A model for individual supervision in a general hospital

Abstract

HE TRAINING of physicians, in general, is based on the apprenticeship model. The student learns by observing the teacher and then is himself observed by the teacher. Until the advent of psychoanalysis, psychiatry could be taught according to this mode. The nature of the clinical task for the psychiatrist was not fundamentally different from that of any other type of medical intervention, and, thus, teaching in this area could follow the apprenticeship model of general medical training. With psychoanalysis, however, the clinical task assumed altogether different dimensions. The focus shifted to the patient’s internal subjective life and away from external objective symptomatology. The vicissitudes of the relationship between the therapist and patient became central to the treatment. In fact. psychoanalytic treatment was arranged so that the manifestations of the patient’s disturbance were encouraged to appear in the treatment itself. The realities of the patient’s life situation were given less emphasis than the internal fantasies any realities might generate. It is easy to see that an apprenticeship model of teaching would be difficult to adapt to psychoanalytic treatment. The unique psychic qualities of analyst and patient and the vicissitudes of their interaction cannot be easily translated into a learning scheme in which student observes teacher. Nor could a teacher easily make objective assessments about the work of his student by observing him, since not only would the teacher’s presence interfere with this delicate interaction, but the highly subjective nature of the work would make direct observation more or less irrelevant. The formal psychoanalytic training that was developed to meet the needs of this new discipline had three aspects: personal analysis for the student, didactic teaching, and individual case supervision. The first recorded mention in the psychiatric literature of case supervision is attributed to Eitingon in 1925.’ In the years since then, contributions to the literature on the nature and proper functioning of analytic case supervision have been enormous. Several major books and articles have been written on the subject.“-”