Both the pleasures and pains of psychotherapy supervision have been described for the three parties--resident, supervisor, and patient--involved in such work. Although both positive and negative aspects have been included in order to be comprehensive, it is clear to those who have engaged in supervision for many years that the pleasures far outweigh the pains for those concerned. A variety of means of facilitating the growth and increasing the knowledge of student psychotherapists have been undertaken. My own experience over 33 years suggests that individual supervision remains the second most important way to become a competent psychotherapist. The first, of course, is to engage in psychotherapy with patients. This paper is an overview of the interpersonal aspects of individual supervision of psychotherapy. When the resident and supervisor bring certain attributes to the supervisory situation, then all the more can be accomplished in their work together. Including both its pleasures and its pains, psychotherapy supervision is a creative and fulfilling undertaking for both residents and their supervisors.

The question of neutrality in psychotherapy is considered in the light of original historical psychoanalytic attitudes, and present usual practices. A disparity between what is reported and what is done is examined, and explanations for its existence are put forward.

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In the course of life's experiences mistrust develops in childhood and adulthood. Clinical manifestations of mistrustfulness in patients are discussed. Successful psychotherapy has as one of its principal goals the re-establishment of trust within the patient. This takes place through the development of trust toward the therapist. This experience serves as a bridge to the re-establishment of trust in others. Those personal qualities in the therapist which are of the greatest importance in this area are reliability and realistic hopefulness. Being taken seriously and the opportunity to attach to the therapist are also very significant. The place of the therapist's interventions as well as the relevant significant qualities in the patient are also discussed. Trust breeds trust, connection with others and, thence personal security. This is a basic goal of psychotherapy.

Undergraduate psychiatric education should be concerned mostly with those aspects of psychiatry required for the proper practice of medicine. Psychiatric concepts and techniques are applicable to all medical practice and relevant to the daily work of every physician or surgeon. Therefore, in the psychiatric training of medical students the focus should be primarily on teaching "psychiatry of medical practice" and much less on teaching "specialty psychiatry." The teaching of psychiatry for medical practice will be best accomplished by selecting patients who are more like those the student will see later on as a practising physician. A systematic effort should be made to develop joint teaching with other departments, if we are to hope that students will carry over the approach we teach them to other subjects of medicine. Counselling and psychotherapy are essential skills for every physician or surgeon; medical students should be taught these skills by psychiatrists who are not just skilled psychotherapists but are also comfortable in their role as physicians in view of the importance of this role for the development of the identity of the medical student as a physician. The quality of the psychiatric training of medical students is dependent to a large extent on the priority accorded to undergraduate teaching by the department of psychiatry; competing activities, however, can result in undergraduate teaching being given less than top priority. Long-standing difficulties which psychiatry and psychiatrists experience in the medical school may impede undergraduate psychiatric education; these difficulties can be lessened by the closer involvement of psychiatrists with other physicians in the clinical and educational programs.