Psychodynamic Supervision Research Articles

Exploring the intersection of psychiatry, art, and medical education through photographic portraits

This paper describes a technique using photographic portraits in medical education to encourage close observation, cultivate empathic curiosity, explore learners’ values and beliefs, and to reveal and reflect on fundamental biases. This new and evolving educational method uses the lens of psychotherapy to explore learners’ experience of the portrait in a similar way we would discuss a case in psychodynamic supervision. Through close looking and small group engagement, the facilitator creates a space for deeper reflection and collaborative exploration of the therapeutic relationship, with emphasis on countertransference and the role of prior expectations. The exercise strengthens dialectical thinking through perspective-taking, challenging implicit assumptions and fostering cultural humility. Radiologists are taught to look in every corner of the X-ray and to observe each shadow, all while evaluating the entire image. Portraits can be examined in the same way, looking for subtle clues to the personality and history of the subject. Information from other sources confirms, or sometimes profoundly changes, our evaluation. In this example, we use a historical photographic portrait to demonstrate ways of engaging medical learners as they discover common psychotherapeutic approaches. The method has the potential to enhance therapeutic encounters, improve analytical skills and reduce bias.

Race and culture in contemporary psychodynamic supervision

Over the past two decades, there have been significant strides towards an improved understanding of race and culture in clinical supervision. Yet, there continues to be less attention directed towards the influence of the contemporary sociocultural context on the lives of supervisees and supervisors. This manuscript explores how race and culture are experienced in supervision amidst ongoing sociocultural traumas and injustice. In particular, I highlight how the key features of psychoanalytic supervision have recently been expanded to include attention to sociocultural dynamics, and then examine how the contemporary sociopolitical context has specific impacts on the lives of supervisees and supervisors. I also underscore the importance of centring the experiences of racial minority supervisees and supervisors, which have remained less visible within scholarship concerning psychodynamic clinical supervision. In an effort to expand prior theorising on racial and cultural dynamics in supervision , I propose further attention to the following areas in psychodynamic supervision: 1) role of unconscious relational processes (e.g. transference, countertransference, and parallel process); 2) the influence of external realities; and 3) the role of vulnerability and humility. The manuscript is a call for a collective mission to integrate race and culture in psychodynamic supervision.

The Development of Transference-Focused Psychotherapy and Its Model of Supervision.

Transference-focused psychotherapy (TFP) is an empirically based, manualized psychodynamic psychotherapy that emerged as an adaptation of psychoanalytic techniques to meet the needs of patients with personality pathology. As it became more clearly defined through a series of treatment manuals and empirical research, TFP has also come to be considered a conceptual and technical model of therapy that can be used to introduce therapists in training to the principles of psychodynamic psychotherapy in a systematic way. Advanced levels of TFP training and practice involve an emphasis on supervision that is applied in a more structured way than traditional psychodynamic supervision, while respecting the depth and subtlety of psychoanalytic exploration. This article reviews the development of the treatment model and the supervisory process that guides the therapist to carry out TFP in accordance with its proposed mechanism of change.

65.3 DELIVERING PSYCHODYNAMIC PSYCHOTHERAPY SUPERVISION IN CHILD AND ADOLESCENT PSYCHIATRY FELLOWSHIP PROGRAMS

In this presentation, attendees will learn practical approaches to assess and/or improve the quality of psychodynamic supervision within child and adolescent psychiatry residency training programs. Attendees will also identify potential barriers to providing psychodynamic supervision in child and adolescent psychiatry training programs and engage in a discussion about creative solutions to remove these barriers.

Play in social workers’ psychodynamic therapy supervision

ABSTRACT Various studies in the science and culture fields have long recognised the power of play in facilitating human development and therapeutic processes. This paper focuses on the developmental potential of play in psychodynamic therapy supervision for social workers who function as therapists, but its conclusions might be applied to supervision of other social work interventions. It is suggested that play is represented in supervision by an illusion shared by the supervisor and supervisee of their complete togetherness in the supervisee’s clinical struggles and clinical responsibility. This element of play temporarily reduces supervisees’ sense of loneliness in their responsibility for clients’ welfare and for the integrity of therapeutic processes. This illusion is healthy and growth promoting when supervisees acknowledge reality and when, by repeatedly experiencing this illusion, they assimilate it into their professional self. Through such a process, supervisees eventually internalise a professional community of supervisors, colleagues, and writers, who become symbolic representations that can be projected onto reality and facilitate professional interactions.

