How do I get trained in specific forms of psychotherapy?

[bGMx]

I resonate with existential psychotherapy and would also like to gain expert training in mindfulness practice-- how does one go about finding these schools of thought to be formally trained? Or is it more of a self-taught endeavor?
My understanding is you find a mentor through residency-- thanks!

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[WisNeuro]

Please, please, please do not conduct self taught therapy with patients.

One can read through manuals and literature and understand the premise of some of these modalities. But, unless you have formal training that includes quality supervision, you're doing your patients a great disservice at best, and possibly harming them at worst. Hopefully you'd get experience while still in training. If you are past that point, didactics/CEs are a starting point, but I'd also say that is crucial to find someone skilled in that modality to supervise you for a certain period of time.

That period of time varies depending on your previous experience and training. For example, someone with years of training in CBT and PE, would probably be able to pick up CPT pretty quickly, as there is a good deal of overlap with skills already obtained. But, if you had little to no CBT experience, it'd be a much longer training period.

 

[When is graduation again?]

I resonate with existential psychotherapy and would also like to gain expert training in mindfulness practice-- how does one go about finding these schools of thought to be formally trained? Or is it more of a self-taught endeavor?
My understanding is you find a mentor through residency-- thanks!

You can get MBSR training. The courses are virtual. Note, it involves sitting and standing yoga which I'm not a fan of, but I found it helpful for learning mindfulness. If you advance far enough, you can take instructor courses.

 

[NickNaylor]

As others have mentioned, there are plenty of opportunities to get specific training in most psychotherapeutic modalities. If you're really wanting to become proficient, though, these courses are extremely unlikely to be sufficient to become truly competent. You'll probably want to pay for ongoing supervision with someone who has particular expertise in whatever modality you're training in.

 

[Stagg737]

You could start by looking into training programs. Here's what I found with the Google. The founder/president trained at Stanford, seems like a decent starting point:

Home - Existential-Humanistic Institute

EHI specializes in Existential-Humanistic (E-H) therapy professional enrichment programs, training, and events for both licensed professionals & graduate students.

ehinstitute.org

Agree with others that direct supervision is essential to becoming truly proficient in almost every modality.

 

[bGMx]

I agree with that-- thanks for your help. I'm really hoping to pursue my own interests instead of be at the mercy at whatever institution I end up happens to teach. I hope to make that known in my residency interviews-- any ideas on what I could do to begin distinguishing myself? I have a strong background in psychiatry already, I'm hoping to take a more nuanced approach in regards to this subject matter. Is it worthwhile to reach out to these institutions?

 

[ridethecliche]

I agree with that-- thanks for your help. I'm really hoping to pursue my own interests instead of be at the mercy at whatever institution I end up happens to teach. I hope to make that known in my residency interviews-- any ideas on what I could do to begin distinguishing myself? I have a strong background in psychiatry already, I'm hoping to take a more nuanced approach in regards to this subject matter. Is it worthwhile to reach out to these institutions?

I recommend skipping over that part and just expressing an interest in psychotherapy.

 

[NickNaylor]

I agree with that-- thanks for your help. I'm really hoping to pursue my own interests instead of be at the mercy at whatever institution I end up happens to teach. I hope to make that known in my residency interviews-- any ideas on what I could do to begin distinguishing myself? I have a strong background in psychiatry already, I'm hoping to take a more nuanced approach in regards to this subject matter. Is it worthwhile to reach out to these institutions?

Agree with the above. When you're interviewing, see how program leadership and the residents talk about their psychotherapy experiences. Ask how much time is spent each week doing psychotherapy. That will probably give you a rough sense of how seriously psychotherapy is taken by the program. Some programs see psychotherapy training as a necessary evil that must be included in order to be an accredited residency program. Others see it as a truly valuable treatment modality and incorporate it heavily into their programs (or offer opportunities to get more extensive training beyond "the bare minimum").

I don't think it's necessary to sell yourself as interested in psychotherapy to programs. I'd argue that the situation is exactly the opposite: you should be on the lookout for programs that offer experiences that fit your own interests and goals.

 

[Sikrouf]

I resonate with existential psychotherapy and would also like to gain expert training in mindfulness practice-- how does one go about finding these schools of thought to be formally trained? Or is it more of a self-taught endeavor?
My understanding is you find a mentor through residency-- thanks!

