complicated dilemma. There was a fracture in his institute. He wanted to be completely transparent and open for optimal learning. He is very open with two of his supervisors he really trusts but with one he stated, “I need to play the game at this point.” He found this disheartening and intolerable. At the time of this interview, he was too close to graduation to switch supervisors.

Helen admitted to being guarded about her internal world and her personal life with her supervisors. She was steady with her emotions in supervision. When questioned, she did not share her fears or anxieties of the case with her supervisors. Her supervisors did not seem to know her internal world. She attributed this lack of transparency to her lack of having analytic language around her cases. Yet, she would call her supervisors when at an impasse and was open with her mistakes. She tended to work out her anxieties about her cases with her analyst.

Drake was so transparent there was no doubting the importance of his supervisor’s understanding on how he thought about cases. He assumed training required one to be completely transparent and found it unbearable to not be. He wondered to himself why he

repeatedly found supervisors that needed him to think like he was an extension of them.

He has now found supervisors that he is allowed to have his own mind with. His process has been rocky. He reported that he was almost kicked out of his institute and was advised to play the game, but clearly, he felt it hurt his patients and himself.

Ironically, the candidates that were more obsessive and contained seemed to have less challenges within supervision. Although there appeared to be a limit to what supervisors were able to understand or know about their supervisees’ countertransferences with patients, the supervisions went smoother, even if the cases failed with inevitable heartbreaks. These supervisors had less information about the candidate’s personal life and were kept from having a full view of who their candidates were. This allowed a more collegial-type relationship since there was little containment needed. The more collegial the relationship the more guarded the candidate were and their progression appeared smoother in their training.

The candidates stated that some supervisors have deficits and are able to handle training from a more cerebral and theoretical level, unable to truly handle the intense emotions of the candidates. Two candidates chose to leave their internal, emotional lives out of their supervisions. They carefully picked supervisors that appeared to match their own styles With these candidates, while presenting with blank slates were more advantageous in getting through their training, their reports seemed less deep and rich in learning.

Some candidates had a collaborative process, felt respected, were supervised in a way that contained their anxieties, and were able to express their entire selves. These candidates felt they had authentic relationships with their supervisors who had their

genuine interest at heart about themselves and their learning. These candidates shared that their collaborative supervisors were vulnerable, more real with themselves, and reported rich learning.

When I went back to the candidates with my results that “all” candidates wanted to be honest, I had missed that I had stated the information as a blanket fact. Three candidates responded back quickly to say, “most candidates are honest” and backed their view with further experiences they had from their cohorts. Allen did not think all candidates were honest. He had an experience with a candidate “that was more narcissistic.” Aron had a similar experience. He stated that he did not believe all candidates are honest due to his experience with a fellow candidate. Melinda went into detail about “a narcissistic candidate” that she knew from her institute who had “completely conned his supervisors.” She reported that this candidate was also a professional colleague and had not completed the requirements for graduation, but their well-published supervisor insisted that the progression committee graduate the candidate. She backed how charming the candidate was because of his “very cerebral approach to knowledge in theory,” but she knew he was not accurately reporting his cases. It sounded like the candidate had this charm, like a snake charmer, leading one to believe he was brilliant, and she went into how he bluffed everyone. So, with caution, most candidates have tried to be honest, but all the candidates in this study reported they desired to be honest.

Despite all the candidates in this study wanting to be open and honest in their learning, the question that arose next was: why are these candidates reporting that they are more open and honest with some supervisors and more guarded with others? The

candidates were clear that not all supervisors are created equal. From the candidates’ perspective, some supervisors had qualities that allowed them to bring their entire selves, while others had deficits that made the task impossible. This need or desire to be open and honest was universal amongst all the candidates interviewed. Where these candidates were universally aligned in this desire, in other areas of this study, they diverged and had different responses. What circumstances created impediments to their ability to be open and honest?

Not All Supervisors Are Created Equal

Candidates unanimously reported that honesty was important in supervision. Yet, despite how transparent the candidates wished to be; they were not as open with some supervisors as others. Every candidate reported that not all supervisors are created equal. There were themes that arose in the interviews that demonstrated some supervisors’ methods helped generate openness and honesty from candidates. The candidates needed to feel respected, allowed to have their own minds, and invited to collaborate with their supervisors. Themes of supervisors’ approaches impeding the process of learning, collaboration, and transparency in the cases also arose Using authoritative approaches, taking a one up position, having to be the all-knower, and speaking down to candidates hampered openness. Yet, candidates also left supervisors that they considered “pushovers,” even though they could be very honest and open. These supervisors were reported as being overly praising and supportive, but provided very little guidance and feedback. Helen stated, “I used different strategies with different supervisors.” When Mo was asked how open and honest he was with supervisors, he said, “It kinda depends on the

supervisor.” Michelle reported, “They are all great in different ways, and I bring different parts of myself to all of them because the cases that we are talking about, or particulars, pull for different things.”

Qualities supervisors possessed that create more openness and honesty.

The candidates had themes that arose around what helped them to be open and honest. The most important themes noted were respect, collaboration, being allowed to have their own minds, and safety that generated vulnerability. Subthemes arose when the candidates felt close to the supervisor and felt the supervisors were generally invested in them so they could be more open. Other subthemes were the ability for the supervisors to admit when they made mistakes, to tell stories of their own trepidations, and describe struggles they themselves had with patients. It was important to candidates that the supervisors be respectful of their patients. Yet, there were mixed reviews on how “warm” the supervisors felt. Four candidates described having supervisors that were cold, yet these supervisors were also described as being knowledgeable with theory and could explain the topography of the patients’ inner worlds, providing valuable guidance in cases. These candidates were driven by a thirst for knowledge to be open with this type of supervisor, this is not like the “know it all authority” that will be discussed in the next section.

Aron said, “I felt respected by two of my supervisors and honesty was the only way I could be, I had to be completely honest.” He continued that honesty depends on “How they are being with me.” He also described what respect was for him, “If they are real

and down to earth, you can tell them anything . . . if I really trusted [my supervisors] I could tell them anything.”

Mo, who said his openness depended on the supervisor, continued with a story about how he disclosed an exchange between him and his patient that revealed something personal about himself. His supervisor picked up on his anxiety about his moment of selfdisclosure with his patient, she was curious if she had been condemning self-disclosure and made an interpretation about what occurred in the dyad during supervision. The supervisor encouraged Mo to continue to try his approach and to find his own path. His supervisor said they would discuss the pros and cons about what worked best for him. He said, “It was a precious moment of contact. There we were in the weeds together.” He said he felt she was saying, “Do whatever, learn your own style, and I’m here to help you with that.” Once he felt this, he said, “I felt so open, I could talk to her about anything.” Rose was very happy with her institution and supervisors and said, “They treat us with respect and kindness as candidates.” Paula said, “My supervisor was respectful of my patient, and he was respectful to me as a candidate.” She said, “Openness is sharing personal experiences and mutuality.” She told a story of one of her supervisors she was clearly transparent with and said, “He was a real human being.”

Bella said, I want to be in a collaborative relationship. I say equal, but it isn’t equal, the supervisors the knowledge that I desire, so it’s asymmetrical in a way. They are evaluating me too. But, as a person, as a human being, I don’t think they are better than me. They’re only better at being an analyst because they have more experience and have been passing it down to the next generation of analysts. I believe elders are

due more respect. Having a supervisor who is respectful to me, and my patient is important.

Bella continued, “My supervisors have been very supportive of me, but they are not pushovers.” After this, Bella gave stories of challenging learning and accountability. Melinda told a story demonstrating her honesty toward a supervisor that she could say anything to. She said, He’s so respectful. He’s respectful in a good way. He’s respectful of my case and my patient. He’s respectful of me and even if my way of being with the patient is a different way than his. He is also respectful towards students and he’s a real

advocate for students

She reported on a different supervisor, “My supervisor said, ‘We want you to graduate, and we want to get you through progression.’ He was also very respectful towards me.” Further in the interview, she said, “I need the supervisor to like my patient. They can be critical, but I can’t have people make fun of my patients or be disrespectful. . . . All three of my supervisors like my patients.” It was obvious that Melinda felt very ‘liked’ and ‘cared for’ by her supervisors. She said, “I want someone who will have my back.” She stated that when she made mistakes she could not wait for the next appointment with her supervisors. Melinda said, “I have to talk to them now, and I’m quick to talk about it. I’m quick to talk about my mistakes!” She stated, “I have to have my own mind.”

When candidates felt like they were in a real relationship, they felt that they could be more open and honest. Allen stated the more real the relationship was, the more open and

real he felt he could be. He said, “When supervisors, themselves, can be more vulnerable and real, and share anecdotes, the more open I’m going to be.”

Rose said, “They don’t expect us to be analysts when we are not. They look for the truth and they feel with the truth.” She went on to report that she needed honesty back from her supervisors about her work. She said, “They are emotionally invested and engaged in the work.” She described one of her supervisors: “She saw me, and she knew me.” She reported, “They see the patient and see me, they see who I am, not as a candidate or a student really, but they see me. They see me through the same eyes they would see their own patient.” She said a valuable supervisor was someone who respected her, was not intrusive, and had observations versus being critical, which was important to her in supervision. Rose described one of her supervisors as a “soulmate supervisor.” This supervisor helped her with blind spots and helped her learn about her own vulnerability in the case. She said, “I mean, it was incredibly deep learning.” She had a lovely way of describing supervision as being a “healing path” for her.

Kay reported that an alliance her the supervisor was imperative. She reported it was her personal relationship with the supervisor that she based her trust on. She had to feel safe, and the relationship needed to be collaborative. One supervisor that knew everything about her, she said that this supervisor was a “we.” She said, “He would say let’s look at this together.” She said the more equal the relationship felt to her the more she could be open.

Michelle reported that she needed a supervisor that could handle the violent content her case that had unfolded in her case. She switched supervisors when her beloved supervisor was too anxious about the case, needing someone that could contain the

content and her own anxieties. She needed to discuss her fantasies and dreams about her patient, and how that revealed a lot about herself. Michelle had fears of her patient committing suicide, without the patient reporting any suicidal ideation. She said, “He had a trauma history that fit with my own trauma history. So, I really needed someone I could be super up front with.” Michelle reported that she recommended a pet to the patient due to his attachment issues. She said, “I was afraid to say that to the supervisor.” She went on to say it was an effective intervention and explained how the patient had a corrective experience with the pet. Michelle continued to say, “He had this bonding experience that opened all this stuff up and then I was afraid to say that to the supervisor, cause, you’re not supposed to suggest ” This caused her to laugh. She said, “It was so important, and to be able to say this was not the best psychoanalytic thing to do, but I did it. And, this is what happened.” She had a successful intervention, her supervisor listened to the result without critical input, and trusted Michelle. The pet led to deeper analytic processes being able to work in the displacement using the pet. Michelle spoke about other supervisors and said, I have one that is supervising me on my control case. She is just incredibly bright. You say one word and she could go for half an hour on stuff I never thought of and is completely right about this case. She is intimidating and she is not warm. I feel like if I am not honest I will miss something with her. . . . I brought her dreams and dreams are personal.

Drake fired a supervisor on a challenging case, and eventually had success with a new supervisor. He noted his new supervisor was respectful towards him, curious with him, worked collaboratively, and allowed him to have his own mind. Since switching

supervisors, he has felt closer to graduating and supported. What changed for Drake was not his case, but who he was consulting with. He described the supervisors that were able to contain his inquisitive mind and allowed him to use the theory that worked for him to formulate his cases. Drake’s primary concern was finding his own analytic voice. This interviewer saw that Drake was probably not accustomed to taking a lesser position. In his previous profession, collaboration was essential to his success. He had earned a “healthy narcissistic position” from his previous accomplishments intellectually and monetarily. He approached his supervisors as collaborative partners. I asked Drake why he did not play the game with his previous supervisor, and he told me he was advised to. Drake felt honesty was imperative to real learning. He owned his own behaviors and would say that his own narcissism was part of his problem while reflecting on the supervision. In this interview, he was open about his analysis and transference to his analyst and supervisors. I also felt, like Drake, that I had someone thinking with me, and he helped expand my own thinking about openness and honesty. Drake reported the success of a new supervisor he had switched to. He said the new supervisor was able to see the patient’s obsessional tendencies in ways that were helpful for the patient. He said, We looked at the PDM together and the case just opened up The supervisor said, “Let’s look at this together.” My new supervisor is swimming in the unconscious all the time. She is associating all the time. She has internal freedom to associate out loud with me and show me how she thinks. . . . more than I realized that I understood it until I worked with her that way. We read about reverie, but to work with a supervisor that will stimulate you and let you play with your own reverie

What worked for Drake was feeling his new supervisor respected his different views, she worked at understanding his complicated case with her utilizing Drake’s perspective. The new supervisor added ideas and different directions by collaboration. She let the case play out a bit and told Drake, “Let’s see how this turns out.” Doing so, the case became unstuck, and the patient was able to go deeper into their analysis.

Behaviors and impediments towards learning and transparency.

These very candidates that told lovely stories of being vulnerable and able to be completely transparent, also told stories that kept them from being as open and honest with other supervisors. The approaches supervisors used that impeded openness and honesty with their candidates were (a) using an authoritative approach, (b) being overly complimentary supervisors (pushovers), and (c) being unable to contain the material in the case.

The authoritative supervisors were reported to being all knowers, tended to speak down to the candidates, and the candidates were not allowed to have their own minds. These candidates were clear that these supervisors needed to be the smartest person in the room. The authoritative supervisors were experienced as more critical than observing. The candidates’ own knowledge was dismissed and/or disregarded, or the candidates thoughts were made turned down, leaving them feeling humiliated, and/or scared, and/or angry. The candidates felt they were not heard, understood, and eventually felt disrespected. This approach inevitably left collaboration impossible, left the candidates little choice but to focus on doing the “right” thing they thought the supervisor would want. These supervisors wanted to fill up the candidate like a vessel with all their

knowledge. This left the analytic voice outside of the candidates and left the candidates in an ego dystonic state. The candidates usually terminated when the supervisors became overly controlling, imposing their will, and were critical.

Candidates reported the authoritative supervisors not only spoke down to them, but also tended to lecture them. Some of the supervisors questioned their supervisees in way that put them off balance, and would let them know how they should have handled things differently, before hearing how the patient responded. During the supervision, the candidates would become disorganized when discussing their experiences of the authoritative supervisors. Some candidates were scared or angry when they recounted their stories. It became a challenge to track the candidates when recounting their negative experiences. What helped organize the candidates was validating their situations or relaying stories of my own humanness in supervision. During these times, the candidates tended to open up even more with me.

For Kay, she said that she could not trust anyone that had to put her down and was condescending. She said, “It’s hard to put into words.” She reported a “type” of faculty member she had classes with, I feel like they are trying to show me how much they know, and show how smart they are, how much better they are, like they have been doing this longer, and I have to work to be at their level, to be treated with respect . . . I expect all my supervisors to know more than me, that’s why I’m in training. But, there’s a way of, “I have this information, I have been doing this, and I want to teach you so you can do this too,” as opposed to, “you will never be like me.”

