Clinical Impact Statement: The teaching and learning of psychotherapy require as much didactic exposition on the evidence-base for different therapeutic approaches as it does technical instruction on the skillful delivery of behavioral interventions. Less attention is paid, however, to the more granular challenges of teaching and facilitating a greater openness to experience, emotional regulation, and risk-taking among trainees. To boot—to nourish the inner lives and capacity for emotional experience among our students. Using more experiential and artistic methodologies, a clinical supervisor and trainee will explore the promises and challenges of learning psychotherapy, using the language of poetry, short-story, and confessional writing.
Not as Urgent as a Toothache (JM)
The Analyst stares into the steam of his green tea. A morning Rorschach for no one to interpret.
The first of his five patients for the day is out in the waiting room, flicking through one of the old lit mags fanned out on the scuffed coffee table with splintered legs. After all, the Analyst wanted to make and maintain the right impression. Urbane, intellectual, and playful were three adjectives he hoped crossed some folks’ minds some of the time.
The Analyst should have been revisiting his process notes. Instead he is brooding. Since his mid-career burst of publications on posthumanism and psychoanalysis, he had been wondering whether he was a better therapist than person. The idea skittles his innards. Think of the sensation of ingesting a large pill on an empty stomach.
The notion was a parting gift from his second wife, a landscape architect with kind eyes. The day she uttered those words they separated. For several months he had been urging her into psychodynamic treatment.
‘Address the relational disturbance inherited from your deprecating parents’.
His formulation, not hers.
In the Analyst’s mind every one of her attempts to connect became instances of neurotic transference, unjustly projected. Really they were meant for her absent father.
For weeks he’d wake up in the early morning with molten tension in his legs, arms and abdomen. He’d shake her from her sleep.
‘Quit with the unending projective identification’.
These feelings were hers. Not his, he thought.
‘Own them, metabolize them. Take the rocks of your childhood back, stop handing them to me’.
It only got worse when she began psychoanalysis with someone trained at an institute in the right part of town.
She started using all of the in-house terms.
His language, he thought.
For the next few months every few nights, he’d wake up with a jolt and ask her to stop being so ocnophilic.
He said that.
‘Find your own identity’.
‘Quit with the relentless introjective identification’.
‘Stop raiding my stash, build up your own.’
‘We’re not one person, you know.’
She’d respond with red squalls of confusion in her widening eyes.
‘What do you want from me?’
His response was always the same.
‘You’ll work it out, you’ll figure it out, free your mind of the past’.
But she never did figure it out. Neither did he.
She left him on a bright spring morning.
‘You gave up your goodness running after unconscious conflicts and magic-bullet insights’.
The words struck him. A volley of glossy charcoal pebbles.
As the door closed behind her, he shuffled into the kitchen and found her copy of Buber’s I and Thou on the counter top.
He opened it at random, settling on the word vergegnung: mismeeting, miscounter. Think of two wolves baring their teeth, circling one another before trotting off in opposite directions.
He wept heavily. No tears fell.
A windy pain bore into his middle.
He snapped the book shut and put it outside on the stoop for a stranger to pick up. He found himself in a cold house that used to be their home. He went upstairs to finish writing a paper. “Healing beyond words: on the co-creation of silent mutuality.”
The Analyst broke from his reverie and the ceiling in his office spun. The ovoid light above leered at him. He sighed, lips billowing. Think of the tattered sails of a boat blown off course.
The Patient was new to analysis.
‘You know, none of my stuff is that bad. It’s not as urgent as a toothache’.
He mumbled this the first time they met.
The Analyst, embodying a well-worn pose of clipped kindness, beckoned him into the room.
In their previous session The Analyst, a psychiatrist from elsewhere, wrote the Patient a prescription. The Patient hadn’t slept safely in weeks, waking up each night with gargoyles in his stomach and spiders in his bronchi.
‘Have you taken a benzo before?’
‘That’s rare in this day and age. How have you avoided them?’
‘Well, I don’t usually get into relationships with people. That’s the trick’.
Their sessions usually began in thick silence. Today was different. As soon as he uncrossed his arms, laying them by his sides, he spoke.
‘You have an accent. Where are you from?’
The Analyst froze in time. A blaze swept his hippocampus and amygdala, scorching through neglected neural circuits. Think of the cracked concrete floor of an abandoned courtyard. Green life reaching for the sun from below.
The Analyst is four years old, nestled under the staircase.
He is absorbed in play, building castles in the air.
His cheap plastic figurines are knights on a quest to rescue a princess held captive by an evil sorcerer. Think of Grendel, think of Sauron. They run into many obstacles on the way. Most perish. As the last two reach the sorcerer’s fortress, readying themselves for the final standoff, a voice dials in from another universe.
‘Come meet your sister’.
