Introduction
Psychotherapy (often referred to as ‘talking therapy’) involves using psychological approaches to understanding and treating mental health problems. Developing psychotherapeutic skills is an essential part of general psychiatric training and these skills can help psychiatrists in a range of settings and specialities. The Royal College of Psychiatrists sets out the aims of psychotherapy training during core training as follows.
Doctors will be able to:
- Account for clinical phenomena in psychological terms
- Deploy advanced communication skills
- Display advanced emotional intelligence in dealings with patients and colleagues and yourself
- Refer patients appropriately for formal psychotherapies
- Jointly manage patients receiving psychotherapy
- Deliver basic psychotherapeutic treatments and strategies where appropriate
Although some parts of psychiatry are taught through specific placements, psychotherapy training runs through the whole of core training and Post Graduate Drs In Training (PGDIT’s) will normally set aside a part of their working week to undertake their psychotherapy training. In CT1 psychotherapy training starts with doctors participating in Case Based Discussion Groups (CBD groups, formerly known as Balint Groups). CBD groups are weekly groups which last 60-90 minutes. Each week a different group member will present a case and the group will discuss psychological and emotional aspects, often looking in greater depth at the doctor-patient relationship. Please see the ARCP requirement section to learn about how the CBD groups must be evidenced.
Once PGDIT’s have completed their CBD group requirements, they can move on to conducting formal psychotherapies, normally in CT2-CT3 years. PGDIT’s will need to complete a formal psychotherapy with at least two patients and using at least two different modalities. Examples of modalities include cognitive behavioural therapy, psychodynamic psychotherapy, cognitive analytic therapy or family therapy. Other modalities are also used but should be discussed with the local psychotherapy tutor. All formal psychotherapies will be conducted under the supervision of a qualified psychotherapist. There are a number of formal assessments that trainees will need to complete in order to pass their ARCP requirements (see ARCP requirements section), please make sure that you are familiar with these.
To view the Core Psychotherapy Training: Problems, Myths and Solutions webinar, click on the below button. Password to view is CORE2021
Opportunities following Core Psychiatry Training:
Following Core Training, there are opportunities to continue to develop psychotherapy skills and/or qualifications as a higher PGDIT (also known as ST or registrar). Some higher PGDIT’s formally specialise in psychotherapy and become consultant psychiatrists in psychotherapy (also known as medical psychotherapists). Others undertake a longer (5 year) dual training to become consultants in both psychotherapy and another psychiatric speciality such as general adult psychiatry. Some higher PGDIT’s don’t formally specialise in psychotherapy, but undertake qualifications in a specific modality of psychotherapy such as Cognitive Behavioural Therapy. Higher PGDIT’s may also take on individual patients for psychotherapy under supervision. Anyone wishing to specialise in psychotherapy should aim to gain more than the minimum amount of experience in psychotherapy. PGDIT’s can gain obtain further experience for example by taking on further cases, doing external psychotherapy courses or observing psychotherapy assessments. Opportunities for additional training can be discussed with your local psychotherapy clinical lead.
The Royal College of Psychiatrists curriculum for core training can be found here and information relating to psychotherapy starts on page 102.
Further information on the Faculty of Medical Psychotherapy (one of the faculties of the Royal College of Psychiatrists) can be found here
ARCP requirements for completion of core training in HEENW
Case Based Discussion Groups
Core PGDIT’s are required to attend the Case Based Discussion Group (CBD group, formerly known as Balint Group) for the first 12 to 18 months of their training. The groups are usually specific to individual trusts so trainees usually move to a different CBD group every 6 months. Participation in CBD groups is assessed through the CBD group assessment form (CBDGA) which will be completed by the group facilitator – the form can be found on your online portfolio. PGDIT’s are required to attend at least 25 CBD groups and to complete a CBD group assessment form every 6 months. If the trainee completes 25 CBD groups and has achieved competency in their CBD group assessments then they can move on to seeing the first of their formal psychotherapy patients.
Familiarising yourself with the CBD group assessment form can help you to understand which competencies you are aiming for within the CBD group.
Supervised Experience of Delivering Psychotherapy
PGDIT’s are required to see two patients for formal psychotherapy before they can complete their core training. This is normally undertaken during the CT2 and CT3 years. PGDIT’s must complete both a “long case” (at least 20 sessions) and a “short case” (12-20 sessions) and the two cases must be in different modalities of psychotherapy. Core PGDIT’s will have regular supervision from a qualified psychotherapist while they undertake the therapy. Contact your local psychotherapy tutor as soon as you have completed your CBD group competencies to arrange your cases. Details of your local psychotherapy tutor can be found in the contacts section.
The experience of delivering psychotherapy is assessed using the SAPE and Psychotherapy ACE (PACE) assessment forms– these are found on Portfolio Online. Minimum number requirements for WPBAs are shown below.
The SAPE is conducted by your psychotherapy supervisor and is a formative assessment of key psychotherapeutic competencies. Familiarising yourself with the assessment form can help you to understand what you should be aiming for. Minimum number requirements for SAPEs are shown below, however it is best practice to complete a SAPE early on in therapy and another SAPE towards the end of therapy. This can help to trainees to identify learning objectives early on in therapy, so that they have reached their competencies at the end of therapy.
The Psychotherapy ACE is a summative assessment, ideally conducted by a medical psychotherapist who is not your supervisor, but can be by your supervisor with presentation and discussion conducted as if the supervisor is new to the case. Please check with the local Psychotherapy Tutor as to which applies in the relevant Trust, and how to arrange it. For the PACE you will need to write a 500 word summary of the therapy that you have undertaken and also bring along copies of satisfactory SAPE(s) for the modality of therapy that you have undertaken. You will then present your case to the assessing psychotherapist who will discuss this with you.
