Psychotherapy Training

What the College wants you to have learned regarding psychotherapy, in Basic Training:

By the completion of basic training you should be able to:

• Formulate an individual's psychological issues in terms of basic developmental principles
• Assess and describe an individual's personality functioning, relationship style, adaptive and maladaptive or defensive behaviours
• Recognise the transgenerational transmission of relationship difficulties and psychological problems
• Select an appropriate psychological therapy
• Integrate appropriately the psychological therapies with biological and social therapies
• Demonstrate an understanding of the psychotherapies in terms of their historical development, theoretical underpinnings, research base and outcomes, including:
  
  • Normal human development across the lifespan
  • The infant-carer relationship
  • Developmental psychopathology
  • Attachment and other psychoanalytic theories
  • Families and couples therapies
  • Group psychotherapies
  • Individual dynamic psychotherapies
  • Structured therapies, including cognitive behavioural therapies

In addition, in Advanced Training continuing development of psychological management skills is required:
During advanced training you are required to further develop and integrate psychological aspects of management into your clinical practice. Therefore you must spend at least 1 hour per week throughout the 2 years, for at least 40 weeks of each year of advanced training, devoted to the provision of formal psychotherapy (of any modality) to a number of different people. At least 1 hour per month must be spent in individual or group supervision of these psychotherapeutic experiences.

Clinical Experience Needed in Basic Training:
The College requires you to have to have a minimum amount of experience with several types of therapy. This isn't aimed at making registrars into fully fledged, experienced therapists, but to give you some idea about the different types of therapy so that you have some techniques, can explain about these therapies to patients when discussing treatment options with them, can assess someone's suitability for therapy and so that you can write a sensible referral to a therapist. If you find that you particularly enjoy psychotherapy you'll need to continue with more cases under supervision, and to seek out suitable courses for further training.

So in Basic Training, the RANZCP requires you to complete:

• Therapy informed by psychodynamic principles - 1 patient for a minimum of 40 sessions, over at least 6 months, with weekly sessions (as this takes about a year to complete it's advisable to find a patient and begin this in second year)
• Cognitive or Behavioural therapy with a minimum of 2 patients for at least 5 sessions each
• Brief psychologically-based therapy - minimum of 10 sessions each with 2 patients (people often do more CBT but any modality is OK - such as brief Psychodynamic therapy or Grief therapy)
• Either Group, Family or Marital therapy for a minimum of 5 sessions

Documenting your Experiences:
Therapy with all the above patients must be recorded on the appropriate form available from the Links page of the College website here, and counter-signed by the psychotherapy supervisor for each case. Note that while verbal consent is of course always required, a written consent form is also needed for any patient whose case you eventually write up as the Case History.

Finding a Suitable Patient
Plan to incorporate therapy into your training. You need to get organised for this from the start of 2nd year. Think which runs can provide certain experiences - for example, many community runs with adult and older patients are a chance for CBT experiences. Child & adolescent runs may well offer a chance for Behavioural therapy or to be a co-therapist in Family therapy. Segar House and Buchanan Rehab Services offer a chance for Group work, as do some CMHCs and the North's Maternal mental health team. Old Age and Liaison runs may well offer opportunities for short-term Grief therapy. Psychodynamic cases can often be found in CMHC and Liaison settings. Forensic placements are also useful to achieve most of these modalities of therapy. Talk to your supervisor at the start of the run about what you need to do and what the team might be able to offer.

Rosalynn and Felicity, at the Training Centre, can link trainees up with referrers - from time to time, emails are circulated with a patient's details and the referrer's contact information. These are usually for long cases plus a few people needing CBT.

If you're looking for a patient for the psychotherapy long case it's a good idea to email the Training Centre and ask that an email be circulated to all registrars asking for referrals. You can also tell all suitable referrers such as CMHCs, Segar House, Liaison Psychiatry colleagues, crisis teams, etc.

It can be a little difficult finding a patient suitable for a novice therapist within the public system. So make sure that you don't agree to commence therapy until you've presented the patient's case to your supervisor and discussed their suitability.

Finding a Supervisor
You are required to have appropriate supervision for all psychotherapy cases as above. This is additional to the usual 4 hours weekly of clinical and 1:1 supervision and generally occurs each week, for an hour. Supervision may be arranged individually or in a small group, and can be provided by a suitable therapist who's not a psychiatrist. In multidisciplinary teams, psychologists often assist with this, especially for CBT or behavioural therapy. If you're not sure whether the supervisor you plan to work with is accredited with the Auckland Training Programme, email Felicity. Most local psychiatrists are accredited, and all that's required to accredit local clinical psychologists is a CV emailed in to Felicity.

A list of local accredited DHB-based supervisors with an interest in psychotherapy is kept by the Training Centre and updated at intervals. List of Potential Supervisors (recently updated).

The RTC has been able to arrange some limited additional funding for external therapists to assist with psychotherapy supervision where no DHB-based supervisors are available. See the List of Potential Supervisors above, for information on how to access this if you need it.

The Psychological Methods Case History:
In Basic Training you also need to write up a "Psychological Methods" Case History. This can be either -

• A case history of a person treated with therapy informed by psychodynamic principles who required at least forty hours of therapy on an individual basis for a minimum of six months, with at least one session weekly (the therapy can continue beyond the time of writing the case history) or -
• A selection of two people treated with any accepted model of individual psychotherapy (including cognitive and/or behavioural therapy) - either with brief psychologically-based therapy for at least 10 sessions each, or with cognitive and/or behavioural therapy for at least 5 sessions each. These must be completed cases. (Note that there would need to be some sort of connection between the two patients if you choose this option - either regarding the same type of therapy which was used for both, or perhaps that the patients' issues were similar but somewhat different therapy modalities were used for each. In other words, the discussion at the end somehow needs to cover both cases and to integrate your experience with them.)
  
  Read the link about the Case Histories carefully before embarking on therapy with any patients who you might write up in the Case History. Read the Link again before starting to draft the Case History, and read the marking proforma for the Case History before finalising it. It's also crucial to get a minimum of two supervisors to read your final draft and give you feedback, before you finalise the Case. 

Psychotherapy Teaching and Courses
Psychotherapy teaching is provided as part of the academic programme from 1st to 3rd year. The academic programme covers: 

• Psychodynamic Theories 
• Psychotherapy for Beginners: the pragmatics of psychodynamic psychotherapy
• Brief Focussed Therapies
• Family/marital Therapy 
• Group Therapy
• Severe Personality Disorders & Dialectical Behavioural Therapy (DBT)
• Behavioural theory and therapies
• Cognitive Behavioural Therapy (CBT)
• Interpersonal Therapy (IPT)
• Psychodynamic Formulations
• Discussing and presenting Management Plans incorporating psychotherapy
• Psychotherapy research and evidence-base
  

Aspects of the current RANZCP Curriculum Relevant to Psychotherapy:  Curriculum Extracts

If you don't have Adobe Acrobat Reader, it can be downloaded from this link:

The Massey CBT Course
The CTA have agreed to fund the Massey (Albany) University CBT Diploma course as CBT is a mandatory requirement of your training. You need a support letter from Felicity if you want to be reimbursed for this, and you need to be able to arrange the necessary time for the course with your team and supervisor.

Psychotherapy References
Some of these References are in local libraries. The Training Centre has a number of texts from this list and is prepared to lend them out provided they come back again - you can arrange this via Rosalynn.