Jefferson Journal of Psychiatry


While much of the literature on psychotherapy supervision focuses on teaching psychotherapeutic techniques, most residents and supervisors realize that there is another agenda: making the often drained and narcissistically injured therapist feel better. The beginning therapist's self-esteem is especially vulnerable to injury because most psychiatric residents have "heavily committed themselves to a field of endeavor for which ... they are relatively untested" (I). Coupled with this, they are often assigned the most difficult and demanding patients, those with narcissistic disorders who are unable to soothe themselves. Both Searles (2) and Balint (3) describe the barrage of counter transferences usually experienced by therapists treating such patients; these can be overwhelming for the new therapist struggling to develop a professional identity. Discussion of process and counter transference issues is often insufficient to the task of helping the resident maintain the positive self-regard which is essential to the development of adequate empathy for these patients.

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