Deborah L. Cabaniss

The Columbia supervision project: Data from the Dyad

Anonymous questionnaires were sent to all candidates and supervisors at the Columbia University Center for Psychoanalytic Training and Research (hereafter “Columbia”). Questions focused on the four domains most emphasized in the literature on supervision: logistical issues; the “teach or treat” question; the evaluatory function of the supervisor; and the affective experience of supervision. By coding the questionnaires, anonymity of respondents was maintained while allowing for a matched pair of analyses of supervisors and supervisees. Return rate was over 85 percent. In general, rates of satisfaction with supervision were high, and candidates and supervisors agreed on such issues as the “teach or treat” question, as well as the technical and theoretical frame of reference of the supervisor. However, there were striking disagreements between candidates and supervisors as to the role of the supervisor, what candidates find useful in supervision, the evaluatory function, and the relation between supervision and progression to graduation. Although 50 percent of candidates reported anxiety about receiving credit for cases, this was not routinely discussed in supervision, and the supervisory relationship itself was not discussed in over 50 percent of dyads. Despite high overall satisfaction ratings, 25 percent of candidates said they wished they had a different supervisor for the case, and 75 percent believed that a candidate who asked to switch supervisors would be labeled problematic. In contrast, over 75 percent of supervisors reported that switching supervisors carries no stigma. In a follow-up study conducted one year later, many candidates reported that they feared reprisals for switching, and some reported that their training analysts advised against “rocking the boat.” Candidates felt that participating in the study emboldened them to think more openly about supervision and in some cases to make changes.

Psychoanalytic practice in the early postgraduate years

As a pilot investigation for a longitudinal study of psychoanalytic careers, a survey was conducted of analysts who graduated during the last fifteen years from the Columbia University Center for Psychoanalytic Training and Research. Graduates were asked to describe both their analytic practice and their interest in pursuing appointment as training and supervising analysts. The 23-item questionnaire was completed by 67 of 102 potential respondents (66%). The study identified two subgroups of graduates: those who were not certified and were not training analysts (GAs), 78% of the sample, and certified and training analysts (CAs, TAs), 22% of the sample. GAs started a mean of 1.4 new analytic cases since graduation, as compared to CAs and TAs, who started a mean of 5.4 and 8.3 new cases, respectively. CAs and TAs also saw more twice-weekly therapy cases than did GAs. Once-weekly therapy was the most commonly practiced treatment for all subgroups. Interest in becoming a TA was highest during the first five postgraduate years and was lower among non-TAs five to fifteen years after graduation. Only one of the CA respondents met current APsaA immersion criteria for training analyst appointment.

Candidate progression in analytic institutes: A multi-center study

This study documents the criteria for graduation and for awarding credit for training cases used by thirteen institutes of the American Psychoanalytic Association (APsA). At the time of this study, these thirteen institutes were training 63% of all candidates enrolled at institutes of the APsA. Questionnaires were sent to the progression committee chairperson (PCC), a junior candidate and a senior candidate, and a recent graduate at each institute. Each participant also had a follow‐up semi‐structured telephone interview. Return rate was 100%. 92% per cent of the institutes reported that in order to receive credit for cases, the patient needed to be in treatment for some minimum amount of time (average 18.3 months). Many PCCs were skeptical about writing down the criteria for credit, stating that this made candidates overly focused on the time requirement. 85% per cent of PCCs felt that graduation from the institute was based primarily on obtaining credit for cases. Few required a terminated case and only one felt that classroom work was an important factor. 47% per cent of candidates felt that the need to keep patients in treatment to receive credit for cases affected their treatment of patients and only 46% of candidates could state the minimum time requirement used by their institute. These results indicate that graduation from institutes of the APsA depends primarily on receiving credit for cases, that case length is an important criterion for awarding credit and that this method of evaluating candidates may not be the best way to support educational objectives.

The aim of the training analysis.

Although the training analysis is considered by many to be the most important element of a candidates analytic training, its aim remains unclear. Some think of the training analysis as being a strictly therapeutic tool, while others assign it a more frankly educational role. This paper reviews the literature on this topic from Freud to the present, discusses the problems that lack of clarity about the aim of the training analysis generates for psychoanalytic education, and proposes future research in this area.

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

ObjectiveThe 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.MethodsTwenty-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.ResultsSixteen 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.ConclusionThese 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.

Recruiting Researchers in Psychiatry: The Influence of Residency vs. Early Motivation.

