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Residency Program in Psychiatry
Didactics
Psychotherapy
Course Director
Andrew
Aronson, M.D.
Overall Course Goals and Objectives
A primary goal of the residency training program is the
cultivation of sophisticated and scholarly clinicians with theoretical
knowledge and practical skills in applied psychology. Complimenting
our training curriculum in applied neuroscience, we focus on the intellectual
capacity for practical synthesis and integration of these fields of
knowledge.
Toward these goals, residents actively participate in
an intensive and progressive curriculum marked by a systematic instruction
in the major psychological theories, formats and modalities
of
psychotherapy. In addition to extensive theoretical work, residents
accrue closely supervised clinical experience in psychotherapy, including
short- and long-term individual psychotherapy, psychodynamic psychotherapy,
family/couples therapy, group therapy, and cognitive and behavioral
therapy. At graduation from the program, residents must demonstrate
competencies in each of these therapeutic modalities. Detailed evaluation
instruments are utilized to describe and document progress toward defined
training objectives. Teachers and supervisors of the psychotherapy
core
curriculum are selectively drawn from an extensive roster of several
hundred faculty of extraordinary diversity and expertise.
Reflecting the high value placed on psychotherapy training,
the department has formally and proudly established a collaborative
affiliation for education and training with the New York Psychoanalytic
Institute. Established in 1911, the New York Psychoanalytic Society and Institute
is the oldest and historically the most esteemed psychoanalytic
organization in the United States. The formal education and training
collaboration with the Mount Sinai Department of Psychiatry is the
first
such arrangement the Institute has ever established. Essential components
of the collaboration include assignment of Institute supervisors for
long term intensive psychotherapy work and Institute leadership and
instruction of the core curriculum in psychodynamic theory and clinical
practice, beginning in the PGY-II year. Additionally, the collaborative
affiliation makes specific provision for residents who elect a professional
path involving psychoanalytic training. Such residents, if also accepted
for Institute training, are able to commence this training while
still in residency, so long as it does not interfere with the other essential training requirements.
Psychotherapy Training Clinic
The Department has established a specific administrative
structure to support psychotherapy training. Patients accepted into
the psychotherapy training clinic may be seen as frequently as is
clinically
optimal—up to and including five days per week in classical psychoanalytic
cases—with no minimum fee. The Department has cultivated sources of referrals for psychotherapy training, including the Treatment Center of the New York Psychoanalytic Institute, university and graduate studies programs, and the performing arts community.
Other Goals of Psychotherapy Training
The program defines a number of other educational goals
as integral to training in psychotherapy. Residents are expected to
learn concepts connected to the psychological and social
concepts of all doctor-patient relationships and be able to manage
non-psychotherapy relationships with patients more effectively. Training
is designed to
enhance learning about and management of other dyadic relationships
within psychiatry such as supervision, consultation, and mental health
administration. Another goal is acquisition of a unique perspective
from in-depth and longitudinal study of both conscious and unconscious
mental functioning, both normal and pathological, in the context of
an ongoing relationship with patients. This understanding is considered
essential to the treatment planning and management of virtually all
psychiatric disorders. It is also important to develop abilities to anticipate, analyze,
and avoid ethical dilemmas and transgressions and manage complex feelings and reactions to patients.
Personal Psychotherapy
The training program explicitly endorses personal psychotherapy
as a uniquely useful strategy for the development of psychotherapeutic
and psychological sophistication. Toward this goal, the program has
taken care to establish a consultant available to all residents
to secure affordable psychotherapy of the highest quality in a completely
confidential manner. Free consultation and referral to affordable care
are available to residents of all four years via a consulting clinician
who has no contact or correspondence with the department.
PGY-I
- Interviewing Seminar
- Course description:
Review of the essentials of psychiatric interviewing with a focus
on diagnostic assessment, including the role of dynamic factors and
psychotherapy. Residents will meet every other week throughout the year on the inpatient units, where they will take turns conducting patient interviews directly supervised by master clinicians. Goals of this course include enhancing skill in history-taking, nondirective interviewing, eliciting the psychiatric review of symptoms, conducting the mental status examination, and providing a differential diagnosis, case formulation, and case presentation.
- Introduction to Psychotherapy
- This courses serves as an introduction to how talk to patients and a survey of different psychotherapeutic modalities, including psychodynamic, supportive, and cognitive behavioral therapy approaches.
PGY-II
- Interviewing Course
- Course description: Complements on-unit inpatient preceptoring.
Review of classic and contemporary papers on psychosis and interactive
discussion of videotaped interviews conducted by participating residents.
Consideration of how a psychodynamic orientation and related techniques
may further engage acutely and severely ill patients, including psychotic
patients, and how it may be used to facilitate assessment, evaluation
and treatment.
- Psychodynamic Psychotherapy - Theory I
- Course description:
Readings
and discussions build upon the basic conceptual vocabulary of the
PGY-I course with a study of models of development and the psychoanalytic model of the mind.
- Psychodynamic Psychotherapy - Principles / Technique I
- Course description:
Indications and subject suitability; requirements of the patient and
therapist; establishing a framework for treatment; commencing treatment;
working with transference, countertransference and resistance; what
to say when, and how to say it. Both selected readings and actual clinical/process material (written or videotaped) are used as framework
for discussion and learning. Educational objectives include the goals of understand - the rationale, relative indications and contraindications for psychodynamic psychotherapy, posses a basic knowlege of its terms and concepts, and a practical working knowlege of how to establish a framework for treatment to commence psychodynamic psychotherapy.
