Psychiatrists conducting psychotherapy and other psychological interventions

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edieb

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Does anybody know what kind of training they generally receive in terms of psychotherapy and in other psych interventions (e.g., Motivaional Interviewing, et cetera)? I cannot imagine it could be that much because aren't they spending all their time on the medical side of things?

The reason I ask is that I see a lot of them advertising these services at very high rates. Even more perplexing is that a lot of them advertise proficiency in multiple, disparate modalities (e.g., Psychodynamic, cognitive-behavioral).

Although I attended a very, very research based clnical PhD. program and conducted and co-published quite a bit of peer reviewed journal articles and conducted quite a bit of in-person I remember still not feeling 100 percent competent in conducting CBT. I would always go home and read about cbt, cognitive theories behind all the various Axis I and II disorders and case collaboration techniques after I would get home from intenship and the next day I would attempt to apply the germane ones with my patients. I still have the worn out copies of Dr Padesky's "Collaborate Case Conceptualization" and Dr. Freeman's Cognitve Therapy of Personality Disorders on my desk!

Despite the thousands of hours of researching, reading and conducting these techniques, I always had the nagging feeling that there was always more to know, especially because I knew I had to match the particular type of evidence-based version of cbt to the disorder (e.g., worry exposure to GAD, interroceptive cue exposure to Panic Disorder) and cross-combine interventions most of the time because patients would present w/ multiple co-morbidities.

In order to engage in medication management, I had to attain my clinical psychologist license and then attend an in-person 2.5 year post-doctoral course on the weekends, pass a test much more demanding that the EPPP, and then complete a 500 hour practicum. Even now I still have people question my credentials. On the other hand, why do other professions lay claim to what we specialize in with likely minimal training? Of course, I know some do specialized post-doctoral training but this can't be most of them...

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1. The AMA does a far better job of promoting itself and its members, so the general public is far more trusting of physicians.

2. There are a range of training opportunities for psychiatrists during their residency training, though not all opportunities are created equal. The most proficient psychiatrists (in regard to psychotherapy) I know have all pursued additional training following residency at places like the Beck Institute. It is one thing to be able to provide supportive assistance and a complete different matter to actual provide therapeutic interventions.
 
Does anybody know what kind of training they generally receive in terms of psychotherapy and in other psych interventions (e.g., Motivaional Interviewing, et cetera)? I cannot imagine it could be that much because aren't they spending all their time on the medical side of things?

The reason I ask is that I see a lot of them advertising these services at very high rates. Even more perplexing is that a lot of them advertise proficiency in multiple, disparate modalities (e.g., Psychodynamic, cognitive-behavioral).

Although I attended a very, very research based clnical PhD. program and conducted and co-published quite a bit of peer reviewed journal articles and conducted quite a bit of in-person I remember still not feeling 100 percent competent in conducting CBT. I would always go home and read about cbt, cognitive theories behind all the various Axis I and II disorders and case collaboration techniques after I would get home from intenship and the next day I would attempt to apply the germane ones with my patients. I still have the worn out copies of Dr Padesky's "Collaborate Case Conceptualization" and Dr. Freeman's Cognitve Therapy of Personality Disorders on my desk!

Despite the thousands of hours of researching, reading and conducting these techniques, I always had the nagging feeling that there was always more to know, especially because I knew I had to match the particular type of evidence-based version of cbt to the disorder (e.g., worry exposure to GAD, interroceptive cue exposure to Panic Disorder) and cross-combine interventions most of the time because patients would present w/ multiple co-morbidities.

In order to engage in medication management, I had to attain my clinical psychologist license and then attend an in-person 2.5 year post-doctoral course on the weekends, pass a test much more demanding that the EPPP, and then complete a 500 hour practicum. Even now I still have people question my credentials. On the other hand, why do other professions lay claim to what we specialize in with likely minimal training? Of course, I know some do specialized post-doctoral training but this can't be most of them...

I imagine it varies quite a bit. I know that the psychiatry residency at our local (university-affiliated) hospital has dedicated rotations in both CBT and psychodynamic psychotherapy. For at least the CBT rotation, the supervisor is a seasoned and research-consuming (if not producing) clinical psychologist. However, I've observed that coming into the rotation, the residents seem to know very little about psychotherapy, but so do a lot of grad students!
 
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I'm involved in psychiatry residency training - accredited programs are required to meet the ACGME requirements, which among other things, include proficiency in 3 evidence based psychotherapies. This will typically look something like psychodynamic psychotherapy, CBT, and one other (MI, DBT, IPT, etc).

Of course, like Therapist4Change noted, there is a lot of variability in the quality and time spent on training - and some programs are likely to do the bare minimum to meet the requirement, while others will dedicate significant resources toward ensuring that residents receive this psychotherapy training.

In a typical 4 year psychiatry residency, residents will begin their psychotherapy training in year 2, with the heaviest didactics/application of skills/supervision in PG3-4, when they are in their outpatient years. Nevertheless, even in the outpatient years, the ratio of psychotherapy/combined treatment cases to strict med management cases will typically be pretty skewed (in the expected direction).

Also, for whatever reason, psychiatry residents tend to *love* psychodynamic therapy, perhaps because it fits their overall gestalt of what psychotherapy is "supposed" to be. Even in our program, where there are actually psychiatrists on faculty running CBT clinical trials, the residents have a love affair with psychodynamic treatment and most seem to merely tolerate CBT. We've tried to balance it out, but it has been a challenge. I suppose it's hard to compete with the "sexiness" of psychodynamic treatment when you are otherwise offering thought records and homework. Alas... if only Aaron Beck had a long beard instead of a red bow tie! 😉
 
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