This interviewer clarified that collaboration worked for Kay. Her supervisor’s oneupmanship did not work for her, as it did not feel like they were working with her, or like she was being treated as an equal person. She said, “I can still be viewed as a peer, that I have something to offer, and have my own ways of thinking about things (having her own mind), that can be valued.”

Mo, who was very open with his supervisor, told a challenging story of a previous supervisor, he referred to as a traditionalist. When Mo reported on the traditionalist, he became hard to track and less clear, and visibly more anxious in the interview. He said, “She didn’t advocate for casual interactions like laughing” with his patient. He said, My supervisor kinda suggested I talk less. But, my supervisor is the one who made me more reserved and cold, and distant, and why I say what I think my supervisor would want me to say to my patient. . . . I tend to try and do whatever I think she thinks I should do. I’d be afraid to act outside of the way she would want me to do the case or speak to the patient. Mo discussed that when he had a break from supervision he would relax with the patient. He described supervision as being scary. Yet, there was also a reason why he was afraid. Mo eventually told a story that almost anyone would have been mortified by. The supervisor’s words were critical and shaming. He said, “I know after that she handled me with kid gloves. She could probably tell I was anxious and a wreck after that day. Every intervention I thought she’d take issue with, I’d say like, I’m not sure why I said this.” Mo said he worried, “Was I doing a good job? Was I doing what was right? Was I fucking this up? I know my stuff is mixed up in there.” I asked him if he became hypervigilant after the harsh words from the supervisor, and he said, “Yeah, like my

intervention was designed to avoid criticism as opposed to one that made sense to me, or because it was the right thing to say. What she said wasn’t effective.” I disclosed my own humanism to Mo in the interview so that he could relate, which led to him to open up more. He went on to say, “My supervisor is brilliant, I’ve learned so much from her so there is this conflict. This person I’m scared of is also someone I value and has these nuggets of wisdom, that’s the dilemma.” Mo believed there was a parallel process and wondered about the enactment, and what played out between them. This was a supervisor inquired about how Mo experienced her and adjusted to what Mo needed. This was a successful intervention and repair, and Mo was able to cautiously open up more.

Bella started to laugh as she told a story of her relationship with an authoritative supervisor. After reporting two successful supervisions, she said, “Oh, there’s one more story, I had met with another supervisor. I should have known he was going to be a problem, but he actually chose to supervise me. I will never forget it!” Bella continued, “I should have run away. Today, I would. He was into power and wanted to make me into what he wanted. Now, I want to be acknowledged an equal, in the sense that we are colleagues.”

Bella was clear that her position was not equal, but as a person was. She continued to speak about her supervisor, He is the smartest person in the room. I could never just exchange, collaboratively, what I was thinking or think with him about the case. He was like a magician, showing off all the answers. As he did his magic tricks, all I could do was observe, like I could only have his voice, but I knew I had to develop my own voice. When he talks, he likes to hear his own voice. It’s like he selects candidates to be in his club,

as if it were a sect. He was also arrogant and spoke down to me. I don’t take it personally because he’s that way with everyone. I know he was helping me, but I wanted to be in a collaborative relationship

Bella ended up firing this supervisor. At the beginning, Bella needed the idealized, safe supervisor. As her analysis progressed, she said she grew and her supervisor was unable to adjust to her growth.

Drake talked about his first supervisor, whom he had had for almost five years, and learned a lot from. He said, I learned a tremendous amount from my first supervisor on my first case. He is widely known as being the most difficult supervisor to work with in our institute. He has also been fired the most but, I really admired him and wanted to look at cases the way he did.

Drake spoke about this supervisor with fondness and considered him as being very gifted, intellectually. Then Drake said, “He lectured! You’d read the case and he’d hijack the session by talking. It was difficult to develop my own analytic voice . . . He had to be right 99.9 percent of the time and is an expert in everything.” Drake said ask his supervisor for help if he got stuck on the case. He reported that, “(His supervisor) couldn’t help himself, I would get three sentences out and he would talk for 15 minutes. Eventually the case stalled.” He informed me that many people have commented that he sounds similar to this supervisor, how he thinks about the preconscious, and how he formulates cases. Drake has found this to be an enduring compliment. He told me how he has internalized this very important supervisor, and yet there were complicated authoritative dynamics of having to be the “all knower,” where there wasn’t much room

to discuss anything Drake wanted. Since there was no space for Drake, except to be an empty vessel to learn and follow directions from, the supervisor inadvertently left no space to see if Drake could be open and honest in the supervision They were on the supervisor’s agenda. Eventually, Drake told me he figured out, in his analysis, working through his own internal world, that his supervisor was very much like his mother. Before he had worked through the issues of his mother’s need to be an “all knower,” he attracted another “all knower” supervisor when he took on his second case.

Drake discussed his second “all knower” supervisor, one that his fellow candidates used. He had consulted with the supervisor first and, over time, he felt the supervisor was a good fit. But, like many of the candidates, Drake’s story became confusing and difficult to track when he started to talk about the aggravating, authoritative supervisor. He had to start with the important, professional men in his life that he had had successful relationships with. He said, “They have been in my life for years and years and years!

Like my analyst, they are not authoritarian. All of them are secure in themselves.” Then he discussed the “authoritative” male supervisor, and he said, “He doesn’t allow me to think.” Drake explained, “It’s like saying, ‘watch me play, but you can’t play. ’” He told stories of how the case was collaborative at the beginning Once the case was declared a controlled case; however, Drake experienced the supervisor as being more controlling. The supervisor wanted Drake to restructure the fee schedule for less, add more days, change the frame, etc. Drake felt different and explained his stance since he had been seeing the patient for a few years. It became apparent, in his stories, that a power struggle emerged. Drake would read the notes and the supervisor would feel he was being

oppositional by not adding the questions the supervisor wanted him to ask. Drake saw the diagnosis differently and believed the patient needed medication. Drake said, I changed (supervisors) because if you’re not a sycophant he couldn’t tolerate it. He is small minded and slightly sadistic if you didn’t worship him. He is too fragile to look at his own role in any relationship. He could not see that there was a parallel process in the case. He was the only mature person in the room, and he was fully analyzed, and there was this perversion of projection!

He said, Getting out of the institute doesn’t mean I’m going to be a stellar analyst, it means I have basic competencies to think analytically and to work analytically. I have some tools to build a practice and art for the next 30 years I think there is so much oedipal stuff that gets projected onto the male candidates . . . I have quite a few friends that have had this supervisor and love him, but they are all female. One friend, who recommended him, recently graduated. She developed her own voice and was more free to express herself. After she graduated, the relationship changed. She challenged him, and he treated her like he did me, and she fired him. She admitted that she didn’t let in how angry he made her, or how infantilized she felt till after she graduated I think there is something to say that only one person could have a mind in that relationship. . . . He has no idea how aggressive he is, imposing, or infantilizing. The supervisor said I was trying to equalize the relationship and I thought, “Really? I thought that was your job!” On a certain, fundamental level the supervisor’s job is to equalize the relationship, but you’d have to resolve your own oedipal issues to be able to do that.”

He discussed the idea that Surgarman relayed at an APsaA conference on supervision: “Quite a few years ago Sugarman said you need to spoon feed sugar to some supervisors to get through the training.” Drake said his analyst told him, “Either spoon feed him some sugar or blow on his dick.”

Drake continued to tell stories about his analyst that validated him and got him through this difficult time. He said,

At one point, he said, “You are not shrieking like a girl and taking him in.” But I take my analyst and supervisors in. I often wonder what my supervisors would say when I’m with my patients, because I do take them in, but I don’t want to be forced to take them in. That feels intrusive and invasive. I took the first supervisor in with great benefit. I am grateful to him

The difficult part I heard from Drake was how the supervisor wanted to terminate his candidacy with the progression committee. Drake was angry when he learned this from colleagues on the progression committee, and he was unaware of his supervisor’s intent. He felt betrayed and angry that the supervisor became retaliatory. Drake reported he had important relationships that advocated for him to switch supervisors to eliminate the threat. Drake fantasized about having a place to rate supervisors. He said, “I don’t think candidates are well protected in a place that should feel safe.” The supervision that followed was successful. Two years later after our initial interview, Drake was still scared and requested that I not present my findings until he graduated.

Aron reported earlier of being very open and honest with two of his supervisors. Yet, when I inquired about his third case, he went silent for a while. I pointed out his hesitation, then he proceeded to say, “There’s an archaic hierarchy that’s very frustrating.

It’s generational, with lots of rigidity.” He became disorganized telling his story about a particular supervisor. It was apparent he struggled due to his loyalty to the supervisor, despite his feelings towards her. He finally said, “I don’t trust the other one, just very rigid, arrogant, and on a power dynamic to feel better about herself. I don’t open up with her. She could be nasty with others.” When I asked why he did not switch, it was because he was afraid of losing his hours in supervision, and delaying his graduation, a similar worry with Michelle. He continued to say,

I don’t want to play the game, but we are forced to with some supervisors! I just want to be open! I don’t have to play the game with my other two supervisors, just this one. I keep my cards close to my chest It puts us in a position of being the child and having adults who are mean spirited parents

Three candidates reported leaving supervision because the supervisors could not contain the affect in the case. Melinda reported that she adored her supervisor and they had a good working relationship. Her patient became terminally ill and they decided the patient would continue their analysis. After this, Melinda noted that her supervisor became less present in sessions and cancelled many supervisions with her. He stopped giving the feedback she was used to and felt stranded Later, she found out that the supervisor also had cancer and was dealing with his mortality at the time.

Michelle described a very aggressive analysand with strong sexual perversions. The case was riddled with stories of painful childhood abuse and neglect. She could see that the training analyst had difficulty listening to the patient’s history. When she would read the patient’s process notes containing sexual perversions, with willing participants, she could sense the training analyst’s discomfort with the material. Michelle’s supervisor had

difficulty making the connections of how the analysand was living out his past in the present. Instead, the supervisor focused on stopping the acting out and making sure Michelle herself was safe The more difficult the material became, the more the supervisor would question the analyzability of the established case, despite the analysand’s reflective ability, able to internalize her, and utilize Michelle as a useful object. Michelle pointed out that it took years for her analysand to open up “all of him.” Eventually, even though she cared for this supervisor, she fired them and found someone who could help her through the rocky terrain of trauma. Michelle found her next supervisor was able to contain her anxieties and the material in the case. This patient and Michelle were able to benefit from a supervisor who could contain all the acting out, fantasies, and affect in the case. Michelle had a powerful observation, no one really knows what we are getting into, or what will unfold when we start analyzing our patients.

The candidates also left supervisors that were ineffective, even though they were easy to be with, could be completely transparent with, and wrote lovely reports to the progression committees. These supervisors were described as “pushovers” or trying to be “popular” with candidates. These supervisors were overly encouraging and gave feedback that focused on the positive aspects of the treatment. Here, the candidates could say anything and be totally open and honest with anything, but there was no guidance on how to create a frame, hold boundaries, think about the difficulties of the case together, or understand the enactments happening in the cases. The candidates described their time with these supervisors as floundering, and being left alone with no direction, with nice people, and this did not create safety for them.

Bella said,

The next supervisor I picked was because people liked her, she was likable, and warm. It’s strange to say, but I fired her. She was easy, but I wasn’t learning anything from her. She was a pushover and everything I said was “great!” And everything I did received a “good job.” She was overly complimentary, and it didn’t feel real, which made me feel unsafe.

Summary.

Throughout these interviews, it became apparent that candidates based their openness and honesty on their supervisors’ approaches to supervision. Candidates are more open and honest with supervisors that are respectful towards them, collaborate with them, and let them have their own minds. Candidates are not as open with the more authoritative supervisors. Candidates do not find pushover supervisors helpful due to the lack of learning, and the relationship feeling inauthentic. Candidates reported that they needed supervisors who were capable of containing affect laden cases, and/or the intense acting out of their patients, and their own anxieties treating patients with intense trauma. It is less clear why some candidates stayed with some of the authoritative supervisors longer than others In some of the interviews, it became apparent that candidates felt safe with the authority supervisors at the beginning of their training. For others, there the familiarity of a parent (transference), towards the supervisor. Yet, the candidates reported, through their own analysis, that they became aware of their own narcissistic vulnerabilities, and no longer wanted to participate with those supervisors. Some authoritative supervisors grew with the candidate and corrected their approaches as

the candidates grew. Yet, some candidates stayed due to their apparent loyalty to their supervisors, or possibly they were not as far along in their own analysis. Some candidates decided to make a deal with the devil and consciously stayed so they could keep their hours, or they were too close to graduating, and did not want to stir up issues with the supervisor, and/or their progression committees.

This study's findings expand the previous writings on supervision that have been predominantly written by training supervisors on supervision. Where failed supervision tended to focus on the pathologies and deficits of candidates. In this unique study candidates’ voices brought the other half of the conversation/perspective on the supervision dyad. Since, from the candidates’ perspective, they have had supervisors with strengths and mastery, deficits and pathologies, and/or both, candidates reported effective supervisions, complicated supervisions, collaborative supervision, heartfelt supervisions, painful supervisions, and failed supervision dyads that turned around with new supervisors into successful working relationships. Hence, from the candidate’s perspective, not all supervisors are created equal.

Candidates Leave Supervision over Conflicts with Openness and Honesty

When candidates are not as open or transparent in supervision, they decide to switch supervisors. With only one anomaly, this seemed to be a universal issue within this study. The interesting finding was that it appeared to be a blind spot for the candidates themselves. Even though they were clear why they left a supervisor, their stories indicated that, during the process of leaving a supervisor, there were a variety of uncomfortable conflicts within the candidates. Almost universally, this researcher heard

guilt, entangled with loyalty in the candidates’ stories when they disclosed how and why they left a supervisor. There were a variety of conflicts, including caring for the supervisor personally (attachment), having a variety of fears about leaving, having frustrations of their needs not being met, being in misfit dyads, and supervisors behaving poorly, all blended into their grounded reasons.

It was virtually impossible to pick up the strong emotions just by reading the interview. It was when I relistened to the candidates’ recordings I could hear the conflicts and/or pain shortly after they left a supervisor, mixed with relief. When the candidates reported leaving a supervisor. I could hear the fluctuations in their voices, their stories became disjointed. But, three stories were followed up with reassurances about the positive things the candidate had gained in the supervision. I was not sure if the candidates were trying to convince me or themselves about the “goodness” of their supervisors they were leaving or contemplating to leave. Candidates only left when it was in their best interest for themselves, and/or their patients, and after a significant amount of consideration. It was clear that the process of terminating with a supervisor was not easy for these candidates.

My follow-up conversations, at least a year later, showed the candidates were generally no longer conflicted about leaving their supervisors, nor did they report loyalty issues after. None of the candidates indicated they had made a mistake in leaving.

