dianamd

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Hello,
Like some other people on this board, I am really thinking about going to UCLA for residency... It is a big move from New York, especially without a lot of family/friends on the West Coast.

One thing that is tough is to get an impression of what people think of UCLA Psych training. Respected? Too biological? I know that they are ranked high in USNews, but I have the feeling that there is a certain lesser respect given to UCLA perhaps because it doesn't have the "east coast prestige" of those programs in NYC and Boston.

I know that UCLA psych is very respected in California/the West, but not sure about nationally.... my family thinks I should go to Harvard/Yale, but it is mostly so they can feel good about themselves (even they acknowledge that being the motivation).

Any advice is much appreciated before I make this decision!!
Thanks.
 

Doc Samson

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Hello,
Like some other people on this board, I am really thinking about going to UCLA for residency... It is a big move from New York, especially without a lot of family/friends on the West Coast.

One thing that is tough is to get an impression of what people think of UCLA Psych training. Respected? Too biological? I know that they are ranked high in USNews, but I have the feeling that there is a certain lesser respect given to UCLA perhaps because it doesn't have the "east coast prestige" of those programs in NYC and Boston.

I know that UCLA psych is very respected in California/the West, but not sure about nationally.... my family thinks I should go to Harvard/Yale, but it is mostly so they can feel good about themselves (even they acknowledge that being the motivation).

Any advice is much appreciated before I make this decision!!
Thanks.
UCLA is plenty respected by those of us who trained out East - lots of our former colleagues are running around the place.
 

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I think the social/geographic differences between harvard/yale and UCLA are MUCH bigger than the reputation differences. Decide where you want to be for 4 years +/- the rest of your life.
 
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strangeglove

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I'm not so sure that Harvard and Yale are equivalent programs.
 

agrasky

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I'm not so sure that Harvard and Yale are equivalent programs.
What do you mean by this? could anyone elaborate on the differences between these 2 programs as I'm considering both. Info on Yale would be especially appreciated.
 

Doc Samson

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What do you mean by this? could anyone elaborate on the differences between these 2 programs as I'm considering both. Info on Yale would be especially appreciated.
Your first job is to define which of the 4 Harvard programs you're referring to.
 

mgdsh

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Rankings for various categories often change year to year or every few years, but you really shouldn't be concerned about the reputation of anything at UCLA. IMO and the opinion of many UCLA is the best all around school in the world.
 

strangeglove

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MGH/McLean is the research powerhouse of the Harvard system. Arguably, this program and Columbia are the top research programs in the country. Both are considered significantly more competitive than Yale, which is also a research-oriented program, as is UCLA.
 

dianamd

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I guess my real concern is that I worry that my UCLA training won't carry as much weight "back East," should I choose to return at a later date. Probably at most or all academic institutions, it will be well-respected. With the general public, probably more indifference than being impressed, at least relative to those people who actually know psychiatric institutions.

The other thing is that I am not sure that I will be as good of a therapist as I would from a comparable place - Yale or MGH/Columbia, or even NYU/Sinai in New York. There is something to be said for the generally neurotic culture in New York and Boston--in the Woody Allen way--that is conducive to learning the psychological aspects of psychiatry... as if it is treated more seriously in the general east coast culture, and that benefits the trainees.

There is also an aspect of learning dynamic therapy in a place where their is more narcissistic personality d/o, where medications are used perhaps more freely than they are in New York.

Basically I am deciding between UCLA and the places in New York (not Columbia) and possibly Longwood, Yale, or Brown -- less likely to any of those because of location. UCLA is a fantastic place, no doubt, but the others on that list are terrific as well. TOUGH CHOICE!!!
 

CaMD

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A someone who does not know you at all, who isn't sure your priorities in choosing a program, and who did not apply to most of those programs...it sounds to me like you want to stay east. :)
 

dianamd

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A someone who does not know you at all, who isn't sure your priorities in choosing a program, and who did not apply to most of those programs...it sounds to me like you want to stay east. :)
:)

Yes, it may sound that way - part of me is trying to convince myself to stay in NYC.

My reason for wanting to leave my home here, and the pros for UCLA (to me) are:

1. California and LA in particular is a fantastic place, people are nice in the hospital, it is relaxed even when your hours are long, and the weather is near-perfect.

