Supervising Individual Psychotherapy: The Guide to “Good Enough”

BOOK REVIEW

Supervising Individual Psychotherapy: The Guide to “Good Enough”

Edited by Katherine G. Kennedy, MD, Randon S. Welton, MD, and Frank E. Yeomans, MD, PhD; Washington, D.C.; American Psychiatric Association Publishing (APPI), 2023

392 pages• $70.00 (paperback)

Reviewed by Sharon Packer, MD

Recently, I received an unsolicited email from an EAP (Employee Assistance Program) recruiter that read, “I see that you are a psychiatrist. Do you currently hold any social worker or therapist license? We offer therapy, not medication management.”

I was astounded, not that I received yet another solicitation from a recruiter who was desperate to connect with psychiatrists, who are in short supply. Rather, I was astounded that she appeared to be completely unaware that psychiatric residency requires training in psychotherapy—and in 3 to 5 types of therapy, at that.

That email further convinced me of the importance of APPI’S Supervising Individual Psychotherapy. This impressive 25-chapter, multi-authored, edited collection can encourage prospective psychotherapy supervisors and educate seasoned psychiatrist-supervisors. In my opinion, this volume should be required reading for current and future supervisors. It can also recruit prospective supervisors, who are much needed.

Although the practice of providing direct supervision is a tried-and-true tradition, and although parallels between supervising psychiatrists-in-training and providing psychotherapy to patients are readily apparent, there is plenty of new information here. That information is sometimes surprising—and occasionally startling.

The subtitle itself is encouraging: the guide to “good enough” supervision invokes Winnicott’s concept of the “good enough” mother and reminds readers that supervisory practices do not demand perfection. It dispels the idea that only the most accomplished or best-credentialed psychiatrists are qualified to supervise psychiatrists in training. Still, it is implied that supervision standards will improve after completing these chapters.

After digesting this consoling introduction, my gaze darted to the section on “the so-called difficult supervisee.” Fortunately, this chapter addressed my most common concerns. It was a relief to know that my own concerns, especially about attendance, occur often enough to merit top mention. The authors approach these challenging issues beautifully, offering not just abstract ideas, but hypothetical dialogue, as if they were writing a script for a play. This role-play approach prepares the reader for what would otherwise be difficult conversations.

Included in the section on challenges in psychotherapy supervision is a chapter on sexual issues. Some factoids frankly shocked me. Reading that 9.4% of male residents have sexual encounters with patients convinced me that my standard offhand admonitions about these taboos are not sufficient and that assumptions that “everyone already knows this” are just plain wrong. Clearly, this important issue deserves constant supervisory attention.

The chapter on medicolegal considerations contains many eye-openers. It is somewhat reassuring to learn that few of the hypothetical issues mentioned arise in real life, but the author raises valid concerns about contracts between supervisor-supervisee, and spelling out clear-cut guidelines about when supervisees should alert their supervisor and when the supervisor should alert the program director, or the hospital’s risk management service.

Given that telepsychiatry became the mainstay of supervision since the pandemic started, this chapter held special interest for me. I await an expanded section on telesupervision’s benefits—and not just the drawbacks—a­s more data become available.

Another chapter on fostering supervisor growth includes useful charts for evaluations. While one hopes that the chapter on death and suicide from Michael Myers, MD, will never be needed, statistics tell us otherwise. Having access to this information in advance will be appreciated.

As expected, some chapters address current social concerns about race, gender, sexual orientation, gender identity, national origin and ethnic identification and their interplay with psychotherapy supervision.

The chapter on supervision during life transitions is essential, given that divorce (the endpoint of 50% of marriages), pregnancy, medical problems, or family deaths can occur during training and can impact resident performance. Supportive supervision during trying times is important. Equally important are the boundaries between personal psychotherapy and supportive supervision, as discussed here. As for support for supervisors, this excellent edition provides exactly that.

Dr Packer is an assistant clinical professor of psychiatry and behavioral sciences at Icahn School of Medicine at Mount Sinai in New York, New York.