The analyst puts down his toys and exits the alcove. Think of the feeling of waking up from a technicolor dream before it ends. An aborted promise.
The Analyst slowly climbs the staircase to the bedroom above.
He squeezes through the crack in the sliding door, entering the adjacent bathroom. He hovers on the outskirts. Think of an evening sky before a thunderstorm.
At the center of the rectangular bathroom, lined floor to ceiling with cold charcoal tiles, is a large oblong tub. Water on the brink, almost overflowing.
The Mother washes life into the Newborn. Two entangled souls.
The water darkens with blood. Think of beet soup, maybe borscht, with two dollops of sour cream, one subtending the other.
The Analyst stares at this scene, something inside him coils. He doesn’t know what.
The Mother speaks.
‘This is your little sister. Come meet her.’
The analyst speaks.
He turns away, banging his left shoulder on the frame of the sliding door.
He walks past the bare bed and down the stairs, back to his universe in the alcove.
The Analyst tries to resume his quest but can’t. He batters the heads of his knights against the iron balustrade of the staircase. Once the demolition is over, he lies down.
The Analyst looks up into the dusty crevices zig-zagging the cream surface of the ceiling above. There is usually a story to find up there. Think of clouds that congeal in the shape of a fox or the face of someone you know in profile.
But the Analyst sees nothing. A palette of unnamable feelings.
A dream, recurring for the Analyst in his forties.
He is driving a matte black, helmet shaped car down a looping highway into the pith of the city.
To his left a mountain clambers into the sky, draped in a cotton-wool pall of stringy clouds. To the right, a bay spangled with the burst of early morning sunshine extends into infinity. Inert cargo ships draw his gaze to the horizon. Beyond lies an Island circled by sea gulls with the smoke of past atrocity in the beat of their wings.
The highway is empty, not another vehicle insight. The Analyst is not alone. Two figures sit in the back of the car, bodies with heads but no faces. Think of what it is like to strain for sight in a dark room. That is what it is like trying to picture who they are.
There are no cars, only pedestrians in single file. They walk in the emergency lane, in the opposite direction, with broken umbrellas in hand.
The Analyst is feverish, his breathing shallow. He feels his heart thudding in his fingers wrapped around the steering wheel.
The car is perilously close to the slow-walking caravan. Think of the rush of stale air as a subway car hurtles past.
The Analyst takes the nearest off ramp and stops at a bronze traffic light. The sky is a ruddy brown, a convexity of dried blood. He turns his gaze to the left, catching his faceless companions in his peripheral vision. An old fort, wound tight in barricade tape, abuts the road.
He exits the car and squints into the glinting sun. He joins the silent chain of travelers lilting onwards. No words are exchanged.
The two faceless figures on the back seat sit still as statues. Then each extends a gloved hand into the chasm of the other’s blank face.
The Analyst, momentarily immobilized, returns to his office. To his Patient, lying there. Looking upwards. Wanting answers, craving respite.
A stranger, promising to revitalize the Analyst’s tiring curiosity.
The Analyst veers back to the irruptive question.
Think of the feeling stirred in your body by the atonal bark of a PA system in a government office of one kind or another.
‘Well, I would like to give you an answer. I wonder though, if we could explore where that question is coming from first?’
Response: Better Get That Tooth Checked (DG)
Reading the beginning of Joshua Maserow’s piece, “Not as Urgent As A Toothache,” reminded me of a 90s newspaper cartoon one of my graduate school professors posted on her door. It depicted a monstrous, twisted depiction of a therapist. The text surrounding this image read:
By day a Rogerian counselor, at night she turned into…
No matter how hard she tried, she couldn’t stop the frothy fount of senseless psychobabble from spilling out and dominating the conversation. Just when you thought you were safe… she came to your party
The PSYCHO-therapist was depicted spouting tropey lines such as “You’re putting up barriers! Get in Touch! Let Go! You’re Projecting! Unfinished Business!” Each charge more accusatory than the last. An empathic, caring, intuitive therapist in the consulting room, no less than the warm, brilliant mind that comes across in books and articles. They look like a duck and quack like a duck, but do not be fooled—they may both turn out to be an asshole.
Nobody Likes to Go to the Dentist
A wave of anxiety washes over me—Is this Joshua’s future? Is it mine? Is it ours? Are those of us who work in the science of human relationships at risk of rupturing, breaking, losing them?
The therapist in Joshua’s story was successful, scholarly, clearly very intelligent and versed in the art and science of our field, and yet “he had been wondering whether he was a better therapist than person.” Is this the price exacted by our field? To sacrifice our relationships, our happiness, our inner life? To hide behind the veneer of “the therapist” while our world crumbles about? To help patients create and find a life worth living while failing—even refusing—to live our own? To ignore the molar that has been stinging for months? Years? Decades?