2. UCLA is indeed one of the best hospitals in the country -- Probably the #1 overall hospital I saw.

Very wide patient population (indeed "Best in the West" for like 20 years). Semel Neuroscience institute attached to the psych hospital is a great preparation for where I see psychiatry heading -- more imaging, medication that is more tailored, etc.

Part of me is also tired of NYC after 8 years here and thinks that I need some change. I have mixed feelings about the prospect about basically making all new friends -- since it's not even like I can fly and see my friends over the weekend or something. I would like LA, but it is a long commitment and I don't want to be thinking about transferring one year from now.
 

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If you want to learn psychotherapy in residency these days, you're probably better off going to a program that really emphasizes this, since
it is something that is diminishing quite rapidly on the national stage. In other words, you want to be in a place that is defending against this actively and takes a stance about the teaching of psychotherapy to residents, as opposed to a place where this is merely taught in order to satisfy requirements for the boards. I'm not so sure that UCLA emphasizes psychotherapy in this way.
 

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If you want to learn psychotherapy in residency these days, you're probably better off going to a program that really emphasizes this, since
it is something that is diminishing quite rapidly on the national stage. In other words, you want to be in a place that is defending against this actively and takes a stance about the teaching of psychotherapy to residents, as opposed to a place where this is merely taught in order to satisfy requirements for the boards. I'm not so sure that UCLA emphasizes psychotherapy in this way.
If psychotherapy "is something that is diminishing quite rapidly on the national stage" (and sure it is), then why would you go to a place "that is defending against this actively and takes a stance about the teaching of psychotherapy to residents" ? Why would you need smth that is going to be extinct in 10-20 years, or will be practiced only by psychologists and SWs ? What is the point?
It seems to me that residencies like those are probably too much influenced by old school trained psychiatrists/ psychoanalysts, who would see the biological advances and the promotion of CBT as a profound narcissistic injury and a blow to their self image. And then would come the overcompensation by promoting psychodynamic psychotherapy in the face of a complete lack of evidence of its effectiveness.
I think that a primarily biological residency with a strong emphasis on neuroimaging, basic neural science, psychopharm, neurology and neuropsychiatry (UCLA rules there) would be a very good investment in the years to come. But the other programs mentioned also have very good reputation for biological psychiatry.
I would prefer UCLA over the harvard programs - Longwood, McLean, Cambridge and Brockton (that one for sure) simply for lifestyle reasons. I don't like Boston , and people in California are much more laid back. But otherwise, the Harvard programs (Brockton out of the equation) and UCLA have equally good reputation.
NYC programs are very different from each other. I don't know why you are not considering Columbia- it is by far the best program in NYC. Cornell and Montefiore in the Bronx would probably follow next. NYU and MSSM are no match for UCLA and I heard from ppl training there that the atmosphere in these places is not friendly. NYC Community hospitals, SUNY Downstate, SI "University" hospital etc. should be out of the equation. Since you are considering Harvard/ UCLA, the only NYC programs of interest would be Columbia, Cornell and Montefiore. Again, I would prefer UCLA over them for lifestyle reasons. 5 years in NYC is too much for me.
I don't know much about Yale and Brown.
 

Doc Samson

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If psychotherapy "is something that is diminishing quite rapidly on the national stage" (and sure it is), then why would you go to a place "that is defending against this actively and takes a stance about the teaching of psychotherapy to residents" ? Why would you need smth that is going to be extinct in 10-20 years, or will be practiced only by psychologists and SWs ? What is the point?
It seems to me that residencies like those are probably too much influenced by old school trained psychiatrists/ psychoanalysts, who would see the biological advances and the promotion of CBT as a profound narcissistic injury and a blow to their self image. And then would come the overcompensation by promoting psychodynamic psychotherapy in the face of a complete lack of evidence of its effectiveness.
I must've missed the memo re: CBT no longer being psychotherapy.

Would also note that psychodynamic psychotherapy is going nowhere, and that choosing willful ignorance of its practice is simple complicity with managed care's plan to turn us into med check technicians.
 

OldPsychDoc

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I must've missed the memo re: CBT no longer being psychotherapy.

