PGY3 Outpatient Psychotherapy
Educational Goals & Objectives
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.
Case review
includes discussion of clinical history, session dynamics, developments
between sessions, case formulation, and ongoing evaluation of treatment
effectiveness.
Intervention
focuses on cultivating rapport, assessing patient readiness and psychological
capacities, supporting the resident’s clinical development, selecting
and refining therapeutic techniques, integrating psychotherapy with broader
psychiatric care, collaborating with multidisciplinary providers, managing
boundaries, and making informed decisions about treatment continuation
or discharge.
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.
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Establish and maintain a strong therapeutic alliance with patients, developing the capacity to anticipate, recognize, and effectively
manage professional clinical boundaries.
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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.
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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.
- Be able to identify, increasingly explain, and incorporate theoretical
principles across core psychotherapeutic modalities (supportive, psychodynamic,
and cognitive-behavioral).
- Identify and use techniques from supportive, cognitive-behavioral, and
psychodynamic psychotherapies, while working towards comparative intervention
selection regarding potential risks and benefits.
- 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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.