Supervising the primary care counsellor within the psychodynamic frame

This paper addresses the unconscious processes that manifest through organizational dynamics, transference relationships and splitting. I suggest that one of the primary tasks of supervision is to help the counsellor understand and manage the complexities of the setting and multi-professional working in order that the clinical work can be thought about and understood. Supervision therefore represents what Winnicott (1960) calls the environmental mother who holds and contains the object mother in undertaking the clinical work. A psychodynamic approach to supervision is considered and I argue that its focus on transference, countertransference, unconscious processes and defences is apposite. The frenetic pace of primary care is often recreated in supervision through parallel process. The challenge for the supervisor is to grasp the significance and impact of the setting on the clinical work and on the supervisory space and to create the necessary reflective space and boundaries where both the setting and the clinical work can be worked with. An intersubjective approach to supervision utilizes the countertransference to understand the multiple transference relationships that manifest between the counsellor, the patient, GPs, different members of the primary care team and the supervisor