What is the right time for supportive versus expressive interventions in supervision? An illustration based on a clinical mistake.

Although supportive-expressive (SE) psychotherapy is one of the most studied psychodynamic therapies today, little is known empirically about effective strategies in SE supervision, or in psychodynamic supervision in general (Diener & Mesrie, 2015; Watkins, 2011). One of the important questions in SE psychotherapy is how to decide when to use supportive and when to use expressive interventions. As a parallel process, this type of decision is relevant also to SE supervision. The present case study focuses on the decision-making process in an SE supervision session: when should supervisors use supportive as opposed to expressive strategies with their supervisees? Our aim is to develop decision rules that reliably support supervisors' decisions. We analyze a clinical error made by supervisors in this type of decision making, and show how mistakes of this type can either be avoided or, when they occur, how to turn them into opportunities for learning and for the formation of new understanding and growth. Similarly to the finding that therapists with better skills in managing their countertransference feelings were shown to have better outcomes with their patients (Gelso, Latts, Gomez, & Fassinger, 2002; Hayes, Gelso, & Hummel, 2011), we suggest that the management of the supervisors' feelings, and working through their mistakes with the therapists, can contribute to the supervisory relationship and to the development of the psychodynamic therapists' skills. (PsycINFO Database Record

Trainee Practitioners’ Experiences of the Psychodynamic Supervisory Relationship and Supervision: A Thematic Analysis

The objective of this research was to explore trainee practitioners’ experiences of the psychodynamic supervisory relationship and supervision. Eleven trainees were recruited and data were analyzed using thematic analysis (Braun & Clarke, 2006). Most of the trainees described strong supervisory relationships that enhanced their therapeutic practice and their accounts depicted features of the real relationship in supervision (Watkins, 2011, 2012). However, some of the participants discussed the consequences of challenging supervisor-supervisee dynamics. Future researchers studying negative supervisory relationships could explore if and how the absence of the real relationship in supervision contributes to problematic supervisory dynamics.

Psychotherapy Supervision for Psychiatry Residents

Objective To review specificities of and difficulties in psychodynamic psychotherapy training for psychiatry residents. The Royal College of Physicians and Surgeons of Canada requires a minimum of 32 weeks of the PGY2-PGY5 psychotherapy experience. Most of Canadian universities organize training in supportive psychotherapy, cognitive-behavioral therapy and long-term psychodynamic psychotherapy for psychiatry residents. At the beginning of the PGY3 year, residents will begin supervised practice in psychodynamic psychotherapy for a minimum of one year. Residents may perceive psychodynamic psychotherapy as too complicated and they may require a more directive approach in supervision and guidance regarding psychotherapy technique and psychotherapy process. This is understandable because they lack personal/didactic analysis. Supervisor trained in psychoanalysis needs to take into account differences in supervision as a part of psychoanalytic training and psychiatry resident supervision in psychodynamic psychotherapy. Unlike the psychoanalytic training organized by psychoanalytic institutes, training in psychotherapy as a part of residency training is much less defined in terms of standards and expectations from both residents and supervisors. The profile of psychodynamic psychotherapists who serve as supervisors for residents may vary significantly with regards to their training, experience and personal style in supervision. Criteria for assessment of resident performance and his/her progress in training are not well established. Residency training committees and psychotherapy training committees should work on developing training standards of psychotherapy supervisions for residents. In conclusion, psychodynamic psychotherapy supervision for psychiatry residents is a specific and modified type of psychotherapy supervision. There is a need for standardization of the long-term psychodynamic psychotherapy supervision.

“We Don't Get Fooled Again”…Or Do We? One Social Worker's Artistic Perspective on Supervisee Resistance and the Process of Meaning Making in Contemporary Psychodynamic Clinical Supervision

In the following article I analyze the construct of resistance in contemporary psychodynamic supervision. I reframe supervisee behaviors that have been labeled as resistance and advance the idea that, at times, these behaviors may be better understood as attachment behaviors intended to reduce anxiety through the restoration of a particular state of relatedness to the supervisor. I supply a vignette from my own work to illustrate this point. Throughout, I highlight the influence of epistemology on supervision and advocate that the objectivist/constructivist distinction presents a dialectic to be embraced rather than a conflict to be resolved.

