Aims and MethodA telephone questionnaire to assess psychotherapy training in the 12 psychiatric training schemes in South-West England was conducted in April 1999. The findings were compared with the 1993 guidelines recommended by the Royal College of Psychiatrists.ResultsOnly one scheme was achieving the standards set by the College guidelines. The majority of trainees in this region were not receiving adequate psychotherapy training.Clinical ImplicationsPsychotherapy training for psychiatric trainees needs urgent review in South-West England.
Effective use of scarce psychotherapy resources requires knowledge of the research evidence of treatment effectiveness, careful assessment of the patient and a logical and collaborative approach to treatment planning.
Doctors, like other health professionals, show increased rates of psychological morbidity, including anxiety, depression, suicide, drug and alcohol misuse and professional exhaustion (burnout). This might be due in part to the pressures of clinical work, but might also reflect Malan's 'helping profession syndrome', in which an individual chooses, usually unconsciously, to work as a carer as a response to personal vulnerability, or 'the patient within'. This paper reviews the literature relating to the complex relationship that health professionals have with their work role, discusses the implications for the profession, and proposes areas of prophylactic or remedial action.
Training in psychotherapy is a mandatory part of general professional training in psychiatry. The College produced guidelines in 1993 outlining the breadth and depth of training required (Royal College of Psychiatrists, 1993).
There is a need for evidence to demonstrate the clinical and economic effectiveness of psychotherapy as a component of mental health service delivery. A naturalistic cohort study was carried out in a specialist psychotherapy department in a district mental health service. Thirty-six patients were identified with hospital admissions in the study period who had also received a course of outpatient psychotherapy. There was a significant decrease in hospital in-patient usage temporally associated with receipt of psychotherapy and associated cost savings. Out-patient psychotherapy leads to less in-patient bed usage and significant health-care savings among previously hospitalized psychiatric patients (approximately 6700 pounds sterling per patient).
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