In a moment of total disconnect, having “miscountered” his wife and lost her, the therapist goes on to connect with the analytical ideas and themes that haunt him so. Later his patient makes what we might call an interpretation, not only of himself but of the therapist—None of his stuff is that bad, “not as urgent as a toothache.” Ignoring the pain. Putting it on the other. Causing and experiencing suffering. Many patients, but especially those with histories of trauma, are highly adept at picking up on our “professional hypocrisy,” to use Ferenczi’s phrase. The belief that our stuff is not that bad, not in dire need of being addressed, worked through, challenged, brought to light, and freed up so we may live a fuller, freer life with joy and integrity instead of bitterness and grit.
Open Up and Say . . .
An accent takes us down the winding roads of memory to a staircase. The therapist slays dragons and rescues princesses—as Oedipal boys are wont to do. Except this princess is in another castle and not in need of rescue. “Come meet your sister,” she bellows. The therapist responds by returning to the staircase to finish a fantasy, but he can’t. Fear of connection and the failure to connect, or fear of love and the loss of love as another of my professors once put it, haunts him. Possibly—probably—haunts us all. The therapist comes to, returning his attention to his patient, “a stranger, promising to revitalize the Analyst’s tiring curiosity.” We connect with our patients, driven by curiosity, empathy, and care. But what happens when that is our primary mode of connection in life? What happens when we push others away more and more? Do we risk depending more and more on this work for nourishment, meaning, excitement?
I turn to my students. I remind them to mind self-care. Go out. Pick a hobby. Date. Write a song. Watch the game. Play a game. Sing karaoke. Go dancing. Go to a concert. Take to the streets. For all that is good and true go and do something outside this field. Save yourself, run away! Practice what we preach as therapists and live. Then I realize these are the first four years of graduate school talking.
How often do we preach self-care while depriving trainees of the means to practice it?
How little do we care for them to? I think, and this is just a hunch:
We all have cavities.
How to Become a Beginner (DG)
The teacher is of course an artist, but being an artist does not mean that he or she can make the profile, can shape the students. What the educator does in teaching is to make it possible for the students to become themselves.
I am not her father
Firm, authoritative but not authoritarian
Guiding, questioning, supporting
holding back hands impelled to reach out and soothe-say
“It’s going to be ok”
Restraining warmth that blossoms tears when I see her grow
And in learning, I learn
And grow with her
I am not his therapist
But I’d be lying to you if I said pedagogy can be spelled
Caring, mindful, sustaining
Extending a part of yourself that remembers
what it was like to
“So it sounds like I’m hearing what you’re saying is…”
His and her intervention
not exactly my best moment
the best example of technique
It was, what, first year?
I had read through the instructions for the camera in the consulting room
I read them again
Ok, I think I got it working
Did it delete the video?
It deleted the video.
… … … Fuck.
Then again, I won’t have to embarrass myself in supervision
The memory was fresh, crisp
As she bashfully reported she didn’t have a video this week
like I didn’t know that subtle smile
behind blush apologies
I smiled that smile too, you know
I blushed that blush
But that’s exactly why I take a beat, step back
Let the memory wash over me
And in remembrance, learn
She and I talk about how exposing training can be
How vulnerable it is to share your imperfections and your
“What’s good for the gander is good for the goose”
They laugh nervously
How can we ask others to show us their worlds
Reveal their wounds
Put it in words
If we don’t learn about our own?
More importantly, how can I get them to understand that?
That question was my first mistake
The “fundamental rule” is fundamental, but also
Meant to be broken
Isn’t that what we do?
Work with what is broken and not demand to be “fixed”?
A doctor who tells their patient “How dare you have allergies!” is going to have a hard time treating allergies
A therapist who tells their client “How dare you resist!” is in dire need of their own therapy
A teacher who tells their student “How dare you be afraid!” needs to go back to school
I am neither his father nor her therapist
But I know joy when I see them learn
I know pain when I feel their struggle
And once the year is over I’ll know sadness
That’s when I realize
love is a sign that learning is happening
I just had to become a student again to remember
“good for the gander” indeed.
Response: On the Importance of Staying a Beginner (JM)
“I cannot see any basic difference between a handshake and a poem.”
Reading Dr G’s poem, “How to Become a Beginner,” conjured a number of recollections and associations for me. The first is a memory of our first supervision together. Dr G, three of my peers, a co-supervisor and I gathered around an oval table with a large, dark, blank but blinking screen mounted on the wall looking over us ominously. The supervision began with a grounding exercise, settling our attention and bringing us into the present moment. Once we opened our eyes, slowly returning to the task at hand, I recall Dr G asking us, “What is going on for you?” Instantaneously, I felt the pull of two dueling forces. On the one hand, I wished to speak as candidly as possible, as I might in the sanctum of my therapist’s office. On the other hand, I thought: “Here I am, in a sterile, cloistered room, with five people I don’t know all that well. Would sharing my safely guarded thoughts and feelings be appropriate? What is supervision anyway? Is it a class? Is it therapy? Is it some undecidable chimera purling in the spaces between those two? What should and should not be disclosed here?”
