Int J Psychoanal 2005;86:1099131

Approaching countertransference in psychoanalytical supervision:

A qualitative investigation1
a

JAC ZASLAVSKY,2 bMARIA LCIA TIELLET NUNES and cCLUDIO LAKS EIZIRIK
Av. Taquara, 572/301, 90460-210 Porto Alegre RS, Brazil jacozas@terra.com.br Rua Vicente da Fontoura 2539/104, 90640-003 Porto Alegre RS, Brazil tiellet@pucrs.br c Rua Marques do Pombal,783/307, 90540-001 Porto Alegre RS, Brazil ceizirik.ez@terra.com.br (Final version accepted 5 August 2004)
a b

A recent examination of the literature concerning countertransference and its developments reveals its clinical usefulness in different psychoanalytical cultures. Nevertheless, a shortage of publications is apparent with respect to its approach in supervision. The authors aim in this study was to examine the concepts of transference and countertransference and how countertransference is approached in supervision, in the training of candidates, at an institute of psychoanalysis belonging to a society afliated to the International Psychoanalytical Association (IPA). Qualitative research was carried out, interviewing supervisors and supervisees. Through analysis of the material acquired, the authors classied the data into initial, intermediate and nal categories. The principal ndings were subdivided into three categories: the concepts of transference and countertransference, psychoanalytical listening and the complementarity of the phenomena, and the approach to countertransference. The concepts of transference and countertransference predominantly used by those interviewed are based on the totalistic outlook. Countertransference in supervision has been approached in a more direct and objective way when compared with the previous period, although great care is taken to delimit the boundaries between supervision and personal analysis. The main aim of supervision is to broaden comprehension and to deepen the interpretations directed towards the patient. These ndings suggest that the evolution of the concept of countertransference in different psychoanalytical cultures and developments in the analytical eld are contributing to this change. Keywords: countertransference, education, qualitative research, supervision, training

Introduction

The aim of this paper is to identify, describe and examine the approach to countertransference in psychoanalytical supervision carried out in analytical
This article is a summary, adapted from a masters dissertation for the Postgraduate Programme in Medical Sciences: Psychiatry of the Faculty of Medicine of the Federal University of Rio Grande do Sul, presented in September 2003. Translated by George Nurse. 2 Corresponding author.
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2005 Institute of Psychoanalysis

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training by an institute of a society afliated to the International Psychoanalytical Association (IPA). Psychoanalytical training is founded on three basic pillars: didactic analysis, theoretical seminars and supervision. Various authors have already emphasised the importance of supervision in the teachinglearning process of the psychoanalytical technique (Balint, 1948; Arlow, 1963; De Bell, 1963; Fleming and Benedek, 1966; Grinberg, 1970, 1975; Solnit, 1970; Gaoni and Neumann, 1974; Wallerstein, 1981; Blomfield, 1985; Eizirik and Zaslavsky, 1989; Szecsdy, 1990a, 1990b, 1997; Eizirik, 1991; Mabilde, 1991; P.M. Machado, 1991; Soares, 1991; Jacobs et al., 1995; Vollmer and Bernardi, 1996; Brito, 1999; Zaslavsky, 1999; Zaslavsky et al., 2002, 2003). In recent years, an increasing number of studies have examined the usefulness of countertransference as an indissociable element of transference in analytical work (Racker, 1948, 1953, 1958; Baranger and Baranger, 1961, 1992; Kernberg, 1965, 1993; Manfredi, 1994; Grinberg, 1997a, 1997b; De Bernardi, 2000). However, the literature on the approach to countertransference in psychoanalytical supervision indicates a scarcity of specific bibliography (Anderson and McLaughlin, 1963; Goin and Kline, 1976; Blomfield, 1985; Eizirik and Zaslavsky, 1989; Eizirik, 1991; Grinberg, 1995, 1997b; Coburn, 1997; Zaslavsky, 1999; Jaffe, 2001). Countertransference has been correlated with developments in the psychoanalytical eld, enactment and intersubjectivity, by various analysts of separate schools (Baranger and Baranger, 1961; Jacobs, 1986; Ferro, 1991, 1993, 1997a, 1997b; Ogden, 1991, 1994a, 1994b, 1994c; Manfredi, 1994; Dunn, 1995; Gabbard, 1995; Zaslavsky, 1997; Renik, 1998). In a recent examination of the concept and evolution of countertransference, Hinshelwood (1999), Jacobs (1999), De Bernardi (2000) and Duparc (2001) have emphasised its principal historical and present-day characteristics, linked to the different psychoanalytical cultures.
Countertransference in supervision

The comprehension and utilisation of transference and countertransference are singled out as essential elements in the application of the psychoanalytical technique, deserving special attention in supervision (Eizirik and Zaslavsky, 1989; Eizirik, 1991; Eizirik and Arajo, 1997; P. M. Machado, 1991; Gabbard, 1995; Grinberg, 1995, 1997a, 1997b; Vollmer and Bernardi, 1996; Coburn, 1997; Zaslavsky, 1999; Kernberg, 2000; Zaslavsky et al., 2002, 2003). A recurrent polarisation exists between two attitudes in supervision, one known as didactic and the other experiential (Abuchaim, 1996; Fleming and Benedek, 1966). This leads us on to examining the different models of supervision and countertransference.
The methodological models of supervision and countertransference

Starting from the contributions of Fleming and Benedek (1966), Ekstein and Wallerstein (1958), Abuchaim (1996), Vollmer and Bernardi (1996), Mabilde (1998),

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Frawley-ODea and Sarnat (2001), it is possible to describe three methodological methods of supervision and, for didactic purposes, to group them in accordance with what is observed in Table 1.
Table 1 Methodological models of supervision (Zaslavsky et al., 2003)
Description of the models Models Supervisee x Presents the material to the supervisor Classical or demonstrative Supervisor x Constantly demonstrates the technique x Transmits a range of knowledge x Shows in his interventions how analysis would be performed and the interpretations which would be formulated x Bases him/herself on the classical model x Performs moment-by-moment corrections to the interventions and to how they are understood x Points out errors and adjustments x Appraises the unconscious aspects, but lets the supervisee lead on spontaneously towards his analysis Focus

Patient-centred

Corrective or communicative

x Presents the material in a very detailed way x Appraisal of the unconscious aspects x His unconscious aspects are spontaneously guided towards personal analysis

Superviseecentred

x The supervisor participates at an empathic level in the experience of apprenticeship of the supervisee x The supervisor uses his own self as an instrument for developing in the supervisee the essential functions of an Comprehensive, analyst relational or x Observation of the supervisorsupervisee interaction as a experiential way of understanding the patient x Transference and countertransference are approached directly in the supervision x The supervisor indicates what the supervisee should take to his analysis, and when

Centred on the interaction of the pair

In practice, the three models are complementary. Nonetheless, in recent years a tendency has been observed for the comprehensive or experiential model to predominate, which appears to be related to the growing inuence of valuing of phenomena which occur in the psychoanalytical eld, of the utilisation of the transferencecountertransference relationship and a consequent valuing of the interactional aspects of the analytical pair (Cruz Roche, 1991; Dunn, 1995; Ferro, 1995; Zaslavsky, 1997; Zaslavsky et al., 2003).
The phases of the supervision and the countertransference

The viewing of phases of the supervision is an exercise in articial systematising with didactic or expository endsa process which is continuous and which

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presents innumerable variables, frequently described as developing in three periods: initial, intermediate and nal (Fleming and Benedek, 1966; Grinberg, 1975; Dewald, 1987; Cruz, 1991; Jacobs et al., 1995). Its characteristics are classied in Table 2.
Table 2 Phases of the supervision (Zaslavsky et al., 2003)
Phases Objectives of the supervision 1. 2. Initial 3. 4. Intermediate 1. 2. 1. 2. 3. listening with floating attention learning how to infer interpretations of the latent meaning, but not yet formulate them, i.e. to develop the integrative function learning how to appraise the degree of resistance and anxiety presented by the patient and to develop empathy with his regressive state (sensitive function) formulating interventions, even in a predominantly imitative way judging the moment and the intensity of the responses and interventions grasping the transferential and countertransferential reactions as thoroughly as possible recognising the dynamic boundaries and the changes from session to session recognising the insight, the elaboration and the possibility of termination increase of autonomy, independence in relation to the supervisor and expression of a greater creative capacity

Final

Consequently, supervisees and supervisors appear to be more capable of approaching and, principally, of deepening the examination of transference and of countertransference at an intermediate stage of supervision, which, however, is not equivalent to saying that this stage should be expected to approach it.
Supervision, countertransference and researches

