Psych residencies friendly to psychoanalysis?

[greatgefilte]

Hi all,

 

I'm in second year meds at UWO, and we've just started our psychiatry block. I've been doing a bit of reading about academic psychiatry and the general trend of training programs, and my impression is that most hospital-based psychiatrists aren't particular fans of psychodynamic approaches to Axis I/II issues.

 

I'm interested in possibly pursuing psych in residency, and I'm wondering if anyone has anecdotes or experience in how training programs generally view people who are interested in psychoanalytic therapy, as opposed to more mainstream CBT, etc. Are there any programs that are known to be more Freud-friendly, for lack of a better description? (Yeah, I know things have come a long way since Dr. Sigmund in the world of psychodynamics...)

 

Thanks!

[apache]

No offense, but psychodynamic approach are complete bs... narrative therapy, cbt, humanistic existential therapy, counseling, psychological approaches... are actually effective. Psychoanalytic theory is nebulous and unefficous by any of even the most vague research criteria.

 

I'd personally use Neuro Linguistic Processing, Mindfulness Meditation, Social Cognitive Approaches (think Bandura) and Yoga, assertiveness training, social support network building, exercise groups, and breathing techniques, before I even touched psychoanalytic therapy.

 

 

 

Hi all,

 

I'm in second year meds at UWO, and we've just started our psychiatry block. I've been doing a bit of reading about academic psychiatry and the general trend of training programs, and my impression is that most hospital-based psychiatrists aren't particular fans of psychodynamic approaches to Axis I/II issues.

 

I'm interested in possibly pursuing psych in residency, and I'm wondering if anyone has anecdotes or experience in how training programs generally view people who are interested in psychoanalytic therapy, as opposed to more mainstream CBT, etc. Are there any programs that are known to be more Freud-friendly, for lack of a better description? (Yeah, I know things have come a long way since Dr. Sigmund in the world of psychodynamics...)

 

Thanks!

[greatgefilte]

No offense, but psychodynamic approach are complete bs... narrative therapy, cbt, humanistic existential therapy, counseling, psychological approaches... are actually effective. Psychoanalytic theory is nebulous and unefficous by any of even the most vague research criteria.

 

I'd personally use Neuro Linguistic Processing, Mindfulness Meditation, Social Cognitive Approaches (think Bandura) and Yoga, assertiveness training, social support network building, exercise groups, and breathing techniques, before I even touched psychoanalytic therapy.

 

No offense right back, but there's actually evidence to support some kinds of psychodynamic therapy, not necessarily the "lying on the couch for five years" sort of thing, but more contemporary practices whose effects can be measured. (See, for example, http://www.ncbi.nlm.nih.gov/pubmed/17535596). To rule it all out because of misconceptions or closed-mindedness is doing a disservice to the people who need it.

[Mourning Cloak]

(See, for example, http://www.ncbi.nlm.nih.gov/pubmed/17535596).

 

Published by the Journal of Psychology and Psychotherapy, written by guys working at one of those funny little German bastions of Freud / Jung worship?

Nope, try again.

 

http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001360/frame.html

http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005537/frame.html

(note the author's conclusions that there is no evidence for the effectiveness of psychotherapy in patients with a clinical diagnosis of depression)

 

Back in psych 101 they told us about a landmark study (I'll have to suss it out, it's from a while ago) which basically demonstrated that talking therapy was equivalent in effectiveness (with the possible exception of CBT) to having a heart-to-heart with a completely untrained but sympathetic listener. So there is benefit, if you like, in talking therapy, but all you need is a friend - not a psychiatrist - to benefit.

 

There's a lot to learn in psych, and better things to spend one's time learning!

[greatgefilte]

Published by the Journal of Psychology and Psychotherapy, written by guys working at one of those funny little German bastions of Freud / Jung worship?

Nope, try again.

 

Wow, now that's a fine example of objective criticism.

