THIRD YEAR PGY-III Psychiatry and Psychotherapy

Clinical Program Residents enter this portion of the program after completing their inpatient experience. In addition to learning the technique of expressive psychotherapy, this aspect of the resident's training focuses on evaluation and treatment planning for outpatients. Emphasis is placed on differentiating patients who are suitable for insight-oriented work from those who require more supportive treatment. Through extensive experience in long term treatment of adults and children, residents learn to understand the patient's psychodynamics and to use this understanding to facilitate making timely, helpful interventions. In addition, residents learn to combine expressive psychotherapy with pharmacotherapy for appropriate patients. The resident's clinical work in insight-oriented psychotherapy occurs at one of three outpatient facilities: the George Washington University Outpatient Clinic, the North Community Mental Health Center and the Region 3 Community Mental Health Center. Residents develop and maintain a varied individual psychotherapy caseload. At the clinics and through continued work at St. Elizabeths, residents gain experience in four modalities of therapy: long-term individual psychotherapy with patients requiring supportive and interpretive psychotherapy, group therapy, therapy with children, and treatment of families. With both children and adults residents conduct many diagnostic evaluations and develop thorough treatment plans. Residents are supervised a minimum of three hours per week in their expressive/psychotherapy cases. Ongoing supervision is also provided for child group and family therapy by a faculty member who is expert in these modalities. During their PGY-III year, residents also gain experience combining the interpretive psychotherapy and pharmacotherapy. Residents also continue treatment of patients with whom they began treating on the inpatient rotation during the previous year or have received through referral. Supervision from faculty especially skilled in work with more severely ill patients is provided. Residents will continue to treat these patients throughout their residency.

Seminars

Outpatient Psychiatry and Psychotherapy - Didactic Program Basic Psychoanalytic Literature is a weekly seminar which runs throughout the year. The theory of psychoanalytically oriented psychotherapy, both brief and extended, is the major focus of this course. Regularly assigned readings in each session successively review the development of the psychoanalytic theory of therapy beginning with Freud's early writings and continuing with the elaboration of ego psychology. An extended study of Franz Alexander and other revisionists of classical theory is also presented. The course is illustrated with clinical vignettes from the work of both the instructor and the residents. The seminar is conducted by Ben Zeichner, M.D., a senior psychoanalyst from the community.

The Individual Therapy Conference utilizes process notes presented by residents to senior faculty members to focus on various aspects of the case material. Such subjects as psychodynamics and transference are explored, with a particular emphasis being placed on therapeutic techniques. In the Continuous Case Conference four residents, rotating on a weekly basis, present material from an ongoing case to one of four senior consultants. Residents thus have an opportunity to study the longitudinal development of four treatment cases throughout the year and to gain a sense of the variation in personal technique among four experienced psychiatrists. One of the four cases is a child. This conference and the individual therapy conference are given throughout the year.

The Didactic component in group psychotherapy is comprised of three seminars. In the Group Psychotherapy Literature Seminar, which meets weekly throughout the year, residents consider the three major perspectives from which groups can be examined: the focus upon the individual in the group, the focus upon interaction within the group, and the focus upon the group as a whole. Case Material is presented to highlight these three major perspectives. The Continuous Group Psychotherapy Conference meets weekly for eight months. In this seminar, residents, on a rotating basis, present their psychotherapy group for critique by peers and consultants. Two courses augment the resident's clinical work in Child Psychiatry: The Diagnostic and Disposition Conference meets three hours per month. In this conference, residents present a detailed assessment of a child or adolescent. Issues of assessment technique are explored in depth. Developmental, biological, environmental, psychodynamic, social, and cultural factors are taken into consideration in arriving at a comprehensive treatment plan for each child. The Child Psychopathology course also meets three hours per month and uses readings from the recent and classical literature to provide an overview of the major areas of the psychopathology of children. Emphasis is placed on the development of practical treatment interventions based on a dynamic understanding of the child's psychopathology. Topics considered include childhood psychosis, retardation, organic brain syndromes, arrests of psychological development, enuresis and encopresis syndromes, arrests of psychological development, minimal cerebral dysfunction, neurosis, learning problems, attention deficit hyperactivity disorders, adoption, drug related problems, and pediatric liaison.

Treatment and Rehabilitation In Chronic Mental Illness is a six-session seminar that includes principles of rehabilitation, comprehensive psychosocial treatment and special issues such as the role of childhood abuse as a complicating factor and the role of traditional psychotherapy in the treatment of those with chronic mental illness.

The following roster reflects a representative clinical experience of a resident in the third year.