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Supervision in Psychiatry

Key Words: Letter to the Editor • Supervision • Training

TO THE EDITOR: I read with interest the commentary written by Malcolm D. Bowers, Jr., M.D., entitled "Supervision in Psychiatry and the Transmission of Values" in the Spring 1999 issue of Academic Psychiatry (1). The author identifies transmission of values as an important function of supervision in psychiatry. He quotes his personal experiences and how pleasant these memories have been for him. However, supervision is neither always pleasant nor is transmission of values the sole function of clinical supervision.

Between 40% and 60% of trainees are reported to have experienced educational or emotional neglect, severe criticism, or humiliation from supervisors (2). On the other hand idealization, denigration, envy or competitiveness, and other transactional reactions are prone to occur in trainees and are often directed toward the supervisors (3). Given the complexity of the process, it is hardly surprising that a recent review has cast doubts on the impact of supervision on professional practice and patient outcome (4). The authors have suggested that a well-run peer-review system can substitute for personal supervision.

In addition to the transmission of values, there are three other roles of supervision: 1) educative/formative: development of technical and interpersonal skills, 2) supportive/restorative: examination and management of clinical work on the trainee, and finally, 3) managerial/normative: to ensure that quality is achieved in clinical practice (5). Supervision sessions also have a high potential for resembling, or even becoming, psychotherapy sessions given the regular, structured 1:1 time between the trainee and supervisor, development of rapport, and disclosure and sharing of experiences and power imbalance—features that are integral to supervision. Supervisors and trainees need to be alert to this fact to avoid supervision from becoming psychotherapy sessions. The lack of experience in trainees prepares the background for strong transference to develop and may prompt the supervisors to respond by reflecting on their experiences. This effect, indeed, may have some therapeutic benefits, as recalled by Dr. Bowers.

Supervision should also not be an opportunity in which the frustration and disappointments of supervisors are projected onto the trainees. In this instance, the personal experience of supervisors may have a determining effect. Some of us who have experienced unpleasantness during our own supervision may easily recreate similar situations with our trainees. Similarly, it should not be an opportunity in which issues such as power, control, and superiority are resolved. As identified by Dr. Bowers (1) humility, openness to learning, and sharing an exchange of knowledge may be helpful in this regard.

REFERENCES

1. Bowers MB Jr: Supervision in psychiatry and the transmission of values. Academic Psychiatry 1999; 23:42–45[Abstract/Free Full Text]
2. Kozlowska K, Nunn K, Cousens P: Adverse experiences in psychiatric training. Part 2. Aust N Z J Psychiatry 1997; 24:499–506
3. Clarke DM: Supervision in the training of a psychiatrist. Aust N Z J Psychiatry 1997; 27:306–310
4. Rose DM, Boyce PM: Clinical supervision and its effects on the quality of practice of qualified practitioners. Australasian Psychiatry 1992; 7:11–13
5. Hawkins P, Sohet R: Supervision in the Helping Professions. Buckingham, QC, Australia, Open University Press, 1999

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