Where i work (inpatient hospital) there simply is no psychoterapy offered other than psychoanalysis (non manualised) with close to zero effect at best

6 month ago i got fed up with the huge amount of borderline patients clugging up the beds with no improvement whatsoever and an ever rising amount of psychotropics
I ended up buying the 2 princeps books by linehan about dbt (the one from 1993 and the second edition of skill training)

6 months later ive got the more severe patients in a group training session, they all attend to sessions and do most of the exercices, and bit by bit dbt skills are being spread over the impatient unit personnel
They all improved, we got some patients declining prn anxiolytics saying the skills they learned are more effective

Now this is just me spending hours learning stuff from 2 books, its far from perfect but its a definite improvement so far, if i ever get the chance to be supervised i ll take it but i ll probably be long dead before this happens

Just an experience i wanted to share

 

[calvnandhobbs68]

Where i work (inpatient hospital) there simply is no psychoterapy offered other than psychoanalysis (non manualised) with close to zero effect at best

6 month ago i got fed up with the huge amount of borderline patients clugging up the beds with no improvement whatsoever and an ever rising amount of psychotropics
I ended up buying the 2 princeps books by linehan about dbt (the one from 1993 and the second edition of skill training)

6 months later ive got the more severe patients in a group training session, they all attend to sessions and do most of the exercices, and bit by bit dbt skills are being spread over the impatient unit personnel
They all improved, we got some patients declining prn anxiolytics saying the skills they learned are more effective

Now this is just me spending hours learning stuff from 2 books, its far from perfect but its a definite improvement so far, if i ever get the chance to be supervised i ll take it but i ll probably be long dead before this happens

Just an experience i wanted to share

Yeah so I totally get this feeling.

I understand the angst about psychiatrists trying to do self taught psychotherapy, but honestly there's a pretty decent amount of manualized (esp CBT based) manuals/programs out there that are probably better than what I'm seeing most LPCs/SWs do if you actually perform the programs to fidelity. Half of them just seem to be shooting the **** with patients. To give an example, I try to talk to some of them about coming up with a specific structured behavioral/positive/negative reinforcement plan for kids with ODD/ADHD and it's like whoooosh right over their head in terms of specifics.

Would it be great if you had a supervisor to bounce ideas off of? Sure. And I totally get it's frustrating from the perspective of a psychologist who spent years training in this stuff. But at the end of the day the vast majority of our patients can't get in to see a PhD for weekly psychotherapy. Any LCSW can go get an EMDR certificate in 2 weekends with 10 hours of "case consultation" in between and right now the "direct supervision" part consists of 20 hours of practicing on zoom. Then bam, you can go around touting that you're "EMDR certified" and running wild doing trauma therapy with patients...which is probably the highest risk group for actual negative effects from therapy.

Lot less likely to cause actual harm (and probably more likely to actually have some improvement compared to some of the "therapy" I see out there) by picking up the Coping Cat CBT manuals and running through them with kids for GAD or the Unified Protocol manuals and running through them with patients (which are actually designed as standalone modules if you want anyway).

 

[clozareal]

You're still 3 years away from graduating medical school. Once you get to psychiatry residency, you'll need to learn the foundations of more common forms of psychotherapy first. During residency or while you're an attending, you can take supplemental courses (typically they require commitment of a certain time period like a year up to 5 years for full analytic training), be part of a weekly/monthly consultation group, have a supervisor in that modality, and then find patients who are willing to pay for that type of therapy.

If you're really set on existential psychotherapy, then training or working physically near those who are practicing it can help (Irvin Yalom now lives in San Francisco and has supervised many therapists in the Bay Area) as it may be easier to rub shoulders with those who have similar therapeutic orientations.

 

[WisNeuro]

Yeah so I totally get this feeling.

I understand the angst about psychiatrists trying to do self taught psychotherapy, but honestly there's a pretty decent amount of manualized (esp CBT based) manuals/programs out there that are probably better than what I'm seeing most LPCs/SWs do if you actually perform the programs to fidelity. Half of them just seem to be shooting the **** with patients. To give an example, I try to talk to some of them about coming up with a specific structured behavioral/positive/negative reinforcement plan for kids with ODD/ADHD and it's like whoooosh right over their head in terms of specifics.

And now you understand why so many people are ok with NP/PA/RxP.

 

[calvnandhobbs68]

And now you understand why so many people are ok with NP/PA/RxP.

Except the potential for harm is way higher with medical management than any type of therapy. There's a reason your malpractice insurance is basically nothing. Show me the study actually demonstrating significant harm from a therapy modality that isn't something crazy like re-birthing therapy or something?

You're not gonna give someone TD, get them addicted to benzos, give them metabolic syndrome/HTN/CAD, give them serotonin syndrome/NMS, make them hyponatremic or make them go into torsades with bad psychotherapy.

 

[WisNeuro]

Except the potential for harm is way higher with medical management than any type of therapy. There's a reason your malpractice insurance is basically nothing. Show me the study actually demonstrating significant harm from a therapy modality that isn't something crazy like re-birthing therapy or something?

