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Psychodynamic Psychiatry Education and Training for Trainee Psychiatrists
- James FitzGerald, Lorna Bo, Fraser Arends, Pamela Peters
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S21
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Aims
Psychodynamic psychiatry training seminars are a blended supervision and experiential style approach to training health care professionals in reflective practice and formulation. They apply psychodynamic theory through case formulations, seminars, and Balint groups so that health care staff can improve their communication style, formulation skills and enhance their appreciation for patients with complex mental health problems. Our aim is to evaluate the provision of our psychodynamic psychiatry training sessions for psychiatry trainees in the Cambridgeshire and Peterborough NHS Foundation Trust, and to evaluate the perceived benefits of attending in terms of personal and professional development.
MethodsThe evaluation used a standardized mixed-methods approach, with the sample consisting of psychiatry core trainees as part of the regional MRCPsych course. Sessions were delivered via an online format. The evaluation period was between November 2021 and January 2023. Data were gathered via a survey tool, adapted from the literature using Likert scales and free text questions to identify barriers and facilitators to the sessions.
ResultsThe survey collated data from thirty-seven core trainees ranging between CT1 to CT3. The majority of participants (> 90%) scored the sessions positively across the board in terms of the content of session material, length of training, and quality of delivery. The majority of attendees felt the sessions focused on the relevant clinical issues (97%), were relevant to their training (95%), and felt the group was a safe place to express and process anxieties and frustrations about their work (89%). Notably, the majority either agreed or strongly agreed the group had changed the way they think and practice (91%), including an appreciation of the emotional and symbolic aspects of patients' presentations (89%).
ConclusionThis evaluation reports early findings on psychodynamic psychiatry teaching for psychiatry trainees. Overall, the participants felt the sessions were relevant to their training and improved their personal and professional development. Key benefits of the sessions included increased insight into the emotional and symbolic aspects of the patient's symptoms and clinical issues, team working through cohesion, and the humanity of the doctor in the clinical relationship with the patient. This suggests that the sessions provide a much-needed space to process and reflect on the often-intense demands of clinical work and training. The main theme within barriers to the group processes was external in terms of other clinical demands requiring prioritization.
Psychodynamic Psychiatry Education and Training for Health Care Staff in the Acute Hospital Setting
- Lorna Bo, James FitzGerald, Fraser Arends, Pamela Peters
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S21
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- Article
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- You have access Access
- Open access
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Aims
Psychodynamic psychiatry training seminars are a blended supervision and experiential style approach to training health care professionals in reflective practice and formulation. They apply psychodynamic theory through case formulations, seminars, and Balint groups so that healthcare staff can improve their communication style, formulation skills and enhance their appreciation for patients with complex mental health problems. Our aim is to evaluate the provision of our psychodynamic psychiatry training sessions for healthcare staff in the Cambridge University Hospitals (CUH) NHS Foundation Trust, and to evaluate the perceived benefits of attending in terms of personal and professional development.
MethodsConvenience sampling was used to recruit CUH doctors, nurses, and healthcare assistants at all stages of training as part of their in-house teaching schedule. Sessions were delivered via an online format or in person. The evaluation period was between October 2021 and July 2022. Data were gathered via a survey tool, adapted from the literature using Likert scales and free text questions to identify barriers and facilitators to the sessions
ResultsThirty-three participants responded to our survey, with the sample consisting of gastroenterology (n = 4), acute medicine (n = 6), and emergency medicine doctors (n = 10). The sample also included emergency department nurses (n = 8) and health care assistants (n = 5). included. Most respondents (>90%) described the experience of the sessions including the material covered as ‘Positive’ or ‘Very Positive’. All participants felt they were able to express themselves in the session and the majority (>97%) felt that the sessions were relevant to their training needs and focused on the right issues. Notably, most participants (>88%) felt the sessions enhanced their ability to recognise the importance of the therapeutic relationship, the emotional significance of symptoms as well as the impact of group dynamics on patient's presentations.
