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EPG: Introduction

Overview of the EPG Project.

Published onJun 29, 2019
EPG: Introduction
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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, experimental psychology (e.g. cognitive dissonance and engagement theories [3] [4] or rationalization studies [5][6]) 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 or exposure and visuo spatial tasks [7] or the emerging field of psychedelic use in psychotherapy explained in this guidebook [8]) will be interesting to follow. Neuropsychoanalysis [9] [10] could inspire new psychotherapeutic approaches.

New technological developments allowed the European Psychiatric Association (EPA) to organize  a Massive Open Online Course (MOOC) on Cognitive-Behavioral Therapies [11]. The first edition enrolled 7,116 participants, with 954 (13%) completing the course. However, the economic model of the MOOC needs further thought to warrant its sustainability [12][13]. The cost-free model of the MOOC allowed for easy promotion of the course on social media, mailing lists and trainee networks. On the other hand, a subsequent EPA online course on motivational interviewing, was worth  30€ and reached 35 times less students [14]

I hope that this guidebook work of synthesis allowed us and we hope the reader to find convergences, complementary approaches but also thought provoking divergences between this diversity of approaches in psychotherapy. A better communication combined with a better training and research in clinical and necessary theoretical sciences could allow to obtain a better consensus in psychotherapy in the future [15].

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.

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.

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


Theodoros Koutsimitros (Teo)

Coordinator of the 2nd and 3rd edition, Project Leader

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.

The 1st edition contained 12 chapters about:

  • CBT: Cognitive Behavioural Therapy

  • Client Centred Psychotherapy

  • Cognitive Remediation Therapy

  • Family Therapy

  • Institutional Psychotherapy

  • Interpersonal Psychotherapy

  • Mindfulnes

  • Psychoanalysis

  • Psychodrama

  • Psychoeducation

  • Rational Emotive Behaviour Therapy &

  • Supportive Psychotherapy.

Our psychotherapy working group has expanded and together with the increase in the number of our members,  we also increased the number of chapters of our 2nd edition by doubling them in a few months. We included more chapters about:

  • Art therapy

  • Acceptance & Commitment Therapy

  • Cognitive Analytic Therapy

  • Dialectical Behavioural Therapy

  • EMDR: Eye Movement Desensitization and Reprocessing

  • Group Therapy, Hypnotherap

  • ISTDP: Intensive Short Term Dynamic Psychotherapy

  • MBT:Mentalization Based Treatment

  • Play Therapy

  • Psychedelics, entactogens and Psychotherapy &

  • Schema Therapy.

Last year we also updated  the mobile friendly version of it on a web authoring platform. of MIT . PubPub.org is an open source platform for collaboration. Every chapter can be co-authored by multiple psychiatrists at the same time from every corner of Europe. 

Each chapter and the whole book can have a DOI - a digital object identifier that now for some time has been replacing ISBN numbers for scientific publications. Each chapter can have versions - that means each chapter can be expanded and improved over time. People from Massachusetts Institute of Technology have created a genuinely simple, but hackerishly sophisticated platform for intellectual collaboration. Some of the reviewers of our chapters are well known psychiatrists worldwide for example Irvin Yalom  who is emeritus professor of psychiatry at Stanford University, as well as author of both fiction and nonfiction.

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.There are over a thousand different psychotherapy techniques, some being minor variations, while others are based on very different conceptions . It is difficult to comprehend and to orientate ourselves in this “jungle”! The literature argues than even if the basic foundations and the practical aspects are very different between different  types of psychotherapies, there are important common factors (motivation of the patient, empathy, transference, counter-transferance, the therapeutic alliance) that lead to a general efficacy of psychotherapies.

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 decided to use a similar template for every psychotherapy, and to promote books, journals, videos, psychotherapy associations and related training events worldwide. The goal is for each chapter of our EFPT Psychotherapy Guidebook to be written by trainees who have had experience or interest in that particular psychotherapy. This work does not pretend to be comprehensive but would like to open trainees’s  eyes to the richness of this field. 

The road of psychotherapy is still open and long. There are many psychotherapies that we have not yet included in our guidebook that are looking for new authors, contributors! Are you interested in psychotherapy ? Do you want to help our guidebook to have a happy continuation? 

