The case for remote supervision

As the necessity of meeting state regulations has continued to mount in the public mental health sector, and insurance companies limit the number of therapy sessions covered in a year, the emphasis on evidence-based treatments, most often in the guise of some form of Cognitive Behavioral Therapy, continues unabated. Meanwhile, knowledge about and the ability to practice psychodynamically have all but vanished from most community mental health clinics in the United States. With shrinking funds, increasing demand for services, and increasing costs, therapists and their supervisors in these settings are expected to meet productivity and documentation requirements imposed by state and federal regulations and by the clinics themselves. These demands leave little time for therapists to discuss actual cases with their supervisors, to reflect on their experiences with patients and to wonder about the patient's experience with them, skills that are in themselves among the essential tools of psychodynamic clinical training and are crucial to patient care. This paper summarizes the qualitative data collected at the conclusion of a pilot study in which a dozen staff therapists in a community mental health center met weekly individually with psychodynamic supervisor/consultant volunteers to discuss their ongoing cases.