Illuminating the Phenomenological Challenges of Cross-Cultural Supervision

ABSTRACT

The authors discuss transference enactments that occur during cross-cultural supervision. Previous research has shown that few mental health professionals willingly talk about race during supervision and that White supervisees experience significant difficulty when directly engaged in discussions about race. They introduce a new phenomenon, “stereotypical” transference enactments, as a means for understanding the countertransference Black female clinical supervisors experience during clinical supervision of White supervisees. The findings indicated that effective cross-cultural supervision should address the intersectionality of race and gender to enhance the development of multicultural clinical skills. The clinical and educational challenges are discussed by using two case vignettes.     

Transference Enactments in Clinical Supervision

Transference enactments play a central role in clinical supervision regardless of whether supervisors or supervisees consciously recognize or acknowledge their presence. Supervisors who do recognize enactments better understand the core issues that interfere with supervisees’ capacity to relate therapeutically to patients. Supervisory process is markedly enhanced when supervisors consciously study manifestations of transference within the supervisory relationship and respond to them correctively. Corrective interventions, whether purposeful or unintentional, expand supervisees’ relational and self-reflective capacities.

Therapeutic Love and Its Permutations

Compensatory treatment theory rooted in object relations and self psychology is typically silent about issues of love in the therapeutic relationship, particularly the erotic and sensually infused affects and enactments that may permeate patient-therapist interactions, even in the treatment of preoedipal patients. This paper presents a series of case reports in which the therapist consciously or unconsciously experienced some permutation of love in response to the patient's loving and/or erotic feelings. The central thesis is that patients benefit when therapists recognize the sensual components in transference-countertransference interactions and use them to inform therapeutic interventions.     

Why We Need a Biopsychosocial Perspective with Vulnerable,Oppressed, and At-Risk Clients

This article considers why we need to take a biopsychosocial perspective in assessment and treatment of individuals. Using psychological concepts drawn from drive theory, ego psychology, object relations, attachment theory, self psychology and relational theory, the author makes explicit the need to connect these ideas with social and biological contexts. Arguing that psychodynamic theories contain the social as well as the psychological, the author traces Freud's social commitments, the role of critical race theory, the importance of social contexts in shaping development while also considering the effects of neglect, trauma and abuse on the developing brain. Holding in mind all of these positions, is what makes clinical social work truly the impossible profession.     

Considering Improvisation: Play,Transitional Space,and Discovery

This article explores the concept of improvisation in the therapeutic setting as a complex construction when elaborated in the idiom of jazz music. A composite clinical case is offered that illustrates an impasse and how improvisational thinking offers a way forward. Improvisation has recently been conceptualized through the metaphor of theater improvisation, dance, and rhythm. The therapeutic hour is considered an improvisational dialogue with the main theme (melody) and counter melodies, and harmonic possibilities that underlie the rhythmic pulse of the hour. Improvisation requires a reflective/interpretive process that draws on patterns, structures, and experiences reformulated in the relational field of the participants. The client initiates the call and response pattern, from which improvisation emerges as a mutual process of discovery. A more relaxed, receptive, and reflective posture extends Winnicott’s 1971 notion of play to integrate classic understanding and relational interaction.     

Listening for and Holding Traumatic Rage in an Intersubjective Intercultural Field

This article highlights various constructs from the perspective of D.W. Winnicott, trauma theories, intersubjectivity, and intercultural practice as guides for listening on multiple levels to inform the biopsychosocial–spiritual assessment and treatment. Using a clinical case composite, the author will illustrate the working alliance with a severely traumatized client, emphasizing the intense transference and countertransference rage and enactments that occurred during the course of the clinical social work practice. The therapeutic holding environment was challenged but maintained by working through relationship breakdowns, restoring intercultural subjective space and containing powerless rage.     

Enactment and Dissociation: A Retrospective Journey Applying Relational Theory

Relational theory was not yet an endorsed psychoanalytic model 30 years ago. This composite case identifies a process of struggling with a classical theory education that collided with the then young analyst’s immediate clinical experience. Ambivalence about the best therapeutic course contributed to delays and enactments, and ultimately to effective interventions. This article describes the clinical growth process of the analyst progressing toward integrating aspects of what now would be mainstream relational technique. This shift was necessary to bring into open clinical discourse the dissociated self-state experiences and enactments that were paralyzing patient and analyst. The here-and-now interpersonal exchange, including identifying transference and countertransference, allows conflicts and developmental gaps to be clarified; their significance then worked to accelerate self-cohesion and self-esteem. Selective self-disclosure, authentic engagement, and self-recognition in dialogue, which would now be embraced by relational theory, are presented here as the analyst’s and the composite patient’s journey toward a core sense of self that had been sacrificed to dependence on external authority.     

Exploration of Racial Enactments in an Interracial Therapeutic Dyad to Foster the Strengthening of Voice and Identity in African American Male Adolescents

The purpose of this paper is to examine the impact of systemic racism on an interracial therapeutic dyad between a white therapist and an African American adolescent male. Leary (2000 Leary, K. (2000). Racial enactments in dynamic treatment. Psychoanalytic Dialogues, 10(4), 639–653. doi:10.1080/10481881009348573[Taylor &; Francis Online], [Web of Science ®] , [Google Scholar]) operationalized the term “racial enactments” and made the important point that its “most common” manifestation “has been our relative silence about racial issues” (p. 647). It is the premise of this paper that the youth of color’s subjective experience of racial microaggressions and assaults experienced on a daily basis must be validated and explored prior to a meaningful intersubjective exploration in the clinical encounter. The emphasis in this paper is on the racial enactment that precedes the clinical encounter. A treatment vignette is used to highlight the intersection of social and psychic spheres of human experience and how an awareness of unconscious bias in the therapist can facilitate a more meaningful dialogue in which priority is given to the emergence of a powerful client narrative voice.