A narrative review of group analytic literature on clinical supervision: Seeking coherence and correspondence

Abstract

A systematic narrative literature review was carried out with the aim of identifying key themes in the group analytic literature on clinical supervision, and to inform the development of theory, practice and research in this area. The systematic literature search identified 103 relevant publications, nearly all involving case vignettes of supervisory practice and theoretical reflections on group analytic supervision, with only a handful of published research studies in this field to date. Four core themes were identified in this literature, indicating what group analysts have considered to be the key functions of clinical supervision—one primary theme: Providing critical holding and containment, and three other themes radiating out from this primary concern: Supporting capacity to bear and process emotionally, sustaining ability to think deeply and widely, and counteracting isolation and enabling creative exchange. The nature of each of these themes is elaborated, and this material is critically considered in terms of the group analytic contribution to the clinical supervision field (considering theoretical coherence) and its relationship with the wider literature on supervision (considering correspondence with other disciplines). In conclusion, some implications and recommendations are outlined.

Keywords

group analysis clinical supervision holding and containment group supervision team and organizational supervision systematic narrative literature review

Introduction

We have over a century’s experience of engaging in clinical supervision, with Freud’s case discussion groups typically referenced as one of the earliest examples of supervised practice (Freud, 1914/1986). However, it is only in recent years that supervision has become recognized as a distinct professional practice and deserving of focused study (Watkins and Wan, 2014). Alongside this, the research and theoretical literature on clinical supervision has increased exponentially over the last 20 years.

This paper presents the results of a systematic narrative review of group analytic literature on clinical supervision, carried out as part of my engagement in an MSc in group analytic psychotherapy. Following training and practising as a clinical psychologist and integrative psychotherapist, supervision became a specialist area of practice, teaching and research for me over the last 10 years. However, during my training as a group analyst, I became aware of an apparent absence of group analytic writings within the burgeoning literature on clinical supervision. I wondered where the group analytic voice was and what insights group analysts might have to offer to this area of professional practice for various helping professions, and this prompted me to undertake the current literature review study. In order to provide a context for this study, I would first like to offer a broad overview of the wider literature on clinical supervision, noting some key areas of theory and research to date, as well as considering definitions and practice issues.

In the most often cited definition of clinical supervision, it is described as having the objectives of enhancing supervisees’ professional functioning, monitoring the quality of their work and being a gatekeeper for the relevant profession (Bernard and Goodyear, 2019). Another prominent definition describes clinical supervision as ‘a relationship-based education and training that is work-focused and which manages, supports, develops and evaluates the work of colleague/s’, noting its objectives to be ‘normative’ (e.g., case management and quality control issues); ‘restorative’ (encouraging emotional experiencing and processing); and ‘formative’ (maintaining and facilitating the supervisee’s competence, capability and general functioning)’ (Milne, 2009: 15, drawing from Proctor, 1988).

Supervision is described as the ‘signature pedagogy’ of the mental health professions (Bernard and Goodyear, 2019: 2) and traditionally involves an apprenticeship model of learning one’s discipline under the guidance and oversight of experienced professionals. However, clinical supervision may also be attended throughout one’s career, this being required for ongoing registration or accreditation for some helping professions in some countries. For example, a minimum of 10 hours’ attendance at clinical supervision per annum is required by law for psychologists in Australia (Australia Psychology Board, 2015), and at least once-monthly attendance is required for continuing accreditation with the Irish Association for Humanistic and Integrative Psychotherapy (IAHIP, n.d).

It is also the case that many qualified professionals choose to attend regular supervision, even when not required by law, accrediting bodies or their employers, indicating its perceived value as a professional practice. For instance, 88% of 431 qualified Irish psychologists surveyed reported attending regular clinical supervision (McMahon and Errity, 2014), high numbers also reporting doing so in the United Kingdom (86% of clinical psychologists: Golding, 2003), and in the United States (61% of counselling psychologists, Lichtenberg et al., 2014, cited in Nicholas and Goodyear, 2021). Supervision is not legally required in these professional contexts, although many professional body guidelines specify that ethical practice involves ongoing attendance at clinical supervision (e.g., Psychological Society of Ireland, 2017; New Zealand Psychologists Board, 2021; British Psychological Society, 2017). Regular attendance at supervision has also become recognized as part of good clinical governance within public health contexts (e.g., Health Service Executive (Ireland), 2015). Overall, attendance at clinical supervision is now widely considered to be an integral part of good practice as a health professional, from training to retirement.

