Psychodynamic Psychotherapy
Head: Rex Kay (rex.kay@utoronto.ca)
Administrative Coordinator: Julie Wilson (jwilson@mtsinai.on.ca)
Introduction:
During the course of your residency you will spend a considerable amount of your
time learning how to work and think psychodynamically. Between your own clinical
work, seminars and supervision, and dynamic teaching that occurs during many
other rotations, you will develop the requisite skills and perspectives. However, you
are well-advised to be patient with yourselves: this is not an easy field to encompass
and you are unlikely to encounter a supervisor who does not feel they continue to
improve year-by-year.
This document seeks to give you a sense of the entire program, and contains
information for junior residents, senior residents, and supervisors. It is a work in
progress, and residents and supervisors alike are asked to let us know if you note
errors or omissions.
Requirements:
150 hours of treatment: once weekly treatment of an adult up to 80 hours, and at
least one case seen in weekly or twice-weekly therapy for at least 70 hours. Most
residents exceed these numbers, and all residents are encouraged to try to work
with more than two patients during the course of their training.
Objectives:
This program has two primary objectives:
1. To enable residents to work psychodynamically with patients
2. To enable residents to think dynamically, where appropriate, with all psychiatric
patients
What is Psychodynamic Psychotherapy?
'Psychodynamic Psychotherapy' is that form of psychotherapy directly derived from
the work of Sigmund Freud. However, to say that is akin to saying that Evolutionary
Biology is that field of study directly derived from the work of Charles Darwin, or
that Physics derives from Newton (or Galileo) or, perhaps, Einstein and Bohr. While
we recognize and respect Freud for the trail-blazing brilliance of many of his
insights, the field has progressed dramatically since Freud's death three quarters of
a century ago. Jonathan Shedler points out that, in the wide sense, all
psychotherapists are 'Freudian,' while in the narrow sense, none is. Currently
Psychodynamic Theory derives significantly from myriad sources, including
neuroscience, infant research, philosophy of mind, feminist theory, queer theory,
sociology, cognitive psychology, non-linear dynamics, evolutionary biology, political
science, anthropology, Buddhism, evolutionary psychology and ethology, and a
range of other areas I am sure I've neglected. Underlying it all, however, is clinical
experience. No one will ever teach you more about the theory and practice of
psychodynamic psychotherapy than your patients. And not just your 'dynamic'
patients.
To get you started, here is a list of several concepts associated with Psychodynamic
Psychotherapy. Some of your supervisors may take exception to one or two (or
more) of these ideas, and all will want to add a few ideas they value, but this list
captures what most University of Toronto supervisors feel is essential to the field.
Please treat it as a beginning to your own thoughts and conversations, not an ending.
It may also be of value for you to use this list to reflect on treatment modalities,
thinking about ways in which they converge and diverge from this perspective.
Unconscious mentation: The majority of human thought, feeling, conflict and
perception is guided by processes out of our awareness. Even such processes that
seem uninfluenced or experiences that seem to emerge spontaneously are likely
guided by some form of unconscious mentation. The interest in dreams, 'slips,' and
associations lies in the glimpse they may provide into the workings of the
unconscious.
Defense and Resistance: In the course of life (and therapy) the mind will devise
ways to keep unpleasant or threatening thoughts, memories, feelings, desires, or
perceptions out of conscious awareness. These experiences may emerge, however,
in disguised a disguised fashion, and cause symptoms or characterological
difficulties.
Centrality of Affect: A focus on affective states, especially shifts in affective state.
Conflict: All psychodynamic perspectives respect the idea that we can want and
need more than one thing at any given moment, or over prolonged periods of time.
Even fundamental motivations can be in conflict.
Subjectivity: A focus on the inner, subjective experience of the patient, which may or
may not be consciously experienced at any given moment. One way or another, all
therapists utilize empathy, understood not as 'kindness' but as the attempt to think
and feel our way into the subjective experience of our patients.
Individuality: A focus on the individual as an individual. In much of our work as
psychiatrists we try to generalize, which is crucial when, for example, we want to
treat someone with a major depressive episode. At such times, our patient is much
like all other patients with an MDE, and we treat according to an algorithm. This
may be required at any given time, even with a dynamic patient However, when we
are functioning as dynamic psychotherapists, we seek to break through the general
to the specific, depressed individual, and see him or her as a unique individual with
a unique history and unique ways of dealing with life. As the great Canadian
physician William Osler said, 'It is much more important to know what sort of
patient has a disease than what sort of a disease the patient has.'
