Psychotherapy training for Psychiatric trainees

Psychotherapy experience is an important component of specialist training in Psychiatry. Royal College has implemented this in the Core Curriculum. The key aim of this experience is Psychotherapeutically informed practice. Please refer to:

Psychotherapy is recognised as an essential Psychiatry training component not only in the UK, but also elsewhere in Europe. The Royal College has played an important part in developing harmonised medical specialist training guidelines in Europe for over 20 years. If you wish to read more, refer to the Chapter 6 of the European Training Charter for Medical Specialists in Psychiatry.

Psychiatric Trainees, especially when beginning their training, have been interested in the psychotherapy aspect of Psychiatric practice. A study by Psychotherapy Working Group of European Federation of Psychiatric Trainees ( EFPT ) in 2017 in a sample of 572 trainees of found that about 90% of trainees are consider psychotherapy to be an important part of their professional identity and only slightly fewer trainees would wish to practice some form of psychotherapy upon finishing their training, especially if a psychiatry training scheme funded psychotherapy qaulifications were more readily available.

Psychotherapy training for Core Trainees in Psychiatry in BEH

In Haringey, Barnet and Enfield there should be access to different psychotherapy therapy experiences:

  • Balint Groups
  • Psychodynamic Psychotherapy
  • Cognitive Behavioural Therapy
  • Systemic Family Therapy *
  • Cognitive Analytic Therapy *
  • Mentalization Based Therapy *
  • Psychodynamic Group Therapy *

* some BEH sites only; you may wish to consider those differences when planning your training at BEH. I have not seen anyone do this in practice.

All of these experiences should allow for WPBAs from CBDGA (Balint groups) to SAPEs and PACEs to meet your curriculum requirements.

How to plan your supervised therapy cases

With exception of Balint groups you will be expected to make process notes of the session for your supervision.

Process notes

Do allow enough time for writing up the session. Regardless of the modality of treatment you may expect to spend about an hour on writing up a session. Do try to accomplish this on the same day, but if you must do it some other day - spend at least 10 minutes on jotting down some skeleton notes. They will help you to write up the session even a day or two later. Try to have full notes, or at least skeleton notes for every session.

Psychodynamic psychotherapy session writeups usually are 1200 to 1500 words long and tend to fill about 3 pages.

Formulation

Typically your weekly supervision session will last an hour and you will share it with one or two other trainees. Therefore you may not need to present your session every time. However you can and you should write a formulation of your patient that you can update every couple of weeks - as your understanding of the patient grows. You will find this helpful and rewarding and it will allow you to gain a better understanding of what you are working on. Moreover - if you practise this skill regularly, the ending summary for the case will come easy.

Formulation should read simple, but it can feel difficult to write. It is not a diagnosis, nor it is plain recounting of facts of history. It is your view on how the patient’s main difficulties have developed, how they are maintainted and where they are now (i.e. if there is any change) at this stage of treatment. This is relevant, with some modifications, to all types of therapy. As a rough guide - you should be able to fit your formulation in 3 to 5 paragraphs and on about half or maybe two-thirds of an A4 page. Your formulation will be influenced by theory (the type of therapy you are undertaking), but you can actually keep it remarkably free from professional jargon. It is perfectly ok to write in a common-sense language.

The usual experience when starting with formulation is to write lots of history, very little of your own thoughts and then it becomes too long. This is not a failure, this is how most people start. Then you can go on and cut back on what is less relevant to what you want to convey about the patient and their progress in therapy at this time.

Be in touch with your psychotherapy supervisors and tutor

Your time spent in acquiring psychotherapy competences needs to be adequately protected. If you find it difficult, please speak to your supervisors - clinical supervisor, educational supervisor, case supervisor and trust psychotherapy tutor.

On-line resources

There is an interesting psychotherapy guidebook project by psychiatry trainees for psychiatry trainees. It is an on-going project that contains informal descriptions of various therapies that trainees have had experience with:

Austria - trainee achievement

In 2007 Austrian psychiatric trainees made an observation that most psychiatrists trained in some form of psyhcotherapy, but had to pay for it from their own pocket.

Psychotherapy training, thanks to the intiative of the Austrian trainee organisation, has been incorporated in Austrian psychiatric training as mandatory. Therefore if you are going to become a psychiatrist in Austria - you will have to also become a qualified psychotherapist in a recognised therapy modality of your choice. You will need to have self-experience (i.e. your personal therapy; the experience of being a patient) even if you choose to learn CBT or other non-psychodynamic therapy. The upside of such arrangement is that the training scheme (i.e. the state - see here ) pays for this.

References

  1. UEMS. Charter on Training of Medical specialists In The EU: Training Requirements For The Speciality Of Psychiatry. (2017).
  2. Awal, M. CT1-3 Psychotherapy Training Guide for Trainees. (2016).
  3. Gargot, T. et al. How is psychotherapy training perceived by psychiatric trainees? A cross-sectional observational study in Europe. European Psychiatry 45, 136–138 (2017).
  4. Fleischhacker, W. W. & Wancata, J. Psychiatry in Austria. International Psychiatry 4, 86–88 (2007).
  5. CT 1-3 Psychotherapy Training Guide for Trainees. Royal College of Psychiatrists (2017)
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Psychotherapy Tutor
Psychotherapy Trainer for Psychiatric Trainees

My professional interests are around practice of psychotherapy within psychiatry.