What we Talk about When we Talk About Supervision: The Clear and the Confusing in Graduate Psychiatric Education

Supervision plays a key role in psychiatry residents’ professional development. In their early years of training, supervision helps residents learn to deal with acute safety issues and determine appropriate treatments and care settings. In later clinical work, outpatient supervision may more closely resemble supervision as it is thought of in the analytic tradition, helping residents grow into more skilled psychotherapists. However, there is little guidance about the specifics of psychiatry supervision. In this poster we explore supervision's roots in psychoanalysis, general medical education policies including guidelines for supervision, the role of supervision in the unique specialty of psychiatry, and the trainee experience of the supervision process.

In psychoanalytic supervision, one of the three components of analytic training, candidates meet with a supervisor, usually weekly, to discuss their “control cases.” The trainee presents information through process notes or recollections of a patient encounter, including disclosure of associations and interventions. The supervisor explores the trainee's thinking regarding the case and the session's interventions, suggests alternative ways of listening to and speaking with the analysand, refers the trainee to pertinent literature, and helps the trainee understand countertransferences in the case (Akhtar 2009). Differentiating supervision from treatment, Salmon Akhtar (2009) writes: “the supervisor is not the analyst of the supervisee's character, only of the supervisee's analytic ego as it is engaged in the clinical supervision under scrutiny” (p. 21). Although this process is now well established and widely familiar to the analytic community, formal supervision initially had little role in psychoanalytic training. Freud wrote little about supervision and described it as something one “can” get rather than “should” get. He did, however, meet regularly meet wi