Most of this set of candidates had difficulty disclosing all of the reasons why they had or were leaving supervision, whether they had open conflict, were scared of the supervisor, the case was not a fit for the dyad, or the myriad of other reasons they left that have been reviewed thus far in this research. Importantly, none of these candidates left

their supervisors without consulting other colleagues, mentors, their analysts’, or other training analysts. For the candidates, it seemed to take a team to leave a supervisor. In most cases, candidates were already getting other supervision whether the they realized it or not. They were consulting with other supervisors on the case, presenting the case at conferences, or as one candidate, who was very conscious of their process, said, “I was two timing.” In this instance, the candidate had hired a consultant without letting their supervisor know. The candidate was scared to leave because of the leadership position their supervisor held and was worried about “how it would look,” even though he did not think his concerns were logical. Furthermore, his voice indicated that he was very attached to the supervisor. It sounded more like the candidate’s case was incompatible with the supervisor’s strengths.

In two instances, supervision was only transferred after the candidates’ progression committees recommended a new supervisor, despite the candidates wanting to leave prior to their recommendations. A few institutes have recommended other supervisors when difficulties in supervision is sensed. This practice provided a feeling of protection and integrity, allowing the candidates and supervisors to have a sense of safety. The candidates indicated that they appreciated the intervention and option to leave.

The reasons candidates gave their supervisors for leaving were not the same, nor as complete as they revealed in their interviews. I am certain, in the later recordings of the candidates’ interviews, that they were unaware of the conflicts inside of themselves I heard during the first interviews. Even if candidates did not switch supervisors, they found other extra-supervision when they were stuck and did not tell their supervisors.

Only one candidate went to their supervisor and disclosed why they were leaving.

The supervisor had multiple conflicts affiliated with them, including legal and board issues. Hence, loyalty and attachment were not heard in this story at the time of leaving the supervisor. The candidate also did not fear retaliation since the leaders of the institute supported their decision to switch supervisors. In fact, this candidate only expressed anger towards their supervisor. Perhaps this is why this candidate was able to be completely transparent. Even though Drake was very angry with his supervisor, he did not disclose how the authoritarian approach did not work for him. He also did not wonder why his supervisor had recommended he be dismissed from training.

Candidates were not able to say, “I am choosing to leave because . . .” with all their reasons. That does not mean that all candidates are not completely up front about their processes, it just depended on whom they felt they could be up front with. The candidates gave honest reasons for leaving, but they tended to omit some of the information, if not the driving factors, with their supervisors. The majority of candidates did not want to hurt their supervisors. Bella stated she liked her supervisor, but she did not respect her.

Loyalty and attachment was harder to qualify or quantify in this study. It was hidden in their recordings, where I could hear the conflicts in their voices and their strong emotions, that could not be captured in their written dialogues. When I reread or listened to a particular candidate’s story focusing on this discovery, I would contact them regarding their thoughts about loyalty and whether it had interfered with terminating sooner. Some candidates responded in ways that precipitated me having to explain to them why I was revisiting their responses, needing further clarity since they seemed to be disconnected from the difficulties they had leaving supervision.

What was heard in these interviews was the tones and the emotions. The vacillations in disappointment, frustration, and affection. Affection and loyalty can cause as much confusion as anything else. This is when the candidates might have taken a pause in the interview to make sure their stories were confidential. Combined with the fear of retaliation, whether from the supervisor or their progression committees, candidates’ Achilles heel in transparency was “in the why” they switched supervisors.

Even Michelle, who was a straightforward and easy candidate to interview, having a “what you see is what you get” attitude, was unable to be totally honest with a supervisor on why she left. Yet, in her mind, she was totally up front until she heard herself repeat the story and caught herself. She could not tell the supervisor that he appeared to be nervous and uncomfortable with the material she presented. Speaking about her supervisor, she said, “He was a nice guy…. I think [the material] freaked him out.” She went to her other supervisors about the case and asked, “What should I do here?” She never had to address the driving reasons inside of her why she wanted a new supervisor. Instead, she had circumstances that made supervision tough to keep the frame they originally started with. The supervisor said her new situation and frame did not work for him. Michelle was able to fly under the radar by using an external situation to explain why she left, instead of disclosing the real, internal reasons. The situation sounded like the supervisor had co-created this external opportunity to end supervision with Michelle. Ironically, Michelle was told by friends that the supervisor had been asking other colleagues if it was going to be held against him for Michelle quitting. Michelle observed, “In the end he was only worried about himself.” Yet, Melinda also offered stories and concerns of colleagues that had opportunities to create external reasons to

leave without being totally transparent. When leaving her supervisor, there appeared to be an attachment and loyalty that complicated the situation.

Helen stated, in a follow-up conversation, on the topic of loyalty and difficulties in leaving supervision, “I would say yes (to being loyal to supervisors), there is loyalty and attachment, which can be good or bad, but we probably play out family of origin with our supervisors.” Drake said, in a follow-up interview, even with the supervisor that tried to kick him out of his institute, that he has continued to keep up the appearance of a collegial relationship. Yet, he has “absolutely zero respect or loyalty to him,” and does not trust him. Drake also had another authoritative supervisor he still felt he gained invaluable learning from. Drake’s relationship with the supervisor he experienced as destructive has been irreparable. Yet, he has held a space for appreciation with that supervisor for his best interest.

I revisited Allen after relistening to his interview that sounded like he was loyal to his supervisors. He said, I think loyalty is probably a huge dynamic in most cases, but a fellow candidate keeps coming to mind who didn’t seem to have much loyalty to his supervisors. I’m thinking for more narcissistic candidates, the loyalty piece isn’t probably as strong of a motivation [to stay in a difficult supervision]

When asked, most candidates were loyal to certain supervisors in their stories, even if they had conflicts. Mo said, “Do I really want to say everything I want to say if you publish one day? There is still this fear to talk to you.” Allen said, It feels like I’m a little child going to CPS. I’m not a snitch, because I’ve been told to be open about my supervisors, but it feels off to say shit behind their back when they

have been saying “talk to me.” It’s my own fear about talking to them directly. It

feels like a bigger issue [is in me] than how they are. It feels like the biggest culprit is my own inhibitions of being direct and open, not about them being mean or something

Every candidate that sat for this study had some fears about how I was going to protect their identity. I had to let them know the study would only include, “From west coast to east coast, from up north to down south of the USA.” No titles nor disciplines would be mentioned; however, when sharing their stories, the candidates were worried about their supervisors being identified. They wanted to protect the supervisors like children do with parents. That made me wonder if I was asking candidates to do something harder than I had realized when I ventured out on this study. For six of the candidates, there appeared to be a dimension of parental transference to their supervisors. The number might have been higher, but the other six candidates did not make direct links in their stories to me.

Cultivating loyalty.

There is no evidence that loyalty is cultivated in this study; however, two nonfiction books about loyalty in psychoanalysis, The Secret Ring: Freud’s Inner Circle and the Politics of Psychoanalysis by Phillis Grosskurth (1991), and Illusions of a Future: Psychoanalysis and Biopolitics of Desire by Kate Schechter (2014), have provided evidence that history has been riddled with loyalty, both destructive and constructive. The need to be loyal to supervisors and important figures in institutions is not a new idea to

our field. Through the years, there has been hope that we are becoming more aware and, ideally, less destructive than Freud was.

Drake had a very interesting experience with the way loyalty was cultivated with his own attachment with some of his supervisors. He said, Occasionally, we are lucky enough to have a supervisor who concerns themselves with the attachment relationship and, subtly, guides how we respond to our analysands, not by long pedantic explanations or ossified case formulation. They tell the truth at a slant. They help us work with the unconscious dynamics in the parallel process, and model interventions softly, so that the truth, told with that slant, slides in and finds a home within us. Lola (his supervisor) did that in a lovely way and was right. John (another supervisor) did it frequently, with great compassion, great humor, and a gentle touch. This is where loyalty may be cultivated in an authentic way.

There is no evidence, but I suspect some supervisors may cultivate loyalty as Bella spoke of with her supervisor, luring her in with “specialness.” Somehow this specialness generated affection and loyalty, or deification as with Drake’s story, where his supervisor seemed to need idealization from women supervisees. This might be one reason that candidates are unable to be as transparent to supervisors about why they leave. Yet another phenomenon arose in this study when I went back to the candidates to check my findings. In this study, every candidate desired to be open and honest, yet I ended up with more data than I expected.

The intellectual endeavor.

Originally, in my writing of the findings, I had found that every candidate in this study had wanted to be open and honest. I had written to some of the participants that “all candidates want to be honest,” only to be quickly corrected. Of the four candidates that responded within hours, they said, “Most, but not all.” Those candidates sent me stories of candidates they knew from their institutes that they felt were not “honest” candidates. In these stories, these “dishonest” candidates were referred to as “narcissistic,” “autistic,” or “sociopathic.” Their stories had a common theme: the dishonest candidate could seduce their faculty and supervisors. Melinda reported that a candidate at her institute was writing articles, trying to get published. She said that the candidate had not finished the requirements to graduate, but the candidate had a supervisor that was well published. She reported that this author/supervisor went to the progression committee and demanded their candidate graduate, despite not completing the rubrics to graduate. The candidate was graduated without finishing criteria the rest of the class was held to. Michelle heard this story from one of her supervisors and a few colleagues on the candidate’s progression committee. She said her supervisors formulated that it was the wish of this supervisor to have a protege that would follow in their footsteps and was completely hoodwinked by the candidate. She felt this candidate was sociopathic. So, despite this group of candidates that wanted to be honest, they were aware of other candidates in their classes and institutes that seemed to con their supervisor and progression committees. Candidates that slipped past their supervisors and progression committees shared a theme of “intellectualizing” and using “admiration” towards those in power. I asked what qualities the candidates I interviewed had that were missing from the self-absorbed

candidates. I heard, “real empathy,” “emotions,” “heartfelt feelings,” and a “case with heart.” I heard, “They say empathic words, but there is nothing behind the words.” One candidate said,

If you’re really doing this work, I think it’s a messy process. It ain’t pretty. There is heartfelt work, it’s not easy, and what I gained was endurance. There are times it’s overwhelming, times I’m running to my analyst, or my supervisor, falling apart and then holding space for me to come back together. Maybe it’s me, maybe I’m more chaotic, but this guy (the “dishonest” candidate) was a perfect actor on the perfect set, sort of like on the Truman Show; if it’s too perfect it probably isn’t real.

Rachel reported that, in her class, she had a medical doctor that was accomplished and held a hospital job. She reported that the candidate was able to intellectualize her cases and the faculty gave her high reviews. She could speak from this expert place since she had a specialty in trauma. Yet, Rachel knew that the candidate had only gone to her analysis for a year three times a week and finished her analysis in three years. She said that the candidate lacked any emotion, but could speak from an elevated position because of her expertise, not through psychoanalysis. Rachel said, “She was always an expert, E F Hutton spoke, and we all listened There was a concreteness about her, and could never be like one of us, holding this special place as a candidate.” This made me curious about the idea of a “transactional” candidate versus a candidate that was “heartfelt” about their cases.

Some of the candidates I interviewed were very transparent and reasonable about how they felt, even though emotional. They did not pause long or take a lot of time to answer the prompts. They seemed to answer questions from this heartfelt place mixed

with lots of emotion and, at times, cried during their interviews. Yet, also, the second interview showed that the candidate had processed the experience and had some mastery. They were honest from this “heart space.” Then I had a few candidates that seemed to be very contained who used a lot of filtering even in the interview. They methodically considered their cases, and they had a clear idea of their analysand’s personality structure before declaring a case. These candidates had an easier time with training. I noted that one candidate could be very guarded when being interviewed, depending on the questions. Later, I revisited the person for a third interview. The candidate had graduated. I experienced a much more vulnerable now “analyst,” who was no longer a candidate reflecting on her original interview. This candidate could share that they had been doing a lot in their analysis to become more open and vulnerable in their own life. The candidate said that they would answer questions very differently. I would say that I was able to observe this candidate/now analyst’s progression of growth and awareness from the first to third interview.

In all the follow-up interviews, I felt I was able to witness the power of analysis as the candidates, themselves, grew. So, this is important to mark the experience of being a candidate in a transformational process. Hence, I hesitated to jump into different categories of candidates as open and honest versus being guarded. These interviews have shown that there is an array of states in “honest” work and learning.

There was a candidate that approached the findings as “business as usual.” The candidate I interviewed three times was very open with some questions and guarded in others. Though, I think it’s better to say that she was not as open with herself, yet. She had an easier time in training, and seemed to be more regulated, which probably made it

easier for her supervisors. By the third interview, however, she was more vulnerable and less guarded, showing more affect.

I wondered if there was another approach that candidates could consider, after all, what did these different presentations mean? There was a variety of stances in this research. I have posed many reasons that candidates reported why they are more open and honest with some supervisors than others. Truthfully, there is also the space where candidates are in the middle of their own transformations. How do the supervisors recognize the candidates that are in an honest enough process that may look very chaotic and harder to contain, from the “dishonest” candidates that are “conning” or “seducing” their supervisors? Plus, the candidates that are transforming from being less intellectual and feeling more? Maybe the more guarded or “business as usual” approach to supervision has graduated candidates quicker than others. These candidates have been able to push themselves along; however, it’s up to the supervisors to wonder what process the candidate brings to the supervision and whether they can be honest about what they need from a candidate. Perhaps this approach could alleviate the pathologizing of some candidates, allowing a pause with the candidates that progress smoothly. Some cases are harder than others, and some candidates and supervisors are more challenging than others. It appeared that the candidates able to intellectualize their cases with less emotion were able to push through the system quicker. This author has thought that the candidates that are able intellectualize and mix in the rocky terrain of emotions, are able to grow using these stimuli, and build more resilience and endurance for this emotional work. Being able to do this would also lead to a candidate that could use their

countertransference to understand themselves and lead their patients to a transformational position.

Summary.

In interviewing this set of candidates, their Achilles heel in openness and honesty was in what they presented to supervisors why they chose to leave their supervision. The interesting dynamic is it appeared to be a blind spot for the candidates themselves. Most of the candidates gave honest reasons, just not all the reasons. There was one anomaly with one candidate who was completely honest with why they left. Candidates may cultivate extraneous situations to leave instead of addressing the real issues of why they left Loyalty and honesty can be heard in the interviews by listening to the emotions that were displayed and demonstrated in the candidates’ stories. Yet, a year later, the candidates appeared to have processed their termination process, and had mastery in their stories why they left supervisors. As candidates go through their own transformational process in their own analysis, they tend to have more insight to their own processes and growth.

Some candidates are more guarded, which has seemed helpful in graduating faster than others. These candidates used more intellectualization and filtering of the material they shared. They could push themselves through. This approach appeared to be riddled with high functioning defenses and a lack of openness with themselves. Yet, as this set of candidates graduated, they tended to be more vulnerable and open with themselves when not under the scrutiny of progression committees and supervisors.

