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The purpose of this paper was to identify examples of supervisory and treatment impasses that occur in psychotherapy training and to examine aspects of their resolution. A self-administered questionnaire was completed by resident volunteers in two Ontario university departments of psychiatry. Despite responses indicating an apparent overall contentment with psychotherapy supervision, resident case vignettes detailed the most frequent impasse situations between themselves and supervisors. The majority were unresolved leading to distressing experiences for residents and failed psychotherapies for patients. Supervision promoting learning, combined treatments, and discussion of similar impasses, while focusing on the resident's immediate concerns and transference/countertransference issues appeared responsible for resolution. This pilot study underscores the need for an enhanced focus on the recognition and repair of impasses and highlights recommendations concerning the need for continuing education devoted to the supervisory alliance. We believe this will increase the residents' ability to effectively treat their patients. This paper emphasizes the experience of residents in psychotherapy supervision. A future study will focus on the supervisor's experience of impasses in supervision.

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A strong commitment to undergraduate teaching will improve the attractiveness of psychiatry as a career. This must include exposure of students to teachers who mentor practice patterns attuned to provincial mental health reforms, since government initiatives alone, developed to promote desired transitions in psychiatric care, will not influence training program choice.

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