Psychology and Therapy must book to read.

[PsyMD]

Hello there.

I am psych resident now about to start PGY-3 and am out to begin my psychology and therapy rotation. I was wondering what would be a must read for this rotation. I have zero experience on it and was wondering where to start it and what are the must read books for it.

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[jbomba]

I really liked Psychodynamic therapy a guide to evidence-based practice by Summers and Barber

 

[tr]

What's the orientation of your program? Generally speaking, if you have zero exposure to any kind of psychotherapy I'd start with Feeling Good by David Burns.

 

[WisNeuro]

Is it common to start therapy training so late for psychiatry?

 

[FlowRate]

If you have dynamic cases, I overall liked Psychodynamic Psychotherapy by Cabanis et al. for its pragmatic/structured approach to learning how dynamic therapy "works" (like what to actually do/say.)

Is it common to start therapy training so late for psychiatry?

It's common for the third-year to be 100% (aside from occasional call duties) outpatient and is when the bulk of therapy didactics and caseload are planned. Some programs build in limited therapy/outpatient caseloads (1-2 therapy patients, a few outpatient med mgt cases) earlier in residency and also do the intro to psychotherapy didactics in the 2nd year.

 

[calvnandhobbs68]

Is it common to start therapy training so late for psychiatry?

Yea because the first couple years tend to be more inpatient heavy at most programs, so not much time for therapy. Sometimes people will be in a half day resident clinic off and on during that time but that tends to be pretty medication focused.

 

[Stagg737]

If you have dynamic cases, I overall liked Psychodynamic Psychotherapy by Cabanis et al. for its pragmatic/structured approach to learning how dynamic therapy "works" (like what to actually do/say.)

Our attending with the most therapy education/experience also recommended Cabanis as a good initial book for psychodynamic. I have not read it, but do have it in my "books to read" pile at home.

 

[thepoopologist]

Broad overview
Gift of Therapy
Freud and Beyond

For nuts and bolts
Concise guide to psychodynamic psychotherapy 2nd edition

Anything else I read was an add on to this

 

[thepoopologist]

Is it common to start therapy training so late for psychiatry?

It varies I think. Some places put very low emphasis on it. Some are fairly intensive. I started 1st year and a different modality was added on each year.

 

[WisNeuro]

It varies I think. Some places put very low emphasis on it. Some are fairly intensive. I started 1st year and a different modality was added on each year.

I only have direct experience with a couple programs, and they appeared to function more like yours with 1st year experience. Just curious what the modal experience was.

 

[FatherPsychiatry]

Is it common to start therapy training so late for psychiatry?

We picked up a few (2-3) psychotherapy patients from PGY-2 year with the goal of continuing with them through PGY-4 year, but I don't think this is typical for residencies. We had 1-2 supervisors that continued with us for these cases all the way through. I thought this was a very valuable experience (despite how annoyed I was making the time PGY-2 year to schedule the patients during the day while I was on my other rotations) to appreciate the value of developing a long-term relationship with a patient/client/customer, and definitely had a few "aha!" moments in PGY-4 year where things felt like they were going nowhere for the last 2+ years, but suddenly there's some epiphany. Very rewarding.

In PGY-3 year it was more traditional with more therapy patients, but usually shorter duration and the more typical CBT-type stuff.

 

[tr]

We picked up a few (2-3) psychotherapy patients from PGY-2 year with the goal of continuing with them through PGY-4 year, but I don't think this is typical for residencies. We had 1-2 supervisors that continued with us for these cases all the way through. I thought this was a very valuable experience (despite how annoyed I was making the time PGY-2 year to schedule the patients during the day while I was on my other rotations) to appreciate the value of developing a long-term relationship with a patient/client/customer, and definitely had a few "aha!" moments in PGY-4 year where things felt like they were going nowhere for the last 2+ years, but suddenly there's some epiphany. Very rewarding.

In PGY-3 year it was more traditional with more therapy patients, but usually shorter duration and the more typical CBT-type stuff.

My residency training was similar. First year was a lot of medicine and neurology, no room for psychotherapy. We started therapy exposure with a few long term psychodynamic cases starting in PGY2, with more exposure to shorter, targeted therapies in the outpatient years PGY3-PGY4.

I actually had a couple of "psychotherapy" cases on my psychiatry rotation in medical school, but it wasn't anything I would consider useful training. Really more like, put the med student and the patient in a room together for an hour with no structure or instruction, and pretend this was somehow beneficial for either of them. Meet with attending later to pontificate wisely about case formulation.

