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EPG: Introduction

Overview of the EPG Project.
EPG: Introduction
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Contributors (4)
Published
Jun 29, 2019

EPG Introduction

Thomas Gargot,

Coordinator of the 1st edition

Psychotherapy is an important aspect in psychiatry. When patients ask about different therapy options, psychiatrists should know about these, and preferably be able to deliver some therapy themselves.

In our recent survey of 574 trainees and young psychiatrists in Europe, 92 % considered psychotherapy important for their professional identity, and 90% wanted to practice psychotherapy after psychiatry training. However, the training possibilities are scarce and only 52 % of trainees were receiving any training in psychotherapy [1].

Psychotherapy efficacy studies are quite hard to carry out as there are still methodological problems to consider, but a lot of studies show an effect size fully comparable with biological treatments, even for severe illnesses like schizophrenia [2].

Some authors state that there are more than one hundred kinds of psychotherapies. It is difficult to comprehend and to orientate ourselves in this jungle! The literature argues than even if the basic underpinnings and the practical aspects are very different between types of psychotherapies, there are important common factors (motivation of the patient, empathy, transference, the therapeutic alliance) that lead to a general efficacy of psychological therapies.

That's why, as trainees throughout Europe, we wanted to share with you our different tastes of different kinds of psychotherapies based on our interest. Even though the diversity of therapies is large, we tried to use a similar template for every kind of psychotherapy, and to promote books, psychotherapy associations and training events related to each school. This work does not pretend to be exhaustive but would like to open trainees’ eyes to the richness of this field.

As a psychiatrist, one needs to keep an open mind to other disciplines. In the past, discoveries about the unconscious inspired psychoanalysis, neuropsychology inspired cognitive remediation therapy, theatre inspired psychodrama, ancient Buddhism inspired mindfulness and so on.

Patients and family associations always challenged our practices in Psychoeducation and Institutional psychotherapy to become as patient-centred - not doctor centered, as possible.

Maybe in the future, social psychology (e.g. cognitive dissonance and engagement theories) will improve our understanding of general factors and improve the links with Patient centered psychotherapy and Motivational interviewing. An emerging field of combination of medications with psychotherapy (for instance exposure and beta-blockers after a trauma) will be interesting to follow, and neuropsychoanalysis [3] could inspire new psychotherapeutic approaches. New technologies challenge psychotherapy with computer-based cognitive remediation and psychoeducation. They also offer easier training with massive open online courses like the cognitive behavioural therapy programmes run by the European Psychiatry Association or the Beck Institute. The road of psychotherapy is still open and long.

This work is still in progress and any feedback is appreciated. We struggled hard against social loafing and perfectionism to present you this work that we hope will inspire you! We thank the EFPT board that encouraged and found this project, and Chantelle Wiseman (a native English speaker) who revised some of the articles.

How to write, adapt and share this

This work is published under Attribution 4.0 International (CC BY 4.0) Licence. You can do whatever you want with it but you need to cite the source.

<p>Licence Creative Commons</p>

Licence Creative Commons

We would be very interested to welcome chapters about other kinds of psychotherapies, written by trainees and for trainees and according the following template. It will be revised by a trainee or psychiatry or an Early-Career-Psychiatrist. To know more about pubpub, check here. We welcome also translations that will be soon available on this platform.

It is possible to ask for a bursary from EFPT to print this guidebook, contact psychotherapy-wg@efpt.eu

To know more about open science framework, check EFPT website.

Theodoros Koutsimitros (Teo),

Coordinator of the 2nd edition

We want to tell you a story, the story of our EFPT psychotherapy guidebook.We have to warn you, though, this story does not have a happy ending! It basically does not have an end, yet…and we would like to invite you to be part of this story…

Trainees in Psychiatry are curious doctors and most at some point wonder – what psychotherapy really is. When we study it, it is most likely studied from a specific point of view of ‘masters’ who teach it from their perspective, limiting the scope of the therapy. There are so many kinds of talking therapies out there and what better way to explain and discuss them in a peer-to-peer relationship than a trainee exchanging ideas about experiences in the particular therapy with a fellow trainee.

It all started in London in 2014, when some colleagues from our Psychotherapy working group started to discuss the idea of creating a free guidebook on Psychotherapy written from trainees for trainees. Victor Hugo stated it best: “Nothing is more powerful than an idea, whose time has come.” The idea travelled across Europe along with the members of our group. It expanded and evolved year after year, from forum to forum (London, Porto, Antwerp, Istanbul), when finally the time had come to return to the UK, in Bristol this time, in 2018 with its first edition of our free EFPT psychotherapy guidebook.

