LONG-TERM PSYCHOTHERAPY EDUCATION GUIDELINES
Sam Izenberg
Rex Kay
1) KNOWLEDGE DOMAINS
1.
2.
3.
4
5.
6.
Nature of open-ended psychotherapy – differential meanings of “dynamic
psychotherapy”, “expressive psychotherapy”, “long-term psychotherapy”,
“supportive psychotherapy”
- relevance of these terms to psychotherapeutic models
Nature and role of transference
Subjectivity and its particular application in psychotherapy
The unconscious – history of the term and its multiple meanings
Current relevant neuro-scientific concepts as especially related to memory,
affect and unconscious
Various psychoanalytic models
- Instinct Theory
- Ego Psychology
- Kleinian Thought
- Object Relations Theory
Fairbairn
Winnicott
Etc.
- Self Psychology
- Attachment Theory
- Relational Psychoanalysis
7.
Theoretical and technical implications of different models
- the meaning of “insight” and the and the nature and function of
interpretations
- projection and introjection in therapy
- the nature of the therapeutic relationship
- differential meanings and uses of “idealization”
- working with dreams
8.
Application of psychotherapeutic concepts to inpatient and emergency work
- borderline conditions
9.
Selection and Exclusion Criteria for expressive psychotherapy
10.
Application of psychotherapeutic concepts to treating patients at different life
stages: i.e. childhood, adolescence, young adulthood, middle age,
geriatric
2) SKILLS
- To understand and utilize empathy
- To tolerate ambiguity and ambivalence
- To maintain boundaries and frame of psychotherapy
- To understand the nature and function of interpretation and to carry it out
- To utilize both supportive and exploratory techniques
- To apply critical thought to theory and its application
- To engage in treatment as a process
3) ATTITUDES
- Non-judgmental attitude
- Openness to examination of counter-transference
- Understand and appreciate the empowerment afforded by using
models
4) ENABLING OBJECTIVES
1) Total number of required seminar hours…100
2) Total number of clinical cases…at least two cases for two years and at least
one case for the other two years…of at least once a week frequency
3) One case to be seen twice weekly
4) Number of hours of total supervision…150…at least two different supervisors
over course of four years
5) No psychotherapy work undertaken without supervision
6) Understand and utilize concepts of development and attachment
7) Understand and be able to utilize concepts of transference and
countertransference
8) Understand concept of empathy…be able to use it and distinguish it from
sympathy
9) Written Reports:
a) Proficiency Level

At least two formal assessments concluding in a detailed formulation
demonstrating an understanding of psychodynamics and which draws
primarily on experience of the patient during the assessment as well as
appropriate historical material. The first in the PGY II year and the second in
the PGY IV year.

At least two “course of therapy” write-ups consisting of course of therapy and
formulation, covering 3-6 months of therapy. They should describe central
themes in the process, note transference and countertransference elements,
note changes in the patient during that time and if none are apparent relate
that to the formulation. One of these write-ups should come in the PGY III
year and the other in the PGY IV year.
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b) Advanced Level

two additional assessments as above

two additional course of therapy reports as above…but including deeper and
more detailed understanding of transference/countertransference…ability to
formulate relating it to at least one psychodynamic model and demonstrating
linkage between current psychological organization and relatedness,
transference/countertransference, current difficulties, patient’s history and
theory…more in-depth evaluation of progress in course of therapy.
5) SPECIFIC CONTENT
- Developmental Theories
- Concept of the Unconscious
- Subjectivity
- Transference
- Instinct Theory
- Countertransference
- Relationality
- Ego Psychology
- Klein
- Object Relations Theory
- Self Psychology
- Attachment Theory
- Support
6) LEARNING OBJECTIVES
a – Grasp of role of therapist
b – Maintenance of frame of psychotherapy
c – Understanding of boundaries
d – Understanding of silences
e – Tolerance for ambiguity
f – Capacity for empathy
g – Understanding of Interpretation
h - Recognition and use of transference
i – Recognition and use of countertransference
j – Understanding supportive techniques
EVALUATION:
Supervision is a process which contains some elements of the psychotherapeutic
process itself in that it is a collaboration between two persons who have differing roles
but a common goal. Disruptions or difficulties in the relationship may occur. The
supervisor should encourage the resident to discuss such occurrences and be open to
exploring them. While it is understood that evaluation is occurring on an ongoing basis
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during the supervisory process, it is essential that specific formal evaluation be done in
writing every six months. Given the individual and intensive nature of the supervision
there should be no significant surprise to either supervisee or supervisor at this time.
