"I put this to my patient in the next session. He stared at me and said; 'That makes sense.'” Supervision is intimidating at first. Not only have you just been faced with a real-life patient looking to you for help—bad enough—but then you have to write up every single little thing you remember about the session and read this out to a group (all patient details disguised). It’s supposed to be judgment-free but it isn’t, of course. When someone reads out a crass interpretation they’ve made, you can feel the room wince. Once I was in a group where a sexually abused patient had got the trainee to re-abuse her (not physically, obviously), to bully her with a sexual overtone. One group member ran out of the room. The supervision leader, a senior psychoanalyst, had a real job containing us and an even bigger job trying to help the trainee and his poor patient. In my first supervision group on the foundation course at the Institute of Psychoanalysis, I read out my session with a very unwell man I observed for the purpose of the course. There was a long silence in the austere room. Then one of the students cleared her throat and said; “Well, it’s very well written.” Couldn’t have been much harsher. Actually, that same person came up to me after the course to tell me that she found me unbearable. Nice. There’s this idea, I suppose, that all this honesty means everything should be said. Like in relationships when someone says; “Can I be honest?” This always means, can I be cruel. Later, supervision is one-to-one and is a miracle. I have a new supervisor and his searing insight has, in moments, unfogged the most difficult patients for me. Unlike student supervision, he doesn’t naff about asking me what I think. He listens, then he tells me what is going on and suggests how I might frame it for the patient. I brought him a very troubled young man who sometimes remains silently angry for the whole session. He can be drunk and violent at home, but always more a danger to himself than to anyone else. He had a catastrophic early childhood. He is much better now than when I first saw him. (Initially, I was tempted to suggest he go straight to hospital, but then I thought this is probably how everyone fobs him off—go away, I can’t deal with you.) I have spent ages trying to work out what triggers his acting out. It’s so frustrating when we have a great session and seem to get somewhere and then the next week he hates me and won’t speak. His girlfriend is driven insane by his unpredictability (“for masochistic reasons of her own,” says my supervisor). “He can’t bear to be cared for because if he accepts love and care he will have to face up to a childhood of deprivation,” my supervisor said. I thought of Russian orphans who, rescued from the orphanage by wealthy Americans, instead of sucking up this great new life, want to burn the house down. “If someone has only eaten McDonald’s all their life, when they’re taken to Ottolenghi they can’t stand it. Your patient finds being cared for unbearable. But I probably shouldn’t say Ottolenghi because it makes me sound like a ponce.” I put this to my patient in the next session, without the Ottolenghi reference. He stared at me and said; “That makes sense.” The next week he told me his girlfriend was amazed by how he’d seemed more able to believe she loves him. I’m already convinced that therapy works, but this worked.
