Department of Psychiatry
School of Medicine Queen's University
 

Psychotherapy

Psychotherapy Training For Residents In The Department Of Psychiatry

Psychotherapy

Psychotherapy is a voyage of discovery. When spoken by the patient, and received without tumult by the therapist, isolating experiences and fears can be stripped of their power to limit and to harm. The patient’s need for symptoms and defenses must be explored, understood, and worked through before previously unknown aspects of the self can be integrated in a more stable and fulfilling life. Used creatively, talking is the channel through which a patient’s challenges and discoveries can be expressed and examined with the therapist and with other companions in the therapeutic enterprise, such as fellow members of a group or family. To be therapeutic, the process of understanding must be integrated with a process of change.

Psychotherapy Modalities

The psychotherapies are a variety of psychological treatments that help relieve symptoms and improve functioning in patients suffering from psychiatric disorders and psychological problems. Empirical evidence supports the use of a variety of psychotherapies as part of the treatment of patients with psychiatric disorders across the lifespan.

Training for Residents

Given the evidence for the effectiveness of psychotherapeutic treatment for a wide range of psychiatric conditions, graduating psychiatrists should be knowledgeable and sufficiently skilled to deliver some of these treatments to patients with psychiatric disorders.

Developmental Model

Fundamental skills focusing on alliance development should precede the learning of specific skills or therapies.  Learning of individual therapies should precede the learning of systemic therapies.

Therapeutic Alliance

The therapeutic alliance is defined as the fundamental relationship between the therapist and the patient, which is made up of the following three components:

  • A bond (relational component)
  • Mutually agreed-upon goals
  • Tasks (means to attain goals)

Therapist Attributes

  • Warmth
  • Genuineness
  • Respectfulness
  • Capacity for Empathy

Basic Therapeutic Techniques

  • Empathic Reflection
  • Affective Exploration
  • Supportiveness
  • Facilitation of the expression of affect
  • Attention to the patient’s experience

Positive Outcome

Expression of positive therapist attributes and consistent and effective use of basic therapeutic techniques have an impact on positive therapeutic outcome.  They are key capacities to learn and demonstrate in psychotherapy training.

Period of Training

Training in the evidence-based psychotherapies must involve no less than a full 32 weeks or eight months of the 60-month period of training (1200 hours).

  • Structured didactic learning
  • Patient treatment
  • Supervision

Levels of Knowledge

Proficiency: the resident is the primary therapist with one hour of weekly supervision

Working knowledge: participation as an observer or co-therapist

Basic or introductory knowledge: didactic seminars or structured learning activities

Proficiency

  • Cognitive Behavioural Therapy
  • Psychodynamic Psychotherapy
  • Supportive Therapy
  • Crisis Intervention

Working Knowledge

  • Behavioural Therapy
  • Dialectical Behavioural Therapy (DBT)
  • Family or Group Psychotherapy
  • Interpersonal Therapy (IPT)

Basic Knowledge

  • Brief Psychodynamic Psychotherapy
  • Mindfulness Training
  • Motivational Interviewing
  • Relaxation