RECOMMENDATIONS AS TO TYPE OF CASE
At least one of the cases should be a patient that has some difficulty forming a therapeutic
alliance. Ideally, each resident should experience treating both a man and a woman.
RECOMMENDED CORE READINGS
The following readings give the underpinning for the above knowledge objectives. One of these
should be read in first year, and one in second year.
THE FOLLOWING TEXTS ARE SUITABLE INTRODUCTORY TEXTS
The APA Concise Guide to Psychotherapy, by Ursano, Lazare, and Sonnenberg (1991) is a brief
overview of psychotherapy which is recommended to all residents in the first summer of the
residency to orient them to the goals of treatment, the basic contract, and what to expect in
treatment. It is a user friendly map. Because it is so brief, it should be read in conjunction with
another book.
Dynamic Psychiatry in Theory and Practice. Wallace, E.R. (1983)Philadelphia: Lea and
Febiger is a good introduction to dynamic theory, and has especially good chapters on technique
in the initial phase, middle phase, and termination. Good clinical examples. Its one weakness is
that it overvalues the role of childhood experience as causative in psychosis. Currently out of
print, but available in libraries.
Psychodynamic Psychiatry in Clinical Practice, American Psychiatric Association Press, by
Glen O. Gabbard (1994) is the most widely used overall introduction to psychodynamics,
organized according to DSM-IV psychiatric diagnosis.
The Psychiatric Interview in Clinical Practice, W.B. Saunders Company, Philadelphia, by
MacKinnon, R. and Michels, R. (1971) is an older text, with a good introduction to dynamic
psychiatry. Its chief strength is that it demonstrates how to talk to patients with different
psychodynamic constellations. It is a hands on book.
THE FOLLOWING TEXTS ARE SUITABLE INTERMEDIATE AND ADVANCED
TEXTS
Psychotherapy of Neurotic Character. Shapiro, D. (1989) Basic Books, New York. This book
shows how to work very close to the surface of character disturbances, to spot conflicts and
articulate them for patients.
Theory of Psychoanalytic Technique, 2nd edition. Basic Books, New York. Menninger, K. &
Holzman, P. (1973)Used at the famous Menninger Hospital.
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The Technique and Practice of Psychoanalysis, (1967) Vol 1, by Ralph Greenson, International
Universities Press. In contrast to Shapiro, this book is noted for teaching practitioners to work
with deeply warded off fantasies. It is known for its clinical richness, and lengthy discussions of
how to work collaboratively with patients in the psychodynamic model, while unwelcome,
warded off material emerges.
THIRD YEAR: Residents are to choose a book from the list of elective psychotherapy reading,
in the Appendix of this Subcommittee report.
Psychotherapy supervisors will be expected to help clarify the core concepts in these readings for
residents, and residents will be expected to keep up with reading in a timely fashion.
FOURTH YEAR: No Additional requirement, except for career track residents.
FIRST & SECOND YEAR RECOMMENDED TEXT OFFERINGS. One of these is to be
read in each year.
Up to date Overview of Psychodynamic Psychiatry
Glen O. Gabbard (1994) Psychodynamic Psychiatry in Clinical Practice: The DSM-IV Edition.
American Psychiatric Association Press, Washington D.C. The most widely used overall
introduction to psychodynamics, organized according to DSM-IV psychiatric diagnosis.
Psychotherapeutic Technique: General Texts
Ursano, R., Lazare, S., and Sonnenberg. S (1991) APA Concise Guide to Psychotherapy, by
American Psychiatric Press, Washington, D.C. A brief, clear overview. Only to be used in
conjunction with another text, if used for third year reading.
Greenson, R. (1967)The Technique and Practice of Psychoanalysis, Vol 1, Ralph , International
Universities Press, New York. Best for more senior students, it can be used at the introductory
level, if taught. This book shows how to get to material that has been warded off from earliest
childhood, and is a classic text, known for its clinical richness.
Luborsky, L. (1984). Principles of Psychoanalytic Psychotherapy: A manual for SupportiveExpressive Treatment. New York: Basic Books, Inc., Publishers. Though, as the author states,
this manual is not a substitute for other texts and supervision, it is excellent at helping the
reader focus on an essential transference derivative called the core conflictual relationship theme.
