Psychotherapeutic skills and College requirements

Pretorius & Goldbeck (Psychiatric Bulletin, June 2006, 30, 223–225) commented on difficulties encountered by psychiatric specialist registrars in fulfilling the College requirements for experience of psychotherapy (Royal College of Psychiatrists, 2003). To determine the extent of the problem in Merseyside, we performed a survey of the psychotherapy experience of 73 trainee senior house officers (SHOs). Only 31 (42%) were aware of College requirements. Five trainees (7%) had conducted a long-term individual case and 41 (56%) at least a short-term case. Of those who had cases allocated, 21 (29%) had one short case, 11 (15%) had two short cases and 9 (12%) had three short cases or more. Of 11 trainees who sat their MRCPsych part II examination in March 2006, only 2 (18%) fulfilled the College requirements for psychotherapy experience. Only 14 trainees (19%) expected to fulfil the requirements by the time they were to sit their MRCPsych part II examination.

Of the 73 placements, 49 posts (67%) had supervision by a consultant psychotherapist. These included a Balint group, which most trainees had to do in their first two placements. The other trainees were not receiving supervision by a psychotherapist at the time of the survey. Our findings are consistent with those of Webb (2005) from Nottingham, Dharmadhikari (2006) from Leeds and Pretorius & Goldbeck (2006) from Scotland.

With the current 3- to 4-year training scheme it is difficult for trainees to fulfil College requirements. Pretorius & Goldbeck (2006) found that organisational changes have improved exposure to psychotherapy in different modalities. It is hoped that with improved planning, the changes proposed in Modernising Medical Careers and stringent record of in-training assessments, more trainees will have the opportunity to fulfil the training requirements and develop the basic psychotherapeutic skills essential for any competent psychiatrist.

We would like to propose that the College makes it mandatory that approval for a training post at SHO, specialist registrar, or even consultant level only be granted if the base hospital has a full-time or part-time consultant psychotherapist. This might apply much-needed pressure to some reluctant trusts and will certainly help to eliminate unequal opportunities which are currently present in psychotherapy in different parts of the country.