Training in Formal Psychotherapy in the Psychiatric Residency Program

This report has been prepared by the Nucleus Committee of the Section on Psychotherapy of the Canadian Psychiatric Association. It is based on a questionnaire study of training in formal psychotherapy in psychiatric residency programs. We received replies from ten of the twelve university centres in Canada which currently have such programs, and from some selected centres in the United States and Great Britain. Our findings support the contention that psychoanalytically-based training in psychotherapy is a generally accepted mandatory feature of residency programs in Canada. This training is carried out in a similar way in both the United States and Canada. Our study indicated that there is a tendency in Canada for this training not to be as organized as it should be and we recommend that steps be taken to improve this situation. Particular concerns were lack of knowledge of the numbers of patients treated in psychotherapy by a resident during the residency program and the number treated for more than a year. Stemming from the further discussions of the Nucleus Committee, recognizing the facts that there are a number of different valid theoretical orientations to psychotherapy and that there are differences among centres which lead to different teaching techniques, we also recommended: a) That the resident be exposed to different theoretical approaches, but in such a way as to avoid excessively confusing him. b) As one method of achieving objective (a), that a resident receive supervision from at least two different teachers during his residency. c) That, providing other aspects of the program are adequate, didactic seminars need not total more than forty. d) Because interviewing skills and psychodynamic understanding are essential skills of the psychiatrist, that whatever the particular orientation and methods pertaining to training in psychotherapy in a teaching setting, the psychotherapeutic approach should pervade the resident's total learning experience. e) That formal training in psychotherapy should begin in the first residency year, with the practical experience optimally being individualized according to the resident's level of development of psychotherapeutic skills. f) That the resident should have experience in treating patients in formal psychotherapy for more than a year. g) Where the resident's experience of psychotherapy deviates significantly from what he can expect when he is fully qualified, that the nature and implications of these deviations be clarified with him by the supervisor (s); these deviations include failure to obtain objective (f), and limitations on psychotherapy that are a direct result of factors that are unique to the training situation. We also commented on other features of the supervisory role, including responsibilities to patients.