Psychotherapy

[Psychintern2006]

How do I get good at it ? Please advise.

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[Doc Samson]

How do I get good at it ? Please advise.

Ummm... get good training at a program that focuses on it?

 

[Therapist4Chnge]

1. Solid theory + conceptualization.
2. An identified primary orientation. People often try to be 'eclectic' without really having a solid basis in one or more orientations....which is REALLY important.
3. An experienced mentor to guide you (Supervision).
4. Practice!

There are more, but that's a start.

-t

 

[Psychintern2006]

2. An identified primary orientation. People often try to be 'eclectic' without really having a solid basis in one or more orientations....which is REALLY important.

-t

Can you please elaborate? Thanks....

 

[Therapist4Chnge]

Can you please elaborate? Thanks....

There are various orientations with which to conceptualize and treat the pt. (CBT, DBT, Psychodynamic, etc). Each orientation has their own framework and nuances. Often time people cherry pick from a variety of different areas, which isn't inherently bad, but if you don't have a strong grounding in all of the areas you cherry picked from, you may misapply the knowledge and/or violate one framework by instituting a conflicting idea. In practical application, one style may focus on the here and now, while another may be more exploratory into the patient's history. Jumping around may confuse both the pt and the clinician.

If you have a strong basis in at least one orientation, you can then branch off from there, and understand the differences of the other orientations because you have something to compare it to. The idea of 'eclecticism' is great in hands of skilled clinicians because they utilize a variety of techniques to apply to specific issues of the patient, while still having an over-arching framework with which to refer back to. Eclecticism in the hands of someone newer to practice can be haphazard because it ends up being a mishmash of ideas that may or may not work together, and there isn't a real direction to the work.

I am very much on the front end of my career, so I started out learning all of the theory behind the various orientations, but only focused on one in the therapeutic setting. Once I became comfortable with that orientation, I then branched out to another orientation. There are some orientations that are closer to each other than others (Cognitive and CBT....compared to behavioral and any flavor of the psychodynamic) I prefer a psychodynamic approach (the flavor may vary on what works with the pt, but object relations is my preference), though one size does not fit all. My first training was in CBT, which can work well in many cases.

I come from the clinical side, but from what I've seen from some psychiatrists I know, psychodynamic and DBT seem to be pretty popular. I've dabbled in DBT, but it isn't something I use actively in session. I'm still very much learning other orientations, so instead of trying to cram it all under the 'eclectic' umbrella....I try and stick with a specific orientation with each pt.

-t

 

[doctorpsych]

In my opinion, get a GOOD survey of the different schools of psychological treatments--CBT, psychoanalytic, psychodynamic, object relations, client-centered approaches, family systems, etc... critically examine each, their conceptualization and their basis for case formulation, examine scientific literature concerning their outcome, as you learm more, you should naturally incline toward one that fits your style more... also, if accessible, I would strongly recommend enrolling in an institute for advance studies eg. William Alanson White, Albert Ellis's Institute, Robert Leahy's American Institute for Cognitive Therapy, etc... having a good supervisor is key.
good luck.

 

[PsyKardinal]

Practice, Practice, and get lots of feedback from experienced therapists and supervisors. Videotape yourself if the client/patient will allow you to and watch yourself critically. Watching and listening to yourself can be really really hard on the ego at first, but having an objective person watch the tape with helps alot. I agree with the above posters that focus on one particular area at first and get good with the skills in that particular area and then branch out and add to your toolbox. Trying to use to many techniques or use too many ideas from a multitude of theories will ultimate confuse you and the patient/client which then leads to poor outcomes.

Jeff

 

[Therapist4Chnge]

Videotaping can be golden....audiotaping is also REALLY helpful. I still hate transcribing tapes (it takes forever), but it is invaluable for the learning experience.

-t

 

[Psychintern2006]

Will start working on one orientation at a time and tape the session with the patient.

Hopefully the patient won't object and it is not a HIPPA violation.

What is the simplest and easy to read book to start with ?

thanks again.

 

[Psychintern2006]

In my opinion, get a GOOD survey of the different schools of psychological treatments--CBT, psychoanalytic, psychodynamic, object relations, client-centered approaches, family systems, etc... critically examine each, their conceptualization and their basis for case formulation, examine scientific literature concerning their outcome, as you learm more, you should naturally incline toward one that fits your style more... also, if accessible, I would strongly recommend enrolling in an institute for advance studies eg. William Alanson White, Albert Ellis's Institute, Robert Leahy's American Institute for Cognitive Therapy, etc... having a good supervisor is key.
good luck.

Thanks

 

[Psychintern2006]

Ummm... get good training at a program that focuses on it?

program does focus on therapy, I will have my own patient in 2nd year to follow with and then get to discuss with my supervisor every week, I am very excited, hopefully will be a smooth transition, thanks

 

[Doc Samson]

program does focus on therapy, I will have my own patient in 2nd year to follow with and then get to discuss with my supervisor every week, I am very excited, hopefully will be a smooth transition, thanks

If your program emphasizes psychotherapy, and you have a decent supervisor, you'll be fine. Get used to the feeling that you're "faking it" for at least the first 18 months. One therapy patient in PGY-2 sounds a little light to me, though.

 

[Therapist4Chnge]

*edit*

Although I quoted DS, ,I meant this towards the OP.

If your program emphasizes psychotherapy, and you have a decent supervisor, you'll be fine. Get used to the feeling that you're "faking it" for at least the first 18 months. One therapy patient in PGY-2 sounds a little light to me, though.

It will definitely take you awhile to get use to doing therapy; you'll need to develop your own style. One therapy pt. isn't going to give you much experience, but it will at least get you started. It took me a good dozen pts or so to develop my style and feel comfortable; I do mostly longer term/intensive work, so I'm not sure how that effected my adjustment period. YMMV. Coming from the clinical psych side, it is nice to see psychiatrists going for formal therapy training during their residency, I think it is important to get exposure to traditional individual therapy, even if it isn't something you plan to do when you get out.

-t

 

[PsyKardinal]

I hated transcriping audio tapes, but it does force you to listen to your self. When you have to rewind and listen to the tape over and over and over again, oh how I hated my voice.

Jeff