How do you repair and sustain a therapeutic relationship with an angry
patient? Therapeutic alliance has come to be recognized as crucial in every
doctor-patient encounter and a critical factor in the outcome of
psychotherapy. And this year, APA members attending the annual meeting in
Toronto, will have an opportunity to sharpen their alliance-building skills in
a course that has won awards at the Mt. Sinai Institute of Psychotherapy at
the University of Toronto.
"Achieving and Sustaining Psychotherapy Effectiveness" is a
full-day course that will seek to offer psychiatrists practical skills to
improve psychotherapy outcomes through enhancing the therapeutic alliance.
Course codirector Paula Ravitz, M.D., told Psychiatric News that
the course, which can be taken for six hours of continuing medical education
credit, is designed to provide experienced psychotherapists with an expanded
clinical repertoire to manage commonly encountered clinical challenges in
Her co-director is Molyn Leszcz, M.D., of the University of Toronto, who is
a coauthor with Irving Yalom of the newest edition of Interpersonal
Particular attention will be paid to the therapeutic alliance, effective
use of countertransference, and therapeutic metacommunication, Ravitz
A distinguishing feature of the course will be the use of"
standardized patients"—typically, professional actors
enacting patient roles in scripted scenarios.
At the opening of the course, a scenario will be enacted with faculty
playing the role of the treating psychiatrist. The presentation is designed to
be interactive—lending a "living theater" quality to the
teaching—so that faculty may stop to make more transparent some crucial
aspect that is being illustrated in the scenario or to allow course
participants to ask questions.
Later, course participants will break into small groups in which
patient-actors will enact separate scenarios for each group with participants
playing the role of clinician.
Throughout, the emphasis will be on providing experience, not theory.
"We want to go beyond theory and give participants very practical
approaches and strategies for commonly encountered clinical challenges related
to the therapeutic alliance," Ravitz told Psychiatric News.
She is director of the Mt. Sinai Psychotherapy Institute, head of the
Interpersonal Psychotherapy Clinic at the Center for Addiction and Mental
Health, and an assistant professor of psychiatry at the University of
"The dynamic approach of this course is going to have an
impact," added Nancy McNaughton, M.Ed., director of the standardized
patient program at the University of Toronto School of Medicine. "People
will have a very clear memory of this class because it's practical and
The course will enable participants to
Ravitz emphasized that the therapeutic alliance has come to be recognized
as critical in all forms of therapy. "Our curriculum focuses on skills
enhancement related to the therapeutic relationship across models," she
said. "Rather than focusing on the question of what works for whom, we
focus on how to make whatever therapy is being employed work as effectively as
possible. It's meant to be skill building rather than
And participants will be able to continue the learning experience after
they leave the annual meeting. Through the University of Toronto Faculty of
Medicine and Mt. Sinai Hospital Department of Psychiatry, Mt. Sinai
Psychotherapy Institute, course participants can receive one-on-one distance
supervision, allowing them to communicate problems, questions, and clinical
vignettes through a confidential, password-protected Web site.
The course will be held Tuesday, May 23, from 9 a.m. to 4 p.m. in the
Dominion Ballroom South on the second floor of the Sheraton Centre. Advance
registration for APA members is $160.
Deborah Hales, M.D., director of APA's Division of Education and Career
Development, urged clinicians to sign up.
"Our intention is to offer this as a CME exercise for experienced
physicians to get a meaningful review of their interviewing technique with
standardized patients under observation," she said. "We want to
begin to help practicing physicians realize that communication skills need
practice, just as clinical skills do." ▪