Introduction
Psychotherapy (often referred to as 'talking therapy') involves using psychological approaches to understanding and treating mental health problems. Developing psychotherapeutic skills is an essential part of general psychiatric training and these skills can help psychiatrists in a range of settings and specialities. The Royal College of Psychiatrists sets out the aims of psychotherapy training during core training as follows.
Doctors will be able to:
Although some parts of psychiatry are taught through specific placements, psychotherapy training runs through the whole of core training and trainees will normally set aside a part of their working week to undertake their psychotherapy training. In CT1 psychotherapy training starts with doctors participating in Case Based Discussion Groups (CBD groups, formerly known as Balint Groups). CBD groups are weekly groups which last 60-90 minutes. Each week a different group member will present a case and the group will discuss psychological and emotional aspects, often looking in greater depth at the doctor-patient relationship. Please see the ARCP requirement section to learn about how the CBD groups must be evidenced.
Once trainees have completed their CBD group requirements, they can move on to conducting formal psychotherapies, normally in CT2-CT3 years. Trainees will need to complete a formal psychotherapy with at least two patients and using at least two different modalities. Examples of modalities include cognitive behavioural therapy, psychodynamic psychotherapy, cognitive analytic therapy or family therapy. Other modalities are also used but should be discussed with the local psychotherapy tutor. All formal psychotherapies will be conducted under the supervision of a qualified psychotherapist. There are a number of formal assessments that trainees will need to complete in order to pass their ARCP requirements (see ARCP requirements section), please make sure that you are familiar with these.
Opportunities following core training
Following Core Training, there are opportunities to continue to develop psychotherapy skills and/or qualifications as a higher trainee (also known as ST). After Core Psychiatry training, some trainees undertake a longer (5 year) dual training to become consultants in both psychotherapy and another psychiatric speciality such as general adult psychiatry. Some higher trainees don’t formally specialise in psychotherapy, but undertake qualifications in a specific modality of psychotherapy such as Cognitive Behavioural Therapy. Higher trainees may also take on individual patients for psychotherapy under supervision. Anyone wishing to specialise in psychotherapy should aim to gain more than the minimum amount of experience in psychotherapy. Trainees can gain obtain further experience for example by taking on further cases, doing external psychotherapy courses or observing psychotherapy assessments. Opportunities for additional training can be discussed with your local psychotherapy clinical lead.
The Royal College of Psychiatrists curriculum for core training can be found at http://www.rcpsych.ac.uk/traininpsychiatry/corespecialtytraining/curricula.aspx
Further information on the Faculty of Medical Psychotherapy (one of the faculties of the Royal College of Psychiatrists) can be found at http://www.rcpsych.ac.uk/workinpsychiatry/faculties/medicalpsychotherapy.aspx
ARCP requirements for completion of core training in HEENW
Case Based Discussion Groups
Core trainees are required to attend the Case Based Discussion Group (CBD group, formerly known as Balint Group) for the first 12 to 18 months of their training. The groups are usually specific to individual trusts so trainees usually move to a different CBD group every 6 months. Participation in CBD groups is assessed through the CBD group assessment form (CBDGA) which will be completed by the group facilitator – the form can be found on your online portfolio. Trainees are required to attend at least 25 CBD groups and to complete a CBD group assessment form every 6 months. If the trainee completes 25 CBD groups and has achieved competency in their CBD group assessments then they can move on to seeing the first of their formal psychotherapy patients.
Familiarising yourself with the CBD group assessment form can help you to understand which competencies you are aiming for within the CBD group.
Supervised Experience of Delivering Psychotherapy
Trainees are required to see two patients for formal psychotherapy before they can complete their core training. This is normally undertaken during the CT2 and CT3 years. Trainees must complete both a “long case” (at least 20 sessions) and a “short case” (12-20 sessions) and the two cases must be in different modalities of psychotherapy. Core trainees will have regular supervision from a qualified psychotherapist while they undertake the therapy. Contact your local psychotherapy tutor as soon as you have completed your CBD group competencies to arrange your cases. Details of your local psychotherapy tutor can be found in the contacts section.
The experience of delivering psychotherapy is assessed using the SAPE and Psychotherapy ACE (PACE) assessment forms– these are found on Portfolio Online. Minumum number requirements for WPBAs are shown below.
