COURSE DESCRIPTION:
This innovative group supervision course offers students a transformative experiential approach to understanding their patients through the therapist’s own internal responses. The course is entitled “The Analyst as Instrument” because the focus is on how the clinician uses his/her own feelings, thoughts, sensations, and perceptions in each therapeutic session as an avenue to the most acute understanding of their patients. Students learn through firsthand sharing of clinical struggles what is deflected and projected out from the patient’s internal world.
THEORETICAL FOUNDATION AND CLINICAL APPLICATIONS
This approach is based on the work of generations of object relations theorists, originally derived from the British object relations school. The theoretical foundation stems back to Melanie Klein’s concept of projective identification, Paula Heimann’s understanding of countertransference, Heinrich Racker’s contribution on “concordant” and “complementary” countertransference, as well as Wilfred Bion’s views on translating concrete unprocessed “beta” elements (enactments) into symbolic “alpha” communication, which involves processing projective identifications as an integral part of countertransference phenomenon. Further contributions were made by representatives of the British school, such as D.W. Winnicott (in his paper on “Hate in the countertransference”) and by American theorists who wrote about “subjective” versus “objective” countertransference (Otto Kernberg, Lawrence Epstein, and Jeffrey Seinfeld).
Dr. Kavaler-Adler has integrated many aspects of British and American Object Relations theory in her own theory of “developmental mourning” as a critical psychic change process. Her unique perspective on character disorder developmental arrest as an internal world fantasy of a “demon-lover complex,” while seeing trauma and pathological mourning in object relations terms, has offered clinicians all over the world a unique view of clinical work and psychological transformation.
The basic idea is that everything that a psychoanalytic object relations clinician experiences while in the room with the patient can be mentally (Peter Fonagy’s “mentalization”) and symbolically processed, so that it is understood in terms of core traumas and conflicts within the patient’s internal world, which are enacted upon the therapist, because the patient cannot contain and consciously experience his/her own traumas and conflicts. Whatever is said by the patient is then seen as secondary to what the patient might be enacting at any one moment, especially in relation to a core developmental arrest trauma that disrupted basic self-integration and separation-individuation.
This approach is critical with character disordered patients, as their psyche does not operate on containing repression; this results in compulsion to propel their own internal experience out into the other they are with, inducing feelings in the therapist of being either the traumatizing parent (part object) or the traumatized child self (part self). Object relations theories help therapists to process those projective identification experiences, so that they can understand the traumatic disruptions in a patient’s core, stemming from the time of the early pre-oedipal parent-child sadomasochistic enactment.
For all patients, it is essential that their analysts understand/feel how to be “in their skin.” In the case of neurotic patients, verbal associations do reflect such feelings in terms of core conflicts. Thus, the understanding of these symbolically meaningful verbal associations and memories allows the therapist to understand the patient’s core conflicts, as they are continually retriggered in the unconscious areas of a repressed psyche.
Through case presentations, role-play demonstrations, and group discussion, Dr. Kavaler-Adler teaches students to actively apply essential object relations concepts including:
Core Clinical Concepts: “Projective identification,” therapist’s “object survival,” the analyst as a “psychic container,” “the holding environment,” “primitive” vs. neurotic transferences, “primal envy” and its manifestation in treatment, “the transformational object,” “object internalization,” and “objective vs. subjective countertransference.”
Developmental and Therapeutic Processes: Empathy developing through the Winnicottian “capacity for concern” and Kleinian “depressive position,” capacity to process loss, “existential guilt,” self-sabotage related to “unconscious loyalties” to internal parental objects, “the true self,” and “the capacity to be alone.”
Advanced Clinical Topics: Developmental mourning, envy, and erotic transference—challenging areas that require sophisticated clinical understanding.
Students learn to distinguish between:
- Dissociation and splitting (in character-disordered patients) vs. repression and defenses (in neurotic patients)
- Primitive vs. neurotic transferences and their different treatment requirements
- Objective vs. subjective countertransference and their clinical implications
- Depressive vs. Schizoid-Paranoid Position of one’s being and their clinical presentations
Through group sharing and role-play, participants develop skills in:
- Processing projective identifications as clinical information
- Creating a therapeutic “holding environment” and serving as a “psychic container”
- Understanding how patients induce feelings in therapists that mirror either the traumatizing parent or the traumatized child self
- Translating concrete behavioral enactments into symbolic understanding
UNIQUE EXPERIENTIAL METHODS
Two-Phase Process: Students begin with traditional clinical case presentations, sharing their therapeutic work and challenges with specific patients. Following this initial presentation, the innovative role-play phase begins.
Role-Play Supervision: After presenting their case, students then embody their patients—adopting their mannerisms, speech patterns, silences, and body postures. Dr. Kavaler-Adler responds as the analyst, creating spontaneous therapeutic dialogues that demonstrate clinical concepts in real-time. The group then engages in discussion, processing both the original case material and insights gained through the role-play experience.
“Understanding the Patients Inside-Out”: This sequential approach allows students to move from intellectual case discussion to embodied understanding of their patients’ internal states. The role-play reveals how patients’ unconscious material gets enacted and projected into the therapeutic relationship in ways that traditional case discussion alone cannot capture. Participants benefit from the experiential learning of how to process “objective countertransference,” and such concepts as transitional space, transitional object, holding environment, psychic container, and projective identification.
GROUP LEARNING PROCESS
The group format allows students to learn through multiple channels:
- Direct presentation of their own challenging cases
- Empathic identification with other group members’ process and struggles
- Witnessing role-play demonstrations that illuminate clinical concepts
- Collaborative processing of countertransference reactions, including somatic ones
A unique aspect of this supervision approach is understanding how the supervisor becomes internalized as an “internal object” within each supervisee’s psyche. Drawing from Dr. Kavaler-Adler’s seminal research “The Supervisor as an Internal Object” (1990), students experience firsthand how they internalize the supervisor in varied ways—some primarily cognitive, others visceral and embodied, and some involving dynamic fantasies of the supervisor occupying psychic space.
The supervisory process typically involves working through initial persecutory or critical internal representations of the supervisor. As Dr. Kavaler-Adler’s research demonstrates, supervisees often begin with split “good” and “bad” part-object views that must be integrated through the supervisory relationship. The nature of these internalizations depends on each supervisee’s developmental level and character structure.
Through the group process, students experience the reparative aspects of supervision—developing gratitude and the capacity for realistic criticism alongside appreciation. This transformation from split part-object relations to integrated whole-object relationships mirrors the therapeutic process itself and teaches students about object usage in Winnicott’s sense. Students learn to recognize when they’re operating from defensive splitting versus genuine learning integration, ultimately developing their capacity to “use” the supervisor as an internal resource without destroying the relationship through projection or idealization.
Note: This experiential approach requires students’ willingness to share clinical challenges openly and engage in role-play. The group provides a safe container for exploring difficult countertransference reactions that are often central to treatment breakthroughs.
