APA, AADPRT Develop Model For Psychotherapy Competence

Psychiatrists in training now have new standards to meet when they practice psychotherapy. A collaborative effort between members of the American Association of Directors of Psychiatric Residency Training (AADPRT) Task Force on Core Competency and APA’s Commission on Psychotherapy by Psychiatrists (COPP) have produced sample standards for residency training programs across the country.

The standards, or competencies, include the knowledge, skills, and attitudes that residents should have to practice the following types of psychotherapy: cognitive-behavioral, psychodynamic, brief, supportive, and psychotherapy combined with psychopharmacology.

Residency programs across the country received the sample competencies at the end of last year. The standards describe the knowledge, skills, and attitudes that psychiatry residents must demonstrate when practicing each type of psychotherapy.

Two years ago, the Residency Review Committee for Psychiatry asked residency programs to implement new training requirements by January 2001, including a requirement that residents demonstrate competency in the five types of psychotherapy listed above (Psychiatric News, January 7, 2000).

The responsibility for developing the standards for psychotherapy practice by residents fell to AADPRT and its Task Force on Core Competency, in particular. However, the group consulted with members of APA’s COPP during the development process.

Lisa Mellman, M.D., co-chair of the AADPRT task force, told Psychiatric News, “Members of the COPP who were experts in the specific psychotherapies provided enormous help in writing the initial samples of the competencies.”

Mellman said that, in addition, members of APA’s Task Force on Competency in Graduate Education, of which she is vice chair, and residency training directors in AADPRT helped to edit the sample standards.

‘Sample’ Competencies

The new standards are not written in stone, explained Mellman, but instead provide a template for psychotherapy training. The standards are referred to as samples because it is expected that training programs will modify the standards to meet their individual needs. “Since the RRC is now requiring that residents demonstrate competence for each of the five psychotherapies, it falls upon each of the residency programs to teach and supervise residents so that they gain the needed competence,” she said. “By further defining the competencies, I think it sets the standards for what residents can expect from their training programs.”

When writing the sample competencies, Mellman said, task force members deliberated about how comprehensively the key components of each psychotherapy should be defined and the level of expertise that should be demonstrated by residents in terms of knowledge, skills, and attitudes for each type of psychotherapy.

The group decided that residents practicing cognitive-behavioral therapy should be able to understand the relationship of thoughts to emotions, the concepts of automatic thoughts and cognitive distortions, and the common cognitive errors, for example.

When practicing psychodynamic psychotherapy, residents must be able to recognize, utilize, and manage aspects of transference and countertransference, defense, and resistance in the course of treatment.

Residents treating patients with a combination of psychotherapy and psychotropic medications should be able to understand the conscious and unconscious aspects of the doctor-patient relationship, placebo effects, and the signs of comorbid medical conditions.

Common to all the competencies are the requirement that residents be sensitive to sociocultural and socioeconomic issues that arise in the therapeutic relationship.

Next Step

Now that the sample competencies have been issued to training programs, Mellman said, the next step is measuring the competence demonstrated by residents. This will involve determining how to assess and measure the competencies, developing the tools to measure the competencies, and ensuring that the competencies being measured are valid.

“The field of psychiatry is in an early stage in terms of assessment and measurement,” said Mellman. “This is a project that will continue over the next decade.” ▪