Candidates that were more open with their supervisors, emotionally, by “falling apart,” or by including information about their personal lives and internal worlds, such as their regressed processes, tended to graduate slower. Their lives led to divorces, break ups, switched jobs, and array of other changes These candidates were in a messy, vulnerable process that was labeled a “heart felt path.” These candidates appeared to be more “open” with through the entirety of their training. It was clear, to this researcher, that none of the candidates appeared to be in the paranoid position. One of the candidates interviewed might have been more scared than the others. This candidate came with a script and kept any organic process of spontaneity out of the process. This was the only candidate that disappeared after the first interview, did not answer any texts, emails, or calls.

Some candidates reported that they knew other candidates in their cohorts, or in their institutions, that tended to be “narcissistic, ” “autistic,” or sociopathic,” and could seduce their way through training. These candidates were reported to be exceptional in their fields. These candidates were not interested in an internal process as much as an external process. Ironically, a few candidates in this study had published and presented, yet had no problems showing how human and vulnerable they were The candidates they reported on were already masterful and had an extra layer of specialness that was presented in class, and they set themselves apart from being “one of the group.”

These various types of presentations of candidates left this researcher wondering about the “messy” process of having a heartfelt process versus the “intellectual” or “guarded” candidates, and how this might be a red flag that supervisors might be missing. Or, how candidates can become what a supervisor needs, or is able to seduce the

supervisors. The one thing that seemed to stand out to this researcher was that the more open and honest a candidate was with their supervisors, the messier their process became, and the more vulnerable they were This researcher could not figure out when a process was too messy or too guarded. It seemed that the part of the understanding depends on the supervision dyad, how much supervisors can handle, and how much candidates can contain. This goes back to the idea of the candidates figuring out how much sugar they should feed their supervisors and the candidate figuring out how open they can be with their supervisors.

The Supervision Dyad: The Open System

Ten of the eleven candidates reported they had at least one invaluable, wise supervisor who was a mentor, if not more. When reading the psychoanalytic supervision literature, it concentrated predominantly on the dyad. The pairing can be invaluable in many ways, and this researcher concentrated on honesty and openness in this dyad. We think about the patient’s defenses, the formulation of the case, transference/countertransference issues, and the optimal intervention/and or interpretations the patient needs. It is wrapped in a nice package, but truthfully, the system is open, and no one really knows where the intervention that is the most helpful to the patient and/or candidate will come from. The candidates know which supervisors they can be more open and honest with as well as who else they could turn to when they need help. There were themes that arose about what helps candidates be more open and honest. Interviews showed the candidates turned to many different people, in different settings to help them move their cases along. These people are not always training supervisors No

one seems to know where the most valuable learning and interventions come from, but the candidates in this study seemed to learn who to turn to for help.

I was reminded of Dr. Efrain Bleiberg; he talked about parenting and mentalizing. In a case conference I was co-teaching with him in 2019, he said, “We think when a kid does well, then we think the parents did a good job! But, we don’t really know that!” This made me think about when a case goes well, and how we assume that the supervisor did a good job, but we do not really know that either.

Even with the candidates that “loved” their supervisors it became clear, in their stories, that when their learning needs could not be met by one person, they sought help elsewhere. Candidates have been known to be resourceful when they want to learn and help their patients, and themselves. Additionally, sometimes, candidates have been known to seek validation or encouragement when their supervisor is unavailable, which Emanuel Berman (2004) called his same-titled book, The Impossible Training.

The candidates’ extra-supervision seemed to serve the following functions: (a) helping candidates with their interpretations, and opening doors in their patient’s analysis different from their supervisor’s voice; (b) offering technical advice that resulted in opening doors to help the patient and augment candidates’ techniques, from techniques other treaters use; and (c) talking to candidates in a new way, and/or in a more general way, where candidates could grasp something they were unable to understand previously about the formulation of their cases.

5 of these 11 candidates presented a case at a national level. Most of the candidates presented to visiting teachers or in case conferences. Three candidates did not mention if they presented cases or not. Seven candidates appreciated presenting their cases to other

people besides their supervisors. Two candidates presented their cases to other analysts and received rigid or critical feedback that was not helpful. A few analysts, listening to these cases, rejected them, saying “that is not analysis ” These analysts are described as “archaic analysts.” This response has continued to happen infrequently A few of the candidates took sabbaticals or switched institutions in their training and described how presenting cases was easier than in the past. One candidate presented a case in multiple venues. The candidate was told, by a well-known writer, that when a patient brought their baby to their appointment, it was “not analysis” or “in the frame.” The same case was presented to a well-published analyst who made meaning of the appointment, discussed the reparative process the patient received, and the growth the patient had, after hearing “how it all turned out.” Same case, different training analysts, different meanings. Yet, the determining feedback that was most helpful was what the candidate let in, used, and saw what worked. No one really knows where helpful feedback will come from, what supervisor’s feedback the candidate used and falls flat, or what the candidate decide not to use.

The candidates gave rich experiences of learning from fellow candidates’ ideas and contributions in case conferences to institutional faculty who were helpful, adding valuable feedback. I had one candidate who left material out of the case they were presenting, and their supervisor asked why the material was left out later. We had candidates show the written material to their supervisors that they were going to present at a conference, and/or case conference, and/or institutional colloquium reports. In addition, there were candidates that did not look for feedback from their supervisors.

Candidates within working dyads still run down the halls to other colleagues’ offices, or go to lunch to discuss cases, sometimes in disbelief of a new revelation the patient presented or talked about outlandish things their analysands may have said. As a patient’s life can move quick and easily be filled with chaos, a week or two without seeing their supervisor is felt, and it can too long. Some supervisors want processing notes, while others do not use them, some candidates find the processing notes helpful and some find them painful.

Two candidates had supervisors that recommended getting a consultation outside of supervision with someone who had more experience with a particular subject, or when the case was stuck. At least three candidates, as told from their stories, were encouraged by their supervisors to present their cases at a conference or in case conference. Yet, sometimes, the candidates sought extra-supervision and it appeared that the supervisors were usually unaware of it happening.

Four of the eleven candidates consulted with their other supervisors when their cases were stuck or their current supervisor was unavailable. Candidates often used their analyst as a backup supervisor whom they could bring most of their anxieties to. These candidates also consulted other mental health providers, who were not analysts, to discuss medication or other therapeutic interventions that might help their patients. In one story, the supervisor did not think medication was necessary, yet the candidate had their patient do a medication consultation that helped the patient tremendously. Sometimes the intervention may even be “non-analytic,” like medication, in-patient, or more cognitive behavior type interventions. I knew a candidate, that did not participate in this study, that did trauma classes and presented their case to their analytic supervisor and their trauma

supervisor. One of the candidates discussed their case and it was clear they thought in terms of systems.

The poorer the fit in the dyad, the more extra-supervision the candidates needed to keep in place. One candidate stated, “I was two timing on my supervisor.” The case moved along beautifully by taking in what was useful from each of their supervisors, but they kept the matter private from their training supervisor, and their progression committee. As one candidate said, “Some theories work better for some cases than others. I let my patients dictate the theory that works best for them, and I pick supervisors based on the patient.”

The candidates who had difficult supervisors were having extra-supervision on how to survive difficult supervisors from other candidates, faculty members, and supervisors. There were two candidates whose progression committees recommended other supervisors, and this study clearly showed that changing supervisors could change the cases, as in Drake’s case. Drake was the candidate whose supervisor wanted him kicked out of his institute. His new supervisor was encouraged by Drake’s analytic thinking and the case progressed, and his issues with his progression committee ceased.

This reminded me of when I was a psychoanalytic candidate and simultaneously was in my PhD program. Between the two programs, I had nine supervisors, all required. I was being supervised daily and was constantly presenting cases in class. Sometimes I would share a case I presented at a case conference to my PhD class and tweak the writeups depending on what the rubrics were. It seemed, whomever I met, wherever I was, offered invaluable guidance and suggestions that helped my patients and helped me find my own analytic voice, despite working with different therapists using different

theoretical approaches. It seemed odd at first, that I was consulting with non-analysts, but

I was humbled quickly with wise guides wearing different theoretical hats, with different life experiences.

Listening to the candidates, it became clear what they gained from extrasupervision: (a) help with interpretations that opened doors in their patient’s analysis that was different from their supervisors voices, (b) technical advice that resulted in opening doors to help patients and augment the candidates’ techniques from the successes of other treaters, and (c) different conversations with different mindsets that allowed candidates to grasp something they were unable to understand previously about the formulation of their cases.

Supervisions dyads are necessary, analysis is a complicated therapeutic intervention, yet getting a private teacher and/or mentor has proven invaluable to candidates. That is, if there was respect and an appropriate fit. However, despite how beloved the supervisors are, the fallacy may be that supervision happened solely in the dyad for these candidates. No one seems to know where the helpful intervention will come from to help the candidates and/or the patient. Whose voices will help the candidate become a more effective analyst, or where the interventions come from that the candidate uses, is unclear. The supervision dyad is an open system and there are many voices heard. What candidates have come to know or have learned in their training is which supervisors they trust, will turn to when needed, and is “in it with them” in their “impossible training.”

Having interviewed some of the candidates who graduated a second or third time, they attributed certain supervisors’ as having helped shape their analytic voice. These

supervisors/wise mentors seemed to be those that they could be the most open and honest with, along with their analysts.

Candidates Are Sensitive to Institutional Processes and Turmoil

Candidates consistently reported being sensitive to disturbances in functioning within their institutions. 8 of the 11 candidates shared anecdotes about their institutions and how they affected them in their advanced learning experience. At first, it was difficult to understand why candidates wanted to tell their “whole” training experience outside of supervision. Yet, once their stories unfolded, it became clear why these disturbances induced feelings ranging from fearfulness to rage; their emotions affected their openness with their supervisors, even if they were trusted. The candidates reported on how the faculty responded and conducted themselves during these conflicts. The primary difference, despite the initial interference with the openness and honesty within supervision, after a candidate was activated by institutional conflict, was that most candidates were able to resume transparency; however, a few candidates were unable to resume their trusted relationships and remained guarded because of the institutional conflicts. The type of conflict determined whether the trust resumed, regardless of the candidates’ desired outcome. Five candidates referred to their institutions as being the “borderline mother” or “narcissistic father,” one candidate even referred to their institution as the “drunk father.”

Candidates shared that they understood that conflicts and differences of open are normal, in any institution, since they already passed the hurdles of higher education in their fields of practice. The difference for them was that the conflicts they endured were

between “analyzed” faculty members, if not the candidates fantasized that the faculty was analyzed enough to resolve conflicts harmoniously. There was some idealization that analyzed faculty would have fewer problems that caused some de-idolizing of the institution and faculty, which is considered normal while in training, similar to what one goes through when de-idolizing parents.

Some of the candidates in this study experienced destructive forces, where aggression ran amok, and trust was difficult to rebuild. Is the key to the candidates’ ability to maintain supervision be whether the psychoanalytic institution they belonged to could withstand the aggression and rage between the faculty themselves, as well as the aggression from the students they serve? Or, did their institutions’ fractures and splits create discord and chaos that impeded openness and honesty with supervision?

According to the candidates, there were different levels of containment. A few reported a complete trust between faculty members, where there were no known conflicts, though the candidates suspected the faculty kept their conflicts private. Others reported uncontained aggression, described by Melanie Klein’s (1946) schizoid position within these institutions (citation). Some institutions were able to bridge the different sides of the conflicts in time to either become or maintain a workable/functioning institute. A few candidates took sabbaticals or switched institutions. Sadly, two candidates shared stories of complete, institutional, schizoid/insanity, resulting in their programs’ failure.

The candidates that experienced their programs falling apart were affected in their ability to be completely open and honest with at least one supervisor, depending on the splits within the institutions. They reported five different types of conflicts that affected them:

1. Policy changes that increased graduation requirements, or a lack of policy changes (archaic graduation policies that still include getting a patient off the couch).

2 Political turmoil within the institutions amongst the faculty, including administrative governance, unresolvable policy issues, pedagogical differences, personality conflicts, or power struggles.

3. Progression committees, or similar governing bodies (AKA “The analytic police”).

4. Ethical violations.

5. General disrespect of candidates, where faculty seemed to forget or ignore they were dealing with professionals. Many of these candidates held prestigious positions within their communities, only to be infantilized by their institutions.

To protect the privacy of the candidates I will not be going into the stories I was given in this section, since the stories could identify the locations of the candidates that were interviewed. Broadly, two candidates had programs that fell apart during training due to pedagogical differences between the faculty, different standards to govern graduation requirements, or personality differences between the faculty, resulting in power struggles. In these instances, candidates felt that the ruptures were irreparable during the activation time. Most of the candidates turned towards cohort members, trusted faculty, and supervisors to help ride the turbulence of training, yet others were caught in the crossfire between their supervisors and faculty.

Policy changes or the lack of them.

Institutions that changed graduation requirements cost candidates more time and hoops to jump through, creating responses of rage. All candidates were angered with these changes. The more nonchalant the information was delivered, the more rage there appeared to be. Seven candidates reported they would not be graduating with the same policies that they started with, all wished they could have been grandfathered in with the policies they started with. One story involved a conflict where their analyst, being the head of their progression committee, had to be sorted out between the dyad. Their experience was that the analyst understood the candidate’s perspective, and the dyad resumed with a more trusting candidate.

Interestingly, when the candidates reported policy changes, faculty members were rarely singled out as part of the problem, the anger was directed toward the “institution” or a “whole committee.”

These issues immediately affected openness but, in time, the candidates opened back up. How change was delivered to the candidates contributed to how they felt about their institution. In general, it was better when faculty had mindful conversations, imagined the impact on the candidates, and left space for them to express grievances. If the candidates were unsuccessful in their pursuit to be grandfathered in with the original policies, they felt duped and angry. If the candidates were treated like children and messages were delivered with a “because we say so” attitude, the candidates felt incredibly disrespected and rageful. One candidate said, “I fiercely disagreed with the changes.” One candidate’s face went completely red during the interview when they described the policy changes. The candidate said, “We are not children! And . . . this training is optional! You would

never get away with this in another institution.” Another candidate said, “Our institute has sadism built into the system.” Many candidates tried to make sense of the callousness of the changes. Another candidate said, “This is what happened to them, so they do it to us.”

Candidates were also angered by the archaic policies needed to graduate. I was shocked to hear that some candidates still had to get patients off the couch to graduate. This policy brought a lot of rage. I noted that the candidates with this policy wanted to be heard. They did not seem to have the same fear as other candidates interviewed, in fact, they wanted a platform to discuss what was happening to them. In one institution, a candidate reported that they would probably need a waiver to graduate, another did not have that option. There was one anomaly in this category. The candidate loved their training and did not even know if they would be able to graduate due to the stringent policies of becoming an analyst. This candidate found the learning invaluable for their private practice and their personal life. They also felt “held” by their supervisors. The one thing that was in this candidate’s story involved a cohesive faculty, void of conflict. She felt very respected by the faculty and her supervisors; however, she mentioned that her supervisors were retiring. She had clear and steady opinions about training, and implemented her ideas in another educational setting. She had a valuable perspective about her fears of loosening the standards in training, concerned that learning would be lost. I found myself rereading this candidate’s views, as they seemed to expand my own biases. Sadly, she was an anomaly and did not seem to be pressured by time or becoming an analyst.

