Supervising Individual Psychotherapy: The Guide to “Good Enough”

In the introductory chapter to Supervising Individual Psychotherapy: The Guide to “Good Enough,” author-editors Randon S. Welton and Katherine G. Kennedy explain Donald Winnicott’s concept of the “good enough” mother as one who makes occasional missteps but, overall, “adapts to her child’s needs and supports their growth and eventual autonomy.” Extending this concept to psychotherapy supervision, the book strives to help supervisors accept that they, too, will falter at times but that “becoming a supervisor is a life-long journey” wherein it is sufficient to be “good enough.” In keeping with this both forgiving and aspirational metaphor, the editors (Kennedy, Welton, and Frank E. Yeomans) of this comprehensive discussion of psychotherapy supervision have curated a collection of chapters that address an impressive range of supervisory issues, from anxieties facing the early-career supervisor (chapter 1: “Introduction: Am I Qualified to Supervise?”) to complex topics meriting the attention of even the most seasoned supervisor (e.g., chapter 21: “Sexual Issues in Psychotherapy Supervision”). At its core, this book explores the panoply of challenges psychotherapy supervisors face and offers measured, knowledgeable advice to advance one’s supervisory practice.

This review presents the perspectives of two individuals who are at different points in their career trajectories. One reviewer (I.B.) is new to the role of clinical supervisor, whereas the other (H.A.S.) has decades of experience as a psychotherapy supervisor. We happily report that this volume speaks to both of us and provides wisdom that directly informs our supervisory needs. For instance, the early-career reviewer (I.B.) found the sections on practical advice for creating a supportive, trusting, and helpful supervision space (e.g., chapters 4 and 6) and navigating difficult or sensitive discussions (e.g., chapters 19 and 23) to be especially informative. The later-career reviewer (H.A.S.) appreciated the useful framework for promoting trust within the supervisory relationship (chapter 4) and strategies for addressing exhaustion and burnout (chapter 25). We were both enthusiastic about helpful suggestions for providing virtual supervision (chapter 10), an approach that was rarely used prior to the COVID-19 pandemic but is now ubiquitous. Thus, we are confident that this book will appeal to most psychotherapy supervisors, regardless of experience level.

Strengths of this book include many illuminating clinical vignettes, informative supervisor-supervisee “scripts” that provide excellent models for effective communication, and a three-step supportive psychotherapy manual (an appendix at the end of chapter 17), all of which can be used in nearly any patient care setting. In addition, several chapters address potentially uncomfortable but important topics that are not always discussed in supervision or clinical training, such as processing patients’ or supervisees’ experiences with death and suicide (chapter 22), navigating difficult discussions during supervision (chapter 23), and discussing issues related to sexual feelings toward patients (chapter 21). This volume’s practical suggestions for navigating such sensitive or uncomfortable discussions in the supervision space are helpful for new and experienced supervisors alike. Further, we commend the authors and editors for their close attention to issues of diversity in clinical and supervisory relationships (e.g., chapters 13 and 15). Acknowledging issues of race, culture, sex, and gender within the supervisory relationship and in the clinical setting is critical to the success of such relationships; this volume provides actionable frameworks for understanding and addressing these timely and significant topics. Last, we appreciate the authors’ attention to and suggestions for managing the nuts and bolts of supervision, such as using process notes, viewing and reflecting on supervisees’ recorded sessions, and conducting supervision virtually.

The book focuses primarily on the supervision of resident or early-career physician trainees who are conducting psychodynamic psychotherapy. Given the relative dearth of evidence-informed guidance on psychotherapy supervision in psychiatry, this primary focus is welcome. For instance, physician-supervisors working in academic medical centers will benefit from the discussion of milestone-based tools developed by the American Association of Directors of Psychiatric Residency Training to support psychiatric resident assessment (chapter 6) and from the provision of psychodynamically informed tips for working with the “difficult” supervisee (chapter 19, with most vignettes focusing on the challenges of supervising psychiatric residents). On the other hand, individuals who supervise nonphysician therapists and practitioners of modalities other than psychodynamic psychotherapy may feel misled by a book title that implies an inclusive supervisory framework. Unlike the psychiatrist-reviewer (H.A.S.), the psychologist-reviewer (I.B.) found parts of the book to be less relevant to her supervisory practice, which includes nonphysician trainees who typically deploy structured modalities such as cognitive-behavioral therapy (CBT). For instance, sections focusing on psychodynamic principles within supervision (e.g., parts of chapter 7: “The Process of Psychotherapy Supervision”) or on issues that apply almost exclusively to physicians (e.g., chapter 11: “Supervising Integrated Psychotherapy and Pharmacotherapy”) were not especially informative for the psychologist-reviewer. Although chapter 18 addresses supervision of CBT and incorporates a few helpful pages on CBT-specific supervision techniques, much of the chapter constitutes a literature review of the efficacy of such supervision and iterates general suggestions that are not specific to CBT. Readers should be aware that they may struggle to connect with some of the material in this volume if they do not identify with a psychodynamic orientation, because this orientation is the framework used throughout the book.

Although some chapters cover supervision of other therapeutic modalities (i.e., supportive therapy in chapter 17 and CBT in chapter 18), the editors miss opportunities to explore supervision in the context of other commonly used psychotherapeutic modalities (e.g., interpersonal psychotherapy, dialectical behavior therapy, or acceptance and commitment therapy) and to examine supervisory challenges that are shared by practitioners of different modalities. Explicitly differentiating recommendations specific to the practice of psychodynamic psychotherapy versus those that apply to psychotherapy in general would have been helpful. The editors also omit considerations of differential approaches to the supervision of trainees from varied professional backgrounds.

Nevertheless, many topics discussed in this volume can be applied to the supervision of most psychotherapists practicing most psychotherapies. For instance, the sections on fostering a trusting supervisor-supervisee relationship to facilitate trainee learning and openness (chapter 4), providing useful and effective feedback (chapter 6), and helping trainees to set stage-appropriate goals (chapter 8) will be useful to supervisors of any theoretical orientation. Similarly, chapter 12, “Termination of Psychotherapy Supervision,” provides guidelines for recognizing trainees’ readiness to end supervision that can be applied across modalities. Thus, this volume offers much “cross-modality” information and many suggestions for providing effective, supportive psychotherapy supervision.

Supervising Individual Psychotherapy: The Guide to “Good Enough” is indeed a good-enough volume on psychotherapy supervision. Despite a few missteps (e.g., an overemphasis on psychodynamic psychotherapy), the comprehensive examination of important issues in psychotherapy supervision will make this book an invaluable text for years to come. Its content will be most informative for those who are supervising psychodynamic psychotherapy trainees or psychiatric residents, but useful pearls can be found even for individuals whose primary supervisory activities involve other therapy modalities and types of trainees. This book boasts contributions by internationally recognized experts in psychotherapy supervision and training and is filled with clinically useful tips, excellent vignettes, and thoughtful recommendations for novice and expert supervisors alike.