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Psychoanalytic supervision and consultancy: promoting containment and support in institutions

Abstract

In conjunction with personal analysis and theory/technique seminars, clinical supervision represents one of the three pillars of psychoanalytic training. Since several years, however, ‘supervision’ is also a term which describes consulting for staff groups in health and social institutions, a practice standing at the crossroad between training and consultancy, offered to teams more and more heterogeneous and involved in an often confused  network of  related services. The Authors developed their hypotheses by reflecting about their work as consultants/supervisors providing staff support systems within various institutions. The first part of the paper focuses on similarities and differences between individual and institutional supervision, with particular attention to clinical supervision, experiential team building, organizational development, and the issues involved in the relationship, overlapping and conflict among training, support and administrative functions. The second part examines the notion of  institutional container, word which has become a magical passepartout in healthcare organizations. The AA explore the functions implied by such notion in the light of: Winnicott’s concept of ‘holding’; Pichon-Rivière and Bleger’s concepts of ‘deposit’ and ‘context’; Bion’s theory of container/contained; Abadi’s paper on paradigmatic shift from the boundary to the network. The last part discusses how the so called ‘managed care’ has indeed created new institutional scenarios. The AA look at the analysis of Read more

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On the concept of “institutional container: an introduction

The subject of this monographic issue was inspired by an hypothesis which the three authors of one of its papers had shared from their own work: that the real object of the so-called “supervisions” within healthcare and social institutions is not so much the clinical case, or the quality of the provided service, or the staff support, but rather the institutional container. In my view this discourse could apply to all social organisations, even those from the private and commercial sector, where other methods – such as organisational consultancy, executive coaching etc. – might be assimilated to supervision as a way to “take care of the container”.
The concept of an “institutional container” is not a new one, even though from a quick survey of the literature it seems that it did not undergo a deep inquiry, except in sociological studies and in  applications to groups. Furthermore, when mentioned it is generally conceived as a “thing” or a frame, with relatively little attention to its functions and particularly to its relationship with the “content”. Paraphrasing Winnicott[1], I would suggest that there is not such a thing as a “container”, separated from a linkage to the content. In the meaning used in the following articles this concept is seen more as a dynamic process than a structure, and its origins go back to Bion’s studies on the mind’s function of containing emotions in early relationships and in the development of thought; other contributions from the psychoanalytic field are the concepts of “holding” (Winnicott, 1965), “deposit” and “encuadre” (Pichon-Rivière, 1960; Bleger, 1967), “institution as a defence” (Jaques, 1955; Menzies, 1961), and “institution-in-the-mind” (Armstrong, 1997).
The psychological function of containment and the related model of container/contained relationship (♀↔♂) are explored in the following articles starting from Bion’s insights in Learning from Experience (Bion, 1962), where he traces the containment process back to the early relationships between the mother and the infant. As Obholzer suggests (1996), these relationships imply processes of projective and introjective identification, which in favourable conditions promote for the infant the experience of being “contained” by the mother, helping the creation of his/her inner world and the development of the capacity for thinking. The Bion (1962) concept of container and contained are crucial at this stage of development…. The baby experiences a state of distress or ill-being while not being clear what the problem is – merely the fact that there is a problem. The mother recognizes that the baby has a problem Read more

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The symbiotic lure: organizations as defective containers

Abstract

The purpose of this article is to explore the psychodynamics of regression in organizations. First, the paper presents a brief critique of the rationalist and mechanistic approaches to organizations and their selective inattention to subliminal and unconscious aspects of organizational life, particularly regressive actions. Then, the association between psychological regression and organizational identity is explored with an emphasis on group psychology. Next, the symbiotic lure is introduced as a metaphor for understanding collective regression. Members react to their anxieties about change at work by denying their individual differences and psychologically merging with each another. This common form of regressive withdrawal among organizational participants under stress, threatens participation, consensual decision making, learning and effectiveness. Using Bion’s notion of “container” and Winnicott’s concept of a “holding environment, ” the author presents a brief example and discussion that clarifies the processes of change necessary for repairing the damaged organization and renewing its potential for democratic practices and effective service delivery. Much of organizational studies has assumed that decisions and actions are guided by rational (logical and  sensible) norms and intentional processes. The assumption of human nature in much of mainstream organization theory was that of a one­-dimensional worker void of inner life. Consequently, many scholars persuaded their students that logic and Read more

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Therapeutic groups and the institutional container: curative factors of the psychiatric institutional field and its destructive elements

Abstract

Starting from increasing destructiveness of symbolization processes in contemporary psychopathology, this paper try to suggest connections between institutional containers , subjective mind and group (mostly bionian one), allowing everyone a way to  keep available oniric elements for the care Read more

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The institutional container in severe pathologies

Abstract

This paper analyzes the problematic interlacement  in Psychiatric Therapeutic Communities between the process of subjectivation, which is singular, and the intersubjective dimension of psychic sufferings, which is plural. Two tools are indicated to support the clinical function of Psychiatric Communities: Psychoanalytic Read more