Psychotherapy Division

Robert Gregory, MD, Director

The Psychotherapy Division is responsible for developing the psychotherapy curriculum for psychiatry residents, and promoting, supporting, and coordinating psychotherapy clinical and research activities within the Department.  Our Department is unusual in having several unique and innovative aspects of our training program, such as:

• A coherent, progressive 4-stage model of psychotherapy training. This model is shaped like a martini glass, with empathic capacity and reflective functioning forming the base, common factors the stem, and specific modalities the bowl
• Emphasis on building reflective functioning and empathic capacity
• A mentoring program for all PGY-1 and PGY-2 residents
• A one-year seminar on biopsychosocial formulation to develop integrated thinking across different domains
• A comprehensive webcam system for recording and observing interviews
• Expectation for basic competency in several psychotherapy modalities and advanced competency in at least one modality by the time of graduation
• Several of our full-time faculty choosing psychotherapy as their primary clinical and academic interest

4-Stage Model of Psychotherapy Training

Sequential Training Objectives by Postgraduate Year:

1. Build empathic capacity and reflective functioning.
2. Build integrative thinking and ability to apply common factor skills to clinical encounters.
3. Develop basic competency in cognitive behavioral, psychodynamic, and family therapies.
4. Develop basic competency in group, adolescent, and geriatric therapies and advanced competency in at least one therapy modality.

Some key assumptions of our training model:

• Residents come into training relatively lacking reflective functioning, including empathic capacity and complex decision-making, due to dehumanizing aspects of medical school training.
• Residents have a strong need to feel competent as a psychiatrist. They often cope with this situation by endorsing simplistic views of psychopathology, avoiding paying attention to upsetting experiences, and having strong “therapeutic ambition”.
• Psychotherapy is less about doing something to a patient than a way of being with a patient. It involves staying close to experience while paradoxically maintaining reflective space.
• All interactions, including evaluations and med management visits have the potential to be therapeutic. The physician-patient relationship forms a core of all effective psychiatric interventions.
• The development of reflective functioning requires a holding environment sufficient to contain feelings of shame, anger, and incompetence, and that provides opportunities to verbalize emotions and experiences with another person.
• No model of psychotherapy, whether psychodynamic or CBT, or even psychopharmacology, is going to be effective without reflective functioning.

Psychotherapy-Related Didactics

PGY-I

• Cornerstone Program (first month)/Psychiatry Clinic (on-going). These programs foster reflective functioning through discussions of family of origin experiences, clinical experiences, videorecordings of interviews, role playing, and other experiential activities. 
• Mentorship program (on-going).  Provides support and facilitates residents talking about their experiences.
• Participation in the resident-run support group is strongly encouraged.
• Family therapy consultation program on 4B Inpatient Unit (on-going both PGY-I and II).

PGY-II

• Biopsychosocial Formulation (on-going). Each resident in the seminar presents a case over 3 classes. We review the history, observe a video recording, and then everyone writes a formulation of that case.
• Common Factors in Psychotherapy (on-going). This course teaches residents to apply common factor skills, such as active listening, building and repairing the alliance, setting expectations, establishing the frame, motivating, and using transference and countertransference.
• Foundations of Human Experience (on-going).  Covers ego functioning and defenses, object relations, affective neuroscience, attachment, behavior and learning theory, child development, play, sexuality, and family systems
• Introductions to CBT, DBT, DDP, play therapy, and SCT.

PGY-III

• Dedicated weekly CBT, psychodynamic, child, family, and combined medication management/psychotherapy supervision (on-going)
• Theory/Practice of Individual Psychotherapy (26 sessions). This is a survey course of major figures and concepts in psychodynamic theory.
• Monthly Case Conference.  Dr. Gabbard utilizes a case-based format to review key concepts from his book, Long-Term Psychodynamic Psychotherapy: A Basic Text.

PGY-IV