Space and Time: A focus on creating a relatively safe and regular space and time in
which therapy is conducted, one respecting boundaries and frame while allowing
for a measure of individual flexibility. Long-term psychodynamic psychotherapy
takes the perspective that change happens over time, and can't be rushed. The
average analysis lasts (whether funded by a third party or paid for by an individual)
about four-and-a-half years, while we think of the average psychodynamic
psychotherapy as lasting two or more years. Space and time are also relevant within
the room: at times we are relatively quiet to allow our patients the room to develop
their own thoughts, while also being active and engaged at other times.
The importance of early experience: Psychodynamic psychotherapy takes the
perspective that early experience is crucial in forming the brain and behaviour of
our patients. While all analysts, from Freud on, have recognized the role of
temperament and genetics, early experience is viewed as shaping even those 'given'
aspects of who we are. Physical, sexual and relational trauma (including neglect) are
viewed as sources of later pathology.
Transference: Within life and within therapy, early patterns of behaviour and
mentation recur. The ways in which they recur within therapy is referred to as
'transference,' and the exploration of the transference provides a central, if not the
central, means to understand and effect change.
Countertransference: In the narrow sense, the therapist's response to the patient's
transference; in the broader sense, the therapist's response to the totality of the
patient. While often viewed as a sign that the therapist needs to do some work on
their own, increasingly countertransference is viewed as a powerful tool that can be
used to understand the patient and the therapeutic dyad.
The therapeutic alliance: the importance of the therapeutic relationship, as both a
means to allow work to proceed and as a therapeutic mechanism in itself. Different
theorists and supervisors will place emphasis on one side of this dichotomy or the
other.
Source of Patients:
All residents should turn to their local psychotherapy coordinator when they are
looking for a new psychodynamic patient. Other common sources will include
Assessment Clinics, Inpatient Units, CL Services and the resident grapevine.
Individual supervisors are often helpful, though supervisors with patients they feel
are appropriate for Psychodynamic Psychotherapy are encouraged to give that
information to their local Psychotherapy Site Coordinator, who will take charge of
finding a resident to work with that patient. If a resident has explored these
possibilities without finding a suitable patient, they are encouraged to contact the
Psychodynamic Psychotherapy Head (currently Rex Kay, email above).
Suitability:
Selection of patients who are appropriate for Psychodynamic Psychotherapy is a
topic that will be discussed in seminars and supervision. No resident should ever
feel pressured to work with a patient if they feel uncomfortable about that
arrangement. This is a long-term commitment and the resident should feel hopeful
and excited entering into the treatment. All referred patients should be assessed by
the resident, no matter the source of referral, and a decision made with the help of
their supervisor. Psychodynamic Psychotherapy can be of value to a very wide
range of patients, but training, especially for PGY2 residents, requires a 'good'
patient to help the resident learn the modality. Some senior residents may choose to
work with more difficult patients to explore such treatments while in supervision.
Generally speaking, the appropriate psychodynamic patient for junior residents
should be:
-symptomatic, perhaps with multiple symptoms
-not actively suicidal, or with a recent history of strong suicidal ideation
-not exceedingly impulsive
-not self-harming or substance abusing
-reliably able to attend weekly therapy
-able to change sites every 6-12 months
-likely to be able to attend for two or more years (no commitment required)
We hasten to add that patients not meeting these criteria can benefit from
psychodynamic treatment. This is simply a guideline for junior residents (in
particular) who are trying to learn a treatment modality. In the end, the decision is
best made in consultation between the resident and their supervisor.
Seminars:
Required:
PGY2 Core: As part of your core seminars, held Wednesdays at CAMH, you will
participate in a small-group seminar exploring the theory and practice of
psychodynamic psychotherapy.
PGY2 Clinical Seminar: At your local hospital, you will participate in a seminar that
seeks to provide you with two things: a chance to apply the principles you are
learning in both your CBT and psychodynamic seminars to clinical material, and a
chance to talk to peers and one or two faculty about common experiences in
psychotherapy, and about the experiences you might be having as you learn
psychiatry and psychotherapy.
PGY3 (Child Psychiatry): During your rotation in child and adolescent psychiatry
you will have a seminar series covering a lot of psychodynamic psychotherapeutic
principles with a developmental focus.