Turmoil turns into politics.

Two candidates reported that when it came to institutional politics, their institutions were “cesspools ” Another, however, reported her supervision with two of her three supervisors was a positive experience.

The bedrock of psychoanalytic education is based on conflict with Freud, who was at the center of the political turmoil of his time. Based on our history, unsurprisingly, analysts have continued to fight on how the training and the profession should move forward, these institutional, pedagogical differences have manifested turmoil and splitting. From the candidates’ perspectives, this is when faculty goes from being seen as a whole entity, such as “faculty” or “the institution,” and begins to separate into individual objects with specific people at the core of the conflicts. This is when trust breaks down for candidates and they become guarded to stay “under the radar” of the faculty. They see certain faculty members as being archaic, clinging to past ideologies, narcissistic individuals seeking power and self-importance, and/or act like children themselves during conflict, infantilizing candidates.

Today, many candidates do not want to join the ugly in-fighting. The game of seeing who can outwit whom, needing to know more than another, or debating better than another, are of no interest to this set of candidates. They indicated that they wanted transparent and defined criteria to graduate, a few suggested rubrics. Case in point: I was unable to officially interview a candidate who had an important story that stood out to me. I had become familiar with this candidate by going to the same conferences and tried to persuade her to let me record her story. She started training in one institute, and had completed a significant amount of training, when

she took a job in another state and switched institutions. I called to connect with the her and she said, “They just seem nuts here too! Just differently. Why do analysts have to fight with each other? I just had a potential supervisor turn me down because they didn’t feel a three day a week analysis was analysis.” Due to her new position, other analysts were letting her know about the power struggles going on in her new location. She laughed and said she was naive when she started her training, and that politics came with the territory. When she began training she was struck by the learning she was exposed to and those who shared their knowledge. That is what hooked her into the “talking cure.” She said, “They had knowledge I needed to understand how to help patients and their families beyond medication.” For this candidate, when she went to another institute, she had a greater awareness of faculty conflicts that made the idea of graduating untenable, even though there were proponents of rigid policies. There were faculty who wanted candidates to adhere to training standards they had to graduate, which created resentments and stereotypes towards the analytic profession. Some candidates, like this one, were not interested in institutions where arrogance, within a few analysts, goes cattywampus. Analysts that wanted to uphold stringent policies, and/or campaigned for arbitrary requirements made post-postgraduate education unappealing. Some candidates’ stories reflected that some faculty seemed to forget that this training is optional. This candidate ended up taking a sabbatical from training because she was not willing to participate in the battles that never seem to die.

One candidate’s formulation of infighting caught my attention. He noted that some analysts in organizations are provided time for research and writing. He felt that those analysts are usually so busy with their duties at work and are less interested in taking on leadership duties in their institutions. He observed, at his institution, that a few analysts, who were in private practices, seemed bored and alone. He felt analysts in private practices were more isolated, needed more people to connect to, and needed to find a sense of importance/belonging with their colleagues. Yet, some inadvertently ended up competing with the analysts that participated in national/international level conferences, who were getting notoriety for contributing to the profession on a more academic level. He felt that isolated analysts created conflicts out of self-importance and status. Although an interesting concept, there were no other similar observations. Rachel had the opposite view of infighting in her institute, positing that the analysts with private practices seemed to be more grounded and connected, because they consistently worked directly with clients, whereas analysts who focused on writing and research, isolated themselves in “ivory towers,” much like academics at universities are often portrayed.

Another candidate sounded like he had checked into Hotel California, where he could check out anytime he wanted, but could never leave. He considered following some of his cohort to another institution. His institution was conflicted over easing policy requirements. He described one faction of the faculty being rigid, “pure Freudian,” and “superior knowers” of the psychoanalytic pedagogical

frame. Surprisingly, this person did not describe what I anticipated as older leaders, but a mixture of middle-age faculty. The candidate said, “They are flatly arrogant, have something to prove, and think they are so superior as they leave a trail of destruction.” The more “reasonable” and “senior” faculty was concerned the institution would slowly die, unable to produce analysts in time to replace them once they retired. The more years in training made it harder to produce training analysts to become faculty members, because some candidates lost motivation. The candidate said, “It threatens their specialness if they have more analysts.” Sadly, this candidate still had not graduated since our last talk. I contacted a faculty member from there that I had presented a case to, to see if she could help me find candidates willing to interview. The faculty member needed to talk to me before they would refer me to potential candidate research participants. She confirmed the candidate’s destructive experience was hurtful and hard to grasp. She was unaware I had already interviewed a candidate. The faculty member joined another institution because she was asked to leave. I could not believe this very reputable supervisor I had presented a case to in my early years of training was run off. She had been pivotal in my training direction due to the knowledge I had learned from her. Dismally, the faculty member reported their previous institute graduated MDs faster than any of their psychologists and social workers, clearly highlighting the privileged MD position. She too described a “Good Old Boy” system of MDs, despite the notoriety that some of their candidates had achieved in their intellectual endeavors, research, and academia.

Luckily or tragically, only two of the candidates reported that there were privileges among the mental health fields in these interviews.

When candidates have experienced policies that turn into conflicts, creating fractures or splits in the organizations, there has appeared to be a lot of acting out from the faculty that affects the candidates. Although candidates are affected, there has seemed to be faculty/supervisors to balance the candidates’ experiences of the splits until things settle down. Occasionally, candidates will truly be left in analytic training purgatory, training that takes years to graduate, or they will seek another institution to continue their training. Either way, it was apparent that when aggression was not contained, and there was fighting, newly aspiring analysts did not want to participate. They appear quieter and are not as transparent with their own learning. There appeared to be unsettling feelings in candidates when faculty was unable to contain the aggression amongst themselves, or worse, talent lost from candidates not willing to participate.

Progression committees.

Every candidate demonstrated that they were aware and in an evaluation process to become an analyst. In the candidates’ minds, their progression committees were powerful entities who determined their worthiness of being analysts. Within the candidates’ minds, progression committees determined if they possessed the clinical aptitudes to be analysts, or if they had the character structure of a neurotic person, and if the candidates themselves were analyzable. Anything

that threatened a candidate’s thoughts of being an analyst, has been known to upset a candidate. So, even if messages are given harmlessly, the candidates may tend to jump to an alert position. Narcissistic injuries are inevitable in becoming an analyst. Being in a regressed state; however, has made the evaluation process more painful, if feedback is required. Everyone in analysis is faced with looking at their own defenses, their internal objects relationships, their personality structures in response to those objects, usually in the privacy of their analyst’s office. It is painful to know that there is a larger analytic lens evaluating these intimate pieces of oneself. Yet, candidates are not sure what pieces are being seen by the progression committees. Some of these committees do a better job than others delivering their messages on how to help a candidate grow. When things are perceived as critical, and the candidate feels exposed, then the concept of the “analytic police” arrives. In the candidates’ mind the progression committees are not only evaluating them, they are policing them as well. Who will be allowed to progress to become analysts, which candidates will be recommended to switch to a didactic candidate (if that option is available), and who will be told that this is not the profession for them? These decisions are determined by the progression committees. Someone has been policing this process in the candidates’ mind, someone has always been watching them, just as they have been watching the faculty.

I was telling a supervisor about my research in an institution different from mine. The supervisor told me they do not evaluate the character of their

candidates, that is not their job on the progression committee. I was told all the candidate had to do was follow the rubrics/criteria and the candidate would graduate. Ironically, I interviewed a candidate in their institution and the candidate’s experience was just the opposite. Regardless, if the supervisor was correct, in the mind of the candidate, there was an analytic process evaluating their personality structure. This idea of “analytic police” is supported by seven candidates.

Each student had stories of their progression committees, or appraisal committees. One candidate said, “They will release me when I’m baked.” It was apparent that some institutions want to progress their candidates quicker than others. Three candidates volunteered how many hours they had to see their analysands and how many hours of supervision were required to graduate. These candidates seemed to be less anxious than the other candidates. Some candidates told me there were policies in place, but they didn’t know the exact hours they needed. One candidate said, “It’s all arbitrary. The main thing is when I get my third case, I need to complete my hours, and show I have the basic competencies to build on.” Two candidates were upset that their supervisors had seemed critical of them in the progression reviews but did not tell the candidates directly. Some candidates learned about these reports from their other supervisors. A supervisor’s lack of transparency, in a negative report to the analytic police, could be a deal breaker for their relationship. Either way, supervisors who are not transparent with

their evaluations of candidates will have candidates who want to be seen less and not be as transparent themselves in supervision.

Eight candidates seemed to have varying levels of distrust toward their progression process, or the people on the progression committees. The stories that arose were all different in how they decided that their progression committees were untrustworthy. Some of these candidates had access to their progression committees if they had concerns, and some committees were phantom ghosts. Three candidates reported wanting more transparency on how they were evaluated. Two candidates that were a part of their evaluation process found it intolerable. Their stories reflected poorly behaved analysts who were openly critical with the candidate and other faculty members. One candidate reported that each committee member was trying to outsmart the others at the candidate’s expense, while the candidates felt like they had to smile and thank the progression committee for their valuable insights. Yet, the candidate’s reactions to their evaluations processes certainly showed me that their feedback was anything but valuable. The other candidate wanted to talk to everyone but not all of the faculty showed up. The candidate reported having no intention of being connected to those analysts in the future. Drake did not do well under one set of supervisors, yet he changed supervisors and was successful. In a way, this does not make sense, if only one supervisor had issues with him, he would almost be kicked out. It made me wonder what was happening in those meetings that changed so drastically. It was almost like Drake had to have a supervisor who was willing to campaign for

him to change the minds of everyone on his progression committee from ousting him.

The “analytic police” have become more real and more powerful, as some of the candidates noted that they must now be coached on how to survive the different views of the progression committee members. Or, as my dissertation chair pointed out, there is a Dean’s committee. Some progression committees seem to trust the supervisors’ reports and recommendations, while other institutions have questioned the supervising analysts’ pedagogical differences if supervisors are requesting the candidates to be less transparent. Supervisors have told candidates, “We want to leave this material out,” in fear of the reaction of the progression committees’ responses to the material. The most common theme candidates were told to withhold was if their patient was sitting up during their analysis. The candidates that had less issues were the ones who had vigilant supervisors, who knew the predilections of the committee members, and avoided any material that might bring unwanted questions about the candidate’s work.

One candidate told me that their progression committee was concerned about how often their analyst traveled, and if the patient’s analytic process counted since they met virtually. The supervisor handled this by offering the candidate to leave out the frequency the patient traveled. During the second interview the candidate felt the progression committee was a bunch of hypocrites,

(It’s) ironic that you can’t be in an analytic process on zoom unless there’s a pandemic. Now, since the progression committee is working remotely, it’s miraculous how there’s an analytic process in their work. The “analytic police” seem to change their perceptions if it benefits them from this candidate’s perspective. These evaluation views can change as the progression committee members change. So, it is not farfetched to see why candidates might not trust certain progression committees or why the idea of the “analytic police” arose.

One candidate said that her progression committee was having a hard time with “ending.”

It doesn’t make sense, in my first case, I had a patient that almost looked psychotic. As I’m trying to get my third case, they have now told me twice that the people I have presented are not neurotic enough. Not neurotic enough? (she laughs) . . . I ended up getting a training analyst to consult with the patient to assure me, and my committee, that the next case is neurotic enough. It doesn’t make sense, so I have to believe they don’t want my training to end either, or to say good-bye.

Bella told me stories of how rigid her institution was, conversely, she told me that she felt that her institute was very understanding of her inability to get papers written. She told me the chair of her progression committee contacted her to understand why she did such good clinical work yet had a hard time keeping her

writing assignments up. The chair asked her if she knew what was going on with herself. Bella laughed,

I knew exactly what was going on with me and what was playing out. I was honest and told her about my analysis and what I was working through. I think

I told her too much of what was happening with me, but I had to be honest to make sense of why I wasn’t doing what I was supposed to. I felt very held by my progression committee and supported. I believe they really want what is best for me and want me to be successful. They let me work through the issue and eventually I got my write ups done.

Bella told me that, “The analytic police are also necessary.” Bella happened to work with another candidate named Cory. Cory had stopped paying their bills at the office. A business associate told Bella that she needed to protect herself and that Cory was making some poor financial choices with her money. Later, Cory was kicked out of their institute and lashed out at Bella, who was unsure why she was kicked out. Bella saw a lot of patterns with this candidate that were not getting resolved. Yet, she knew the “analytic police” were doing their job and she trusted them. So, despite the idea of the “analytic police” having a negative connotation, there were stories of the “analytic police” being protectors and loving supporters of candidates and their institutions.

Ethical violations and blind spots.

As we have seen before, analysts themselves, are only human and have blind spots of their own. Ethical violations only provide further proof that no one is a fully analyzed analyst–if we even understand what that fully means. As one faculty member said to me recently after a faculty meeting, “Some analyzed people are just not likable because that is who they are!”

One of the more painful, unacceptable stories was of a candidate who reported her supervisor had blatant ethical violations with a patient that were published in their community. This candidate felt betrayed and lied to. The candidate was flat out angry and confronted the supervisor. Yet, the supervising analyst only continued to show the candidate how flawed he really was with slippery excuses, despite having been found guilty by a governing board. Faculty themselves may not want to see their comrades as having such flaws that could question their own relationships. Other candidates reported similar stories in their institutes who were not their direct supervisors but were on faculty/and or other candidates’ supervisors, and or analysts. Ethical violations are problematic for candidates and who they can trust.

Ethical violations are different from blind spots because ethical violations have legal and licensing ramification. Blind spots are when candidates feel the faculty ignore issues within the institution. One candidate told stories of faculty falling asleep in class from being so old no one appeared to want to intervene from the faculty member teaching. Another candidate complained that their institution

did not want to admit one of their beloved faculty members had dementia. The blind are when the candidates have seen “fishy” things, and wonder why no one is helping the faculty from faltering publicly. One candidate said they had a gentleman go into their class and randomly chastise them in an incoherent way. One candidate told a funny story of an older analyst who had been married multiple times and currently was married to a woman “much younger than his children, who used to work under him.” The candidate’s stories indicated that the faculty member was a “dirty old man, ” and condescending and degrading towards the candidates. In the era of the internet, candidates have more access to information on the faculty. The candidates had a heyday in class, texting each other about this person’s airs of superiority, when they clearly saw flaws in the faculty member. One candidate wondered how the rest of the faculty was making sense of this “arrogant misanthrope.”

In one institution, the candidate was angry that they had a cohort member in their class married to a training analyst that appeared to fly through candidacy a few years before anyone else could graduate. One candidate said, “We have candidates married to faculty, we have candidates that are friends with administrators, we have candidates who are friends with colleagues in other settings, which can give the perception of playing favorites.”

