Do most Psychiatry residencies offer the chance for great training in Therapy??

[psychMDhopefully]

I know most psychiatrist don't do therapy because they can make more money, or employers push them to do med checks, but with most adequate psychiatry programs, can you get good at therapy if you want to?

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[splik]

no, not most but many

 

[Shikima]

Would be good if the RRC could come up with better milestone proficiencies and directed educational content/goals for psychotherapy training during residency that spanned the breadth and depth away from psychodynamic only.

 

[SourceOfDenial]

I think it's quite residency dependent. Some programs really emphasize it. If you are looking for a program with strong psychotherapy training, look at who the faculty is, how they specifically do psychotherapy didactics, if recording sessions is required or suggested(and how they are reviewed), how good psychotherapy cases are identified for residents. Also a program that is flexible can be really helpful. I'm in my last year of training at University of Louisville, and have an abundance of psychotherapy cases. A half day a week is protected, plus an hour weekly for supervision. Program gave me an extra 3-4 hours a week for psychotherapy, an additional supervisor(have a psychodynamic supervisor and a more analytically trained supervisor, protected time for my own weekly psychotherapy, and then to get additional training with adolescents go to the child clinic for a case.

Still, I think psychotherapy training is not nearly as robust as say in some MFT programs. I spent a lot of extra time teaching myself CPT, DBT, MBSR to further bulk up my skills.

 

[Amygdarya]

MFT programs

?

 

[SourceOfDenial]

?

Marriage and family therapy.

 

[Amygdarya]

Marriage and family therapy.

Thank you!

 

[splik]

Still, I think psychotherapy training is not nearly as robust as say in some MFT programs. I spent a lot of extra time teaching myself CPT, DBT, MBSR to further bulk up my skills.

I'm not sure why you are making this comparison. MFTs often have pretty poor training, and the ones that are well trained are trained primarily in couples and family therapy (which is of course why they are called MFTs) - two areas that are now distinctly lacking in psychiatry residency training. They might also potentially have more training in sex therapy than the average resident in this day and age. They do not tend to have particularly good training in individual therapy (though often practice in this area). The approach is supposed to systemic - something that is again conspicuous by its absence in psychiatry training. The MFTs would refer the more difficult patients to me for psychotherapy when I was a resident which I think says it all really. Many masters level therapists are completely ill-equipped to deal with patients with personality disorders which is most patients seeking long-term psychotherapy in this day and age. They are more likely to see patients who have relational problems, whereas psychiatrists tend to see people with some degree of so-called mental illness (try as they might to avoid this).

 

[SourceOfDenial]

I'm not sure why you are making this comparison. MFTs often have pretty poor training, and the ones that are well trained are trained primarily in couples and family therapy (which is of course why they are called MFTs) - two areas that are now distinctly lacking in psychiatry residency training. They might also potentially have more training in sex therapy than the average resident in this day and age. They do not tend to have particularly good training in individual therapy (though often practice in this area). The approach is supposed to systemic - something that is again conspicuous by its absence in psychiatry training. The MFTs would refer the more difficult patients to me for psychotherapy when I was a resident which I think says it all really. Many masters level therapists are completely ill-equipped to deal with patients with personality disorders which is most patients seeking long-term psychotherapy in this day and age. They are more likely to see patients who have relational problems, whereas psychiatrists tend to see people with some degree of so-called mental illness (try as they might to avoid this).

Huh, where are you located? Possibly there aren't many good LMFTs(or maybe you don't know as many) in your area or more psychotherapists come from CSW programs. Yes, MFTs train in couples and families, but there is a lot of individual psychotherapy hours and supervision. Also Id guess greater training in individual psychotherapy modalities than there are in psychiatry training. The LMFTs I know and refer patients too all do individual work, and use CBT, CPT, DBT, EMDR, MBSR, emotionally focused work, in addition to psychodynamic if that is their preferred modality. I've found they have been less likely to pathologize than my psychiatry brethren. For really difficult trauma cases I will often call several of my LMFT colleagues to make a referall. I've found it's partially a location thing too, MFT programs are much more popular in certain parts of the country it seems.

In addition, our program will routinely refer residents to MFTs for their own individual therapy. Could it possibly be you aren't as familiar with MFT training programs, the supervision and licensing requirement?