Few studies systematise the instruction and the apprenticeship in psychoanalytical technique in supervision (Zaslavsky et al., 2003). Though supervision may be utilised in practically all the institutions of psychoanalytical education, it is rarely researched (Szecsdy, 1990a). Among the authors who have researched supervision Fleming and Benedek (1966), Gross-Doehrman (1976), Wallerstein (1981), Szecsdy (1990b) and Brito (1999) may be mentioned. Various authors emphasise serious methodological difculties (Fleming and Benedek, 1966; Szecsdy, 1990a, 1990b). Obstacles are described, such as collecting material for study and a lack of research instruments capable of investigating the proposed objectives quantitatively. Fleming and Benedek (1966) have taken advantage of recordings of their own activities as supervisors. Preoccupied with discrimination between learning and teaching, they concluded that the theory of supervision ought primarily to be a theory of teaching before one of apprenticeship. The impact caused by supervision on the therapeutic process was studied by GrossDoehrman (1976). He suggested that the resolution of neurotic reactions or parallel processes3 produces progress in the supervisee and is therapeutic for the patient.
Searles (1955) originally described parallel processes as being the repetition in the relationship of the supervisor with the supervisee of the conicts and the difculties that occur during the therapeutic process.
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The principal ndings observed by Szecsdy (1990b) were that apprenticeship in supervision is a complex process which depends on the quality of the connection between supervisor and supervisee; and what is taught by the supervisor depends on his own clinical experience, sensitivity, intuition, and on the supervisors and supervisees defensive patterns. He also demonstrated the frequent occurrence in supervision of parallel processes or neurotic resonance. Among the reasons indicated for the occurrence of learning problems are lack of aptitude and knowledge, and the interference of unconscious conicts as much from the supervisee as from the supervisor. Brito (1999) carried out a qualitative research study, The transmission of psychoanalytical knowledge through supervision, which included interviews with supervisors and supervisees. His principal ndings were: (a) psychoanalytical supervision is seen as a teachinglearning process; (b) the process of supervision is inuenced and at a certain point determined by the institutional life; (c) there is intense emotional and interpersonal involvement, mobilising conscious and unconscious sentiments between supervisor and supervisee; (d) both highlight the fundamental importance of the personal style and skill of the work of the supervisor as a prominent element of the teachinglearning process in the supervision. According to Brito (1999), a divergence of attitudes exists about how much work is to be carried out in relation to countertransference. Among the supervisors, there is a tendency not to emphasise, and work on and with, the countertransference of the supervisee. On the other hand, the supervisees have expectations of exposing their intimate emotional experience, a fruit of their relationship with the patient, and wish their countertransference to be more explored by the supervisor, since they recognise the value of these communications. The supervisees feel frustrated by the meagre intervention of supervisors in that respect.
The approach to countertransference in supervision

One of the most controversial questions with respect to supervision concerns the boundaries between supervision and analytical treatment (De Bell, 1963; Lebovici, 1970; Eizirik and Zaslavsky, 1989; Rubinstein, 1992; Grinberg, 1995, 1997b; Zaslavsky, 1999). In the literature reviewed, there exist two tendencies adopted by analysts with respect to an approach to countertransference in supervision. In the rst position, defended by Grotjahn (1955), Keiser (1956), and Ekstein and Wallerstein (1958), the analyst-supervisor, should it become necessary, would in supervision treat some of the aspects of the unconscious and of countertransference of the supervisee. The position that at least one case should be supervised by the training analyst himself is recommended by Grotjahn (1955). Along the same lines, Ekstein and Wallerstein (1958) emphasise that, to the extent that the candidate is free of his unconscious conicts, he acquires the capacity to use his own self and unconscious, and thus that the technical apprenticeship should not be separated from his therapeutic experience, which constitutes an additional and different problem in his training. In the second position, supervisor and analyst would take on different tasks; this would not t with the supervisor treating the unconscious motivations of the

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supervisee, and this task would be left to the analyst, according to the tradition of the Berlin (or Vienna) school. For De Bell (1963), neither of these two positions is sustainable. He suggests that systematic interpretation is not a task of the supervisor but nevertheless does not reject the possibility that this may occasionally happen. The trend in the specic bibliography favours the second position, and is shared by Anderson and McLaughlin (1963), Solnit (1970), Gross-Doehrman (1976), Blomeld (1985), Szecsdy (1990a, 1990b, 1997), Eizirik (1991), Rubinstein (1992), Vollmer and Bernardi (1996), Eizirik and Arajo (1997), Mabilde (1998), Zaslavsky (1999) and Zaslavsky et al. (2003). These authors maintain that the discussion of the countertransference is useful for broadening the comprehension of the patient in question, acquiring greater capacity and depth in interpretations, and these skills are generally attained at more advanced stages of the supervision. Meanwhile, the discussion about the boundaries between supervision and analysis resurfaces each time the work becomes limited when faced with the emergence of emotional conicts during the process of supervision. The concerns pointed out by the analysts who defend the second position are varied. Grinberg (1995, 1997b) maintains the position that supervision is a process of a cognitive-affective nature in which the interventions of the supervisor ought to favour the learning of the candidate. Based on Bion (1962a), he considers learning from experience in the supervision as essential for the development of an emotional experience capable of producing behavioural changes in the supervisee. Among us, some authors conceive supervision as a teachinglearning process, leading on to attempts to avoid deviations from that objective (Eizirik, 1991; Mabilde, 1991; Schestatsky, 1991; P. M. Machado, 1991; Vollmer Filho and Bernardi, 1996; Pechansky, 1996; Zaslavsky and Brito, 2004). Meanwhile, they do not exclude the perception of intrapsychic conicts and countertransferential situations in working with this material from the supervisee, with the aim of broadening the comprehension of transference and formulating interpretations to the patient. Owing to the possibility of aspects of the personality of the supervisee entering on to the scene, and the risk that the supervision will be transformed into treatment, it is recommended that the supervisee should be under personal treatment when countertransferential feelings are about to be broached (Goin and Kline, 1976; Greben, 1979; Gauthier, 1984; Zaslavsky and Brito, 2004). The approach to countertransference in supervision ought to start, in principle, from the supervisee, a task that will be facilitated when he is under treatment (Eizirik and Zaslavsky, 1989). The understanding of transference and countertransference, according to Eizirik (1991), is an important route towards comprehension of the object relations and the internal world of the patient. The uctuations in the relationship, from subtle to more crude manifestations, are also focialongside the verbal and behavioural expressionsof observation of the supervisor/supervisee pair for understanding of the case under study. Therefore, various authors (Fleming and Benedek, 1966; Grinberg, 1970, 1975; Eizirik, 1991; Mabilde, 1991; Zaslavsky, 1999) draw attention to the utility of the establishment by the supervisor of a contract (verbal) of supervision with the

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supervisee, setting out the specic terms of a framework. Ruptures in or deviations from this framework may be expressions of countertransferential aspects or of parallel processes. Clarity about the cognitive-affective nature of the process of supervision, and about the multiple functions exercised by the supervisor, are important, according to Szecsdy (1990b, 1997) and Vollmer Filho and Bernardi (1996). In that sense, Zaslavsky (1999, p. 130) stresses the role of the supervisor as a guardian of the supervision process in order to indicate, if necessary, that personal aspects may be removed to the most appropriate place, within the respective limits of supervision and analysis. The various factors that inuence psychoanalytical supervision, according to the literature reviewed, are also useful in the approach to countertransference and are set out in Table 3.
Table 3 Factors that inuence the psychoanalytic supervision process (Zaslavsky et al., 2003)
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. The teachinglearning process as being of a cognitive-affective nature. The multiple functions of the supervisor as a model of identification, ethical values and guardian of the process. The development of a learning alliance, also known as a functional alliance. The delineation of a framework including a contract (verbal), making explicit the form of work, the timetables, fees, the writing-up of the sessions as dialogues and with a copy for both. The relationship between supervisor and supervisee: motivation, empathy and affectivity. The theoretical referential of the supervisor. The character traits of both. The intuitive capacity of both. The approach to transference and to countertransference. The models and the phases of the supervision.

Methodology
Participants: Inclusion criteria

A cross-sectional study was carried out (Bardin, 1977, p. 66) in which the participants (subjects) were selected by the criteria of intentionality and convenience, known as the intentional sample (Guba, in Castro, 1994, p. 59), within the macrocosm of didactic analysts, supervisors and supervisees (candidates) of the Institute of Psychoanalysis of a Society affiliated to the IPA. In the selection of the supervisors, these were considered according to accessibility of contact, knowledge and personal experience of the interviewee about the process of psychoanalytical supervision. Those supervisees who had already completed the first and second case of supervision in psychoanalytical training were included. All the supervisees and supervisors agreed to participate in the research.