Over the years, many authors have developed supervision models to describe and guide practice. The earliest models were based on psychotherapy theories, focused on enabling the supervisee to develop the knowledge and skills of a particular therapeutic approach, and theory or discipline-specific books on supervision continue to be published (e.g., on supervision for coaching [Clutterbuck et al., 2016], cognitive-behavioural therapy [Milne and Reiser, 2017] and psychoanalytic therapy [McWilliams, 2021]). Models have also been developed which focus on adapting to the developmental stage of the supervisee, the most popular of these being the Integrative Developmental Model (Stoltenberg and McNeill, 2010). A third category involves social role or process models, which describe key roles and processes in supervisory work (e.g., Seven-Eyed model: Hawkins and McMahon, 2020; Cyclical model: Page and Wosket, 2015). New models and frameworks for supervisory practice continue to be published, Bernard and Goodyear (2019) dubbing most of these as second-generation models as they typically build upon one of the three previous categories of models.

A recent review identified as many as 52 models of supervision, noting inconsistency in the elements included in the models and a lack of research evidence to support them (Simpson-Southward et al., 2017). Thus, while substantial work has been done to develop theoretical models and frameworks to guide supervisory work, empirical support is needed to validate their applicability and relevance in various professional contexts. In line with this, recent research has focused on the application of the Seven-Eyed model and Heron’s Six-Category Intervention Framework to post-qualification supervision in a public youth mental health service (McMahon et al., 2022a, 2022b).

Guidance for specific modes of supervisory practice has also been provided in the literature, including theoretical and research publications on group, peer and triadic supervision formats (e.g., Kemer et al., 2021; Kleist, 2021; Proctor, 2008). More recently there have also been publications on tele-supervision, following developments in supportive technology and the increased use of remote supervision since the Covid pandemic (e.g., Inman et al., 2019; Phillips et al., 2021; Rousmaniere, 2014).

Work is also being done to develop a shared understanding of what is involved in good supervisory practice across disciplines. Surveys indicate that most health professionals take up a supervisory role without any training (e.g., McMahon and Errity, 2014), and that many supervisees experience inadequate and even harmful supervision (Ellis et al., 2015). The traditional assumption that ‘competence as a supervisor is accomplished through osmosis’ (Falender and Shafranske, 2012: 133) has been widely challenged, and the need for training in specific supervisory competencies has been argued. Research to develop robust measures to identify and assess areas of supervisory competence is emerging (e.g., Hamilton et al., 2022; Swank et al., 2021) and at this stage there is international consensus regarding some key supervisory competencies. These include: establishing and maintaining the supervisory relationship, attending to contracting, power and diversity; facilitating/overseeing supervisee development and competency through gate-keeping, goal-setting, evaluation and feedback; and maintaining knowledge of ethical, legal and professional issues, including supervision theory and research (Borders et al., 2014; Watkins and Wang, 2014).

As research has indicated the importance of the supervisory relationship for supervisees’ satisfaction, well-being and learning (Watkins, 2014), there has also been a growing theoretical and research focus on key relational issues in supervisory practice. This has included publications on power dynamics, supervisee non-disclosure and experiences of inadequate and harmful supervision, relational ruptures and repairs in supervision, and working with cultural competence and humility (e.g., Ellis et al., 2015; McMahon, 2020; Singh-Pillay and Cartwright, 2019; Watkins, 2021). There is also growing attention to post-qualification supervision and to the importance of restorative supervision for maintaining career-long resilience (e.g., Davys and Beddoe, 2021; Milne and Reiser, 2020).

There has also been research work to investigate the benefits of clinical supervision for practitioners and their clients. There are significant methodological challenges involved in linking supervisory work to client outcomes, meaning that the number of methodologically sound studies is limited and the findings to date are inconsistent. However, it can be tentatively concluded at this point that supervision is more likely to have a positive impact on client outcomes if it is regular and frequent, includes a focus on specific therapeutic models or skills, and is supported in its organizational context. There is a more consistent and growing body of research evidencing that attendance at clinical supervision is associated with enhanced practitioner competence, greater job satisfaction and well-being, and reduced burnout (see Hawkins and McMahon, 2020, and Watkins, 2020, for recent research reviews).

This broad overview shows that many significant issues have been written about and researched in relation to supervision practice. However, while the literature on supervision has grown rapidly over the last 20 years, this is still a developing area of study. Much of the recent literature is transtheoretical, focusing on supervisory practice and competencies across disciplines and contexts. However, the continued development of discipline-specific literature is also important to advance our understanding of supervision in different contexts. Furthermore, it is considered that the group analytic discipline may have insights to offer other disciplines given its understanding of groups, which would be of particular relevance for group supervision and for considering the impact of practitioners’ organizational contexts on their clinical work.

