Teaching Psychotherapy: Tryin’ Again!
Posted by Dr. Vollmer on June 6, 2013
Well, I considered hanging up my hat on the teaching front. The world of psychiatry was tilting far towards algorithms, away from the individual relationship with patients. My world in my office, I could manage the way I saw fit, but the world of the new psychiatry trainees was concerning me. How would they learn how to talk and, perhaps more importantly, how to listen. Then, without any warning, there was a query. The residents were looking for someone to answer the following questions.
How do you structure an initial session?
How do you decide or explain goals of therapy?
How do you evaluate if a patient is appropriate or not for psychodynamic therapy?
How do you set the frame properly? (ending on time, minimizing time spend talking outside of sessions, other boundary issues, etc).
Wow. I am back in business. They were asking questions which lit the fire in my belly. I dragged out my book “Becoming A Psychotherapist” by Rosemary Balsam MD and her husband Alan Balsam MD. I am going to bring chapters and we are going to have a discussion about how one, as a psychiatrist, learns to become a psychotherapist. Maybe the psychiatric world is ready for another pivot; only this time a pivot back towards the individuality of the patient. I can hope.
So, how do you structure an initial session? I think that question is going to be how do I structure an initial session. I am going to talk about listening with a mental outline. Is the patient mentioning their childhood? Why now are they coming in for treatment? Whose recommendation did they take to get here? It is not that I am going to ask these questions, but I am going to be curious if the opening remarks address these issues. I am interested in what the patient says and what he does not say, as well as how he says things, including the nature of his presentation. The goals are co-created, discussed in an ongoing way about what makes sense to focus on. The appropriateness for therapy depends on the psychiatrist’s assessment of the patient’s mental state and mental capacities. The frame is constantly negotiated depending on the needs of the individual. I project we will have a rich discussion. Stay tuned.