In 2019 after the EPA psychotherapy summer school and EPA and WPA congresses we managed to inspire more trainees to contribute to our valuable project. Therefore over the last year we have added 12 more chapters.

In the middle of the photo above you can identify Prof Sartorius, one of the living legends of Psychiatry worldwide. Prof Sartorius always said “find something that speaks to you” . EFPT Psychotherapy Guidebook spoke to me from the very 1st sight .

I am really happy that we could share with you our extraordinary project .I would like to take this opportunity to thank again all 53 authors that I was privileged to work with

When I informed the EFPT newsletter editor, about our Psychotherapy guidebook he told me: “Some of the 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.


EFPT Psychotherapy Working Group 2018

We have presented our EFPT Psychotherapy Guidebook during congresses worldwide (Mexico,Portugal, France, Greece, Japan, Indonesia) in order to promote our project. Below you can find our presentation during the 28th EPA European Congress of Psychiatry that took place virtually in Spain in 2020.

Hugo Canas-Simião

Co-chair of the EFPT Psychotherapy Working Group (2020-2021)

As a psychiatrist, more than the transversally required knowledge related to the diagnosis and treatment of mental disorders, a psychotherapeutic attitude is imperative. Naturally, verbal and non-verbal communication are key processes in creating a therapeutic relationship - the key element and the root of any psychotherapy. However, the training of a psychiatrist is uneven in this field from country to country. In addition, psychotherapy is in itself a large tree whose branches have grown more and more over the years, which does not facilitate the journey of the young psychiatry trainee who seeks to complement his general training with one of these branches.

As a Portuguese psychiatry trainee who started his training in 2017, psychotherapy was a clouded world for me and, not wanting to generalize, I think that is also the thought of a large percentage of my colleagues. However, without really knowing what to expect, it was at the 2018 EFPT Forum in Prague that I was lucky enough to meet colleagues from other countries and get in touch with the Psychotherapy Working Group - since then, I am proud of being part of this group. In 2020, I became co-chair of this group and one of the coordinators of the third edition of the Psychotherapy Guidebook - a project that continues to grow and that has been increasingly recognized, including beyond Europe. For instance, during 2019, the guidebook accounted for 4.360 viewers worlwide, while during 2020, it accounted for 14.717 from 138 countries! Meanwhile, the project was promoted in the January 2021 edition of The E-Magazine of the Washington Psychiatric Society[16]. Right now, it counts with more than 34 chapters, each of them about a different kind of psychotherapy.

The Group also started an interactive journal club across Europe. Videoconferences allowed the EFPT working group to organize until January 2021, 9 journal clubs presenting different aspects of psychotherapy from clinical to theoretical, historical or most up-to-date publications, each gathering contributors from around 30 trainees and early career Psychiatrists on a variety of topics (e.g., Minfulness, Psychodrama or Rationalisation[17]) . Future sessions will be announced on EFPT social medias networks.

I hope that, like the various branches of the psychotherapy tree, the Psychotherapy Guidebook will continue to branch out and bear fruits that will be useful not only for mental health professionals who read it, but also (and above all) for their patients.

Roberts Klotins

Technical supervisor, author, 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 [18]. 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?”[19]

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, M.Sc Cognitive Science, PhD Student in computer science, former Chair of EFPT Psychotherapy Working Group (2015-2018), Paris, France

Theodoros Koutsomitros, MD, Psychiatrist-Psychotherapist,
Former president of Hellenic Association of Psychiatric Trainees,
Former co-chair of EFPT Psychotherapy Working Group (2018-2020), President of Early Career Psychiatrist of Hellenic Psychiatric Association, Co-chair of International College of NeuroPsychopharmacology (CINP) Young Member Engagement Committee,
Project Leader of EFPT Psychotherapy Guidebook (EPG),Thessaloniki, Greece

Hugo Canas-Simião, MD, Psychiatry Trainee in Centro Hospitalar de Lisboa Ocidental, Collaborator in CENC - Sleep Medicine Center, Advanced post-graduate specialization in cognitive-behavioral psychotherapy, Co-chair of EFPT Psychotherapy Working Group, Lisbon, Portugal.

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

Bibliography

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