Last updated September 2010.

Life Member LogoLooking back from here what I remember most from my years as a trainee is the sense of knowing very little coupled with the expectation that somehow I would be able to function as a psychiatrist anyway. Patients were assigned to my care irrespective of my limitations. The saving grace of that anxious time was the opportunity to meet with supervisors who had seen and dealt with that which was so new to me.

It seemed generally true that the more years of clinical experience a supervisor had, the more useful I found the time with him or her. I thought this was because they had seen more and knew more. But it also seemed that often, though not invariably; years of experience correlated with understanding of and sympathy for my situation.

Even before I could catch my breath as a trainee, it seemed that I was also to become a supervisor. I don't remember the first student I was assigned, but I clearly recall the feeling that I was now posing as a teacher as well as a doctor. I believed that teachers should be knowledgeable, and I did my best to be so. My landscape was cast in black and white. There were diagnoses. There were treatments. There were proper doses of medication, (even though we had precious few medications to work with in those days). And most of all there were rules. "Don't answer personal questions." "Don't give advice." "Don't accept gifts". Those were givens only later understood as a protective framework within which to work while you were in over your head.

Over the years the givens shifted with the sands of time. But for each new generation of trainees, they were still givens. And for a number of years when the givens of my youth were most different from the givens of the day, my efforts as a supervisor were often unappreciated. And the less interested trainees were in my ideas, the more rigid and difficult they seemed to me.

Fortunately over time my own landscape shifted towards shades of grey. As I gathered experience with newer medications and more precise behavioral approaches, I felt more in tune with my supervisees. Fortunately also over the past few years our profession has been moving toward a renewed interest in psychodynamics-always my forte. And I have been granted the delight of being appreciated once again.

Now, looking back over forty years, I can recognize my growing sense of comfort and certainty in myself as a clinician. Increasingly, as I listened to presentations or read case summaries, the elements fell into place. The rush of anxiety about finding the right intervention eventually gave way to the certainty that understanding will come and ideas about what to do will emerge.

And I can appreciate more fully now what those older supervisors of my training days brought to my sessions with them. I wish they were around for me to thank.

Jacqueline Etemad, M.D.
Recently retired as Clinical Professor of Child and Adolescent Psychiatry at UCSF.