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Subjects

The concepts of transference and countertransference were studied, as well as where, when and how countertransference comes to be approached in psychoanalytical supervision, and in what way it can have an inuence on the teachinglearning process in psychoanalytical technique among those interviewed.
Data collection

In this qualitative research, semi-structured interviews were carried out, according to a schedule of open questions that allows the person interviewed free association on the questions posed. The schedule had been tested earlier. The number of participants was dened by the saturation or repetition of the data, which according to Guba is repetition of the focus in a study, which determines its limits (Guba in Castro, 1994, p. 62). There were a total of eight interviews: four supervisors and four supervisees. Supervisors and supervisees had been informed previously, by means of a consent form, about the aims and structure of the study, including the use of audio recordings and ensuring the anonymity of the interviewees.
Data analysis

Data analysis was carried out through the Method of Analysis of Content, in which any forms of communication, written or spoken, are subject to analysis of content (Kude, 1997). The method consists in classifying the different elements of a text according to criteria that can permit arrangement in a certain order. Its objective is to discover or learn patterns, nuclei of meaning that put together the communications of the subjects being researched and give information relating to the research question. When the aspects researched had not been approached spontaneously in an interview, they were included or examined at the end of the interview. The citation or non-citation of any element was also useful for the data analysis. Smiles, slips, silences, constraints, confusions or other reactions were observed, to obtain clues about the importance or not of a particular factor. The analysis of the contents of the interviews was processed using Bardins (1977) model, as described by Moraes (1999), consisting of ve stages: (1) preparation of the information: identication by reading the interviews to be analysed and coding the materials; (2) unitarisation or transformation of the content into units of meaning: rereading and classication of the units of meaning (UM); (3) categorisation or classication of the units into categories: grouping and classication of the units of meaning by similarity or analogy to form the thematic categories, taking into account the category of homogeneity and giving rise to the nal categories; (4) description of the ndings: communication of the results through a summary text, including the citations from the original data of the interviews; (5) interpretation of the ndings: comprehension of the manifest and latent contents, foundation and theoretical construction of the meaning expressed in the categories.

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The analysis of the contents was observed and validated by two judges, who participated in the discussion of the ndings. The 682 UM encountered were codied and grouped, amounting to 41 initial categories (Tables 47). In the description of the ndings, the principal ideas of each category are condensed, accompanied by passages from the interviews that illustrate the main idea of the text, along with the identication of supervisor and supervisee. The initial 41 categories were grouped anew, giving rise to 13 intermediate categories (Tables 47). Subsequently, working with these categories, it was possible to rearrange them into three nal categories. Sixty-two UM were rejected, corresponding to 9.2% (by convention up to 10% is acceptable) of the initial verbal statements in the study, because they did not t into the nal categories.
Description of the ndings

The ndings were described in three nal categories (Tables 47) according to: (1) the concepts of transference and countertransference: 134 UM (19.9%); (2) psychoanalytical listening and the complementarity of the phenomena: 92 UM (13.5%); and (3) approach to countertransference: 394 UM (57.7%).
The concepts of transference and countertransference

In this category, 134 verbal statements (UM) were selected and grouped into three intermediate categories: the concepts of transference and countertransference, working with transference, and countertransference as being essential but difcult (Table 4).
Table 4 Category: The concepts of transference and of countertransference
Initial categories the concept of transference is important (12) transference is a total situation (10) repetition of the object relations (8) the past in the present (6) the concept of countertransference (14) the patient attributes roles to us (8) totalistic concept (9) specific concept (2) Intermediate categories 1.1 Transference (36) Final category 1 The concepts of transference and of countertransference (134)19.6%

1.2 Countertransference (67) 1.2.2 A concept in itself (33)

neutrality is relative (10) being ethical is fundamental (14) the analyst ought to be neutral in relation to the conflict (8) one cannot be neutral towards a person (2) working with transference and countertransference is essential and effective (19) working with transference and countertransference is difficult (12)

1.2.2 Relationship with neutrality and ethics (34)

1.3 Working with transference and countertransference is essential, but difficult (31)

The numbers in brackets express the number UM verbalised.

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Research was performed to nd out which elements of psychoanalytic technique were considered essential. Supervisees and supervisors stressed the comprehension of transference and countertransference as a basis for the interpretation of the patient. Less frequently mentioned were relative or possible neutrality, abstinence, resistance, interpretation and management of the setting, but almost constantly they referred to the nuclear phenomena of transference and countertransference. Theoretical psychoanalytical elements were also pointed out as basic in teaching and learning good technique, as, for example, projective identication, unconscious fantasy, negative capacity, continence, ethics and the Oedipus complex. The theoretical orientation of the supervisor and of the supervisee can have an inuence on the comprehension of the case and on the course of the supervision. As a function of this, a question has been formulated concerning the concepts adopted for transference and countertransference, as we shall be able to verify in the following categories.
The concept of transference

The concept of transference (36 UM) has been mentioned as a fundamental route of access to the unconscious and for comprehension of the patient. The following aspects have been included: an expression of the totality of the feelings; the repetition of the relationships of object, of the character traits, of the patterns of behaviour and of the unconscious happenings of the past and present, which can be expressed, either verbally or non-verbally, in relation to the analyst. The verbal statement illustrating this is: Transference is broader than just listening, observing and identifying it is hearing, it is accepting, examining what you are thinking and what is happening to you transference is everything that is happening in the session it is the total situation (supervisee).
The concept of countertransference

Sixty-seven (67 UM) references were encountered, directly or indirectly, to the concept of countertransference, for which reason this category was subdivided into two intermediate sub-categories: the concept in itself and its relationship to neutrality and ethics. The concept in itself. The concept of countertransference was mentioned in 33 UM, 18 of which were indirect references to the concept and 15 of them direct, which included the following aspects: the totalistic view of the feelings (13 UM) and the specific view of the feelings (2 UM) of the analyst in relation to the patient. There was a significant predominance of the totalistic point of view (corresponding to the concept described in the review), as can be observed in the following verbal statements: We study three concepts of countertransference: the first was that of Freud, which was that it was an obstacle to treatment, the second, that of Paula Heimann and associates, was the totalistic view, everything that you feel, and the third was the concept of Sandler, which was more specific (supervisee); and The concept of countertransference which I

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adopt is that of Paula Heimann. The totalistic concept all that the analyst feels in the hour of the session can be taken as having been provoked by the patient (supervisor). Relationship to neutrality and ethics. Referring to countertransference indirectly we encounter a signicant number of verbal statements from the two groups (34 UM) which stress the importance of relative or possible neutrality (Eizirik, 1993) in relation to the psychic conict of the patient and to the relevance of the ethical attitude. A greater number of verbal statements in this intermediate category was encountered among the supervisors (24 UM) than among the supervisees (10 UM). Thus, it appears that countertransference, neutrality and an ethical attitude are indissociable elements in psychoanalytical work, and consequently of heightened relevance in supervision: Countertransference has to do with the roles which are attributed to the analyst. That is the reason why it has to be ethical, and this is the essential point for everyone. Neutrality is something relative, which means handling transference adequately, without being blind to its countertransferential aspects (supervisor).
Working with transference and countertransference is difcult, but essential

There are 31 (UM) verbal statements that refer to the difculty in learning to work with transference and countertransference, but at the same time it was stressed that, when used, these are effective methods and are essential to a good technique. Though the supervisees (24 UM) may have produced more verbal statements than the supervisors did (7 UM), which is in part natural because the candidates have less experience, a consensus does exist among those interviewed that one of the most difcult tasks is to teach working with transference and countertransference, but that it is fundamental, as is shown by this example: The most difcult thing is the management of transference. I had great difculty, although less nowadays, because this involves some phrase of the supervisor, the patient can speak against or in favour of any person, including the analyst. To bring out for yourself the feelings of the patientamorous, sexual, in shortis not an easy matter (supervisee). The concepts of transference and countertransference are intrinsically bound, and it can be said that the interviewees have considered them complementary both in clinical practice and in the supervision itself.
Psychoanalytical listening and the complementarity of the phenomena

In this category, we encounter 123 UM. As agreed among those interviewed, the teaching and learning of the psychoanalytical technique presupposes some basic elements for understanding and working with countertransference. Among the components of this intermediate category (see Table 5) we come upon an emphasis on psychoanalytical listening as a form of privileged learning about the unconscious (46 UM), and the notion that transference and countertransference are complementary phenomena, indissoluble and indissociable in practice (46 UM).

