Psychotherapy training for CT1-CT3 (NHS Grampian)
All Core Trainees in Psychiatry need to provide evidence of the competencies in psychological
treatments in order to progress from CT3. The basic minimum is to undertake, under supervision,
two psychological therapy cases in two modalities between years CT1 and CT3. One of these cases
should be a brief treatment (12-20 sessions) and the other a longer term treatment (24 sessions or
longer).
It is the aim of the Psychotherapy Department to support our trainees in acquiring the necessary
competencies and progressing in their training however it is the trainee’s responsibility to make sure
they are getting the necessary experience.
Balint Group (Department of Psychotherapy)
The process of developing competencies in psychotherapeutic approaches starts with the CaseBased Discussion (Balint) group. This group is an ongoing opportunity for developing clinical practice
by thinking psychologically about everyday work experiences. The College expects evidence of
attending a minimum of 30 case-based discussion groups. The Balint group is mandatory to training,
runs for 1 year (the duration of CT1) on once/week basis irrespective of term times and fulfils
current College recommendations. Core trainees receive a completed CBD form after 6 months and
after 12 months of attending the group. Trainees will need the evidence of attending the Case-Based
Discussion group for their ARCP and to apply for the CASC.
“The essence of the group’s work is a speculation and empathy exercise in what it may be like to be
the doctor and what it may be like to be the patient in the relationship that has been presented for
the group to consider. The result for the presenter (and only a little less directly for the group
members) is a different perspective on this patient, on the sources of difficulty for the doctor, and
finally on alternate (and hopefully more effective) ways for the doctor and patient to be in a healing
relationship.” Balint 1957
Recommended reading:
 see Appendix 1
Personal psychotherapy is not obligatory but may be beneficial to enhance the tolerance of distress,
anger and mixed emotions about professional situations and to develop insight. The decision to have
personal therapy rests with the trainee and the Department of Psychotherapy does not participate
in arranging such therapy.
At the beginning of CT2 year trainees are allocated either to CBT or Psychodynamic Psychotherapy
supervision groups. In Child and Adolescent or YPD posts there may also be an opportunity for
conducting therapy but this experience and the necessary supervision with an accredited supervisor
would need to be organised directly within that post. Once the first two cases have been completed,
Core Trainees also have an opportunity to undertake a case of IPT.
Psychodynamic Psychotherapy supervision (Department of Psychotherapy)
The Department of Psychotherapy organises supervision for Psychodynamic Psychotherapy cases.
Patients suitable for psychotherapy by a trainee would be assessed by one of the therapists within
the Psychotherapy Department. Supervision is mandatory and is on once weekly group basis. Usually
a trainee would attend supervision for a few weeks prior to taking on a suitable patient. The two
completed SAPE forms and a Psychotherapy ACE form would provide the necessary evidence of
completion of therapy.
Recommended reading:
 P. Hughes, D. Riordan “Dynamic Psychotherapy Explained”, Radcliffe Publishing 2006, 2nd ed.
 P. Casement “On learning from the patient”, Routledge 1985
 J. Wilson “Starting out in Psychodynamic Psychotherapy”, Psychiatric Bulletin (2001), 25,
pp.72-74
Trainees who are interested and able to attend on a regular basis are also invited to come to
Psychotherapy Department in-house educational seminars. These seminars are held once/month on
Mondays 11.00 – 12.00 noon.
Cognitive-Behavioural Therapy (CBT) supervision (EDS, Fulton Clinic)
The Department of Psychotherapy organises supervision for CBT. Suitable cases can be taken from
the caseload of the team where the trainee works. However, it is important that the trainee does
not take on patients for therapy from their own caseload. All cases need to be discussed with Mrs
Sally Hill, CBT supervisor, prior to the assessment being carried out. The trainee assesses the patient
for CBT under Mrs Hill’s supervision. Supervision is mandatory and is on once weekly group basis.
The two completed SAPE forms and a Psychotherapy ACE form would provide the necessary
evidence of completion of therapy.
Recommended reading:
 K. Hawton, P. M. Salkovskis, J. Kirk, D. M. Clark “Cognitive Behaviour Therapy for Psychiatric
Problems: A Practical Guide” Oxford University Press 1996
 “Overcoming” series of books for various psychiatric problems
 Websites – http://www.moodjuice.scot.nhs.uk/
https://www.moodgym.anu.edu.au/welcome
http://llttf.com/
http://www.cci.health.wa.gov.au/
http://www.getselfhelp.co.uk/
Interpersonal Therapy (IPT) supervision (Eden Unit, RCH)
Those Core trainees, who have completed their first two cases, may be interested to see a patient
for IPT.