 

[Merovinge]

The LMFTs I know use EMDR

Ergh

 

[smalltownpsych]

Midlevel therapists might know all the initials of various popular therapies, but that doesn't necessarily mean they know what they are doing. In fact, what I have seen is a negative correlation between competency and number of therapies espoused. As a clinical director I hired and supervised many midlevel therapists and can tell you that there is a wide variance in competency and even the best struggle with some of the core competencies that a psychologist or psychiatrist has. With understanding and ability to interpret research and knowledge of legal and ethical issues being the first that spring to mind.

 

[milesed]

You should get most of your mandatory therapy training during the 3rd year of residency and can do as much as you are interested in during your 4th year.

 

[Nasrudin]

I really love my therapy training. I did not come to applying to residencies even knowing what 'therapy training' meant. Or what I should look for.

I think good case selection and good supervision and some good engaging didactics are a good basis. Reading on your own is big too. And finally being in therapy with a master therapist.

I have the luck of all of these. And the curiosity to read. My biggest piece of luck was being assigned to some of my program's best supervisors. I don't know how you would look for these details as an applicant. Block didactic time would be a vague measure.

 

[MiddleRoad]

I really love my therapy training. I did not come to applying to residencies even knowing what 'therapy training' meant. Or what I should look for.

I think good case selection and good supervision and some good engaging didactics are a good basis. Reading on your own is big too. And finally being in therapy with a master therapist./QUOTE]

These are the things you should ask residents and faculty about when you're interviewing (if quality of psychotherapy training is a primary concern of yours).

Ultimately, a program that can offer all of this to you provides the tools for getting adequate training in psychotherapy. The resident then has to actively use these opportunities to become competent in psychotherapy. It takes a lot more self-motivated activity and experiential learning than learning how to become competent in psychopharmacology.

 

[MiddleRoad]

I know most psychiatrist don't do therapy because they can make more money, or employers push them to do med checks, but with most adequate psychiatry programs, can you get good at therapy if you want to?

This assumption has been debated repeatedly on other threads. The bottom line is that while the majority of psychiatrists may not have cases that are psychotherapy only, there are many psychiatrists who do. This type of mixed practice occurs in certain urban centers in this country that account for a significant portion of the population, but a very small percentage of the land mass.

My opinion is that every psychiatrist, even those who primarily focus on pharmacology, should have at least some basic experience in psychotherapy. It will help with diagnosis, understanding character pathology, managing maladaptive thoughts and behaviors, fostering motivation, being mindful of transference/countertransference, and working with resistance. An expert psychopharmacologist lacking these skills will generally have far less treatment success than the equivalent person who is also proficient in these basic psychotherapeutic principles. I hesitate with this analogy because I hate the cliche split between psychopharmacologist and psychotherapist. Simply put, many great psychiatrists can do both.

 

[Nasrudin]

These are the things you should ask residents and faculty about when you're interviewing (if quality of psychotherapy training is a primary concern of yours).

Ultimately, a program that can offer all of this to you provides the tools for getting adequate training in psychotherapy. The resident then has to actively use these opportunities to become competent in psychotherapy. It takes a lot more self-motivated activity and experiential learning than learning how to become competent in psychopharmacology.

I don't know that an interviewee could get an accurate answer to this from interview selection process. Maybe. It's worth a try, if it means something to you.

 

[HarryMTieboutMD]

I really love my therapy training. I did not come to applying to residencies even knowing what 'therapy training' meant. Or what I should look for.

I think good case selection and good supervision and some good engaging didactics are a good basis. Reading on your own is big too. And finally being in therapy with a master therapist.

I have the luck of all of these. And the curiosity to read. My biggest piece of luck was being assigned to some of my program's best supervisors. I don't know how you would look for these details as an applicant. Block didactic time would be a vague measure.

This is absolutely NOT required and unfortunately is encouraged by departments around the country. Sure, plenty of people would respond with anecdotal statements filled with false bravado ("oh, I never realized how much being a patient and in therapy myself really made me a better therapist"), which is generally complete BS. Your attendings/therapy supervisors do not need to know your personal business; if you need therapy for whatever reason, that's a separate issue and ideally should be with someone not in your department (or for financial reasons if you need to use someone in house the therapist should be as minimally involved in your education as possible).

