Rising M-1 Seeking Information and Advice

[my existential crisis]

Hi all,

I'm a rising M-1 and am interested in specializing in psychiatry, especially as it relates to psychotherapy. I am curious if anyone is aware of programs in the West and Southeast that emphasize psychotherapy training within their curriculum. I've researched into Colorado and MUSC so far. FYI, I plan to attend an MD school in South Carolina to complete my medical degree.

Moreover, I've read that a psychiatrist interested in becoming certified in a certain type of psychotherapy (CBT/Psychodynamic/DBT) will still need to take additional training post-residency to achieve this. Can anyone certified in a type of psychotherapy or that currently practices expand on the training that he/she/they went through to get to where they are?

Additionally, can anyone speak to the role that psychotherapy plays in an academic position versus a private practice one? I'm attempting to compare and contrast different types of psychiatry, specifically academic vs. private practice. I've heard that one doesn't train nearly enough in a private practice setting in medical school or residency, so I'm curious how that looks and feels to psychiatrists that use psychotherapy.

Note, I know psychotherapy isn't the only piece of psychiatry. I'm also interested in psychadelic and advanced psychopharmacological treatment, so I know that psychotherapy will be just a piece of the puzzle. Thank you in advance for your time.

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[comp1]

Whoa dude...you've just been accepted to med school? Pump the brakes a bit. You've got two straight years ahead of you with almost nothing vaguely related to mental health and then ANOTHER two years with only a couple of weeks that focus on psychiatry. You haven't even been on your first date yet, but you seem to be aggressively planning the wedding. Don't go into med school so focused on a single specialty. You might not recognize that something else actually interests you more. I went into med school with absolutely NO idea of going into psych. If I had been as wedded to IM as you appear to be to psych, I'd be very, very unhappy now.
So to answer your question, even though the landscape will of course be dramatically different in over 3.5 years when this is actually relevant to you, psychotherapy strong programs tend to be in bigger cities. The bigger the city, the more wealthy people that can afford to pay for it individually and finance things like psychoanalytic institutes. It's not a good idea to pick a residency based on this, however. Pick a residency based on where you want to live. Unlike med school, most people stay where they did residency. And yeah, by definition you're going to get exposed to more academic everything in...academics. Still somehow most practicing psychiatrists aren't in academic positions, so it works out. You can of course do therapy in both. Academics will let you do it with a broader range of socioeconomic statuses, in general. PLEASE remember that formal (as opposed to the informal kind a lot of doctors do) psychotherapy is a very, very small part of the vast majority of psychiatric practices. But again, who knows, you may fall in love with path from your first day in the anatomy lab and none of this may be relevant in the least.

 

[calvinhobbes]

Your focus should be to obtain the best grades and clinical and diverse volunteer/research experiences possible —you can think about a speciality later on, as many med students switch all the time, even close to residency application season. But you need to have a great CV, even for top FM programs for example. Shoot for the stars and then you’ll be able to pick any speciality you want (yes, optimism and a positive attitude go a long way and PD’s love that, no matter what field).

 

[romanticscience]

Can anyone certified in a type of psychotherapy or that currently practices expand on the training that he/she/they went through to get to where they are?

Additionally, can anyone speak to the role that psychotherapy plays in an academic position versus a private practice one?

I appreciate your enthusiasm! I thought I'd share as someone else who had a laser focus on private practice psychiatry since day 1.

I completed basic and advanced training through my local psychoanalytic institute and then completed the TFP training online through Columbia University. In medical school, I also completed the elective in psychodynamic psychiatry at Austen Riggs.

I'm in private practice; I can't really comment about academics. At your stage, you may want to appreciate doing therapy from being therapeutic. Training in psychotherapy prepares one to be effective in all areas of clinical practice (e.g., psychodynamic therapy), from formal, longer, high-frequency psychotherapy appointments to shorter, low-frequency medication-focused appointments. The skills you learn about maintaining relationships, setting a frame, managing your own feelings, etc., are quite valuable in running a solo private practice because there's less "distance" between you and the patient, which would be available in a clinic or academic setting.

 

[clausewitz2]

I appreciate your enthusiasm! I thought I'd share as someone else who had a laser focus on private practice psychiatry since day 1.

I completed basic and advanced training through my local psychoanalytic institute and then completed the TFP training online through Columbia University. In medical school, I also completed the elective in psychodynamic psychiatry at Austen Riggs.

