Academic journal article Journal of Cognitive Psychotherapy

Supervising Child Psychiatry Fellows in Cognitive Behavioral Therapy: Crucibles and Choices

Academic journal article Journal of Cognitive Psychotherapy

Supervising Child Psychiatry Fellows in Cognitive Behavioral Therapy: Crucibles and Choices

Article excerpt

Child psychiatric fellows enter cognitive behavioral therapy (CBT) training experiences with a wide variety of backgrounds and experiences in this area of treatment. Although some child fellows have fundamental knowledge of cognitive-behavioral theory, most struggle with the CBT model and even more so, subsequently using this model to guide treatment. Unlike supervising early career mental health professionals, child residents often possess a skill set apt for CBT including using a problem-oriented focus, a tendency to use structured methods in treatment, the use of psychoeducation, and basic clinical skills including genuineness, understanding, and empathy. On the other hand, child psychiatric fellows find several areas of CBT challenging because it is often vastly different from previous experience, including more frequent and longer sessions, the use of collaborative empiricism, developing case conceptualizations, and tolerating negative affective arousal. Moreover, training climates in psychiatry departments may shape the supervision experiences. Various specific recommendations are offered to manage these crucibles. Overall, although there are significant challenges when supervising child residents in CBT rotations, having knowledge of these crucibles and access to choices for addressing these supervisory tests enhances both supervisor and supervisee competence.

Keywords: psychiatry; cognitive behavior therapy; supervision; child; adolescent

The Accreditation Council for Graduate Medical Education (ACGME) is the U.S. organization that is responsible for evaluating and awarding accreditation to residency and fellowship training programs, including psychiatry. The ACGME requires that all residents in a general psychiatry training program receive at least 2 months of training in child and adolescent psychiatry. To meet this requirement, most programs offer lectures and shadowing experiences which encompass a brief overview of child and adolescent psychiatry. Residents that are interested in further specialty training apply for admittance to a child and adolescent psychiatry fellowship program. This program comprises 2 years of experience typically occurring after the completion of at least 3 years of general psychiatry training (Sudak, 2009). Although residents in a general psychiatry program do receive brief training in child and adolescent psychiatry, this article will focus on the training of those residents who choose to specialize in this area during a 2-year fellowship (i.e., "fellows"). According to the ACGME, training in cognitive behavioral therapy (CBT) has been designated as an integral part of this fellowship curriculum. During this time, child and adolescent psychiatry fellows must experience a minimum of basic clinical experience using fundamental cognitive-behavioral theory (Sudak, 2009).

In keeping with adherence to the ACGME requirements, many child and adolescent psychiatry fellowship programs have instituted training in CBT as part of their core clinical experience. However, implementing adequate training in CBT for fellows is a daunting and nebulous task. The ACGME requirements are not well defined; they indicate that training in CBT should result in a "conceptual understanding and appropriate clinical skills" (p. 128) for work with children and adolescents leaving the level of mastery for understanding and demonstration of CBT by the fellows unclear (Sudak, 2009). Sudak, Beck, and Gracely (2002) conducted a survey of psychiatry residency training directors which revealed 25% of programs did not include training in CBT and 40% of programs lacked faculty that were properly trained in CBT. Therefore, approximately 15% of programs who did include CBT training did not have adequate supervisors. Moreover, about 40% of the programs had no didactic training available in CBT (Sudak et al., 2002).

The availability and accessibility of well-trained supervisors is strongly correlated with fellows developing sufficient CBT skills; even if a program includes CBT training, without adequate supervision, it is likely that the skills learned do not disseminate to proper client care (Cassidy, 2004). …

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