You're not gonna give someone TD, get them addicted to benzos, give them metabolic syndrome/HTN/CAD, give them serotonin syndrome/NMS, make them hyponatremic or make them go into torsades with bad psychotherapy.

Show me the data that NP/PA/RxP providers result in higher rates of harm.

 

[calvnandhobbs68]

Show me the data that NP/PA/RxP providers result in higher rates of harm.

You're just starting your argument from a weaker point though to begin with. Baseline RISK of harm to the patient is much higher regardless of level of training. Whatever the appropriate level of training is to mitigate that risk, it's going to be higher than the level of training needed to administer CBT. It just is.

 

[WisNeuro]

You're just starting your argument from a weaker point though to begin with. Baseline RISK of harm to the patient is much higher regardless of level of training. Whatever the appropriate level of training is to mitigate that risk, it's going to be higher than the level of training needed to administer CBT. It just is.

There are decades of data on this, if someone wanted to look at it, they could. Explain it away if you want, but it's the same argument. It just is.

 

[calvnandhobbs68]

There are decades of data on this, if someone wanted to look at it, they could. Explain it away if you want, but it's the same argument. It just is.

I don't get what you're saying. If you're arguing that the level of risk to the patient is similar for poor medical management vs poorly administered psychotherapy...that's pretty clearly not true.

We can also argue up and down about the NP thing but we all know the "decades" of data on this are pretty clearly skewed by many many extraneous variables we won't get into here.

Show me the data that psychotherapy administered by a random person I pick off the street with an undergrad degree in psychology and hand a CBT manual results in higher rates of literally any type of harm than a psychologist?

 

[WisNeuro]

I don't get what you're saying. If you're arguing that the level of risk to the patient is similar for poor medical management vs poorly administered psychotherapy...that's pretty clearly not true.

We can also argue up and down about the NP thing but we all know the "decades" of data on this are pretty clearly skewed by many many extraneous variables we won't get into here.

Show me the data that psychotherapy administered by a random person I pick off the street with an undergrad degree in psychology and hand a CBT manual results in higher rates of literally any type of harm than a psychologist?

Show me the same data for psychopharm tx.

 

[calvnandhobbs68]

Show me the same data for psychopharm tx.

The entire point is that the baseline level of risk is higher for one therapy vs the other. It's like saying the level of risk is the same for a couple sessions of not great physical therapy vs zanaflex.

What exactly is the SPECIFIC risk to the patient in non-protocol administered CBT for instance that has been demonstrated?

I can easily list of 10 specific risks to the patient with inappropriately prescribed Abilify.

 

[WisNeuro]

The entire point is that the baseline level of risk is higher for one therapy vs the other. It's like saying the level of risk is the same for a couple sessions of not great physical therapy vs zanaflex.

What exactly is the SPECIFIC risk to the patient in non-protocol administered CBT for instance that has been demonstrated?

I can easily list of 10 specific risks to the patient with inappropriately prescribed Abilify.

But, you're still alleging harm, with no evidence. If the risk and harm is there, and it is so much higher, it should be that much easier for you to find in the data as the signal to noise ratio woudl be much more dramatic from what you allege. So, if that risk is so potentially egregious and damaging, where is it?

 

[Sikrouf]

And now you understand why so many people are ok with NP/PA/RxP.

yea medical studies and nurse/psycho are about the same regarding how much you learn so it makes perfect sense to compare

 

[WisNeuro]

yea medical studies and nurse/psycho are about the same regarding how much you learn so it makes perfect sense to compare

See, this guy gets it!

 

[hebel]

But, you're still alleging harm, with no evidence. If the risk and harm is there, and it is so much higher, it should be that much easier for you to find in the data as the signal to noise ratio woudl be much more dramatic from what you allege. So, if that risk is so potentially egregious and damaging, where is it?

Wisneuro,

You're a PhD, correct? This is a logical expectation for someone to have at face value, but I'm honestly surprised you expect this (with you being someone who is familiar with research and the field in general).

 

[WisNeuro]

Wisneuro,

You're a PhD, correct? This is a logical expectation for someone to have at face value, but I'm honestly surprised you expect this (with you being someone who is familiar with research and the field in general).

Why is it surprising, exactly? I never claimed we could have the perfect, be all end all, data from this sort of study. But, data of this sort does indeed exist, and this could be done, somewhat easily. It is extremely easy, relatively speaking in terms of big studies, to get approval for archival chart analysis. And, it's much cheaper than starting multi-site, large N studies. The point would be doing the retrospective study to more broadly look at outcomes, and use that data to support grants for more tightly controlled studies. We do this all the time, there is nothing unreasonable about it. Just because research is hard is a poor excuse to say that it can't be done.

