Monday, June 10, 2013

Hail the China American Psychoanalytic Alliance

This is written to encourage any psychoanalytically oriented therapist, no matter how experienced or confident, to consider volunteering time supervising budding therapists in China via the China American Psychoanalytic Alliance. Sharing the professional life we love, helping it flourish around the globe, and consolidating our own ideas about the work we do are among the many gifts we receive when we give our time to nurturing young professionals in China.

It was intriguing to me that psychoanalysis was being disseminated in China. I thought how exotic Freud might be to many parts of China just as names like Beijing and Shanghai seemed exotic to me.  I thought that no matter how little I might know, I was sure to know more than an entire culture which might never have grown up with id and ego and oedipal complex in its lexicon. I was eager to share what I know, partly because I love psychoanalysis and partly because I am a teacher already at my local psychoanalytic institute. I was excited to meet the young woman who had decided to dedicate herself to training in a culture where her interest would be pioneering. I imagined my supervisee must be heroic, or, at the very least, highly motivated. I might be available to her at 9:30 in the morning, but she saw me at 930pm after a long day. I was moved by her dedication.

We met first by Skype and it took a number of meetings for my ear to acclimate to her accent. I wondered how she was able to hear me, English being foreign to her. She always would have an English to Chinese dictionary on hand.  I always made an effort to enunciate each word carefully. It was sometimes slow going, but in a peaceful and meandering way, like tubing down a shady, spring fed river on a hot summer’s day. Frustration came from the internet Skype connection which too frequently dropped calls, lost video, or had whirring noises which obliterated our conversation. We soldiered on, calling back numerous times, sometimes giving up and confirming by email to meet again next week. It was a privilege to be part of this neophyte’s growth and development and we worked together for almost two years. When the sixty required supervisory sessions were up and she had to move on to a new supervisor, we took a half dozen more sessions for termination. There were tears on both our parts at our final goodbye.

Blossom and I got to know each other. What had drawn us to psychoanalysis? How might she and I make use of our time together? How did she conceive that people benefit from treatment? Blossom was quick to offer that patients, in the presence of the therapist, might better become aware of themselves and their feelings. Blossom hoped to help them face things in their minds and hearts that were difficult to face. There was always an opportunity for me to say something taken as smart as she had so little theory yet on which to rely, compare and contrast. This can be very confidence boosting for the supervisor. And nothing helps us grapple more with our theories than having to teach them. Thus, I highly recommend to all the supervising of a younger colleague.

Sometimes we discussed particular topics like ambivalence or empathy.  I told her empathy was about understanding the good sense of bad behavior, this long before we ever expect the patient to change behavior.  Sometimes Blossom would read papers she had asked me to recommend and we would discuss them. Sometimes she expressed disappointment that many of her patients did not stay in treatment as long as she had hoped.  Sometimes she wondered how to manage the angry and disappointed feelings in her patients who were dissatisfied with their treatments. In other words, Blossom was becoming a therapist, struggling with all the same issues as any American therapist beginning to learn how to be with patients.

Sometimes supervision includes, as it does for the therapist vis a vis the patient, creating together a safe space to discuss one’s fears and fantasies. The medium is the message in supervision too.  The supervisor must create a reliable and accepting space which invites in all possible content. Over the course of Blossom’s work with her patient, Blossom was courageously candid about times when her understanding and empathy flagged, her wish for the patient to hurry up and get better, and about her desire sometimes, such as when the patient did not improve or cancelled sessions, to transfer her patient to a different therapist. We discussed enactments, and managing the therapist’s helplessness and sense of incompetence. Blossom could recognize that her patient’s new struggles indicated a forward edge for the patient, a finding of her own voice. Blossom too was finding a voice and I was gratified to be part of that.

One example of Blossom finding her voice occurred in the tenth month of our supervision when she had to present her case before her coworkers and to the psychiatrist in charge of the clinic. The psychiatrist was somewhat famous, was more experienced, and was very aware of his authority. Nonetheless, Blossom was able to joke with the psychiatrist about his criticisms which she thought misunderstood the case and, to her delight and surprise, the psychiatrist changed his tone and encouraged her to be herself with her patient. Blossom, likewise, reported she was able to be more openly questioning and critical about information presented in her classes. She felt more engaged with the training.

When it came time to say goodbye, Blossom reported that her patient, also reaching termination, had said to Blossom, ‘What else do we need to do? Nothing, so I leave my case material to you as a gift. The only thing I can do for you is to give my private material to you as a gift.’ I acknowledged that it had been a gift to me to work with her in supervision. Blossom noted that she too had received gifts, from me, that would last, as what one gains from therapy lasts, after treatment ends.

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