Would also note that psychodynamic psychotherapy is going nowhere, and that choosing willful ignorance of its practice is simple complicity with managed care's plan to turn us into med check technicians.
Perhaps the idea you wished to express was that it is not going away.

Or perhaps you really meant "going nowhere"? :laugh:
 

masterofmonkeys

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If psychotherapy "is something that is diminishing quite rapidly on the national stage" (and sure it is), then why would you go to a place "that is defending against this actively and takes a stance about the teaching of psychotherapy to residents" ? Why would you need smth that is going to be extinct in 10-20 years, or will be practiced only by psychologists and SWs ? What is the point?
It seems to me that residencies like those are probably too much influenced by old school trained psychiatrists/ psychoanalysts, who would see the biological advances and the promotion of CBT as a profound narcissistic injury and a blow to their self image. And then would come the overcompensation by promoting psychodynamic psychotherapy in the face of a complete lack of evidence of its effectiveness.
While no one advocates using psychodynamic psychotherapy to cure schizophrenia (except for maybe Szasz), we are seeing more and more that the effects of SSRIs are not as strong as once thought, SNRIs may not be any more effective, relapse rates are higher when not accompanied by psychotherapy, etc.

A full evaluation of all SSRI studies reveal that pre- to post-treatment effect size is moderate at best. CBT enjoys at least as good an effect size (somewhat larger, in fact). Short term dynamic, IPT, and DBT, while not enjoying near as many published trials all show a similar if not greater effect.

Psychotherapy lost ground namely because of the rise of 'biological psychiatry'. Which was a flawed paradigm to begin with. Brain is behavior. Behavior is brain. Chemicals are emotions and thoughts. Thoughts and emotions are chemical. How you think changes the brain and the brain changes the way you think.

No drug will change persistent flawed thought patterns, nor change abusive relationships, although it might alleviate the psychological distress related to those things.

Psychotherapy can change the way you view the world, how you react to the world, and how you choose to live.

As the studies come out, we are having to accept that the biochemical model was an absurd reduction of a very complex phenomenon. And that pure biochemical treatment ignores the complexity of these diseases.

If psychiatry stays true to science and true to itself, the role of psychotherapy in psychiatry will only grow in years to come.
 

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While no one advocates using psychodynamic psychotherapy to cure schizophrenia (except for maybe Szasz), we are seeing more and more that the effects of SSRIs are not as strong as once thought, SNRIs may not be any more effective, relapse rates are higher when not accompanied by psychotherapy, etc.

A full evaluation of all SSRI studies reveal that pre- to post-treatment effect size is moderate at best. CBT enjoys at least as good an effect size (somewhat larger, in fact). Short term dynamic, IPT, and DBT, while not enjoying near as many published trials all show a similar if not greater effect.
Kinda confusing since you don't specify which disorder you refer to. Anyway, the data shows that CBT derived approaches give most robust results across the DSM labels. That is why they are actually promoted as even more evidence comes out. On the other hand, dynamic therapy is by default not subject to research since it cannot be standardized and manualized. That is why there is no evidence for its efficacy. The published studies about dynamic therapy that I came across, have no scientific value. Mostly they consist of case reports and meta analyses, but nothing original. Moreover, it is absolutely impractical to try to teach a resident in 4 years to become a dynamic therapist. You need at least 10 years in dynamic therapy practice to become a good therapist (again, no evidence for that, only impressions from seasoned analysts, who think that they are good therapists). So, what is the point of trying to do smth, that you cannot finish, is of very questionable efficacy and is going to be extinct very very soon? To me this is a lack of vision.
I think that residency education should be grounded on solid scientific proof, not assumptions and traditions. I am not saying that the resident should not have a flavor of dynamic therapy. It is important for historical reasons and for a more complete diagnostic picture, probably having 1 class in PGY 2 , reading the Gabbard's book and having 1 patient for dynamic therapy for 1 year. But to make it the primary mode of psychotherapy , like it is in some programs, to me this is ridiculous.
For a more complete discussion, the reader is referred to the article below. I would endorse Dr. Yager's position, not because he is affiliated with UCLA, but because he makes more sense.