PGY5: During your PGY5 year you will participate in a seminar series aimed at
reviewing some basic psychodynamic principle relevant to all (or almost all) of your
psychiatric work.
Electives:
PGY4 Elective in Contemporary Psychotherapy: A sixteen week long elective
seminar, held Mondays from 5:30-6:45, with a focus on psychodynamic thinking
over the last decade (or so). You will receive a request to register for this seminar in
the spring of your PGY3 year.
PGY5 Elective in Clinical Psychodynamic Psychotherapy: Held Mondays from 3:154:30, and running from September to June (with time off to study for your Royal
College exams) this seminar consists largely of clinical presentations and
discussions, interspersed with sessions talking about clinical issues and practical
questions, generated by the residents attending.
Psychotherapy Interest Group Meetings: A resident-led series of up to three
evenings per year, devoted to psychotherapy and organized by the resident
representatives on the psychotherapy committee. Look for notices or get involved email Julie Wilson to find out who the current resident reps are.
Supervision:
The supervisor-supervisee relationship, and the work done in supervision, can be
one of the most rewarding aspects of the residency. Whether on inpatients, CL,
outpatient clinics, ACT teams, Shared Care, geriatrics, child and adolescent, or any of
the psychotherapies, residents are encouraged to get the most out of the
supervisory relationship.
Psychotherapy coordinators at each site should assign resident/supervisor dyads
during June, and communicate that to both before the end of the month. PGY3
through 5 residents should contact their new supervisor(s) before the end of June,
and set up a first meeting within the first two weeks of July, vacations permitting.
PGY2 residents should contact their new supervisor during the first week of July (at
the latest) and set up a first meeting by the third week of July (again, at the latest).
Supervisory hours should be regarded by both members of the dyad as committed
time. Supervisors are required to meet with residents even if the resident has not
seen a patient during the preceding week. Residents are required to attend
supervision on time and with either: detailed process notes (which may be taken
during the session or, preferably, written out immediately after the session) which
focus on ‘I said/they said' detail), or audio/video recorded session material plus
brief written notes. Either way, it is expected that the resident will have spent some
time reviewing the session(s) prior to supervision and enter supervision having
thought through the material to a depth appropriate to their level of study.
Supervisors are expected to conduct their supervision with the resident’s year of
training in mind.
For residents beginning their PGY2 year in 2013 or later, it is now required
that during the course of your residency you get six months of supervision on
a psychodynamic case using either audio or video recordings. Be sure to get
signed consent, and be sure to erase the recordings after supervision.
Supervision should take place, whenever possible, at the resident's site. When this is
not possible, please discuss the situation with the local site psychotherapy
coordinator. Except in unusual circumstances, residents should change supervisors
when they change sites. If you feel there is a very good reason to continue with a
current supervisor, contact both your current and future site coordinator, and the
modality head, before the end of your current rotation.
Absences are to be minimized, and respect is to be given in both directions.
Residents are expected to attend supervision weekly unless they are ill, on vacation
or post-call, or, in rare circumstances, in the event of a clinical emergency. Advance
warning is expected, whenever possible. Thus, residents who will be missing
supervision post-call or for vacations should notify their supervisors as soon as
possible.
All supervisors should review the resident’s charted notes at least once per six
months. Both parties should acquaint themselves with the departmental guidelines
for psychotherapy notes, available on the department website (see below).
Supervisors are also required to keep brief notes on every supervisory session.
PGY2 and PGY4 residents are required to submit a psychodynamic case report
during the year (see below). These case reports should be discussed with the
individual supervisor and a draft submitted to and discussed with the individual
supervisor before the finished report is submitted.
Supervision year-by-year:
We ask supervisors and residents to attend to the following guidelines, with
an understanding that the primary responsibility of the dyad is to the
psychodynamic patient(s) in care.
PGY2: All PGY2 supervisors should receive regular updates from the Core
Seminar leaders, letting them know what was read and talked about week-byweek. Where appropriate, supervisors should try to integrate the theme of the
Core seminar into their supervision.
PGY3: Residents are engaged in their Geriatric and Child rotations, so we
encourage the supervision to focus on developmental thinking, whenever
possible. Supervisors are encouraged to recommend approximately 6 papers
and one book to their residents during the year.
PGY4: During this year many residents will be attending the PGY4 Elective in
Contemporary Psychodynamic Thought but, whether they attend or not, we
encourage the supervision to focus on integrating theory and practice,
including the discussion of what theoretical ideas they are currently
employing and how different perspectives might be applied tot he same case
material. Six-eight articles and one-two books may be suggested.
