The process of supervision is rich and complex and can be approached from a variety of perspectives. During the actual review of a trainee's work, it often seems as though the teaching takes place in direct relationship to specific didactic suggestions and observations. We comment, we summarize, we offer a perspective from experience—all of this sort of activity constitutes the supervisor's task, at least we go about it with some such idea in mind. However, after speaking to residents years later, long after their training has been completed and asking them what recollections they have of their years with us, I have come to a different view. These graduates do not focus upon the details of their training so much as the broad concepts and attitudes that their supervisors conveyed. Over and over, I have heard that their favorite supervisors, the ones they remember especially or for whom they reserve the coveted name of mentor, these supervisors mainly communicated, often quite indirectly and subtly, a kind of professional credo, a set of values. Therefore, I would like to explore the idea that a fundamental dynamic in the process of supervision is the transmission of values held and practiced by the supervisor, and further I will be somewhat bold to suggest some of the values I believe we ought to be transmitting to our supervisees at this point in the history of our profession, a time when change and challenge are in the air. As I have suggested previously

And furthermore, I would add, with this challenge at hand, it is essential that we begin to forge a consensus about our fundamental values.

It is, of course, risky to attempt to talk about values. One can easily give an air of professional foppery, of presumed authority without adequte justification. So let me begin by saying that there are indeed certain values that should be considered generic, self-evident for any health professional: for example, as physicians we strive to respect the patient and his/her autonomy, pursue the well-being of patients as the foremost goal of practice, remain free of inappropriate personal contact with patients, and charge a fair fee. These and related values have been part of the medical code of ethics since Hippocrates, and they do certainly apply to psychiatry. Our supervisees should have no question that we honor and uphold them in our work. However, I personally feel no authority based upon experince to expound upon these values that we, as supervisors and physicians, should pass onto our trainees. They appear to me as indeed self-evident, requiring little further commentary or discussion. However, with regard to other values that may pertain more uniquely to our work as psychiatrists and have impressed me as somewhat unspoken by us as professionals, I do feel some responsibility, if not authority, based upon more than 30 years of supervisory work. So let me attempt to propose some of these values that may govern much of what our superisees glean from their time with us.

I begin with the idea that we are fortunate to be able to do what we do for a living. There can be nothing inherently more sacred than living a life as well as one can, and no profession more privileged than one that aims to assist this goal. I begin here because I believe that this idea needs to be grasped firmly and held onto as we attempt to maintain our balance during stormy times, when our work and our profession appear less in vogue than in prior years. And we need to remind our supervisees gently that despite the rigors of training, despite the seemingly unsolvable and heartbreaking problems that some patients present, despite the changeable market for our services and the ambivalent respect of some colleagues, despite all these things—individuals still do (and always will) suffer from the vicissitudes of living their lives and the pain of mental illness, and we are one group specially trained and entrusted to help. A rare privilege indeed.

There are at least three corollary values that stem from the fact that the aggregate knowledge from which we proceed is still very much in progress. The first is that we must stay informed by reading, by continuing our education throughout our professional lives, and by being always open to new information. Our trainees must know that we read and expect them to do the same. We should give them copies of papers that we have found particularly useful, and we should encourage them to search the literature themselves in hope that they will come across a paper that they can give to us. (Most students and trainees nowadays are much more adept than we are at getting into the electronic literature.) We should attempt to use individual cases to lead us back to the generic problem areas that the individual case reflects, so that we can convey to the trainees a sense of where the edge of accruing information lies. For example, a case of first-episode psychosis could ultimately lead to a discussion of possible strategies for prevention that are currently under consideration (+2). Or the difficulty encountered in understanding and tolerating repeated episodes of wrist cutting by a borderline patient could lead to a discussion of newer behavioral techniques for dealing with this type of patient and why such approaches appear to be gaining wide acceptance (+3).

The second implication of our incomplete knowledge base is that we must often push on with treatment while living with and tolerating an inner state of ambiguity and uncertainty. In such circumstances, the supervisor helps the trainee to see that continuing therapeutic work is not only possible but also essential, and to choose diligently between options in a manner that guards both safety and flexibility. And he/she will hopefully testify to the possibility of living with the inevitable degree of anxiety that tracks along with uncertainty. And he/she will discuss what one can do when one does not know: such things as reviewing again what one does know, or consulting with a colleague, and, most important of all, talking yet again with the patient.