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Table 5 Category: Psychoanalytical listening and the complementarity of the phenomena

Initial categories to learn psychoanalytical listening is fundamental (21) the understanding of the unconscious is the basis (14) perceiving significances (11) transference and countertransference go hand in hand, are complementary (25) attention to the field is useful in working with countertransference (21) Intermediate categories 2.1 Psychoanalytical listening as privileged learning about the unconscious (46) Final category

2.2 Complementarity between transference and countertransference (46)

2. Psychoanalytical listening is the complementarity of the phenomena (92) 13.5%

The numbers in brackets represent the quantity of units of meaning (UM) verbalised.

Psychoanalytical listening as privileged learning about the unconscious

It is evident from the statements (46 UM) of those interviewed that psychoanalytical listening is a specialised listening, which is focused on unconscious elements and fantasies, on symbolism and signicance. Supervisees and supervisors have stressed that one of the requirements for working from a psychoanalytical perspective is to have a personal aptitude for learning the language of the unconscious. The understanding of the dynamic unconscious that emerges from the analytical relationship, as can be observed from the example below, can be taught and learned through theoretical seminars, from supervision and from personal analysis. This training, associated with the personal requisites, is what will build the capacity for psychoanalytical listening, and is what will develop in the supervisee skills for understanding and working with transferencecountertransference: I guide myself much more by the responses of the patient, by the response to the response, and I see that what is important in the teaching is that after a certain time the supervisee may get a true approximation and understanding of the matters of the unconscious (supervisor).
Complementarity of the phenomena

During the interviews, the linkage of transference to countertransference and vice versa was proved. There was a representative number of statements (46 UM) which pointed towards a growing recognition of its importance in the work and of the complementarity of the phenomena. It can also be ascertained that this complementarity and, therefore, the indissolubility of these phenomena, comes accompanied by citations from the two groups, which utilise the following expressions: observing the patientanalyst relationship, attention to the intersection of projective identications in the session, the patientanalyst interaction, the analytic eld and the participation of the subjectivities of the pair. These concepts appear to be intrinsically related to this complementarity as is apparent in this example: Transference and countertransference are complementary Nowadays there exists a major inuence of the model of understanding of the interaction of the pair, of what goes on in the eld, and this will inuence the person who works on the supervision (supervisee).

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Approach to countertransference

In this category, there were 394 (UM) statements encountered, more than half (57.7%) of the total UM selected in all the material of the study. For ease of reference, this category was subdivided into three intermediate categories (Tables 6 and 7): presence of indicators (132 UM); working with countertransference (137 UM); and inuencing factors (125 UM).
Table 6 Category: Approach to countertransference
Initial categories the stages of the supervision (12) feelings: motivation, medium of selfexposure, spontaneity, stagnation, worry (20) no understanding of the patient (12) attention to the emotional climate of the relationship between supervisor and supervisee (16) it is important to make a contract and arrangements (12) difficulty in remembering, writing, delays, errors (12) observing the acting-outs (8) identification with patient (11) the patient attributes roles (12) the parallel processes (7) in supervision one works on top of blind spots (10) teaching is directed more towards the unconscious of the supervisee (21) working with the countertransference of the supervisee is more recent (14) utilisation of countertransference for understanding and interpreting (20) supervisor and supervisee have multiple functions (14) having patience, respecting the person (15) talking kindly (14) its easier when it comes from the supervisee (10) observing the limits of the approach to countertransference in supervision and in analysis (29) Intermediate categories 3.1 Presence of indicators (132) 3.1.1 Emotional manifestations (60) Final category 3. Approach to countertransference (394) 57.7%

3.1.2 Behavioural manifestations (32)

3.1.3 Identification with the patient and the blind spots (40)

3.2 Working with countertransference (137) 3.2.1 The changes, the approach and the functions of the supervisor and the supervisee (59)

3.2.2 Care and respect for the other (68)

emotional and cognitive (82)* emotional and cognitive (43)*

3.3 Influencing factors (125) (*see Table 7) 3.3.1 Facilitators (82)* 3.3.2 Disturbers (43)*

The numbers in brackets represent the quantity of units of meaning (UM) verbalised.

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Presence of indicators

The indicators of countertransference in psychoanalytical supervision, also called the unconscious derivatives of countertransference, have been presented in a variety of ways. These ndings have been subdivided according to the statements of those interviewed into emotional manifestations (60 UM), behavioural manifestations (32 UM), and identication with the patients and the blind spots (40 UM): We observe the signs derived from countertransference it is unconscious, but people have indicator signs which can be observed (supervisor). Emotional manifestations. In this intermediate category four groups of statements were observed: (a) the emotional manifestations can vary in conformity with the stages of the supervision (12 UM); (b) attention to the emotional atmosphere of supervision, principally of the supervisor/supervisee relationship as indicator: empathy, affection, honesty, trust, receptivity, afnity, condence, being at ease (16 UM); (c) periods of non-comprehension as indicator (12 UM); (d) feelings in general: motivation, fear of self-exposure, spontaneity, stagnation, worry and others (20 UM). This division of the ndings about the emotional manifestations is merely didactic, since in practice they appear mixed, as is seen in the following statements: I nd that the emotional climate is different with each supervisor and at different moments of the supervision. This can make it easier or not (supervisee); and The periods of non-comprehension, generally, are related to something in the analytical eld which is being projected into one. In that respect, examining countertransference is essential, to see what we are feeling and using it to interpret (supervisor). Behavioural manifestations. Another way of presenting the statements about the indicators of transference encountered in supervision was according to manifestations of behaviour or of conduct (32 UM), which were subdivided into manifestations relative to the contract, the arrangements between supervisor and supervisee (24 UM), and the actings-out (8 UM) properly speaking. For example, I make the usual arrangements, a verbal contract. It helps to detect any sign of countertransference. For instance, difficulty in remembering and writing down. I never interpret this; I try to see its relation to the case. I make some comment and ignore what the supervisee might carry away for his analysis (supervisor); and It is very annoying writing up sessions for supervision, but it is still the best way of being trained. There are moments when, depending on what is going on in the analytic field, one does not want to write things down, or one goes so far as not even to go to supervision. But the wish to learn and the good relationship with the supervisor make people overcome that barrier (supervisee). Identication with the patient and blind spots. One manifestation of countertransference mentioned in the interviews was identication with the patient and blind spots. In this category, we encounter the following groups of verbal statements: the attribution of roles to the supervisee by the patient (12 UM); the identication of the supervisee with aspects of the functioning of the patient,

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which in some circumstances evolves towards what are called parallel processes (17 UM); and the emergence of blind spots (10 UM). The ascertainment of these aspects in the supervision, on the part of the supervisee as much as the supervisor, causes discomfort, but needs to be made clear by both. Parapraxes were veried as emerging during some interviews, such as the substitution of the terms supervision for analysis and of supervisee or candidate for patient, as in the following illustrations: The patient provokes countertransferential events. It is as well to pay attention when he is being induced to assume roles, for example, of mother, of father. When this is repeated and intensied, even after one has shown what it means, the supervisor ends up having to say carefully to the patient [he means the supervisee], and then raises some matter which needs to be looked into in another place. This can be a blind spot (supervisor); and In a supervision I did not like to hear something the supervisor subtly told me that it perhaps was concerned with me that hurt me, I swallowed, took it to analysis, but perceived that that had been an identication with the patient or a blind spot of mine he was actually right (supervisee).
Working with countertransference

In this intermediate category, 137 UM were encountered, subdivided into two groups: the changes in the approach to countertransference in supervision, the approach and functions of the supervisor and of the supervisee (59 UM), and mutual care and respect (68 UM). The changes, the approach and the functions of the supervisor and the supervisee. In this group of communications, the tendency for changes in the approach to countertransference in psychoanalytical supervision is suggestive. These changes were made explicit principally by the interviewees themselves, as they were confronted by the growing valuation of countertransference by the supervisors, when compared with the period preceding the psychoanalytical training. Both supervisees and supervisors, but especially the latter, emphasised that the teaching of psychoanalysis is more directed towards the manifestations of the unconscious of the supervisee (21 UM). Working with the countertransference of the supervisor in a more direct and objective way is a more recent trend among us (14 UM), and the ultimate aim is to broaden and deepen the comprehension and the interpretation of the patient (20 UM). Included were the verbal statements about the roles or functions (14 UM) which the supervisees or supervisors ought to exercise within the context of the supervision, such as discriminating feelings which have their origin in the patient from those which originate in the analyst, discriminating a lack of understanding from a pathology of countertransference, discussing countertransference, comprehending in order to interpret, maintenance of the supervisor setting, attention to the limits between what is examined in the supervision and in personal analysis over and above other functions, as in the following examples: The personal analysis is the most suitable place for approaching countertransference but, contrary to some supervisors and to some dismal periods, supervision also appears to me