PGY5: During this final year the focus should be on the therapeutic process.
This should include some discussions of what the supervisor thinks is
effective in therapy and allow for an exploration of the therapeutic
relationship, with an emphasis on transference and countertransference.
Residents often find this final, exam, year difficult, so please assign papers
according to the wishes of the resident, but at least three-four should be
offered.
Notes:
Note-taking is an important part of your psychiatric and psychotherapeutic
education, and a crucial part of your responsibility to your patients and your
profession. Think of your notes as being, at least:
For you: your notes should meet your own needs, both now and in the future. For
cases in psychotherapy supervision you should have a separate set of process notes
(in addition to your basic notes) that include an attempt at 'I said/he said' detail.
Your notes should be good enough that you can readily re-read them and recognize
changes in themes, transference, countertransference, mood and the therapeutic
relationship even over years. As in all charts, you should also be able to identify why
medications were started, changed and altered.
For your patient: Remember that your patient might see these notes, and write with
that in mind, where appropriate. Confidentiality must be protected (see below) at all
times.
Meeting Medico-legal requirements: as a part of a self-regulating profession, and
under the OHIP system, we have an obligation to ensure our notes are completed
quickly and adequately.
The following comes from the CPSO guidelines (the entire file is available at:
http://www.cpso.on.ca/policies/policies/default.aspx?ID=1686 )
Patient Encounters Where Focus is Psychotherapy
The Psychotherapy Act, 2007, defines the scope of practice of psychotherapy as “the
assessment and treatment of cognitive, emotional or behavioural disturbances by
psychotherapeutic means, delivered through a therapeutic relationship based on
verbal or non-verbal communication.”50 The same legal requirements apply to
records maintained for psychotherapy as to other sorts of records. However, some
differences exist based on the scope of psychotherapeutic practice. For example, in
psychotherapy, the physician would record observations about the patient’s
emotional status, speech, cognitive pattern, etc., in place of recording a physical
examination. Maintaining records that “tell the patient’s story” is particularly crucial
in the psychotherapeutic context because there may be less objective physical data
upon which to base management plans.
The following list of potential elements is applicable to the psychotherapy-focused
progress notes of physicians who include psychotherapy as part of their general
medical practice. The list is not meant to be comprehensive, but to serve as a guide
only:51
The problem/story the patient presents;
Developments between visits;
Any progress made;
Responses to treatment;
Physical complaints;
Relationship/family issues;
Work/social problems;
Patterns and insights noted by the physician;
Interventions or therapeutic approaches by the physician;
Mental status – especially if changed;
Suicidality – risk, discussion, plan, if present;
Assessment, impression, formulation or diagnosis – A DSM-IV-TR (or subsequent
DSM edition) or ICD diagnosis may be made whenever possible for medico-legal,
consultation, and other purposes which are in the patient’s interest;
Specific therapy used (where applicable);
Patient homework, goals, plans;
Medication and any change in medication or dosage;
Community or education resources suggested;
Referrals;
Meeting or conversation with a supervisor and any additional insights (e.g., with
regard to communication patterns that cause the patient difficulties, diagnoses,
formulations or plans of action). Any notes regarding therapist learning or dealing
with counter-transference are recommended to be kept in the therapist’s own
notebook, and not in the patient’s chart;
On the patient’s last visit, when known, the physician can record the outcome of the
work and the patient’s response to the end of therapy.
End of Rotation Note Care:
The following document has been prepared by the Psychotherapy Committee and
serves as the University of Toronto requirement for transitions:
Psychotherapy Training: Transitioning to a New Site
(May 2013)
Preamble: Transitioning to a new site and rotation involves looking after a number
of administrative tasks. These include orienting to new core rotational learning
objectives, site-specific logistics, and educational requirements. Residents, with the
support of psychotherapy faculty, will need to arrange for long-term psychodynamic
patients to transfer, and secure psychotherapy supervisors at your next site for
other modalities.
Transitioning to a new supervisor for psychodynamic psychotherapy can enhance
learning through the potential for a new perspective and discoveries about your
patient. In order to facilitate this transition, the psychotherapy training program
recommends that residents, with the assistance of their supervisors and
psychotherapy site coordinators, follow the steps below.
Site-specific questions with regards to transitioning?
Any site-specific questions with regards to transitioning to a new site should be
directed to the psychotherapy site coordinator at your current or new site.