In response to the question, which became louder and louder in my mind with each passing moment, I responded: “I don’t really like the sound of my voice.” As you might guess, Dr G followed up with: “What is it that you don’t like about it?” I paused for a few seconds and ventured a few words that skirted the edges of the truth. The discussion moved on. Eventually, I acknowledged that my response was evasive, but I stopped there, waiting for a time when I thought I might have a firmer grip on the puzzling ontology of supervision. Several months have passed since then and I must admit that moment is yet to come.
It’s a cliché to say this but I will say it anyway: The power of poetry lies in its irreducible suppleness. It is able to do justice to paradox, aporia and ambiguity in ways that few other forms of representation can. Dr G’s poem enacts the polysemy of supervision—that I found, and still find, so stupefying—from a different vantage point: that of the supervisor. In the ebb and flow of his lines, we hear a voice sparring with what it means to be a clinical supervisor. Is he a father? No, not entirely but sort of. Is he a therapist? No, not that either really but there’s a little of that in the mix. Is he a seer? No, that would be over-reaching. So, what is a supervisor? A supervisor is ‘Firm, authoritative but not authoritarian’. I found myself repeating this line over and over to myself, appealing to reason to fathom out its meaning. After a while, I relaxed my will to meaning and settled down with the notion that it conveyed a felt sense rather than a symbolizable idea.
As I read on, it became clear to me that the speaker in the poem—who may or may not be one with Dr G—is not trying to define “supervision,” “supervisor” or “supervisee.” Instead, it is staging the mercurial, ever-shifting identities, relations and boundaries which emerge when “supervision” occurs. This verve to trace the shimmer of the ineffable brought to mind the lionized words of John Keats, who in a letter written in 1817 wrote:
Several things dovetailed in my mind, and at once it struck me, what quality went to form a Man of achievement especially in Literature & which Shakespeare possessed so enormously—I mean negative capability, that is when man is capable of being in uncertainties, mysteries, doubts, without any irritable reaching after fact & reason.
In this poem, the voice who may be Dr G points out the tremendous importance of maintaining a beginner’s mind, of “becoming a student again,” for the “supervisor” in order to ensure that the mystery of supervision is nourishing and mutative. It demands that we, supervisor and trainee alike, build the capacity to tolerate ambiguity and uncertainty “without any irritable reaching after fact & reason.” Bringing Keats’s notion of negative capability into the psychoanalytic fold, W.R. Bion notes, “the capacity of the mind depends on the capacity of the unconscious—negative capability. Inability to tolerate empty space limits the amount of space available” (1992, p. 304). It is in the process of becoming a student again, of welcoming the empty space between being authoritative without being an authoritarian, between being neither a parent nor its opposite, between being a therapist and not a therapist, between being an expert and a beginner that the supervisor exists. It is in this role between roles where love may arise and be a “sign that learning is happening.”
I was also reminded of Ogden’s (1999) message in his paper “‘The Music of What Happens’ in Poetry and Psychoanalysis.” For Ogden, the acoustics of poetry and psychoanalysis are alike: both require an aural attentiveness that demands a relaxation of the proclivity to get behind the text of a poem, and the surface of the person, to their underlying truths. Both psychoanalysis and poetry have this in common: they are more likely to yield answers—to unveil their vaulted secrets—when curiosity shifts its emphasis from content to form, in the case of poetry, and from pure interpretation to process, in the case of psychoanalysis. Ogden articulates this by stating that the question analysts should be asking of the ever-shifting field in which patient and analyst exist is what’s going on here? rather than what does that mean? After reading Dr G’s poem, I will hear the question what’s going on for you? in a new register—one that celebrates the vulnerability, vitality and therapeutic importance of being, and always remaining, a beginner.
Cite This Article
Gaztambide, D. J. & Maserow, J. (2019). Becoming trainees, becoming therapists: A poetic call and response between supervisor and supervisee. Psychotherapy Bulletin, 54(1), 30-37.
Bion, W. R. (1992). Cogitations. New York, NY: Routledge.
Celan, P. (2003). Collected Prose. New York, NY: Routledge.
Horton, M., & Freire, P. (1990). We make the road by walking: Conversations on education and social change. Philadelphia, PA: Temple University Press.
Keats, J. (2002). Selected Letters of John Keats. Cambridge, MA: Harvard University Press.
Ogden, T. H. (1999). “The music of what happens” in poetry and psychoanalysis. International Journal of Psychoanalysis, 5, 979-994.