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a suitable setting, within its limits, provided that this is not transformed into treatment. There has been a change in supervision; currently the supervisor uses himself more, talks more, and there one has how to take an objective approach (supervisor); and I find that it is a duty of the supervisor to bring to ones notice, not so that he should go on to treat whatever it is, its not his job, but I find that he should have the duty of alerting the supervisee: look, something is not quite right here with you, there is some countertransference to be detected (supervisee).
Mutual care and respect

This intermediate category complements the previous one where 68 UM verbal statements were encountered about care and limits in the supervision relationship. Both groups demonstrated a preoccupation with care, patience and respect for the other (15 UM) in approaching countertransference of the supervisee under supervision. Moreover, the form, the skill, the sensitivity (14 UM) are fundamentals which help the person concerned feel himself respected and understood. The approach to countertransference is made easier when the supervisor gives examples, using material from the case discussed or from other cases of a similar type. When the initiative for exposing the countertransference starts from the supervisee (10 UM), it helps the supervisor to know how far he can proceed. Finally, concerns are brought about boundaries preservation (29 UM) in the approach to countertransference in supervision and treatment. The usefulness of countertransference for the comprehension of the case under discussion is newly emphasised, leaving the unconscious motivations of the supervisee to be examined in their personal analysis. On the other hand, it has been stressed that the personal analysis is not a suitable place for the discussion of clinical material. The verbal statements are divided according to the form of the approach to countertransference. Some supervisors prefer to leave it so that the supervisee spontaneously brings up the unconscious aspects for the analysis, others prefer to indicate that unconscious aspects ought to be approached in the analysis. Nevertheless, the two groups have stated verbally that, when the emotional climate of the supervision is favourable and receptive, the supervisee brings up countertransference spontaneously, and the same happens in relation to personal analysis, towards which these questions are also directed. In practice, therefore, they are complementary, as these examples demonstrate: The supervisor had an interesting attitude, the skill of dealing, to say things without being critical, and this makes one feel more at ease to show oneself (supervisee); and To have a little bit of time, of tact, and also keep from making the person feel invaded, because this is very delicate you can enter only when invited It is different from analysis one must wait (supervisor).
Factors which inuence the approach to countertransference

The verbal statements of those interviewed which point to the factors that inuence the approach to countertransference in supervision are summarised in Table 7.

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Table 7 Inuential factors in the approach to countertransference in supervision

Cognitive or behavioural (64 UM) Clinical experience, eventually supervising other cases, making people feel at ease, trust, exposure, personal analysis, supplying a personal example, indicating some literature, pointing out countertransference, being at an intermediate stage of supervision, establishing a setting for supervision, de-bureaucratising the supervision (37) Attitude of hiding things, omnipotence, narcissism, rigidity, displacement of material from the analysis for the supervision, divergences in understanding, impasses, transgressions in the relationship, eroticisation of the bond, enactments, persecutory influence of the institution, group disputes (27) Emotional or affective (61 UM) Enthusiasm, satisfaction, spontaneous exhibition of feelings, sincerity, tranquillity, a taste for learning and a desire for growth (45) Factors (125 UM) Facilitators (82 UM)

Persistent paranoid anxieties, low self-esteem, intolerance of not knowing, exaggerated fear of being exposed, low motivation for learning (16)

Disturbers (43 UM)

The numbers in brackets represent the quantity of units of meaning (UM) verbalised.

We found 125 UM in this intermediate category, a very signicant number, subdivided into two groups: facilitating factors (82 UM), quoted on a signicantly greater number of occasions, almost twice the number of verbal statements about disturbing factors (43 UM) in the approach to countertransference. The facilitating and disturbing factors have been classied and divided according to their emotional (affective) and cognitive (behavioural) natures (Table 6). A larger number of verbal statements of disturbing cognitive aspects (27 UM) was ascertained when compared with the disturbing emotional aspects (16 UM).
Discussion of the ndings

Initially, worthy of mention is the interest and the accessibility of the interviewees, since all of them agreed to participate in the study. That situation, not always so frequent in research, suggests the existence of a growing preoccupation among psychoanalysts with researching and presenting evidence of results in a methodologically scientic format. Although psychoanalysis is a science that has existed for more than a century, there is a shortage of publications about supervision, and especially about researches into psychoanalysis (Szecsdy, 1990a, 1990b; Zaslavsky et al., 2003), highlighted by the subjects, and this situation may have been an additional motivating factor. A study resembling this one was carried out by Brito (1999), using the same research methodology, but focusing on the transmission of psychoanalytical knowledge. The ndings of this research will be discussed based on the three nal categories.
The concepts of transference and countertransference

The interviewees recognise transference and countertransference as essential elements of psychoanalytical technique for the comprehension and formulation of interpretations, together with other components (neutrality, ethics, abstinence,

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resistance, interpretation, working through, setting). The difculty in learning and teaching how to work with transference and countertransference has already been discussed in this paper. This nding conrms what has long been said in the principal journals and treatises on psychoanalytical technique about transference and countertransference: that these are considered essential elements, frightening and difcult to learn to work with (Etchegoyen, 1991; Kernberg, 1993; Gabbard, 1995; Grinberg, 1997a). Freud confronted serious difculties at the beginning of his professional career and afterwards went on to consider transference the most important therapeutic instrument: on the one hand, an unavoidable necessity and, on the other by far, the most arduous part of any task (Freud, 1905, p. 113). Grinberg, in a recent publication, pointed out that, because of the perception that transference is a potentially hazardous burden (1997a, p. 11), the analyst tries to protect himself from it with theoretical rationalisations and defensive techniques. The interviewees attributed the same considerations to countertransference. The concept of countertransference utilised by the subjects of this research includes the repetition of the object-relations, defences and character traits, the patterns of behaviour and of unconscious happenings of the past and present, and of the totality of feelings, which may or may not be expressed in verbal form, in the relationship with the analyst. The synthesis of the concepts utilised coincides with the concept of transference, the total situation described by Melanie Klein (1952), as Joseph puts it: it is essential that one should think in total situations transferred from the past to the present, as well as in terms of emotions, defences and object relations (1985). On the other hand, as regards the concept of countertransference, there has been an appreciable preponderance (13 UM) of the totalistic viewpoint, which conglomerates the totality of the feelings aroused in the analyst, as described by Heimann (1950) and various other authors (Racker, 1948, 1953, 1958; MoneyKyrle, 1956; Kernberg, 1965). Sandler et al. (1970) adopt the more specic concept, less frequently mentioned by the interviewees (2 UM). The observed tendency is the absence of signicant discrepancies in the conceptualisation of transference and countertransference between both groups. The concepts utilised, as well as the theoretical references quoted, indicate predominance of the methodological model of comprehensive, relational or experiential supervision, though it would not be possible to exclude the utilisation of the rest of the models mentioned in Table 1. Neutrality and ethics were also stressed by the interviewees as a basic requirement for work with countertransference. According to Eizirik (1993), it is necessary that the analyst should develop in his personal, extra-professional life enough satisfactions and certainties in order to be able to maintain a certain possible distance (neutrality) in relation: to the patients conicts, to his transference and countertransference, to his own cultural and ethical values, and to the expectations and pressures of the external ambience. As one of the supervisors interviewed put it: One cannot be neutral towards the person of the patient. Someone gets joined to you for years, condes things to you important things about life to you in that case, one has to be neutral regarding the psychic conict.

