Learning to Appreciate Psychotherapy

All of us are aware of the residency training requirement to show competency in various types of psychotherapy prior to graduating. However, not all of us were thrilled with the idea of learning how to do this. I must admit that when I started residency almost four years ago, I was one of those individuals. I saw myself as a future clinician who would be known for her strength in psychopharmacology, not as one who would be practicing psychotherapy. Time and experience sure have a way of changing people.

I began working with patients in psychotherapy as a PGY-2. After fumbling my way through several cases, I began treating a woman using psychodynamic psychotherapy in January 2002. She initially started as a medication-management case only, but she later decided to pursue more intensive therapy and agreed to weekly sessions with me. Two years later, she has made remarkable progress. She taught me how to appreciate the importance of being skillful in psychodynamic psychotherapy to be a complete clinician. I think I have finally learned how to be comfortable with the silence in a session and to refrain from trying to “fix things” for patients. Sure, I made mistakes, but despite this, my patient stuck with me, and she got better.

As my interest in psychotherapy grew, I was asked by my training director to attend the Beck Institute’s Cognitive-Behavioral Training Program in Philadelphia for one year. This involved three intensive weekend seminars and weekly phone supervision on a case of my choice. One of my patients was confronting a significant life change associated with her career and needed help changing her belief system about her capability, self-worth, and ability to cope with incredible stressors. We worked together in CBT on identifying automatic thoughts and changing core beliefs. After one year, she and I learned a lot from each other. I’m proud to say that she has succeeded, and I am grateful for the opportunity to hone my therapeutic CBT skills with her.

I can’t put into words how gratifying and humbling it is when a patient shares with you that you have helped to change his or her life. Sure, we hear this same type of thing from patients who have wonderful responses to medication, but there is something special about knowing that the act of listening, interpreting, gently confronting, and supporting can change a life by itself. My experience has been so positive that I have decided to continue working with patients in psychotherapy, along with psychopharmacology, once I begin in private practice.

When I think back to my initial resistance about psychotherapy, I can’t help but think about why some of us shy away from learning how to be good therapists. I believe that it has to do with our fear of the unknown. You can’t teach this skill by hearing lectures about it. You simply have to jump in with both feet, make mistakes, learn via trial by fire, and utilize the wisdom and expertise of your supervisors along the way. Learning how to do this well is an integral part of what we do. It’s what makes us different from other doctors who can just as easily prescribe medicines. Even if you never practice psychotherapy after your training is completed, understanding and appreciating the importance of what makes people the way they are and how they got to be that way are crucial to providing good patient care.

If you have any questions or concerns or if you are interested in writing an article for the Residents’ Forum, please contact me by e-mail at [email protected]. ▪