Abstract
Dear Editor,
We read with interest the article by Fefergrad and Mulsant 1 published in the Journal in June 2022 on their proposed model for resident psychotherapy training. We agree with Fefergrad and Mulsant's position that, given the limited access to psychotherapy, psychiatrists should not be prohibited from providing psychotherapy. Indeed, it should be further encouraged. We also recognize that challenges exist for specialty committees to manage time in residency programs to provide training in everything that trainees need to master. As psychiatrists practicing across a variety of settings in Ontario, we are tied by our shared value of there being protected space for long-term psychotherapy training in residency and the aforementioned article sparked our desire to highlight that in this letter.
Extensive advocacy 2 has taken place across Ontario to ensure that evidence-based, life-saving, long-term/intensive psychotherapy remains part of the publiclyfunded psychiatric tool kit here. There can be a false dichotomy set up by the idea of moving away from long-term psychotherapy in the service of neurobiological approaches as that is in contradiction to the literature, which identifies changes at the level of the brain occurring following long-term psychodynamic psychotherapy being correlated with symptomatic relief. 3 The Canadian Psychiatric Association's own Psychotherapy in Psychiatry position statement 4 highlights the importance of long-term psychotherapy within the comprehensive biopsychosocial approach. Further, the Accreditation Council for Graduate Medical Education 5 requires child/adolescent psychiatry fellows to demonstrate competence in psychodynamic psychotherapy as it is a way of thinking in multiple clinical contexts.
While we support Fefergrad and Mulsant's concept of applying “psychotherapy skills to manage multiple populations and settings,” 1 experiences of supervisors among us have specifically highlighted trainees’ desire for high-quality experiential learning of long-term psychotherapy skills to manage the most complex of cases. Training would involve sufficient case exposure and opportunities for role play, for practicing the microskills of therapy, for observation of experts, and for review of trainee performance, whether live or through the use of technology. The personal experiences of those of us who are early career psychiatrists have exposed areas of psychotherapy training that remain lacking. Resident-led advocacy in 2019 directly to the Royal College Psychiatry Specialty Committee, with which over 100 trainees from across the country were involved at the time, has demonstrated this desire for ensuring long-term psychotherapy training is prioritized in residency programs.
Psychiatric training is supposed to elucidate for trainees the true complexity of the human mind. Long-term psychotherapy informs all relational encounters and helps psychiatrists to be better teachers and clinicians, even if they do not end up practicing it formally. In keeping with Fefergrad and Mulsant's call for competence in a variety of psychotherapeutic skills, we extend that in foreseeing a huge disservice being done to both the profession and the public if long-term psychotherapy training is eroded over time.
Sincerely,