 

[robellis]

My residency training was similar. First year was a lot of medicine and neurology, no room for psychotherapy. We started therapy exposure with a few long term psychodynamic cases starting in PGY2, with more exposure to shorter, targeted therapies in the outpatient years PGY3-PGY4.

I actually had a couple of "psychotherapy" cases on my psychiatry rotation in medical school, but it wasn't anything I would consider useful training. Really more like, put the med student and the patient in a room together for an hour with no structure or instruction, and pretend this was somehow beneficial for either of them. Meet with attending later to pontificate wisely about case formulation.

That can be very beneficial as we know the most important thing is the relationship and sometimes all patients need is some support

 

[WisNeuro]

Definitely some start training differences between the disciplines.

As for books, I wish I could remember the name of the Wachtel book from my first year, but it was great, and I don't see it listed when I peruse Amazon. And, Cognitive Behavior Therapy: Basics and Beyond by Judith Beck is always a good starter.

 

[Stagg737]

It varies I think. Some places put very low emphasis on it. Some are fairly intensive. I started 1st year and a different modality was added on each year.

I only have direct experience with a couple programs, and they appeared to function more like yours with 1st year experience. Just curious what the modal experience was.

Interesting, during interview season and from friends at other programs, I've only heard of one place that starts seeing outpatients during PGY-1. Most places I interviewed at (including my program) start seeing outpatients PGY-2 with or without psychotherapy cases. My program did not start psychotherapy-specific encounters until PGY-3 and is optional during PGY-4 year.

For modalities (if that's what you mean Wis), supportive, CBT, and psychodynamic are required components of residency per ACGME requirements. Other modalities may or may not be taught in depth and varies a ton from program to program. My program is essentially minimal therapy exposure with the opportunity to do more therapy if requested.

Definitely some start training differences between the disciplines.

As for books, I wish I could remember the name of the Wachtel book from my first year, but it was great, and I don't see it listed when I peruse Amazon. And, Cognitive Behavior Therapy: Basics and Beyond by Judith Beck is always a good starter.

Agree that JB's book is a great overview for those just starting CBT. Was very helpful for me.

 

[FlowRate]

Interesting, during interview season and from friends at other programs, I've only heard of one place that starts seeing outpatients during PGY-1.

Also find it surprising/didn't interview at any programs where that was a thing. I thought it might be CHA but, after looking it up, even they don't start therapy training until PGY-2.

 

[Stagg737]

Also find it surprising/didn't interview at any programs where that was a thing. I thought it might be CHA but, after looking it up, even they don't start therapy training until PGY-2.

I thought Baylor might be one since they have the Menninger Clinic associated with them, but it looks like they don't start outpatient until PGY-2 either. I honestly can't remember which program started that early, and not going to dig further, but would be interested to know what programs start outpatient in first year.

 

[tr]

That can be very beneficial as we know the most important thing is the relationship and sometimes all patients need is some support

Yeah that's what they kept telling me. Don't worry, you don't have to actually know anything or have any skills, just being there is enough! (Funny we don't take that approach in any other area of medicine though, right?)

Of course a good therapeutic relationship also relies heavily on the patient feeling like they are doing something that is useful/effective, so it's a bit circular. If all we are selling is a listening ear, that can be had elsewhere for free. I ask all my patients if they are finding their psychotherapy work useful/effective, and most of the ones who aren't say some variation on "She's nice enough... I guess it's good to be able to vent..." but either express frustration that they aren't making any specific progress, or resignation to the idea that psychotherapy is just a place to vent and not an avenue for change, and surprise at the idea that it could be otherwise.

Not saying supportive is useless, just that it's limited in its utility for bringing about actual change.

 

[robellis]

Yeah that's what they kept telling me. Don't worry, you don't have to actually know anything or have any skills, just being there is enough! (Funny we don't take that approach in any other area of medicine though, right?)

Of course a good therapeutic relationship also relies heavily on the patient feeling like they are doing something that is useful/effective, so it's a bit circular. If all we are selling is a listening ear, that can be had elsewhere for free. I ask all my patients if they are finding their psychotherapy work useful/effective, and most of the ones who aren't say some variation on "She's nice enough... I guess it's good to be able to vent..." but either express frustration that they aren't making any specific progress, or resignation to the idea that psychotherapy is just a place to vent and not an avenue for change, and surprise at the idea that it could be otherwise.