Where do I find psychotherapy training documents online?
Psychotherapy Training Program documents pertaining to training requirements,
charting, off-site supervision as well as other important educational resources are
available online on the departmental website at www.psychiatry.utoronto.ca,
postgraduate education, psychotherapy training.
What do I need to do before I transition to a new site?
Contact the psychotherapy site coordinator at the new site to discuss your
supervisory needs, review your progress in terms of the required supervised
casework, and ensure you continue to fulfill them. Note there is some variation to
the breadth of modality specific supervision offered at each site and residents are
encouraged to take advantage of the supervision available at each site. See the
psychotherapy page of the departmental website for listings of supervisors and to
review the requirements.
BEFORE you leave your current site:
 TERMINATING or CONTINUING? Decide whether you are terminating or
continuing with your patient. Residents may continue with the same
supervisor if you are conducting a time limited therapy and are close to
concluding treatment. If you have just started a new case and supervision is
available at your new site, starting with a new supervisor is recommended.
Please note: If off-site supervision is approved for you to complete your
short-term case, please follow off-site supervision guidelines, available
online on departmental website.
If you are TERMINATING with the patient:
 Write a termination note summarizing the patient’s progress in therapy and
any potential follow-up that you have arranged for the patient. This must be
reviewed with your supervisor and sent to the referring physician.
If you are CONTUINUING with your patient:
 CONSENT FORM: Please have your patient sign a consent form for disclosure
of their personal health information pertaining to the therapy you are
conducting – this will allow you to photocopy the initial consultation note
and end of rotation progress note which should then be faxed or sent via
mail to you at your new site. Photocopy the consent form as well to include
with the package to go to your next site (see below for further details).
 SUMMARY FOR CHART: Write an end of rotation progress note in the chart
summarizing the patient’s progress and goals for ongoing therapy – please
refer to charting guidelines for details of the note which are available online
on the departmental website.
It is required that you review this summary note with your supervisor.
MAILED/FAXED to you (or another individual such as your supervisor/site
postgraduate education administrative assistant) at your new site for your initial
supervision sessions:
 Copy of the initial consultation note
 Copy of the end of rotation summary of patient
 Copy of the consent form signed by patient to disclose personal health
information
The above documents should be included as part of the new chart you create at your
new site.
CASE REPORT: If you have written a PGY2 or PGY4 psychodynamic case report, it
is recommended that you share this report along with the feedback you received
(reader’s report) with your new supervisor. This case report should not be included
as part of the chart. Please ensure that the patient’s identity in the case report has
been disguised.
REGISTER your patient at your new site and create a new chart.
What do I do with the confidential patient information before I have an office
assigned to me at the new site?
In order to comply with regulations pertaining to patients’ rights to confidentiality,
it is not permitted to bring any documents from patients’ charts home with you.
Either the administrative assistant for your primary supervisor or the postgraduate
education administrative assistant should be able to hold on to the patient
information until you are assigned a new office. At that time, the information can be
mailed or faxed to you. Ensure that you have obtained patient consent before
initiating the above process (see above for details).
PGY2 and PGY4 Case Reports:
PGY 2 and PGY 4 residents are required to submit a case report as part of their
psychodynamic psychotherapy education. The purpose of these reports includes
(but is not limited to) the following:
1) Provide the resident with an opportunity to integrate theoretical information
with clinical experience. Too often it will seem that there are two components to
learning psychodynamic therapy - theory and practice - and they are scarcely
related. Case reports are an opportunity to bring them together.
2) Help the resident develop the ability to review their notes and extract major
themes, transferential material and identify countertransference. This will be an
important skill throughout a career, especially when facing difficulty in a particular
therapy. It will also teach the resident about what is important to put into a note, in
order to be of use in the future.
3) Allow and require the supervisor to teach the resident about formulation in a
way that is clinically relevant. In getting a response from a reader the resident also
has the opportunity to read about alternative ways to reflect on the same material,
which is both educational and, often, clinically useful.
***PGY 4 case reports are due the first Friday in November. PGY2 case reports are
due the last Friday on March. Case reports are to be sent to the residents'
Psychotherapy Site Coordinator as well as copied to Julie Wilson, Psychotherapy
Program Assistant (jwilson@mtsinai.on.ca). Each case report will be read by a
psychodynamic psychotherapy supervisor (who is not the resident's primary
supervisor) and a "Reader's Report" with feedback about the report will be returned
within one month. Site psychotherapy coordinators are responsible for collecting
the reports and assigning the readers.***
Residents are expected to consult their supervisors when writing the reports
but the role of the supervisor is guidance, not writing. Patients should be identified
by initials only (which may be false), and information that might compromise
confidentiality should be disguised.
