Psychoanalytic supervision and consultancy: promoting containment and support in institutions

Issue addressed: The challenges involved in effectively integrating cross functional and multidisciplinary teams. 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 as a staff support system to teams more and more heterogeneous and involved in an often confused network of related tasks and services. The Authors develop their hypotheses by reflecting about their work as consultants and/or supervisors providing staff support and educationwithin various organizations in the public, private and voluntary sector. 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, drawing on Winnicott's notion of 'holding', Pichon-Rivire and Bleger's concepts of 'deposit' and 'context', Bion's theory of container/contained relationship, Menzies' studies on 'social defenses', and Abadi's paper on paradigm shift from the boundary to the network, examines how the notion of institutional container in healthcare organizations is increasingly involved in dealing with specific massive anxieties related to interprofessional work and diversity management. The last part, looking at the social analysis by Bauman and Sennett, discusses how the new scenarios created by the 'managed care' modify the containing function of institutions, lower their capacity to create links and deal with system anxieties, allowing primitive turbulent group, intergroup and leadership dynamics to impact on productivityand wellbeing. While organizations are progressively becoming boundaryless, networked and porose systems, relatedness and loyalty become less important, and mobility and turnover are so fast to impede a healthy and mature attachment to work, people and the cultural values of one's organization. Drawing on case studies, the AA formulate some working hypotheses concerning ambivalence, ambiguity, emotional pressures and social defenses implied in both the demand and the offer of institutional supervision; these could be related to a unique mix of concurrent elements including a resistence to learning from experience and fear of the responsibility for knowing (see '-K', Bion), environmental insecurity, unsafe boundaries between person, role and organization, dilemmas involving control/support and professional/managerial interfaces, competition for care between staff and clients, inter-group or inter-professional conflicts, and leadership regression, against the new social challenges brought about by globalized networks and the problems of diversity, liquidity, complexity, uncertainty, turbulence, and rapid, sometimes catastrophic, change.