ConclusionOur findings suggest that these psychodynamic psychiatry training seminars provide an effective, safe, non-judgemental space for experimentation and interdisciplinary discussion to support healthcare staff management of complex patients. Our results support the expansion of this low-cost, high-value intervention for both the well-being and professional development of healthcare staff.
A Mixed-Methods SWOT Analysis of a Medical Student Balint Group Programme
- Robyn McCarron, James FitzGerald, Peter Swann, Sharon Yang, Sally Wraight, Fraser Arends
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S20-S21
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Aims
Balint groups explore the clinician-patient relationship, with benefits for empathy, resilience, and interpersonal skills. Their use with medical students is increasing, but more research is needed to understand how their benefit, feasibility and accessibility can be optimised. We aimed to explore this over a one-year pilot of a medical student Balint group programme.
MethodsAn explanatory sequential mixed methods design was used. Eight medical student Balint groups ran for six weeks during 2022–2023, with 90 students participating. Students completed quantitative and qualitative feedback at the end of each cohort. Themes were identified using qualitative content analysis. Balint group leaders kept reflective session notes and used these alongside student feedback to undertake a strengths, weaknesses, opportunities and threats analysis of the programme.
ResultsStudents reported a neutral to slightly positive experience of the groups. Strengths were coded as containment, learning, and community identity. Students identified weaknesses due to pace, facilitation, and anxiety. Threats to the future success of the Balint group programme were related to engagement and the group being perceived as inauspicious and intimidating. Potential opportunities to develop the Balint group programme included widening participation and sharpening focus. The strengths, weaknesses, opportunities, and threats identified by the group leaders were in line with those of the students, but also acknowledged the broad range of ethico-legal material discussed by students, timetabling and organisational challenges. A range of opportunities were identified for how the Balint group programme could optimally enrich the clinical curriculum.
ConclusionIntegrating successful Balint groups into the medical school curriculum is challenging on individual and organisational levels. However, students perceive value in these groups, and they provide a unique space to combine learning and emotional support with personal, professional and community development. Ongoing consideration is needed to optimally and sustainably incorporate Balint groups within the undergraduate medical curriculum.
Sleep & Dreams Group in a Specialist Eating Disorders Unit, an Evaluation
- Fraser Arends, Miles Rush, James FitzGerald
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S128
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Development of an eating disorder in childhood has been shown to predict sleep disturbance in adulthood. Both the National Institute of Health and Care Excellence (NICE) and the wider scientific literature support interventions to help support patients with their sleep. The aim of this project was to evaluate the perceived benefits of the Sleep and Dreams Group to adult patients with anorexia nervosa (AN) on a specialist eating disorders unit.
MethodsAdult patients with severe AN on an inpatient specialist eating disorders unit attended a 6 session, once weekly group on a voluntary basis. The therapeutic group included psychoeducation around sleep hygiene, and an experiential component focusing on sleep/dreaming context of inpatient treatment of severe AN.
ResultsAll participants(n = 6) either agreed or strongly agreed that their understanding of sleep and dreams had improved. Quality of sleep strongly improved in 20% of participants, however, the remainder reported no significant change in this domain. Despite this, 80% of participants agreed or strongly agreed they got what they wanted from the group, finding the content of the psychoeducation material slightly positive or very positive. The total program length was thought to be appropriate, with 80% describing this as very positive.
ConclusionThe impact of the group on quality of sleep was variable, these results indicate that the value of the group to participants was found in the intergroup processes as evidenced by positive evaluation. This is of particular relevance to severe AN, where interpersonal deficits are often seen and from a treatment perspective in addressing the isolating nature of the disorder. Suggestions for improvement included bolstering the interactive component, and assessing participants regarding eligibility for dream discussion to aid formulation work of the unit.
