Psychotherapy Overview
The Brown General Psychiatry Residency teaches and assesses competence in five individual psychotherapies; psychodynamic, cognitive behavioral, brief, supportive and psychotherapy combined with psychopharmacology. In addition, residents participate in a one-year group therapy experience and a two-year course in family therapy. These psychotherapies are learned through clinical experiences, didactic seminars and supervision.
Clinical Experience
While residents incorporate aspects of psychotherapy in all their clinical encounters, the Universal Treatment Program (UTP), the residents' longitudinal outpatient clinic allows residents to follow patients for up to three years and serves as the setting where residents develop their practice of psychotherapy. It is in this clinic that residents apply the instruction that is the focus of their didactic seminars. The UTP, which is administered by the Butler Hospital Outpatient Department, consists of two afternoons per week of structured outpatient clinic time during PGY-2 through PGY-4. Residents begin to acquire patients at the end of their PG-1 year, receiving referrals from departing PGY-4 residents and faculty supervisors or by following their own former inpatients. The UTP was developed twenty years ago as a clinic where psychiatric residents could see long-term psychotherapy patients at low, negotiated fees. This spirit continues to guide the UTP. Currently, the UTP allows residents to practice a broad range of psychotherapeutic interventions within the context of supervision. Various approaches include both traditional and brief, dynamically-oriented individual psychotherapy, family therapy, couples therapy, cognitive/behavioral therapy, supportive therapy, and group therapy. All modalities can occur over the majority of the residents' training. A second educational focus of this program is to develop longitudinal experience in the use of psychopharmacologic agents. This experience includes the initiation of drug treatment, assessment and discussion of the risk/benefit of psychotropic medication, management of side effects and drug interactions, evaluation of efficacy, and decisions involving the maintenance and termination of pharmacotherapy. Thirdly, residents have the opportunity to select and engage patients in the initiation of outpatient therapy and gain the experience of terminating with their patients. Residents may select their patients in consultation with their faculty supervisors and the Training Directors with the goal of developing a caseload reflecting a balance of disorders and treatment approaches.
Didactic Experience
PGY-1 Residents meet weekly with senior psychotherapy teaching faculty to review basic concepts in psychotherapy theory and practice. Supportive psychotherapy and psychotherapy combined with psychopharmacology are emphasized as they are particularly applicable to the clinical demands and experiences of the first year of psychiatry residency.
PGY-2 Residents have a yearlong seminar with two senior psychotherapists who teach and facilitate a systematic and comprehensive curriculum with an emphasis on psychodynamic psychotherapy principles and application. The texts used in that course are Long-Term Psychodynamic Psychotherapy by Glen Gabbard.
PGY-3 Seminars include a half year series of cognitive behavioral therapy ( CBT ) as well as seminars on brief psychotherapy, the different schools of psychodynamic therapies, and the history of psychoanalysis.
PGY-4 The yearlong psychotherapy course focuses on advanced psychodynamic psychotherapy with an emphasis on ego psychology. The format of this course is a combination of seminars on theory and resident presentations of clinical material.
Supervision
PGY-2 Residents select one supervisor for UTP clinic. A psychotherapy supervisor, with whom they meet weekly, guides them through one or two cases of intensive psychotherapy. The outpatient supervisor, during the bi-weekly supervision, helps the residents with the remaining cases that typically consist of a mixture of supportive, psychotherapy and psychopharmacologic treatments.
PGY-3 In addition to individual psychotherapy supervision, the residents have a number of additional supervisions. They participate in weekly small group supervision on CBT in which the residents gain the practical experience of learning CBT . Resident pairs co-lead a weekly group therapy, which is supervised by a specific group therapy supervisor. For family therapy supervision, the residents videotape the family sessions and review their videotapes during weekly supervision.
PGY-4 Residents select two supervisors for the year for both psychotherapy supervision and outpatient general supervision. If residents choose to, they may receive additional supervision in other areas such as child and adolescent psychotherapy or continued group therapy.
Group and Family Therapy
During the first and second year, residents lead groups in on inpatient units to begin getting experience in group therapy. In addition, there are a series of seminars at the end of the PGY-2 . Starting in PGY-3, residents colead and outpatient group with another resident.
The family therapy didactics consist of a combination of seminars and resident presentation of family assessment and therapy during the PGY-2 and 3, coordinated with supervision and ongoing family therapy experiential training.