Psychotherapy training — Bare minimum vs. extensive?

[AbnormalPsych]

Totally fair. My biggest issue with the discussion was the side tracking to issues with psychiatrists having the legal right to do therapy and the NP comparisons. I agree that the efficacy question is still important to examine.

Would you agree that your field (as honestly wonderful as it is), currently doesn't have a great way to uniformly define or answer the efficacy question?

Edit: also, if this is even answerable, what things come to mind when you picture a prozac-depth knowledge equivalent in psychotherapy?

I agree with the uniformity concern, it is a problem. Although I think psychology and APA's training requirements are the best compared to other related fields (MFT, LCSW, LPCs, etc). Perhaps in the future other practitioners of psychotherapy might have to also pass our licensing requirements (e.g., same # of supervised hours, same supervisory requirements, coursework), since they are engaging in these services?

Regarding your edit question about depth of knowledge: I think the answer to most of this is that for many here you are missing the forest for the trees. I don't have a concrete set of criteria, nor do I think one could reasonably exist in this field. I would just say at the end of the day, those who spend 6-9 years in full time doctoral level study and training in providing psychological services, including often specialized internships and post-docs, are likely, but not exclusively, in a better position to provide superior care, than those who do not have this background. I mean, imagine if your medical school and psychiatry residencies replaced all medicine and medication related training with psychological assessment and intervention training. How different your experiences and skill sets might be, how further developed your depth in this area could be.

There are obvious exceptions, which others pointed out and I am thankful to hear. And perhaps my colleagues and I in the other forum have just been jaded by experiencing some cringe-worthy practices by psychiatrists engaging in talk therapy, when we are here with all kinds of additional training and experience that would (probably, not exclusively) make our work more beneficial to the patient. I applaud the psychiatrists here that have and are going out of their way to get additional training in psychotherapy. I wish more would.

Edit: removed part of the last paragraph because 1) I think it again leads to losing the forest for the trees and 2) I am not interested in sharing further on that topic in a public forum.

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[CalmAndCollected]

I agree with the uniformity concern, it is a problem. Although I think psychology and APA's training requirements are the best compared to other related fields (MFT, LCSW, LPCs, etc). Perhaps in the future other practitioners of psychotherapy might have to also pass our licensing requirements (e.g., same # of supervised hours, same supervisory requirements, coursework), since they are engaging in these services?

Regarding your edit question about depth of knowledge: I think the answer to most of this is that for many here you are missing the forest for the trees. I don't have a concrete set of criteria, nor do I think one could reasonably exist in this field. I would just say at the end of the day, those who spend 6-9 years in full time doctoral level study and training in providing psychological services, including often specialized internships and post-docs, are likely, but not exclusively, in a better position to provide superior care, than those who do not have this background. I mean, imagine if your medical school and psychiatry residencies replaced all medicine and medication related training with psychological assessment and intervention training. How different your experiences and skill sets might be, how further developed your depth in this area could be.

There are obvious exceptions, which others pointed out and I am thankful to hear. And perhaps I and my colleagues in the other forum have just been jaded by experiencing some cringe-worthy practices by psychiatrists engaging in talk therapy which has caused harm and interfered with treatment plans and interventions. I applaud the psychiatrists here that have and are going out of their way to get additional training in psychotherapy. I wish more would.

I would love to hear more about your negative experiences with psychiatrists giving poor psychotherapy and its effects on the patients. Just for the sake of getting perspective.

 

[tr]

I’m confused, are you suggesting therapist should only be able to prescribe SSRIs?

Once the discussion turns to other antidepressants like TCAs or mood modulators like lithium or VPA your argument for safety falls apart. And that is not even talking about antipsychotics, controlled substances, or difficult meds like MAOIs or clozapine.

