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Job planning in medical psychotherapy
Learn about the structure and activities specific to medical psychotherapy psychiatry and read guidance regarding what would constitute an acceptable job plan.
Consultant psychiatrists in medical psychotherapy (abridged to consultant medical psychotherapists for the purposes of this chapter) integrate the delivery of talking therapies with other effective biopsychosocial interventions.
They promote the therapeutic value of relationships, working together, and the application of knowledge from psychiatry, psychotherapy and the neurosciences.
They have a range of skills that are particularly helpful for patients who present with complex difficulties such as personality disorders, complex trauma, treatment-resistant affective disorders, eating disorders, and medically unexplained symptoms.
They specialise in diagnostic and therapeutic complexity and deepen the understanding of complex interactions between the patient, healthcare professional, and the wider team in order to provide the best and safest quality of clinical care.
The consultant medical psychotherapist has specific expertise in:
- Assessment: carrying out psychotherapeutic assessments of complex conditions by integrating an individualised biopsychosocial approach
- Intervention: providing a range of evidence-based interventions that alleviate symptoms and address underlying factors. The aim is to reduce suffering and support holistic recovery and development.
- Consultation: offering psychotherapeutic clinical consultations to teams. This involves contributing psychological perspectives to patients presenting in a variety of complex ways which may have led to situations of clinical impasse, anxiety, or conflict with other teams or services.
- Systemic support: supporting the integration of families, the wider community, and broader systems alongside the patient
- Supervision: providing clinical supervision to a range of staff
- Governance: ensuring robust clinical governance frameworks for psychological therapy services
- Institutional health: developing and maintaining psychological, social, and cultural health within institutions
- Leadership: providing strategic leadership in reflective practice, ensuring staff are supported in managing emotional demands while enhancing clinical expertise
- Advocacy: promoting public understanding of mental health.
Based on their specialised and highly skilled training in organisational, team and individual relations, across a range of psychotherapeutic models, consultant medical psychotherapists are well placed to offer expert advice on service and organisational development.
The consultant medical psychotherapist’s leadership expertise is applicable to a wide range of settings (e.g. community, inpatient, crisis team, secure unit, specialist service) for patients presenting with various complex needs. Specialist services for example, may include those supporting individuals presenting with medically unexplained symptoms, treatment-resistant affective and anxiety-related disorders, personality disorders, eating disorders, perinatal disorders, and complex trauma.
Consultant medical psychotherapists lead integrated models of care organised across a variety of agencies, as well as advising on the psychological basis of organisational principles generally. This may involve leading on the development of reflective practice to all teams throughout the organisation as well as the development of specialist panels for complex and high-risk cases.
Consultant medical psychotherapists may also be involved in:
- working in a wide range of psychiatric settings including inpatient and outpatient services in which the combination of their psychiatric and psychotherapeutic skills contributes to the overall holistic clinical care
- developing existing psychological treatment services in keeping with the current evidence base
- developing and maintaining psychological therapy care pathways for patients presenting with different levels of complexity, across a range of primary, secondary and tertiary care services
- advising on (evidence-based and sustainable) innovations in psychological and psychotherapeutic practice
- establishing and monitoring a clinical governance framework for psychological and psychotherapeutic treatments.
- developing protocols regarding the use of psychological and pharmacological interventions
- planning and developing new services in line with local, regional, and national priorities including within the field of academia and research
- supporting the mental health of the workforce, to ensure the delivery of psychologically minded practice and supporting teams to enable them to sustain compassionate care for their patients. Given the consultant medical psychotherapist’s skillset, this may also include leading staff wellbeing services
- bringing their distinctive medical, psychiatric, psychological, and psychotherapeutic perspective to the leadership of the organisation
- working collaboratively with a range of other psychological professions across the workforce.
Consultant medical psychotherapists have a mandated essential role to play in the training of psychiatrists in specific psychotherapy capabilities and towards the overall development of psychotherapeutic psychiatrists across all levels of training and experience.
Core psychiatry training schemes are mandated to ensure that a Consultant Psychiatrist in Medical Psychotherapy is employed as the designated 'Psychotherapy Tutor' (GMC 2013).
The Psychotherapy Tutor has responsibility for the leadership, educational, and clinical governance of the delivery of mandatory psychotherapy training as per Royal College of Psychiatrists curricula for core and higher specialty psychiatry resident doctors.
