Psychotherapy Training Program

Student Handbook, Psychiatry and Behavioral Sciences: Reno

An extremely important part of a psychiatrist’s professional identity is the ability to conduct effective psychotherapy. Every patient contact provides the potential for conducting some measure of psychotherapy contributing to patient wellness. This potential begins in the first year while providing care for patients hospitalized for medical reasons and extends toward the end of training when residents have mastered a number of evidence-based psychotherapy modalities. Like personal development which extends over a lifetime, residents engage in professional development over the course of the residency in their ability to conduct psychotherapy.

By the completion of the residency, all residents should demonstrate competency in a number of psychotherapy modalities, both brief and long term as required for program accreditation by the Accreditation Council of Graduate Medical Education. These modalities include supportive, psychodynamic, cognitive-behavioral, and combined psychotherapy and pharmacotherapy. Competencies for each of these modalities can be found in Appendix A. Residents are also required to have some knowledge and skill in the area of couple, family, and group psychotherapy.

Psychotherapy training occurs throughout four years by means of both regularly scheduled seminars and supervised clinical experiences.

During PGY 1, residents learn basic listening skills during orientation. These skills are the basic building blocks for establishing a working alliance, the most important element in treatment effectiveness of all psychotherapeutic modalities. Later in the year, first year residents experience two seminars. The first addresses supportive psychotherapy, which accounts for approximately 90% of what occurs in all psychotherapies. The second is core psychotherapy which reviews all of the important ingredients of psychotherapy in general. This seminar is held with PGY 3 residents who are actively conducting outpatient psychotherapy at various training sites. PGY 3 residents frequently relate experiences with existing patients which help bring life to required reading materials.

During PGY 2, when residents are rotating at inpatient psychiatry sites, residents are encouraged to conduct active problem-solving psychotherapy using supportive techniques taught during the first year. Toward the end of the year, residents have a seminar on cognitive-behavior psychotherapy and selecting patients for psychotherapy in preparation for the third year. While at inpatient sites, residents are encouraged to co-facilitate at least one group.

PGY 3 is an outpatient year during which psychotherapy training is the emphasis, and all residents are actively providing psychotherapy. Three seminars also occur. These include core psychotherapy as described above, brief psychotherapy, and psychodynamic psychotherapy.

An important part of training is the provision of at least two hours of weekly individual supervision. Each resident meets for one hour weekly with their assigned site supervisor. The purpose is to review cases and discuss specific topics germane to the outpatient practice of psychiatry. Site supervisors may also supervise specific psychotherapy cases. At the beginning of the third year, each resident will be assigned a psychodynamic supervisor. The role of the psychodynamic supervisor is to supervise all psychodynamic cases the resident has throughout the year.

In addition to these two supervisors, the resident is expected to use other supervisors for specific cases. A list of supervisors can be obtained from the RTD office. Because these supervisors are often outside the facility and may include clinical or adjunct faculty; these supervisors are often referred to as “off site” supervisors. Residents should have a least one off site supervisor for psychotherapy cases that utilize these forms of therapy.

Residents and supervisors will meet as a group quarterly in the Psychotherapy Consultation Seminar. The purpose of PSC is to collectively review then number and type of each residents cases to insure an appropriate balance and to review important cases in a congenial and collaborative environment. Typically this occurs the last Wednesday of every quarter.

PGY 4 is largely elective but electives chosen provide the opportunity for continued psychotherapy mastery, particularly in an area in which a resident has particular interest. Appropriate supervision is arranged. An advanced psychotherapy seminar is held throughout the year during which local experts in their field present to residents. Supervisors maintain logs of supervision and assess competencies in each of the required modalities.

All PGY-3 and PGY-4 residents who have active Psychotherapy cases and their supervisors attend the Psychotherapy Consultation Seminar which is held quarterly. This is a meeting where residents share and discuss cases and where their case loads and progress can be reviewed. Residents are expected to be able to present all their cases during this seminar.

Regarding group therapy training, all residents are encouraged to participate in the weekly process group which deals with both personal and professional development. This group always ends with an educational process discussion. It is strongly believed that active group participation is the best means of learning group facilitation. Each third year outpatient site has a number of groups available. Residents are encouraged to speak with their site supervisor to arrange participation.