ndividual supervision, case conferences, and didactics remain the cornerstones of psychodynamic psychotherapy education in psychiatric residency. Although supervision has been written about extensively in both the psychoanalytic and psychiatric education literature, there is little systematic research on this topic (1) and none that addresses the translation of the core competencies for psychodynamic psychotherapy to the individual supervision process. Most studies of supervision in psychodynamic psychotherapy are written from the supervisors’ perspective on topics that range from how supervisees learn (2—4) to the characteristics of good supervisors (5, 6). Residents have conducted five studies about psychotherapy supervision in general (7—11) and a handful of studies specifically about psychodynamic psychotherapy supervision. One study (12) focused on the factors that residents associated with good supervision, while others explored the relationship between the quality of teaching offered by supervision and the supervisory rapport (13, 14).

Despite these studies, the central question of how the core competencies for psychodynamic psychotherapy translate into the day-to-day work of individual supervision remains unanswered. Although programs now have outlines for the clinical skills in psychodynamic psychotherapy that their residents should acquire during training, we had questions about how effectively we were accomplishing these goals. Did residents know what they were supposed to be learning in psychodynamic psychotherapy supervision? Did they know how they were being assessed, and what knowledge, skills, and attitudes they needed to adopt to improve or achieve competency? Were discussions taking place in supervision about the objectives of psychodynamic psychotherapy competencies?

In response to the delineation of competencies in psychodynamic psychotherapy, the Columbia psychiatric residency program developed an assessment tool for psychodynamic psychotherapy by translating the key competencies into an electronic survey completed by supervisors for each supervisee semiannually. Despite the implementation of this instrument, we hypothesized that although competencies for psychodynamic psychotherapy are now defined and operationalized as part of our assessment system, a need exists to translate those competencies into meaningful day-to-day goals and activities for supervision to guide learning and evaluation. We suspected residents did not know what they were supposed to be learning in psychodynamic psychotherapy supervision, how their supervisor was measuring their progress and assessing them, and what to do to improve their performance.

In September 2007, course evaluations for psychodynamic psychotherapy supervision were distributed to the mailboxes of all 24 psychiatric residents in postgraduate years 3 and 4 at Columbia University. These were accompanied by a cover letter stating that the evaluations were anonymous and that we were interested in hearing about residents’ psychodynamic psychotherapy learning experience in supervision. The evaluations were then anonymously returned to an envelope in a mailbox. Residents were asked to give feedback about their educational experience. The evaluation had eight items: seven yes or no questions (Table 1) and the following open-ended question: "What knowledge, skills, and attitudes do you think you should be learning in psychodynamic psychotherapy supervision? (Please be specific)."

Sixteen of 24 evaluations were returned for a response rate of 66.6%. The results are summarized in Table 1. Of the residents who responded, eight (50%) said that they did not know what they were supposed to be learning in psychodynamic psychotherapy supervision. Nine respondents (56%) had not discussed this with their supervisor for psychodynamic psychotherapy supervision. Six (37.5%) did not believe that their discussions in psychodynamic psychotherapy supervision correlated with didactic courses.

We received 10 replies to the open-ended question about what residents thought they should be learning in psychodynamic psychotherapy supervision. We divided the responses into categories of knowledge and skills.

In the category of knowledge, six residents (60%) believed that learning how to develop a psychodynamic formulation was important to learn in psychodynamic psychotherapy supervision. Three residents (30%) mentioned the importance of learning to understand patients from multiple perspectives in psychodynamic thought (e.g., object relations, self psychology, and ego psychology) and how to apply those models in a clinical context.

In the category of skills, seven residents (70%) emphasized that psychodynamic psychotherapy supervision should help them understand when to make supportive versus expressive interventions on a moment-to-moment basis. Four residents (40%) mentioned learning to establish a treatment frame and treatment goals, as well as learning to work with transference and countertransference.

Perhaps the most significant finding from our course evaluation survey is that one-half of the respondents reported that they did not know what they were supposed to be learning in psychodynamic psychotherapy supervision. The majority of residents surveyed did not know how they were being assessed or how to improve their performance. Furthermore, a majority of respondents had not discussed their lack of awareness of these issues with their supervisors.

Another finding of interest was that one-third of residents believed that what they discuss in supervision does not correlate with what they learn in didactic courses. Also notable is that half the residents surveyed did not believe that different psychodynamic psychotherapy supervisors shared common educational goals. These data suggest that faculty may not have a defined and shared view of the developmental goals for learning psychodynamic psychotherapy.

It is quite likely that the real message of this study is not that residents do not know what they are supposed to be learning but, rather, that supervisors do not know what they are supposed to be teaching. To take this a step further, it may even be that supervisors do not know that there something specific that they are supposed to be teaching. In contrast to supervision for a manual-based psychotherapy, such as cognitive behavior therapy, dialectical behavioral therapy, or interpersonal therapy, psychodynamic psychotherapy supervision has generally been a somewhat formless endeavor, designed to be reactive rather than proactive. Although didactic courses may have objectives, supervision generally does not. In addition, supervision tends not to be closely coordinated with didactic offerings. The result is that supervisors do not have well-defined educational goals for the residents they are supervising. The results of this study suggest that residents are then puzzled about how to progress in supervision and unclear about how they are being assessed in their clinical work.

The findings of this study are limited by the fact that it was an exploratory survey with a small sample size, restricted to one site, and thus may not be representative of other institutions. Replication of our data at multiple sites with a larger sample size would be required to establish whether our findings could be generalized to other sites and residents in other programs. Our findings are also limited by the fact that we only surveyed residents. Replication of this study with supervisors would be required to get their perspective.

Our findings support the hypothesis that despite the implementation of a competency-based evaluation instrument, residents remain confused about what they are supposed to be learning in psychodynamic psychotherapy supervision. Of great concern is the residents’ lack of awareness of the standards by which they are being assessed and, as a result, their inability to know how to improve their performance. Also of concern is the fact that discussions are not uniformly taking place between residents and their supervisors about the objectives for psychodynamic psychotherapy supervision, how residents are being assessed, and how they can improve. The well-documented lack of training for supervisors (15—18) may be part of the problem, but the need for explicit educational goals for each year of training in both didactics and supervision is crucial (19, 20). In particular, the development of phase-appropriate learning objectives for supervision may help demystify the teaching and learning process for residents and supervisors in psychodynamic psychotherapy. Given the current educational importance of demonstrating the achievement of competence in residency training, the development of learning objectives for psychodynamic psychotherapy supervision may represent an important step in translating the competencies in psychodynamic psychotherapy into meaningful guides for day-to-day learning and assessment in supervision.

At the time of submission, the authors reported no competing interests.