BackgroundThe declining numbers of clinician-researchers in psychiatry and other medical specialties has been a subject of growing concern. Residency training has been cited as an important factor in recruiting new researchers, but there are essentially no data to support this assertion. This study aimed to explore which factors have influenced motivation to conduct research among senior psychiatry residents.MethodsThe authors surveyed senior residents, inquiring about their level of interest in research, demographics, background, research experiences, and factors influencing motivation for research. The authors had confirmed participation from 16 of 33 residency programs with a class size of 10 or more. They received 127 responses, a 67% response rate, from participating programs.ResultsResidents with high stated interest in research differed from those with low and moderate interest in their research-intense post-residency plans. They were more likely to have graduate degrees. Those planning research careers had a consistent pattern of interest and involvement in research, starting well before residency. The majority of residents had had research exposure in college, but research involvement of those with very high versus lower interest diverged sharply thereafter. Those with high research interest were overwhelmingly male and tended to have lower debt than those with less interest.ConclusionThe great majority of residents appear to have decided whether or not to pursue a research career by the time they reached residency, and few of those with less than the highest research interest were enrolled in research tracks. Efforts to increase recruitment into research should center on identifying early developmental influences, eliminating barriers specific to women, and ensuring adequate funding to provide secure careers for talented potential researchers.

Training Psychiatry Residents in Quality Improvement: An Integrated, Year-Long Curriculum.

ObjectiveThe authors describe a curriculum for psychiatry residents in Quality Improvement (QI) methodology.MethodsAll PGY3 residents (N=12) participated in a QI curriculum that included a year-long group project. Knowledge and attitudes were assessed before and after the curriculum, using a modified Quality Improvement Knowledge Assessment Tool (QIKAT) and a QI Self-Assessment survey.ResultsQIKAT scores were significantly higher for residents after participating in the curriculum when compared with pretest scores. Self-efficacy ratings in QI improved after the course for each item. Residents demonstrated gains in QI skills through participation in the group projects in which they increased rates of depression-screening and monitoring in an outpatient clinic.ConclusionsCombining didactic and experiential learning can be an effective means for training psychiatry residents in QI.

Points of Contact: Using First-Person Narratives to Help Foster Empathy in Psychiatric Residents

ObjectivesThe authors aimed to determine if writing narratives in psychiatric training can foster empathy for severely and persistently mentally ill patients.MethodsOne resident wrote first-person narrative pieces about three different patients at a community mental health clinic. She reviewed these pieces with a writing supervisor weekly. The supervisor and resident examined the style of writing, choice of words, and story line to help the resident learn about her feelings about the patient.ResultsIn each narrative, different choices were made that provided clues about that particular resident-patient relationship. These writing exercises helped the resident become more connected to her patients, develop interviewing skills, and engage in more self-reflection.ConclusionNarrative writing effectively fostered empathy in a PGY-1 psychiatric resident working with severely and persistently mentally ill patients. This exercise also fostered understanding of countertransference and improved psychiatric history-taking skills. Psychiatry training programs may want to consider incorporating narrative writing exercises into their curriculum.

The Training Analyst: Analyst, Teacher, Mentor

Although the literature has stressed that the training analysis should be identical to a nontraining “therapeutic analysis,” it was hypothesized that differences do exist between the two, particularly with respect to educational aims. Candidates at the Columbia University Center for Psychoanalytic Training and Research were sent anonymous questionnaires and asked to identify aims they felt were being achieved in the training analysis and to identify certain types of interventions that their training analyst made. Most candidates reported that widely accepted goals of the training analysis, such as promoting understanding of countertransference reactions, were being met in their analysis. Many also endorsed didactic and educational goals. Almost all reported using their analysts technique to some degree as a model for their own. Most notably, a significant minority of candidates reported that their analyst made interventions that appeared to have a primarily didactic, supervisory, or mentoring purpose. The implications of these findings for an understanding of the role of the personal analysis in psychoanalytic education are discussed.

The Role of Culture in Psychodynamic Psychotherapy: Parallel Process Resulting From Cultural Similarities Between Patient and Therapist

T his case illustrates how cultural issues can influence the progression of psychodynamic therapy. During the course of supervision, the resident learns how understanding the cultural similarities and differences between patient and therapist both enhances and hinders the treatment. The supervisor demonstrates the utility of parallel process during supervision in general and as a tool to uncover key cultural issues. The Grand Rounds discussant highlights cultural aspects of the case such as psychotherapy in a second language, assumptions about traditional roles, and demonstrations of closeness.