Video recording is an established element of psychotherapy supervision. The American Association of Directors of Psychiatric Residency Training (¹) underscored its importance by stating, in each set of its psychotherapy guidelines, "The resident will be open to audio or videotapes or direct observations of treatment sessions." Abbas (²) described the use of video for teaching small groups and elaborated on the benefits to participants from observing the treatment. With video supervision, the resident and supervisor usually see and discuss the first few minutes of a recorded, recent psychotherapy session, then fast-forward to later segments. The novice therapist may fail to select the portion of a session for which supervisory help is most needed, so it may be chance that determines what is reviewed and what is overlooked. The teacher-supervisor does not know what he or she will see in a supervisory session. Like psychotherapy, video supervision is an unrehearsed performance.

In musicians’ education, the "master class" is a single event or series of events without the supervisor-supervisee relationship. Students perform before an audience that includes an expert—a "master" singer or instrumentalist—who then offers detailed, specific instruction for improving the performance. It is unrehearsed for both student and teacher.

Psychotherapeutic technique can be taught with a format that has elements of a master class. The teacher can use video editing software to edit a recorded psychotherapy session and insert subtitles so that as the patient-therapist conversation is heard, the "master’s" comments appear on screen. As in group supervision, the subject matter is a recent session conducted by a member of the class. Preparation for the recording-based master class is comparable to preparation of a lecture. The video created is the centerpiece of a seminar. Because subtitles must be brief, the teacher elaborates when appropriate.

With the patient’s written consent, a psychotherapy session is recorded with a camcorder or digital video camera. The recording is transferred to a computer for editing. With operations familiar to users of word processing programs (e.g., cutting and pasting), segments of any length can be removed, repeated, or placed in new locations, and segments of different sessions can be intermixed. The distinctive feature of the movie-making process is that subtitles can be inserted at any point. Subtitles in the psychotherapy movie may be used to explain what the therapist is doing, to comment on the interaction, suggest alternative responses, or pose topics for discussion. The finished product is a video that can be played on any DVD player or computer. The creator need not be technically sophisticated but must have the computer skills necessary to master a moderately complex new program. Descriptions of several edited movie software programs can be found on the Internet.

The instructor should review the entire recorded session to determine what portions of the session to use and what is to be the focus. The resident may indicate areas of concern or interest. Conversation that is not needed is cut (excised), but a segment that has been cut can be pasted elsewhere. For example, if an important topic is dropped and then taken up later in the session, the second portion can be presented immediately after the first. Repeating a segment by pasting gives the instructor more control than reversing a tape or a disk during playback in class. Evidence of psychopathology or important body language might be repeated for emphasis. It may be informative to repeat the first few minutes of a session just before the end, demonstrating that the patient had indicated at the start what he or she wanted to talk about. Showing the last few minutes of a session before the beginning is useful if the class task is to understand why the session turned out as it did. When the movie is used as a stimulus for seminar discussion, a 45—50 minute session must be significantly cut; 20—25 minutes is an appropriate length for a 60—70 minute class. Eliminating portions while preserving enough to give the sense of the conversation is an often time-consuming challenge in making a video. Telephone interruptions, coughing spells, and anything that might embarrass the patient or the therapist (even as little as a word or two) can be removed. When the focus is psychotherapy, it may be appropriate to omit discussion of medication. As with commercial films, editing may make the difference between success and failure.

Insertion of subtitles, using the standard keyboard, is easy. The instructor determines the point at which a subtitle appears and how long it remains on-screen. "Crawling" titles are more distracting than stationary; they may be useful for special emphasis. Table 1 illustrates subtitles reflecting, for the most part, a supportive psychotherapy orientation.

The original material is a recent psychotherapy session conducted by someone in the class. The subtitles, in addition to conveying the teacher’s thoughts, function also as flags, indicating spots at which the teacher intends to stop for discussion or elaboration. Because the primary focus of the master class is technique, not treatment planning or supervision, only a brief history is needed. Often, it is possible to explain how, in response to the clinical situation observed, different psychotherapy modalities would employ different responses. At the end of the class, the trainee who was recorded keeps the video, which might possibly be a better reminder of what was said than memory or notes taken during an anxiety-producing supervisory session.

Because subtitles commenting on the therapist-patient conversation appear as the conversation is ongoing, the density of information contributed by the teacher can be much greater than when a video is repeatedly stopped and started. Stopping and starting disrupts the flow of patient-therapist conversation and wastes class time. In a group supervisory seminar, with unedited tape, considerable class time may be taken by waiting or hoping for something to happen. Uncertainty about what comes next and the risk of having an unproductive class may cause a teacher to prefer discussion to continued watching. The teacher who prepares a movie has the opportunity to observe the entire session and direct attention to what he or she thinks is important. With conventional individual or group supervision, both teaching and evaluation of trainee competence are based on samples.

Psychotherapy supervision addresses the therapist’s understanding of the patient, understanding of himself or herself, and the overall direction of treatment. Success as a psychotherapist, however, just as for the musician, athlete, surgeon, or pilot, involves technique. Understanding is not enough. Coaching and practice are time-tested strategies for mastering technique and improving skills. The edited, subtitled movie is an efficient way to provide answers to the question asked over and over by beginning psychotherapists: "What should I say?" Use of subtitles facilitates attention to choice of words, nuance, and reinforcement of what the trainee is doing right. When the focus is technique, it is often productive to study treatment of patients for whom psychotherapy is an adjunct to medication management or other patients who often do not attract supervisory attention.

Supervisor evaluation of ongoing videotaped sessions, according to Winston et al. (³), is the best method of teaching and evaluating residents. Even though the usefulness of video recording is well established, the resistances described by Goldberg (⁴) 25 years ago continue to limit its use. The video with inserted subtitles facilitates close attention to technique and to the therapeutic alliance; it is an enhancement to the teaching enterprise enthusiastically accepted by students, most of whom are accustomed to multimodal video presentations. Although the subtitled movie can be used as a standalone entity or as illustration for a lecture, it is described here as a master class that may be an occasional event or part of a series. The master class resembles video supervision, but in supervision the most important portion of a session can escape scrutiny; it resembles a lecture in that the teacher is responsible for determining objectives and devising a strategy for achieving them with the clinical material available. The intent of a master class is improvement of technical performance, although the student will not have the opportunity to follow the expert instruction until the next patient session. The suggestions for improved performance may not alter the outcome for the patient studied, but they may lead to greater satisfaction from doing the job well.

At the time of submission, Dr. Pinsker disclosed no competing interests.