Method

A systematic narrative literature review was carried out, the research question being: What key themes can be identified in the group analytic literature on clinical supervision? It was aimed to critically analyse the results in order to inform the development of theory, practice and research in this area.

A preliminary search had indicated that group analytic publications on supervision primarily involved clinical and theoretical papers so a narrative literature review was considered appropriate as it had the flexibility to incorporate theoretical, professional and research publications. This methodology is useful for reviewing, interpreting and critiquing current knowledge in an area of professional practice, which can be beneficial for informing and guiding practitioners, as well as providing direction for further research or theory development (Baumeister and Leary, 1997; Byrne, 2016; Greenhalgh et al., 2018). Guidance for taking a systematic approach to narrative literature reviews has also been offered in recent years, bringing increasing rigour to this methodological approach (Baethge et al., 2019; Booth et al., 2022; Ferrari, 2015; Siddaway et al., 2019). As such, it has been argued that the historical divide between conventional systematic and narrative reviews may no longer be relevant as a narrative literature review can now be both systematic and narrative (Greenhalgh et al., 2018). The systematic search strategy for this study involved:

- On 09 January 2022, a search was carried out (see Figure 1 for databases searched and search terms used), with no date restrictions and including publications in the English language, books and academic journals only. This yielded 98 items after excluding irrelevant results (see Figure 1 for reasons). Thirteen of these texts could not be accessed (list available from author on request).

- On 09 January 2022, a search for ‘supervision’ in the title and abstract of articles in the Group Analysis journal archives since its first issue in 1967 yielded 53 relevant articles. Two more relevant articles were identified in special sections of the journal in 1993 and 2007. These 55 articles represent 2% of articles published in the journal up to the search date (eight of these results had not been captured in the database search).

- A number of books (19) on group analysis or written by group analysts were reviewed for material on supervision (list available from author on request). This included seminal texts by Foulkes and one edited book on group analytic supervision by Sharpe. Some of these books made no reference to supervision but 12 had some reference (ranging from just one line to a full chapter or more); ten of these had not been identified in the database search.

Figure 1.

PRISMA flow chart depicting process of identifying group analytic publications on supervision.

Results

Nearly all of the 103 group analytic publications on supervision identified in this systematic literature review were either theoretical or anecdotal, there being only a small number of published research studies (five studies, described in six articles). There was a primary focus on theory in 52 of the texts, and a primary focus on presenting case vignettes in 45 texts, although both theory and case illustrations were included in most texts. The majority of the literature focused either on supervision of group analytic psychotherapy practice, or on a group analytic approach to supervising other practitioners or teams working in healthcare contexts. A small number of vignette-based texts (seven) and theoretical texts (nine) were not focused on either group analytic psychotherapy practice or group analytic supervision, but drew on group analytic theory or concepts regarding supervisory work. Four core themes were identified in the literature—one central theme and three connected themes (see Figure 2), and these will be elaborated on below.

Figure 2.

Core themes identified in the group analytic literature on supervision.

Providing critical holding and containment

The critical need for a safe, contained space for practitioners to discuss their work and its impact on them is a central theme in the group analytic literature on supervision. Other themes are seen to radiate out from this core concern.

Although he did not use the term supervision in his early writings, based on his own experience, Foulkes (1948/1983) asserted that regular meetings with colleagues to exchange clinical experiences could lead to considerable improvements in the standard of therapeutic work. Many group analytic writers since then have emphasized the importance of supervision to support good practice, it being described as an ethical responsibility (Gregurek, 2007) and ethical imperative (Scanlon, 2002), of ‘indisputable’ importance (Tsegos et al., 2004: 61), providing vital support (Gordon et al., 1994) and a vital container (Gallop, 2019), and as having the potential to promote ‘profound development and growth’ (Cohen et al., 1991: 53). In addition, supervision has been described as a key forum for facilitating the integration of theory and practice for group analytic trainees (Behr, 1995), offering a critical counterbalance to the ‘plethora of theoretical and experiential stimuli which increase their anxiety, confusion and fear’ (Tsegos et al., 2004: 61). In support of this, group analytic trainees have rated the work of their supervisor and supervision group as the most beneficial aspects of their training (Lorentzen et al., 1995, 2002). Barwick (2018) also described how the containing support of supervision, in addition to theory and personal therapy, helped over time to forge what he called a ‘group-analytic skin’ during his training, involving a ‘social and psychic robustness’ and a more secure sense of his own ‘realistic authority’ (Barwick, 2018: 139).

