Psychotherapy Learning Objectives

PGY-2 residents begin to treat 3 patients in psychotherapy, and PGY-3 residents increase their psychotherapy caseload to 8-10 patients per week in psychodynamic, CBT and supportive psychotherapy.  PGY-4 residents continue to work with psychotherapy patients electively.  The following Goals and Objectives apply to all psychotherapeutic modalities.

Patient Care

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

Medical Knowledge

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

Professionalism

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

Interpersonal and Communication Skills

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

Problem Based Learning

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

Psychotherapy Learning Objectives for 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

Supportive Psychotherapy

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