The Department of Psychotherapy coordinates supervision for IPT. Suitable cases can be taken from
the caseload of the team where the trainee works. However, it is important that the trainee does
not take on patients for therapy from their own caseload. All cases need to be discussed with Dr
Jane Morris, IPT supervisor, prior to the assessment being carried out. The trainee assesses the
patient for IPT under Dr Morris’s supervision. Supervision is mandatory and is on once weekly group
basis on Wednesdays at 16.00. The two completed SAPE forms and a Psychotherapy ACE form would
provide the necessary evidence of completion of therapy.
Psychotherapy assessments process:
All trainees, irrespective of the modality of the therapy cases they do, need to complete assessment
forms that would provide the evidence of the Psychotherapy competencies for ARCP.
These forms are SAPE (Supervisor’s Assessment of Psychotherapy Expertise) and Psychotherapy ACE
(Assessment of Clinical Expertise).
SAPE forms are completed by trainee’s supervisor and Psychotherapy ACE forms are completed by
Dr M. McLoughlin, Psychotherapy Tutor.
For each psychotherapy case a trainee needs to write a short formulation (the current
understanding of the patient’s difficulties) mid-way through therapy. This formulation is then
discussed with the supervisor and the first SAPE is completed at this point. At the end of treatment
the final formulation is written and another SAPE is completed. Thereafter a trainee would need to
arrange an appointment with Dr Marina McLoughlin in order to complete a Psychotherapy ACE.
The two SAPE forms are used to inform the completion of the Psychotherapy ACE and
Psychotherapy ACE provides the Psychotherapy competencies evidence for the ARCP process.
Appendix 1
Balint in a Nutshell
An Introduction by Heather Suckling
History of the Balint Group
The name is that of Michael Balint a Hungarian psychoanalyst.
His main work was as a psychoanalyst at the Tavistock Clinic, in London. He started groups for GPs in
the 1950s to study the doctor-patient relationship; he described them as “Training-cum-research”
groups. He worked closely, and ran groups with his third wife, Enid – a Social Worker and Marriage
Guidance Counsellor. Her influence on medical training is probably as great as his.
What is a “traditional” Balint Group?
It consists of 6-12 doctors with 1-2 leaders and it meets regularly.
Meetings usually last for 1-2 hours and the group continues for 1 or more years.
The method is that of case presentation without notes.
What happens in a Balint group?
The leader asks “Who has a case?”
The presenter who volunteers tells the story of a consultation; this is not a standard case
presentation, but a description of what happened between the doctor and the patient. It need not
be long, complicated or exciting but something that is continuing to occupy the presenter’s mind. It
may be puzzling, or has left the presenter feeling angry, frustrated, irritated or sad.
The group discusses the relationship between the doctor and patient and tries to understand what is
happening that evokes these feelings. The feelings which the patient evokes are significant and may
be reflected in the presenter or in the group. This facilitates the understanding of the patient.
All discussions within the group are confidential.
What can a Balint group do?
It provides an opportunity for doctors to reflect on their work. It can provide an outlet for anxieties
and frustrations generated by their work. It can arouse a doctors’ interest in patients whom they
have previously found upsetting, annoying or “difficult”. It can open minds to other possibilities,
both of diagnosis and day to day management. The group provides support and improves
communication with patients and other professionals. It can improve job satisfaction, the patient’s
perception of care and help to prevent burn-out.
What does a Balint group not do?
It does not tell the doctors “how to do” their work.
It does not provide easy answers.
It will not solve all doctors’ problems with patients.
Who was Michael Balint?
He was born in Budapest in 1896, the son of a GP.
He became interested in psychoanalysis after first hearing Freud speak in 1918 and when he met his
first wife, Alice, who was an analyst.
He obtained his Doctorate in medicine in 1920 and initially worked as a biochemist.
Later he undertook psychoanalytic training, his analyst was Sandor Ferenczi. Balint worked as a
psychoanalyst in Budapest during the Fascist regime, but in 1939 came to Manchester (UK) as a
refugee.
In 1945 he was appointed as a Psychoanalyst at the Tavistock Clinic.
In the early 1950s he began his work with GPs- the Balint Group was born.
In 1957 “The Doctor, his Patient and the Illness”, his seminal work, was published.
The founders of the Royal College of General Practitioners were profoundly influenced by Balint’s
ideas; they formed the basis of modern postgraduate training for general practice.
He used the term “patient-centred medicine” in his description of the group he ran at
University College hospital for medical students in 1969
“Perhaps the essence of Balint Groups has always been to share experiences and enable people to
observe and rethink aspects of their relationships with patients and their work as doctors.”
Enid Balint (1992) ‘The Doctor, the Patient and the Group’
HCS Jan 2006 (amended Feb.2007)