The necessity for regular supervision in post-qualification practice has also been asserted, given the complex demands on group analytic conductors (Schlapobersky, 2016). Group analysts wrote about the importance of supervision to facilitate practitioners to learn to be group analysts in their own way (Sharpe and Blackwell, 1987), to develop faith in their own personal style and resources (Kalai, 2007), to develop an ‘internal compass’ for their work (Pernar, 2017: 222), and to achieve a personal integration of the group analytic method, representing ‘their own authentic and critical position’ (Balmer, 2017: 268). Supervision has been described as ‘a lifetime’s undertaking’ (Garland, 2010: 114) and the process of becoming a ‘good enough’ group analyst as involving ‘continuous and never-ending supervision, not presenting any general answers or final conclusions’ (David, 2019: 205).

Pines (1995: 2) highlighted the ‘firm holding and containment that supervision provides’ and Moss (2008) drew from Winnicott’s (1965) and Bion’s (1961) conceptualizations of these critical developmental processes to apply them to supervision. Holding in supervision is described as attending nonverbally to supervisees’ basic needs, providing a secure, non-impinging context, thus helping them to feel whole rather than fragmented, better able to ‘go-on-being’ and to recognize and empathize with others as separate from them. Containment is understood to be a ‘sorting-out function, which contributes to the integration of conflicting experiences’, helping supervisees to think and find meaning (Moss, 2008: 189). It is argued that both processes can greatly enhance capacity to reflect rather than act out—supervisees who have been successfully held will be better able to ‘hold’ themselves, and those have been successfully contained will be better able to tolerate powerful and sometimes conflicting thoughts and feelings without becoming overwhelmed or overly anxious (Moss, 2008).

As part of providing secure holding and containment, the need for clear boundaries and expectations regarding supervisory work has been emphasized, thus facilitating greater freedom and safety for inner exploration (Schneider and Berman, 1991). In this regard, many group analysts have written about the importance as well as complexity of holding a boundary between supervision and personal therapy. Foulkes (1975/1986) believed that the characteristics, values and personal growth of the trainee conductor were strongly connected to the quality of their work (‘progress in skill and therapeutic change in the trainee go hand in hand’, Foulkes, 1964/1984: 251). He also noted that supervision can be a therapeutic experience to some degree, but he was clear that supervision should not be therapy and personal boundaries should be carefully respected (Foulkes, 1964/1984). Foulkes (1975/1986) and others (e.g., Matjan Stuhec, 2010; Westman, 1996) have also highlighted the importance of learning from the therapist’s countertransference, or unconscious emotional responses to clients (discussed in the next section). However, this is described as sensitive communicational work (Gregurek, 2007), speaking about one’s work in supervision having the potential to be strongly self-revealing, exposing deeply hidden conflicts (Olivieri-Larsson, 1993). Similarly, Cohen et al. (1991: 54) described the ‘delicate overlap between therapy and supervision’, noting the need for ‘circumspection and fine judgement to enable the supervisee to identify and handle blocked areas in him- or herself while at the same time retaining respect for personal privacy’.

Supporting capacity to bear and process emotionally

The importance of working with the emotional impact of complex therapeutic work is a strong theme in group analytic writings on supervision. Therapists’ ability to tolerate their emotional experience has been described as critical for their clients’ therapeutic progress (Gordon et al., 2005). It has also been noted that the container that therapists provide for clients ‘quickly fills’ (Ahonen-Eerikainen, 2003: 173), leading to a risk of fatigue or vicarious traumatization. Through offering non-judgemental holding, encouragement and belief, it is argued that supervision can enable group analysts to process anxiety and aggression triggered by their work, to calm down, and to bring calm back to their work (Doron, 2014a). A secure supervision space is particularly valued for processing emotional responses to traumatic material, so that therapists can restore trust in themselves and others (Rohr, 2009), and continue to engage in meaningful work (Corbett, 2014). It has also been argued that for supervision to be ‘both creative and rigorous’, there needs to be a ‘delicate balance’ between emotional and cognitive work, but that it is the emotional reactions that ‘fuel reflection and theoretical understanding’ (Tubert-Oklander and Hernandez, 2003: 153).