Dynamical Systems Therapy (DST): Theory and Practical Applications

Despite bringing about a revolution in our comprehension of the world, reductionist science has constructed a mechanistic picture of the Universe with no place for emergent complexity, free will, or mental phenomena (Murphy, 2007). The Cartesian split between the material and the mental continues to impact our models of human nature and psychopathology, nowhere more evident than in the widely divergent languages of neuroscience and psychodynamics. The informational language of complexity theory stands as a holistic approach with the power to reunify the domain of the mind (first-person subjective perspective) with the “objective” domain of affective, cognitive, and social neuroscience. The author’s earlier paper (Shapiro, 2014) used the complexity paradigm to construct a comprehensive psychodynamic formulation that transcends the brain/mind dichotomy by examining the patient’s adaptive landscape, where both subjective experiences and observational data are charted as malleable attractor/repellor states. The therapeutic implications of this complexity approach were operationalized as Dynamical System Therapy (DST). The DST model is built on a strong evolutionary foundation, incorporating qualitative emergence in the phylogeny and ontogeny of the brain/mind system, as well as systemic complexity in the patient-therapist interaction. It allows us to revise the classical assumptions of human nature, psychopathology, and therapeutic process in the light of recent research on non-linear Complex Adaptive Systems that incorporate both biological and psychological self-organizing processes. It is the aim of this paper to provide theoretical and practical review of the DST model in clinical work, ranging from individual to group therapy to psychodynamic training and supervision.

Practice based learning: The impact of psychodynamic supervision groups on the development of psychodynamic clinical skills

This study explored the experience and skills development of newly qualified clinical psychologists attending fortnightly psychodynamic supervision groups for 30 months, using a questionnaire and qualitative methods. The emotional complexity of learning and the effectiveness of group supervision are discussed.

Can a new observational tool distinguish between CBT, systemic and psychodynamic supervision?

We examine the validity of a new instrument for rating competence in supervision. The tool appears to have content validity and shows early promise in discriminating between cognitive behavioural therapy (CBT), psychodynamic and systemic supervision, as each had distinctive and theoretically-congruent profiles.

Mutual Influence in Psychodynamic Supervision

This article examines three hypotheses: (1) supervisory process is reciprocal, (2) supervisors as well as supervisees benefit, and (3) supervisors and supervisees benefit personally as well as professionally. The article begins with a comparison of three relationally oriented approaches to the “teach-or-treat” controversy and continues by briefly summarizing the psychoanalytic literature on mutual transformation. Two case summaries illustrate mutual change: the first describes how supervising an MSW student early in my career affected my professional and personal development, whereas the second illustrates bidirectional supervisory action in case consultations with an experienced therapist.

In sickness and in health: An exploration of some of the unconscious processes involved in the decision by family caregivers to place a family member with dementia in residential care

This paper explores the feelings, conscious and unconscious, evoked by the difficult decision to place a family member with dementia into residential care. In an exploratory study I interviewed five people who had made this decision with a view to exploring some of the unconscious processes involved in their decision-making. The interviews were interpreted paying attention to my understanding of the transference and my countertransference feelings and as triangulated by a psychodynamic supervision group. Intimate contact with ageing and death evokes fears about mortality and activates primitive anxieties. The progress of dementia may amplify primitive or psychotic states of functioning, particularly those involving evacuatory projection, and family carers may resort to splitting off unbearable feelings of anxiety which such projections can evoke and may contribute to their decision to look for residential care. Once placed in residential care different dynamics evolve and further difficult questions arise: how often to visit; whether and when to dispose of the person's possessions and ultimately how to grieve. The focus of this paper is, as far as it is possible, on the partner without dementia as an individual and the impact of their relative's dementia on their lives.

