Acad Psychiatry (2015) 39:99–103 DOI 10.1007/s40596-014-0219-3
IN BRIEF REPORT
Use and Characterization of Personal Psychotherapy by Psychiatry Residents Jessica G. Kovach & William R. Dubin & Christopher J. Combs
Received: 26 March 2014 / Accepted: 18 August 2014 / Published online: 26 November 2014 # Academic Psychiatry 2014
Abstract Objective The authors evaluated psychiatry resident participation in and description of personal psychotherapy, reasons for being in psychotherapy, and barriers to personal psychotherapy. Methods All 14 program directors for programs accredited by the Accreditation Council for Graduate Medical Education in Pennsylvania, New Jersey, and Delaware provided e-mail addresses for current categorical residents. The authors emailed a voluntary, anonymous, 10-min survey to residents through www.SurveyMonkey.com. The survey inquired about time spent in various aspects of training, value assigned to aspects of training, residents’ involvement in their own psychotherapy, reasons for being in or not being in therapy, and overall resident wellness. Results Of the 328 residents e-mailed, 133 (40.5 %) replied to the survey, of which 34 (26.5 %) were in personal psychotherapy. Most residents described their psychotherapy as psychodynamic, once weekly, and located in a private practice not affiliated with the resident’s academic center. Approximately half (49 %) were in treatment with a social worker (MSW, LCSW) or psychologist (PhD or PsyD). “Self-awareness and understanding” was the most commonly reported primary and contributing reason for being in psychotherapy. Close to half of the respondents (44.5 %) listed personal stress, substance dependence, mood, anxiety, or other psychiatric symptoms as the primary reason for seeking personal psychotherapy. The most common reasons for not entering psychotherapy were time and finances. Residents who were in personal psychotherapy valued personal psychotherapy as more important to training than residents who were not in personal
J. G. Kovach (*) : W. R. Dubin : C. J. Combs Temple University, Philadelphia, PA, USA e-mail: [email protected]
psychotherapy. Half of all respondents reported that their program recommends psychotherapy. Conclusion Far fewer residents responding to the survey reported being in psychotherapy than residents from some previous surveys. A continuing discussion of whether and how to accommodate personal psychotherapy in the training and education of psychiatry residents by psychiatry educators is warranted. Keywords Psychiatry residents . Psychotherapy . Emotional problems of trainees According to recent surveys of psychiatry training directors and residents, personal psychotherapy is considered an important part of psychiatric and psychotherapy training [1–3]. Reasons agreed upon by over 80 % of US residency training directors include the importance of psychotherapy as a general educational tool, for teaching residents about therapeutic technique, and for teaching residents about managing their emotional reactions toward patients [4]. Training directors also report that therapy is useful for residents coping with premorbid psychopathology and for dealing with the stresses of training in psychiatry [4]. Despite the importance with which training directors view personal psychotherapy, the number of psychiatric residents in personal psychotherapy has decreased over the last several decades. Surveys from the 1950s estimated that up to twothirds of residents were in therapy [5, 6]. With one exception [7], published rates of psychiatry residents in personal psychotherapy have decreased to 20–33 % over the last 15 years [2, 4, 8]. Potential reasons for fewer residents going into personal therapy include cost, training demands, and lack of perceived need [2, 4]. Factors associated with a higher likelihood of being in personal psychotherapy include advanced year of
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Acad Psychiatry (2015) 39:99–103
training, Caucasian race, being a graduate of an American medical school, training in the Northeast or on the West Coast, and encouragement by training directors of the use of personal psychotherapy for professional and personal reasons [1, 2, 4, 8]. We sought to evaluate current trends in personal psychotherapy among psychiatric residents. In order to do this, we surveyed residents about their participation in personal psychotherapy, including type of therapy, perceived value of therapy, and barriers to pursuing therapy.