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The greater number of the verbal statements of the supervisors (24 UM) in relation to the supervisees (10 UM) on the question of neutrality and of ethics applies, probably, to the attributions and the multiple functions of the instructorsupervisor in transmitting knowledge and the theoretical and technical teachings of psychoanalysis, being a model of identication, and practising the responsibility associated with the institution, according to Szecsdy (1990b, 1997), Vollmer Filho and Bernardi (1996), Zaslavsky and Brito (2004).
Listening and the complementariness of phenomena

Psychoanalytic listening, like privileged understanding of the unconscious and the complementariness of the phenomena of transference and countertransference, became a category, because they were jointly pointed out by the interviewees as basic components for understanding patients and as a result essential for understanding and approaching countertransference in supervision. The notion of the unconscious is a concept which has persisted relatively unchanged in the course of the evolution of the psychoanalytical schools, ever since Freud (1915) explored its meanings and presented certain rules of mental functioning. Only the notion of unconscious fantasy (Isaacs, 1952) has made an equivalent contribution. Nevertheless, listening as privileged apprehension of the unconscious is at the core of theoretical and technical psychoanalytical integration, as several authors mention (Hinshelwood, 1989; Etchegoyen, 1991; Kandel, 1999; Romanowski et al., 2002). Psychoanalytical listening is not uninterested listening. For this, various schools point towards the unconscious or to unconscious fantasy as a basic element in listening to the patient. One of the most prominent characteristics of the unconscious, according to those interviewed, is its atemporality, as Romanowski et al. illustrate: Transference can act as if the analyst were the father, the mother, the child or any other gure (2002, p. 110) As the literature shows, psychoanalytic listening has been undergoing evolution (Baranger, 1992; Faimberg, 1992; De Paola, 1993; Eizirik, 1993; Ogden 1994a, 1994b, 1994c; Ferro, 1995). Even with the maintenance of the intrapsychic focus in the patient, the relational aspect of the patientanalyst dyad needs to be appropriately valued, and the impact of this relationship on both components of the dyad becomes a work instrument which encompasses the complementariness of transference and countertransference, and this too should integrate itself into the supervision. The complementarity between transference and countertransference, widely quoted in the ndings, is a trademark of the interactionists, interpersonalists and of some intersubjectivists. Racker (1948, 1953, 1958), for example, subdivides countertransference into direct and indirect, and the latter into concordant and complementary identication; Baranger and Baranger (1961) talk in terms of reciprocal and crossed identities. The convergence among psychoanalysts with respect to attention to the symmetry between transference and countertransference is stressed by Kernberg, but he observes that this is less prevalent among ego-psychologists, and British Independents and Kleinians. He recalls that the general tendency is to utilise the

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analysis of countertransference solely for the formulation of interpretations, carefully avoiding the confession of the same to the patient (1993, p. 662). Reviewing countertransference from within the Latin American perspective, De Bernardi ascertained that conceiving the reciprocity of the transferential and countertransferential phenomenon did not imply in those authors an abandonment of the notion of analytical asymmetry or of the analysts principle of neutrality (2000, p. 232). Such a nding reinforces the care taken by the interviewees to maintain the asymmetrical aspects of the analytical relationship; at the same time, it does not exclude the importance of the symmetry between transference and countertransference being used as elements for the comprehension and interpretation of the patient.
Approaching countertransference

There appears to be agreement between the interviewees and contemporary analysts about the utility of approaching countertransference during supervision as a means of broadening the comprehension of the patient in question, with the aim of enabling and deepening the formulation of the interpretations directed to the patient (Blomeld, 1985; Eizirik and Zaslavsky, 1989; Vollmer and Bernardi, 1996; Grinberg, 1995, 1997b; Coburn, 1997; Mabilde, 1998; Jaffe, 2001; Zaslavsky and Brito, 2004). The discussion is deepened when there is a need to establish the presence of indicators; the mechanisms involved; the form, the criteria and the limits of the approach to countertransference in supervision and in analysis; and the facilitators and disturbers of this task. The intermediate categories encountered provide a possibility for classication of the indicators of countertransference during supervision: (1) emotional manifestations; (2) behavioural manifestations; (3) levels of identication with the patient. In practice, these indicators are found to be interwoven, since the emotional and behavioural manifestations present themselves as a mechanism basic to the projective identications underlying the relationship of the supervisee with the patient, with his analyst and with the supervisor himself, as can be veried from the verbal statements. The periods of non-comprehension of the analyst, according to Joseph (1983, 1985), and of difcult management by the analyst can be extremely useful in understanding what is passing through the mind of the patient. These occur through projective identication related to the personality of the patient, which is trying to attract the analyst towards the interior of this structure. These defences, which militate against comprehension, can lead the analyst into acting out his countertransference. Supervisees and supervisors have shown a preoccupation with the patient exerting pressure on the analyst for him to assume decisive roles and hence that, possibly, the latter may be able to provoke his countertransference under the form of complementary identication or projective counteridentication (Racker, 1948, 1953; Grinberg, 1956; Hinshelwood, 1999). A question put forward by the interviewees was what to do about the feelings and the pressures exerted by the patient on the analyst. Supervisee and supervisor ought to have a capacity for continence (negative

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capacity) from the projections (Bion, 1962a, 1962b), in a process of elaboration in the countertransference, like that described by Pick (1985). In a representative verbal statement one supervisor said: Currently I have been very interested in listening to the listening the teaching in supervision is more involved with the unconscious aspects of the supervisee. The analyst needs to listen as the patient listened to his silence or interpretation. In this sense, the countertransferential position is, in agreement with Faimberg, a general psychic activity of the analyst, centred on the analytical function, placed at the service of listening to what the patient says, or is not able to say, during the session (1992, p. 81). The notion of listening to the listening, of negative capacity and of countertransferential position seems expedient when we approach the countertransference in supervision, by means of which it may be useful to the analyst to pay attention to what the supervisee has heard in the supervision and to what the patient has listened to of what has been said to him. The interviewees demonstrated a preoccupation with the possible interruptions or breaks (actings-out) in the framing, since these can reect different stages of projective identication and countertransference in supervision, of projective counteridentications, of parallel processes and of locating blind spots, bringing to light conicts which have not been worked through in the supervisees analysis or in the supervisor himself. The supervisees interviewed, perhaps through being at a more advanced level of training, appeared more preoccupied with the necessity of approaching countertransference. This seems to reect an interest, a desire for learning, a relationship of condence in the institution, and is consequently less paranoid than during earlier stages of training. The atmosphere between supervisees, supervisors and institution is of integration and a work alliance, a process of teaching and learning that is cognitive-affective in nature (Vollmer Filho and Bernardi, 1996; Brito, 1999; Zaslavsky, 1999). On the other hand, the supervisors demonstrate an obvious, more direct and objective adherence to approaching the countertransference in the supervision than during earlier periods of analytic training. There has been a change; one works more with countertransference today than in earlier times or teaching is more directed towards the unconscious aspects of the supervisee say the supervisors. This nding contrasts with that of Brito (1999), who encountered a divergence of positions with regard to the work to be carried out in relation to countertransference: for those supervisors, there was a tendency not to highlight, interpret or even work on and with the supervisees countertransference. Among the possible reasons for this contrast, emphasis can be placed on the inuence of the evolution of the concept of countertransference in the different psychoanalytic cultures, the developments concerning projective identication, the analytic eld, enactment and intersubjectivity (Baranger and Baranger, 1961; Jacobs, 1986; Ferro, 1991, 1993, 1995, 1997a, 1997b; Ogden, 1991, 1994a, 1994b, 1994c; Manfredi, 1994; Dunn, 1995; Gabbard, 1995; Zaslavsky, 1997; Renik, 1998; Hinshelwood, 1999; Jacobs, 1999; De Bernardi, 2000; Duparc, 2001; Zaslavsky and Brito, 2004).

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Countertransference has come to be approached more broadly in supervision through the discovery that what amplies the comprehension of the patient relieves the analyst and allows the patient to formulate more profound interpretations. In research carried out on modications in psychoanalytical practice, Eizirik et al. (1999) observed a growing emphasis on the utilisation of countertransference as an essential element for analytic practice, in accordance with Kernberg (1993). If, on the one hand, this nding shows a rapid evolution in analytic work on supervision when compared with the research of Brito (1999), on the other, it exposes the slowness with which changes in the teaching of psychoanalytic techniques occur, when one takes into account theoretical evolution and clinical practice. Ever since Heimann (1950) introduced the totalistic view of countertransference, counterposing it to Melanie Kleins, and the concept of the analytical eld arose (Baranger and Baranger, 1961), many developments have contributed to the notion that countertransference extends the understanding of the patient. The 50 years which have passed since then make us think that changes in the teaching of psychoanalysis occur many years after such changes have been established in clinical practice. Among the possible reasons for this enlightenment, one may mention, under a speculative heading, the concern and care of the analysts and institutions responsible for the teaching of psychoanalysis with the preservation of rigour in method and a dread of change in the character of its theoretical and technical framework. Another issue that might be related to the tardiness of changes in the teaching of psychoanalysis is the relationship between teaching and power, since changes are liable to threaten established knowledge. Such speculation would merit more indepth study, as Brito (1999) has already emphasised. The supervisors concern with the person of the supervisee, when approaching the countertransferential aspects, tends to emerge in a more specic manner, after some time of mutual acquaintance and familiarity in the supervision. This nding appears to be in accordance with the literature when it mentions the intermediate phase of supervision as the moment at which supervisees and supervisors are most inclined to deepen the examination of transference and countertransference (Grinberg, 1975; Cruz, 1991; Jacobs et al., 1995). The interviewees stressed that it is not up to the supervisor to examine the unconscious motivations, fantasies and conicts of the supervisee. The supervisor will be able to suggest or indicate that certain aspects also need to be examined in the supervisees personal analysis. The experience of some of the supervisors interviewed emphasises that this occurs in a natural way when the supervisee spontaneously brings up the signs of countertransference and a relationship of condence and work alliance predominates, as Eizirik and Zaslavsky (1989), Eizirik (1991), Mabilde (1991), and Vollmer Filho and Bernardi (1996) mention. Another preoccupation of the interviewees in approaching countertransference in supervision is how much is due to arousal of actings-out of the supervisee with the shifting of issues of the analysis regarding supervision (Lebovici, 1970). In these cases, it is fundamental that the supervisor preserves the setting of supervision, keeping clear the multiple functions which he performs, as recommended by Szecsdy

