Psychotherapy Instruction
Child psychiatry fellows receive teaching and training in a variety of types and modalities of psychotherapy, including cognitive behavioral therapy, dialectical behavior therapy, play therapy, psychodynamic psychotherapy, supportive therapy, group therapy, therapy combined with medication management, and family therapy. Psychotherapy is a skill set that is categorized into the subsets outlined above, but in our teaching of psychotherapy we recognize the importance of integration of the various skills along with knowledge of child development. The ability to apply these skills in multiple settings is critical to care for children along a continuum of care ranging from inpatient to consultation to outpatient work. We begin teaching the theories of psychotherapy in the first year and utilize clinical correlation to integrate the theories into practice on the inpatient and consultation services. Fellows are expected to consider the developmental level of each child and family in order to conceptualize and develop an effective treatment plan. The didactic series includes both specifics of normal development as well as discussions of abnormal development and the implications of developmental level in a clinical setting.
Didactic teaching of psychotherapy begins in the first year and is a two year long class that includes fellows from both years. The class typically meets twice per month, with the first half devoted to class teaching on a specific subject, led by faculty and occasional fellows with specific interests and expertise. For the second half of class the two classes split up and meet with a faculty supervisor to discuss psychotherapy cases and psychotherapeutic interventions in clinical rotations.
The first-year fellows apply their knowledge of therapy in multiple settings. On the inpatient services they have the opportunity to work with the social workers to lead family sessions for their patients. They also can participate in group therapy on the units and in the Partial Hospital Program. The fellows work individually with the children and teenagers on the inpatient services to provide psycho-education and supportive therapy. They learn about the integration of pharmacologic decisions with appropriate therapeutic interventions.
On the Consult-Liaison rotation, the fellows participate in family meetings with multidisciplinary teams. They provide brief supportive therapy to children as well as teaching children and families coping skills to help them deal with chronic pain and chronic illness.
Second-year fellows identify cases for individual psychotherapy including Cognitive Behavioral Therapy and Psychodynamic Psychotherapy. Fellows with a particular interest in psychotherapy may use their elective time for additional psychotherapy cases or to deepen their understanding of a specific modality of psychotherapy.
Supervision
In the first year, the supervisors rotate based upon the clinical site to ensure expertise in the clinical skills necessary for the site. Supervision for the consult service is provided by the consult team of faculty, and supervision on the inpatient service is provided by faculty with significant interest in and experience with inpatient work. First year fellows also have a longitudinal supervisor for the first year with weekly meetings on a variety of topics.
Supervisors for the second year fellows are assigned for the entire year. Each fellow is assigned one supervisor who has expertise in psychotherapy to ensure that all fellows have direct supervision as they develop skills as therapists. The second supervisor is a child psychiatrist with expertise to ensure a strong knowledge base in clinical and decisions and to participate in career guidance. Fellows also work directly with faculty in their elective sites, providing additional supervision.
In summary, the fellowship provides a strong foundation for understanding how to practice evidence based psychotherapy for children and adolescents. Our teaching factors in the level of training of the fellow, the clinical application of the knowledge and skills, and the emotional impact of the challenges faced when working with psychiatric disorders in children and adolescents. The faculty provides excellent support and education regarding psychotherapy.