Abstract
Bob Adler's Interim Report[1] has had the useful function of focusing Fellows’ attention on training issues. Amongst members of the Section of Psychotherapy it has focused our anger. This is because we are already aware of the glaring deficiencies in the psychotherapy components of current training programs, and suspect that our worst suspicions may be confirmed in the future as we read the current report. We have been concerned because reading the Interim Report has not allayed our anxieties as to whether current problems will be rectified in the new training program.
The report addresses the future of training. As a psychotherapist reads the Interim Report, s/he is likely to be very influenced by present anger to read the report as a justification for maintaining the current unsatisfactory state of affairs, or indeed to diminish any presently existing benefit in the current teaching program. And unfortunately Bob Adler's report facilitates this process because it is written in such a way that it allows us to believe that psychotherapy will again be sidelined. Bob Adler and Pete Ellis met with the Section committee only two days prior to the Colloquium to try to allay the anxieties that were being expressed.
I want to address these two aspects. First, the anger regarding current training in psychological understanding, and second, the project for future training.
THE CURRENT SITUATION
I think it is important that Bob Adler and the Fellowships Board understand that not only are psychotherapists angry, but that there is also something close to a sense of despair amongst our members. I heard this surface in the response of members of the Section when Dr Foulkes presented the results of the questionnaire he had circulated to trainee psychiatrists. We heard that trainees find teaching in psychotherapy too little, too disorganised, and too theoretical. Also that training in Family and Group modalities of psychotherapy was lacking to such an extent as to threaten extinction to these modalities. Supervision of all psychotherapy modalities was also a problem, in that it was too variable, and in some centres entirely lacking in expertise. And in some centres trainees have to pay private supervision fees to receive an adequate supervisory experience. These complaints from the trainees vividly delineate the deficiencies that fuel the anger and despair felt by the members of the Section of Psychotherapy, as we struggle in a College which seems uncaring of the skills we have to offer.
Then we are faced with this Interim Report, which we read as overlooking the necessity for a component of psychotherapy training. I don't know if the Fellowships Board realises the extent to which many psychotherapists feel marginalised within the College — and that this report has unwittingly provided a spark to ignite their anger.
DISCUSSION OF FUTURE TRAINING
The Central Committee of the Bi-national Section of Psychotherapy expressed its concern about the report, and subsequently members of the Executive and the Fellowships Board met with the Section of Psychotherapy Committee to discuss the high feelings and intense reactions. I want to report on the discussion that took place, and the outcome of that meeting which took place two days before the Colloquium.
The Section of Psychotherapy had previously submitted to the Fellowships Board a document detailing recommendations re development of core skills, and educational goals for pre-Section 1 training. In a written response to the Interim Report, the Section of Psychotherapy made three proposals:
That current by-laws be maintained as a minimum standard of training
The recommendations of the Section's pre-Section 1 training document be adopted. Emphasis was placed on core skills, minimum supervisory requirements, and the requirement for a long case in psychotherapy
That standards of pre-Section 1 training not be jeopardised as more emphasis is placed on Advanced Training.
The Fellowships Board, and Bob Adler, made it clear that they accepted the principles embodied in these documents, particularly the Recommended Experiences and Educational Goals for pre-Section 1 psychotherapy training.
There was lengthy discussion concerning the necessity that there be a requirement for a long psychotherapy case, supervised by an approved supervisor, in the two years of basic training. We received verbal assurances that this requirement would be met. The Section Committee requested that this be written into the document, but we could not reach agreement on a written understanding. Bob Adler and Pete Ellis agreed that they would table the Section's Response and pre-Section 1 document when the Interim Report was discussed by the Fellowships Board, and they agreed that the long psychotherapy case will be included in their discussion.
Both Bob Adler and Pete Ellis were insistent that they accepted the importance of “psychological expertise”. They spoke of how destructive it would be “to remove the psychotherapist from the psychiatrist.” They repeated several times that there is to be no reduction in psychotherapy training requirements. However they urged us to rethink our attitude to the pre-Section 1 training. They stated that the new model for training proposed in the Interim Report is a 5-year training experience — and it must be seen as a 2-year + 1-year + 2-year course, in which basic psychotherapy training is laid down in the first 2 years, and then added to cumulatively in the last 2 years. They pointed out the MOPS requirement for advanced trainees (i.e. trainees in the final 2-year period). Every advanced trainee will be required to have between 60 and 100 hours of “psychological approach” each year in order to reach the defined threshold to move to an exit consultancy-style viva. These hours might be spent in psychotherapy supervision, or they might be experiential seminars with an approved supervisor discussing everyday ward patients.
Bob Adler asked us to note Recommendation 13 d) of his document, which states that “psychological, biomedical and consultative expertise are all core skills for all psychiatrists”.
CONCLUSION
My understanding is that the Fellowships Board earnestly wish us to believe in its good will toward psychotherapy and psychological understanding in the training program. The Section Committee accepts this with a degree of reservation, and would like to see their commitment in writing. The Board points out that the Interim Report is only an outline and that nothing of the detail will be written in until the By-laws are written. And no By-laws can be written until General Council approves the training document. It remains unclear whether the Interim Report will be altered before it is presented to General Council for discussion, and what discussion process will take place concerning the preparation of By-laws.
Following the intense discussions that took place prior to the Colloquium, between the Section of Psychotherapy and the Fellowships Board, there can be no doubt of the Board's (and Bob Adler's Interim Report) commitment to the ‘psychological understanding’ component of training. However, until we see the outcome of the Fellowships Board's discussions, and the written document that results, an air of uncertainty remains regarding the necessity for a long case in training, which the Section regards as non-negotiable. Otherwise we accept that the Interim Report was respectful of psychotherapy and its rightful place in the training of psychiatrists — though we regret that the Report was written in such a way that psychotherapists who read it were not able to draw this conclusion immediately.