therapy for residents

[Wardles888]

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Ive heard that a lot of psychiary residents go to therapy themselves. I would love to try that because I think it will help me be a better psychiatrist. How do residents do this? Do they use their insurance to cover the therapy? I heard using insurance is tricky, because you get branded with a diagnosis for the therapy to be covered. Do you then have to constantly disclose this diagnosis every time you apply for a job or when you apply for your lisence?

 

[hamstergang]

Ive heard that a lot of psychiary residents go to therapy themselves.

My program doesn't do this (that I know of). I wonder what the stats actually are.

 

[birchswing]

My program doesn't do this (that I know of). I wonder what the stats actually are.

After watching In Treatment (in which Paul sees a supervisor) I asked my psychologist about this. He made it sound like it's sort of a spectrum between being in therapy for individual need and what is called supervision to discuss cases, which he said is also a type of therapy. He meets with a group of psychologists to discuss cases.

 

[Wardles888]

Im talking about seeing a therapist for oneself to gain insight into one's way of thinking, not to discuss work related cases

 

[downwithDTB]

I'm talking about seeing a therapist for oneself to gain insight into one's way of thinking, not to discuss work related cases

Some programs offer [discounted/free/essentially free/full cost] [analysis/therapy/process group] for [1 year/all of residency/never] with [alums/faculty/local psychoanalytic institute]. Analytic training requires undergoing analysis for a period of time (and is not part of residency, although many have affiliations). The offer varies tremendously by program. I doubt that any insurance company covers analysis/therapy for those sans pathology. If you are in need of psychiatric treatment, the best be is probably to seek it out and not worry about a "diagnosis label." If you are interested in analysis for training/self improvement, that doesn't count as medical care. I can't speak to any experience of residency, only that the offers varied tremendously by program.

 

[splik]

Im talking about seeing a therapist for oneself to gain insight into one's way of thinking, not to discuss work related cases

it is a requirement at my program for residents to have a minimum of 6 months personal psychotherapy. you will undoubtedly discuss cases at some point during your therapy so in some ways it does serve as supervision. in fact one of my analytic supervisors says "your own personal therapy is the best supervision you'll get".

some analysts provide free therapy for residents, others heavily discount it, some waive the copay, others charge.

many people do use their insurance the DC is often something like "adjustment disorder" or "anxiety nos" and no it's not going to make a difference for licensing etc. unless of course you actually have a serious mental disorder like bipolar I or schizophrenia.

 

[Doctor Bagel]

My program doesn't do this (that I know of). I wonder what the stats actually are.

People in your program as a rule don't do their own psychotherapy? How would you know?

 

[hamstergang]

People in your program as a rule don't do their own psychotherapy? How would you know?

We were a very close program. I'd be very surprised if I were wrong about this.

 

[Doctor Bagel]

We were a very close program. I'd be very surprised if I were wrong about this.

It seems odd to have a psychiatry program where no one is seeking out their own psychotherapy. Do you train at a place that really de-emphasizes therapy? If no one were in their own treatment, I'd almost assume you're at a place that stigmatizes it. If you're at a place where no one talks about doing therapy, they probably for sure wouldn't talk to a chief resident about it anyway.

From my experience, I'd say the majority of residents don't seek out their own therapy but a fairly sizable number do and/or have already participated in therapy in some way in the past. I'd also say that if you're interested in doing therapy, it would be good to have some experience as a patient doing therapy.

 

[Ceke2002]

After watching In Treatment (in which Paul sees a supervisor) I asked my psychologist about this. He made it sound like it's sort of a spectrum between being in therapy for individual need and what is called supervision to discuss cases, which he said is also a type of therapy. He meets with a group of psychologists to discuss cases.

