Shirah Vollmer MD

The Musings of Dr. Vollmer

Picking A Supervisor

Posted by Dr. Vollmer on March 5, 2015

Residents, psychiatric residents that is, pick supervisors to help them learn psychotherapy. From medical student to hard-working internship to inpatient psychiatry, these residents jump off a cliff into outpatient psychiatry land, which requires learning a completely new skill set. Acuity decreases, and the long journey of psychotherapy begins. The skills required to manage emergency situations, skills which are honed over many years, are no longer needed. Instead, the skills of patience, careful listening, thoughtful hypotheses, and a cerebral mode of being, rather than an action mode of being are required. For some, this transition is the reward of many years of training. For others, it is simply terrifying. And for a few, this is “old fashioned psychiatry” with skills that are “hardly useful.” As their second academic year comes to a close, they are faced with the uncertain task of finding a supervisor, a psychiatrist who can shepherd them through their development as a psychotherapist. They want to learn, but they do not want to feel the shame of not knowing. They are faced, as they hover thirty, with the humiliation of being a student, a pupil who knows little, but is expected to grow rapidly. The anxiety, for some, is large, whereas for others, it is yet another hurdle in their long road of professional development. So, how do they choose their teacher: by reputation, by their curriculum vitae, and/or by the chemistry they feel when they have seen these teachers in other settings such as journal clubs or lectures? Or, is the system broken? Maybe the supervisor should choose the student, based on the supervisor’s judgment of which student would have the most growth potential? Or, as I said in a previous post, maybe supervision is not the best way to teach psychotherapy. Maybe they need to have a psychotherapy boot camp, where, with the help of a facilitator they can rely on each other to struggle through the fog of psychotherapy. Or, maybe they need to learn some basic concepts of technique before launching into seeing outpatients? Maybe they need to read, and write papers, to demonstrate knowledge of psychotherapy before seeing outpatients? At the moment, that is not how the system works. The resident picks their teacher, making it so charismatic teachers, those who the residents perceive to be nonjudgmental, are highly sought after, leaving the less assertive residents with the quieter, less charming supervisors. Maybe the system works, despite its flaws. Maybe, though, this is a time for big data, a time to be more scientific about what works. It is a thought.

4 Responses to “Picking A Supervisor”

  1. Eleanor said

    Shirah, I would be interested to hear your opinion concerning those individuals who become “therapists”, “counselors”, etc. outside the confines of the psychoanalytic community (psychiatrists, psychologists, social workers at MD, phd, masters, and bachelor levels, and their ability to do quality therapy when they have had no personal psychotherapy themselves as part of their curriculum. I saw no mention of treatment of the “self” as part of supervised training above. It seems to me that a deeper understanding of one’s self would be vital in order to be more aware of their countertransference issues, etc etc. Thanks.

    • Hi Eleanor,
      I agree that every mental health professional should have in-depth psychotherapy and/or psychoanalysis in order to function fully as a psychotherapist. Having said that, the exact nature of this treatment (eg number of times per week, number of months, and with what kind of therapist) are also issues of debate. It is true that many mental health licenses, including being a psychiatrist, does not require personal psychotherapy as part of licensure. As such, it is up to the individual practitioner to take this on for themselves. This leaves the mental health community with a large variety of practitioners with a large variety of their own personal psychotherapeutic experience. Thanks.

  2. Shelly said

    I would think that the chemistry between student and supervisor would be far more important than reputation. Those that go into psychiatry are not the cut-throat surgery or orthopedics residents, am I right? Those residents go for die-hard showy “science-based, reputation only” teachers, I would think. To me, psychiatrists truly care about the one-on-one daily interactions, and that is why I would think that supervisors who they can really be themselves with would be the best fit. Where does charm fit into the mix? Is it really necessary for students to learn in a one-on-one environment?

    • The dance of student/supervisor is complicated, as with all relationships, the comfort level can increase or decrease over time, so it is hard to predict. Charm is something I have been wanting to write about for a long time, but sadly, I am at a loss of words, to articulate this aspect of some charismatic people in which they provide a warmth and superficial acceptance and humor, which may or may not translate into a trustworthy individual. Whether students need one-one teaching is indeed very debatable. Right now, the system is repeating the past, without much thought as to whether that makes sense or not. Thanks.

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