As noted earlier, Foulkes emphasized the value of learning from countertransference, and his long-running supervisory seminar at the Maudsley hospital in London has been described as ‘an emotional experience, as the active discussion disentangled the warp and woof of the transference–countertransference field’ (Tubert-Oklander and Hernandez, 2003: 151). Many group analysts have written about the importance of experiential work in supervision to explore and process the therapist’s countertransference (Shultz and Stoeffler, 1986). Through this work, it is argued that blocks to creative intuition can be resolved (Ormont, 1980), countertransference distortions corrected (Behr and Hearst, 1995) and the danger of seeking narcissistic gratification from clients avoided (Horwitz, 2001). Similarly, Battegay (1990) discussed how supervision is important for sensitizing group analytic psychotherapists to their own desires (conscious and unconscious) which may disturb their conscious therapeutic aims and hinder clients’ development. These include narcissistic expectations of fusion with the analytic group, anxiety to fulfil clients’ expectations which may result in overactivity, and pleasure from realizing personal desires for power. It has also been asserted that working with projections and projective identifications (where the client’s emotional experience is ‘put into’ the therapist) enables increased sensitivity to these experiences as well as a greater capacity to tolerate and not identify with them, leading to an enhanced emotional understanding of clients (Gordon et al., 1994; Knott, 2016).

Group analysts have also frequently written about the value of attending to parallel processes in supervision (dynamics from the therapeutic setting being mirrored in the supervisory setting), Wood (2019: 53) noting that this concept has ‘taken root within group analytic discourse’. Some illustrative vignettes have been published, Voorhoeve and van Putte (1994) highlighting how recognizing a parallel process enactment can be enlivening and bring rich emotional learning. The potential for reversed mirroring has also been written about, where problems in supervision are subsequently re-enacted in the therapeutic setting, indicating some lack of supervisory skill or unresolved conflicts regarding supervisory authority (Kutter, 1993; Matjan Stuhec, 2010).

Sustaining ability to think deeply and widely

While the value of live, emotional processing and learning is emphasized in the group analytic literature, another strong theme involved the importance of supervision to enable practitioners to reclaim and sustain a capacity to think deeply and widely about their work. Gordon et al. (2005) described how intense countertransference pressures can cause anxiety and paralysis of thought, and both these authors and others (e.g., Hanson, 2007; Yasky et al., 2019) have argued that supervision provides a necessary intermittent distance from therapeutic work, enabling connection with a fuller emotional experience as well as the capacity to formulate over time, thus building capacity to think in action (Moro, 2007).

The value of having to reconstruct one’s work in order to describe it to a third party has also been noted (Ghirardelli, 2000), as well as the benefit of others’ help to acknowledge, articulate and understand the dynamics involved (Doron, 2014a). The particular value of group supervision has been emphasized, and how a collective process of thinking can generate ‘a sophisticated train of ideas that may have exceeded the individual understanding of its members’ (Yasky et al., 2019: 311). Doron (2014b: 134) described how group analysts can become ‘thick-skinned’ or insensitive to the context of their work. She evocatively illustrated how a supervision group helped her to become like ‘a fish in water’ (Doron, 2014b: 139), able to see the quality of the water (including the social unconscious) surrounding her and her group for the first time. The significance of this fresh perspective was regularly written about, Barnes et al. (1999: 176) asserting that supervision brings ‘a wider range of vision than can be gained from a singular vantage point’.

In group analytic supervision, Ezquerro (1996) observed that thinking involves an integration of mind, heart, and gut rather than being a purely intellectual exercise, and the value of accessing deeper and broader thinking is emphasized in the group analytic literature. This has been most commonly described as encouraging reverie (including ruminations, daydreams, fantasies and bodily sensations: Berman and Berger, 2007; Kalai, 2007; Rohr, 2012) and free group association or discussion (Foulkes, 1975/1986). Many other ways of formulating this expansive thinking have been offered by group analysts, including: nurturing a ‘wide gaze’, allowing different things to come into focus at different times, and resisting resolving paradoxes (Thornton, 2016: 182); facilitating a reflective atmosphere for creative thinking and dialogue (Behr, 2010); allowing as much as possible to unfold (Knott, 2016); reaching beyond the details for ‘far flung metaphor and the work of imagination’ (Barnes et al., 1999: 176); enabling supervisees to ‘jump to the unknown’, facilitating a dialogue between unconscious and conscious aspects of the mind (Ahonen-Eerikonainen, 2003: 180); supervisors themselves working to remain open to the unknown, to difference and otherness (Balmer, 2017); and working with deeper resonances, where quality of voice rather than content is seen as important (Gallop, 2019).