That sounds very similar to what my Psychiatrist has in place. He has individual supervisors he can go to to discuss specific cases (although patients are kept anonymous) as well as a peer group he can meet with to discuss stuff as well. I know he recently (within the last few months) met with one of his supervisors to discuss my case and whether or not he was still on the right track regarding formulation of treatment and therapy. It was interesting, he showed me some of the notes and diagrams from the meeting and let me take them home so I'd have a reference point for some of the Cognitive Analytical Therapy we've started doing alongside the Pychodynamic and Object Relations based stuff (plus whatever else gets thrown into the mix from session to session, depending on my needs at the time). So yeah, very similar to what your psychologist is talking about from the sounds of it.

it is a requirement at my program for residents to have a minimum of 6 months personal psychotherapy. you will undoubtedly discuss cases at some point during your therapy so in some ways it does serve as supervision. in fact one of my analytic supervisors says "your own personal therapy is the best supervision you'll get".

This was my understanding as well, from an Australian point of view. I know my Psychiatrist underwent 6 months of Psychoanalysis during training and I'm pretty sure that was a requirement of the course (or at least that potential Fellows receive 6 months of Psychotherapy as part of their overall training). I'd be surprised if it wasn't a requirement for residency/fellowship/other training pathways.

 

[splik]

personal analysis is definitely not part of the standard training of psychiatrists in australia, though it is quite possible your psychiatrist chose to do so. although it is technically possibly to have a 6 month analysis, the vast majority of analytic treatment is over years (and sometimes many years indeed) at great expense.

it is not a requirement for australian psychiatrists receive personal psychotherapy as part of their training. psychotherapy is a pretty limited part of psychiatric training in australia and new zealand as is not a big part of psychiatrists work. as in other parts of the world, registrars in australia gripe about not getting enough experience with private practice and seeing patients with the neurotic disorders that might be amenable to psychotherapies. i would imagine only a small minority of australian psychiatrists engage in their own personal psychotherapy, far less than their american counterparts.

 

[Ceke2002]

personal analysis is definitely not part of the standard training of psychiatrists in australia, though it is quite possible your psychiatrist chose to do so. although it is technically possibly to have a 6 month analysis, the vast majority of analytic treatment is over years (and sometimes many years indeed) at great expense.

it is not a requirement for australian psychiatrists receive personal psychotherapy as part of their training. psychotherapy is a pretty limited part of psychiatric training in australia and new zealand as is not a big part of psychiatrists work. as in other parts of the world, registrars in australia gripe about not getting enough experience with private practice and seeing patients with the neurotic disorders that might be amenable to psychotherapies. i would imagine only a small minority of australian psychiatrists engage in their own personal psychotherapy, far less than their american counterparts.

Thanks for the correction, much appreciated. 🙂 I was going on remembered snippets of conversation from a few years back so I wasn't entirely sure what the exact requirements were. I know my Psychiatrist still has an analyst he can go see, so maybe his sessions did extend beyond 6 months -- I just remember him mentioning 6 months of psychoanalysis, but I don't really have specific knowledge beyond that. It's a pity my sessions aren't recorded, I might have been able to go back through some files and double check half remembered conversations and chit chat, LOL. 😀 Anyway, always happy to be corrected if I've missed the mark on something, so cheers for that once again.

 

[Armadillos]

many people do use their insurance the DC is often something like "adjustment disorder" or "anxiety nos" and no it's not going to make a difference for licensing etc. unless of course you actually have a serious mental disorder like bipolar I or schizophrenia.

Is this insurance fraud (for those seeking therapy for purpose of meeting the requirements) seeing as the resident is not getting treatment out of medical necessity?

 

[splik]

there has been an advanced psychotherapy training scheme in psychotherapy for psychiatry registrars and consultants for some years in australia (allowing you to do advanced training on on of psychodynamic, CBT, group, couples/family psychotherapy) - the last year which I saw figures was 2010 in which only 19 psychiatrists chose to pursue training in psychotherapy and this was a significant increase upon previous years. the situation is more dire in the UK - at least there are good private practice opportunities for australian psychiatrists to do psychotherapy if they wish.

