psych2b said:
Hey all. Do you guys happen to know which programs out there stress training in Psychotherapy? All of them seem to say they stress the "biopsychosocial" approach, but some really mean it, while others don't. From what I can figure, Cambridge does this...
Thanks in advance!
I think that it is really important for all of us as future psychiatrists to not become entangled in the failed biology versus therapy polemic. This is a false dichotomy.
The fact is that most psychiatric problems are responsive to medicines and therapy, depending on the problem unique to that patient. There are notable exceptions. Consider a patient with schizophrenia or a psychotic depression, they will never respond to "talk therapy" alone. Substance use disorders will not respond (if at all) to medicines alone (the best outcome data exists for AA in alcoholism, i.e., behavioral therapy). It seems that what is much more important is to understand what elements of personality vulnerabilities and strengths, behavioral problems, circumstantial problems, and medical or psychiatric diseases contribute to your patient's presenting distress. From this up-front evaluation can flow the appropriate therapy.
To seek a program that is dedicated to one type of therapy seems to miss the point. Talk therapy and psychopharmaceutical therapy can only be appropriate if that is what the specific patient needs. Beware of any program that is dedicated to a specific THERAPY -- whatever the therapy may be -- "talk therapy" (e.g., psychodynamic, cognitive, etc.) or medicinal. Then your range of treatment resources becomes extremely limited, and in that case, as the expression goes "if you only have a hammer, everything is nail." Moreover, treatment-dedicated educations (i.e., backward-facing consideration of your patient's needs) will drive your care of the patient instead of careful consideration of all the patient's vulnerabilities FIRST to guide selection from a wide array of appropriate therapies. This may seem obvious, but we all have experienced psychiatrists who are treat random symptoms without doing an appropriate assessment to understand why the patient is presenting as he or she is.
I would take issue with the characterizations of the lists of programs noted in this thread. What is most important is to choose a program (assuming you like the people) that allows you to properly assess a patient and their needs first, and then trains you adequately in ALL the therapies you will likely need. One might argue that these are primarily CBT, Psychodynamic and Pharmacotherapy.
I would suggest that several of the programs listed as biological or therapy driven that are not one or the other; they are both. Based on this old form of distinction, I have to admit to as a bias towards improperly-labeled "biological" programs for two reasons. First, you know that you will get good training in psychopharmacology. Even if you get no training in the classic treatment modalities, you will get training in the most important modality -- supportive psychotherapy -- assuming you see a good number of patients. Regardless of the medical discipline, every encounter with a patient is therapy, and it is a mistake to relegate "therapy" exclusively to psychiatry or to a very specific, formalized therapy model. Second, the "biologic" programs seem to be more dedicated to the medical model of psychiatry. I feel this is important in that it is becoming increasingly clear that certain psychiatric conditions are clearly driven by some form of disease and genetic vulnerabilities.
Although it has been argued in the past that there are no diseases in psychiatry because no "pathology" has been found, remember that this was the case with all diseases until we discovered the pathophysiology. Pneumonia was a syndrome until we discovered its etiology. I think that in a program that is more wed to the idea of non-medical models (those often mislabeled as "therapy" based programs) it is more possible that the distinction between pathophysiology and other vulnerabilities is lost.
Whatever your preference, it seems most important to avoid holding yourself to a more narrow, treatment-driven philosophy that most likely will provide you with very limited resources to treat the WHOLE patient.
I hope this approach contributes in some way to your search. Best of luck!
🙂