Core components of the Case Report:
* Introduction
- Identifying data, reason for presenting for therapy
* Background data
- Past history (psychiatric, substance use, forensic, family psychiatric,
medical hx if relevant)
- Personal history, especially developmental experiences that may have
contributed to the patient's current problems. This is expected to be more detailed
than in a standard psychiatric report
-An initial mental status exam
* Course in Therapy
-Major themes that have emerged in the therapy and a brief description of
how the themes manifest themselves in therapy sessions
- Discussion of transference and countertransference, including comments on
how the doctor-patient relationship has unfolded
-This section should include at least some examples of I said/they said
process notes that illustrates the therapeutic process.
-PGY4 residents may use the same patient they wrote about in PGY2,
but then the focus should be the Course in Therapy since the first report, and
the new Formulation should reflect both the course of the work and the
deepening understanding of the now senior resident.
* Formulation
- An understanding of an individual and his or her difficulties that serves to
guide the therapy
- A synthesis, integration and hypothesis or set of hypotheses put forward
that remain open to revision as the therapy unfolds
- An attempt to capture the therapist's current thinking about the patient
The formulation is the part of the report that most residents find anxiety-provoking.
It is often seen as a time the resident has to make their work fit into one or more
theoretical models, and dazzle the reader with their ability to quote the literature
and write an essay fit for publication. This is emphatically not what we are looking
for.
The formulation need not be long, overly inclusive or replete with psychoanalytic
theory - the resident's own words and descriptions are powerful enough as a
baseline. However, the formulation is an opportunity to try to integrate theory with
clinical practice. PGY 2 residents should be encouraged to utilize some
psychoanalytic concepts with which they are familiar, as a way to broaden their
understanding. PGY 4 residents should demonstrate their ability to use at least one
theoretical concept to illuminate their clinical work. The formulation is primarily a
chance for the resident to be creative, to take all the time they have spent with their
patient, thinking about their patient and talking about their patient and tell us who
they think this person is, and how they got that way. The resident should pick a
couple of aspects of their patient that intrigues them - why are they so successful at
work and not in relationships? What happened in their relationship with their last
girlfriend? Why are they mad at their psychiatrist so much of the time? They should
strive to think and feel their way into their patient's world, to puzzle it through,
knowing that there is no one right answer.
Complete reports should be about 8-12 pages double-spaced, with at least a page
(two-to-three pages for PGY4s) devoted to the Course in Therapy (including some
process material), and about one page for the Formulation.
After you receive the Reader's Report you MAY CHOOSE to contact the reader for a
conversation of about fifteen to twenty minutes, either in person or on the phone,
about your work. These conversation should be viewed as educational opportunities,
to seek expansion or clarification of any points made in the original response.
Personal therapy:
During the course of training, many residents find they wish to enter personal
therapy, including, but not limited to, psychodynamic, CBT, IPT, Couples, and Family.
We have created a data base of faculty interested in working with residents, and
willing to facilitate, as possible, a resident's therapy, while ensuring that no fees
beyond OHIP will be charged. This list can be accessed by contacting Julie Wilson
(email above) at any point during your training.
Post-Graduate Training:
Through the years many residents have inquired about options for further training
in psychodynamic psychotherapy and psychoanalysis. We encourage this training to
enhance your knowledge and skills, and require some additional training if you
would like to be a psychodynamic supervisor. Many graduates develop by a
combination of: attending lectures and courses, starting peer-supervision groups,
paying for supervision or joining study groups. Here are four training institutes to
consider if you are interested in further formal training. These are not the only four
places to obtain training in Toronto, but they are four we are familiar with, and have
great confidence in. This training is usually done following the completion of the
residency, but some residents have started during their senior years. Should you
have further questions, feel free to discuss this with your psychodynamic
supervisors, or the Head of the Psychodynamic Program.