 

[splik]

Is this insurance fraud (for those seeking therapy for purpose of meeting the requirements) seeing as the resident is not getting treatment out of medical necessity?

residents don't seek out therapy for requirements, that's just their "cover story". no analyst is going to buy the story the resident is just there for their "training" though i know one resident who was rejected for being too "healthy". one could argue most residents would meet criteria for adjustment disorder, depression NOS or anxiety NOS during their training. after all 50% of psychiatry residents experience burnout, and there's enough psychopathology in your average psychiatry residency to fill the DSM. in my experience, the better the residency program the more personality pathology.

there's a pretty significant proportion of residents who are taking psychotropics too.

 

[Ceke2002]

there has been an advanced psychotherapy training scheme in psychotherapy for psychiatry registrars and consultants for some years in australia (allowing you to do advanced training on on of psychodynamic, CBT, group, couples/family psychotherapy) - the last year which I saw figures was 2010 in which only 19 psychiatrists chose to pursue training in psychotherapy and this was a significant increase upon previous years. the situation is more dire in the UK - at least there are good private practice opportunities for australian psychiatrists to do psychotherapy if they wish.

I guess having *finally* found a good Psychiatrist, who also happens to be skilled in Psychotherapy, I do sometimes forget just how bad our mental health system can be in terms of delivering quality psychotherapeutic treatment.

 

[hamstergang]

It seems odd to have a psychiatry program where no one is seeking out their own psychotherapy. Do you train at a place that really de-emphasizes therapy? If no one were in their own treatment, I'd almost assume you're at a place that stigmatizes it. If you're at a place where no one talks about doing therapy, they probably for sure wouldn't talk to a chief resident about it anyway.

My program director was actually more into therapy than medications (she personally taught us psychotherapy and almost never discussed medications). I know of at least 2 residents that were in psychiatric treatment for OCD and anxiety, so it wasn't stigmatized to the point that we wouldn't discuss it.

Also, I'm chief of my child fellowship, but I'm talking about my general psych residency, where I wasn't chief. I'll give you that I didn't know all the residents this well, but at least half I did. Different culture? Bad sampling bias? Random variation? I'm wrong? All possible.

 

[angleslam08]

doing personal therapy seems like a damn good idea, i see it as mechanism of self improvement. look forward to it in residency. somewhat ironic that for what the field is, only a couple of programs i interviewed at (did only apply 'decent' academic programs) actually conveyed a supportive environment (PD was analyst at one of them).

 

[downwithDTB]

I'd also say that if you're interested in doing therapy, it would be good to have some experience as a patient doing therapy.

Not to derail this too much, but is there an empirical basis for this idea or is it based on experience? I'm curious as to whether there is evidence that undergoing therapy 1) improves outcomes for ones own therapy patients and 2) has a benefit for those without complaint or diagnosable illness, especially vs other activities like running, yoga or socializing (eg protective or improved well-being above baseline). My guess is that this hasn't been studied.

 

[deleted343839]

Not to derail this too much, but is there an empirical basis for this idea or is it based on experience? I'm curious as to whether there is evidence that undergoing therapy 1) improves outcomes for ones own therapy patients and 2) has a benefit for those without complaint or diagnosable illness, especially vs other activities like running, yoga or socializing (eg protective or improved well-being above baseline). My guess is that this hasn't been studied.

(1) That would be a tricky study to design. What little data exist are based on therapists' perceptions of how their own psychotherapy has influenced them as professionals.
(2) The CBT literature sometimes has comparison/control groups that include activities like exercise, social support groups, etc.

 

[smalltownpsych]

One benefit of participating in psychotherapy is understanding what it feels like from the patient's perspective, but that doesn't take very many sessions. Whether it is of benefit to healthy people might be impossible to tease out. Maybe in adolescents you could find an effect. It does appear, based on my experience, that some of the healthier teens will use and benefit from psychotherapy. Of course, they could also talk to an admired coach or teacher and probably derive similar benefit. Healthy adults that come to see me usually only last a few sessions and it is typically related to a crisis. I believe that it is beneficial and the patients usually agree, but they probably would have been okay either way.