As an example of group analysts’ search to uncover deeper levels of knowing in supervision, as well as their acknowledgement of unconscious blocks to such knowledge, Lashkova et al. (2018) offered an interesting analysis of ‘disappeared elements’ in a supervision group (e.g., chronological gaps when presenting a client’s history; the presenter or supervision group forgetting a significant event). These authors argue that such disappeared elements can point to strong countertransference feelings or blind spots for the presenter or other supervision group members. They also suggest that they represent a search for a temporary retreat from the ‘narcissistic trauma’ involved in presenting one’s work in supervision (e.g., fear of judgement or shame; anxiety about complex cases or ethical dilemmas, Lashkova et al., 2018: 37). Lashkova et al. (2018) highlight the value of attending to such ‘disappearances’ and working to connect them to the dynamics of the presented case, thus enhancing understanding.

Counteracting isolation and enabling creative exchange

The final theme represents the strong recognition in group analytic writings of how supervision (particularly in groups) works to counteract professional isolation and foster creativity, once group dynamics are well understood and managed.

Many group analysts have emphasized the multipersonal basis of individual development and disturbance (e.g., Foulkes 1975/1986; Friedman, 2007; Pisani et al., 2006), and attendance at supervision is believed to address the distress caused by isolation (Behr, 1995). Similarly, supervision has been described as bringing practitioners back from ‘emotional exile’ when struggling with professional difficulties on their own (Berman and Berger, 2007: 245). The specific value of being part of a supervision group has been regularly highlighted, being particularly important for group analytic psychotherapists for live learning in groups about groups (Barnes et al., 1999; Foulkes, 1975/1986).

Group analysts have written about the importance of harnessing the supervision group’s resources and minimizing the supervisor’s authority, thus enabling freer exchange of experiences and associations. This has been described in various ways, including seeing supervision as involving ‘constructive interdependency’ (Tanna, 2017: 174); a ‘creative journey’ generating new knowledge through exchange between all parties rather than involving static transmission of knowledge (Brunori et al., 2007: 233); the supervisor being a partner and questioner, giving up the need to teach or influence (Sternberg, 1994); knowledge being better achieved through horizontal group relating rather than leading the group (Tsegos and Tseberlidou, 2002); and group reverie being encouraged, rather than the supervisor being an ‘interpretative magician’ (Kalai, 2007: 214), such collective reverie being understood to promote learning through reducing an unconscious split between the presenting supervisee and the rest of the group (Berman and Berger, 2007). Reflecting on power inequalities in his own supervision experiences, Dalal (2021: 16) argued that ethical supervision should be ‘characterized by reciprocity and mutuality’, knowledge being emergent and co-created. However, Bacha (2021) emphasized that supervisors need also to remain mindful of an inherent power inequality in supervision in order to actively encourage supervisee openness and avoid abuses of power.

Group analysts have also argued that the potential of supervision groups can be maximized through explicitly recognizing and working with processes identified within group analytic theory, including mirroring, resonance, location, condensation, exchange, and the social unconscious (e.g., Gallop, 2019; Smith, 2019; Tanna, 2017). In addition, many authors have asserted the importance of attending to anti-group dynamics which interfere with learning in group supervision, including regression, rivalry, scapegoating, envy and inhibitive shame (Benson, 2019; Moss, 2008; Pernar, 2017; Tanna, 2017); the unconscious wish to avoid the discomfort of learning (Thornton, 2016); and unresolved superego conflicts which cause conflicting wishes to delegate responsibility and to be autonomous (Olivieri-Larsson, 1993). Matjan Stuhec (2010: 19) asserted that ‘whenever a group is formed, group and anti-group forces are at work’ but also that disruptive forces can be contained and changed into creative possibilities.

The operation of Bionian basic assumption groups in supervision groups has also been written about, it being argued that discussion of such group processes can ‘enable anxieties to become exterior, interpersonal, and held collectively by the group, rather than being held internally by an individual’ (Granville, 2010: 138). A recent longitudinal study of basic assumption and work group dynamics in a supervision group also affirmed the need to work with regressive group dynamics, the authors noting that resistance to productive work is a ubiquitous group phenomenon (Yasky et al., 2019). Smith (2001) also argued that group analytically informed supervision provides a vital space to verbalize and make sense of such unconscious processes, thus helping to transform destructive forces into creative potential.

