Presentation originally recorded and published in 2014.

Key Takeaways

• Psychotherapy is an effective form of treatment with an extensive evidence base
• There are core features of psychotherapy across schools of therapy
• Integrating the teaching of psychotherapy to trainees and residents across schools of therapy helps to maintain psychotherapy as an important skill set and identity of psychiatrists

Presentation Overview

The initial five core competencies in psychotherapy introduced by the Review & Recognition Committee (RRC) have been reduced to three: Cognitive Behavioral Therapy (CBT), Psychodynamic Therapy, and Supportive Therapy. Teaching these forms of therapy to residents has been a challenge. One issue in teaching them has been the tendency of representatives of the schools to compete for the interest of trainees. Residents often wonder which school is “right” in its theoretical and technical approach and why there seems to be so much tension from past generations in the discussions. 

This presentation offers an overview of the evidence for the effectiveness of psychotherapy as a form of treatment, then offers a re-conceptualization of the three schools of therapy and their competencies into one unified whole in a “Y-shaped” structure based on evidence about core features of psychotherapy across schools of therapy and evidence from the comparative psychotherapy process research literature.

The Y Model also preserves all of the original five psychotherapy competencies in modified form. In the Y Model, Brief Psychotherapy and Combined Medication and Psychotherapy are conceptualized as among other psychotherapy skills that are common across schools of therapy, and are located in the model on the stem of the Y. CBT and psychodynamic Therapy are then conceptualized as two divergent therapies forming the forks of the Y that build on the common basic skills using different underlying theoretical assumptions that lead to rationally differentiated approaches to managing therapist activity, the role of the unconscious, the therapeutic relationship, symptoms and emerging affects. Supportive therapy is conceptualized as largely composed of skills common to all therapies, with some components of both psychodynamic therapy and CBT added. The model integrates the teaching of psychotherapy to trainees, compares and contrasts schools of therapy based on their underlying theoretical assumptions, with technique following from theory, and is based on the available evidence.