PGY3 Outpatient Psychotherapy

Rotation Director: Dan Powell, MA. LMFT, BCBA

Location: Ventura Adult Clinic

Educational Purpose

The Outpatient Psychotherapy experience in the PGY3 year marks the beginning of residents' direct application of psychotherapy in a structured outpatient setting. During this rotation, residents begin to translate foundational knowledge into practice by engaging with patients in ongoing psychotherapeutic relationships. They will start to develop and apply psychodynamic, cognitive-behavioral, and other evidence-based approaches in a flexible and clinically responsive manner. Emphasis is placed on building therapeutic alliances, formulating cases with increasing depth, and beginning to manage the complexities of professional boundaries within a therapeutic context.

This rotation serves as an essential step in preparing residents for independent practice, equipping them with the foundational psychotherapy skills and clinical judgment necessary to meet patient needs and to engage in effective, collaborative mental health care.

Teaching Methods

The core teaching and learning activities are grounded in direct patient care, complemented by regular clinical supervision. The educational experience encompasses comprehensive case reviews, including psychiatric history, mental status examinations, and developments occurring between sessions. Residents will learn to differentiate and apply appropriate interventions drawn from a range of psychotherapy modalities, while gaining an appreciation for the capacities and limitations of each approach.

Supervision will emphasize the use of residents' own emotional and cognitive responses to patients as valuable tools for assessment and treatment planning. Additional focus areas include managing therapeutic boundaries, integrating holistic considerations such as lifestyle and interpersonal or social dynamics, and engaging in collaborative care with other treatment providers when appropriate. Further, residents will begin to comprehend various interpersonal dynamics with patients, such as transference and countertransference.

Psychotherapy Supervision

In the PGY3 year, residents begin dedicated psychotherapy supervision, meeting individually with a supervisor on a weekly basis throughout the academic year. These sessions provide a structured forum to explore cases in depth, with supervision organized around two primary domains: case review and therapeutic intervention.

Overall Education Goals and Objectives

To develop competence in incorporating psychotherapy theory and technique into the comprehensive care of psychiatric patients, with a focus on the appropriate application of non-pharmacological interventions in an outpatient clinic setting. This includes learning to assess and apply evidence-based psychotherapeutic modalities, integrating them into individualized treatment plans, and understanding the therapeutic relationship as a core element of effective care. Special emphasis is placed on recognizing and working with transference and countertransference as essential clinical tools for deepening case formulation, guiding intervention, and enhancing therapeutic effectiveness.

Core Competencies:

Patient Care:

Definition: Residents must be able to provide patient care that is patient- and family-centered, compassionate, equitable, appropriate, and effective for the treatment of health problems and the promotion of health.

1. Establish and maintain a strong therapeutic alliance with patients, developing the capacity to anticipate, recognize, and effectively manage professional clinical boundaries.
2. Apply selected psychotherapeutic techniques, including supportive, cognitive behavioral, behavior therapy, psychodynamic, mindfulness-based, humanistic, systemic perspectives, postmodern and positive psychology approaches, through collaborative goal setting and the integration of strategies across modalities. Emphasis is placed on tailoring interventions to individual case formulations for more effective, patient-centered care.
3. Identify, reflect on, and collaboratively address core emotional experiences, anxiety patterns, and key therapeutic issues as they emerge within sessions. The goal is to promote deeper clinical insight and foster continuity of care by linking themes and values across sessions in a holistic manner.

Psychology Knowledge

Definition: Residents must demonstrate knowledge of established and evolving neurological clinical, psychological, and social-behavioral sciences, evidence-based approaches, as well as the application of this knowledge to patient care.

1. Be able to identify, increasingly explain, and incorporate theoretical principles across core psychotherapeutic modalities (supportive, psychodynamic, and cognitive-behavioral).
2. Identify and use techniques from supportive, cognitive-behavioral, and psychodynamic psychotherapies, while working towards comparative intervention selection regarding potential risks and benefits.
3. Summarize and increasingly demonstrate a capacity to analyze the evidence base for combining various psychotherapeutic approaches.

Systems Based Practice

Definition: Residents must demonstrate an understanding of, and responsiveness to, the broader health care system and context in which patient care is delivered. This includes awareness of structural and social determinants of health, as well as the ability to effectively utilize and coordinate external resources to ensure high-quality, patient-centered care.

1. With appropriate written patient consent,residents will develop proficiency in communicating and collaborating with ancillary medical professionals, mental health providers, and other relevant sources of support or care. This coordination aims to inform and enhance the treatment plan. In the context of this rotation, such collaboration frequently includes engaging with primary care physicians and psychiatric colleagues to clarify diagnoses, coordinate treatment strategies, and align on goals of care.

Practice Based Learning

Definition: Residents must demonstrate the ability to investigate and evaluate their clinical practice, integrate scientific evidence, and continuously improve patient care through self-reflection, feedback, and lifelong learning.

1. Residents will apply the best available evidence to guide clinical decision-making, prioritizing acute concerns while learning to critically evaluate and navigate conflicting data or clinical uncertainty. This skill will be used to support individualized treatment planning and to guide the patient’s broader recovery trajectory over time.
2. Deliberate practice will serve as a cornerstone of the psychotherapy rotation. Residents are expected to approach supervision with humility, curiosity, and a strong motivation to grow. Through structured reflection and feedback, they will analyze their evolving clinical knowledge and therapeutic skills. Progress will be monitored collaboratively with the supervisor, using patient outcomes and resident development goals to identify strengths and target areas for continued improvement.

Professionalism

Definition: Residents must demonstrate a strong commitment to professionalism and consistently adhere to ethical principles in clinical practice.

1. Development of professionalism and ethical practice in the psychotherapy rotation is primarily demonstrated through the resident’s increasing ability to maintain the therapeutic frame and manage boundaries effectively. These skills are essential to fostering trust, safety, and therapeutic efficacy.
2. These expectations build upon the foundational professionalism required in all psychiatric settings, particularly in managing complex and emotionally charged situations. Residents are expected to demonstrate insight into their own professional conduct and recognize when to seek supervision or consultation in response to potential lapses. Emphasis is placed on reporting concerns appropriately and using feedback constructively to improve both individual practice and patient outcomes.

Interpersonal and Communication Skills

Definition: Residents must demonstrate interpersonal and communication skills that facilitate effective information exchange and collaborative relationships with patients, families, and healthcare professionals.

1. The PGY-3 psychotherapy rotation provides a unique opportunity for residents to begin building therapeutic rapport, navigating transference and countertransference, and engaging in culturally responsive communication. Residents will begin to recognize and address implicit bias at both individual and systemic levels.
2. By the end of the rotation, residents will begin to demonstrate proficiency in collaborative treatment planning, aligning with patient goals, negotiating treatment preferences, and responding to ambivalence or resistance. This includes the ability to assess and support patients within their zones of proximal development and to navigate clinical uncertainty or conflicting interests with professionalism and empathy.
3. Supervision in this rotation models the principles of parallel process, fostering a learning environment rooted in mutual respect, openness to feedback, and a shared commitment to growth. Feedback is an opportunity for professional development and relationship strengthening. When systemic concerns arise, residents are encouraged to escalate them thoughtfully, with attention to respect, compassion, alliance building, and continuous quality improvement.