The essential need for supervision for understanding and processing dynamics in healthcare staff teams and their organizations has also been a focus in the group analytic literature (e.g., Behr and Hearst, 2005; Sternberg, 1994; Scani, 2002). Brown (2014) argued that having a group analytic understanding in supervision offers psychological containment, providing a structure for making sense of intrapersonal and interpersonal processes in organizational contexts. Others have also asserted that a supervision group can provide a transitional space to explore the political, cultural and organizational context of a staff group, helping to find new perspectives and creative ways of handling conflict (Rohr, 2013); that this transitional supervision space can help to work through severe role strain and primitive defences (Wilke, 2014); that staff supervision groups can help to form ‘good enough’ teams, working with interdisciplinary tensions and power struggles so that they can become forces for growth rather than regression (Guimon, 2006); and that a staff supervision group can be a safety net in crisis, and become ‘more alive, interesting and dynamic’ through identifying parallel process dynamics (Bloomfield, 1987: 329).

Sorlie et al. (2007) illustrate the value of group analytic supervision for a staff team in a psychiatric hospital. Through supervision, staff were helped to recognize how they were projecting persecutory superego parts onto organizational managers, their passivity contributing to an authoritarian system. The authors described how staff came, gradually, to reinternalize their superego functions, become more aware of their own responsibilities and capabilities, thus facilitating more creativity and cooperation with managers.

Discussion

A paper written by Malcolm Pines on academic disciplines offers a useful framework for discussing the results of this literature review. Pines (2006) distinguished between a coherent theory, which aims to establish internal consistency in its own field of study, and a correspondence theory, which aims to find compatibility and connections with other fields of study. Pines noted that a coherence model is typical in psychoanalysis but that a correspondence model is more relevant to group analysis, given its concern with connectedness and the horizontal ‘in-between’. However, I would argue that both coherence and correspondence are important in group analytic theory, fitting with the value Foulkes (1948/1983) afforded to both vertical depth and horizontal breadth.

Seeking coherence

Four themes were identified in the group analytic literature on clinical supervision—one primary theme: Providing critical holding and containment, and three other themes radiating out from this central concern: Supporting capacity to bear and process emotionally; sustaining ability to think deeply and widely; and counteracting isolation and enabling creative exchange. In this literature, there is recognition of the need for secure, boundaried holding in order to bear and safely process the often intense emotional impact of therapeutic work, as well as the need for containment to enable practitioners to think more broadly and deeply about their work through the use of reverie, free association and free discussion, recovering and extending their capacity to find meaning. The containment and generativity that can be enabled through group and team supervision is particularly valued by group analysts. Within this, the value of harnessing the group’s resources and minimizing the supervisor’s authority is emphasized, as well as the importance of understanding and working with anti-group dynamics.

These thematic findings indicate what group analysts have considered to be the key concerns or functions of clinical supervision practice. These concerns are believed to be consistent with the principles of group analysis, indicating a welcome alignment between group analytic practice and supervision (as called for by Dalal, 2021). These thematic findings are also considered of value in offering some coherence to extant group analytic theory on clinical supervision. This is important as group analytic writings in this area have been rare and fragmented, spread over more than 50 years, there being a focus on supervision in only two percent of publications over the history of the Group Analysis journal. It was also found that group analytic authors typically did not reference each other’s writings on supervision, generally neither building on nor critiquing each other’s contributions (nor indeed referencing the wider literature on supervision, as discussed in the next section). It seems that group analytic literature on supervision has remained at an early exploratory stage, many authors focusing on sharing their experiential learning through supervisory vignettes.

It is believed that the core themes that have been identified in the group analytic literature on supervision can provide a useful platform for further theoretical development. Such development would be valuable to guide supervision of group analytic psychotherapy, as well as inform supervision with other helping professionals. Significant areas needing development are the elaboration of the importance and relevance of the social unconscious and of the matrix for supervisory work, as these concepts were rarely referenced to date. In addition, further work to develop and illustrate the importance of other key group analytic processes within supervision would be valuable, including mirroring, resonance, condensation, location and exchange, as well as further articulation of anti-group dynamics in supervision, such as regression, envy, negative mirroring and scapegoating. This is particularly important for supervising practitioners and teams working in organizational settings, where anti-group processes can be experienced as endemic and insurmountable, but where creative possibilities can emerge when recognized and worked with over time. Related to this is the need for a theory of group supervision to be developed (as noted by Thornton, 2016). Group analysts, given their strong understanding of both destructive and creative group dynamics, are particularly well positioned to meet this need.

Looking for correspondence

As already noted, the literature on clinical supervision has increased dramatically over the last 20 years, and particular areas of focus have included the development of supervision models to guide practice; the delineation of supervision competencies; enhancing awareness and sensitivity to relational issues in supervisory practice, including issues of power and diversity; and building research evidence to develop understanding of supervision practice and its benefits for clients, practitioners and organizations.

