Anxiety, supervision and a space for thinking: some narcissistic perils for clinical psychologists in learning...

The process of learning psychotherapy involves narcissistic dangers--there may be injuries to self-esteem and self-image, especially when working with certain kinds of disturbed and hostile patients. Some patients will unconsciously recreate, in the transference, representations of early damaging experiences with parents, but now reversed with the therapist as the victim. It is vital for the trainee to be helped to understand these powerful interactional pressures. There are aspects of the professional culture and ideals of clinical psychologists (and possibly of some psychiatrists and social workers as well) which may make them particularly vulnerable in work with the hostile patient. It is argued that the function of supervision is not to teach a technique directly, but to create a 'space for thinking'--a kind of thinking which is more akin to maternal reverie, as described by Bion, than problem solving.