Medical Psychotherapy in Core Training: FAQs

These experiences are designed to help you think psychologically about patients and develop the reflective and relational skills central to psychiatric practice, such as understanding unconscious processes and emotional patterns in clinical work.

You may also benefit from any additional local reflective opportunities available, such as reflective practice or case discussion groups where formulations are discussed.

We do not advise that a resident doctor should be key worker for a patient whom they are seeing for psychotherapy.

The key worker role involves taking an overview of the person’s support from the mental health team, often including a varying range of needs, sometimes needing to be immediately available for patients. Many resident doctors are likely to be visiting therapists who are not integrated into the care team and as such it is not safe to undertake this coordinating role.

Even if you are seeing your patient for therapy in the team within which you work, it will be difficult for you to focus on therapeutic work and development of psychotherapy capabilities if you are also being pulled into other roles. There will be local clinical governance arrangements to support the work and the keyworker role should be allocated as part of this arrangement.

No. You should not be offering therapy to someone who you are also the clinician for in another context.

You may see a patient who is under the care of the service where you are working but who sees another psychiatrist.

There is a lot to cover in Core Psychiatric training, and it is important that psychotherapy capabilities are actively considered from the start. Most schemes ensure that Balint/Case-Based Discussion groups start immediately, and we encourage you to start taking on cases early, approximately after 6-12 months of beginning core training if possible and to start the long case in good time.

There is no requirement to do the cases in a particular order. In some situations, cases may run in parallel e.g. starting a CBT case within a CAMHS rotation where they are good opportunities for CBT, while completing a long case that is already started. It is important to liaise with your scheme's Psychotherapy Tutor(s) regarding this, and particularly if there are specific concerns (e.g. OOP plans, extended leave, changes in personal circumstances etc).

Supervision for cases is required for their duration as a minimum. Depending on local arrangements, residents usually join a supervision group for a period before taking on long cases, which can be helpful preparation.

Different group members may be at different stages with their cases, which provides those new to the group the chance to observe and consider how therapy might evolve and how different themes may become more prevalent at the beginning, middle and end of therapy.

We advise you to start your psychotherapy cases early so that unforeseen events do not undermine your opportunities to gain capabilities. If there are factors that you feel might impact on your training, seek timely support and guidance as per the core curriculum.

If you have a change of your individual circumstances that affects your provision of therapy please discuss with your Psychotherapy Tutor(s). Your tutor, educational and clinical supervisors are all sources of support.

If a psychotherapy case is ongoing at the time of your final ARCP, the panel may assess whether you are making satisfactory progress toward meeting the psychotherapy curriculum requirements by your end of training date.

If the required work is set to finish after the panel but before you complete your training, a temporary outcome or later ARCP panel may be used to allow for final documentation.

Across all therapeutic approaches and all psychiatry specialties, patients stepping out of care is not infrequent. When a patient drops out of therapy before the ending this needs to be reflected on and discussed with the Psychotherapy Tutor. 

A second case is usually started, depending on the stage of the work and level of experience of the resident doctor.

Learning from work already completed, from participation in supervision and from academic learning, all contribute to demonstrating capabilities. 

In exceptional circumstances, at the discretion of the Psychotherapy Tutor(s), capabilities may be demonstrated even though a second course of therapy is not finished providing there is sufficient experience in total with consideration of the arc of therapy including beginning, middle and ending and there is a commitment to complete the therapy with the patient. This can be evidenced with an extra workplace base assessment.

Endings, like transitions, are significant events for patients whether receiving a specialised psychotherapy or general psychiatric care. These events are carefully considered in psychotherapy and often represent an important part of the work. Starting cases early minimizes the possibility of not completing a case within the three years of core training. 

The use of AI tools in psychiatry is subject to local clinical governance guidance and should not be used unless you have been clearly told by the mental health organisation and service where you are seeing the patient that you can do so.

For your write up for your PACE you should not use AI tools. This is partly to maintain essential confidentiality, but also very much because writing your report without the help of AI gives you space and time to think in depth about your patient and the work you have been doing with them.

Much of this work is about considering feelings and relationships as well as content, and that takes time and emotional engagement. AI could give you a reasonable report, but it would not help your emotional processing and development of formulation skills, which is an essential part of the work.

Where the opportunity exists for residents to attend Balint/Case-Based Discussion groups beyond a minimum 30 attendances, we encourage you to do so. Balint groups and reflective practice provide opportunities to think psychotherapeutically, offering a supportive space for residents to speak about difficult cases and to learn from each other. These groups help develop your learning from clinical interactions and provide an important resource for managing stress related to clinical work, reducing risk of burnout during your career as a psychiatrist. 

Reflective practice or Balint group/Case Based Discussion Group attendance is part of psychiatric practice both as a resident and consultant. You might also consider other ways to develop reflection such as mindfulness and experiential training strategies for different therapeutic approaches.

The Strategic Plan of the Royal College of Psychiatrists states that the College will take a leadership role in re-establishing therapeutic relationships in mental health care. 

The long case in psychotherapy places the therapeutic relationship centre stage and foregrounds it as a vehicle for recovery. It allows an experience of providing continuity of care and understanding how relational attunement to varying presentations and at different stages of engagement, is therapeutic in its own right. Such an experience is otherwise not possible to gain during six monthly CT rotations. Across all psychotherapy interventions, regardless of the main modality they are aligned to, the quality of the working alliance accounts for a significant part of the outcome of the intervention. 

Psychotherapy experiences in Core training build on approaches to consultation studied during medical pre-clinical and clinical training and Foundation years and allow the psychiatry resident to further develop psychologically skilled relational practice and gain experience in engaging with complexity and uncertainty.

The RCPsych curriculum for all branches of psychiatry is to train a clinician who can integrate a biological, psychological and social understanding of their patient and devise their patient's management plan drawing on their understanding of all these aspects together and how they interact.

It is widely recognised that clinical relationships are powerful therapeutic agents across all psychiatric disciplines and taking on psychotherapy cases is an important opportunity to further these skills. This allows us, for example, to be relational prescribers - understanding that when we prescribe, our relationship with our patient and the meaning of that for our patient contributes significantly to the effectiveness of whatever treatment we prescribe. These relationships are often complex, bringing up a range of feelings.

Time in your Balint Group/Case Based Discussion group, and understanding the dynamics of your short and long psychotherapy cases, and using the skills and understanding gained from your cases, allows you to hone skills to use throughout your practice, with every patient you work with, whatever service you work in. 

Continuing thought about psychotherapeutic aspects of the work is vital throughout one's career as a psychiatrist. 

CT resident doctors may choose to pursue additional psychotherapy experiences in core training. 

Psychotherapy training is part of all ST Higher trainings in psychiatry, giving further opportunities to explore, expand and deepen capabilities. A guiding principle for psychotherapy training in higher specialist training across faculties is that it should allow for a range of psychotherapy experiences which serve the resident’s interests in keeping with their developing area of specialism and provide valuable, relevant and maturational psychotherapy training experiences. Residents have protected time in higher training to advance their psychotherapeutic capabilities. 

Higher training in Medical Psychotherapy is a multi-modality training offering depth and breadth, the Medical Psychotherapy Faculty have provided information about Medical Psychotherapy as a higher training specialty. 

For those interested in psychotherapy, who are not able to secure a post in higher training in medical psychotherapy, you can consider the portfolio route to gaining a CCT in Medical Psychotherapy.