[A Pilot Program of Training in Psychotherapeutic Approach for Psychiatric Residents].

Abstract

One of the main problems in the training of psychiatrists in Japan is psychotherapy. What is meant by "psychotherapy" in this context is not some special form of therapy, but the skills regarding constructing and sustaining therapeutic relationships in order to carry out daily medical practice smoothly. Those with skills in medical practice, in the case of psychiatric practice, will meet difficulties when facing patients' pathologies and personalities, and thus require professional training. In other countries, as a condition for acquiring the qualification of a psychiatrist, experi- ences on individual supervison are included. Supervision is productive in the sense of receiving evaluations on therapeutic relationships from the eyes of a detached observer and obtaining advice accordingly, and also in the sense of contributing to establishing identities as psychia- trists through one-to-one affective relationships with senior psychiatrists. In Japan, however, it is difficult to provide trained supervisors who can meet the needs of initial psychiatric training. The absolute number of supervisors is limited and they are not evenly distributed. Against this situation in Japan, for example, in the psychiatric departments of university hospitals and psychiatric offices of hospitals, they have made attempts to provide group consul- tations by inviting external consultants a few times a year. Although those attempts have a certain significance, they have demerits such as each resident can give a case presentation only once a year at the most, there are no chances to continually receive advice, and relation- ships with the consultants are not intense. In the Neuropsychiatry Department, University of Tokyo Hospital, a new training pro- gram, TPAR (Training in Psychotherapeutic Approaches for Residents), is in operation in order to overcome this situation. Residents form groups of 2 to 3 and visit a number of exter- nal consultants to receive continuous advice once a month. After 6 months, they rotate to other consultants. The advantages of this program are discussed from the perspectives of continuity, individuality, and subjectivity of the residents.