These fishy-type stories leave candidates wondering how fair the “analytic police” are, by creating specialness. Not all candidates are protected the same. Blind spots are the cracks in candidates’ de-idealization, seeing their faculty or

supervisors are not perfect versus ethical violations that seem to shake up an organization. Honesty may not break down with blind spots, but ethical violations will scare candidates from being completely transparent.

Even though blind spots tend to be unseen areas faculty “miss,” the stories I have heard, the blatant ethical violations were taken seriously in institutions in the stories presented. The stories that were presented reflected institute leaders addressing the issues directly with the candidates in some way. Whether their supervisors talked to them directly or the leaders went to the class to inform the candidates. Every candidate felt the faculty’s transparency was meaningful when ethical violations were committed. These candidates were given a safe space to learn about the violations and express concerns in a supportive environment. Eventually the candidate that reported she had felt betrayed by a supervisor, due to an ethical violation, eventually found a supervisor she felt she could be completely open and honest with. Basically, when there were ethical violations, these institutions provided transparency and support, and the candidates were able to regain trust with other supervisors and the organization.

Candidates told stories where the faculty tended to forget they were working with professionals looking for additional training. A common theme, mentioned previously, was “This is what was done to them, so they are doing this to us.” What happened to the faculty did not sound nice; however, continuing the compulsion has not been helpful to today’s candidates. There was an era when

psychoanalysis was a prestigious path, yet today candidates have other avenues to gain notoriety in mental health.

One published candidate reported that she was vocal about the changes made in their institute that affected her graduating. She was called into a meeting with leadership because, My unhappiness was affecting others (faculty). I told them I had no control of their unhappiness, and that my career was much bigger than this so . . . this is when my second supervisor stepped in to help me navigate the politics of the institute. You know I present at a national level; I don’t need this for my career. There was a time I cared about the institute, and I think . . . it is going in the wrong direction.

This was an enthusiastic candidate that valued her analyst, her training, and supervision, but the institutional leaders evoked rage. The candidate has planned to join another institute when she graduates. Administrators and faculty forget that not only do they have professionals they are training, but future ambassadors and leaders of psychoanalysis.

One candidate said, “Administrators are hedonistic and sadistic.” Another candidate stated, “Some administrators are just nasty and mean spirited.” A few candidates reported “one upmanship” and “power dynamics” played out between the faculty. One candidate appeared to blow the obnoxious comments off, “They will be dead soon.” Another candidate told a story about their case conference, where a faculty member asked them how they could charge so much. The faculty

member was clueless about the business avenue the psychologist had taken. One candidate reported a training analyst had admitted, in class, to a candidate, that they assumed their partner was wealthy and analysis was a hobby. The candidate was mortified at how degrading this faculty member was. One candidate told a story about how they had an MD at their institute doing important research on Transcranial Magnetic Stimulation, and it appeared that the faculty member was jealous. They had also known a candidate, who had a ketamine clinic, that left due to poor treatment, being questioned in class about his ethics. Despite having candidates running intensive outpatient clinics or running parts of prestigious universities and medical hospitals, there seemed to be a barrage of microaggressions the candidates had to maneuver.

Rachel shared that she had found that her classes were very intellectually stimulating in her institution. She told a story about a class that her cohort was struggling with because,

The two teachers just lectured at us. I asked if they could put the material around a case to make sense of it. Instead, they assigned us more reading. They were defensive, saying we resisted the learning by not doing the additional reading. I was angry, my class was angry. It’s like we offended them, so we were punished. They just forget we are professionals, and they don’t treat us like we are professionals. It’s not everyone, in fact, almost everyone is respectful that I’m learning from. It’s those few . . . archaic

teachers though, that set the tone. I think this is what was done to them, and so they are doing this to us.

These are the candidates that have gone back to their supervisors/analysts and cohorts/colleagues and informed them of those who misbehaved.

One candidate said that she would get to the institute early. She could hear the president of the institute talking, with her committee members, about other faculty or candidates in disrespectful ways.

It often seemed like I blended into the furniture, and they forgot I was there.

The president and some of the other officers felt so comfortable in their power that they would freely say negative and derogatory things in front of staff

members and candidates

Again, the administrators forgot that they had professionals, with advanced degrees, listening to what they were saying. The two candidates who eavesdropped on these conversations found them demeaning. These candidates ended up thinking poorly of these faculty leaders.

Two candidates reported that they did not know what their institutional conflicts were in their institutes, because they felt that the faculty handled the problems in a healthy manner in privacy away from the candidates. Seven of the candidates were clear that they knew about the conflicts, and three of them indicated they were “not supposed to know.” It appeared that, despite that faculty matters are supposed to be private, there were some institutions where there was a free flow of information these candidates had attained and discussed. On a sidebar,

I thought that I knew of the conflicts in my institute and thought there were no secrets. My first faculty meeting was shocking. The faculty was fighting. I had no idea there was any conflict at the time I knew there were plenty of conflicts in the past because I worked in the school the institute owned and ran. After the meeting, people came up to me to assure me that the meeting was unusual. My first thought was, “I want no part of this dysfunctional family.” It took a year for me to attend another faculty meeting and it has been fine ever since. The point of my own story was made to juxtapose what candidates might believe they “know” is happening in their institute, but as for myself, I did not have the whole story.

Summary.

These are the stories and experiences of candidates, the other half of the dyad in supervision. Yet, this dyad is also affected by their institutions, which affected the openness and honesty of candidates. Even if the candidates are open with their supervisors, there may be constraints in the dyad with being transparent. There were times when most of the candidates, in this study, felt disrespected by the institutional processes, turmoil within their organizations, and faculty that were directly disrespectful to them. The candidates were sensitive to what the faculty was doing. Faculty should know they are being watched by other professionals, and that they, as candidates who are being evaluated, are sensitive to their actions, intentions, and perceived aggressions.

The Unseen Guide Behind the Couch: The Candidates’ Analysts

Candidates have many different strategies to navigate training. As candidates told their stories about being open and honest with their supervisors, it became apparent that their stories were riddled with their analysts’ wisdom and guidance. This is the one place all the candidates were open and honest: behind closed doors, away from their supervisors, progression committees, and their institutions.

Out of 11 candidates, 7 openly shared their relationships with their analysts without prompting. The candidates felt that one of the most important people “in it with them,” in their training, was their analysts. One candidate only answered “yes,” that their analyst was an important part in training, but would not expand how. Another candidate said they did not find their analyst important in their training, but then told stories how their analyst was quintessential in guiding their training through their internal and external conflicts. Two candidates reported that their analyst was not a guide through their training, and their stories lacked any mention of their analyst during external conflict. This did not mean their analysts were not helpful to them becoming an analyst, but they did not mention them in their stories of supervision, being outside consultants when they were stuck in a case or had issues with their institutions

For some candidates their analyst was essential from the beginning of their training. Paula and Drake both had analysts who encouraged them to become analysts. Paula felt pressure to start her training even though she did not feel ready. She stated, “I always thought I would do analytic training. I wish I would have started my training a few years later.” She described her life circumstances and why she wanted to wait,

I felt some pressure from my training analyst to get started, and that colored my experience. So, I have been more ambivalent than I think that I would’ve been under other circumstances. I finally have a client now that makes it seem like I am doing it for me (she starts laughing), because it is helping me become a better clinician, and it has given me a cohort of peers to hang out with, opportunities to teach, and do the other things I want, not something I need to do. I have found (the process) interesting. I like many things about being an analyst, but I recognize that I brought in many of my own fantasies. Maybe it would have been good to have a little more time before my training to see my own ambivalence.

Drake had been in treatment with his first analyst who helped him find the path to becoming an analyst. Closer to training, Drake’s analyst pointed out he would probably not be alive to see him through his training. So, Drake started his training analysis with someone that his analyst had analyzed and recommended.

Melinda responded, “I kept it in the family.” Since her supervisor analyzed her analyst, she stated, multiple times, that her analyst was, “most important in my training.” Michelle and Aron echoed, in their interviews, that their analysts were important in their training. Kay’s stories indicated that her analyst was also at the core of her training. She had a supervisor that had an ethical violation while she was in training. Her analyst helped her process this painful experience. He helped her put into words the betrayal she felt and was able to tell the supervisor how she felt.

Most candidates discussed who they picked for supervision with their analysts. On two occasions, when the candidate reported who their supervisors would be, their analyst

intervened. The analysts did not think the supervisor would be helpful in the training process and steered the candidates in different directions.

Mo and his analyst discussed who he was thinking of, and his analyst confirmed that he had heard good things about the potential supervisor. Helen and Kay thought, together with their analysts, what supervisors would be the best fit for their patients’ personality structures.

Analysts help with cases when the cases are stuck under supervisors. Michelle spoke of an instance where her supervisor was unable to contain the material in a case, You know, I ended up doing more supervision with my own analyst than with my own supervisor. My analyst helps me a lot, he knows my cases. He allows me to bring things into him that are sitting with me in a way. He’ll say, “Okay, I’m going to give you supervision for a minute” (she laughs). But, he’s been fantastic.

Drake’s analyst helped guide him out of a supervision that almost had him kicked out of his institute. His analyst knew his supervisor and validated that what Drake was experiencing was part of the supervisor’s personality structure.

I asked Bella if her analyst helped her with training and supervision. She, laughing, responded, “No!” Yet, she wished for more help. Her analyst did not give her supervision on her cases or guide her out of a supervision that was authoritarian. Her analyst did, however, work with her internal conflicts and helped her put to words what she was feeling. Her analyst encouraged her to have conversations with her supervisor that she struggled with. Once Bella realized her efforts with her supervisor were futile, her analyst helped Bella understand why she was staying in a relationship that she was ineffective with. This seemed to be an important experience that had a parallel process in Bella’s

life, as she found the words to talk to her husband and put boundaries around what she would not tolerate with her husband and her supervisor. In the end, Bella fired her supervisor and then divorced her husband. Her analyst did not supervise Bella’s cases, but her analyst helped her understand what her patients were stirring inside of her.

Eight candidates expressed rage towards their institutes that they then processed with their analyst. Many candidates received advice from their analyst on how to handle the complicated political climate of their individual institutes. Candidates reported complicated issues with curriculum changes, policy changes, archaic policies that need revision, feedback from progression committees, administrators’ interactions with the candidates, abrasive faculty comments from classes, such as condescending treatment or rudeness, and general institutional politics and in-fighting. The candidates’ analysts helped process all of the feelings involved within the structure of their institutes.

Debbie’s interview was different from the other candidates. She reported being very activated by her administration at her institute. Prior to her interview, she constructed bullet points and other material, anticipating what would be asked. She formulated some of these with her analyst. Debbie contemplated stopping her training, but her analyst assured her that this was part of the “crazy making of training” to become an analyst. She quoted her analyst, “Surviving the non-sense of the narcissistic needs of the leadership.”

The phenomenon of the analyst being the unseen guide in training arose as a subtheme. The sub-theme aligned with how groups of analysts analyze each other and align. They have done this by recommending their analysts as supervisors or their supervisors as analysts. Candidates tended to know who analyzed whom. As Melinda said, “Keeping it in the family.” This is congruent with Drake, Paula, Allen, Bella, and Michelle’s

interviews. Only one candidate, Aron, reported this dynamic as being destructive and polarizing within the politics and training of his institute. Ironically, when I was searching for candidates, I contacted a visiting professor, whom I had presented with in another state for leads on candidates for this study. The well-published training analyst had me visit to receive the list of potential candidates. I traveled by plane, sat down with this supervisor, and heard about the highly volatile situation within the institute. It was the same story from different perspectives, the student and the teacher. Both parties reported the polarizing effects of the division of an institute. Yet, between the two, when the system lacked political conflict, the candidates found a place of harmony.

Candidates reported being the most honest behind the couch Here, they found solace from supervisors, advisors, cohorts, institutional dynamics, and progression committees. They have reported that this has been safest place for them to be completely honest. The candidates also reported that their analyst have guided them through the turbulent emotional topography of training, including the challenges of their controlled cases, stalled cases, supervisors, progression committees, and institutes. Two candidates expressed that their analysts did not guide or advise them on how to maneuver the rocky terrain of training. Yet, these two candidates reported their analysts helped them put words to their situations, and the candidates eventually found their way to healthier solutions. There was some resentment for not receiving the same guidance as their peers. Although, as we saw with Bella, this approach appeared to be beneficial for the candidate in leaving an authoritative supervisor and, eventually, a toxic marriage. Hence, at the center of their training, the unseen guide to enable candidates to progress successfully into becoming an analyst, was their own analyst.

The Unseen Power and Support of Cohorts

Within their cohorts, candidates have accessed an unseen power. This is where information about supervisors, analysts, institutional dynamics, and grievances are passed along. With the help of their peers, this informal venue has helped candidates assess and review these individuals and groups. Mostly, when candidates have shared their reviews, either passively or openly, an informal review has taken place. As there is safety in numbers, candidates have been known to working with their cohort to address conflicts and concerns about their training to administrators. Additionally, within large cohorts, consisting of more than five candidates, friendships have been made, allowing some candidates to share personal challenges in training, normalizing their internal struggles through their regressive processes. The smaller the cohort, the less the candidates shared amongst themselves as a group. These smaller groups did not appear to socialize outside of their institutions within this set of candidates. They were less likely to know how each other’s supervision experiences were going and kept things private from the group. From this sample, the candidates did not discuss their opinions about their evaluations of courses, or the faculty teaching. The smaller groups also did not report any stories addressing concerns to administrators and faculty members. They also did not promote or advocate for change when they perceived things as challenging or unfair. It appeared that with greater numbers came greater experience. Besides a lack of numbers, smaller groups in this study lacked candidates that experienced previous setbacks and the knowledge of how to deal with them.

Most candidates knew their potential supervisor(s), even before they requested to go into supervision with them. As we have discovered, there are few secrets about the personalities of supervisors to candidates. Although, in progression committees, where there is a formal process and guidelines to review candidates’ work, it is the wild west for candidates reviewing supervisors, since most institutions lack a formal review process. In fact, there can be a brutal, harsh kind of honesty that is aggressive and/or destructive, that progression committees might frown upon. However, honesty has been known to be constructive and affirming, it basically comes down to the intent of the individuals providing the review or feedback. Candidates have turned to cohort members in their classes or other classes, for recommendations on potential supervisors.

