The Psychotherapy Division is responsible for developing the psychotherapy curriculum for psychiatry residents, and promoting, supporting, and coordinating psychotherapy clinical and research activities within the Department. Our Department is unusual in having several unique and innovative aspects of our training program, such as:
- A coherent, progressive 4-stage model of psychotherapy training. This model is shaped like a martini glass, with empathic capacity and reflective functioning forming the base, common factors the stem, and specific modalities the bowl
- Emphasis on building reflective functioning and empathic capacity
- A mentoring program for all PGY-1 and PGY-2 residents
- A one-year seminar on biopsychosocial formulation to develop integrated thinking across different domains
- A comprehensive webcam system for recording and observing interviews
- Expectation for basic competency in several psychotherapy modalities and advanced competency in at least one modality by the time of graduation
- Several of our full-time faculty choosing psychotherapy as their primary clinical and academic interest
4-Stage Model of Psychotherapy Training
Sequential Training Objectives by Postgraduate Year:
- Build empathic capacity and reflective functioning.
- Build integrative thinking and ability to apply common factor skills to clinical encounters.
- Develop basic competency in cognitive behavioral, psychodynamic, and family therapies.
- Develop basic competency in group, adolescent, and geriatric therapies and advanced competency in at least one therapy modality.
Some key assumptions of our training model:
- Residents come into training relatively lacking reflective functioning, including empathic capacity and complex decision-making, due to dehumanizing aspects of medical school training.
- Residents have a strong need to feel competent as a psychiatrist. They often cope with this situation by endorsing simplistic views of psychopathology, avoiding paying attention to upsetting experiences, and having strong “therapeutic ambition”.
- Psychotherapy is less about doing something to a patient than a way of being with a patient. It involves staying close to experience while paradoxically maintaining reflective space.
- All interactions, including evaluations and med management visits have the potential to be therapeutic. The physician-patient relationship forms a core of all effective psychiatric interventions.
- The development of reflective functioning requires a holding environment sufficient to contain feelings of shame, anger, and incompetence, and that provides opportunities to verbalize emotions and experiences with another person.
- No model of psychotherapy, whether psychodynamic or CBT, or even psychopharmacology, is going to be effective without reflective functioning.
- Cornerstone Program (first month)/Psychiatry Clinic (on-going). These programs foster reflective functioning through discussions of family of origin experiences, clinical experiences, videorecordings of interviews, role playing, and other experiential activities.
- Mentorship program (on-going). Provides support and facilitates residents talking about their experiences.
- Participation in the resident-run support group is strongly encouraged.
- Family therapy consultation program on 4B Inpatient Unit (on-going both PGY-I and II).
- Biopsychosocial Formulation (on-going). Each resident in the seminar presents a case over 3 classes. We review the history, observe a video recording, and then everyone writes a formulation of that case.
- Common Factors in Psychotherapy (on-going). This course teaches residents to apply common factor skills, such as active listening, building and repairing the alliance, setting expectations, establishing the frame, motivating, and using transference and countertransference.
- Foundations of Human Experience (on-going). Covers ego functioning and defenses, object relations, affective neuroscience, attachment, behavior and learning theory, child development, play, sexuality, and family systems
- Introductions to CBT, DBT, DDP, play therapy, and SCT.
- Dedicated weekly CBT, psychodynamic, child, family, and combined medication management/psychotherapy supervision (on-going)
- Theory/Practice of Individual Psychotherapy (26 sessions). This is a survey course of major figures and concepts in psychodynamic theory.
- Monthly Case Conference. Dr. Gabbard utilizes a case-based format to review key concepts from his book, Long-Term Psychodynamic Psychotherapy: A Basic Text.
- Dedicated adolescent, geriatric, and group therapy supervision
- Elective opportunities to develop advanced competency in at least one of the following modalities: CBT, DBT, DDP, SCT, MI, combined med management/psychotherapy, adolescent therapy, geriatric therapy, or couples/family therapy
- Post-Freudian Theories (12 sessions)
- Self, society and Culture, Robert Daly, 26 sessions, engages individual reflections on the family, cultural and religious contributions to each resident's sense of self and how these contributions affect their interactions with others as therapists.
- Applied mindfulness: Embodied imagination, Gita Ramamurthy, all PGY, 2 sessions
- Cognitive Behavior Therapy case supervision, PGY III & IV, Robbi Saletsky, all year
- Cognitive Behavior Therapy group participation, PGY IV, Robbi Saletsky, 13 sessions
- Dialectical Behavior Therapy case supervision, PGY III & IV, Jean Shook, all year
- Dialectical Behavior Therapy skills group, PGY III & IV, Jean Shook, all year
- Dynamic Deconstructive Psychotherapy case supervision, PGY III & IV, Robert Gregory, all year
- Eating Disorders, therapy interventions, PGY II, III, IV, Kathleen Deters-Hayes, 4 sessions
- EMDR, PGY III & IV, 4 hrs/week, Sandra Kaplan, 12 sessions
- Fairy tales, PGY I, III & IV, Gita Ramamurthy, 5 sessions
- Family Therapy, group consultation, all PGYs, David Keith, 1 hr/week, all year
- Psychoanalytic Study Group, all PGY, Lynn Stormon, monthly, 12 sessions
- Psychotherapy Journal Club, all PGY, Robert Gregory, monthly, 12 sessions
- Psychotherapy Rotation, PGY II, Robert Gregory, one month
- Resident-run support group, all PGY, 1 hr/week all year
- Short-Term Dynamic/Experiential Therapy, Deborah Pollack, PGY III & IV, all year
- Systems Centered Psychotherapy, Richard O’Neill, PGY III & IV, 30 sessions
The Psychotherapy TrackThe Psychotherapy Track provides an opportunity for highly motivated residents with a special interest in psychotherapy to gain additional training and experience in this area. Whereas all residents at Upstate are expected to develop a therapeutic mindset and obtain basic competence across therapy modalities, residents in the Psychotherapy track are expected to obtain both a broader exposure to psychotherapy principles and a more in-depth proficiency in one specific form of therapy. Residents will work closely with a faculty mentor towards this latter goal. Areas of expertise that residents may choose from include:
- Cognitive Behavioral Therapy
- Dialectical Behavior Therapy
- Dynamic Deconstructive Psychotherapy
- Integrative Psychotherapy
- Psychodynamic/Psychoanalytic Psychotherapy
- Systems Centered Therapy
- Family Therapy
- Group Therapy
- A full 4 years in the general psychiatry training program.
- Involvement in one form of personal therapy -- individual, family, or group (e.g., SCT Group).
- Participation in the monthly meeetings of the Psychotherapy Division Journal club (the fourth Monday of every month at noon). This meeting is open to all residents and psychology/social work interns. Psychotherapy Division faculty and associates also attend.
- Psychotherapy research or scholarly activity. The proposed project must be approved by the Director of the Division.
- A clinic caseload in 3rd and 4th year consisting mainly of hourly psychotherapy visits (may include medication management during psychotherapy sessions). This should involve at least 100 hours of supervised clinical experience with one specific form of therapy.
- Participation in at least two of the psychotherapy electives offered by the Psychotherapy Division during residency training (see list of electives on the Division webpage). Residents in the track are also strongly encouraged to see outpatients for psychotherapy earlier than PGY-3.