The Psychotherapy tutor has oversight of the core psychiatry resident doctors ensuring they have the opportunity to meet Royal College of Psychiatrists curriculum requirements for their developmental level. These requirements may include Balint groups and the delivery of psychotherapy to patients in terms of their short and long cases in differing modalities of therapy.
The Psychotherapy Tutor ensures that competencies developed in core training are extended and built upon further in higher specialty training.
The Psychotherapy Tutor along with local psychotherapy colleagues support higher speciality resident doctor (across the range of psychiatric specialties) to access a variety of psychological and psychotherapeutic opportunities, such as, Balint, case-based discussion, formulation, or reflective practice groups.
The Psychotherapy tutor in conjunction with local consultant medical psychotherapists and non-medical psychotherapy colleagues can also advise and support the higher specialty resident doctor to gain further experience in other individual or group psychological treatments locally and regionally.
All the above contributes to the continuing development of psychotherapeutic psychiatrists. The tutor along with local consultant medical psychotherapy colleagues can also support the training of non-medical psychotherapists in the use of medical psychotherapy Work-Based Placed Assessments to allow ongoing assessments of core and higher residents in psychiatry, and to maintain the relevant standards held by the Royal College of Psychiatrists ePortfolio.
The Psychotherapy Tutor also supports and actively encourages the development of psychotherapeutic thinking and integration within the biopsychosocial model of formulation throughout the training years.
In order to carry out the extensive requirements for the medical psychotherapy tutor role, the consultant medical psychotherapist needs to work within a psychological therapy service to ensure availability of psychotherapy cases for resident doctors.
SAS psychiatrist job plans should follow the same principles as above. The College supports 8 DCC plus 2 SPA for both speciality and specialist psychiatrists. The model job plan for SAS psychiatrists should reflect the 0.5 SPA difference, which should be added to patient facing DCC.
If the SAS doctor does not have formal or informal educational responsibilities in relation to resident doctors, medical students and other health professionals, the specific time allocated for this in the consultant model job plan should be added to DCC activities for either patient reviews or for liaison with families/carers/other professionals in relation to patient care as appropriate to the service and their role in the team.
| Description | Professional activities |
|---|---|
| Direct clinical care, including: | 7.5 |
| Referrals management for psychological therapy services including management of waiting list | 0.5 |
| Therapeutic assessments of complex cases in out-patients, on the wards, or in patients' homes as indicated | 0.5 |
| Treatment of complex cases on inpatient wards or in the community as indicated (e.g. individual psychotherapy, group psychotherapy, family therapy) | 2.5 |
| Supervision including direct clinical supervision of clinical staff and resident doctors, indirect clinical supervision of other supervisors, and clinical managerial supervision of those managing clinical services | 1.5 |
| Reflective practice meetings, Balint groups, and away day facilitation | 1 |
| Clinical administrative tasks | 1 |
| Supporting professional activities (SPAs) including CPD, QI activity, supervision, appraisal and job planning | 2.5 |
Factors that should be taken into consideration in a job description include the following:
In addition to their own direct contact with patients, consultant medical psychotherapists play a key role in supporting other staff in the management of patients. This activity (e.g. reflective practice groups, Balint groups, supervision) is clinical work and should be considered as part of direct patient care activity.
Consultant medical psychotherapists should have at least 3 PAs for supporting professional activities, reflecting their major and significant contribution to education and training for the whole clinical workforce, as highlighted by the section above.
Given the full scope of the Psychotherapy Tutor role outlined above, the role may comprise a combination of PA (DCC) and APA work.
Consultant medical psychotherapists commonly work in psychological therapies services alongside psychology teams and adult psychotherapists. Medical line management must be in place for consultant medical psychotherapists as this fulfils and maintains requirements for clinical governance, appraisal and revalidation, along with ensuring that the medical psychotherapist has an attainable and realistic job plan.
The GMC requirements for good medical practice must be met by the consultant medical psychotherapist as they would be for any other doctor. Line management by psychologists or operational managers is not a suitable arrangement to ensure the above standards are met.
Robust, designated, and timely administrative support is vital for the role of the consultant medical psychotherapist. Effective delivery of psychological therapy services requires consistency and containment within the clinical setting and this needs to be reflected in the provision of suitable rooms and equipment for the consultant medical psychotherapist and clinical service.