Countertransference issues can be dealt with using good supervision but this does not mean you need to be a therapy patient. And common factors (warmth, empathy, genuineness, etc) are learned skills that are honed over time.

But yes, cases, supervision, and reading are indispensable.

 

[TheRiddler]

This is absolutely NOT required and unfortunately is encouraged by departments around the country. Sure, plenty of people would respond with anecdotal statements filled with false bravado ("oh, I never realized how much being a patient and in therapy myself really made me a better therapist"), which is generally complete BS. Your attendings/therapy supervisors do not need to know your personal business; if you need therapy for whatever reason, that's a separate issue and ideally should be with someone not in your department (or for financial reasons if you need to use someone in house the therapist should be as minimally involved in your education as possible).

Countertransference issues can be dealt with using good supervision but this does not mean you need to be a therapy patient. And common factors (warmth, empathy, genuineness, etc) are learned skills that are honed over time.

But yes, cases, supervision, and reading are indispensable.

You need more analysis.

 

[Nasrudin]

This is absolutely NOT required and unfortunately is encouraged by departments around the country. Sure, plenty of people would respond with anecdotal statements filled with false bravado ("oh, I never realized how much being a patient and in therapy myself really made me a better therapist"), which is generally complete BS. Your attendings/therapy supervisors do not need to know your personal business; if you need therapy for whatever reason, that's a separate issue and ideally should be with someone not in your department (or for financial reasons if you need to use someone in house the therapist should be as minimally involved in your education as possible).

Countertransference issues can be dealt with using good supervision but this does not mean you need to be a therapy patient. And common factors (warmth, empathy, genuineness, etc) are learned skills that are honed over time.

But yes, cases, supervision, and reading are indispensable.

Who said anything about supervisors. Maybe the culture is different elsewhere. All I know is. For this brief period of my life I have benefits that enable to see a analyst/psychotherapist who I never could've afforded before. Who has spent decades writing and thinking about therapy and philosophy and such.

And experiencing how he works with me is a master class in myself and in the techniques in play.

Its not necessary. But I also think it doesn't need to be needed. Optimization and clarification of self to the oneself is a fine goal for this type of thing.

Do it or don't.

But I maintain. It's augmenting my training in ways I think I would be remiss otherwise.

 

[NickNaylor]

This is absolutely NOT required and unfortunately is encouraged by departments around the country. Sure, plenty of people would respond with anecdotal statements filled with false bravado ("oh, I never realized how much being a patient and in therapy myself really made me a better therapist"), which is generally complete BS. Your attendings/therapy supervisors do not need to know your personal business; if you need therapy for whatever reason, that's a separate issue and ideally should be with someone not in your department (or for financial reasons if you need to use someone in house the therapist should be as minimally involved in your education as possible).

Countertransference issues can be dealt with using good supervision but this does not mean you need to be a therapy patient. And common factors (warmth, empathy, genuineness, etc) are learned skills that are honed over time.

But yes, cases, supervision, and reading are indispensable.

I would disagree. I find my experience as a patient extremely valuable, both personally and professionally. I think there is value in playing the patient role that can provide useful insights as a clinician. I wouldn't go so far as to say that everyone should be in therapy, but for those that are thinking about it, I do think that it's a valuable experience if it's something that you can fit into your schedule are willing to pay for. I do agree that working with a faculty member that could possibly supervise you and/or be involved in your academic dealings isn't a wise idea - at my program, however, this is not a concern as all of the therapists that provide reduced-fee therapy for residents are generally not involved in resident supervision or otherwise involved in the department at a significant level.

That being said, at my program we are very much encouraged to get involved with therapy and have a specific liaison at the psychoanalytic institute to help us get plugged in with training analysts willing to work with residents for a reduced fee. The ability and value of psychotherapy is institutionalized, so it is easy to get involved with.

YMMV. This seems to be a pretty polarizing topic, but speaking for myself I'm glad to be doing it and am more than willing to pay the costs - both financially and with my time. I will also say, however, that I'm interested in making psychotherapy a core part of my practice, so I think I have a somewhat different perspective than the average resident.