Not saying supportive is useless, just that it's limited in its utility for bringing about actual change.

It can be had elsewhere for free and that’s precisely why a long conversation with a supportive loved one or trusted friend is often times very therapeutic, you don’t need to be regimented/manualized in your approach to call it “therapy”

 

[erg923]

It can be had elsewhere for free and that’s precisely why a long conversation with a supportive loved one or trusted friend is often times very therapeutic, you don’t need to be regimented/manualized in your approach to call it “therapy”

Many things are "therapeutic." But we wouldn't say talking to your mom is "getting psychotherapy." "Psychotherapy" is suppose to be an actual thing, right?

 

[tr]

It can be had elsewhere for free and that’s precisely why a long conversation with a supportive loved one or trusted friend is often times very therapeutic, you don’t need to be regimented/manualized in your approach to call it “therapy”

Mom can wash your cut and put a Band-Aid on it too right? If I provide the same service do I need to go through 4 y of med school, and am I justified to charge $450/h for it?

 

[robellis]

Mom can wash your cut and put a Band-Aid on it too right? If I provide the same service do I need to go through 4 y of med school, and am I justified to charge $450/h for it?

You’re justified to charge whatever people pay..if they’re getting value that’s all that matters

 

[robellis]

Many things are "therapeutic." But we wouldn't say talking to your mom is "getting psychotherapy." "Psychotherapy" is suppose to be an actual thing, right?

Talking to your mom is a thing..and it can be much more valuable than talking to a stranger with a phd..I don’t see the need to be regimented or strict in the definition but to each their own

 

[erg923]

Talking to your mom is a thing..and it can be much more valuable than talking to a stranger with a phd..I don’t see the need to be regimented or strict in the definition but to each their own

state licensing board disagree with you.

 

[tr]

I thought Baylor might be one since they have the Menninger Clinic associated with them, but it looks like they don't start outpatient until PGY-2 either. I honestly can't remember which program started that early, and not going to dig further, but would be interested to know what programs start outpatient in first year.

I think San Mateo might start psychotherapy in the first year. They are pretty focused on outpatient psych; their medicine, neuro, and inpatient psych are thinner than at other programs.

 

[Stagg737]

Not saying supportive is useless, just that it's limited in its utility for bringing about actual change.

Realistically though, most loved ones and friends are terrible at supportive psychotherapy though. Just agreeing with someone and sympathizing doesn't make it supportive therapy or even beneficial. Some of the most obliviously dysfunctional people I've treated are oblivious because everyone they vent to just says "Omg, you're so right. It's all their fault!" The "their" being whoever or whatever the patient vents about. Supporting malignant coping mechanisms and behaviors is the opposite of supportive therapy.

Talking to your mom is a thing..and it can be much more valuable than talking to a stranger with a phd..I don’t see the need to be regimented or strict in the definition but to each their own

Sure, venting can be very beneficial and therapeutic. But it can also lead to reinforcing the wrong lessons, which is why decent therapists are important. You talk to friends and family when you want someone to sympathize with you and provide encouragement. Therapists should only be doing this selectively and calling people out on their malignant traits/coping mechanisms (even if it done in a very subtle, indirect way). Some family and friends are decent therapist in that way, but many of them are not.

 

[clausewitz2]

Not saying supportive is useless, just that it's limited in its utility for bringing about actual change.

At it's best I think supportive therapy can be helpful in this regard provided that it has a fair amount of gentle confrontation mixed in. Being a warm, validating, empathetic listener who maintains unconditional positive regard while at the same time doggedly returning to the fact that there is a major conflict between different aspects of what someone is saying is a bit more than just what you'd expect from a good friend. A great friend or canny religious leader, sure, but not just the average sympathetic ear.


I still am in agreement with you about the need in general for an actual theoretical and empirically supported framework for doing this in a more skilled and deliberate fashion. The "relationship is everything" folks often forget that "a coherent model of change that gets buy-in from the client" is the other ingredient that ends up coming up a lot in the common factors literature.

 

[PikminOC]

Many things are "therapeutic." But we wouldn't say talking to your mom is "getting psychotherapy." "Psychotherapy" is suppose to be an actual thing, right?

Tell that to 85 percent of the therapists patients see...

 

[PikminOC]

state licensing board disagree with you.

