Psychotherapists often need to embark on their own therapy to understand themselves more deeply and to unpack more specifically how their own issues and relational patterns affect their work.
All forms of psychotherapy share in common a significant relationship between patient and therapist, with research strongly indicating that the quality of this relationship is crucial to the treatment.
Relational styles, attachment patterns and blind spots
The importance of clinical supervision for psychotherapists is illustrated by Mia*, who walked into supervision with us looking frustrated and harassed. She was feeling irritated and frustrated with one of her patients, a young man called Dan who desperately wanted a relationship that was close and intimate, but had been unable to achieve one.
Dan was charming and intelligent, and there was no shortage of potential partners. Yet with every partner to date, as soon as things started to deepen Dan found fault with the relationship and doubted his choice. Until recently Mia had felt that she and Dan were making good progress.
They had unpacked the attachment style of his parents and how his mother was fragile and yet demanding. His dad had a chronic illness and mum looked to Dan to both practically and emotionally fill in the gaps in her life. He was what we call a “parentified child” in that he often had to parent his mother rather than being able to lean on her. If he did try to express his own needs and vulnerabilities, his mother became more unsettled or fragile and increased her demands for support. Dan thus learned that it was best to keep his vulnerability to himself.
It was no wonder then that in relationships with significant others he shied away from the vulnerability that intimacy requires. As he drew closer to someone, he became ambivalent and gave out confusing messages until his partners became progressively more frustrated, fleeing the relationship, or prompting him to do so.
Mia reported that Dan seemed intrigued and interested in exploring his childhood history. He was keen to understand more, especially how it affected his current relationships. In fact, he appeared so motivated that he frequently asked for extra sessions. Mia was usually able to oblige by fitting him into cancellations. After several consecutive weeks of these requests, Mia offered Dan a regular extra session that had become available. To her surprise, Dan not only declined the offer but also indicated that perhaps he had got what he needed from the therapy, and it might be time to wind down. Mia was understandably frustrated given her own commitment to the work and her desire to find a way forward for Dan to achieve his own relationship objectives.
Experiencing the phobia while treating it
Naya* empathised with Mia’s frustration. However, looking from the outside, she was also able to notice that Mia and Dan were now experiencing Dan’s commitment phobia in the therapy itself rather than just talking about it.
Mia agreed with Naya’s feedback and the fact that therapy is potentially most effective when the problem outside the consulting room gets enacted in the room. However, she was concerned that Dan was so triggered that he might flee before this opportunity to understand his relational difficulties could be processed.
Mia acknowledged that she had missed an important element in Dan’s dynamic, namely that he is prone to feeling as if he is at the service of others just as he was at the service of his mother. Mia’s offer of a regular session had inadvertently triggered in Dan a confusion as to whether it was Mia’s need for him to come to therapy or his own. In her desire for Dan to move forward, Mia had inadvertently co-created the very circumstances that led to Dan’s need to flee significant relationships in the first place.
For Dan to progress, Mia would need to step back to make a space for Dan to discover his own wishes and desires outside the muddle he always unconsciously felt in significant relationships.
Mia’s own relational patterns were such that she often automatically adapted to the wishes of others. This had led her to offer Dan a regular extra session in line with his previous requests. However, in doing so she was blinded to the fact that she had taken the initiative away from Dan, leading to confusion in Dan because of his particular attachment history.
Supervision with Naya allowed Mia to understand her own dynamics in tandem with Dan’s.
This lessened her frustration, and she was able to hold back and not second-guess Dan’s need but rather wait until he could articulate it himself. By allowing Dan’s ambivalence, and being clear that his choice to stay or go was his own, Mia facilitated Dan staying and continuing his journey towards intimacy.
This frustrating push and pull dynamic is common in significant relationships and can provoke partners into withdrawing or coming up too close.
So, a clinical supervision of her own helped Mia to take a broader view of what was happening between her and Dan. This enabled Mia to let Dan know that she thought it was her moving closer that had led him to move away. Dan in turn was freed to think about whether he did indeed wish to move away or not and what was involved in both choices.
While friendships and love relationships are not therapy relationships, the patterns that emerge in therapy are often the same as those that emerge in other significant relationships. As relational dynamics are co-constructed, therapists’ understanding of their own unconscious contribution to the therapeutic relationship is crucial to the treatment. Supervision can play a vital role in illuminating how these blind spots may be affecting the therapeutic process.
Prof Gill Straker and Dr Jacqui Winship are co-authors of The Talking Cure. Gill also appears on the podcast Three Associating in which relational psychotherapists explore their blind spots
