Project IMPART

Project IMPART, the Initiative for Manual-Guided Psychotherapies to Augment Residency Training, is a multi-disciplinary initiative that brings together expert supervisor MDs and PhDs with the goal of teaching the principles and practice of core psychotherapies to residents.  This initiative seeks not only to help residents to develop psychotherapy skills, but to do so by focusing on modern psychotherapies with a proven evidence base, using state-of-the-art guidance in the form of explicit, published manuals.

What is “Manual-Guided Psychotherapy?”

Manual-guided psychotherapy is the current state-of-the-art in providing psychotherapy to individuals with a wide variety of conditions and mental health challenges.  A wide variety of types of psychotherapies have now been supported by explicit manuals.  These include, for instance, cognitive therapy, behavioral therapy, several family therapies, psychoeducation, supportive psychotherapy, interpersonal psychotherapy, and various types of psychodynamic therapies including both short- and long-term treatments.

Manuals are simply guidebooks and resource kits for treatment.  They are not “cookbooks” to be followed in lockstep fashion (except in some formal research protocols).  Rather (to continue the book analogy) they are more like “travel guides”: the traveler-clinician uses the manuals when entering what seems at first to be strange territory to begin to identify important landmarks, become familiar with the lay of the land, and move around the locale without getting lost.

In clinical practice, and in residency training, the first goal is to develop specific technical skills that are applied in a focused course of treatment for specific goals.  However, once these are mastered in focused treatment, the skills can be used eclectically.  For instance, one might begin to learn behavioral therapy skills in developing and implementing a focused course of behavior therapy.  Subsequently, when s/he is comfortable with behavioral skills, the resident can incorporate these techniques into ongoing treatment with elements of, for example, interpersonal, psychoeducational, and even psychodynamic treatment.  In fact, research data doing micro-analysis of sessions in many “focused” types of psychotherapies indicates that even these reportedly “pure” therapies actually incorporate a mix of techniques!  But the place to begin is by learning specific skills, and manual-guided approaches, in conjunction with expert supervision, help the resident to develop them.

Which Psychotherapies are the Focus of Project IMPART?

The main psychotherapies addressed in Project IMPART are:

• Supportive Psychotherapy:  The fundamental skills necessary for enhancing illness management skills and dealing with life stresses.
• Psychodynamic Psychotherapy:  Modern, practical, manual-guided versions of the therapeutic approaches first developed by Freud and subsequent psychoanalysts.
• Cognitive-Behavioral Psychotherapy (CBT): The combination of both cognitive and behavioral techniques to address mood, anxiety, and personality disorders with application to other serious mental illnesses as well.
• Cognitive Processing Therapy (CPT): A cognitive-behavioral therapy focused on trauma and recovery.
• Motivational Interviewing (MI): Initially developed for substance dependence, techniques and approach that specifically addressing ambivalence and enhancing motivation for change for a wide variety of conditions and for enhancing adherence to treatment. 

How Does Manual-Guided Psychotherapy Supervision Work?

Supervision is an integral part of training in manual-based psychotherapies, as it is in all clinical skills (the old medical dictum of “See one, do one, teach one” doesn’t typically work in psychotherapy training!).  Supportive psychotherapy training and supervision is incorporated into weekly sessions in Continuity Clinic for PGY-IIs, and into weekly clinic meetings in the General Mental Health Clinic for PGY-IIIs. 
   
Psychodynamic psychotherapy, CBT, CPT, and MI are the focus of in weekly seminars and supervision sessions in PGY-III, with three hours of the Wednesday seminar day dedicated to these modalities.  The basic approach that is taken is to first understand the basic psychological and behavioral principles that underlie the therapy, then to develop the basic technical and attitudinal skills, and subsequently to utilize and improve these skills with patients, under supervision of expert clinicians:

Basic Principles -> Technical and Attitudinal Skills -> Ongoing Case-Based Supervision

Residents initiate treatment with a small number of intensively treated outpatients in PGY-III, receiving weekly supervision in these Project IMPART psychotherapies as part of the Wednesday seminar schedule.  Residents are encouraged to video/audiotape sessions for review in supervision.  They have the option to continue treatment and supervision into the PGY-IV year as well.

The training experience is enhanced by related activities as well.  For instance monthly Psychodynamic Grand Rounds provides an opportunity for PGY-III residents to present a case and process notes to a visiting psychoanalyst.  Many residents also take advantage of programs at the Boston Psychoanalytic Institute.
 
Fundamentals of additional psychotherapies, including group and couples work, are also provided in the course of required rotations, case conferences, and seminars.  These can be augmented with PGY-IV electives as well.