Shapiro, D. (1989) Psychotherapy of Neurotic Character. Basic Books, New York. Proceeding
from the notion that all neurotic phenomena (obsessions, compulsions, acting out of character)
are instances of the self being alienated from itself, this short text helps the reader learn to speak
to patients about the neurotic process, and slowly integrate warded off phenomena.
Menninger, K. & Holzman, P. (1973) Theory of Psychoanalytic Technique, 2nd edition. Basic
Books, New York. Used at the famous Menninger Hospital.
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Wallace, E.R. (1983) Dynamic Psychiatry in Theory and Practice. Philadelphia: Lea and
Febiger. This book is outstanding for beginners who want more than an overview. It has clear
chapters outlining core theory, and is excellent in describing the indications of treatment, and
phases of treatment, how to speak to patients, and how to help the process along. It is filled with
examples, with focus on early treatment difficulties.
THIRD YEAR RECOMMENDED TEXT OFFERINGS. One of these is to be read in third
year. Select a text that you have not read in first or second year.
Borderline Personality, Treatment of
Kernberg. O., Selzer, M.A., Koenigsberg, H.W., Carr, A.C. & Appelbaum, A.H. (1989)
Psychodynamic Psychotherapy of Borderline Patients. Basic Books Inc.: New York. A manual,
which is well written.
Masterson, J.F. (1976) Psychotherapy of the Borderline Adult: A Developmental Approach.
Brunner Mazel, New York.
Waldinger, R. & Gunderson, J. (1987) Effective Psychotherapy with Borderline Patients.
Macmillan Publishing Company, New York.
Classical Technique & Attitude
Fenichel, O. (1941) Problems in Psychoanalytic Technique. Psychoanalytic Quarterly, Inc.,
New York. Short classic on working from surface to depth.
Langs, R. editor. ( 1981) Classics in Psychoanalytic Technique. Jason Aronson, New York.
This large text assembles many of the finest papers written on technique. A reading of selections
will be adequate.
Warme, G. (1994) Reluctant Treasures: The Practice of Analytic Psychotherapy. Jason Aronson
Inc., Northvale, N.J.
Dreams
Sloane, P. (1979) Psychoanalytic Understanding of the Dream. Jason Aronson, New York.
Ego Psychology
Blanck, G., & Blanck, R. (1974) Ego Psychology: Theory and Practice. Columbia University
Press. New York.
Blanck, G., & Blanck, R. (1979) Ego Psychology II: Psychoanalytic Developmental
Psychology. Columbia University Press. New York.
Gray, P. (1994) The Ego and Analysis of Defense. Jason Aronson, Inc., Northvale.
Empirical Psychodynamic Research
Miller, N.E., Luborsky, L., Barber, J. P. & Docherty, J. P. (eds.) (1994) Psychodynamic
Treatment Research: A Handbook for Clinical Practice. Basic Books, New York. The most
comprehensive introduction to the field.
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Hysteria and Histrionic Personality Disorders
Horowitz, M. ed. (1991) Hysterical Personality Style and the Histrionic Personality Disorder.
Jason Aronson, Inc., Northvale.
Masochism, & the Masochistic Character, Treatment & Understanding of
Fitzpatrick Hanly, M. (1995) Essential Papers on Masochism. New York University Press.
Glick, R. and Meyers, D. (1988) Masochism: Current Psychoanalytic
Perspectives. Edited by The Analytic Press, Hillsdale New Jersey.
Narcissism, Treatment & Understanding of
Bach, S. (1985) Narcissistic States and the Therapeutic Process. Jason Aronson, Inc., New
York.
Kernberg, O. (1975) Borderline Conditions and Pathological Narcissism. Jason Aronson, Inc.,
New York.
Kohut, H. (1971) The Analysis of the Self. International Universities Press, New York.
Object Relations
Hinshelwood, R.D. (1994) Clinical Klein.
Kleinians work.
Basic Books, New York. Shows how modern
Kernberg, O. (1976) Object Relations and Clinical Psychoanalysis. Jason Aronson, Inc. An
important work, for an advanced resident. One of the main texts to have introduced object
relations to North America.
Segal, H. (1975) Introduction to the Work of Melanie Klein. The Hogarth Press, London.
Seinfeld, J. (1990) The Bad Object: Handling the Negative Therapeutic Reaction in
Psychotherapy. Jason Aronson, Inc. Northvale.
Winniccott, D.W. (1988) Human Nature. Schocken Books, New York.
