Supervising the tearful trainee: opportunities for professional growth and learning

Trainees in psychiatry sometimes become tearful during supervision, and this presents the supervisor with significant challenges and also opportunities for the development of professionalism. This paper describes two major anxieties of trainees: first, that they will be unable to control their feelings during their clinical work and that this will derail the fulfillment of their duties; second, that that their feelings stem from an identification with some aspect of the patient or the patient's circumstances and may fear that this exposes them to the stigma of mental illness. The author describes how the trainee's potential for shame can be greatly mitigated by supervisory interventions that treat this as a 'teachable' moment and opportunity for growth in professionalism. The author outlines effective interventions including didactic instruction and education, role modeling of empathic connection in the context of a boundaried relationship, and sensitive referral to mental health services for unresolved emotional issues or psychiatric symptoms. Suggestions of specific wording of interventions are provided throughout.