Psychiatric training experiences in psychotherapy: integrating a psychological perspective into mental health care

Purpose – This paper seeks to report upon psychiatric trainees' experience of providing psychodynamic therapy for the first time and their experience of group supervision.Design/methodology/approach – A total of five trainees, undertaking training in psychodynamic therapies, were interviewed on multiple occasions over an 18‐month period – before, during, and after undertaking their first case of psychodynamic therapy. A semi‐structured, qualitative interview approach was used to explore providing psychodynamic psychotherapy and participating in psychodynamic supervision groups. Interviews were transcribed in full and data analysed following the conventions of thematic analysis.Findings – Trainees' anxieties about working psychodynamically and their concerns for developing new competencies are recognised. Personal and professional challenges associated with this therapeutic approach are identified and the importance of ”looking after” trainees is stressed; the role of trainee supervision groups in this is ...

What makes for good supervision and whose responsibility is it anyway?

This lecture draws on my recent book ‘Supervision in Counselling and Psychotherapy’ and considers the subject of the respective roles and responsibilities of the supervisor and the supervisee. The book is an introduction to psychodynamic supervision, and was intended primarily for those beginning to supervise, although it also has some interest for those who are more experienced and wanting the opportunity to reflect on their practice. However, it has also generated interest among those who are in supervision, and, as anticipated, many of those present at the lecture were students currently in supervision as well as those beginning to supervise in various contexts. I therefore decided to focus in this paper on supervision as a joint effort. Supervisors need supervisees just as therapists need patients, and both have a role, albeit a different one, in making the process successful. I begin by thinking about the characteristics of good supervision – and importantly, some of the factors that make it a complex and at times a difficult task. I then go onto consider the process of supervision, the part each of us plays in making it productive, and how we can work collaboratively to gain an understanding of the patient.

Don't Leave Teaching to Chance: Learning Objectives for Psychodynamic Psychotherapy Supervision

The way in which the competencies for psychodynamic psychotherapy specified by the Psychiatry Residency Review Committee of the Accreditation Council for Graduate Medical Education translate into the day-to-day work of individual supervision remains unstudied and unspecified. The authors hypothesized that despite the existence of competencies in psychodynamic psychotherapy, residents did not know what they should be learning in psychodynamic psychotherapy supervision. Twenty-four psychiatric residents in PGYs 3 and 4 at Columbia University were asked to complete an anonymous course evaluation about their learning experience in psychodynamic psychotherapy supervision. The evaluation had eight items: seven yes/no questions and one open-ended question. Sixteen of 24 surveys were returned, a response rate of 66.6%. Of the residents who responded, eight said they did not know what they were supposed to be learning in psychodynamic psychotherapy supervision, nine had not discussed this with their supervisor, and six did not believe that their discussions in psychodynamic psychotherapy supervision correlated with didactic courses. These results support the need for specific learning objectives for psychodynamic psychotherapy supervision that can be communicated to both supervisors and supervisees to facilitate the process of learning and assessment.

Experiences of the Group Format in Psychotherapy Supervision

The major purpose of this study was to examine differences between supervisors' and novice supervisees' experiences of actual and desired usage of the group format in psychotherapy supervision. Second, differences between supervisors and supervisees who worked with cognitive-behavioral and psychodynamic group supervision were examined. The results showed significant differences between the actual and desired usage of the group format. Psychodynamic supervisors and supervisees, to some extent, presented higher wish ratings compared with cognitive-behavioral supervisors and supervisees. In conclusion, from a supervisor and supervisee perspective, a more frequent usage of group processes as a teaching tool in group supervision of psychotherapy is desired.

Reminiscences of a Training Director and the Future of Training Programs

Psychiatric education in the United States has undergone vast changes during the past 40 years, from a classical psychoanalytic model to an evidence-based neurobiological paradigm. Training standards, set by the Accreditation Council for Graduate Medial Education, have brought more scientific rigor to the training of young psychiatrists, but the danger of losing the psychotherapeutic skills provided in the past by long-term psychodynamic supervision is of concern to many psychiatric educators. A model for evaluating competence in psychodynamic psychiatry is discussed and postgraduate psychoanalytic training is encouraged.

British Association for Psychoanalytic and Psychodynamic Supervision

British Journal of PsychotherapyVolume 22, Issue 2 p. 285-292 British Association for Psychoanalytic and Psychodynamic Supervision First published: 17 November 2006 https://doi.org/10.1111/j.1752-0118.2005.tb00285.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume22, Issue2December 2005Pages 285-292 RelatedInformation