IJSP Number 4, 2022

79 supervision is to offer support to the supervisee, encourage her and give her the opportunity to express her feelings. In addition, psychoeducation is an important ingredient. Although the psychotherapist knows about the rhythm of therapeutic progress for the psychotic patient, most of the times it becomes necessary to remind her about it and assure the therapist her interventions are appropriate. It is useful to work for decreasing the feeling of failure, through ego strengthening techniques and supportive interventions, especially when we supervise beginner psychotherapists. In the context of the psychotherapist’s difficulties in tolerating the patient’s psychosis, delusions and hallucinations, without immediate interventions for dismissing confusion, the supervisor must help the supervisee tolerate immersion in the psychotic world. In other words, we must help the supervisee work with the patient in the patient’s framework and support her in leaving aside trials of premature cognitive restructuring. Most psychotherapists have the tendency to work with content, finding out as much as possible about the client’s story, in order to gain a complete picture from a cognitive, emotional and psychodynamic stance. But in the case of schizophrenia, working with the direct content has limited value, because, at least in the florid phase, the schizophrenic patient tells a delusional story, or, in the remission phases a fragmented story at the very least. Therefore, the psychotherapist must work mainly with the process, and not the content, so she might need a period of time for mastering this approach. Role play may be useful, with the psychotherapist taking on the role of the psychotic patient and the supervisor offering a model for conducting psychotherapy with the patient. The psychotherapist benefits this way from a direct experience and has the opportunity to empathize with the schizophrenic’s feelings, in order to better understand her inner world. In role play, the most frequent difficulty psychotherapists encounter is connecting to the “odd world” of the psychotic, or, in other words, there is a difficulty in regressing to primary processes of thought. The thinking of the schizophrenic individual is often concrete, fragmented and disorganized and the psychotherapist is trying to find the logic of the story, which is an impossible task. In order to facilitate the psychotherapist’s immersion in the psychotic’s world, it may be useful to train the supervisee, during the supe rvision process, in freely using own creativity, and encourage contact with own primary processes. On the other hand, this may be a difficult process, due to countertransferential aspects that are specific in working with psychosis, such as the psychothera pist’s fear that she herself may become psychotic. Some psychotherapists feel confusion, as if the whole world becomes confused, and the incapacity (through contagion) to speak coherently. The psychotherapist imagines she will lose her mind by treating a p sychotic patient. The supervisor’s role is therefore that of supporting the supervisee and working with the supervisee’s anxiety. In order to be able to manage the hallucinated voices, the patient needs support from the psychotherapist and may benefit from introjecting the psychotherapist as a “voice” that helps her. Most supervisees are afraid of this aspect, due to fear of accentuating psychotic symptoms or the fear that the patient may become dependent on the therapist. The goal of supervision is, in this respect, to demolish the myth of patient despondency (the patient becomes dependent on the psychotherapist to a