How to find a patient for your short case and long case
- Ask your clinical supervisor / team psychologist if they are aware of any patients that you could deliver psychotherapy to, and if there is anyone that would be able to supervise you on a weekly basis.
- If you are unable to identify any potential cases within your current placement, contact the local psychotherapy supervisor for guidance (contact details below).
Below is a summary of the evidence requirements for the final ARCP:
| Aspect of Training | Description | Requirements | Evidence required |
| Case Based Discussion Group (Balint Group) | Opportunity to reflect on doctor-patient relationship and develop psychological understanding of patient. | Minimum of 25 groups. Trainees must present at least one case every six months. Achieve the CBDGA competencies. | 1. CBDGA logbook (evidence of attendance at 25 sessions, plus evidence of presenting at least one case every six months)
2. CBDGA assessment every six months |
| Supervised Experience of Delivering Psychotherapy | Carry out psychotherapy under supervision in two different modalities. | One “long case” at least 20 sessions.
One “short case” 12-20 sessions. |
For short case:
2. 1 x SAPE 3. 1 x PACE For long case: 5. 2 x SAPE 6. 1 x PACE |
Contacts:
Local psychotherapy tutors (East)
Lancashire Care
Dr Swapna Kongara
Lancashire & South Cumbria NHS Foundation Trust
Pennine Care
Dr Mustafa Alachkar
Consultant psychiatrist and medical psychotherapist
Psychological Medicine in Primary Care – Stockport
Pennine Care NHS Foundation Trust
Hollins House, Marple
Stockport SK6 6BA
Tel 01617162018
Greater Manchester Mental Health
Dr Rosemary Clarke
Gaskell House, Swinton Grove, Manchester M13 OEU
0161 277 1120
Psychotherapy CT1-3 Lead Tutor
Dr Adam Dierckx
Gaskell House Specialist Psychotherapy Service,
Swinton Grove, Manchester M13 0EU
0161 271 0620
Local psychotherapy tutors (West)
Merseycare
Dr Simon Graham
Psychotherapy Services, 12 Haigh Road, Waterloo, Liverpool L22 3XP
0151 250 6128
Simon.Graham@merseycare.nhs.uk
Cheshire & Wirral
Dr Kathia Sullivan
Consultant Psychiatrist in Medical Psychotherapy and Adult Psychiatry
Complex Needs Service
Cheshire Wirral Partnership NHS Trust
FAQs:
Do I have to do therapy in a certain order?
You need to complete the CBD competencies first, but then you can do either the short or long case in either order. This is often determined by which cases are available in the area you are working.
If I finish my CBD competencies early, can I start my short/long case early?
This can occasionally happen, but is not normally encouraged. You should also not feel pressured to attend on zero days or leave in order to try to finish CBD competencies early.
What if I can’t attend enough CBD sessions in CT1?
When you get your rota, check how many sessions you can attend. If you are not able to attend enough (around 13-15) in your 6 month block, then discuss this with your clinical supervisor and psychotherapy supervisor, as your timetable will need to be altered in order to allow you to achieve you competencies. If this still does not resolve the issue, then continue to escalate this issue.
What if I can’t find a patient for my short/long case?
You psychotherapy tutor will be responsible for finding a case. This can at times be difficult due to a lack of appropriate cases. If you are delayed in your psychotherapy training due to not having a case, contact your supervisor to raise this. If you are significantly delayed and run out of time to complete you required number of sessions due to a lack of patients, you will not be penalised. If this situation does occur, then this will be discussed with you and your supervisors and TPD regarding how best to support you to maximise your learning opportunity, but you will not be delayed in your progression through training for difficulties outside of your control and not related to your competency.
What if my patient keeps dropping out?
It is common for patient’s to drop out of therapy, especially with short cases. If this happens with your patient, your therapy supervisor will discuss this wih you and complete a SAPE regarding this patient. If this occurs 3 times and is not related to your competency, then you will continue to attend supervision for up to 12 months, and then you will be signed off for that modality. You will not be delayed in your progression through training for difficulties outside of your control and not related to your competency. However, if on review it is felt that patient drop outs may be related to your competency in that modality, then this will be discussed with you by your supervisor to support you in further developing your competencies. Remember, psychotherapy training is supposed to be a learning experience.
Can I do my short and long case at the same time?
Normally, no. Doing both cases at once will take too much time out of your day job clinical training. However, in some cases, due to patient drop outs or delays in finding appropriate patients, some trainees are supported in completing both cases at once. If this is required, this will be discussed with you by your psychotherapy supervisor.
Can I choose what modalities I do?
Normally, no; as it is normally a case of being assigned to whichever group and modality has the next vacancy. You can, however, discuss this with your psychotherapy supervisor if you have any strong interest of desire for certain modalities.
What can I do to help make sure I achieve my psychotherapy competencies?
The best way to achieve the competencies is to attend the sessions and groups and engage with them. This does not mean you have to come in on zero days or annual leave. However, having said that, try not to organise all your leave on your psychotherapy days; there is a reasonable expectation that you try to attend the significant majority of your scheduled psychotherapy training.
The other important advice is to keep in contact with psychotherapy tutor for you area and the psychotherapy lead tutors. When you find out your next rotation, email the local psychotherapy tutor to make contact and update them on your progress through psychotherapy training. This will help them know what you will require during the time you are in that area.