 

[Nasrudin]

I would disagree. I find my experience as a patient extremely valuable, both personally and professionally. I think there is value in playing the patient role that can provide useful insights as a clinician. I wouldn't go so far as to say that everyone should be in therapy, but for those that are thinking about it, I do think that it's a valuable experience if it's something that you can fit into your schedule are willing to pay for. I do agree that working with a faculty member that could possibly supervise you and/or be involved in your academic dealings isn't a wise idea - at my program, however, this is not a concern as all of the therapists that provide reduced-fee therapy for residents are generally not involved in resident supervision or otherwise involved in the department at a significant level.

That being said, at my program we are very much encouraged to get involved with therapy and have a specific liaison at the psychoanalytic institute to help us get plugged in with training analysts willing to work with residents for a reduced fee. The ability and value of psychotherapy is institutionalized, so it is easy to get involved with.

YMMV. This seems to be a pretty polarizing topic, but speaking for myself I'm glad to be doing it and am more than willing to pay the costs - both financially and with my time. I will also say, however, that I'm interested in making psychotherapy a core part of my practice, so I think I have a somewhat different perspective than the average resident.

Yes. I want to offer competent therapy as part of my practice.

What I've learned is from a variety of sources. One of which is my therapist. Is that becoming skillful at it it another 10 year project. I'm looking to cut down that learning curve if possible. I don't see how I could glimpse the work of a master without being his client.

This is secretive stuff.

They don't have the same culture of training gawking medical students that we do.

One on one supervision with recorded sessions. And your own therapy are essential.

Because .... How else could you do it? It's a striking slow process.

Which is daunting to residents who are reaching the end of on huge 10 year climb.

One has to reconcile to a life of learning. Struggle. And challenge seeking.

The quality of therapy training, may have considerable institutional variation, but is has even more resident variation.

I've been coming to realization that I'll have to work hard at with what opportunities I do have and then get extra training after residency.

This whole premise. Of doing that is remarkably at odds with all the economics and social forces acting on medicine as a whole.

Which is attractive to a born heretic like myself.

But applicants interested in this endeavor should do whatever they can to judge the therapy opportunities in programs. I'm just not convinced there's a way to do that. Except by reputation in the shrink community.

 

[Nasrudin]

One thing I've noticed that is helping me is a training environment for psychologists in your program which means that teaching psychotherapy infrastructure will already exist around you.

 

[tr]

One on one supervision with recorded sessions. And your own therapy are essential.

Because .... How else could you do it? It's a striking slow process.

I found review of recorded sessions marginally useful, though frustratingly after-the-fact. Own therapy was an interesting experience but as a teaching tool, extremely limited and not particularly useful for learning how to provide same.

By far the most effective education in psychotherapy I received was hands-on model therapy in small groups, seeded with experienced clinicians, taking turns playing patient and provider, where we were able to practice therapy techniques, receive real-time feedback, and use role-play and reverse role-play to trial different variations and experience the different effects of each, from perspectives of both patient and therapist. No other educational experience came close to this one IME.

 

[Nasrudin]

I found review of recorded sessions marginally useful, though frustratingly after-the-fact. Own therapy was an interesting experience but as a teaching tool, extremely limited and not particularly useful for learning how to provide same.

By far the most effective education in psychotherapy I received was hands-on model therapy in small groups, seeded with experienced clinicians, taking turns playing patient and provider, where we were able to practice therapy techniques, receive real-time feedback, and use role-play and reverse role-play to trial different variations and experience the different effects of each, from perspectives of both patient and therapist. No other educational experience came close to this one IME.

Yeah we're doing that in our didactics too. I learn a lot from it. Maybe i'm underestimating it currently.

 

[Osteoth]

I know most psychiatrist don't do therapy because they can make more money, or employers push them to do med checks, but with most adequate psychiatry programs, can you get good at therapy if you want to?

I was under the impression you could make more doing therapy? 20 hours at $300/hour is 300k before tax.

 

[singasongofjoy]

How common is it for psychiatry residents to be in a place where they can work/train with psychologists? When I was on internship for psychology, psychiatry residents rotated through the clinic I was working in, and a couple of the other clinics as well. The supervisors were great about incorporating them into some therapy sessions, and we would occasionally have joint psychiatry/psychology presentations. The learning certainly went both ways- I loved having them sit in on or be part of my sessions and then discussing it afterwards. Is that type of overlap more the norm or the exception?