I'm in private practice; I can't really comment about academics. At your stage, you may want to appreciate doing therapy from being therapeutic. Training in psychotherapy prepares one to be effective in all areas of clinical practice (e.g., psychodynamic therapy), from formal, longer, high-frequency psychotherapy appointments to shorter appointments, low-frequency medication-focused appointments. The skills you learn about maintaining relationships, setting a frame, managing your own feelings, etc., are quite valuable in running a solo private practice because there's less "distance" between you and the patient, which would be available in a clinic or academic setting.

very much agree that when the patient can get hold of you directly without intermediation, you best be thoughtful about your interactions unless you want to realize you've made a huge mistake way too late to fully fix it.

 

[theduderino]

I practice mentalization based therapy in a private practice setting. MBT is a psychodynamic-ish, relational/intersubjective approach to borderline personality disorder + narcissistic personality disorder. My therapy training came in bits and pieces during residency and covered basic CBT and psychodynamic approaches. Looking back, residency training taught me what kind of psychotherapy best suits my personality but was not enough training to feel competent without additional work. I sought out specific supervision and brief training courses around MBT after residency.

For most psychiatrists interested in psychotherapy, life-long learning/additional training after residency is the norm. It can look like doing a formal training program or can be something like paying someone for supervision, doing a peer-supervision group, etc.

I'd also consider engaging in psychotherapy as a patient, even starting now. That might help keep the flame alive during the first several years of training where you're really aren't interacting with mental health content, at least explicitly. When you start school, there will (probably) be lots of content for you to process with a therapist haha.

I wouldn't worry about practice setting yet. Private practice is the most amenable to doing lots of psychotherapy, but there are so many variations within the broad settings you named (academic, private, etc) that it doesn't make sense to label a particular setting as a "best" fit until you know a lot more about when/where/how you are going to practice as a psychiatrist. For instance, one of my old attendings is a doctor in the IHS system and does more (highly skilled) psychotherapy than most private practice docs I know. You can make a niche in unexpected places

 

[my existential crisis]

I practice mentalization based therapy in a private practice setting. MBT is a psychodynamic-ish, relational/intersubjective approach to borderline personality disorder + narcissistic personality disorder. My therapy training came in bits and pieces during residency and covered basic CBT and psychodynamic approaches. Looking back, residency training taught me what kind of psychotherapy best suits my personality but was not enough training to feel competent without additional work. I sought out specific supervision and brief training courses around MBT after residency.

For most psychiatrists interested in psychotherapy, life-long learning/additional training after residency is the norm. It can look like doing a formal training program or can be something like paying someone for supervision, doing a peer-supervision group, etc.

I'd also consider engaging in psychotherapy as a patient, even starting now. That might help keep the flame alive during the first several years of training where you're really aren't interacting with mental health content, at least explicitly. When you start school, there will (probably) be lots of content for you to process with a therapist haha.

I wouldn't worry about practice setting yet. Private practice is the most amenable to doing lots of psychotherapy, but there are so many variations within the broad settings you named (academic, private, etc) that it doesn't make sense to label a particular setting as a "best" fit until you know a lot more about when/where/how you are going to practice as a psychiatrist. For instance, one of my old attendings is a doctor in the IHS system and does more (highly skilled) psychotherapy than most private practice docs I know. You can make a niche in unexpected places

Thanks for your information! I appreciate it.

 

[my existential crisis]

Whoa dude...you've just been accepted to med school? Pump the brakes a bit. You've got two straight years ahead of you with almost nothing vaguely related to mental health and then ANOTHER two years with only a couple of weeks that focus on psychiatry. You haven't even been on your first date yet, but you seem to be aggressively planning the wedding. Don't go into med school so focused on a single specialty. You might not recognize that something else actually interests you more. I went into med school with absolutely NO idea of going into psych. If I had been as wedded to IM as you appear to be to psych, I'd be very, very unhappy now.
So to answer your question, even though the landscape will of course be dramatically different in over 3.5 years when this is actually relevant to you, psychotherapy strong programs tend to be in bigger cities. The bigger the city, the more wealthy people that can afford to pay for it individually and finance things like psychoanalytic institutes. It's not a good idea to pick a residency based on this, however. Pick a residency based on where you want to live. Unlike med school, most people stay where they did residency. And yeah, by definition you're going to get exposed to more academic everything in...academics. Still somehow most practicing psychiatrists aren't in academic positions, so it works out. You can of course do therapy in both. Academics will let you do it with a broader range of socioeconomic statuses, in general. PLEASE remember that formal (as opposed to the informal kind a lot of doctors do) psychotherapy is a very, very small part of the vast majority of psychiatric practices. But again, who knows, you may fall in love with path from your first day in the anatomy lab and none of this may be relevant in the least.

Thank you for your input!