Psychiatry Residency Areas of Intensive Training & Electives

A crucial attribute distinguishing psychiatrists from other medical specialists is a sophisticated, trained understanding of the individual patient’s psychological forces, deficits and conflicts at work. These elements, which reflect the psychological makeup and personality of the patient, manifest themselves in all contexts, from mild adjustment disorders to psychotic illnesses, trauma, loss and so on.

Learning and practicing psychodynamic psychotherapy is the key experience that develops the trainee's psychological awareness. This allows residents to pursue areas of interest, such as child psychiatry, addiction, women’s mental health, geriatrics, community, forensic, sports psychiatry, psychotherapy and clinical or basic science research.

This component of our training program is unique in that a model of psychotherapy incorporating the four major theoretical dynamic orientations of drive, ego, object and self, anchored in a perspective derived from developmental psychology, forms the basis of teaching. Since it has become increasingly evident that no single school of psychodynamics can meet the therapeutic needs of all patients, the essence of this model is the integration of disparate psychodynamic theories in the clinical setting. This enables trainees to understand the nature of psychopathology from both conflict and deficit viewpoints and allows them to apply this developmental model to the differential treatment of patients.

Simultaneously, a developmental perspective on learning and practicing psychotherapy that parallels the resident’s overall professional development and maturation is applied to their training.

PGY-1:
Considerable supervisory emphasis is given to psychodynamically informed clinical diagnostic interviewing, which marks the first phase of learning psychotherapy. An understanding of the clinical importance of the psychodynamic formulation from the viewpoint of those above integrated conceptual models is emphasized, showing their predictive value in the unfolding treatment of the patient. Didactic seminars during this year review basic psychodynamic concepts and examine fundamental principles, such as transference, countertransference, ego defenses and resistance, as they occur in the clinical situation.

PGY-2:
The long-term inpatient treatment unit provides a unique venue for the application of psychodynamic psychotherapy principles to treating the more dysfunctional patient. Because of the grave psychopathology in this patient population, vivid demonstrations of unconscious phenomena and disturbances in ego functions can be seen. Weekly psychodynamically oriented supervision of the residents' psychotherapeutic treatment of these patients is a key element of PGY- 2.

PGY-3 & PGY-4:
The central clinical experience focuses on conducting intensive long-term psychotherapy with higher-functioning patients. Because a psychotherapy institute that provides mental health services for medical students, graduate students and hospital professional staff is housed in our outpatient department, all residents can have extensive experience treating higher-functioning patients. Didactic seminars during these years include the practice of psychodynamic psychotherapy, fundamentals of psychoanalytic theory and post-Freudian developments. Individual supervision of residents is provided by psychoanalysts affiliated with the significant psychoanalytic institutes in New York City. Additional elective clinical and supervisory experiences are available for residents wishing to subspecialize.

By the end of the residency, each trainee will have a profound understanding of both conscious and unconscious mental functioning and will be able to apply an integrated model of psychodynamic psychotherapy, thus enhancing the clinical treatment of the full range of psychiatric and medical patients.

The Unified Division of Substance Abuse (DoSA), a division of the Department of Psychiatry and Behavioral Sciences, offers advanced training in all aspects of substance abuse or dependence.

The division operates the largest academically affiliated substance abuse treatment program in the United States. Its most significant component, the opiate replacement program, serves 4,300 patients at 12 clinics in five communities throughout the Bronx. These clinics offer opiate replacement with methadone and comprehensive medical and psychosocial services, including complete medical evaluation and follow-up, crisis intervention and a variety of supportive services.

The division’s activities include teaching and training medical students, psychiatry residents and graduate students in the healthcare profession. It also offers consultation and liaison services for patients in hospitals affiliated with the medical school and community education and relations efforts directed toward the grassroots communities served by clinical units.

Clinical assignments may include inpatient and outpatient alcoholism settings, opioid replacement treatment, day programs and drug-free outpatient and residential therapeutic community treatment. In addition, residents can rotate at a medical cannabis clinic.

In addition to intense clinical training in addiction psychiatry, residents can become involved in clinical and/or basic science research projects in substance abuse. Basic and clinical addiction medicine research is conducted within Montefiore Einstein’s Department of Psychiatry and Behavioral Sciences in collaboration with the Department of Epidemiology and Social Medicine, Family Medicine, Internal Medicine, Neuroscience and Pathology.

Clinical research opportunities include studies in specific behavioral therapies, substance abuse medication development and clinical trials of new medications to treat primary substance-related disorders in patients.

All residents will rotate through addiction psychiatry in PGY-2, and residents who have an interest in clinical or basic science research, teaching and clinical treatment of substance abuse and its related disorders may choose to continue their education by participating in an elective during PGY-4.

