At the Fall Meeting in New York City, a discussion group on psychiatric education dealt with the problem of ensuring high-quality psychotherapy training for psychiatric residents and the initiatives in this area undertaken by the American Psychiatric Association (APA).
Psychiatric residents face the challenge of securing a well-rounded education in a system driven by market forces, which demands more “efficient” psychiatrists. “Efficiency” in this context means decreased treatment duration and lower reimbursement for psychotherapy by psychiatrists. The explosion of psychopharmacological treatment options has allowed partitioning of psychiatric patient care. Managed care organizations claim that non-physicians are less expensive and more efficient at providing psychotherapy. Thus they are reluctant to reimburse psychiatrists for this procedure. These changes are reflected in the recent and rapid restructuring of psychiatric training programs.
One goal of the APA's Commission on the Practice of Psychotherapy by Psychiatrists (COPP) is to preserve psychotherapy training to ensure that future psychiatrists remain able to integrate biological, psychological, and social aspects of diagnosis and treatment of mental illnesses. Norman Clemens, chair of COPP, and Eva Szigethy, resident representative to COPP and a 1997-98 Fellow of the American Psychoanalytic Association, discussed some of the commission's initiatives at the New York meeting.
Szigethy reported on an informal survey of 106 residents. Ninety-eight percent believed that expertise in psychotherapy must remain an integral part of their core clinical skills. The same percentage reported that the practice of psychotherapy had a significant impact on their job satisfaction as psychiatrists and that psychiatrists could not maintain their role as mental health-care team leaders without having mastered the basic skills of psychotherapy. More than two-thirds of the residents said that a basic level of competence was essential in psychodynamic, cognitive-behavioral, interpersonal, group, and family therapy. Although three-quarters of the respondents believed that their programs had educational and financial resources to support psychotherapy training, approximately half did not believe they were getting adequate supervision in various types of psychotherapy.
In an effort to help maintain a high level of psychotherapy training, the APA, in conjunction with the American Association of Directors of Psychiatric Residency Training, is developing a program to provide residency educators and interested residents with an intense week-long workshop on methods of psychotherapy training, supervision, and assessment of trainee competence. Glen Gabbard, also a member of COPP, is developing seminars for psychiatric educators in teaching psychodynamic psychotherapy — a “train the trainers” seminar. As another alternative for upgrading psychotherapy training, the APA is hoping to develop teaching tapes and software.
Donna Chen, a member of the APA Task Force on District Branch/APA Partnership and a 1997-98 Fellow of The American, hopes to include district branches of the APA in these efforts. She asked the discussion group to consider ways of involving The American in some of these efforts. One suggestion was to adapt the “Visiting Psychodynamic Professor” concept to the APA's district branches. Another was to hold “Residents and Early Career Psychiatrists Day” at regional and local-level meetings of the APA.
Another opportunity to involve The American in APA educational projects is a workshop modeled on one Chen is chairing with Carlos Blanco (a 1996-97 Fellow of The American) at the 1998 APA Annual meeting in Toronto on applying psychodynamic principles to the variety of clinical settings in which residents practice. This workshop — “The Psychodynamic Formulation: Why Bother?” — features presentations by three Fellows of The American, with Robert Michels and Paul Ornstein as discussants.
We will continue to work, both in the APA and in The American, to strengthen coalitions to ensure high-quality psychotherapy training for psychiatric residents and to maintain the practice of psychotherapy by psychiatrists. Please contact us with any ideas you may have or if you are interested in hearing more about APA initiatives in this area. Donna Chen can be reached by e-mail at dc175@columbia.edu, by telephone at 212-543-5516, or by fax at 212-543-5356. Eva Szigethy can be reached by e-mail at eszigethy@aol.com, by telephone at 216-844-1783, or by fax at 216-844-5883.
Donna Chen, M.D., M.P.H., is chief resident at Columbia University/New York State Psychiatric Institute. She is a 1997-98 Fellow of The American, an APA/Bristol-Myers Squibb Fellow, and a resident representative on the APA Board of Trustees. She is a member of the APA Joint Commission on Public Affairs and the Task Force on District Branch/APA Partnership. Eva Szigethy, M.D., Ph.D., is a first-year Child and Adolescent Fellow at Case Western Reserve University. She is a 1997-98 Fellow of The American, the member-in-training representative to COPP, and a resident representative to the APA's Psychiatric Residency Review Committee.