How to Improve Psychotherapy Skills Post-Residency

[Mad Jack]

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This is a question a few of my soon-to-be psych resident friends have been tossing around. If one were the sort that really desired to cultivate their psychotherapy skills, what avenues exist after residency by which to do so? I'd imagine that it would be challenging to do on your own, given that you might just develop bad habits that will be hard to undo if you don't have a mentor/preceptor figure of some sort, but I've also heard from a couple of people on the PhD end of things that much of psychotherapy is basically self-taught once you have a firm foundation. Are there worthwhile fellowships in this area or any other training options, or do you just end up buying a lot of books and winging it?

 

[WisNeuro]

This is a question a few of my soon-to-be psych resident friends have been tossing around. If one were the sort that really desired to cultivate their psychotherapy skills, what avenues exist after residency by which to do so? I'd imagine that it would be challenging to do on your own, given that you might just develop bad habits that will be hard to undo if you don't have a mentor/preceptor figure of some sort, but I've also heard from a couple of people on the PhD end of things that much of psychotherapy is basically self-taught once you have a firm foundation. Are there worthwhile fellowships in this area or any other training options, or do you just end up buying a lot of books and winging it?

That firm foundation thing is the debate point. Many of us had hundreds of hours of therapy and 3+ years of individual supervision before we even got to internship and postdoc, where another 2+ years of clinical supervision is given. So, after extensive training and supervision in CBT and psychodynamic, along with training in some of the subsets of those (IPT, PE, PCT, ACT, etc) I'm fairly confident I can utilize many approaches, especially since many things are just repackaged concepts. But, there are plenty of people out there that don't know what they don't know. I come across many people "doing" PE therapy, the technique I have the most training and experience in, for PTSD and in conversations with them and it's clear that they do not understand the model at all and are likely butchering the process in the therapy room.

Long-story short, I'd strongly argue against winging it. Even if it's paying someone for supervision/consultation, it's more than worth it.

 

[Bartelby]

You can pay for supervision after residency, and if you are going to do a lot of therapy in your practice this is recommended. You can also sign on with a psychoanalytic institute. Some employers such as the VA also offer training and supervision in selected modalities like CPT and PE for their employees.

 

[Bartelby]

There are also some fellowships, for example I think UPenn has a CBT based fellowship program. This is a much less common route though.

 

[nitemagi]

Do not do a fellowship. The first Q to ask oneself is "what do I want to treat," followed by "how do I want to treat it."
"Therapy" is a very large umbrella. There are technically hundreds of therapies, but for practical purposes, in terms of technique/theory, there's probably less than 20 with all the others being spinoffs or rebrandings of the core ones.

If you're just looking to enhance basic therapy skills, then a psychodynamic training is fine, which most psychoanalytic institutes offer. I'm a fan of Gestalt therapy, which contemporary schools draw from a lot of psychoanalytic theory, but is a bit more human IMHO. There are training institutes in major cities as well. Most people don't really want to be a psychoanalyst (4-5 days a week on the couch). I did a year of analytic training right after residency and it was a helluva lotta work (I had a FT job and was developing another career too).

As Bartelby mentioned you can pay for supervision. At minimum, and I can't overemphasize this, is to get direct feedback of your technique IN session. That means either video recording your sessions or having some two-way mirror sessions. Your benefits from training will at least double. ISTDP training does this as a standard. Otherwise you're talking about what you remember happened, and I guarantee you're missing a thousand things happening in the room (their non-verbals, your non-verbals, other patterns, opportunities for interventions/interpretations/etc that you didn't notice).

One can also consider a supervision/training group. Many headed for private practice fear the isolation, and having a cohort that meets to discuss cases, do trainings together, etc., can help.

Finally many therapies, in terms of the technique, can be learned in workshop format, followed by optional supervision to make sure you're practicing well. At least start with the workshop. I do 1-2 trainings a year, starting in residency, when I went to the Beck Institute for their 2 weeks of training (which I paid for out of pocket). I've made it a point to keep it up, and continually diversify my training. You learn the technique in bursts, and mastery longitudinally. So fellowships IMO are misguided.

I remember a study (which of course I don't have handy), that therapists believe that they continue to improve in isolation, but that they actually stagnate or get worse the longer they practice without supervision/feedback. I'll try to dig it up.

 

[smalltownpsych]

Do not do a fellowship. The first Q to ask oneself is "what do I want to treat," followed by "how do I want to treat it."
"Therapy" is a very large umbrella. There are technically hundreds of therapies, but for practical purposes, in terms of technique/theory, there's probably less than 20 with all the others being spinoffs or rebrandings of the core ones.

If you're just looking to enhance basic therapy skills, then a psychodynamic training is fine, which most psychoanalytic institutes offer. I'm a fan of Gestalt therapy, which contemporary schools draw from a lot of psychoanalytic theory, but is a bit more human IMHO. There are training institutes in major cities as well. Most people don't really want to be a psychoanalyst (4-5 days a week on the couch). I did a year of analytic training right after residency and it was a helluva lotta work (I had a FT job and was developing another career too).

As Bartelby mentioned you can pay for supervision. At minimum, and I can't overemphasize this, is to get direct feedback of your technique IN session. That means either video recording your sessions or having some two-way mirror sessions. Your benefits from training will at least double. ISTDP training does this as a standard. Otherwise you're talking about what you remember happened, and I guarantee you're missing a thousand things happening in the room (their non-verbals, your non-verbals, other patterns, opportunities for interventions/interpretations/etc that you didn't notice).

One can also consider a supervision/training group. Many headed for private practice fear the isolation, and having a cohort that meets to discuss cases, do trainings together, etc., can help.

Finally many therapies, in terms of the technique, can be learned in workshop format, followed by optional supervision to make sure you're practicing well. At least start with the workshop. I do 1-2 trainings a year, starting in residency, when I went to the Beck Institute for their 2 weeks of training (which I paid for out of pocket). I've made it a point to keep it up, and continually diversify my training. You learn the technique in bursts, and mastery longitudinally. So fellowships IMO are misguided.

I remember a study (which of course I don't have handy), that therapists believe that they continue to improve in isolation, but that they actually stagnate or get worse the longer they practice without supervision/feedback. I'll try to dig it up.

I readily believe the part about skills deteriorating. I have worked in isolative environments (such as the one I am in now) verses more collaborative ongoing training environments and the difference is pretty stark. A few seminars or conferences a year is just not enough to keep my skills up.