Many of my complaints about therapists to their board get thrown in the trash. Their boards are very lenient compare to the medical board

 

[NickNaylor]

I'd say it depends on the orientation of your program and the expectations of your supervisors as far as the "type" of therapy you will be providing. Our program was pretty psychodynamically focused, so we used the Deborah Cabaniss texts (Psychodynamic Psychotherapy: A Clinical Manual and Psychodynamic Formulation) as our general introductory texts. Cognitive Behavioral Therapy: Basics and Beyond is a good introductory text to CBT approaches. Clinical Manual of Supportive Psychotherapy might also be a helpful introductory text as the principles are broadly applicable to most therapeutic modalities, though I think this is largely true across the board. The basic principles of most therapeutic techniques are going to be broadly applicable and will be helpful in some way irrespective of the modality you use.

 

[WisNeuro]

Many of my complaints about therapists to their board get thrown in the trash. Their boards are very lenient compare to the medical board

That would not be my experience if we are talking about boards of psychology. They usually drop the hammer on substantiated claims. SW and masters level are usually governed by separate boards, so YMMV.

 

[PikminOC]

That would not be my experience if we are talking about boards of psychology. They usually drop the hammer on substantiated claims. SW and masters level are usually governed by separate boards, so YMMV.

Some of my complaints were about psychologist and social workers who wouldn't give me their notes after the appropriate release was sent numerous times.
All these times their board had them send me the notes
I have seen Physician's reprimanded with fines for the same thing and also have to give their notes. Different boards, higher standards for Physician's.

 

[robellis]

Some of my complaints were about psychologist and social workers who wouldn't give me their notes after the appropriate release was sent numerous times.
All these times their board had them send me the notes
I have seen Physician's reprimanded with fines for the same thing and also have to give their notes. Different boards, higher standards for Physician's.

As there should be there’s obviously a difference between a physician and a therapist and the board should be more stringent

 

[sloh]

It can be had elsewhere for free and that’s precisely why a long conversation with a supportive loved one or trusted friend is often times very therapeutic, you don’t need to be regimented/manualized in your approach to call it “therapy”

I’m surprised Wampold’s “The Great Psychotherapy Debate” hasn’t been brought up in this thread so far.

Thought this was a good thread on this topic:

“However, with therapy change seems to happen when 4 criteria are met: 1. There is a good therapeutic alliance. 2. Empathetic and caring therapist who believes the treatment will work 3. Some sort of psychologically valid explanation of the client's problem is given, which is culturally acceptable and the client believes (creating hope and expectation). 4. The client engages in SOME sort of healthy behavior change (it doesn't matter exactly what they do). He shows that it doesn't matter what you do or how you do it...as long as it meets these criteria.”

Therapy doesn't work how we think it works

Let me preface this by saying I am 100% about empiricism. I was trained hardcore in evidence-based practices, the importance of research informed therapy, and to be a good consumer/critic of research. I currently use CBT, ACT, and exposure and response prevention as my main modalities...

forums.studentdoctor.net

 

[WisNeuro]

I’m surprised Wampold’s “The Great Psychotherapy Debate” hasn’t been brought up in this thread so far.

Thought this was a good thread on this topic:

“However, with therapy change seems to happen when 4 criteria are met: 1. There is a good therapeutic alliance. 2. Empathetic and caring therapist who believes the treatment will work 3. Some sort of psychologically valid explanation of the client's problem is given, which is culturally acceptable and the client believes (creating hope and expectation). 4. The client engages in SOME sort of healthy behavior change (it doesn't matter exactly what they do). He shows that it doesn't matter what you do or how you do it...as long as it meets these criteria.”

Therapy doesn't work how we think it works

Let me preface this by saying I am 100% about empiricism. I was trained hardcore in evidence-based practices, the importance of research informed therapy, and to be a good consumer/critic of research. I currently use CBT, ACT, and exposure and response prevention as my main modalities...

forums.studentdoctor.net

My thoughts are fairly well-known on the Wampold work. Common factors are important, but the common factors work is full of methodological pitfalls that relies on misuse of statistical assumptions to push a certain agenda.

 

[WisNeuro]

Some of my complaints were about psychologist and social workers who wouldn't give me their notes after the appropriate release was sent numerous times.
All these times their board had them send me the notes
I have seen Physician's reprimanded with fines for the same thing and also have to give their notes. Different boards, higher standards for Physician's.

Probably varies by jurisdiction. Heck, in Texas physicians can kill and maim multiple people before having their license pulled I beg to differ about the standards.