As you will notice, the current edition contains 12 chapters. Our psychotherapy working group has expanded and together with the increase in the number of our members, we plan to expand the number of chapters of our guidebook as well. We are already preparing 12 more chapters on: Acceptance and Commitment Therapy (ACT), Art Therapy, Cognitive Analytic Therapy (CAT), Dialectical Behavioral Therapy (DBT), Existential Psychotherapy, Eye Movement Desensitization and Reprocessing (EMDR), Group Therapy, Intensive Short Term Dynamic Psychotherapy (ISTDP), Mentalization Based Therapy (MBT), Play Therapy, Psychedelic (MDMA assisted) Psychotherapy and Schema Therapy.

<p>EFPT Psychotherapy Working Group 2018</p>

EFPT Psychotherapy Working Group 2018

The goal is for each chapter to be written by trainees who have had experience or interest in that particular psychotherapy. There are many psychotherapies that we have not included yet in our guidebook e.g.: dance therapy, gestalt, hypnosis, milieu therapy, music therapy, narrative psychotherapy, Short Term Anxiety Provoking Psychotherapy(STAPP) and many others… that are looking for authors, contributors!

Are you a trainee interested in any of these psychotherapies or any other? Do you want to help our EFPT psychotherapy guidebook to have a happy continuation?

When I informed Nikola, the EFPT newsletter editor, about our Psychotherapy guidebook he told me: “some of my younger colleagues inquired about which Psychotherapy to choose and how and where to receive proper training. That guidebook you are working on should be very helpful to them”. Let’s all put some effort to make our next versions of our Psychotherapy guidebook a valuable gift to our younger colleagues who are choosing their path and to all of us who never stop looking for new challenges and are always into expanding our knowledge.

Roberts Klotins,

Pubpub Technical supervisor,

Former EFPT president (2005-2006)

I think, many of us have had a dream of being a psychiatrist and understanding, everything there is to know about human mind, brain - meaning of life and everything [4]. As we learn more about psychiatry and the afflictions of human mind that psychiatrists are trying to help with, we inevitably reach the point of acknowledging our limitations.

Facing limitations happens too when we get on the pathway of learning any particular psychotherapy - be it of CBT, psychodynamic, systemic or any other modality. We talk to the patients, we stumble, we then think that we are not yet knowledgeable or experienced enough; we think we need to focus on learning our chosen therapy modality in greater depth. This is right; we want to be the best therapists, the best psychiatrists for our patients. With that comes focus on depth and an implicit knowledge that we cannot become very competent therapists in many modalities. With that, often enough, come some turf wars and (secret-ish) belief that my chosen method is superior to that of other therapists. The data do support efficacy of therapies, but not really that some methods are so much better than others - “the key issue may not be the theory-driven question of whether an intervention works, but the implementation question - “Will it work for us?”[5]

With that in mind, I think, the project inviting psychiatric trainees to write summaries about their experience of learning a particular kind of therapy is fantastic. Having the privilege of editing and supporting this project I already have become more aware of therapies I had not ever heard of before. I think this is more than enough of a reason for this guidebook to exist.

And maybe we do not often enough appreciate what it is that psychiatrists bering to the world of psychotherapy. We have had years of medical training. When we learn psychiatry we are exposed to a great number of sufferers of various psychopathologies. No university CBT training, no conventional psychotherapy training ever exposes trainees to as many patients as training in psychiatry does. I salute the ethos of this compilation - to allow trainees to speak about their experience of the fascinating and rich field of speaking to people you are trying to help with their “mental disorders”. I hope this project will allow to have a truly multifaceted glimpse of various ways how therapies, serious enough to be studied by psychiatrists, are conducted and learned.

Something technical

Lastly slightly technical paragraph about publishing here. PubPub is an open source platform for collaboration. Every chapter can be authored by multiple psychiatrists at the same time. The book can be exported to produce a good looking PDF that one can print and bind together. Each chapter and the whole book can have a DOI - a digital object identifier that now for some time has been superseding ISBN numbers for scientific publications. Each chapter can have versions - that means each chapter can be expanded and improved over time. People from MIT have created a genuinely simple, but hackerishly sophisticated platform for intellectual collaboration. If you are a psychiatric trainee interested in psychotherapy - read our book at leisure, learn psychotherapy in your training and contribute to our work here. We look forward to hearing from you!

Affiliations

Thomas Gargot, MD, Psychiatrist, PhD Student in computer science, former Chair of EFPT Psychotherapy Working Group (2015-2018), Paris, France

Theodoros Koutsomitros, MD, Psychiatrist-Psychotherapist,
President of Hellenic Association of Psychiatric Trainees,
Co-chair of EFPT Psychotherapy Working Group,
Project Leader of EFPT Psychotherapy Guidebook (EPG),Thessaloniki, Greece

Roberts Klotins, MD, Psychiatrist-Psychotherapist, former EFPT President, London, UK

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