The Balint Group Experience for Forensic Mental Health Professionals
- Fraser Arends, Graeme Reed, James FitzGerald
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, pp. S128-S129
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Balint groups were initially set up to meet the needs of GPs in better understanding the emotional aspects of complex doctor-patient relationships. They have since been taken up in the training of psychiatrists, GPs, and medical students, having been shown to improve communication skills and sensitise participants to their own psychological processes. Working as a Care Coordinator in a Forensic Community team is a highly challenging role where, by definition, there is the spectre of risk of harm to others. There is very little published data on the use of Balint groups in nursing populations, even less so in the Forensic mental health setting. The aim of this project was to evaluate a longitudinal Balint group for mental health professionals in the Forensic service of Cambridge and Peterborough NHS Foundation Trust, and to report on the perceived benefits to attending in terms of personal and professional development.
MethodsThe evaluation used a standardised mixed methods approach, with the sample consisting of members of the Forensic South Community Service Balint group n = 5. For the evaluation period the job roles were solely clinical nurse specialists, taking a snapshot of the group between September 2020 and January 2022. The group met monthly for one hour virtually, led by Dr Arends, a specialist registrar in psychiatry with appropriate training in Balint leadership. The format in sessions was in keeping with the Balint method, as per The Balint Society, emphasising confidentiality. Data were gathered via survey tool, adapted from the literature using Likert scales and white space questions to identify barriers and facilitators.
ResultsParticipants scored the group highly across the board in terms of acceptability, clinical impact, and fidelity measures. Notably 60% strongly agreed and 40% agreed the group was a safe place to express and process anxieties and frustrations about their work. All participants either agreed or strongly agreed the group had changed the way they think and practice, and that they felt able to consider their clinical encounters in a new light.
ConclusionFacilitators identified were of increased team working through cohesion and notably of increased appreciation for the functional and symbolic elements of the symptoms their patients presented with, suggesting that the value of the group existed in its providing of space to metabolise the often intense demands of Forensic patients, together and as a team. The main theme within barriers to the group processes were external in terms of other clinical demands requiring prioritisation.
Psychodynamic Psychiatry Education and Training for Doctors
- James FitzGerald, Fraser Arends, Pamela Peters, David Christmas
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, pp. S22-S23
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- Article
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Aims
Background and Aim: Psychodynamic psychiatry training seminars are a blended supervision and experiential style approach to training health care professionals in reflective practice and formulation. They apply psychodynamic theory through case formulations, seminars, and Balint groups so that health care staff can improve their communication style, formulation skills and enhance their appreciation for patients with complex mental health problems. Our aim is to evaluate the provision of our psychodynamic psychiatry training sessions for doctors in psychiatry, gastroenterology, and emergency medicine, and to evaluate the perceived benefits of attending in terms of personal and professional development.
MethodsMethods: The evaluation used a standardized mixed-methods approach, with the sample consisting of psychiatry core trainees (n = 9), gastroenterology higher trainees (n = 4), and emergency medicine doctors (n = 10). The evaluation period was between October 2021 and January 2022. Data were gathered via a survey tool, adapted from the literature using Likert scales and free text questions to identify barriers and facilitators to the sessions.
ResultsResults: All participants (n = 23) scored the group highly across the board in terms of acceptability, clinical impact, and fidelity measures. All participants reported that they have a better appreciation of group dynamics, the impact of the doctor's humanity and personality on their clinical work, and the symbolic meaning of the patient's symptoms. Notably, approximately 60% reported that the sessions were relevant to their ongoing training needs and that 95% of participants felt the sessions were a safe place to express and process anxieties and frustrations about their work. All participants either agreed or strongly agreed the group had changed the way they think and practice, and that they felt able to consider their clinical encounters in a new light.
ConclusionConclusion: This evaluation reports early findings on psychodynamic psychiatry teaching for different medical groups. Overall, the participants felt the sessions were relevant to their training and improved their personal and professional development. Key benefits of the group were highlighted and included increased insight into the emotional and symbolic aspects of the patient's symptoms and clinical issues, team working through cohesion, and the humanity of the doctor in the clinical relationship with the patient. This suggests that the sessions provide a much-needed space to process and reflect on the often-intense demands of clinical work, individually and as a team. The main theme within barriers to the group processes was external in terms of other clinical demands requiring prioritization.