- Personality Disorders - Terms and Concepts
- Course description:
Seminar discussions review the basic concepts and theories of character
(psychodynamic/developmental/other) and major cluster classifications
of disorders. Selected classic and contemporary readings and actual
treatment process material are utilized.
- Cognitive-Behavioral Therapy – I
- Course description:
This course introduces the basic concepts of learning
theory as it informs approaches to cognitive and behavioral treatment.
Also discussed are the relative indications for this form of treatment,
as well as basic techniques of assessment and conduct
of empirically based treatments.
PGY-III
- Brief Treatment
- Course description:
Selected readings and discussion in a survey of the major approaches
to brief psychotherapy; the theoretical basis for these approaches;
the universal/essential principles and tactics of brief treatment.
Clinical and process material are used.
- Family and Couples Treatment
- Course description:
Selected readings and discussion in a survey of the major approaches
to the treatment of couples and family; systems theory; the contributions
of Bateson, Minuchin and others, involving both dynamic and non-dynamic
approaches. Clinical and process material are used.
- Supportive Psychotherapy
- Course description:
Selected readings and discussions clarify the essential principles
and techniques of supportive therapy, specifically within the conceptual
and practical continuum of so-called expressive treatments. The focus
is on the relative indications for supportive therapy, the goals of
supportive therapy, and how to integrate supportive strategies into
an enlarging repertoire of verbal therapy techniques. Clinical/process
material are used.
- Continuous Case Conference / Psychodynamic Formulation
- Course description:
Continuous presentation of process material by a single clinician
therapist, and extended presentation of selected cases in a serial
manner, provide opportunities to discuss the technical conduct of
long-term dynamic psychotherapy and specifically facilitate the development
of skills for synthesis of a psychodynamic case formulation.
- Boundaries, Ethics, and Legal Issues in Psychotherapy
- Course description:
Selected readings with reference to salient clinical examples elucidate
the interdependent nature of technical, ethical and legal considerations
reflected in the framework of treatment and inherent to the psychiatrist-patient
relationship. Circumstances and factors which challenge these parameters,
and the therapeutic and legal consequences of significant departures
and violations are discussed.
- Dynamic Pharmacotherapy: Monomodal and Unified Treatments
- Course description:
An examination of the psychodynamic considerations affecting an individual’s
experience of medication and its effect on medication compliance in
situations where formal psychotherapy is and is not part of the treatment.
Identification and management of transference, countertransference
and resistance phenomena related to medication use, and use of the
therapeutic alliance to foster medication compliance. Evidence for
the efficacy and benefits of combined medication and psychotherapy
are studied. The psychodynamic implications of medication prescription
during psychodynamic psychotherapy: the clinical/practical challenge
of psychobiological synthesis. Selected readings and discussion of
actual case material are used.
- Medication and Psychotherapy: Collaborative Care
- Course description:
An examination of the challenges and opportunities inherent in collaborative
care with allied mental health professionals including role definition
and maintenance, practical management parameters and optimal communication
practices, and legal issues.
- Group Treatment
- Course description:
Selected readings and discussion in a survey of group theory and the
major approaches to the group treatment with a focus on long-term
psychodynamic group psychotherapy: therapeutic factors, formulation
of the group (with regard to both patient composition and theme),
patient selection criteria, preparation of the patient, the group
treatment contract, and essentials of group psychotherapeutic technique.
- Cognitive-Behavioral Therapy
- Course description:
Following up on the initial PGY II survey, this course presents an in depth, 30 session, approach to the theory and practice of CBT. Residents will learn how CBT theory guides case conceptualization and treatment planning. basic principles and therapeutic interventions will be taught in modules, such that they can be used accross forms of psychopathology. This method for CBT is based on an transdiagnostic model of psychotherapy for emotional and behavior disorders. Case material, experiential exercises, selected readings, and role playing are used to enhance training in these modules and facilitate competence in applied CBT.
- Psychodynamic Psychotherapy and Psychoanalytic Theory
- Course description:
Later phase technical management of a deepening therapeutic process
in long-term psychotherapy. Recognizing themes, formulating interventions,
and managing treatment-emergent phenomena. Clinical/process material
(written or videotaped) is used and becomes the primary framework
for discussion and learning. Selected readings will inform scholarly discussion of the major psychoanalytic models emphasizing psychological development, Residents will be better able to recognize opportunities for verbal intervention (suggestion, clarification, interpretation, etc), explain their basis and timing, and report greater ability to manage within the established treatment frame. They will also report understanding the basic concepts of the major models of psychological development and their relevance to verbal therapeutics.
PGY-IV
- Advanced Continuous Case
- Emphasis on more advanced technique and the management
of middle, late, and termination phases of psychotherapy.
- Psychodynamics of Treatment Termination
- Focused discussion of the issues of termination of long-term
intensive psychotherapy and the practical and technical approaches
to management of termination-emergent phenomena.
- Dialectical Behavioral Therapy
- Examination of the theoretical basis and practical principles
and structure of this evidence.
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