Psychiatric Residents' Interest in Psychotherapy and Training Stage: A Multi-Site Survey

Article excerpt

Background: Most psychiatric residents enter training intent on learning both psychopharmacologic and psychotherapeutic interventions. After graduation, however, many emphasize pharmacotherapy over psychotherapy.

Methods: A multisite survey of psychiatry residents queried psychotherapy interests, attitudes, and practice intentions. Factors associated with self-reported decreased interest in psychotherapy since beginning residency were examined.

Results: Although 11.8% of the entire sample (n=229 PGY1-PGY4 residents) reported decreased interest in psychotherapy during training, among PGY4s the corresponding figure was 16.4%. Positive attitudes towards psychotherapy, and self-perceived competence in cognitive-behavioral and psychodynamic psychotherapy were most highly correlated with maintained interest in psychotherapy. Dissatisfaction with the quality of psychotherapy faculty and curriculum, and viewing departmental leadership as unsupportive of psychotherapy training were correlated with decreased interest during training.

Conclusions: Maintaining residents' interest in psychotherapy requires improvements in curriculum, teaching, and supervision throughout training. Our data underscore the crucial role that departmental leadership must play in supporting trainees' goals of becoming comprehensively trained psychiatrists.

KEYWORDS: psychotherapy; residency education; psychiatric training; evidence-based practice

INTRODUCTION

A.B. graduates from a top medical school eager to begin her abiding ambition to become a psychiatrist. She carefully researches prospective residency training programs, prioritizing those known to emphasize psychodynamic psychotherapy. She enters one of the best programs, is a hard-working, inquisitive, and talented resident who is unanimously admired by her peers and faculty, and is selected as Chief Resident for her senior year. Upon graduation, she has several job offers for positions in academia, private practice, managed care, and public institutions. She ultimately accepts a position with a large practice that hires her to see patients in monthly visits of 20 to-30 minutes, and which focus on medications. Patients requiring psychotherapy are referred to master's-level clinicians. What caused this change in direction?

A.B.'s story is not unique. Residents enter psychiatric training eager to become well-trained in both psychotherapeutic and psychopharmacology (Davydow, Bienvenu, Lipsey, & Swartz, 2008; Sledge, Leaf, & Sacks, 1987). Yet attaining these aspirations-practicing the well-integrated art and science of both modalities-remains an unfulfilled promise for many psychiatrists (Carlat, 2010). Nationwide, research findings have documented the fading role of psychotherapy in modern psychiatric practice and the concomitant rise of the brief "med check" (Clemens, 2009; Mojtabai & Olfson, 2008). Recognizing the growing gap between a broadly agreed-upon definition of a competent psychiatrist and the focus of contemporary psychiatric practice, the Accreditation Council of Graduate Education Training (ACGME) established core competencies in psychotherapy that programs must provide and assess, including short- and long-term individual psychotherapy, psychodynamic psychotherapy, family and couples therapy, group therapy, cognitive behavioral therapy (CBT), crisis intervention, and concurrent use of medications and psychotherapy (Mellman & Beresin, 2003). However well-intentioned these programmatic requirements, however, they will not have lasting effects if residents are not interested in providing psychotherapy after finishing their training.

Therefore, to better understand contemporary psychiatric trainees' interests, attitudes, and intentions regarding psychotherapy during and after their training, we surveyed residents from 15 residency training programs across the country. The initial report from that survey found that most residents viewed their psychotherapy training positively and felt their competence as a psychotherapist improved as they progressed through training (Calabrese, et al. …