Therapy for the therapist

[Doctor Bagel]

Advertisement - Members don't see this ad

This is a topic I've been interested in and personally pursuing recently and was wondering what the thoughts were out there in SDN land (maybe using this as a gauge for the thoughts in the general psychiatry world) about psychiatrists and psychiatry residents doing their own psychotherapy. Personally, I'm interested in pursuing more training in psychodynamic work and maybe even way down the road training to be an analyst, so this is pretty relevant to my career goals. Of course, couple that with the fact that my GAF isn't 95 on most days, and training is ridiculously stressful, I think some work could be beneficial regardless of these career goals.

My program is maybe a little more psychodynamically oriented than some others out there, but I'd say there's not broadbased encouragement to do your own work. In fact, it's kind of hard to figure out how to fit it into your schedule, and our default insurance option only gives in-network benefits to providers at the place where I work, which is not awesome for all sorts of reasons. We do have a fairly vibrant resident wellness program, but the goals of that for individual treatment are more crisis types of goals. Aside from anything related to my program or insurance, the psychodynamic/analytic community in my city is somewhat robust yet small. Almost every provider you'd see has some affiliation with our program or with the local psychoanalytic institute, meaning you're going to professionally interact in some capacity with almost anyone.

Even with these limitations, though, I'm guessing the opportunities here are better than for residents at lots of other programs. We have a lot of attendings involved in our psychotherapy training who encourage us to do our own, but I think I know maybe 3 to 4 people who are actually doing that. I've heard stories in the old days, though, about how all the residents did their own analysis and moonlit to pay for it. Just curious how the world looks for the rest of you in this regard and what you think about it. I did 2 minutes of research and found this abstract --

http://www.ncbi.nlm.nih.gov/pubmed/20071719

 

[nitemagi]

This is a topic I've been interested in and personally pursuing recently and was wondering what the thoughts were out there in SDN land (maybe using this as a gauge for the thoughts in the general psychiatry world) about psychiatrists and psychiatry residents doing their own psychotherapy. Personally, I'm interested in pursuing more training in psychodynamic work and maybe even way down the road training to be an analyst, so this is pretty relevant to my career goals. Of course, couple that with the fact that my GAF isn't 95 on most days, and training is ridiculously stressful, I think some work could be beneficial regardless of these career goals.

My program is maybe a little more psychodynamically oriented than some others out there, but I'd say there's not broadbased encouragement to do your own work. In fact, it's kind of hard to figure out how to fit it into your schedule, and our default insurance option only gives in-network benefits to providers at the place where I work, which is not awesome for all sorts of reasons. We do have a fairly vibrant resident wellness program, but the goals of that for individual treatment are more crisis types of goals. Aside from anything related to my program or insurance, the psychodynamic/analytic community in my city is somewhat robust yet small. Almost every provider you'd see has some affiliation with our program or with the local psychoanalytic institute, meaning you're going to professionally interact in some capacity with almost anyone.

Even with these limitations, though, I'm guessing the opportunities here are better than for residents at lots of other programs. We have a lot of attendings involved in our psychotherapy training who encourage us to do our own, but I think I know maybe 3 to 4 people who are actually doing that. I've heard stories in the old days, though, about how all the residents did their own analysis and moonlit to pay for it. Just curious how the world looks for the rest of you in this regard and what you think about it. I did 2 minutes of research and found this abstract --

http://www.ncbi.nlm.nih.gov/pubmed/20071719

It's helpful for your stress mgmt, and useful for you as a therapist. But I'd offer that it's usually quite difficult to do anything more than once a week during residency. Hell, I did a year of analytic training After residency and that was very tough (lot of time and money commitments).

 

[silas2642]

I manage to go to psychodynamic psychotherapy twice a week. My program has been very supportive; no questions on clinical services-- even while rotating on medicine.

 

[Doctor Bagel]

It's helpful for your stress mgmt, and useful for you as a therapist. But I'd offer that it's usually quite difficult to do anything more than once a week during residency. Hell, I did a year of analytic training After residency and that was very tough (lot of time and money commitments).

That's what I was thinking. Once a week right now is hard enough. I think I could fit in more time after this block ends in December, but that doesn't help with the financial challenges.

 

[Doctor Bagel]

I manage to go to psychodynamic psychotherapy twice a week. My program has been very supportive; no questions on clinical services-- even while rotating on medicine.

That's awesome. Do lots of other residents do the same thing there? How does it work out financially?

 

[zappeuse]

here in europe you cannot even think of doing therapy without undergoing personal therapy before.

 

[notdeadyet]

At my program, most residents undergo therapy. It seems most start in the second half of PGY1 or the first half of PGY2. Allowances can be made for clinical duties where possible. We are given lists of non-Uni psychiatrists who give big discounts to residents for therapy (some charge as low as $50/hour).

 

[PikminOC]

In residency, when I was training under a therapist, I asked him if I could just use my experiences instead of a patients and he was ok with that. So I got some free therapy.