 

[Salpingo]

Not to derail this too much, but is there an empirical basis for this idea or is it based on experience? I'm curious as to whether there is evidence that undergoing therapy 1) improves outcomes for ones own therapy patients and 2) has a benefit for those without complaint or diagnosable illness, especially vs other activities like running, yoga or socializing (eg protective or improved well-being above baseline). My guess is that this hasn't been studied.

One benefit to undergoing therapy is that you become more empathetic to your patient. The only way of knowing how uncomfortable/thrilling/confusing/tedious it is to be locked into a therapeutic relationship is to be in one yourself. Activities like running and yoga don't really have that interpersonal element, and socializing is a pretty broad activity (does internet communication count? Large groups? Intimate, one on one conversations? Should substance use be allowed?). Its like if you had a personal trainer who never worked out once in their life, but had taken multiple classes and read all the research studies on Cross Training, using meditation for their personal self-improvement.

But the question would be an interesting, albeit difficult, one to study. I think the most challenging would be randomizing the therapists and measuring their "effectiveness". Do you examine individual providers outcomes pre- and then post-therapy, or randomly assign a group of residents to either receive therapy or sham treatment? The therapy is likely going to be exploratory/insight-oriented and not targeted, so it would be hard to determine what the length of treatments should be.

Edit: Sorry, should have read STP's post above.

 

[HarryMTieboutMD]

My take on things:
1) Adjustment disorder is possibly the most BS diagnosis in the entire DSM (and it has stiff competition, I know).
2) You shouldn't go to psychotherapy (as a patient) in order to "be a better psychiatrist." You get to be a better psychiatrist by seeing lots of patients, reading, going over cases with supervisors, reading having attendings watch you interview, reading, having therapy supervision, reading... basically being a proactive resident
3) If you want to do psychotherapy (as a patient) for self actualization or coping skills or to prevent burnout or whatever, I would recommend going to a reputable private practice therapist in town (who hopefully takes your insurance). Your program and department do NOT need to know your personal business insofar as it doesn't interfere with your professional duties.

 

[Rogue Penguin]

I don't think that being interested in seeing what it's like to undergo psychoanalysis indicates that you have some sort of pathology or some other sort of problem you want resolved.

 

[splik]

I don't think that being interested in seeing what it's like to undergo psychoanalysis indicates that you have some sort of pathology or some other sort of problem you want resolved.

(strokes beard) this is what analysts would call resistance...

 

[thoffen]

Cool! Now we get to discuss the definitions of "pathology" and "problem" and "resolved" when it comes to psychoanalysis!

Eh. It's more fun just to ask you to consider it anyway, and that's what good therapists do regardless.

Sadly, the availability and feasibility (cost, schedule) of individual psychotherapy for residents varies by program. If you are open to it, it's a great thing to ask about going in. Personally, I'm paying out of pocket for weekly dynamic therapy, and only started doing so about 2.5 months ago. On the one hand, I do wish I had this avenue much sooner, cheaper, and with dedicated time for it, there is definitely a different benefit of doing it as my choice with my money and my time commitment because I came to the realization of the value in doing so.

 

[notdeadyet]

Sadly, the availability and feasibility (cost, schedule) of individual psychotherapy for residents varies by program. If you are open to it, it's a great thing to ask about going in.

What's helpful about this approach is that folks most interested in their own psychotherapy for reasons of being a psychotherapist are likely to select programs that are strong in psychotherapy. And programs strong in psychotherapy tend to try to make resources available to keep psychotherapy cheap.

Many programs have sliding scale therapists and analysts that residents can afford to go to throughout residency. I've seen some that typically charge $300/hour charging residents $50/session.