Historical trend in psychodynamic training hours in residency

[Mapplicant]

Got a question for you knowledgeable people/history buffs/experienced psych docs. I'm doing a small assignment for my didactic class next week and we had a ground rounds recently on psychodynamic training in residency and a statistic that was presented was:

"50% of 6000 hours of training were devoted to therapy 30 years ago. Now training is down to 200 hours out of 8000 hours of training"

I did not see a reference to backup that statement and was wondering if any of you guys know of the general historical trend in therapy (which refers to dynamic) training vs now.

My own program after some back of the envelope calculations shows this:
300 hours of psychodynamic training (class + lectures provided by dynamically trained docs and estimated therapy time with pts ) over PGY1-4.

200 hours of rough CBT dedicated training over PGY1-4 total.

ACGME seems to have been formalized in the early 80s...and since that is also when DSM-III came out and truly shifted the paradigm of psych away from analysis into biological/evidence-based I assume that is also when psychodynamic training really started to go down.

I remember reading from Lieberman's recent book (Shrinks) where he mentions how in the past Department Chairs would be all analysts and they were quite firm in their stance and then the tide turned with Spitzer's spearheading the DSM-III effort and truly gave rise to modern psychiatry.

I've been looking at green journal articles but coming up short on this specific topic. If anyone can chime in with their own residency experience/knowledge it would quite interesting.

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[MacDonaldTriad]

My guess is that the 200 hours comes from the ACGME requirement of two hours per week of therapy supervision “during the outpatient experience”. For most programs this means the PGY-III year because the RRC says 12 months of continuous outpatient training. Most programs continue with two supervisors in the PGY-IV year so 50 weeks per year, two hours per week, x 2 years = 200 hours. This completely ignores any didactics and many programs have more supervision than this. This is just the mandated minimum.

 

[notdeadyet]

You're wise to pick up on the lack of source for those stats.

I would love to see all of these programs with 3,000 hours of psychotherapy training in 1985. I find that very difficult to believe.

 

[downwithDTB]

I have a feeling they are comparing"psychotherapy" contact time in the first case and direct supervision hours in the second as discussed by MDT adove?

48 weeks times 40 hours = 1,920. It seems pretty reasonable that over the course of PGY3/4 a resident would spend 3,000 hours training in psychotherapy if they considered all of their outpatient visits as constituting "psychotherapy," a philosophy still espoused by many training programs. I'm sure that some programs allow for even more today (again, with a liberal definition of psychotherapy).

 

[erg923]

yeah this kind of BS philosophy is espoused by programs who don't really teach psychotherapy. also who spends 40 hours a week seeing patients as a resident?! I spend about 10 hours seeing patients these days (which is on the low side but 40 hours is high)

Psychotherapy for 8 hours a day for 2 year nonstop is for the pros. And for probably those with masochistic traits.

 

[psychattending]

My guess is that the 200 hours comes from the ACGME requirement of two hours per week of therapy supervision “during the outpatient experience”. For most programs this means the PGY-III year because the RRC says 12 months of continuous outpatient training. Most programs continue with two supervisors in the PGY-IV year so 50 weeks per year, two hours per week, x 2 years = 200 hours. This completely ignores any didactics and many programs have more supervision than this. This is just the mandated minimum.

Current ACGME requirement is not for 2 hours of therapy supervision. That is a misconception. The requirement is for 2 hours of supervision. I do believe that 20 years back or so that the word therapy was in the requirements but that has been dropped in subsequent rules.

 

[MacDonaldTriad]

True, but I still think I'm probably right about this being the misguided source of the 200 hour thing.

 

[psychattending]

That is a reasonable hypothesis.