Arguing therapist should only be able to prescribe “safe drugs” would be so limiting as to be pointless. Why would a patient even go to a therapist for prescriptions if they “can’t get the real drugs”. Wouldn’t there also be problems of therapist overprescribing SSRIs when other drugs would work better because “when your only tool is a hammer, everything looks like a nail”. Maybe they have an anxiety patient who could use a small dose of PRN benzos to rescue themselves from severe anxiety attacks, but the therapist refuses to refer to a psychiatrist out of fear of losing a patient.

Yes, I said this in one of the other threads maybe, that I thought it would be fine for nonphysician practitioners to prescribe safer meds like SSRIs but not more complex ones like lithium or clozapine. I'm picturing something analogous to certified nurse-midwives in obstetrics, who manage healthy/uncomplicated pregnancies and deliveries and have a limited set of medications that they prescribe. If anything complicated pops up, they refer out to an obstetrician. You could make all the same arguments about this model but in practice it actually works fine.

Honestly there's a ton in medicine that relies on providers knowing their own limits. We all have a set of issues that we are comfortable handling ourselves, and then a much larger set of issues where we aren't experts and need help from our professional colleagues. This applies to all of us since there is no such thing as an individual who can master either the entirety of medicine or the entirety of mental health care. It's on each of us individually to know the difference because the boundaries are too complex and individual to be defined by a priori regulation.

 

[tr]

I would love to hear more about your negative experiences with psychiatrists giving poor psychotherapy and its effects on the patients. Just for the sake of getting perspective.

I'm really curious about this too. I have seen a lot of really bad doctor-patient interactions but usually by nonpsychiatrists or by residents early in their psychiatric training. Medical training does have this horrible culture of dismissing the patient's perspective but I felt like psychiatry training did a good job reversing that for the most part.

 

[CalmAndCollected]

Yes, I said this in one of the other threads maybe, that I thought it would be fine for nonphysician practitioners to prescribe safer meds like SSRIs but not more complex ones like lithium or clozapine. I'm picturing something analogous to certified nurse-midwives in obstetrics, who manage healthy/uncomplicated pregnancies and deliveries and have a limited set of medications that they prescribe. If anything complicated pops up, they refer out to an obstetrician. You could make all the same arguments about this model but in practice it actually works fine.

Honestly there's a ton in medicine that relies on providers knowing their own limits. We all have a set of issues that we are comfortable handling ourselves, and then a much larger set of issues where we aren't experts and need help from our professional colleagues. This applies to all of us since there is no such thing as an individual who can master either the entirety of medicine or the entirety of mental health care. It's on each of us individually to know the difference because the boundaries are too complex and individual to be defined by a priori regulation.

Midwives are different, they are a holdover from a time when doctors were not as readily available for births as they are now and they oversee a normal and natural part of human physiology. Midwives do not deal with pathology, they send that out to OBGYNs. There is no equivalent situation in mental health.

I do like to point out that I don’t really agree with midwives continuing to practice in places where there is reasonable access to an OBGYN. The amount of misconceptions around obstetrics and the labeling of alternative birthing modalities and midwives over doctors as “natural” is misleading and I would never in good conscious recommend anyone use a midwife over a doctor.

I also wouldn’t like psychologist to essentially become NPs in psychiatry Giving prescribing rights to psychologist is very likely to strengthen the idea that mental health care by psychiatrists is inherently superior and give psychiatrists less incentive to refer out to them and have team baed practices.

 

[EarlyCareerAcademicPsych]

Given the interest in this thread, I'll tag-in and note that there is an upcoming Virtual Psychotherapy Fair.

It can be hard for medical students interested in psychotherapy to know which residency programs will really give them a strong psychotherapy foundation... especially since most programs will tout their commitment to excellent psychotherapy training. Not all programs are equal, however. PsychSIGN and the APA Psychotherapy Caucus are sponsoring a virtual Psychotherapy Fair. This Psychotherapy Fair will give interested students a way to engage with programs and directly assess the strength of their psychotherapy training.

Sign-up for the Virtual Psychotherapy Fair.

 

[drechie]

what are some of the residencies that provide the most thorough psychotherapy training, besides Cornell and Columbia?