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Psychotherapy for the MRCPsych. Dr Susan Mizen Consultant Psychiatrist in Psychotherapy. Key Competencies. General Account for clinical phenomena in psychological terms Deploy advanced communications skills Display advanced emotional intelligence (patients, colleagues and yourself)

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Psychotherapy for the mrcpsych

Psychotherapy for the MRCPsych

Dr Susan Mizen

Consultant Psychiatrist in Psychotherapy


Key competencies
Key Competencies

  • General

    • Account for clinical phenomena in psychological terms

    • Deploy advanced communications skills

    • Display advanced emotional intelligence (patients, colleagues and yourself)

  • Specific

    • Refer appropriately for formal psychotherapies

    • Jointly manage patients receiving psychotherapy

    • Deliver basic psychotherapeutic treatments and strategies.


Acquiring competencies
Acquiring competencies

  • Routine Clinical Practice

    • Formulation, discussion, reflective diary (Countertransference), personal therapy.

    • Case Based Discussion Group

    • Seeing cases minimum of two, a short and long case in different modalities.

  • Portfolio/Logbook – ARCP

  • WPBA

    • CBD

    • SAPE (yr 2) SAPE 2 (yr 3)

    • Psychotherapy ACE.


The mrcpsych exam
The MRCPsych Exam

  • Paper 2: 40 questions on therapy related subjects

  • Paper 3: 8%

  • CASC

    • Psychotherapy History

    • Case Discussion

    • Difficult Communication


Time table for the day
Time table for the day

  • 10-11 am

    • Indications and contraindications for therapies

    • The evidence base for psychological therapies

    • Prescribing for patients in therapy

  • 11.15-12.30am

    • Formulation

  • Lunch

  • 1.00-2.00pm

    • Case vignettes and Formulation

  • 2.15

    • CASC 1 Difficult Communication

    • CASC 2 Psychotherapy History


Indications and contraindications for psychological therapies
Indications and Contraindications for Psychological Therapies

  • Psychodynamic

  • Short Term Dynamic

  • Group Analysis

  • CBT

  • IPT

  • Family Therapy

  • Arts Therapies

  • Integrative Therapies


Evidence base
Evidence Base Therapies

  • CBT

    • Depression, OCD, Phobias, Panic Disorder with Agoraphobia, GAD, Bulimia, BED, Sexual Dysfunction, PTSD.

  • Psychodynamic

    • PD, Panic Disorder, Depression in the elderly

  • CAT – Anorexia Nervosa

  • Behavioural treatments

    • Anxiety disorders, Substance misuse, Childhood behavioural disorders, sexual dysfunction.

  • EMDR – PTSD

  • DBT-Borderline and emotionally constricted PD

  • IPT- Depression and Bulimia

  • Family Couple – SCZ, Type 1 diabetes in children.


Jointly managing patients in psychodynamic therapy
Jointly managing patients in Psychodynamic therapy Therapies

  • Discussing continuing in therapy with the anxious or ambivalent patient.

  • The patient tells you they think their therapist is useless or abusive.

  • The Patient’s disturbance is escalating in therapy.

  • A patient in therapy begins to establish a psychotherapeutic relationship with you as their psychiatrist.



The meaning of medication
The meaning of medication Therapies

  • Transference and countertransference to the doctor and medication

  • The significance of medication

  • The importance of therapeutic alliance

  • Indications from medication about the relationship with the doctor.


Integrated and combined practice
Integrated and Combined Practice Therapies

  • Integrated Practice

    • Therapy and medication are managed by the same person.

    • Principles

      • Informed consent.

      • Formulate treatment goals at the outset.

      • Focus on alliance not compliance.

      • Address medication issues at the beginning or end of sessions.

      • Symptoms increase at the end of therapy.

  • Combined Practice

    • Separate practitioners offering therapy and medication.

    • Principles

      • Good communication

      • If there is not a joint formulation – mixed messages.

      • Meet and plan treatment clarify roles and crisis responses

      • Meet again if tensions arise.


Prescribing in psychodynamic therapy
Prescribing in Psychodynamic therapy Therapies

  • Depression in Psychotherapy

  • Escalations of disturbance in psychotherapy

  • Splitting and destructive enactments.


Formulation
Formulation Therapies

Current life situation /

symptom

Transference

Infantile object-relations / history

Triangle of person (Malan)


Formulation1
Formulation Therapies