In their stories or direct quotes, the candidates unanimously reported that training was not easy; however, they did not lament the workload or cost. If there was a critique, four candidates openly felt some of their in-class lectures were less than satisfying. Yet, I observed a strong undertone of the unknown, felt by the candidates going into training. Four candidates had almost the same quote, “There is no manual on how to be a candidate.” Candidates expressed a wish for a roadmap for being a candidate and approaching their training. They wanted to know how they should have approached supervision from the beginning, what they would feel, and the desire for a more sophisticated language only acquired after years of reading and training. Most of the candidates appeared to reflect on the unknowns of their painful discoveries. Five candidates openly shared that training is a regressive process. Four candidates volunteered that shame is inevitable as they dug within themselves, within their own self reflections, feedback from their supervisors, and what their patients stirred in them. Four

of the eleven candidates discussed failed cases and the pain attached to losing a case. In larger cohorts, the candidates could find some empathy, understanding, and shared experiences that reflected their own. Candidates tended to feel vulnerable in their analysis and being in a regressive process, this was often compounded further by having evaluations in supervision. One candidate said,

I’m already walking around feeling like I’m naked even when I know no one really knows what’s going on inside my head, but going into a supervision evokes more shame. I find it intolerable some days, even if my supervisor is supportive. In me, I know I bring so much in not knowing what seems so obvious to my supervisors.

Rachel said,

At about year three, a canceled class was cancelled so we went to Starbucks. We started talking, and we all felt somewhat crazy or off balance. I thought I was losing it. It was sorta’ funny, three of us were watching this gross, aggressive, sexual show about vampire called True Blood. We agreed that it was all the rage we were dealing with it in our analysis. A few others were watching similar aggressive shows like Blacklist and Criminal Minds. It sorta’ made me feel less crazy because I don’t even like sci-fi. It just normalized that we were all doing the same things and felt some level of destabilization at the same time. Some of us were gaining weight, some were working out compulsively. We were all looking for ways to emotionally regulate ourselves during a regressive time. In hindsight, I think we wanted to destroy some of the faculty. It’s just difficult work, but it’s more about being the one laying down. But both? It’s impossible training, and yet we have to act sane when it doesn’t feel

like it, ‘cause if we didn’t we’d probably be kicked out. It was a fluke we had that time together and we just opened up.

When discussing the vulnerability of training, and how tough it was, Kay said, “Why am I doing this?” She continued with, “Training is painful.” Paula said, “Being a candidate is a regressive process; it’s a vulnerable profession.” Rose said, “It was a return to the repressed child work.” Unlike their analysts, the candidates knew they were on an exploratory, new journey and in the terrain of their own psychology.

Rachel compared the days of ego psychology training to today and said, It’s a different path from the past. I’m glad those days are gone . . . we have a wiser group, or an evolved group of leaders, or this group of supervisors has changed what was done to them. Yet, the system still lingers with an authority where we have to do what we’re told. Generations change, I’ve changed. This is not the same path. Now it’s a choice to make less money, join a dying profession, and sign up to pay hundreds of thousands to become an analyst. It’s an expensive endeavor that is leaving me with a richer internal world. It’s what makes me a better clinician, who else has to do this work to hang up a shingle? No one really knows these days what a psychoanalyst is or what we do to be called one. Classes and supervision are the cheap part, time is the commodity that has no price. It takes a lot of time to do this impossible training.

The training has always been tough and some of the candidates discussed that asymmetry in power, in supervision, and being at the whim of their institutions’ changes outraged them. Yet, the balance is swayed in informal evaluations. Like Paula said,

We talk about good supervision, bad supervision, who to avoid, not to avoid, which professors you have or don’t have good experiences with in class. We know where the power is, who has it and who doesn’t. We have little (as candidates), and the only power we have is in our information exchange.

Candidates received some reprieve in telling their stories to each other. And, based on these accounts, it was easier for them to be in training with a larger cohort than a smaller one.

The disadvantaged candidates appeared to be in smaller cohorts. There were three candidates with cohorts of four and one candidate that had five, who was an outlier for these results, probably due to being online. Of the candidates in the groups of four, two of the candidates had one really good friend that they were close to. One candidate was not close to anyone in his cohort and information was not exchanged with anyone in class, but with a friend in another cohort. All of the candidates, out of the smaller cohorts, knew other candidates in other classes who they exchanged information with. What was remarkable was the one candidate that was in the group of five, was very scared in her interview. She was online mostly and did not get to know her class. The two candidates that were obviously the most scared in the interviews were the two that did not have anyone to exchange information with in their direct cohort.

One candidate, Sally, is an example of a participant with a small cohort who was isolated, and maybe a good example of someone who did not do well with online learning. Just before COVID, she came with a prepared script for my interview. She was very scared and nervous. She was the only candidate that stopped all communication with me after the interview. Her situation was unique at the time. She was online for most of

her training. My sense was she that had not met her supervisors in person and only met with her class occasionally. Her isolation appeared to affect the group dynamic of exchanging information. This stood out to me, recently, as I was attending a progression committee and the supervisors reported the disconnect the new candidates’ class was having with each other being strictly online. The class did not feel they could be as vulnerable with each other. I thought this was interesting since I was the class advisor and had not heard this feedback yet. But, it reminded me of Sally and her lack of feeling connected–again, this is my sense of her since she disappeared on me. I was not sure if it was COVID, but I do know how scared she sounded in the interview. Hence, information did not seem to travel to Sally, and she felt like she was figuring things out all by herself, compared to Allen, who had other candidates to connect with in different classes.

Candidates in smaller cohorts also did not seem know what the dynamics of their institutions were. They were not aware of infighting or disagreements. Although they did know which supervisors to reach out to or avoid, they did not know what class instructors made the material rich and who would put them to sleep. They did not have the permeable insight into the dynamics of the faculty.

With one candidate, it felt like her institute seemed to fall apart during her training. She started out in a big class then the candidates jumped to other institutes as she stayed to complete her training. She felt supported in the larger class, and they stayed in touch with her during her training. She received information from past classmates, since they were friends with her faculty members, and she continued to know the dynamics of her institute.

The other seven candidates had cohorts of six or more. These candidates were able to organize themselves when they had institutional changes and poor instructors they did not want to work with any longer. If they had faculty that said outrageous things, they had a group meeting with their designated faculty member and negotiated disagreements. One faculty member was kicked out of an institution and others left because of the power of the cohort.

Candidates with larger cohorts appeared to have better chances at changing undesirable circumstances, as Michelle pointed out, “There is power in numbers.” The candidates in larger cohorts met outside of their classes. Some ate at each other’s homes, others met at coffee bars, and had lunch or drinks after classes. This was where friendships and alliances were made. At the same time, this was also where candidates saw the more “autistic, narcissistic, and sociopathic” candidates that did not fit in. This observation did not include all of the candidates who did not engage socially outside of classes.

Candidates in larger cohorts made close friendships with whom they discussed even the more personal pieces of themselves and what they discovered in their own analysis. Some cohorts, in the same institutions, co-mingled with other cohorts. These groups did not appear to start off as a cohesive force, but their experiences of being “in it together” brought them together with other candidates they trusted. Bella spoke about a time she opened up and was vulnerable about a supervisor she was struggling with over dinner one night,

One of my cohort members told me in year three that if had she known me better, she would have told me to stay far, far away from him (the supervisor she had).

Everyone knows how he is and he has that type of reputation. This story indicated that it took a few years for some candidates to open up to each other.

One candidate said, My supervisor was the butt of our class jokes for a while when he was teaching. He is a good supervisor, but he must have been uncomfortable with group settings. I felt torn, wanting to defend him. But, he did say some pretty outrageous things about the frame and expressed these rigid ways you have to be as an analyst. Yet, he wasn’t that way at all in supervision.

I asked if he ever defended him. The candidate replied, Yes, in a way. I told them he was very different one on one and I recommended him. He ended up seeing a few of us, I wouldn’t say he’s a fit for everyone. He was a fit for me and my patient.

Summary

There has continued to be an unseen power in cohorts. This is where information is exchanged about supervisors, analysts, and faculty members. A continuous, informal evaluation process has continued passively, aggressively, openly, or quietly, and out of the sight of the faculty. Candidates in larger cohorts appeared to have safety in numbers. Here they were able to organize themselves over shared grievances to confront administration, normalize the unknowns of training, and validate training as a regressive

process. The candidates from larger cohorts also knew more about the institutional dynamics and conflicts within their institutions. In smaller sized cohorts, the candidates had more challenges and tended to feel isolated. Yet, they were able to find at least one comrade in their class to confide in, and they knew people in other classes. Candidates from either grouping were able to validate and normalize the regressive process of training together. The only isolated candidate who was online, was the most scared. She came with a script to discuss her experience, she appeared to be shaking, holding her script. She disappeared after the first interview. Such phenomenon would need further quantitative research to validate these findings, yet it is something to be mindful of as training in virtual settings and smaller class sizes becomes more prevalent

Surviving Training Openly and Honestly Is Convoluted

Every candidate in this study genuinely desired to be open and honest with their training supervisors. That does not mean that all candidates were open and honest, or even that all candidates desire to be. The candidates in this study desired having supervisors with whom they could share the complexities of their cases, talk about their mistakes without feeling judged or criticized. Candidates told stories of supervisors observing blinds spots. They would go back to the couch and their cases opened up, and they grew as analysts. A few of these candidates would share their deeper discoveries of what they learned about their countertransference issues that arose.

Candidates said they wanted to be able to be vulnerable in a safe place with someone they truly could trust. 7 of the 11 candidates said it was essential they have supervisors they could trust in their training. The other four candidates demonstrated the importance

of being open and honest with their supervisors in their stories. Every candidate felt they had at least two supervisors they could be open and honest with. Although, in listening to the recordings, they tended to have preferences based on the strengths of each supervisor for different issues. Nine candidates had at least one supervisor they were not as open and honest with, and this sometimes led to changing supervisors, or filtering the material to the supervisors’ ear, and/or mustering through supervision and not bringing attention to themselves. This finding in this study is supported by Cabaniss et al. (2001), who reported in their study that candidates had a 75% satisfaction rate in supervision and 25% wished they had different supervisors. 25% of the candidates were afraid to switch for fear of being labeled a problematic candidate. Katz, Kaplan, and Stromberg (2012) found that 80% of their candidates were happy with their training. Few studies have been done on the experience of the candidates’ training (Bosworth, Aizaga, & Cabaniss, 2009; Cabaniss et al., 2001; Ward et al., 2010). What was unique in this study versus Cabaniss et al. (2001) was how the candidates, themselves, were able to differentiate the supervisors they could be open and honest with. Nine participants reported they filtered information from at least one of their supervisors during training. The candidates were able to find their voices, described what worked for them, and knew why they did what they did to grow clinically and survive training. These candidates voiced their strategies and frustrations, who they trusted and why. This study expanded the research about candidates in training. The Cabaniss et al. (2001) study indicated that most of their trainees had concealed information that might have “un-analytic interventions,” and left out decisions modifying the frame of the patients. Richardson et al. (2020) acknowledged that if the candidates concealed information, the candidates were missing out on

opportunities to learn how to manage these modifications in response to the patient’s needs. In other words, they were paying a high price for not discussing the issues with their supervisors.

Many of the candidates in this study felt that being completely honest was imperative. Michelle said, “What works for me is if I can be honest. I am too established to hold things back, that doesn’t work for me.” Michelle wanted to go deeper into herself, which is supported by Richardson, Cabaniss, et al. (2020), pointing out that the candidates miss out on learning when they do not disclose their anxieties to their supervisors. Frawley-O’Dea & Sarnat (2001) noted that various supervision models have developed with theoretical and pedagogical changes and have altered supervision. Psychoanalysis started out with an authoritarian model, yet the real changes in supervision started with Kohut’s self-psychology model, adding empathy and understanding.

For Kay, the alliance was imperative, “It needs to feel safe, collaborative, the supervisor needs to be transparent, so you base the safety in the personal relationship.”

As I heard these passionate stories of honesty from the candidates about supervisors they trusted, I heard their voices lower in caution as they discussed other supervisors they had to filter information to. It was obvious that the candidates were irritated and/or scared they had to filter information. The candidates appeared to have little respect for the supervisors they had more conflictual relationships, especially when had to filter information.

Eckler-Hart (1987) supported why some candidates filter information. They interviewed clinical psychology graduates and concluded that there was a deep pressure

for the candidates to develop a “false, professional self.” Contrarily, when the candidate felt supported and not criticized, the candidate would bring in the anxious material from the candidate’s regressive states (authentic voices). After listening to the stories of these candidates, who were consciously aware of their shifts in strategies with different supervisors, on how open and honest were with different supervisors, two, almost similar questions arose: “Who is managing whom?” or “Who is containing whom?” The candidates in this study were well aware of their evaluation processes and had strategies to survive training.

George Bush (1969) wrote that he believed there were some narcissistic, controlling, and meddling supervisors. Juxtaposed with the idea of how to handle material left out, Richardson, et al (2020) indicated the need for candidates to bring in the material they are filtering, putting the responsibility on the candidate, instead of understanding the risk, and/or cost to the candidate, depending on the character or type of supervisor they have; a process that has left or allowed supervisors’ destructive/and or retaliatory instincts in their organization, which maybe they are assured enough that they do not. To cement this point further, I recalled reading a paper by Otto Kernberg (2006), in which he said, Supervisors must have the willingness and courage to express their critiques or misgivings directly to the supervisee. Supervisory reports should be discussed in such a way that the supervisee feels free to disagree with the supervisor without having to fear any negative consequences evolving from such a disagreement.

Although I support the idea that supervisors should read their evaluations to their candidates, I am not sure advising all candidates to disagree with their supervisors, in this day and age, is wise based on the interviews from this group of candidates. As we saw in

Drake’s case, when he confronted his supervisor over his misgivings and was almost kicked out of his institute. Hence, it has appeared that a candidate’s openness and honesty may depend on their supervisor’s and progression committee’s capacity to hold two minds and contain conflicts. In the Columbian research on the supervisory dyad, the research uncovered tensions related to the subject of progression (Cabaniss, Glick, & Roose, 2001). The candidates were afraid that they would not get credit for their cases (Cabaniss & Roose, 1997), and stayed in difficult supervision (Cabaniss, Glick, & Roose, 2001). I think it would be unfortunately idealistic, at best, to think of Kernberg’s (2006) approach, or Richardson’s, et al. (2020), would go well for all supervisees, heeding their recommendations to openly disagree with certain supervisors. I do think they have valid points, and with certain supervisors, these could be solid recommendations. In an idealistic and utopian, psychoanalytic world, theoretically, these recommendations might work. Unfortunately, according to this research, some candidates needed to weigh in on who their supervisors are and what capacity they have to contain disagreements. Some supervisees have needed time to work their issues out, on the couch, with their own analyst, on how to proceed in such sensitive situations. Karen Marosda (2002) wrote “Self-Disclosures and Vulnerability: Countertransference in Psychoanalytic Treatment in Supervision.” She pointed out that, “. . . many analytic candidates are painfully aware of their supervisor’s flaws and narcissism, but feel compelled to play along so that there are no impediments to their graduation.”