Psychological well-being can be challenging to maintain when facing an illness—problems in physical health can often bring on or exacerbate mental health issues, particularly in children and adolescents. The Children’s Hospital at Montefiore Einstein’s (CHAM) Behavioral Consultation team provides inpatient and outpatient psychiatric consultation, evaluation and treatment to patients under the care of the general pediatric and surgical subspecialty services at CHAM. We serve children and adolescents with psychiatric complications of a medical illness or a primary psychiatric disorder complicating a medical illness.

Our psychiatrists, psychologists and social workers offer compassionate, family-centered care strengthened by research-based treatments such as pharmacotherapy and psychotherapy. We actively listen to you and your child to understand how best to help. In intimate sessions with patients and parents, we collaborate to identify the cause of any issues and implement a constructive solution.

We help patients adhere to their medical regimens, ensuring they follow the path to health, and treat a range of psychiatric and neurological conditions and personality disorders. Our team also specializes in helping patients facing blood diseases, diabetes, transplants, cancer and rheumatic diseases. We also collaborate with CHAM’s Integrative Medicine and Palliative Care (IMPACT) team to offer patients pain relief, social work assistance and therapy when they need it most.

Our Department has played a significant innovative and leadership role in the evolution of social and community psychiatry as a subspecialty area in our field. Some of the services pioneered or substantially developed within this Department include:

• Community Based Organizations
• Community mental health centers, most notably Montefiore Behavioral Health Center (MBHC), allow us to implement unique treatments to provide services to the greatest number of people.
• Intensive Outpatient Programs
• Mental health advocacy
• Assertive Community Treatment Team
• School consultation
• Prison mental health programs
• Working with the unhoused population across the lifecycle

The community psychiatry concentration allows residents interested in working with our underserved community to dedicate 4 hours a week to this work starting in the PGY2 year, through the PGY4 year. In addition to direct clinical care and supervision, you have an opportunity to participate in QI and Administrative work at one of our community psychiatry clinics.

Our program heavily emphasizes social determinants of health and trauma-informed care from an incredibly early age. We employ a nuanced approach, using the stages of trauma treatment as a framework to understand our complex patients. We aim to provide a warm, empathic holding environment while working to help patients rediscover (or discover for the first time!) a sense of agency and cultivation of a recovery-based mental health treatment model. We have examined several unique areas of interest in trauma-focused treatment and developed novel approaches targeted explicitly at our patient population.

During PGY-1, residents have weekly supervision with the chief resident of the emergency room, with an opportunity to discuss the overarching systemic and iatrogenic implications of psychological trauma as experienced by our patients in the crisis management setting.

In PGY-2, during the rotation at the Bronx Psychiatric Center (BPC), residents are given the opportunity to delve into a structural competency curriculum, fulfilling the Accreditation Council for Graduate Medical Education (ACGME) requirement of exposure to community psychiatry in a uniquely rich experience. Residents can tour the Bronx, learn about its history and systemic barriers, and develop the skills to incorporate these issues into our patients’ treatment plans.

In PGY-3, residents can work closely with their psychotherapy supervisors and interdisciplinary teams to learn how to engage patients who have experienced significant interpersonal trauma in the therapeutic space. They learn nuanced approaches to establishing and maintaining the therapeutic alliance. Residents can also receive additional training and resources in evidence-based modalities such as prolonged exposure and cognitive processing therapy.

PGY-4 affords residents continued opportunities to hone their skills in working with trauma, including additional research, specialized group psychotherapy training and other opportunities.

See our pioneering programs for a list of some of our Department’s work on trauma-informed care.

A wealth of information is unfolding daily regarding understanding the brain and behavior. Montefiore Einstein is firmly committed to cultivating research aptitude in our trainees. Interested residents are encouraged to participate in research activities at our Moses Campus or Weiler Hospital. Within the ACGME requisites, residents can engage in research elective activities as early as PGY-2 and sustain involvement throughout training.

There are several research opportunities throughout Montefiore Einstein, a few of which are highlighted below:

• Residents at our Moses Campus can research a variety of psychiatric disorders, ranging from autism to mood disorders. A sampling of ongoing studies includes the use of intranasal oxytocin for compulsive hyperphagia in Prader-Willi syndrome, a pancreatic enzyme treatment for core symptoms of autism spectrum disorder, a vasopressin 1a antagonist to treat social deficits in high-functioning autism and cannabidiol to treat core symptoms of autism.
• The Anxiety and Depression Program is developing and evaluating several new treatments for these disorders as well as understanding their biological underpinnings. Novel agents for the treatment of resistant depression and post-traumatic stress disorder (PTSD) are currently being studied. Residents are encouraged to participate in all phases of research, including presenting and publishing study results.
• Other research activities in which residents may also elect to become involved include, but are not limited to, clinical research exploring parasuicidal behavior in adolescents, effects of trauma in the chronically mentally ill, PTSD, translational research in memory and aging, and basic science research.

