Psychotherapy-heavy residencies

[Transistor]

Before I start, I know there's debate on the utility of psychotherapy in psychiatry. Maybe y'all will say I should have been a PsyD. That's not the focus of what I'm asking.

I was wondering if anyone had any recommendations on residency programs that are very heavy on psychotherapy that are not research powerhouses (ex. Harvard programs, Yale, NYU, NYP etc). That caveat's important to me because I don't go to a powerhouse medical school that attracts these programs.

Specific things I'm looking for: exposure beginning PGY-2 year. Opportunities to explore beyond supportive/CBT/psychodynamic (ex. from my current away rotation I'm really enjoying the DBT/group and family therapy). Maybe a chance to receive mentorship from a local psychoanalytic institute. I'm not geographically limited.

Thanks!

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[Fan_of_Meehl]

I think that the University of Louisville focuses on training psychiatric residents how to do good CBT under Dr. Jesse Wright (who trained with Aaron Beck) and creating a cognitive (therapy) milieu even on their inpatient unit. They wrote a great book entitled 'Cognitive Therapy With Inpatients' describing their approach. I think this was in the 90s but I'd imagine their core faculty are still psychiatrists who are well trained in (and publish) CBT. By the way, Dr. Wright is an M.D./Ph.D. (doctorate in pharmacology), so he believes in the importance of medication as well as psychotherapy.

 

[Monocles]

I was wondering if anyone had any recommendations on residency programs that are very heavy on psychotherapy that are not research powerhouses (ex. Harvard programs, Yale, NYU, NYP etc). That caveat's important to me because I don't go to a powerhouse medical school that attracts these programs.

Not every harvard program requires extensive research, and don't count yourself out just because you are coming from a state school.

With that being said, look into Cambridge Health Alliance as they are an excellent program with a strong emphasis on psychotherapy. I would say they want to see commitment to equity, diversity and social mindedness MUCH more than how many pubs you have.

 

[randomdoc1]

I know this does not answer your question, but I agree with you. Psychotherapy has a huge role in psychiatry. Especially in the outpatient setting. I may even argue in some non psychiatric outpatient settings too. It allows for really detailed, transparent history gathering. And more buy in from the patient for the recommendations. It's helped me talk down a lot of benzo and stimulant begging or any other kind of "fix me with a pill" dynamic that in the wrong hands would have turned into a polypharm horror house but in the right hands, lead to a road of actual clinical improvement.

 

[ObsequiousAplomb]

Before I start, I know there's debate on the utility of psychotherapy in psychiatry. Maybe y'all will say I should have been a PsyD. That's not the focus of what I'm asking.

I was wondering if anyone had any recommendations on residency programs that are very heavy on psychotherapy that are not research powerhouses (ex. Harvard programs, Yale, NYU, NYP etc). That caveat's important to me because I don't go to a powerhouse medical school that attracts these programs.

Specific things I'm looking for: exposure beginning PGY-2 year. Opportunities to explore beyond supportive/CBT/psychodynamic (ex. from my current away rotation I'm really enjoying the DBT/group and family therapy). Maybe a chance to receive mentorship from a local psychoanalytic institute. I'm not geographically limited.

Thanks!

I recommend you look at programs that have directors and faculty that have a heavy psychotherapy disposition. There are plenty of programs that offer PGY-2 (or earlier) longitudinal psychotherapy. Most programs advertise this on their websites.

Wright State in Ohio is VERY explicit that it is a heavy psychotherapy program. Cincinnati has a history of long connection with analytic institute, I imagine there may be some connection still. Summa Akron City is also very heavy on psychotherapy. I bet if you went to one of the programs in Akron or Cleveland you could take classes at the analytic institute there as well. That's just Ohio. Look at the programs in all the relevant states to your application. Look at nearby analytic institutes or CBT programs. Nothing wrong with having a mix of learning outside of your program. Always a good idea to undergo analysis yourself while in residency, the institutes usually have very generous sliding scales (I paid $30/session while in residency).

If you have further questions feel free to PM me.

 

[Fan_of_Meehl]

I know this does not answer your question, but I agree with you. Psychotherapy has a huge role in psychiatry. Especially in the outpatient setting. I may even argue in some non psychiatric outpatient settings too. It allows for really detailed, transparent history gathering. And more buy in from the patient for the recommendations. It's helped me talk down a lot of benzo and stimulant begging or any other kind of "fix me with a pill" dynamic that in the wrong hands would have turned into a polypharm horror house but in the right hands, lead to a road of actual clinical improvement.

