Brief Psychodynamic Training Objectives

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(Revised 2008)
POST-GRADUATE TRAINING OBJECTIVES
IN BRIEF PSYCHODYNAMIC PSYCHOTHERAPY
University of Toronto, Department of Psychiatry
Psychotherapy Stream, PHES Division
I.
PREAMBLE
The following standards for training in brief psychotherapy delineate guidelines for minimum
expectations for training in this modality. Residents will not necessarily be able to fulfil these
requirements in one setting. However, residents should be able to meet these requirements as they
rotate through different clinical settings during the course of their residency. In general,
comprehensive training involves a mix of theory, clinical work, supervision, and
didactic/experiential learning in a group setting. The ultimate goal is to provide training in Brief
Psychotherapy. Although this report emphasizes brief psychodynamic psychotherapy for adults, it
also underlines the importance of exposure to this modality for adolescents, and recognizes
cognitive-behavioural and interpersonal models as other brief treatment modalities.
II.
WORKING KNOWLEDGE TRAINING OBJECTIVES IN BRIEF
PSYCHOTHERAPY
A.
Knowledge
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
Common misperceptions of brief psychotherapy
Resistances to using brief psychotherapy
Developmental history of brief psychotherapy
Similarities and differences between emergency psychotherapy, crisis psychotherapy, longterm psychotherapy as compared to brief psychotherapy
Efficacy and cost-effectiveness of brief psychotherapy
"Ripple effect" of brief psychotherapy
Indications for brief psychotherapy
Inclusion and exclusion criteria for brief psychotherapy
Process of referral for brief psychotherapy
Developing a focus
Resistances to maintaining the focus
Transference and countertransference issues in brief psychotherapy
Defining and understanding the significance of the time-limit
Termination issues in brief psychotherapy
B.
Skills
(1)
The ability to recommend brief psychotherapy appropriately
C.
Attitudes
(1)
Awareness of brief psychotherapy as a "first choice" treatment modality
(Revised 2008)
(2)
(3)
Appreciation of the effectiveness of brief psychotherapy for symptom resolution and focal
shifts in character structure
Practice in an ethical manner including:
i)
ethical obligations as pertains to all psychotherapies, ensuring patient confidentiality,
protecting the integrity of the patient-therapist relationship, prohibiting sexual contact
between therapist and patient at any time, prohibiting any form of exploitation of the
patient by the therapist, and appropriate boundary-maintenance;
ii)
access to treatment without prejudice
D.
Enabling Objectives
(1)
Clinically-based seminar participation where available led by an experienced brief
psychotherapist-psychiatrist, consisting of both theoretical and clinical components.
Treatment should be provided to one patient in weekly individual psychodynamic brief
psychotherapy, through which weekly supervision is received.
No clinical work should be done by residents without supervision. .
(2)
(3)
III
FOR RESIDENTS WHO, HAVING ATTAINED WORKING KNOWLEDGE
TRAINING REQUIREMENTS, SEEK ADVANCED TRAINING IN BRIEF
PSYCHOTHERAPY, OBJECTIVES INCLUDE:
A.
Knowledge
(1)
(2)
History of brief psychotherapy
Range of brief psychotherapy orientations:
i)
psychodynamic
ii)
interpersonal
iii)
cognitive behavioural
iv)
self-help
Range of brief psychodynamic psychotherapy models:
i)
overview of Mann, Malan, Sifneos, Davanloo, Horowitz, Strupp and Binder
ii)
in-depth knowledge of the Luborsky CCRT model
Range of patient population:
i)
adolescent
ii)
geriatric
iii)
physical illnesses
iv)
terminal illnesses
v)
post-traumatic stress disorders
vi)
characterologically-difficult patients
Developing a focus where:
i)
patient resists focus
ii)
there seems to be at least two foci
iii)
an "error" is made in choosing the foci
Working through the focus:
(3)
(4)
(5)
(6)
2
(Revised 2008)
(7)
(8)
(9)
C.
i)
transference and countertransference issues
Identifying and addressing interruptions of and crises in brief psychotherapy
Working through termination:
i)
focus, transference, countertransference issues
ii)
exceptions to maintaining termination contract
iii)
"booster shot" and follow-up
Research issues:
i)
"O" and "o" outcomes
ii)
critical appraisal
iii)
process and outcome correlations
iv)
predictors of outcome
Skills
The ability to:
(1)
Carry out a history of mental status, diagnosis, and decision about appropriateness for brief
psychodynamic psychotherapy
(2)
Develop a focus
(3)
Present the focus to the patient
(4)
Deal with patient's resistances regarding focus
(5)
Carry out a socialization interview
(6)
Maintain the focus in therapy
(7)
Maintain the focus in the context of transference, countertransference issues
(8)
Maintain the focus as it occurs in the here and now
(9)
Point out the ubiquity of the CCRT focus in the present, as well as in the past
(10) Begin to "work through" the focus, particularly with respect to transference distortions and
transference-driven repetition-compulsions
(11) "Work through" the focus in the context of termination
(12) Deal with emergencies in brief psychodynamic psychotherapy
(13) Know when to seek consultation in brief psychodynamic psychotherapy
(14) Understand and utilize therapeutically, transference and countertransference implications of
the "booster shot"
D.
Attitudes
(1)
(2)
Appropriate and realistic therapist confidence and preparedness to conduct brief
psychotherapy
Awareness of biases against, advantages and disadvantages of brief psychotherapy
E.
Enabling Objectives
(1)
Clinically-based seminar participation led by an experienced brief psychotherapistpsychiatrist, consisting of both theoretical and clinical components
Treatment should be provided for three patients in weekly individual brief psychodynamic
(2)
3
(Revised 2008)
(3)
psychotherapy through which weekly supervision is received
Supervision should involve process notes and review of audio tapes
IV.
EVALUATION
(1)
Evaluation should be done collaboratively by the resident and supervisor in an ongoing
continuous manner throughout supervision, and at every six months.
Use of the on-line evaluation form.
(2)
REFERENCES
1.
2.
3.
4.
5.
6.
7.
8.
9.
Barber JP: Efficacy of Short-Term Dynamic Psychotherapy: Past, Present and Future. Journal of
Psychotherapy, Practice and Research, 3:108-121, 1994.
Barber JP, Crits-Christoph P: Dynamic Therapies for Psychiatric Disorders (Axis 2). Basic Books,
New York, 1995.
Bauer GP, Kobos JC: Brief Therapy: Short-Term Psychodynamic Intervention. Jason Aronson, New
Jersey, 1993.
Bongar B, Beutler LE: Comprehensive Textbook of Psychotherapy: Theory and Practice. Oxford
University Press, New York, 1995.
Crits-Christoph P: The Efficacy of Brief Dynamic Psychotherapy: A Meta-Analysis. American
Journal of Psychiatry, 149:151-158, 1992.
Luborsky L: Principles of Psychoanalytic Psychotherapy: A Manual for Supportive/Expressive
Treatment. Basic Books, New York, 1984.
Marmor J: Short-Term Dynamic Psychotherapy. American Journal of Psychiatry, 136(2):149-155,
1979.
Messer SB, Warren CS: Models of Brief Psychodynamic Therapy. The Guildford Press, New York,
1995.
Ursano RJ, Hales RE: A Review of Brief Individual Psychotherapies. American Journal of Psychiatry,
143(12):1507-1517, 1986.
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