The Toronto Institute for Contemporary Psychoanalysis
4-YEAR TRAINING PROGRAM IN CONTEMPORARY PSYCHOANALYSIS
At the core of this comprehensive program is an energizing, interactive balance
between clinically relevant professional training and intellectually rigorous,
scholarly education. The curriculum promotes these mutually facilitating goals
through seminars that integrate evolving theory and practice. The program fosters
the ability to think critically about several major points of view (e.g., classical
psychoanalysis, ego psychology, Kleinian analysis, British Object Relations, Self
Psychology, Relational psychoanalysis), and to formulate clinical material from a
variety of perspectives. This course of study reflects the Institute’s distinctive,
comparative/integrative philosophy. Theoretical positions and clinical approaches
are compared and contrasted, seeking to synthesize them where possible, and to
understand what might make such integration difficult or impossible at this time.
Attention is also given to the historical contexts in which theories develop, the
scientific/philosophical assumptions inherent in them and, where relevant, the
personality of theorists. Above all, the utility of thoroughly considered theory for
understanding and treating patients is stressed. Clinical seminars course through
the entire 4 years so that cases can be considered in depth. Weekly seminars and
clinical supervision are complemented by three weekend workshops each year with
distinguished visiting faculty.
ESSENTIALS PROGRAM
This is a clinically focused program for those desiring to learn the basic principles
and applications of psychoanalytic therapy. It consists of 30 two-hour seminars
covering: an historical overview of psychoanalysis, analytic attitude, concepts of
development, motivations and drives, object relations and the self, relationality,
concepts of change, character, contemporary perspectives on psychopathology,
empathy and mentalization, the unconscious, analytic listening, transference,
countertransference, and psychoanalytic interventions. Eight seminars are devoted
to case presentations, led by senior clinicians. Class members working in a
psychoanalytically informed way will have the opportunity to present cases and
clinical process will be discussed.
For further information on our programs and for application procedures please see
our website www.ticp.on.ca
Or contact our Administrative Director:
Suzanne Pearen at suzanne_pearen@rogers.com
The Toronto Psychoanalytic Society
The Toronto Psychoanalytic Society (TPS) is a not-for-profit association of
professional psychoanalysts engaged in the development and advancement of
clinical psychoanalysis and psychoanalytic thought in Toronto. It was founded in
1965 as a branch of the Canadian Psychoanalytic Society (CPS), a component society
of the International Psychoanalytic Association (IPA) founded by Freud, with
headquarters in London, England.
The IPA is the world's leading association of professional psychoanalysts. It
establishes training requirements to which component psychoanalytic training
institutes must adhere, as well as standards of practice and ethical guidelines that
members of component societies must uphold.
The Toronto Psychoanalytic Society (TPS) is an association of psychoanalysts who
through having completed their training have qualified for membership in the TPS,
CPS and IPA.
The Toronto Institute of Psychoanalysis (TIP) is composed of senior members of the
TPS who have, in addition, qualified as Training & Supervising Analysts. They are
charged with the responsibility of analyzing and supervising candidates in training.
They also oversee the processes of admission of candidates, the assessment of their
progress in training, the development and administration of the curriculum, the
evaluation of members of the TPS who have applied to become training analysts,
among other functions.
The TIP was established in 1969 as a branch of the Canadian Institute of
Psychoanalysis (CIP). The TIP is now the largest psychoanalytic training program in
Canada. As a component society of the IPA and a branch of the CIP, the TIP provides
the only Training in Clinical Psychoanalysis in Toronto leading to the
qualification of psychoanalyst with internationally recognized standards of
excellence and ethics.
In addition to the training of psychoanalysts, the TPS&I offers a range of educational
programs throughout the academic year that are open to the community.
The Advanced Training Program in Psychoanalytic Psychotherapy(ATPPP), in
addition to offering a two-year clinical training in psychoanalytic psychotherapy,
sponsors biannual Scientific Sessions that focus on timely clinical and theoretical
issues in long-term psychoanalytic psychotherapy.
Since 1983, the Extension Program of the TPS has offered to the public a series of
courses on a wide range of clinical and applied psychoanalytic topics, including the
highly attended annual course "Psychoanalysis and Cinema."
Each year since its introduction in 2005, the TPS offers a one year, twenty-four week,
introductory course on the principles of psychoanalysis. The Fundamental
Psychoanalytic Perspectives (FPP) Program combines teaching of basic concepts
of psychoanalysis with presentation of clinical cases and explanation of therapy
technique. Although not a training program, it could easily serve as a preliminary to
one.