 

 

http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001360/frame.html

http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD005537/frame.html

(note the author's conclusions that there is no evidence for the effectiveness of psychotherapy in patients with a clinical diagnosis of depression)

 

Did you even read those before posting? "When compared with treatment as usual, psychotherapy was associated with a significant decrease in depression score." And why there's no evidence for clinically diagnosed depression in cancer patients? "None of the studies focused on patients with clinically diagnosed depression."

 

Look, snarkiness aside, we can both pull studies out of our asses until the cows come home. People are always going to have preconceptions, biases, and treatment preferences. I'm not saying that therapy is a magic bullet that fixes everything, but neither is a purely pharmacological approach. And when it comes to someone with really complex issues, let's say significant axis I and II problems, and they're not responding to anything you throw at them, are you just going to tell them it's out of your domain and they should go talk it out with a friend? I think we can do better than that.

[Mourning Cloak]

You may find this more persuasive:

 

Canadian Psychiatric Association Professional Guidelines

https://ww1.cpa-apc.org/Publications/Clinical_Guidelines/depression/clinicalGuidelinesDepression.asp

https://ww1.cpa-apc.org/Publications/Clinical_Guidelines/schizophrenia/november2005/Interventions.asp

http://publications.cpa-apc.org/media.php?mid=451

[greatgefilte]

Missed the point. The point is that in their review of the literature, "no evidence supports the effectiveness of psychotherapy for patients with clinically diagnosed depression."

 

In patients with incurable cancer, yes... That was the scope of their review. If you're going to take things out of context, this is a lovely quote from the full article: "Our findings suggest that the effects of psychotherapy are almost comparable to those obtained in antidepressant pharmacotherapy

studies in general psychiatry settings."

 

Anyway, I've got better things to do on a Sunday than argue about this.

[Mourning Cloak]

Anyway, I've got better things to do on a Sunday than argue about this.

 

Do what I'm doing. Read guidelines.

 

Canadian Psychiatric Association Professional Guidelines

https://ww1.cpa-apc.org/Publications/Clinical_Guidelines/depression/clinicalGuidelinesDepression.asp

https://ww1.cpa-apc.org/Publications/Clinical_Guidelines/schizophrenia/november2005/Interventions.asp

http://publications.cpa-apc.org/media.php?mid=451

 

You would be within the guidelines applying CBT, IPT +/- meds in mild to moderate depression and anxiety disorders. Given this, I'm sure that most residencies in Canada would teach these modalities to a greater or lesser degree.

[apache]

well then you have to better operationally define your terminology, since your version of psychodynamic theory's semantic generalizability among the lay population is low... ignorant questions get ignorant answers , nothing personal, just saying. Plus, when you get into something as nebulous as psychology/psychiatry it's hard to be evidence based because of numerous errors in the research methodology, so you have to really define the scope of what you're talking about, so what would be the inclusion and exclusion criteria for what would constitute psychoanalytic theory... blah blah blah semantics... personally i'd just send them to a priest

 

 

No offense right back, but there's actually evidence to support some kinds of psychodynamic therapy, not necessarily the "lying on the couch for five years" sort of thing, but more contemporary practices whose effects can be measured. (See, for example, http://www.ncbi.nlm.nih.gov/pubmed/17535596). To rule it all out because of misconceptions or closed-mindedness is doing a disservice to the people who need it.

[apache]

to answer your question, i think u of t does some psychodynamic, i remember checking their curriculum, either them or ubc

 

to be honest, im not a big fan of cbt... i just think of cbt as tools you can use in a more eclectic approach... to even classify approaches is somewhat erroneous, patients don't come with labels, so neither should therapies, at least in individual practices

 

Do what I'm doing. Read guidelines.

 

Canadian Psychiatric Association Professional Guidelines

https://ww1.cpa-apc.org/Publications/Clinical_Guidelines/depression/clinicalGuidelinesDepression.asp

https://ww1.cpa-apc.org/Publications/Clinical_Guidelines/schizophrenia/november2005/Interventions.asp

http://publications.cpa-apc.org/media.php?mid=451

 

You would be within the guidelines applying CBT, IPT +/- meds in mild to moderate depression and anxiety disorders. Given this, I'm sure that most residencies in Canada would teach these modalities to a greater or lesser degree.