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(1990b, 1997) and by Vollmer Filho and Bernardi (1996), besides maintaining his vigilance as guardian of the supervision process, as Zaslavsky (1999) stresses. The approach to countertransference in supervision may be facilitated or disturbed in line with some of the inuencing factors discussed in this study, which are able to serve as a reference for supervisors and supervisees. The facilitating factors, quoted a greater number of times than those that disturb the supervision process, suggest that the atmosphere between supervisors and supervisees is predominantly one of co-operation and condence in the task of teachinglearning, which is favourable to its growth and opens a space through which the aspects of countertransference may be able to be approached in the supervision. A balance is observed between the verbal statements about the facilitating emotional and cognitive factors reinforcing the coherence between feelings and attitudes among the interviewees (Grinberg, 1970, 1975, 1997b; Eizirik and Zaslavsky, 1989; Eizirik, 1991; Schestatsky, 1991; Zaslavsky, 1999). Disturbing cognitive factors have been mentioned more frequently than emotional ones, which appears to be in agreement with the literature, when it refers to preoccupation with the prejudice occasioned by the actings-out of the emotional aspects of supervisees as much as of supervisors (Eizirik and Zaslavsky, 1989; Eizirik, 1991; Kernberg, 1996, 2000; Rosito et al., 1996; Vollmer and Bernardi, 1996; Eizirik and Arajo, 1997; Zaslavsky, 1999; Rocha, 2001).
Theoretical reections

There appears to be consensual agreement that attention to the different levels of manifestation of projective identication and of the phenomena that occur in the analytical eld between the supervisee and his analyst, between supervisee and supervisor, between supervisor and his analyst and also with his supervisor is useful in supervision (Baranger and Baranger, 1961; Grinberg, 1970; Joseph, 1983, 1985; Ferro, 1991, 1993, 1995, 1997a, 1997b; Ogden, 1991, 1994a, 1994b, 1994c; Manfredi, 1994; Zaslavsky, 1997; Jaffe, 2001). One possibility for comprehension of these stages of projective identication, their intersection in the analytical eld and their relationship with countertransference in supervision is summed up synthetically in Figure 1.

Patient Supervisor
Blind Spots

Assigns Roles by Projective Identication

Analyst
Blind Spots

Parallel Processes

Projective Counteridentication

Figure 1 Stages of projective identication and of countertransference in psychoanalytic supervision

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The attribution of roles is a type of manifestation of projective identication transecting the analytical eld. The supervisee may be the container of these projective identications, or may enact them and is then projectively counteridentied. When the patterns of pathological behaviour of the analytical setting are repeated in the setting of supervision, so-called parallel processes arise. The persistence of projective counteridentication and the repetition of the parallel processes will be able to characterise the so-called blind spots of the supervisee as much as of the supervisor, as has been described by Grinberg (1956, 1957, 1963, 1970, 1995, 1997b) in a series of interrelated works. It is a function of the supervisor to identify the stage of projective identication at which the supervisee is encountered, and to approach with care, delicacy and sensitivity the stages of projective identication described in Figure 1, having in view a broadening of comprehension of the case in question, avoiding interpretations to the supervisee. As was observed in the verbal statements of the interviewees, this is the primary aim of the supervision and it is the task of the supervisor to take care that he does not deviate from this intention, as is recommended by P. M. Machado (1991), Eizirik and Zaslavsky (1989), Mabilde (1991), Eizirik and Arajo (1997), Zaslavsky (1999), Zaslavsky et al. (2003), Zaslavsky and Brito (2004). Based on this study, some suggestions may be useful in the task of approaching countertransference in supervision, as emphasised by Blomeld (1985), Eizirik and Zaslavsky (1989), Eizirik (1991), Grinberg (1995, 1997b), Vollmer and Bernardi, (1996), Eizirik and Arajo (1997), Zaslavsky et al. (2003): (a) observing the emotional atmosphere of the superviseesupervisor relationship; (b) observing the personality traits of both; (c) waiting for the countertransference to be brought up by the supervisee (no invasion of privacy), whenever possible; (d) approaching the countertransference with skill, care and sensitiveness; (e) whenever possible, using a personal example from the supervisor, in which something similar has occurred; (f) possibly, indicating some bibliographical reference; (g) having a notion of the objectives and limits of supervision and personal analysis, and the boundaries between them. One of the most controversial questions that arose is how to know the boundaries and differentiate what is looked at in the supervision and what is taken to the supervisees personal analysis. Now, based on this study, it is useful to consider the levels, the stages, the intensity and the persistence of the projective identications as summarised in Figure 1. The task of separating supervision from personal analysis also demands great resolution from the supervisor, who alternates his functions between supervisor and analyst. This difculty has been observed in parapraxes when the supervisor referred to the supervisee as a patient. Identications of the supervisee with the patient are part of the psychoanalytic process. Meanwhile, the continued repetition of projective counteridentications, of so-called parallel processes, and of enactments and blind spots, is indicative of a pathology of the supervisee (Racker, 1958; Grinberg, 1995, 1997b; Jaffe, 2001).

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Final considerations

All the views about countertransference that have been developed during the past 50 years have adopted the opinion that the identity of the psychoanalyst included that of a person with feelings. The analyst has a personal identity as well as a professional one, and both put pressures on the countertransference. Countertransference is the most personal of all professional instruments. Confronted with this, the question arises of how to set this valuable element apart from the supervision. The work of an analyst and of a supervisor, and the relationship between the two, is centred on the person. A supervisor on leaving a session of analysis and commencing a supervision session changes function and role. In that case, what happens to his mind in this alternation of functions? What is to be done to separate the attributes of analyst and supervisor? The analyst is aware of understanding and giving meanings to the patient; in supervision, he needs to reposition himself as an agent of teaching. A considered human effort is required in assuming these roles, now as analyst, now as supervisor. The effort of the analyst who is also a supervisor resides in maintaining the sensitivity of an analyst and the possible neutrality of a supervisor. Supervision is an artisan method, exhaustive and irreplaceable in its professional form, resembling the training that occurs in observing the motherbaby relationship. Some training is necessary to separate the functions of an analyst and of a supervisor. In this sense, it is advisable that institutes of psychoanalysis develop the supervisors training, through courses and supervision of the supervision, as a means of perfecting their training and maintaining the boundaries between supervision and analysis. The principal ndings of this study are: 1. Qualitative research in psychoanalysis permits evidence to be assembled empirically about how a successful teachinglearning relationship works. A similarity exists between the verbal statements of the supervisees and of the supervisors about the approach to countertransference, which can be utilised as a kind of evaluation of the teachinglearning relationship in psychoanalysis through supervision. 2. There is a predominance of the totalistic view of the concept of transference and countertransference, and this appears to be the concept mostly adopted in supervision by those interviewed, though the more specic view of the feelings of the analyst in relation to the patient also has to be remembered. 3. The relative or possible neutrality of the analyst in relation to the patient, as well as an ethical attitude, is a basic condition for dealing with countertransference in the supervisor/supervisee relationship. 4. Transference and countertransference are identied as complementary phenomena and therefore indissociable, which seems to be related to the inuence of the utilisation of projective identication, of projective counteridentication, and of developments in the psychoanalytic eld, enactment and intersubjectivity. Working with transference/countertransference is an essential condition for education in good psychoanalytical technique, though it is difcult to teach and to learn. 5. Psychoanalytic listening is a privileged kind of understanding of the unconscious, of the fantasies and conditions of access to the manifestations of countertransference, including those in supervision.