The Array of Different Personality Structures and Strategies of Candidates

The beauty of these interviews was the array of personalities I was able to meet. I would say most of the candidates had tendencies to be obsessional, which I think is what it takes to become MD’s, PhD’s, and social workers Some candidates felt they needed to tell their supervisors everything about themselves, family histories, countertransference issues, even though they appeared anxious to be so vulnerable. These candidates tended to search for heartfelt paths with “wise mentors,” and wanted to go deeper within themselves. In their recordings you could hear passion, disappointments, wishes, and curiosity about themselves. I heard rich, inner lives filled with more freedom, which would be supported by the Greek interpretation of honesty. Yet, even with these more open type candidates, I could hear them switch to a reserved stance when they discussed a difficult supervisor and had to filter information.

There were also candidates that were more reserved with their supervisors, leaving their countertransference issues with their analyst, seeking deeper learning experiences with their analysts. Their stories showed that they were also able to be vulnerable, when they had impasses, and were very open and honest about what was happening in the consulting room, also with me. They went to their analysts to figure out their countertransference issues privately. One candidate reported that they went back to their supervisors, after they worked with their analyst, and informed them that their father was an alcoholic, since this was important in the treatment that would be helpful to the supervisor and the treatment. Another candidate kept her husband’s self-destructive state out of her supervision because she was worried about being judged by the progression committee. Yet, after working with her analyst, she ended going to one of her

supervisors, confiding the situation when she knew it created blind spots in the case, similar to her own life, that she was treating.

As Helen exquisitely articulated, she did not have a psychoanalytic language to communicate everything that was happening in the consulting room or in the supervisory space, a subject in the complications of learning that would be worth researching further. What I noted was that two of the more reserved candidates processed their loss of cases with me, which at the time they had not discussed with their supervisors. The void, in some of the more contained candidates, was contingent on them withholding their internal worlds from their supervisors, which disallowed the candidates to know their supervisors’ internal worlds as well. Yet, this may be an unintended helpful strategy to progress through training easier. One approach or another, or a combination of approaches, has not appeared to be any better, depending on the needs, desires, and personality structures of the candidates themselves, if they have a good fit with their supervisors. With the more reserved candidates there were just as many tears and/or fears in their voices, and in their struggles during their interviews, as they opened up about their feelings they shared with their supervisors.

Joan Sarnat recently presented at a conference at The Center for Psychoanalytic Studies in Houston (March 5, 2022). She stated that authoritarian type supervision was passed down through generations and was built into the system, which warranted filtering with some supervisors. Wolstein (1984), brought up a conflict built within the psychoanalytic training system: supervisors report to progression committees and evaluate candidates. When a candidate has conceded to their supervisor, he did not feel that the supervisor should go back and inform the progression committee of the

candidate’s private life. He called these supervisors “tell-bearers.” I have sat in progression committees where supervisors disclosed private information while others guarded personal information. I knew a candidate who went through in-vitro, with little success, and her supervisor kept her information private during the progression review. I quietly watched as the committee was upset that she was taking too long with her training and wanted to consider making her a didactic candidate. At the following supervision meeting, the candidate was pregnant (quote Kat’s and women issues in training).

Something had played out and the committee could not accept or trust the supervisor informing the committee that they, the supervisor, supported the time needed, and there was private information.

There have been other reasons to be cautious when being completely transparent. Gabbard and Lester (2006) addressed teach-or-treat issues in supervision in their book, Boundaries and Boundary Violation in Psychoanalysis. Although there were no reports of this issue with this group of candidates in this study, the candidates reported that their supervisors would send them back to the couch to look at issues they thought might be impeding the case. Again, depending on the candidate, and the supervisory dyad, determined how open and honest candidates were in this research.

Wolves in Sheep’s Clothing

I sent out texts to different participants about my finding to fact check. I luckily made a big faux pas and texted them that “all candidates wish to be open and honest.” Three candidates instantly texted me back that not “all” candidates are open and honest. Later a fourth candidate called me about the text. All four had stories about candidates in

their classes or in other cohorts in their organizations. The candidates gave stories from their institutes with more “narcissistic candidates” that seemed to “con,” “seduce,” or “flatter,” the faculty, or use “academic banter.” The candidates gave examples of how they knew the candidates were not giving the full stories on their cases. They reported that these candidates did not have the same graduation requirements and only had done a few years of their own analysis. One story mentioned a candidate that had only been seen twice a week until they graduated. These candidates were “special,” “gifted,” and had some talent, such as writing, or having prestigious employment or research. These types of students were easily pushed through the system.

This information is supported by Reeder (2004), in his book, Hate and Love In Psychoanalytic Institutions. He discussed the suspicions that some analysts will have over the class system in organizations, and that one may be the object of self-doubt. He said the process begins with candidate selection, which manifests in the form of collegiality, characterized by hostility in a phenomenon he designates as “the pursuit of the psychopath,” which has been Reeder’s codeword for disapproving of analysts that use destructive measures against each other. He pointed out that there are true psychopaths in our profession. On Kernberg, Reeder (1986) stated that the psychopath’s distinctive characteristic is that they are so adept in hiding their psychopathy that no one could ever be sure, in selecting candidates, or training analysts, that the screening process can be totally effective, despite how many precautionary measures are taken (p. 831). Or, how “normal” or “healthy” a candidate may seem. This takes us back to Kay’s story. Her supervisor had ethical boundaries around him, as other institutes have experienced. Kay was very angry and believed his characterological structure was very grave, and she fired

him. Her story has been supported by Gabbard’s article “On Knowing but Not Knowing in the Aftermath of Traumatic Betrayal: Discussion of Paper by Dianne Elise” (2015), which was about the paralysis and uncertainty of the new analyst and the disillusionment across the spectrum of the community. Despite every candidate’s desire to be open and honest in supervision, it has appeared that openness and honesty continues to be complicated and convoluted in this study.

Appendix A

Email Invitation to Participate in Study

Hello!

I’d like to invite you to participate in a study of how open and honest psychoanalytic candidates in training feel they can be with their supervisors. I am a recent graduate of the psychoanalytic process and a PhD candidate at the Institute of Clinical Social Work. This study is part of that goal, and also a way to meaningfully pass on to supervisors and supervisees an understanding of what trainees need in order to be able to be open and honest during supervision.

Participation would consist of one 45-60 minute-long in-person interview at a location convenient to you. The interview would be followed by a second shorter interview either in person, VSee, or a phone call. Then you will receive, if you wish, the written transcription pertaining to your interview to make sure that the information you reported is accurately captured. Your responses would be kept strictly confidential. The three attachments are the informed consent statement, the flyer, and the interview questions. I’d be happy to answer any questions you have. Please email me back or phone if you are interested in discussing the possibility of participating.

Kacie Liput 832.875.2724

Appendix B

Informed Consent Letter

Institute for Clinical Social Work Research Information and Consent for Participation in Social Behavioral Research an Exploration of Openness in Psychoanalytic Supervision

I, , acting for myself, agree to take part in the research entitled an Exploration of Openness in Psychoanalytic Supervision.

This work will be carried out by Kacie Liput (Principal Researcher) under the supervision of Dr. Dennis Shelby (Dissertation Chair or Sponsoring Faculty)

This work is conducted under the auspices of the Institute for Clinical Social Work at Robert Morris Center, 401 South State Street; Suite 822, Chicago, IL 60605; (312) 935-4232.

Purpose

The purpose of this phenomenological study is to explore the experience of how honest psychoanalytic candidates feel they can be with their training supervisors. This is a complex relationship since (a) the candidates pay for the supervision, (b) the supervisors must eventually give approval that the candidates are ready to be certified as a psychoanalyst, (c) the evaluation process in supervision creates asymmetry in the system, so those involved cannot escape power dynamic issues, and (d) analytic training takes anywhere from 4 to 8 years or more (according to a conversation with the APssA head office May 4, 2016). This research is significant to clinical social workers and other mental health professionals, in that it will provide new information about psychoanalytic supervision that will allow them to better understand what is often viewed as a complex and secretive process.

Procedures Used in the Study and Duration

After you have agreed to partake in the study, you will be sent the Informed Consent Form and Study Questionnaire. Once these have been returned, your interview will be scheduled. You will be interviewed at least once, and at maximum twice, in your chosen surroundings either in person or via VSee or phone. VSee is video conferencing software used by NASA and medical practitioners. It is HIPAA compliant and free to download. The first interview will last 45-60 minutes, with the duration of the second interview

determined as needed (but not exceed 45 minutes). With your permission, interviews will be audiotaped using a digital recorder, with audio files then transcribed by a professional service using a pseudonym of your choosing. Transcripts of interviews will be shared between the study’s principal investigator, dissertation chair, and dissertation method’s chair. Prior to your second interview, I will email or mail detailed themes and descriptions gathered from your first interview for you to make note of any comments or questions you have regarding accuracy and clarity. This data will be sent to you via a password-protected file.

Benefits

It is hoped that this research will contribute to the understanding of how openness plays out in psychoanalytic supervision, so one possible benefit of the study will provide insight into the experience of supervision from the candidate’s perspective. A second benefit will be to fill a gap in the literature, as there is currently little research related to psychoanalytic supervision that presents the supervisee perspective.

Costs

There are no costs associated with participation in this study. There will be no financial remuneration for your participation in this study.

Possible Risks and/or Side Effects

This research poses minimal potential risk to you. Any such risk would be associated with possible emotional discomfort as a result of discussing personal perspectives and feelings about supervision. You will be asked personal questions about your supervision in this study and will be notified during the pre-interview process to expect such questions. You reserve the right to refuse to answer any questions at any time during the course of the study, and you are encouraged to share information deemed relevant and safe to your emotional well-being and comfort. Should you experience strong reactions during the data gathering experience, and still wish to continue in the study, professional therapeutic help will be provided at your request. If you experience strong reactions and no longer wish to participate in the study, professional therapeutic help will be provided at your request, and the principal researcher will provide you with a full debriefing.

Privacy and Confidentiality

All data you provide for this study will be identified through a pseudonym that you will choose when filling out the initial study questionnaire. Under no circumstances will you be identified by name at any time during this research study or in any publication thereof. Data from the study will be coded and securely stored on the principal investigator’s private computer, which is password protected and kept behind locked doors and a digital security system. Transcribers and dissertation committee members will be required to sign agreements regarding confidentiality. Files passed back and forth between the principal investigator and dissertation committee will be password protected and sent

only through the Institute for Clinical Social Work’s email system. Audio files containing data will be destroyed upon final completion of the research. All other data will be maintained for period of 5 years in a secure location, after which all files will be destroyed.

Use of Results

This research study is to be submitted in partial fulfillment of requirements for the degree of Doctor of Philosophy at the Institute for Clinical Social Work, Chicago, IL. The results of this study will be published as a dissertation and may include verbatim extracts of your narratives. In addition, information may be used for educational purposes in professional presentation(s) and/or clinical publication(s).

Subject Assurances

The following is the format that should be followed in creating the assurances: By signing this consent form, I agree to take part in this study. I have not given up any of my rights or released this institution from responsibility for carelessness.

I may cancel my consent and refuse to continue in this study (or take my child out of this study) at any time without penalty or loss of benefits. My relationship with the staff of the ICSW will not be affected in any way, now or in the future, if I (or my child) refuse to take part, or if I begin the study and then withdraw.

If I have any questions about the research methods, I can contact Kacie Liput (Principal Researcher) or Dr. Dennis Shelby (Dissertation Chair/Sponsoring Faculty), at this phone number 832-875-3724.

If I have any questions about my rights as a research subject, I may contact Dr. John Ridings, Chair of Institutional Review Board; ICSW; At Robert Morris Center, 401 South State Street; Suite 822, Chicago, IL 60605; irbchair@icsw.edu.

Signatures

I have read this consent form and I agree to take part in this study as it is explained in this consent form.

Signature of Participant Date

I certify that I have explained the research to (Name of subject) and believe that they understand and that they have agreed to participate freely. I agree to answer any additional questions when they arise during the research or afterward.

Signature of Researcher Date

Recruitment Script

Hello,

My name is Kacie Liput and I am conducting a research project on the openness of psychoanalytic candidates in supervision. I have recently graduated this last year from being a candidate, but the struggles of being a candidate are still fresh. I am hoping that my research will positively impact the supervision dyad. In 2015, I wrote an article in the Candidate’s Newsletter on “Supervision From a Candidate’s Perspective.” The article I wrote and the research I am going to conduct was inspired by my own struggles in supervision. How open and honest I was with each supervisor was different depending on different variables. I am wondering what contributes to the phenomenon of being open and honest with one’s supervisor. All participants’ identities will be kept confidential with no identifying information divulged. I am looking for specific aspects to study, and the following questions are asked to see if you are a good match to participate.

a. Are you at least a 2nd year candidate?

b. Do you have at least two active cases?

c. Would you be willing to participate in one interview in person and a follow-up interview via phone call or VSee and then read any material pertinent to you to make sure information is accurate and that there is nothing you feel that would identify you in the transcription?

If your answer is yes to each of these questions, I will send out the letter of consent, the recruitment flyer, and the interview questions to be asked.

Appendix D

Interview Questions

The first five questions require only brief response, maybe a minute or less, for demographic information that will be used to describe the characteristics of the interviewees as a group. Care will be taken to give no combination of information that could be used to identify any particular respondent, and you will have an opportunity to view the write-up of results to mandate changes, including deletions or additions to any of your responses.

1. Age range: 18-30, 31-40, 41-50, 61 and over (circle one)

2. Gender: 3. Year of supervision:

4. Number of supervisors you have trained under:

5. Gender(s) of supervisors you have trained under:

Today’s date: ___________. Give yourself a two-initial pseudonym that is not your real initials: ______

Start recording at this point if consent is given, and speak into the recording the pseudonym initials to link the recording with the correct demographic information.

Appendix E

Icebreaker Open-Ended Questions

1. How is your experience as a candidate thus far?

2. How has your supervision been going thus far?

3. How would you compare your current supervisorial strategies?

4. Which strategies work best for you?

5. How do you and your supervisor(s) discuss your countertransference?

6. Have you had to discuss any difficulties about the supervision?

7. How do you and your supervisor discuss their process of evaluation of you?

Recruitment Flyer

VOLUNTEERS NEEDED FOR RESEARCH ABOUT PSYCHOANALYTIC SUPERVISION

• Are you at least a second-year psychoanalytic candidate?

• Do you have at least two active controlled cases?

• Do you have personal insights about psychoanalytic supervision that you would like to share?

If you answered yes to these questions, you may be eligible to participate in a study for people who have stories to tell about their supervisory experience. The purpose of this study is to research the experience and meaning of openness in psychoanalytic supervision.

Participants will be compensated $20 per interview. Up to two 1-hour interviews may be required.

Interviews will be conducted face-to-face at a location convenient to you or through an online meeting software called VSee.

Confidentiality is assured

This study will be carried out by Kacie Liput LCSW, LCDC (Principal Researcher), supervised by Dr. Dennis Shelby, LCSW (Dissertation Chair), and under the auspices of the Institute for Clinical Social Work, 401 S. State St., Ste. 822, Chicago, IL.

Please contact Kacie Liput at kliput@icsw.edu or 832-875-3724 for more information.

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