Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for February 18th, 2010


Posted by Dr. Vollmer on February 18, 2010

     Supervision is a word used to describe the “teaching” of psychotherapy. Psychiatrists, psychotherapists and psychoanalytic trainees all go to supervision as part of their training. Supervision, like so many aspects of my field, is a vague notion. The student sits down with a supervisor for one forty-five minute session a week and they discuss cases. Most of the time it is a free association festival. That is, the trainee starts talking about a case, the supervisor chimes in when he thinks he has something valuable to say, and then the ball goes back and forth until the forty-five minute hour is up. The value of that time together is, of course, hard to say.

     I am in the middle of my career. I have been in private practice for twenty years, and I had five years of psychiatric training before that. In my early years of practice, I entered into psychoanalytic training, an eight year odyssey which included two-hundred hours of supervision, divided over four supervisors. Upon finishing my psychoanalytic training in 2001, I then elected to go for supervision to help me with some of my more challenging clinical situations. All of these supervisors have been male, all substantially older than I am, and each one, offering me a unique perspective on my field. The benefits of these hours in supervision are not tangible, but I have almost always enjoyed the process. I am stimulated by the conversation, and I am challenged to think in new ways.

        For the past ten years,  I have  supervised child psychiatry fellows. I think, although I am never sure, that I have helped my students develop clinical acumen. I also believe that I am offering them a perspective on the field which full-time academic child psychiatrists do not bring to the table. That is, being a child psychiatrist, struggling to help children and their families, is a very different career path than an academic child psychiatrist who is trying to break new ground in the field. Yet, once again, the value of my supervision is hard to quantify.

      In all my years of practice, I have been to one day-long conference on how to be a supervisor. I felt the day was a major waste of time. Supervision is not psychotherapy, the lecturers told us. I knew that. There are still boundaries and confidentiality issues. I knew that too. There are also liability issues. The supervisor assumes liability for the patient that the trainee is taking care of. “Yep,” I thought. What was shockingly missing from that conference was tips on how to be a good supervisor.  Teaching psychotherapy is an art, with few guidelines. I appreciate the art, but a few guidelines would be nice.

      Supervision parallels psychotherapy. The trainee is almost always anxious presenting his work. The supervisor is on the spot to say something meaningful and intelligent. When the trainee appreciates the words of the supervisor, both parties begin to relax. A process has started. There is hope. The stakes are lower than in psychotherapy, but they are still high. That is, the trainee is exposing himself when he describes his thought process. The supervisor is also exposed when he responds, ideally,  in a tactful, thoughtful and sensitive way. Vulnerability is part and parcel of my field. Supervising, and being supervised, is part of that vulnerability. The struggle is there;  mostly, the rewards justify the effort.

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