EXPERIENTIAL GROUP FOR PSYCHIATRIC RESIDENTS

The years of residency training for psychiatrists now encompass four postgraduate years, and it is well documented that they are years of great personal stress. The physician is in process of forming a professional identity while undergoing great emotional turmoil, given the nature of his work, and the fact that he has a personal life.

An experiential group for psychiatric residents has traditionally been part of the core curriculum of quality teaching programs ever since World War II gave American physicians experience with the value of group discussion for war neuroses. Since then, American psychiatrists in particular have formulated a theory and technique of group psychotherapy incorporating Freudian psychoanalytic concepts. In practice, methods vary considerably, taking into account the personality of the therapist and the composition and goals of the group.

An experiential group for psychiatric residents is a training group, not a therapy group. The group consists of professional colleagues with a leader who has training and experience. The goal of the group is education in group dynamics, group psychotherapy and psychodynamic principles (theory and technique). The goal of the group is not a comprehensive or in-depth exploration or restructuring of the personality. However, the four year training and education in psychiatry involves some personality structuring and development, and this natural process is facilitated by participation in a training group.

When the beginning resident is taught to listen to a patient, he is not prepared for what he is going to hear. His own background is, by definition, relatively narrow and circumscribed. The actions and verbal productions of psychiatric patients are, at first, shocking and at times, horrifying. To say the least, they are unsettling and traumatic. The resident needs help to equip himself to listen and not be too upset, and to help him integrate his experiences in training without too great a disruption of his personal life.

A great source of support and insight comes from his peer group, and a peer group that is a cohesive, relatively harmonious working group is a major factor in the resident being able to learn, maintain his composure, and function outside the clinic with friends and family. He is in process of identifying with adaptive and functional elements of the peer group and group leader. He gains some idea of what it is to be a patient, of what it is to be a participant-observer, and to experience some of what is called 'resistance' and 'regression in the service of the ego'.

It is common knowledge that there is a certain 'resistance' to learning psychoanalytic-psychodynamic principles in each person, and the training group helps to clarify and lessen these resistances, thereby enhancing the learning process of the entire residency program and facilitating the incorporation of basic psychodynamic concepts.

The group meets for an hour and a half each week for approximately forty weeks a year, and optimally, the resident can experience over a hundred hours of participation in an experiential group, and can learn about the effect of absences, lateness and other members coming and going. He is in a position to explore and experience the importance of confidentiality and professional ethics.

The training group is open-ended; that is to say that periodically new members come into an ongoing group and members drop out or 'graduate'. Eventually, group members are encouraged to be open and spontaneous about their thoughts and feelings, volunteering their own problems and commenting on the productions of others. These productions are both verbal and nonverbal, there is a manifest and latent content, and much can be learned about psychodynamics and the 'psychopathology of everyday life'. The group is a model for 'family' and problem-solving, and the phenomena of transference, countertransference, acting-in and acting-out are regularly observed and discussed.

The residents can talk about their feelings about patients, other residents, members of the milieu team, supervisors and other senior staff, or be silent. They can also reveal their concerns about dating, family, present and past, and their plans for the future. Residents may volunteer dreams and participate in some dream analysis. As a result, they come to the awareness that it is not only patients who have problems and dynamics, and that many of the problems manifested by patients are common human problems with which we all struggle.

It is a good experience for a resident to be able, at least briefly, to set aside his professional facade and get off his pedestal with his peer group. As a result he or she may consider the extent to which personal private therapy (individual, group or both) can improve his adaptation to life and professional effectiveness.

Many residents, becoming aware of personal problems in the experiential group, have gone into private psychotherapy and psychoanalysis with beneficial results. In addition, many look back on their group experience with appreciation for how it has helped them to grow and develop as psychiatrists and as human beings.

It would be beneficial to residents for senior teaching staff members to allow and encourage residents to attend the experiential group for the entire four years of training. It would be adviseable for the core curriculum to encourage each resident to attend at least ten successive group sessions before deciding not to participate. Those residents who attend one hundred hours should receive a certificate of participation, which will also contribute toward the prerequisites for joining the American Group Psychotherapy Association, which now has a program of continuing education for psychiatric residents.