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| Training in Psychotherapy |
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At a recent American Psychiatric Association meeting, Robert Michaels suggested that psychiatric residency training programs need to train psychiatrists for 40 year careers, with the understanding that the health care system in which psychiatry is practiced may change every 15 to 20 years. Accordingly, it is important to educate psychiatrists in core concepts that will enhance their clinical abilities no matter what the reimbursement climate is at a given time. At The University of Arizona we believe that training our residents broadly is important to prepare them for life-long careers. Our residents develop an understanding of the basic concepts and theories of psychodynamically-oriented psychotherapy, cognitive behavioral therapy, couples and family therapy, group therapy, brief therapy, and crisis intervention. During the PGY-1 year attention is paid to the physician-patient relationship, and the basics of that relationship are addressed in an interviewing course. This course includes sessions on the structure and organization of a psychiatric interview and in-depth discussions of the clinical examination. A case conference is a part of this course. During the PGY-2 year a weekly course entitled "Conceptual Foundations of Psychodynamic Psychotherapy" is taught. This seminar focuses on clinical illustrations of psychodynamic concepts, including empathy, the therapeutic alliance, boundary management, the unconscious, repression and defenses, developmental lines, transference, countertransference, the drive and defense conflict model, object relations, self-psychology, insight, selecting patients for psychotherapy, and psychodynamic formulation. During the PGY-2 year, residents begin seeing weekly outpatients with individual supervision. Group therapy training begins in the second year when residents conduct a daily inpatient therapy group at University Medical Center which is supervised by a faculty member. During the PGY-3 year, third year psychiatric residents are assigned to the outpatient division at University Medical Center where they see approximately 15 hours per week of ongoing outpatients, in addition to outpatient psychiatric consultations and emergencies. The residents have five hours per week of individual supervision. Three hours per week are for seeing new patients with a faculty member present, one hour per week is for supervision of long-term therapy patients, and one hour per week is for group therapy supervision. Residents see a wide range of patients both diagnostically and in terms of socioeconomic status. The resident's education is supplemented by a weekly outpatient case conference and several didactic seminars focusing on advanced psychotherapy topics, such as object relations and self-psychology. Additional seminars are taught in conducting brief psychodynamic psychotherapy. An intensive cognitive and behavioral therapy seminar series is taught during the second year where residents are taught the theoretical background of cognitive behavioral therapy and clinical applications, for depression, for relaxation, for systematic desensitization, for panic disorder and for generalized anxiety disorders, and for insomnia. A year long continuous case seminar is taught in the third year, in which residents meet together with faculty to present video recordings of sessions with selected patients. In addition, reading for this seminar focuses on the clinical application of various psychodynamic concepts as well as basic principles of emotion-focused psychotherapy. The third year residents observe a faculty psychiatrist conducting psychotherapy through a one-way mirror for one year, so that they see the beginning, intermediate, and termination phases of therapy. A 14-session course on family therapy is conducted in the second year. Residents are required to follow families and couples in their third year. They learn the history of family therapy; the use of genograms in family therapy; family life cycle assessment; interventions using structural approaches, multigenerational approaches, strategic approaches; cognitive behavioral; and communication training approaches. Residents in the third year learn group psychotherapy by co-leading a group and by didactic and supervisory experience in group psychotherapy. During the PGY-4 year, residents attend a year-long seminar on advanced psychodynamic concepts and the psychodynamic treatment of borderline and narcissistic character disorders. Residents also attend a weekly case conference that is also attended by third year residents. Residents carry five to six hours per week of psychotherapy patients, including several hours of long-term therapy patients throughout the fourth year. There are a number of electives available in psychotherapy during the fourth year.
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