The third corollary reminds us of the importance of maintaining an open mind. My own clinical and supervisory experience suggests that this value is currently in short supply in our field. It is likely that the origins of attitudes of premature closure are myriad, but for whatever reasons, openmindedness has not been one of our strengths. If our knowledge base is evolving, then there are (hopefully) going to be repeated surprises and we must be open to them. And if we do not now have all the answers, then we can always hold out the possibility of a better future.

I have previously discussed at some length the variety of stories that patients present and my argument for considering these stories the focus of our work and the source of our inspiration. Let me repeat another brief passage (+1).

In supervision, I believe we should encourage the trainee in the task of hearing the patient's story. Early on in training, one may tend to be more focused upon the important and legitimate tasks of assessment and treatment planning, but even in the midst of such structured goals, we must remind ourselves and our students that there is a life story here, however humble or limited, containing universal human aspirations that we also share. Without diminishing the more didactic tasks, we can begin to show a trainee how to weave a human story alongside a good psychiatric history. This skill and perspective may be beneficial, even crucial, throughout one's professional life. For the work we do can easily lead to exhaustion, pessimism, and demoralization, and the ability to step back and see the human spirit at work in a life can, like a restorative ritual, reconnect us to our professional center.

Mistakes and unsatisfactory outcomes are inevitable in life and certainly in clinical medicine. One of the most helpful lessons a supervisor in psychiatry can impart is appropriate grace and humility without self-flagellation on such occasions. One of the clearest memories during my training is of a beloved supervisor and role model carefully opening the door of a limousine and greeting sorrowfully the parents of a young woman who had just recently committed suicide while in the hospital. The parents were well known, and my supervisor, their friend, had been specially selected to treat their daughter. The scene was fraught with tragedy and failure. Yet there he was, helping the elderly couple up the stairs and comforting them. I later asked him how he was able to be present at that moment and so available to them. He simply shrugged and said that he had done his best with the daughter and now the task was to comfort the parents. That event is seared into my memory, and I have often recalled his words when things were not going well with a patient. In a certain sense, our credibility here is at the heart of our work. For patients will search our responses to their stories for signs that we too are shocked or dispirited by what they have told us. I recall another one of my mentors.

As one special instance of professional adversity, the suicide of a patient early in one's career can be particularly devastating, and such a tragedy represents a critical challenge for a supervisor. The analogy here, I believe, can appropriately be made to the devastaing consequences of overwhelming trauma in childhood and its persisting effects upon human development. The death of a patient by suicide is a major blow at any point in one's career, but it is particularly so early on. The supervisor has a special role to play at such times. He must help protect the fragile self-esteem of the young trainee and, by precept and example, let it be known that this too can be endured and overcome. Early on in my training, before I had gathered a significant amount of clinical experience, a patient of mine went home on pass but never returned to the hospital. We learned the next day that he and his wife had quarreled and that he had gone to a motel and ingested a lethal dose of sleeping pills. I was the one who identified his body at the funeral home. The events of the next week or so remain blurred in my memory, except for one single image—that of my unit supervisor. Every day he sat with me and heard my litany of apology and self-criticism, including my conviction that I should resign from the training program. I cannot recall what he said, only that he refused to let me shoulder the blame for the suicide alone, insisted that we learn from the episode, and refused even to discuss my resignation. In retrospect, it was my first confrontation with the core values of our field, taught through the faithful example of my supervisor. Our supervisees must learn from us that it is possible for them to endure the hard times that will come and that from such experiences they will be better psychiatrists. Patients seem to sense it when you speak to them out of personal experience.

These then are some of the values that I believe are important to keep in mind as we pursue our day to day, session by session, conversations with our supervisees. There are undoubtedly others that belong here. Whatever they may be, the values we hold, though possibly never named as such, will likely be the legacy we transmit to our students. We could do well to give greater thought to this legacy and just what it is that we want to offer them for keeps.