Psychotherapy Training

As a Department, we feel that excellent psychotherapy training is essential for all psychiatry residents, regardless of their ultimate career goals.  The Psychotherapy Training Program includes clinical and didactic experiences designed to help the resident progress from a basic understanding of the principles underlying all forms of psychotherapy to a more sophisticated familiarity with more specialized psychotherapeutic approaches.

Through training in psychotherapy, residents achieve basic competency in psychodynamic psychotherapy, cognitive behavior therapy (CBT), and supportive psychotherapy. Training is also available in advanced psychodynamic psychotherapy, short-term dynamic psychotherapy, advanced CBT, dialectical behavior therapy, interpersonal therapy, couples and family therapy, and group therapy.

The PGY-1 Year:

Clinical rotations in the PGY-1 year include inpatient psychiatry and 6 months internship (Medicine/Pediatrics and Neurology).  For this reason, the emphasis during this year is on the development of empathy and interviewing skills as part of the assessment and treatment of acutely ill inpatients.  During psychiatry rotations, each resident is assigned an “off ward” supervisor, who is a member of the regular or clinical faculty who is not the resident’s attending.  This supervisor meets with the resident weekly to discuss clinical cases and to teach empathic listening skills.  The Chief Residents at each site organize interviewing seminars in which a faculty member interviews a psychiatric inpatient to model interviewing skills.  Residents are encouraged to follow carefully selected inpatients after their discharge from the hospital.

The PGY-1 didactic series includes a therapeutic interviewing series; introductory lectures on psychodynamic psychotherapy, cognitive-behavioral therapy, dialectical behavior therapy, supportive therapy, and family therapy; and case formulation exercises.

The PGY-2 Year:

In the PGY-2 year, residents begin their continuity clinic one afternoon per week.  This clinic may be at Harborview, UWPOC, or the VA Mental Health Clinic, and extends throughout the PGY-2 to PGY-4 years, allowing the resident to follow patients over a prolonged period of time.  During this year, each resident completes the Introduction to Psychotherapy course, which is included in the PGY-2 didactics.  This course, which uses a highly interactive small group format, teaches basic principles common to all types of psychotherapy.  Within this overall integrative approach, residents are introduced to the conceptual approaches underlying different “schools” of psychotherapy (e.g. psychodynamic, psychoanalytic, cognitive, behavioral, supportive, interpersonal). Within PGY-2 didactics, residents also participate in a motivational interviewing workshop and courses in Learning Theory and Psychodynamic Theory.

In the second half of the PGY-2 year, each resident completes the first of two required six-month psychotherapy seminars in cognitive-behavioral and psychodynamic psychotherapy.  All residents complete both seminars by the middle of the PGY-3 year. The goal of these small-group seminars is to teach the theory and techniques of a specific form of psychotherapy using both a textbook and review of case material from the residents’ clinical caseloads.  Throughout the year, each resident also has individual psychotherapy supervision weekly with members of the clinical or regular faculty.

The PGY-3 Year:

The PGY-3 year is a full-time outpatient year, with one day per week of Child Psychiatry and the remainder of the time devoted to Adult Outpatient Psychiatry rotations.  Residents have supervisors at each clinical site, as well as at least two individual psychotherapy supervisors. Residents may choose supervisors from the regular or clinical faculty, including the faculty of the three psychoanalytic institutes and one Jungian institute in Seattle.

During the first half of the year, each resident completes the second of the core psychotherapy seminars (cognitive-behavioral or psychodynamic psychotherapy seminar).  The R3 didactics are largely devoted to modules teaching forms of psychotherapy and factors influencing the doctor-patient relationship.  Specific topics include normal development, couples/marital therapy, group psychotherapy, interpersonal therapy, dialectical behavior therapy, cross-cultural aspects of psychiatric treatment, spirituality and psychiatry.  Residents participate in a weekly small-group Clinical Interaction Seminar, which uses the residents’ case material to explore the doctor-patient relationship, transference, and countertransference.

The PGY-4 Year:

Since the PGY-4 year is largely elective, residents may choose to spend as much time as they wish doing outpatient psychotherapy.  All residents are required to continue their Continuity Clinic at least half a day per week and to have at least two psychotherapy supervisors. The content of PGY-4 didactics is determined by the PGY-4 group, and has recently included advanced topics in psychotherapy.

Specialized training programs, clinical experiences, and supervision in object relations; short-term dynamic psychotherapy, advanced cognitive-behavioral therapy; dialectical behavior therapy; interpersonal therapy; couples, family, and group therapy are open to interested PGY-3 and PGY-4 residents.