Many of the monthly scientific meetings of the TPS are open to the community and
focus on a wide range of theoretical and clinical issues, as well as applications of
psychoanalysis in other fields. In 1990, the signature event of the TPS&I was
established as The Annual Day in Psychoanalysis and has become an important
event in the education calendar of Toronto's community of mental health
professionals. With the growing interest in clinical psychoanalysis and applied
psychoanalysis in Toronto, the TPS&I seeks to reach a broad clinical and academic
audience interested in the full spectrum of psychoanalytical thought.
Membership in the TPS is limited to individuals who have completed psychoanalytic
training at a branch of the Canadian Psychoanalytic Institute or another
psychoanalytic institute sanctioned by the International Psychoanalytic
Association.
For a lively and in-depth account of the birth of psychoanalysis in Toronto, and the
development of the Toronto Psychoanalytic Society and Institute, see Dr. Douglas
Frayn's Psychoanalysis in Toronto.
For further information on the various programs and activities sponsored by the
TPS&I you may consult our website (www.torontopsychoanalysis.com) and email us
(info@torontopsychoanalysis.com).
To inquire about training in clinical psychoanalysis at TIP and for application
forms, contact Mrs. Jean Bowlby by email (institute@bellnet.ca) or telephone (416922-7770), or write to the Toronto Institute of Psychoanalysis, 40 St. Clair Avenue
East, Suite 203, Toronto ON M4T1M9
The Institute for the Advancement of Self Psychology
The Institute for the Advancement of Self Psychology (IASP) was established in
1994 to train professionals in Psychoanalytic Theory and Technique with an
emphasis on Contemporary Self Psychology.
IASP offers a two and a four year clinically oriented training program. The two-year
curriculum covers the fundamentals of psychoanalytical psychotherapy with a focus
on contemporary Self Psychology and Relational Theory. The four-year program
offers training in advanced Psychoanalytic Psychotherapy or Psychoanalysis.
Both programs include a series of weekly didactic and clinical seminars, clinical
supervision of treatment cases, and the experience of personal psychotherapy or
psychoanalysis. Graduates are welcome to join the IASP professional community
and participate in study groups, professional meetings, and affiliation with the
International Association of Psychoanalytic Self Psychology.
Contemporary Self Psychology has extended Kohut's ideas and now includes
theoretical contributions from intersubjectivity theory, motivational systems theory,
non-linear dynamic systems theory, specificity theory, infant research, neuroscience
and relational self psychology. The IASP programs will appeal to residents who want
to refresh and extend their knowledge of general psychoanalytic theory, but want to
focus on the theoretical and clinical approaches of Self Psychology.
Please see the following websites for further information:
IASP: http://www.iasptoronto.com/
International Association of Psychoanalytic Self Psychology: http://www.iapsp.org/
Feel free to contact us at:
info@iasptoronto.com
to set up a phone call with an IASP board member.
for further information, or
Canadian Institute for Child & Adolscent Psychoanalytic Psychotherapy
Established in 1975, this four-year program (part- time) involves weekly academic
seminars, supervised clinical work, and infant/toddler observation. This intensive
immersion greatly enriches understanding of clinical complexities and provides
powerful therapeutic tools for treating a wide variety of conditions. Faculty include
graduates of the program and psychoanalysts from other institutes in the city who
are experienced in child and adolescent psychoanalytic psychotherapy. In the first
year, discussion of psychoanalytic theories broadens and deepens understanding of
child development, psychopathology, and family relationships. Readings explore
ages and stages of development from diverse viewpoints including classical
Freudian, developmental ego psychology, object relations, self psychology, and
relational psychoanalysis. Weekly observations of an infant at home and a toddler in
a daycare setting are followed by class discussions on the theory of infant and
toddler development in relationship to caregivers. Following academic years focus
on childhood, latency, and adolescent development, family dynamics, the
therapeutic relationship, work with parents, and continuous case seminars.
Assessment and formulation skills, psychostructural diagnosis, and principles of
therapeutic intervention are taught. Professional practice issues and topics such as
anxiety, conduct disorders, depression, eating disorders, learning disabilities,
attention deficit/hyperactivity, obsessive-compulsive disorder, phobias, trauma and
adoption are covered. Candidates conduct a minimum of three supervised
assessments and four treatment cases covering the full age span. Completion of this
course of study makes one eligible for membership in the Canadian Association of
Psychoanalytic Child Therapists. For more information or to request an application
package, please contact Suzanne Pearen, our Administrative Coordinator by
telephoning 416-690-5464 or emailing suzanne_pearen@rogers.com.