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6. There is agreement among the interviewees about the utility of approaching countertransference in supervision as a means of broadening the comprehension of the supervisee with the objective of deepening the formulation of patient-oriented interpretations. 7. It is useful to observe the indicators of countertransference in the supervision, for example, emotional and behavioural manifestations, and the different levels of projective identication, counteridentications, parallel processes and blind spots. These processes need to be identied and understood, to the end that the feelings of the supervisee are alleviated and the comprehension of the patient is broadened. 8. A change in the approach to countertransference was detected on the part of the interviewees: the supervisors were coming to approach it in a very direct and objective way, in comparison with previous periodsand in contrast to the ndings of Brito (1999). This change appears to be related to the consolidation of new items of knowledge, such as analytic eld, projective identication, subjectivity, as well as inuences from the local scientic output and from discussion of these subjects in the institution. The candidates also contribute, bringing their experiences and cultures from other localities. 9. It is advisable that the supervisor should make a distinction between lack of knowledge on the part of the supervisee, and his neurotic or characterological difculties; the latter may be addressed in the personal analysis. 10. It is essential that the supervisee, and especially the supervisor as guardian of the supervision setting, should keep clear the notion of boundaries and of limits between supervision and analysis. Research is also a kind of knowing, which can touch the feelings profoundly (countertransference), as one of the interviewees stated verbally: This conversation troubles me greatly after having responded to this research I am not the same, in the sense that this makes people stop short to think about these questions of supervision and countertransference. It has been a very enriching experience, for which I want to return my thanks for having had the opportunity to participate. To conclude, it would not be possible to omit mentioning that this study includes, among other possible limiting factors, the countertransference of the researcher himself, since it is impossible to exclude completely ones own interest and sentiments of enthusiasm from the subject being investigated.
Translations of summary
Die Auseinandersetzung mit der Gegenbertragung in der psychoanalytischen Supervision: eine qualitative Untersuchung. Eine aktuelle Untersuchung der Literatur ber die Gegenbertragung und ihre Entwicklungen ergab, dass sie in den verschiedenen psychoanalytischen Kulturen als hilfreiches klinisches Instrument dient. Gleichwohl fehlt es an Publikationen ber den Umgang mit der Gegenbertragung in der Supervision. Das Ziel dieser Untersuchung bestand darin, die Konzepte der bertragung und Gegenbertragung zu untersuchen und zu sehen, wie die Gegenbertragung in der Supervision, in der Kandidatenausbildung an einem der Internationalen Psychoanalytischen Vereinigung (IPV) afliierten psychoanalytischen Institut, behandelt wird. Durchgefhrt wurde eine qualitative Untersuchung, indem Supervisoren und Supervisanden interviewt wurden. Auf der Grundlage der Analyse des so gewonnenen Materials wurden die Daten in anfngliche, intermedire und endgltige Kategorien eingeteilt. Die wichtigsten Ergebnisse wurden drei Kategorien zugeordnet: Konzepte der bertragung und

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Gegenbertragung, psychoanalytisches Zuhren sowie Komplementaritt der Phnomene und Handhabung der Gegenbertragung. Die bertragungs- und Gegenbertragungskonzepte, die von den Interviewten vorwiegend benutzt wurden, beruhen auf dem Gesamteindruck. Die Handhabung der Gegenbertragung in der Supervision erfolgt im Vergleich zur Vergangenheit auf eine direktere und objektivere Weise, auch wenn sehr darauf geachtet wird, die Grenzen zwischen Supervision und persnlicher Analyse zu respektieren. Das Hauptziel besteht darin, das Verstndnis zu erweitern und die Deutungen, die dem Patienten gegeben werden, zu vertiefen. Diese Ergebnisse legen nahe, dass die Entwicklung des bertragungskonzepts in den verschiedenen psychoanalytischen Kulturen sowie Entwicklungen, die sich im analytischen Feld vollzogen haben, zu dieser Vernderung beitragen. Aproximacin a la contratransferencia en la supervisin psicoanaltica: una investigacin cualitativa. Una revisin reciente de la literatura sobre la contratransferencia y sus desarrollos revela la utilidad clnica que esta tiene en diferentes culturas psicoanalticas. Sin embargo parece haber muy pocas publicaciones acerca de su enfoque aplicado a la supervisin. Este estudio examina los conceptos de transferencia y contratransferencia y cmo el segundo de ellos es aplicado a la supervisin (en la formacin de candidatos), en un instituto de psicoanlisis que pertenece a una sociedad aliada a la Asociacin Psicoanaltica Internacional (IPA). Se realiz una investigacin cualitativa, entrevistando a supervisores y supervisados. Mediante el anlisis del material obtenido, los datos fueron clasicados segn las siguientes categorias: inicial, intermedia y nal. Los principales resultados fueron subdivididos tambin atendiendo a tres categoras: los conceptos de transferencia y contratransferencia, la escucha psicoanaltica y la complementariedad del fenmeno, y la aproximacin a la contratransferencia. Los conceptos de transferencia y contratransferencia utilizados prevalentemente por los entrevistados se basan en una visin totalista. La manera de afrontar la contratransferencia en la supervisin ha resultado ser ms directa y objetiva que como se afrontaba en el pasado, aunque se presta un gran cuidado a delimitar adecuadamente el lmite entre supervisin y anlisis personal. El principal objetivo es ampliar la comprensin y profundizar en las interpretaciones dirigidas al paciente. Estos hallazgos sugieren que la evolucin del concepto de contratransferencia en diferentes culturas psicoanalticas y desarrollos del campo analtico estn contribuyendo a este cambio. Lapproche du contre-transfert dans la supervision psychanalytique : une investigation qualitative. Un examen rcent de la littrature concernant le contre-transfert et ses dveloppements montre son utilit clinique dans diffrentes cultures psychanalytiques. Toutefois, une pnurie de publications apparat dans le domaine de lapproche en supervision. Le but de cette tude est dexaminer les concepts de transfert et de contre-transfert, ainsi que lapproche du contre-transfert en supervision dans la formation des candidats au sein dun institut de psychanalyse membre dune socit aflie lIPA. Une recherche qualitative a t mise en place, au moyen de questionnaires destins aux superviseurs et aux superviss. travers lanalyse du matriel obtenu, les donnes ont t classes en trois catgories : initiale, intermdiaire et nale. Les principaux rsultats ont t subdiviss en trois catgories : les concepts de transfert et contre-transfert, lcoute psychanalytique et la complmentarit du phnomne, et enn lapproche du contre-transfert. Les concepts de transfert et contre-transfert utiliss principalement par les personnes interviews reposent sur une perspective totaliste. Lapproche du contre-transfert en supervision sest avre tre amene dune faon plus directe et plus objective que dans la priode prcdente, mme si une grande vigilance est apporte pour dlimiter les frontires entre supervision et analyse personnelle. Le principal objectif est dlargir la comprhension et dapprofondir les interprtations en direction du patient. Ces rsultats suggrent que lvolution du concept de transfert dans les diffrentes cultures psychanalytiques et les dveloppements dans le champ analytique vont contribuer ce changement. Lapproccio al controtransfert nella supervisione psicoanalitica: unindagine qualitativa. Un recente esame della letteratura sul controtransfert e i suoi sviluppi ne rivela lutilit clinica nelle diverse culture psicoanalitiche. Ci nonostante appare evidente la scarsit di pubblicazioni relative al modo di affrontarlo in supervisione. Lo scopo di questo studio era di esaminare i concetti di transfert e controtransfert e vedere come il controtransfert fosse affrontato in supervisione nella formazione dei candidati di un istituto di psicoanalisi afliato alla International Psychoanalytical Association (IPA). Si effettuata una ricerca qualitativa intervistando supervisori e candidati analisti in supervisione. Attraverso lanalisi del materiale raccolto, i dati sono stati classicati secondo le seguenti categorie: iniziale, intermedia e nale. Le risultanze pi importanti sono state ulteriormente suddivise in tre categorie: i concetti di transfert e controtransfert, lascolto psicoanalitico e la complementariet del fenomeno, lapproccio al controtransfert. I concetti di transfert e controtransfert prevalentemente utilizzati dagli intervistati si basano su una prospettiva totale. Il modo di affrontare il controtransfert nella supervisione risultato pi diretto e obiettivo rispetto al

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periodo precedente, anche se si presta grande attenzione nel demarcare i conni tra supervisione e analisi personale. Lo scopo principale quello di ampliare la comprensione e approfondire le interpretazioni dirette al paziente. Queste scoperte suggeriscono che levoluzione del concetto di controtransfert nelle diverse culture psicoanalitiche e gli sviluppi nel campo della psicoanalisi stiano contribuendo a questo cambiamento.

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