Methods We designed and e-mailed a brief, voluntary, anonymous survey to be completed on www.SurveyMonkey.com. A short description of the survey was reviewed with and/or emailed to all 14 program directors for programs accredited by the Accreditation Council for Graduate Medical Education in Pennsylvania, New Jersey, and Delaware. All program directors provided e-mail addresses for current categorical residents. The Temple University Institutional Review Board approved the study. The survey, which was open during May and June of 2013, was successfully e-mailed to 328 residents. Residents were sent up to four e-mails inviting them to answer the survey. Only one response per e-mail address was permitted. Data were de-identified so that neither the
resident nor the resident’s program could be determined. In order to increase resident participation in the study and mitigate the effect of volunteer bias, we raffled one $300 gift certificate from an online retailer. The raffle was anonymous and on a separate website subsidiary of Survey Monkey. With permission, the winner’s name was released to the primary author. The survey first asked demographic questions, followed by whether or not the resident was in personal psychotherapy, description of psychotherapy, and reasons for being in or barriers to psychotherapy at the present time. The survey next inquired about time currently spent versus optimal time spent performing different kinds of psychotherapy, various types of didactics, and supervision. Residents were asked to use a 5point Likert-type scale to assign an overall value to their training of personal psychotherapy, hours of psychotherapy performed as a resident, didactics in psychotherapy, supervision, and reading about psychotherapy. The Multi-Cultural Quality of Life Index (MQLI) was used to assess resident quality of life [9]. Although some data from the MQLI are included in this report, further data on quality of life, as well as data on training hours, are beyond the scope of this paper and will be reported elsewhere. Copies of the survey are available from the authors upon request. Residents who were in personal psychotherapy were compared to residents who were not in therapy on variables measuring the value of different teaching modalities using a
Table 1 Demographics of survey respondents Demographics Sex Male Female Age 25–29 30–34 35–40 Over 40 Ethnicity and race Latino/a Asian Black or African American White “I do not wish to specify.” Other Year of training PGY-1 PGY-2 PGY-3 PGY-4
All respondents (%)
n
Not in therapy (%)
n
In therapy (%)
n
47.7 52.3
63 69
48.5 51.5
47 50
45.7 51.4
16 18
32.6 42.4 21.2 3.8
43 56 28 5
34.0 39.2 23.7 3.1
33 38 23 3
28.6 51.4 14.3 5.7
10 18 5 2
12.2 23.1 1.5
16 30 2
12.4 26.8 2.1
12 26 2
11.8 12.1 0
4 4 0
60 12.3 1.5
78 16 4
54.6 12.4 4.1
53 12 4
75.8 12.1 0
25 4 0
28.0 23.4 24.2 24.2
36 30 31 31
35.8 20.0 22.1 22.1
34 19 21 21
6.1 33.3 30.3 30.3
2 11 10 10
Acad Psychiatry (2015) 39:99–103
t test for independent samples with a significance level selected of p
IN BRIEF REPORT
Use and Characterization of Personal Psychotherapy by Psychiatry Residents Jessica G. Kovach & William R. Dubin & Christopher J. Combs
Received: 26 March 2014 / Accepted: 18 August 2014 / Published online: 26 November 2014 # Academic Psychiatry 2014
Abstract Objective The authors evaluated psychiatry resident participation in and description of personal psychotherapy, reasons for being in psychotherapy, and barriers to personal psychotherapy. Methods All 14 program directors for programs accredited by the Accreditation Council for Graduate Medical Education in Pennsylvania, New Jersey, and Delaware provided e-mail addresses for current categorical residents. The authors emailed a voluntary, anonymous, 10-min survey to residents through www.SurveyMonkey.com. The survey inquired about time spent in various aspects of training, value assigned to aspects of training, residents’ involvement in their own psychotherapy, reasons for being in or not being in therapy, and overall resident wellness. Results Of the 328 residents e-mailed, 133 (40.5 %) replied to the survey, of which 34 (26.5 %) were in personal psychotherapy. Most residents described their psychotherapy as psychodynamic, once weekly, and located in a private practice not affiliated with the resident’s academic center. Approximately half (49 %) were in treatment with a social worker (MSW, LCSW) or psychologist (PhD or PsyD). “Self-awareness and understanding” was the most commonly reported primary and contributing reason for being in psychotherapy. Close to half of the respondents (44.5 %) listed personal stress, substance dependence, mood, anxiety, or other psychiatric symptoms as the primary reason for seeking personal psychotherapy. The most common reasons for not entering psychotherapy were time and finances. Residents who were in personal psychotherapy valued personal psychotherapy as more important to training than residents who were not in personal
J. G. Kovach (*) : W. R. Dubin : C. J. Combs Temple University, Philadelphia, PA, USA e-mail: [email protected]