Motivational interviewing, especially. There's an excellent book on Motivational Interviewing in Healthcare Settings that is great. Understanding how to apply the science/practice of behavior change successfully would be useful for all healthcare providers in all settings (I believe). It is easy to get stuck in 'power struggles' by evoking resistance/discord in a patient using a purely prescriptive approach.

Never get in a messy 'power struggle' with someone who has a personality disorder...he will only drag you down to his level and beat you with experience.

 

[MedMan80]

On the east coast i had heard good things about CHA and IOL in Hartford, CT

 

[tr]

Motivational interviewing, especially. There's an excellent book on Motivational Interviewing in Healthcare Settings that is great. Understanding how to apply the science/practice of behavior change successfully would be useful for all healthcare providers in all settings (I believe). It is easy to get stuck in 'power struggles' by evoking resistance/discord in a patient using a purely prescriptive approach.

Never get in a messy 'power struggle' with someone who has a personality disorder...he will only drag you down to his level and beat you with experience.

Yes I really wish MI were a standard part of the medical school curriculum. Every physician should have at least a passing familiarity with the method.

 

[ObsequiousAplomb]

Yes I really wish MI were a standard part of the medical school curriculum. Every physician should have at least a passing familiarity with the method.

Is it not? My school had multiple days dedicated to it. We had to apply it to multiple situations, very few of them being psychiatric / substance.

 

[Merovinge]

Is it not? My school had multiple days dedicated to it. We had to apply it to multiple situations, very few of them being psychiatric / substance.

Same, it was a huge part of the FM rotation in particular for my medical school.

 

[Mad Jack]

On the east coast i had heard good things about CHA and IOL in Hartford, CT

Those were the two I was going to recommend. I've also heard very good things about the psychotherapy training at Duke, but things may have changed over the years so I don't know if that is still accurate.

 

[Mad Jack]

Is it not? My school had multiple days dedicated to it. We had to apply it to multiple situations, very few of them being psychiatric / substance.

Same. We had MI stuff on exams all throughout med school

 

[Stagg737]

Is it not? My school had multiple days dedicated to it. We had to apply it to multiple situations, very few of them being psychiatric / substance.

I don't believe it's standard or a requirement. I think a lot of schools probably mention it at least superficially, classically in primary rotations when talking about smoking cessation or med compliance, but there's no requirement for actually teaching it. The only time I ever saw it on school tests or standardized tests before PRITE was when it should be utilized.

 

[Transistor]

Thanks for the responses so far y’all. This is super helpful.

For discussion purposes: also wanted to add an n=1 datapoint where my school had just half a morning dedicated to motivational interviewing in the clinical curriculum.

 

[painballer27]

My school made us form groups and do motivational interviewing on one another. Some people got a lot out of this practice I think

 

[nexus73]

My residency was not therapy heavy, a "biological" program, that covered the required therapy training but not beyond. But there were plenty of opportunities to get tons of therapy exposure if you chose to do so during electives 3rd and 4th year. I'd hope all residencies would have this flexibility.

 

[Trieb]

Any recommendations for west coast programs with strong therapy training? My gestalt impression is that the west tends to lean a bit more biological.

 

[erg923]

Before I start, I know there's debate on the utility of psychotherapy in psychiatry. Maybe y'all will say I should have been a PsyD. That's not the focus of what I'm asking.

I was wondering if anyone had any recommendations on residency programs that are very heavy on psychotherapy that are not research powerhouses (ex. Harvard programs, Yale, NYU, NYP etc). That caveat's important to me because I don't go to a powerhouse medical school that attracts these programs.

Specific things I'm looking for: exposure beginning PGY-2 year. Opportunities to explore beyond supportive/CBT/psychodynamic (ex. from my current away rotation I'm really enjoying the DBT/group and family therapy). Maybe a chance to receive mentorship from a local psychoanalytic institute. I'm not geographically limited.

Thanks!

Would recommend The University of Louisville, also. Go Cards!!!

Rif El-Mallakh is also great there for those interested in deep psychopharm and some...uh, "unconventional" approaches.

Can't say there is much psychodynamic stuff happening other than brief psychodynamic-oriented protocols/treatments as well as some folks in the community....some of whom are closely aligned with a local Psy.D. program. As an aside, Louisville's Psychology Department (and its Clinical Psychology Ph.D.) is quite biologically oriented and is actually named "Department of Psychological and Brain Sciences." More traditional psychoanalytic stuff is just not prominent anymore, and rightfully so. Time-limited, evidence-based medicine/measurement-based care is really what we should be striving for as first line.

Jesse H. Wright, M.D., Ph.D. — School of Medicine University of Louisville

Rif S. El-Mallakh, M.D. — School of Medicine University of Louisville

Clinical Settings — School of Medicine University of Louisville

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