For years psychiatry residents have been asking for more training in psychotherapy. More recently, the American Association of Directors of Psychiatric Residency Training (AADPRT) determined that it would be desirable to teach more psychotherapy to residents. Many psychiatry residencies had become extremely biologically oriented and had dropped psychotherapy training entirely. In response to this interest by residents and training directors, the APA Commission on Psychotherapy by Psychiatrists developed a training program for residency directors to teach them how to teach psychotherapy to their residents. Some directors had not been taught psychotherapy, and others wanted to expand their psychotherapy knowledge. The program was oversubscribed when offered two years ago and well attended last year in a more remote location.

As an examiner for the American Board of Psychiatry and Neurology (ABPN), I believe that additional psychotherapy training will clearly be of significant help to many psychiatrists in their performance on the oral portion of the exam. A number of candidates have difficulty with the development and presentation of a comprehensive treatment plan, including appropriate psychotherapy. Most recent candidates have had trouble presenting a psychodynamic formulation.

These issues are among the reasons I selected "Psychodynamic Psychotherapy" as the theme for the 52nd Institute on Psychiatric Services, to be held October 25 to 29 at the Philadelphia Marriott. Traditionally, the institute has tended to emphasize public and community treatment programs and the more severe psychiatric illnesses. After all, its original name was the Institute on Hospital and Community Psychiatry. Even though the name has changed and the presentations are more diverse, there was some initial resistance to a psychotherapy theme. The resistance faded when it became clear that psychotherapy plays an important role in all of our contacts with patients. Psychotherapy is a seminal component of our work, far beyond the 50-minute hour. For example, it is extremely helpful in getting patients to comply with medication instructions and in picking up meaningful therapeutic clues during medication-management visits. Evaluating side effects, symptoms, and therapeutic responses to medications is essential, but not sufficient for optimal results.

The need for additional emphasis on psychotherapy training was recognized by the Accreditation Council for Graduate Medical Education (ACGME) and its Residency Review Committees (RRCs). The ACGME is adding requirements for six general competencies for all residency training programs and five additional competencies in psychotherapy for psychiatric residencies. The general requirements are the use of dependable measures to assess residents’ competence in patient care, medical knowledge, practice-based learning, interpersonal and communication skills, professionalism, and systems-based practice.

Moreover, psychiatry training programs must demonstrate that residents have achieved competency in the following forms of psychotherapy:

• Brief therapy

• Cognitive-behavioral therapy

• Combined psychotherapy and psychopharmacology

• Psychodynamic therapy and supportive therapy

By January 2001, psychiatry residencies must indicate how they are meeting or plan to meet these requirements, which must be in place by 2004. (More detailed information is available at ACGME’s Web site at <www.acgme.org>.)

As the child and general psychiatry training programs determine how to meet these requirements, the ABPN must determine how to measure them appropriately during board examinations. To assist in coordinating the development of the required competencies and their measurements, I have appointed the Task Force on Competency in Graduate Medical Education. The task force resides under the Council on Medical Education and Career Development. Its members are Drs. Sherwyn Woods (chair), Lisa Mellman (vice chair), Renato Alarçon, Allan Tasman, Clarice Kestenbaum, and James Scully. All of the members are extremely well qualified for this project.

Among the wide range of stimulating courses, workshops, seminars, and lectures at the Institute on Psychiatric Services, I have designated the following two as presidential symposia: the Commission on Psychotherapy by Psychiatrists’ all-day symposium on different types of psychotherapy and the American Academy of Psychoanalysis’s seminar on psychodynamic psychotherapy. Special sessions are planned for psychiatry residents.

This a great learning opportunity in a wonderful city with a wide range of cultural activities and a chance to delve into American history. I look forward to seeing you there.