PGY-3 residents gather for class six hours each Thursday, throughout the year. Largely a continuation of the courses begun in the PGY-2 year, the PGY-3 curriculum advances the residents’ classroom experience commensurate with their growing clinical knowledge base and practice. As such, the focus is more on the treatment of outpatients, and various psychotherapies and ongoing cases are discussed in greater depth.
Consisting of multiple courses running in parallel, the PGY-3 curriculum is divided thematically into the following areas:
- Psychopharmacology & Neuroscience
- Social & Psychiatry Services and Global Psychiatry
- Process Group
In this 3rd year of training, outpatient psychotherapy takes center stage, both clinically and in the didactic curriculum. A full 3 hours per week are devoted to classroom learning and discussion of the various modalities of therapy, with a special concentration on psychodynamic and cognitive behavioral treatments, adding academic and theoretical considerations to round out and help consolidate residents’ experiences of providing outpatient psychotherapy and receiving psychotherapy supervision. Residents are expected to learn more advanced concepts inherent in doctor-patient relationships and to be able to manage such relationships effectively. Training is also designed to enhance learning about and managing other dyadic relationships within psychiatry, such as supervision, consultation, and mental health administration. Residents develop further abilities to study and discuss, in-depth and longitudinally, conscious and unconscious mental functioning, both normal and pathological, in the context of ongoing relationships with patients. This understanding is considered essential in the treatment planning and management of virtually all psychiatric disorders. Residents also develop abilities to anticipate, analyze, and avoid ethical dilemmas and transgressions, and to manage complex feelings and reactions to patients.
Teachers and supervisors of the psychotherapy core curriculum are selectively drawn from an extensive roster of several hundred faculty of extraordinary diversity and expertise.
The following series and topics comprise modules within the curriculum, replete with syllabi, readings, and discussions of clinical and process materials:
- Beginning with Outpatient Cases
- Assuming Care
- Conducting New Evaluations
- Planning Treatments
- Using Supervision Effectively
- What Does Psychotherapy Look Like?
- Employing published videos of expert therapists conducting CBT, psychodynamic, and emotion-focused psychotherapy sessions with the same patient, this course
- provides a detailed picture of what happens (or should happen) behind closed doors
- compares and contrasts the different therapies
- provides a roadmap for beginning outpatient residents learning how to employ various techniques in their sessions with patients
- Dialectical Behavioral Therapy (DBT)
- Theoretical bases and clinical application
- Practicum in Treatment of Complex Trauma
- In this year-long monthly course, residents learn the unique therapeutic approaches to treating complex, multiply-traumatized patients with mood, anxiety, and dissociative disorders
- Actual patient encounters form a part of the series
- Combining Medication and Psychotherapy
- The patient’s experience of medication and its effect on medication compliance, in situations both where formal psychotherapy is and is not part of the treatment
- Identification and management of transferences, countertransferences, and resistance phenomena related to medication use, and use of the therapeutic alliance to foster medication compliance
- Split-treatment with allied mental health professionals, focusing on role definition, practical management parameters, optimal communication practices, and legal issues
- Advanced Psychodynamic Technique
- Management of a deepening therapeutic process in long-term psychotherapy.
- Recognizing themes, formulating interventions, and managing treatment-emergent phenomena.
- Selected readings inform scholarly discussion of the major psychoanalytic treatment models
- Residents learn to recognize opportunities for verbal interventions (suggestion, clarification, interpretation, etc.), explain their basis and timing, and manage the established treatment frame.
- Cognitive-Behavioral Therapy
- An in depth, 30 session approach to the theory and practice of CBT, in which residents learn case conceptualization and treatment planning.
- Basic principles and therapeutic interventions are taught in modules, such that they can be used across forms of psychopathology. This method for CBT is based on a transdiagnostic model of psychotherapy for emotional and behavioral disorders.
- Case material, experiential exercises, selected readings, and role playing are used to enhance training in these modules and facilitate competence in applied CBT.
- The Psychodynamic Formulation
- Residents learn about and construct formulations of their patients
- Psychodynamic Continuous Case and Formulation
- Continuous presentation of session/process material both by a single resident as well as extended presentation of selected cases in a serial manner, provide opportunities to discuss the technical conduct of long-term dynamic psychotherapy and specifically facilitate the development of skills for synthesis of a psychodynamic case formulation.
- Psychodynamics of Character/Personality Style
- Brief Treatment
- Theoretical basis for the major approaches to the brief psychotherapies (psychodynamic, cognitive-behavioral, and supportive)
- Universal/essential principles and tactics of brief treatment.
- Residents observe the in-room brief treatment of a patient, conducted by the instructor
- Family and Couples Therapy
- Major approaches, both psychodynamic and non-dynamic
- Systems theory
- Group TherapyMajor approaches to long-term psychodynamic group psychotherapy, focusing on therapeutic factors, formulation of the group (with regard to both patient composition and theme), patient selection criteria, preparation of the patient, group treatment contract, and essentials of technique.