Obsessional and Rigid Characters, Treatment & Understanding of
Salzman, L. 1985) Treatment of the Obsessive Personality. Jason Aronson, Inc. Northvale.
Shapiro, D. (1981) Autonomy and Rigid Characters. Basic Books, New York.
Perversion & Paraphilias, Treatment & Understanding of
Fogel, G. & Myers, W. (1991) Perversion & Near Perversions in Clinical
Practice. Yale University Press, New Haven.
Psychodynamic Diagnosis
MacKinnon, R and Michels, R. (1971) The Psychiatric Interview in Clinical Practice, W.B.
Saunders Company, Philadelphia.
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Shapiro, D. (1965) Neurotic Styles. Basic Books, New York.
Psychodynamic Formulation
Mackinnon, R & Yudofsky, S. (1986) The Psychiatric Evaluation in Clinical Practice. J.B.
Lippincott Company, Philadelphia. Has a superb chapter on how to write up a complete history
and psychodynamic formulation, with good examples.
Psychoses and Near Psychoses, Treatment & Understanding of
Marcus, E. (1992) Psychosis and Near Psychosis: Ego Function, Symbol Structure, Treatment.
Springer-Verlag, New York. An advanced sophisticated text which requires an understanding of
core concepts, but which integrates an understanding of how psychoses relate to a patient=s
psychodynamics, and the role of medication.
Rockland, L. (1989) Supportive Therapy: a Psychodynamic Approach. Basic Books, New
York.
Self Psychology
Elson, M. (1987) The Kohut Seminars on Self Psychology and Psychotherapy with Adolescents
and Young Adults. W.W. Norton, New York.
Kohut, H. (1971) The Analysis of the Self. International Universities Press, New York.
Wolf, E. (1988) Treating the Self: Elements of Clinical Self Psychology. The Guilford Press,
New York. A clear introduction to self psychology.
Supportive Expressive Continuum
Rockland, L. (1989) Supportive Therapy: A Psychodynamic Approach. Basic Books, New
York.
Luborsky, L. (1984). Principles of psychoanalytic psychotherapy: a manual for supportiveexpressive treatment. New York: Basic Books, Inc., Publishers. Though, as the author states,
this manual is not a substitute for other texts and supervision, it is excellent at helping the
reader by focusing on an essential transference derivative called the core conflictual relationship
theme.
Texts In Which Core Psychodynamic Concepts Were First Proposed.
Freud, A. (1966) The Ego and the Mechanisms of Defense. International Universities Press,
New York.
Freud, S. (1900) Chapter II Interpretation of Dreams, Standard Edition IV, Hogarth Press,
London. And Erik Homburger Erikson (1954) The Dream Specimen of Psychoanalysis, in
Psychoanalytic Psychiatry and Psychology: Clinical & Theoretical Papers, Austen Riggs Center,
Volume 1. Edited by Robert P. Knight and Cyrus R. Friedman. International Universities Press,
New York.
Freud, S. 1910; 1957 Five Lectures on Psycho-Analysis. In The standard edition of the complete
psychological works of Sigmund Freud Volume XI London: Hogarth Press.
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Freud, S. (1912) Technique Papers: Recommendations to physicians on the psycho-analytic
method of treatment; Recollection, repetition, and working through; Observations on
transference love; The dynamics of transference. In J. Strachey (Ed.) The standard edition of the
complete psychological works of Sigmund Freud Volume XII.
Freud, S. (1916/17) Introductory Lectures on Psycho-Analysis. In J. Strachey (Ed.) The
standard edition of the complete psychological works of Sigmund Freud Volume XV, XVI.
Trauma, Treatment & Understanding of
Dietrich, D. & Shabad, P. (1989) The Problem of Loss and Mourning. International Universities
Press, Madison.
Krystal, H. (1988). Integration and Self Healing: Affect, Trauma, Alexithymia. Hillsdale, NJ:
Analytic Press. Selected essays by the physician who developed our modern concept of post
traumatic stress disorder by working with Holocaust survivors.
Levine, H. B. (Ed.). (1990). Adult analysis and childhood sexual abuse. Hillsdale, New Jersey:
The Analytic Press.
Rothstein, A. ed. (1986) The Reconstruction of Trauma: Its Significance in Clinical Work.
International Universities Press, Madison.
Volkan, V & Zintl, E. (1993) Life After Loss: The Lessons of Grief. Collier Books, New York.
A brief , clear introduction to the psychodynamic understanding of loss, best read in conjunction
with another of the above.
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