Psychotherapy training during residency and Psychoanalytic institutes

[settoROL]

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Hey all! A couple qs about psychotherapy.

1) What is considered to be good/adequate psychotherapy training in residency? In terms of number of patients, kinds of therapy, kind of supervision.

2) How important is psychodynamic training in the practice of psychiatry?
Say you get enough CBT, group and DBT during residency. Would getting additional outside training in psychoanalytic/psychodynamic studies impact your practice?
If one decides to do this, what year of residency would it be best to start?

 

[Sushirolls]

1) You will not master everything. Therapy is very much so a practice and will continue to be honed over a life time career. You will make mistakes.

2) It is everything. And it is nothing. The right tool in the right hands can be a masterpiece. Wrong tool in wrong hands yields poorly. You have to sample what you can, find what resonates with you that you are willing to apply yourself towards. Even if you don't do modality XYZ, you can at least educate a patient before you refer them some one who does. Not all patients are appropriate for psychoanalysis, or CBT. Start your therapy exposure as soon as you to learn as much as you can.

 

[nitemagi]

1. Fair is 2-4 longitudinal patients per modality. Longitudinal as in the full course -- as defined by the modality. CBT may only be 12-16 sessions. Psychodynamic can be years. The [low] standard of care for supervision is in person supervision with a supervisor discussing the case, once a week. Better is to get one-way mirror supervision or to be video recording your sessions and reviewing them with a supervisor.
I'd argue that a reasonable goal in residence is to get pretty good at CBT and competent at psychodynamic, and to at least have exposure to one other modality in which you can conceptualize patients (structural family therapy is a good one).

2. It is most people's default modality. Let go of the idea of finishing all therapy training in residency. You can build a good foundation, but it's a long term learning process (getting supervision long term to continue to improve your skills).
Agree with above - get exposure early, but don't mistake the forest for the trees -- it's easy to get excited about one modality, but don't lose sight (as sushirolls points out) that not all therapies work for all patients. I've seen a good few clinicians get enamored with a therapy and stop exploring new stuff. Subsequently their own ability also plateaus.

 

[watto]

And, when starting, don't forget that "first, do no harm" applies in therapy as well - nothing worse than supportive psychotherapy that supports primitive defense mechanisms.

 

[settoROL]

1) You will not master everything. Therapy is very much so a practice and will continue to be honed over a life time career. You will make mistakes.

2) It is everything. And it is nothing. The right tool in the right hands can be a masterpiece. Wrong tool in wrong hands yields poorly. You have to sample what you can, find what resonates with you that you are willing to apply yourself towards. Even if you don't do modality XYZ, you can at least educate a patient before you refer them some one who does. Not all patients are appropriate for psychoanalysis, or CBT. Start your therapy exposure as soon as you to learn as much as you can.

1. Fair is 2-4 longitudinal patients per modality. Longitudinal as in the full course -- as defined by the modality. CBT may only be 12-16 sessions. Psychodynamic can be years. The [low] standard of care for supervision is in person supervision with a supervisor discussing the case, once a week. Better is to get one-way mirror supervision or to be video recording your sessions and reviewing them with a supervisor.
I'd argue that a reasonable goal in residence is to get pretty good at CBT and competent at psychodynamic, and to at least have exposure to one other modality in which you can conceptualize patients (structural family therapy is a good one).

2. It is most people's default modality. Let go of the idea of finishing all therapy training in residency. You can build a good foundation, but it's a long term learning process (getting supervision long term to continue to improve your skills).
Agree with above - get exposure early, but don't mistake the forest for the trees -- it's easy to get excited about one modality, but don't lose sight (as sushirolls points out) that not all therapies work for all patients. I've seen a good few clinicians get enamored with a therapy and stop exploring new stuff. Subsequently their own ability also plateaus.

And, when starting, don't forget that "first, do no harm" applies in therapy as well - nothing worse than supportive psychotherapy that supports primitive defense mechanisms.

THANK YOU ALL. Will keep this in mind.