http://ap.psychiatryonline.org/cgi/content/full/29/4/339
 

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First of all, I think it is important to differentiate between psychodynamic psychotherapies (i.e. therapies, including ego supportive psychotherapy, that assume that unconscious processes play some role in behavior) and psychoanalytic psychotherapy, which is a form of psychodynamic therapy that focuses on alteration of character through the uncovering and interpretation of unconscious phenomena. That being said, there is much in human behavior, even in a floridly psychotic schizophrenic, that is driven by unconscious motivations. You don't have to analyze them with the patient, but you need to be aware of them and how they will impact things like the patient's willingness to take medications or their interest in getting a job. And I'm not talking about Oedipal complex and such things - more like defenses, including acting out, projection, denial, and other phenomena that come into play especially in the sickest inpatients. These things aren't just happening because there's too much dopamine around, since not everyone with too much dopamine acts the same way.

Secondly, any good psychotherapist is not dogmatic in their approach to the patient and is open to the form of psychotherapy that is most appropriate for the patient. I'm not so sure that all programs that are teaching psychoanalytic psychotherapy are advocating this form of psychotherapy for every pathology. They are usually also teaching the so-called evidence based psychotherapies, too. And the good ones are also teaching about the brain as much as they are teaching about psychoanalysis, which is better than teaching only about one or the other.
 

strangeglove

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First of all, I think it is important to differentiate between psychodynamic psychotherapies (i.e. therapies, including ego supportive psychotherapy, that assume that unconscious processes play some role in behavior) and psychoanalytic psychotherapy, which is a form of psychodynamic therapy that focuses on alteration of character through the uncovering and interpretation of unconscious phenomena. That being said, there is much in human behavior, even in a floridly psychotic schizophrenic, that is driven by unconscious motivations. You don't have to analyze them with the patient, but you need to be aware of them and how they will impact things like the patient's willingness to take medications or their interest in getting a job. And I'm not talking about Oedipal complex and such things - more like defenses, including acting out, projection, denial, and other phenomena that come into play especially in the sickest inpatients. These things aren't just happening because there's too much dopamine around, since not everyone with too much dopamine acts the same way.

Secondly, any good psychotherapist is not dogmatic in their approach to the patient and is open to the form of psychotherapy that is most appropriate for the patient. I'm not so sure that all programs that are teaching psychoanalytic psychotherapy are advocating this form of psychotherapy for every pathology. They are usually also teaching the so-called evidence based psychotherapies, too. And the good ones are also teaching about the brain as much as they are teaching about psychoanalysis, which is better than teaching only about one or the other.
 

Doc Samson

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Kinda confusing since you don't specify which disorder you refer to. Anyway, the data shows that CBT derived approaches give most robust results across the DSM labels. That is why they are actually promoted as even more evidence comes out. On the other hand, dynamic therapy is by default not subject to research since it cannot be standardized and manualized. That is why there is no evidence for its efficacy. The published studies about dynamic therapy that I came across, have no scientific value. Mostly they consist of case reports and meta analyses, but nothing original. Moreover, it is absolutely impractical to try to teach a resident in 4 years to become a dynamic therapist. You need at least 10 years in dynamic therapy practice to become a good therapist (again, no evidence for that, only impressions from seasoned analysts, who think that they are good therapists). So, what is the point of trying to do smth, that you cannot finish, is of very questionable efficacy and is going to be extinct very very soon? To me this is a lack of vision.
I think that residency education should be grounded on solid scientific proof, not assumptions and traditions. I am not saying that the resident should not have a flavor of dynamic therapy. It is important for historical reasons and for a more complete diagnostic picture, probably having 1 class in PGY 2 , reading the Gabbard's book and having 1 patient for dynamic therapy for 1 year. But to make it the primary mode of psychotherapy , like it is in some programs, to me this is ridiculous.
For a more complete discussion, the reader is referred to the article below. I would endorse Dr. Yager's position, not because he is affiliated with UCLA, but because he makes more sense.

http://ap.psychiatryonline.org/cgi/content/full/29/4/339
This article was about RRC mandated assessment of competency in psychodynamic therapy. Joel Yager's argument (as many pro-psychodynamic PDs have pointed out) is that asking programs to assess "competency" in psychotherapy is a near impossible request - not that psychodynamic psychotherapy shouldn't be a major component of training.
 
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