It was found that group analytic authors typically did not draw from or correspond with this large body of literature on supervision, which is striking given the group analytic concern with connectedness and wide-angled thinking (rare exceptions including Pernar, 2017, and Tanna, 2017). This predominantly insular, self-focused concern in relation to supervision practice seems to indicate a lack of awareness, capacity or flexibility to extend beyond group analytic boundaries into wider territory. To draw from de Maré et al. (1991), it appears that a desire to develop ‘outsight’ (an outward expansion of awareness and thoughtfulness) has been missing in group analytic writings on supervision to date.

There has also been an absence of theory or model development in relation to group analytic psychotherapy supervision, or reference to other supervision models or theories. Some protocols for supervisory work have been offered in the group analytic literature (e.g., Ahonen-Eerikainen, 2003; Tsegos, 1995) but a more elaborated model of group analytic supervision has yet to be developed.

In addition, while many authors have noted the importance of a range of supervisory skills and attitudes (e.g., managing boundaries, Pernar, 2017; holding a tolerant, inclusive attitude: Behr and Hearst, 2005; encouraging reverie: Berman and Berger, 2007; understanding group dynamics: Tanna, 2017), a coherent elaboration of required supervisory competencies has yet to be developed in the group analytic literature. Also, no reference to the international literature on transtheoretical supervisory competencies was found in group analytic writings in this area. There was also only occasional reference to the need for supervisor training (e.g., Sharpe, 1995), while this has been regularly called for in the wider literature (e.g., Falender and Shafranske, 2012).

It was also apparent that the formative and normative functions of supervision were given less emphasis in the group analytic literature compared to the wider literature. While the importance of fostering supervisees’ emotional awareness, countertransference management and capacity to think and formulate was highlighted, there was little consideration of the gatekeeping or evaluative aspects of supervision, or of the changing developmental needs of supervisees over time. This may be in keeping with the non-authoritarian, horizontal nature of group analysis but warrants greater attention in group analytic writings going forward.

The main area of correspondence between the group analytic and wider literature on supervision was in relation to the restorative function of supervision, and group analytic writings offer valuable theoretical contributions in this area. Group analysts have foregrounded the supervisee’s emotional experience and needs, highlighting the critical need for holding and containment in the face of complex therapeutic work. In line with this, there is growing attention in the wider literature on the importance of restorative work in supervision for supporting practitioner competence and resilience (e.g., Milne and Reiser, 2020), research indicating that supervision can reduce levels of burnout, enhance well-being and satisfaction for staff in healthcare organizations (e.g., Wallbank, 2013).

Conclusion and implications

This systematic narrative literature review has identified four core themes or concerns in the group analytic literature on supervision practice, highlighting and illustrating how supervision meets a vital need to provide holding and containment for therapists. However, a focus on supervision has been rare for group analytic authors to date, despite a rapid growth of literature on supervision in allied disciplines over the last 20 years. Further theoretical development is needed in some key areas in order to strengthen the group analytic contribution to supervision theory and practice. This includes greater consideration of the relevance of the matrix and of the social unconscious to supervision practice, particularly in relation to group supervision and to team supervision in organizational contexts. A model to guide group supervision practice is also needed and it is considered that group analysts are well positioned to develop this, while also offering further theoretical elaboration of group and anti-group dynamics in the supervisory context.

The scarcity of research on group analytic supervision has also been notable, the literature being primarily at an anecdotal, descriptive and theoretical level to date. It is hoped that the findings of this literature review work will be helpful in stimulating the desire and impetus for research development in this field. Observational studies of recorded practice would be of particular value to assess and illuminate group analytic principles within supervision practice, and to develop an evidence base for further theory development.

Footnotes

Acknowledgements

This paper is based on a thesis submitted to University College Dublin, Ireland, as part of an MSc in Group Analytic Psychotherapy. Grateful thanks to Dr. Belinda Moller for her inspiring and containing support during this study.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Aisling McMahon

Notes

Aisling McMahon, DPsych, is a clinical psychologist, integrative psychotherapist and assistant professor in Dublin City University, Ireland, where she teaches on postgraduate psychotherapy and clinical supervision training programmes. With Peter Hawkins, Aisling is co-author of the 5th edition of Supervision in the Helping Professions. Her research interests are clinical supervision and practitioner development from training to retirement. Aisling has just completed training as a group analyst and is currently working on her clinical paper before applying for her licence to practice. Address: School of Nursing, Psychotherapy and Community Health, Dublin City University, Glasnevin, Dublin 9, Ireland. Email: aisling.mcmahon@dcu.ie

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