Comparing cognitive behavior therapy, interpersonal psychotherapy, and psychodynamic psychotherapy.

Abstract

he Residency Review Committee of the Accredita-tion Council for Graduate Medical Education now requirespsychiatric residents to demonstrate “competency” in fiveforms of psychotherapy: brief, cognitive behavior, andsupportive therapies; long-term psy-chodynamic therapy; and combinedpsychotherapy and pharmacotherapy(1). The field has been struggling withthe implications of this graduation re-quirement since its promulgation in2001 (2). During training, residentsfrequently choose a particular treat-ment for a particular patient based ontheir caseloads, training needs, andsupervisory availability, with the rareopportunity to see how patients mightrespond to different psychotherapies.As a theoretical exercise, such an ex-perience would clarify the differences and similaritiesamong different psychotherapeutic orientations, includ-ing their theoretical assumptions, technical interventions(3), and the process of differential therapeutics that psy-chiatrists must undertake in evaluating patients and de-veloping treatment plans (4, 5).We simulate that experience by presenting a suitablepatient to experts from the disciplines of cognitive behav-ior therapy, interpersonal psychotherapy, and long-termpsychodynamic psychotherapy. Each expert will describehow his treatment might proceed. As we shall see, thetreatments differ conceptually and technically. Other ther-apies, including time-limited brief dynamic therapy(which has its own conceptual basis and technical ap-proach), are beyond the scope of this presentation.