The SAPE is conducted by your psychotherapy supervisor and is a formative assessment of key psychotherapeutic competencies. Familiarising yourself with the assessment form can help you to understand what you should be aiming for. Minimum number requirements for SAPEs are shown below, however it is best practice to complete a SAPE early on in therapy and another SAPE towards the end of therapy. This can help to trainees to identify learning objectives early on in therapy, so that they have reached their competencies at the end of therapy.
The Psychotherapy ACE is a summative assessment, ideally conducted by a medical psychotherapist who is not your supervisor, but can be by your supervisor with presentation and discussion conducted as if the supervisor is new to the case. Please check with the local Psychotherapy Tutor as to which applies in the relevant Trust, and how to arrange it. For the PACE you will need to write a 500 word summary of the therapy that you have undertaken and also bring along copies of satisfactory SAPE(s) for the modality of therapy that you have undertaken. You will then present your case to the assessing psychotherapist who will discuss this with you.
Below is a summary of the evidence requirements for the final ARCP:
| Aspect of Training | Description | Requirements | Evidence required |
|---|---|---|---|
| Case Based Discussion Group | Opportunity to reflect on doctor-patient relationship and develop psychological understanding of patient. | Minimum of 25 groups. Trainees must present at least 1 case every 6 months. Achieve the CBDGA competencies. | CBDGA assessment every 6 months. |
| Supervised Experience of Delivering Psychotherapy | Carry out psychotherapy under supervision in two different modalities. | One “long case” at least 20 sessions. One “short case” 12-20 sessions. Achieve the SAPE and psychotherapy ACE competencies. | *A minimum of 1 SAPE for the short case and 2 for the long case, and 1 PACE on each case. |
*Prior to Feb 2016, RCPsych requirements were a minimum of 1 SAPE on each case & 1 PACE by the end of CT3. Mersey adopted the revised criteria from August 2016. NW will adopt them from August 2017. Therefore all HENW trainees will have the same requirements from August 2017.
Trainees wishing to undertake higher training in psychotherapy should aim to achieve more than the minimum requirements
ARCP for completion of core training in HEENW
Following the successful piloting of logbooks and a minimum data set for ARCP Psychotherapy Competence evidence in Mersey Deanery, these documents have been rolled out across the rest of the HENW footprint, and will apply to all trainees from August 2017:
The logbooks should be compiled as paper documents that a trainee updates as the groups/cases progress. The trainee’s most up to date compilation should be uploaded to Portfolio online for each ARCP.
The Minimum data set consists of guidance and a checklist to aid trainees in the compilation and submission of evidence, and is used by the ARCP panel assessor(s) to evaluate trainee Psychotherapy Competency evidence.
WPBAs are completed electronically as part of Portfolio online.
Please consult your local Psychotherapy Tutor should you require further information.
Changes to requirements will be applied prospectively, and trainee evidence at ARCP will be evaluated on the basis of the requirements/criteria in place when their CBD Groups or supervised cases were undertaken, so trainees will not be expected to provide new evidence at subsequent ARCPs on experiences already completed and assessed at ARCP as signed off. Flexibility will be applied to CT3 trainees in the transitional period of the 12 months from August 2017, so that no-one is disadvantaged.
Contacts
Local psychotherapy tutors
Lancashire and South Cumbria NHS Foundation Trust (LSCFT)
Dr Swapna Kongara - Swapna.kongara@lscft.nhs.uk
Greater Manchester Mental Health Trust (GMMH)
Dr Hosam Elhamoui - Hosam.Elhamoui@gmmh.nhs.uk
Mersey Care NHS Foundation Trust
Dr Simon Graham - simon.graham@merseycare.nhs.uk
Cheshire Wirral Partnership NHS Foundation Trust
Dr Kathia Sullivan - kathia.sullivan@nhs.net
Pennine Care NHS Foundation Trust
Dr Odelola - deji.odelola@nhs.net, Dr Moghazy - sawsan.moghazy@nhs.net and Dr Papadopoulos
Psychotherapy Training Programme Director
TPD for Dual Psychotherapy and GA (Higher) trainees
Dr Swapna Kongara - Swapna.kongara@lscft.nhs.uk