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Psychotherapy Training in Residency Programs in Demand and in Peril

(PSYCHIATRIC TIMES) - Psychiatry residents want and need solid training in psychotherapy in order to best serve their patients and to remain competitive in the mental health marketplace, concluded a March conference sponsored by the American Psychiatric Association's Commission on Psychotherapy by Psychiatrists (COPP). The event, entitled "Integration and Specificity in Psychotherapy Education," drew 120 training directors, residents and faculty from around the country, and represented approximately 40% of U.S. residency training programs.

According to COPP chair Norman A. Clemens, M.D., while many residency programs offer exposure to cognitive-behavioral, psychodynamic and supportive therapies, residents are not adequately prepared to competently use them to treat patients. In a recent article, Clemens added that exposure to family therapy, group therapy and interpersonal therapy is even rarer, and that there is significant variability in the quality and intensity of psychotherapy training among residency training programs (Clemens, 1999).

COPP vice chair Glen Gabbard, M.D., Bessie Walker Callaway Distinguished Professor at the Menninger School of Psychiatry and Mental Health Sciences, is similarly concerned and feels that there is an ongoing lack of emphasis on the integration of biological and psychosocial therapies in training programs (Gabbard, 1997). "Patients should be thought of both in psychological and biologic terms to avoid fragmenting the patient and the treatment," wrote Gabbard. "Moreover, psychodynamic psychiatry should not be regarded as anti-biologic. Psychodynamic and biological approaches generally work synergistically to enhance treatment outcomes and preserve the patient's holistic experience."

Gabbard believes that managed care has encouraged this dichotomy through the frequent practice of splitting a patient's treatment between a psychiatrist for pharmacotherapeutic interventions and nonmedical mental health care professionals for talk therapy. Moreover, Gabbard told Psychiatric Times, the advent of effective psychopharmacological treatments and growing advances in genetic research and imaging technologies have encouraged many psychiatrists to adopt a primarily biological view of the genesis of psychiatric illness-often at the expense of psychosocially oriented practice.

Still, there is good news, said Clemens. Surveys conducted by COPP and the American Association of Directors of Psychiatric Residency Training show that the demand for solid psychotherapy training is strong among residents. Better training in short-term, structured and problem-oriented treatments is particularly sought after, since these modalities have been systematically evaluated and, therefore, are more likely to be reimbursed by managed care companies.

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