Goals and Objectives

PSYCHOTHERAPY LEARNING OBJECTIVES

For all psychotherapeutic modalities.

The resident will be able to:

Establish and maintain a treatment frame (e.g., time, space, outside agencies/relationships, setting schedules and sticking to times)
Enable the patient to actively participate in the treatment
Establish a treatment focus. Provide a holding environment
Recognize and specifically describe affects
Tolerate direct expressions of hostility, affection, sexuality and other powerful emotions
Identify problems in collaborating with the treatment/therapist
Recognize obstacles to change and an understanding of possible ways to address them
Maintain focus in treatment when appropriate
Confront when appropriate
Assess readiness for and manage termination from treatment
Assess the patient's readiness for specific interventions
Assess the patient's response to specific interventions

The resident will be able to:

Recognize defenses in clinical phenomena
Identify aspects of an ongoing case in terms of theories of drive and defense, internalized object relationships, and consideration of the patient's self experience
Link present to past as demonstrated by understanding the patient's present pattern of thought, feeling, action and relationship in terms of his or her past personal experience
Identify and elicit automatic thoughts and cognitive errors in thinking, and develop and implement a treatment plan employing CBT strategies and techniques

The resident will be able to:

Establish and maintain a professional relationship
Understand and protect the patient from unnecessary intrusions into privacy and confidentiality
Handle financial arrangements with patient in a manner appropriate to the treatment context.
Recognize and tolerate one's uncertainties as a trainee in psychotherapy
Recognize, contain and make therapeutic use of countertransference
Maintain a therapeutic alliance in the face of transference distortions, using concepts of neutrality, abstinence, empathy, and support in an appropriate manner
Manage termination issues within the context of a psychodynamic psychotherapy

The resident will be able to:

Establish rapport
Understand and develop a therapeutic alliance with the patient
Recognize a variety of forms of therapeutic alliances including negativistic ones
Recognize and attempt to repair disturbances in the alliance
Listen to nonjudgementally and with openness
Facilitate the patient talking openly and freely
Empathize with the patient's feeling states
Convey empathic understanding
Communicate appropriatley with others treaters within the Department of Psychiatry
Communicate apprpriately with the patient's permission with referring physicians, and others outside the Department of Psychiatry

The resident will be able to:

Recognize and describe (to the supervisor) one's own affective response to the patient
Establish an educational alliance with the supervisor
Incorporate material discussed in supervision into the psychotherapy

For all specific psychotherapeutic modalities.

Brief and Crisis Intervention

The resident will be able to:

Establish a therapeutic alliance with the patient
Identify the precipitationg event (stressor) and the patient's reactions to
Identify a history of the patient's usual coping mechanisms facilitate the patient's expression of emotions
Normalize the patient's emotional reactions to the event in the setting of crisis, when appropriate
Focus the therapy on the precipitating crisis
Provide support to the patient
Actively listen to the patient to enhance understanding
Provide psychoeducation about the crisis
Help the patient develop adaptive coping mechanisms and identify additional sources of support
Identify patient strengths and to reflect these back to the patient
Establish achievable therapeutic goals with the patient
Rapidly obtain collateral information where appropriate
Know community resources and be able to make timely and safe dispositions

Psychodynamic Psychotherapy

The resident will be able to:

Identify and effectively begin treatment with a suitable patient for psychodynamic psychotherapy
Identify aspects of an ongoing case in terms of theories of drive and defense, internalized object relationships, and consideration of the patient's self experience
Link present to past as demonstrated by understanding the patient's present pattern of thought, feelings, action, and relationship in terms of his or her past personal experience
Identify and respond appropriately and flexibly to a variety of defenses in the clinical setting
Effectively confront, clarify and interpret previousl preconscious and unconscious material in the therapeutic setting
Facilitate discovery of latent meaning of clinical material (e.g. dreams, associations, transference material, etc.)
Recognize and make therapeutic use of transference
Recognize, contain and make therapeutic use of counter transference
Maintain a therapeutic alliance in the face of transference distortions, using concepts of neutrality, abstinence, empathy and support in an appropriate manner
Manage termination issues within the context of a psychodynamic psychotherapy

Combined Psychopharmacology and Psychotherapy

The resident will be able to:

Integrate biological and psychological aspects of a patient's history
Provide psychoducation about psychiatric illness and the risks/benefits of commonly prescribed psychotropics
Understand how the meaning of a medication to a patient can have a significant impact on its efficacy and learn how to explore what medications mean to a patient
Use the placebo effect to more successfully prescribe medications
Demonstrate a basic understanding of diagnosis-specific psychotherapy and medication management
Have a basic understanding of medico-legal and psychotherapeutic issues in the context of one person prescribing medication and another person providing psychotherapy: confidentiality, informed consent and collaboration
Use the concepts of transference and counter transference in prescribing medications in a therapeutic manner
Recognize the ways that prescribing mediation can enhance or hinder psychotherapy and ways that psychotherapy can enhance or hinder medication management
Identify psychological aspects of non-adherence

Cognitive Behavioral Psychotherapy

The resident will be able to:

State the cognitive model
Socialize patient into cognitive model
Use structured cognitive behavioral model including mood check, bridging to prior session, agenda setting, and review of homework, capsule summaries and patient feedback
Identify and elicit automatic thoughts
Use Dysfunctional Thought Records as a tool in therapy
Use Activity Scheduling as a tool in therapy
Identify common cognitive errors in thinking
Use behavioral techniques as a tool in therapy
Plan booster session's, follow-up, and self help sessions appropriately with patients when terminating active therapy

The resident will be able to:

Assess regressive and adaptive shifts in ego functioning
Make interventions specifically in support of a patient's ego functions, including defensive operations
Deliberately take a non-interpretative stance in relation to a defensive operation in a patient
Recognize internal conflict and help a patient contain it without an emphasis on interpretation
Be directive: give advice set limits, and educate when appropriate with a patient. Make appropriate manipulations of the environment or take action on behalf of a patient