- Helping residents navigate, manage, and prepare their patients for termination at the end of the year
Psychotherapy Training Clinic
Adding practical experiences to these extensive classroom studies and theoretical discussions, residents accumulate closely supervised clinical experiences in psychotherapy, including short- and long-term individual psychotherapy, psychodynamic psychotherapy, cognitive and behavioral therapy, family/couples therapy, and group therapy among others. Detailed evaluation instruments, including videotaped sessions, may be utilized to describe and document progress toward defined training objectives. Patients accepted into the psychotherapy training clinic may be seen as frequently as is clinically optimal. The Department has cultivated sources of referrals for psychotherapy training, including the Treatment Center of the New York Psychoanalytic Institute, university and graduate studies programs, the performing arts community, and others.
Reflecting the high value placed on psychotherapy training, the department has formally and proudly established a collaborative affiliation for education and training with the New York Psychoanalytic Institute. Established in 1911, the New York Psychoanalytic Society & Institute is the oldest and historically the most esteemed psychoanalytic organization in the United States. The formal education and training collaboration with the Mount Sinai Department of Psychiatry is the first such arrangement the Institute has ever established. Essential components of the collaboration include supervision of long term psychotherapy cases and leadership and instruction of the core curriculum in psychodynamic theory and clinical practice beginning in the PGY-2 year. Additionally, the collaborative affiliation makes a specific provision for residents who elect a professional path involving psychoanalytic training. Such residents, if also accepted for such training, are able to commence this training while still in residency, so long as it does not interfere with the other essential training requirements.
The training program explicitly endorses personal psychotherapy as a uniquely useful strategy for the development of psychotherapeutic and psychological sophistication. Toward this goal, the program has taken care to establish a consultant available to all residents to secure affordable psychotherapy of the highest quality in a completely confidential manner. Free consultation and referral to affordable care are available to residents in all four years via a consulting clinician who has no contact or correspondence with the department.
Psychopharmacology & Neuroscience
Daniel Iosifescu, MD
The PGY-3 year revisits many previously-encountered psychopharmacology topics at an increasing level of sophistication. This more advanced iteration consists of seminars organized by symptom, syndrome, and disease, rather than by medication-class (as in PGY-2 curriculum). Additionally, the focus becomes more geared toward the psychopharmacological treatment of outpatients. These seminars also cover the neuroscientific bases of such treatments as well as of the underlying conditions.
- Mood disorders
- Anxiety disorders
- Substance abuse
- Attention and cognitive disorders
- Chronic pain
- Eating disorders
- Sleep disorders
- Impulsivity and agitation
- Child psychopharmacology
- Personality disorders
- Mental retardation and developmental disabilities
- Complementary/alternative treatments
- Advanced topics in psychopharmacology
- Future avenues for pharmacological treatments
- Evidence-based medicine
As usual in our curriculum, each mini-module is led by an expert in that area—usually a faculty member who is involved in both clinical care and current research.
Social & Psychiatry Services / Psychiatry in the World
In addition to consisting of an increasingly advanced study of the topics presented in the PGY-2 curriculum (e.g., principles of publicly-funded mental health services and administration; systems of care; legal issues; ethical issues), this course is directed toward augmenting the residents’ experiences of treating outpatients in the community. As such, important elements in community mental health take center stage, including recovery, rehabilitation, and social service provisions. A brief sampling of some of these seminars is provided here:
- Medicaid part I
- Medicaid part II
- Homelessness part I
- Homelessness part II
- Psychiatric Issues in the MRDD population
- ACS (NYC Administration of Children Services)
- Recovery and Person Oriented Services
- PORT Study and Evidence Based Practices
- Pathways to Housing: The Housing First Model
- Substance Abuse in LGBT
- “Supported Employment”
- Suicide I
- Suicide II
- Boundaries/Sexual Interactions with Patients
Again, teaching faculty include specialized researchers and clinicians in the department of psychiatry at Mount Sinai, administrative figures in the department of health policy, and other local and nationally-known figures brought in for their unique knowledge and experiences. As such, residents are introduced to some of the leaders in the field by way of their instructors.
Philip Luloff, MD
For more than 30 years, Mount Sinai's psychiatry residency Process Group program has offered PGY 2, 3, and 4 residents a unique training experience. Building on the Group Dynamics class in the PGY-1, Process Group is a more unstructured experience in which residents come to learn, first-hand, about themselves, their peers, and to process and examine their experiences in real time. Process Group is an in vivo training in how groups function and the effects of an individual within and upon the group. Residents are invited to share anything about their thoughts, feelings, work, patients, etc. and simultaneously observe the influence and power of a group experience in fostering growth and development.
While not explicitly "therapy," Process Group also fosters self-reflection, cohesion among residents, and an opportunity to discuss, in a confidential and supportive environment, the pressing emotional, social, and interpersonal issues involved in being a resident in psychiatry. The process which unfolds from week to week often helps with the pressures and stresses of residency. A fundamental agreement between members of the group and the leader(s) is that all said within the group is confidential.
Each PGY class has its own weekly group, with leaders who remain the same through all 3 years. The leaders are chosen from experienced members of the voluntary faculty who have no supervisory or evaluative functions in the residency. These leaders—by the way they comment and behave—offer a real-time example of group observation, facilitation, and interpretation.
Icahn School of Medicine
Department of Psychiatry
One Gustave L. Levy Place
New York, NY 10029