Residencies and Cognitive Behavioral Therapy

[zyprexaoverlord]

I am an M3. I am interested in psychiatry. At my school I've pretty much only seen medication management. As a 4th year do you get opportunities to see actual CBT and its techniques?
Does anyone know of any good psych programs that have an emphasis on therapy as well as the medical management of psychiatric patients?
My hopes for the future are to practice psychiatry and participate in both aspects of the treatment, not just half.

Any help would be greatly appreciated.

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[strangeglove]

There are many residency programs that emphasize both medications and psychotherapy. They are generally concentrated on the coasts. These are where you will get exposure to therapy as an MS4, though you probably won't get formal supervision unless you did an elective.

 

[zyprexaoverlord]

Thanks!
Would you know of notable programs in particular? If I wanted to pick one One the east coast and one on the west which programs would be the best options? If you know of certain resources to find answers to these questions that would be helpful as well.

 

[whopper]

The Beck Institute which is in the Philadelphia area. While they are not a residency, they work hand in hand with several residency programs to spice up their training in CBT.

 

[TheWowEffect]

There are many residency programs that emphasize both medications and psychotherapy. They are generally concentrated on the coasts. These are where you will get exposure to therapy as an MS4, though you probably won't get formal supervision unless you did an elective.

This is a very misleading statement. Most programs will give you good training in CBT. A few relatively-more biologically-focussed programs may not emphasize it as much but will still train you well in CBT if you show interest.

 

[OldPsychDoc]

This is a very misleading statement. Most programs will give you good training in CBT. A few relatively-more biologically-focussed programs may not emphasize it as much but will still train you well in CBT if you show interest.

I think an enlightened, well-rounded program will tell you that CBT IS a "biological therapy".

 

[kugel]

At Univ of New Mexico, we got didactics in CBT 2nd yr and training and formal supervision in CBT during both 3rd and 4th year.
Albuquerque certainly isn't on either coast, but it does have PLENTY of beach.
No water, but plenty of beach.

 

[erg923]

I would just warn not too get too caught up in techniques, but rather to learn and enjoy the process. Techniques, statistically, account very little variance in the outcome lit.

 

[Scorcher31]

Although every program technically teaches you both psychotherapy (usually group, psychodynamic, and CBT) and psychopharm, some are significantly weighted one way more so than the other. I'd suggest asking residents when you go on your interviews how solid they feel the psychotherapy training is. With this said no one is a master at even 1 type of psychotherapy after residency. Most people that use it are training and improving their skills the majority of their life. So if you don't feel your residency did a good enough job that ok, you’re probably going to get more training afterwards and certification if you want to use it.

While MS3 and MS4 I've rotated through C/L, Psych Emergency, Inpt psych, and Sub-acute psych at many different locations and I have seen almost no psychotherapy. The same can be said for many of the other medical students from my school who are going into psych. From what I had heard, those docs hadn't used it in quite some time and didn’t feel comfortable with their skills anymore. It’s a reach, but I would say the vast majority of MS3 and MS4 soon to be psych residents really don't get on a service that does this. Your best bet would be to track down an outpatient psychiatrist that does it and will allow you to sit in and observe, which also might be tough.

 

[Scorcher31]

Although I agree with your advise erg, I have to disagree erg with the statement in general. Specific types of psychotherapy are better for different types of patients. I would think that a patient's cognitive abilities, personality traits, and psychopathology all need to be considered when determining what type of psychotherapy should be used. DBT has been shown to be the best bet with borderlines for example.

 

[erg923]

Thats very true, tayloring therapy to what the patient is cabable of understanding and doing is always important. And yes, DBT performs better than others with borderline's. However, this does not neccearily mean the techniques themselves are accounting for the differntial outcome. Although no doubt those techniques embeded in DBT can work wonders for partiucular symptoms for this population. It does remain a fact however, that techniques account for less than 1/3 (often less than this) of the variance in pt. outcome. Wampold's 2001 metaanalysis of the lit confirms this.

 

[psychotrope]

While MS3 and MS4 I've rotated through C/L, Psych Emergency, Inpt psych, and Sub-acute psych at many different locations and I have seen almost no psychotherapy. .

of course not. Those rotations are not geared towards residents and faculty doing psychotherapy.

Likewise, if you had rotated through an outpatient eating disorders elective, you could probably say "I have seen almost no psychotic or manic patients"....

Most programs are going to provide a good bit of training in(at least) cbt for the majority of your third year, and then your fourth year depending on how you want to structure that. That quality of the training may of course vary.

 

[Doctor Bagel]

Ditto on the thought that pretty much every program in the midwest, coasts or wherever will provide pretty solid CBT training. At least that's what I saw on the interview trail, and my home program here in the middle of the country teaches a lot of CBT. From what I've seen, you're more likely to see more emphasis on psychoanalysis on the coasts and actually a little less CBT.

 

[TheWowEffect]

I think an enlightened, well-rounded program will tell you that CBT IS a "biological therapy".

I agree.

 

[TheWowEffect]

Ditto on the thought that pretty much every program in the midwest, coasts or wherever will provide pretty solid CBT training. At least that's what I saw on the interview trail, and my home program here in the middle of the country teaches a lot of CBT. From what I've seen, you're more likely to see more emphasis on psychoanalysis on the coasts and actually a little less CBT.

I agree again.