 

[AD04]

“However, with therapy change seems to happen when 4 criteria are met: 1. There is a good therapeutic alliance. 2. Empathetic and caring therapist who believes the treatment will work 3. Some sort of psychologically valid explanation of the client's problem is given, which is culturally acceptable and the client believes (creating hope and expectation). 4. The client engages in SOME sort of healthy behavior change (it doesn't matter exactly what they do). He shows that it doesn't matter what you do or how you do it...as long as it meets these criteria.”

I agree with this. In essence, it is about building trust (step 1 - 3). Then it is about taking action (step 4). I view these different modalities of therapy like the different schools of martial art. It isn't so much the technique itself, but how it is applied. Supportive therapy is very powerful on it's own and should be a fundamental skill all therapist and psychiatrists master. From there, branch out.

The book that taught me the most on therapy was a book on negotiation and in a sense, therapy is negotiating with the patient to change.

"I fear not the man who has practiced 10,000 kicks once, but I fear the man who has practiced one kick 10,000 times."
- Bruce Lee
- ad04

 

[PikminOC]

Probably varies by jurisdiction. Heck, in Texas physicians can kill and maim multiple people before having their license pulled I beg to differ about the standards.

I file alot of complaints. Nursing board and pharmacy doesn't care. Medical and Dental board is strict. Therapy and psychology board are lenient. This is based on my experience with the complaints I file.

 

[PikminOC]

I agree with this. In essence, it is about building trust (step 1 - 3). Then it is about taking action (step 4). I view these different modalities of therapy like the different schools of martial art. It isn't so much the technique itself, but how it is applied. Supportive therapy is very powerful on it's own and should be a fundamental skill all therapist and psychiatrists master. From there, branch out.

The book that taught me the most on therapy was a book on negotiation and in a sense, therapy is negotiating with the patient to change.

"I fear not the man who has practiced 10,000 kicks once, but I fear the man who has practiced one kick 10,000 times."
- Bruce Lee
- ad04

What book?

 

[hebel]

My thoughts are fairly well-known on the Wampold work. Common factors are important, but the common factors work is full of methodological pitfalls that relies on misuse of statistical assumptions to push a certain agenda.

Yeah, I view common factors as the rock bottom to effective therapy. I think technique and training can make a big difference in effectiveness.

 

[WisNeuro]

I file alot of complaints. Nursing board and pharmacy doesn't care. Medical and Dental board is strict. Therapy and psychology board are lenient. This is based on my experience with the complaints I file.

Is this like a hobby for you?

 

[FlowRate]

I file alot of complaints. Nursing board and pharmacy doesn't care. Medical and Dental board is strict. Therapy and psychology board are lenient. This is based on my experience with the complaints I file.

How do you find out what ends up happening? I thought most of this stuff was confidential to the board?

 

[PikminOC]

How do you find out what ends up happening? I thought most of this stuff was confidential to the board?

Since I'm the one who complains I get the results

 

[AbnormalPsych]

Definitely some start training differences between the disciplines.

As for books, I wish I could remember the name of the Wachtel book from my first year, but it was great, and I don't see it listed when I peruse Amazon. And, Cognitive Behavior Therapy: Basics and Beyond by Judith Beck is always a good starter.

Therapeutic Communication

 

[SeniorWrangler]

Many things are "therapeutic." But we wouldn't say talking to your mom is "getting psychotherapy." "Psychotherapy" is suppose to be an actual thing, right?

Lol.

 

[Geraltofrivia]

IMO Psychodynamic Psychiatry in Clinical Practice by Glenn Gabbard has some good stuff. There's another Gabbard book, Long Term Therapy or something like that, I forgot. I would also recommend checking out Jonathan Shedler's twitter

 

[tr]

IMO Psychodynamic Psychiatry in Clinical Practice by Glenn Gabbard has some good stuff. There's another Gabbard book, Long Term Therapy or something like that, I forgot. I would also recommend checking out Jonathan Shedler's twitter

Oh dear. Please do not check out Jonathan Shedler's twitter
If you must, have a look at some of his published work and play find-the-logical-fallacy for a bit. It isn't very difficult, but quickly ceases to be entertaining.

 

[AD04]

What book?

Never Split the Difference

 

[robellis]

Never Split the Difference

What was the most profound thing you learned from that book?

 

[PikminOC]

What was the most profound thing you learned from that book?

To not split the difference