 

[aim-agm]

@WisNeuro for our edification you comment if/what you think is correct/incorrect about @calvnandhobbs68 assertion that (restated):
'A doctoral practitioner trained in other psychotherapies can, if adhering to the manual with fidelity, self-teach manualized psychotherapies without supervision then administer those therapies at a quality at least matching that of the average masters-level practitioner'

 

[WisNeuro]

@WisNeuro for our edification you comment if/what you think is correct/incorrect about @calvnandhobbs68 assertion that (restated):
'A doctoral practitioner trained in other psychotherapies can, if adhering to the manual with fidelity, self-teach manualized psychotherapies without supervision then administer those therapies at a quality at least matching that of the average masters-level practitioner'

As I stated earlier, it really depends in what you are currently trained in, and what that new therapy entails. For example, I am trained in many trauma modalities. And, I think that someone well-trained in CBT in general, can probably pick up panic control treatment, or CBT-i, pretty easily autodidactically. However, trying to pick up DBT without formal training and being able to do it well without pretty intense supervision would be malpractice.

 

[Sikrouf]

As I stated earlier, it really depends in what you are currently trained in, and what that new therapy entails. For example, I am trained in many trauma modalities. And, I think that someone well-trained in CBT in general, can probably pick up panic control treatment, or CBT-i, pretty easily autodidactically. However, trying to pick up DBT without formal training and being able to do it well without pretty intense supervision would be malpractice.

I see how you could think that

Malpractice in my book would be to hold on a first line therapy just because we dont have enough ressources to do it the A way

Same applies for virtually any intervention - like when theres a suboptimal prescription and god knows there are, im not sure it always qualifies for malpractice

 

[WisNeuro]

I see how you could think that

Malpractice in my book would be to hold on a first line therapy just because we dont have enough ressources to do it the A way

Same applies for virtually any intervention - like when theres a suboptimal prescription and god knows there are, im not sure it always qualifies for malpractice

My definition of malpractice and state and federal definitions are obviously different. I see things that I would consider malpractice (e.g., high dose maintenance Rx of xanax in elderly individuals) all the time. It's not reportable to a board, or amenable to litigation in many instances, but I'd still consider it patient harm or unnecessarily increasing patient harm.

 

[Sikrouf]

My definition of malpractice and state and federal definitions are obviously different. I see things that I would consider malpractice (e.g., high dose maintenance Rx of xanax in elderly individuals) all the time. It's not reportable to a board, or amenable to litigation in many instances, but I'd still consider it patient harm or unnecessarily increasing patient harm.

Well i m sure you ll agree we cant say my situation is a case of malpractice since we allowed our most serious borderline inpatients to:

- leave the hospital or start working toward that goal
- improve tremendously their functionning on various domains
- reduce the amount of harmful psychotrops

We re also spreading the dbt way of doing stuff within the nurses and so far theyre glad to have more tools to handle patients

If thats malpractice sign me in

 

[WisNeuro]

Well i m sure you ll agree we cant say my situation is a case of malpractice since we allowed our most serious borderline inpatients to:

- leave the hospital or start working toward that goal
- improve tremendously their functionning on various domains
- reduce the amount of harmful psychotrops

We re also spreading the dbt way of doing stuff within the nurses and so far theyre glad to have more tools to handle patients

If thats malpractice sign me in

Sure, and I'm sure there are plenty of people who see NPs/PAs/RxPs for med management who are doing just great as well.

 

[calvnandhobbs68]

Sure, and I'm sure there are plenty of people who see NPs/PAs/RxPs for med management who are doing just great as well.

I'm sure that's a great way to look at it if you're of the opinion that the real problem with mental health access is that more people need Prozac and Adderall than psychotherapy.

 

[Sikrouf]

Sure, and I'm sure there are plenty of people who see NPs/PAs/RxPs for med management who are doing just great as well.

That we can agree on

What i disgree about is compairing that scenario to psychiatrist doing DBT, i think thats apple to oranges

 

[WisNeuro]

I'm sure that's a great way to look at it if you're of the opinion that the real problem with mental health access is that more people need Prozac and Adderall than psychotherapy.

Well, that was the way that many looked at it even before the proliferation of NP/PAs/Rxp at the current levels. I don't really feel that the ratio has changed at all.

 

[WisNeuro]

That we can agree on

What i disgree about is compairing that scenario to psychiatrist doing DBT, i think thats apple to oranges

I'm fine with agreeing to disagree. Horse is out of the barn in both scenarios anyway.