Elective rotations are individualized to meet the resident’s scientific and clinical interests.

Cognitive behavioral therapy (CBT) is a state-of-the-art treatment approach that has received considerable empirical support and is a critical component of training for psychiatrists today. Our unique program provides comprehensive training in this effective form of assessment, conceptualization and intervention.

The CBT Program provides residents and psychology interns with an understanding of the cognitive behavioral view of problem development and maintenance. Comprehensive case conceptualization is emphasized throughout the training curriculum. Residents experience the following as part of the PGY-3 cognitive behavioral curriculum:

• 16 didactic training seminars
• Weekly small group supervision of clinical cases with expert faculty (three trainees per group)
• Individual consultation and review of videotaped/audiotaped sessions by expert supervisors
• Structured assessment training and experience with empirically-supported interview and self-report measures

Our extensive video and audio training library materials enhance the CBT Program’s training goals. All trainees can access these audio and visual materials and may also use our assessment materials library. Trainees will have the opportunity to participate in clinical research projects and present at major cognitive behavioral therapy conferences.

As part of the PGY-4 curriculum, trainees may choose to continue their cognitive behavioral psychotherapy experience with an individually customized elective. The elective includes further applied training, individual supervision and a clinical project.

The Family Studies Program offers a comprehensive training experience, with components of family therapy and systems theory interwoven throughout all training phases. Courses and supervision in family therapy are included in the curriculum for the first three years and frequently continue into the fourth year, as well as the fellowship in child and adolescent psychiatry and postgraduate training.

Residents are introduced to family therapy concepts and systems theory during the first year and begin meeting with families. They learn to view problems from multiple perspectives, assess family dynamics and resources, interview a family and conduct a brief intervention. The most extensive experience working with families occurs during the second year, during a four-month rotation at the Bronx Psychiatric Center.

Residents receive intensive supervision in working with families, participate in a weekly seminar and have the opportunity to go on home and community visits with their supervisors to understand the complexities of mental illness.

In the third year, the main focus of supervision at the outpatient clinic is treating couples and families with children. After training, residents should understand the importance of family dynamics and context and be comfortable intervening with couples, families and larger systems. They should appreciate the complex interaction of the family and the identified problem. They should be able to negotiate with and refer to other systems of care as appropriate.

Residents are taught organizational dynamics and leadership skills within the family therapy curriculum using a group process model. Residents learning family therapy concepts begin to apply these concepts to themselves and their own families, then to their patients’ families and finally to the larger system. By adapting components of family therapy and systems theory within a group at different phases in training, residents develop skills necessary to engage the larger system in which they work effectively and to become leaders within an organizational structure. Thus, the residents learn to integrate the personal, clinical and systemic levels of understanding to become effective leaders.

Much supervision occurs in small groups and seminars, where the residents become a working group using videotape, film, experiential exercises, live supervision and case-based learning. The process culminates in PGY-4 with a leadership seminar for chief residents that the Director of Family Studies co-leads with the Director of Residency Training.

Opportunities for electives and advanced supervision include:

• Advanced work in a particular area of couples or family therapy
• Mentoring in beginning to teach family therapy courses
• Individual or small group work on a clinical or research project to be presented at a national or international conference
• Publication of an article
• Supervision in the area of working with complex systems
• Other areas of interest to particular residents

Creativity and the pursuit of innovative projects are encouraged and supported.

The Albert Einstein College of Medicine Forensic Department at BPC is the home of the Forensics Fellowship for Albert Einstein College of Medicine/Montefiore Einstein as well as the New York State Division of Forensic Services (DFS) Forensic Coordination for the borough of the Bronx. The division offers access to a wide range of forensic services, spanning criminal/civil consultation, New York State mental hygiene law evaluations, report preparation, risk assessment, testimonial supervision and court diversion services. Working alongside the faculty and the fellows in the division, trainees will have the opportunity to observe and participate in different aspects of this work and gain unique exposure to forensic psychiatric practice in New York State. Learning activities are varied and may include assisting a multidisciplinary team at a court diversion office to provide client evaluation and court recommendation, participating in risk assessment and report generation for hospitalized patients as part of statutory requirements under the criminal procedure of law or per primary team request, or attendance at forensic lectures with current forensic fellows in the New York and New Jersey forensic fellowship programs. Other opportunities, such as observation of the hospital forensic committee at BPC, are scheduled as they arise. Elective length is four weeks for one resident at a time; under special circumstances, two-week electives will be considered. Electives can be scheduled between October and May of the academic year.