 

[Scorcher31]

I can understand the purpose of going through a variety of different therapy types if you are going to be a therapist primarily. This may garner some criticism, but my philosphy for myself is don't rock the boat. If I am happy, relatively healthy, have a nice social life and minimal stressors with no psych hx, I just don't see the need to delve too deeply into myself. Sure I have my own faults we all do, but is it worth thousands of dollars and weeks of my life to get to the route of? We can all take into account our annoying quirks, our faults, our strengths and weaknessess and apply it to our lives and patient care without needing therapy to do so.

At least in our free therapy clinic (so not just for billing), you need to have some type of pathology and goal in order for tx. You don't do exploratory surgery just to see what your insides look like, you need to be looking for something. If I'm seeing someone for med checks or therapy and they are doing well for an extended period of time, chances are I'm going to see them less frequently.

 

[nitemagi]

I can understand the purpose of going through a variety of different therapy types if you are going to be a therapist primarily. This may garner some criticism, but my philosphy for myself is don't rock the boat. If I am happy, relatively healthy, have a nice social life and minimal stressors with no psych hx, I just don't see the need to delve too deeply into myself. Sure I have my own faults we all do, but is it worth thousands of dollars and weeks of my life to get to the route of? We can all take into account our annoying quirks, our faults, our strengths and weaknessess and apply it to our lives and patient care without needing therapy to do so.

At least in our free therapy clinic (so not just for billing), you need to have some type of pathology and goal in order for tx. You don't do exploratory surgery just to see what your insides look like, you need to be looking for something. If I'm seeing someone for med checks or therapy and they are doing well for an extended period of time, chances are I'm going to see them less frequently.

This is the crux of the issue behind a pathology vs. wellness model of treatment.

 

[AcronymAllergy]

This topic comes up semi-regularly on the psychology forum, so I can at least offer some of the perspectives mentioned on that side of things. Many of our doctoral programs actually require or strongly encourage students to participate in therapy. Mine didn't, and I've never sought it out myself, but I can see how it might be useful (particularly if there actually is psychopathology in play).

Additionally, there are certainly providers who focus more on general wellness, as nitemagi mentioned, than on pathology. Counseling psychology programs and providers tend to focus on this slightly more heavily in their training than clinical, so perhaps if you aren't comfortable seeking analytic therapy from someone with whom you might interact professionally in the future, you could consider the counseling psych route.

 

[DD214_DOC]

This is the crux of the issue behind a pathology vs. wellness model of treatment.

I once received a referral for a patient who was young, recently graduated college, and unable to secure gainful employment. He complained of being sad on occasion and frustrated with his situation, but otherwise was functional and negative for any real axis I diagnosis. There was nothing to treat with medications, but he wanted someone, "to gripe to" about his frustrations finding a job once or twice a month because it, "helped to vent".

I told him to call his mom.

 

[Doctor Bagel]

This topic comes up semi-regularly on the psychology forum, so I can at least offer some of the perspectives mentioned on that side of things. Many of our doctoral programs actually require or strongly encourage students to participate in therapy. Mine didn't, and I've never sought it out myself, but I can see how it might be useful (particularly if there actually is psychopathology in play).

Additionally, there are certainly providers who focus more on general wellness, as nitemagi mentioned, than on pathology. Counseling psychology programs and providers tend to focus on this slightly more heavily in their training than clinical, so perhaps if you aren't comfortable seeking analytic therapy from someone with whom you might interact professionally in the future, you could consider the counseling psych route.

The problem here is that our therapy community is pretty mixed between different degrees, so even seeing a non-psychiatrist doesn't totally fix the small community issue.

I'm amazed and happy to hear about all these programs that really emphasize this type of stuff.

 

[splik]

analytic training is fairly cultish and incestuous so it is the nature of the game even if places with larger analytic communities that your therapist will be someone you will find yourself bumping into particularly if you become an analyst yourself. Worst still is that in these sorts of communities it is likely they may know people who you have come into conflict with and that can be difficult too. At least (I hope) things have moved on from the days where one might end up seeing their own PD for psychotherapy! (This situation is described in The Psychiatric Interview in Clinical Practice)

 

[Doctor Bagel]

analytic training is fairly cultish and incestuous so it is the nature of the game even if places with larger analytic communities that your therapist will be someone you will find yourself bumping into particularly if you become an analyst yourself. Worst still is that in these sorts of communities it is likely they may know people who you have come into conflict with and that can be difficult too. At least (I hope) things have moved on from the days where one might end up seeing their own PD for psychotherapy! (This situation is described in The Psychiatric Interview in Clinical Practice)

Freud analyzed Anna Freud. That seems so inappropriate. Our PD is the psychiatrist with our resident wellness program, but he doesn't see psychiatry residents and removes himself from any discussion regarding a psychiatry resident, not even being told our names.