Abstract
This paper is based on the supervision of twenty first-year residents, over a period of three years, within a teaching unit of a traditional psychiatric hospital.
At this stage of training the basic difficulty lies in the transition from previous medical training; not only is the formal content quite different, but the learning of a new interpersonal relationship involving doctor and patient and doctor and other members of the team creates a major problem, especially in the context of psychotherapy.
The functions of tutor and supervisor should remain separate, the former dealing with the management of patients, and the latter focusing on the resident-patient relationship.
Common reactions among residents have been observed. They are confronted with two main tasks — working within a team, (which requires a redefinition of professional identity) and being confronted with psychosis, (with the anxiety this unknown provokes and the disruption of the security which was provided by medical school).
In general, the first reaction is an attempt at adjustment adaptation by turning to the medical model. With the help of the supervisor the defensive character of this attitude can be worked through; then follows a pervasive feeling of helplessness, de-developing into a depressive experience, which is considered to be a prerequisite to a dynamic approach with patients. However, individual residents may present different types of behaviour — passivity, opposition, intellectualization or clinging to the medical model.
This crucial phase in the process of supervision cannot easily be distinguished from personal therapy. Successful outcome depends mainly on a supervisory alliance between supervisor and ‘supervisee’, both feeling and assuming a mutual involvement in the task of helping the resident's work with the patient. A new professional identity as therapist is formed by the resident through identification with the supervisor.