psychotherapy. Half of all respondents reported that their program recommends psychotherapy. Conclusion Far fewer residents responding to the survey reported being in psychotherapy than residents from some previous surveys. A continuing discussion of whether and how to accommodate personal psychotherapy in the training and education of psychiatry residents by psychiatry educators is warranted. Keywords Psychiatry residents . Psychotherapy . Emotional problems of trainees According to recent surveys of psychiatry training directors and residents, personal psychotherapy is considered an important part of psychiatric and psychotherapy training [1–3]. Reasons agreed upon by over 80 % of US residency training directors include the importance of psychotherapy as a general educational tool, for teaching residents about therapeutic technique, and for teaching residents about managing their emotional reactions toward patients [4]. Training directors also report that therapy is useful for residents coping with premorbid psychopathology and for dealing with the stresses of training in psychiatry [4]. Despite the importance with which training directors view personal psychotherapy, the number of psychiatric residents in personal psychotherapy has decreased over the last several decades. Surveys from the 1950s estimated that up to twothirds of residents were in therapy [5, 6]. With one exception [7], published rates of psychiatry residents in personal psychotherapy have decreased to 20–33 % over the last 15 years [2, 4, 8]. Potential reasons for fewer residents going into personal therapy include cost, training demands, and lack of perceived need [2, 4]. Factors associated with a higher likelihood of being in personal psychotherapy include advanced year of
100
Acad Psychiatry (2015) 39:99–103
training, Caucasian race, being a graduate of an American medical school, training in the Northeast or on the West Coast, and encouragement by training directors of the use of personal psychotherapy for professional and personal reasons [1, 2, 4, 8]. We sought to evaluate current trends in personal psychotherapy among psychiatric residents. In order to do this, we surveyed residents about their participation in personal psychotherapy, including type of therapy, perceived value of therapy, and barriers to pursuing therapy.
Methods We designed and e-mailed a brief, voluntary, anonymous survey to be completed on www.SurveyMonkey.com. A short description of the survey was reviewed with and/or emailed to all 14 program directors for programs accredited by the Accreditation Council for Graduate Medical Education in Pennsylvania, New Jersey, and Delaware. All program directors provided e-mail addresses for current categorical residents. The Temple University Institutional Review Board approved the study. The survey, which was open during May and June of 2013, was successfully e-mailed to 328 residents. Residents were sent up to four e-mails inviting them to answer the survey. Only one response per e-mail address was permitted. Data were de-identified so that neither the
resident nor the resident’s program could be determined. In order to increase resident participation in the study and mitigate the effect of volunteer bias, we raffled one $300 gift certificate from an online retailer. The raffle was anonymous and on a separate website subsidiary of Survey Monkey. With permission, the winner’s name was released to the primary author. The survey first asked demographic questions, followed by whether or not the resident was in personal psychotherapy, description of psychotherapy, and reasons for being in or barriers to psychotherapy at the present time. The survey next inquired about time currently spent versus optimal time spent performing different kinds of psychotherapy, various types of didactics, and supervision. Residents were asked to use a 5point Likert-type scale to assign an overall value to their training of personal psychotherapy, hours of psychotherapy performed as a resident, didactics in psychotherapy, supervision, and reading about psychotherapy. The Multi-Cultural Quality of Life Index (MQLI) was used to assess resident quality of life [9]. Although some data from the MQLI are included in this report, further data on quality of life, as well as data on training hours, are beyond the scope of this paper and will be reported elsewhere. Copies of the survey are available from the authors upon request. Residents who were in personal psychotherapy were compared to residents who were not in therapy on variables measuring the value of different teaching modalities using a
Table 1 Demographics of survey respondents Demographics Sex Male Female Age 25–29 30–34 35–40 Over 40 Ethnicity and race Latino/a Asian Black or African American White “I do not wish to specify.” Other Year of training PGY-1 PGY-2 PGY-3 PGY-4
All respondents (%)
n
Not in therapy (%)
n
In therapy (%)
n
47.7 52.3
63 69
48.5 51.5
47 50
45.7 51.4
16 18
32.6 42.4 21.2 3.8
43 56 28 5
34.0 39.2 23.7 3.1
33 38 23 3
28.6 51.4 14.3 5.7
10 18 5 2
12.2 23.1 1.5
16 30 2
12.4 26.8 2.1
12 26 2
11.8 12.1 0
4 4 0
60 12.3 1.5
78 16 4
54.6 12.4 4.1
53 12 4
75.8 12.1 0
25 4 0
28.0 23.4 24.2 24.2
36 30 31 31
35.8 20.0 22.1 22.1
34 19 21 21
6.1 33.3 30.3 30.3
2 11 10 10
Acad Psychiatry (2015) 39:99–103
t test for independent samples with a significance level selected of p
