Teaching Brief Therapy Skills to Family Medicine Residents: Thirty Years of Experience Teaching Brief Therapy Skills to Family Medicine Residents: Thirty Years of Experience Michael Bloom, Ph.D., Sioux Falls Family Medicine Residency Goals, Objectives, Disclosure The process of teaching brief therapy skills to residents A curriculum for teaching brief therapy skills to residents Addressing common obstacles Related topics brought up by participants Disclosure: nothing to disclose (however I will refer to two books I have authored) 1

Motivational Interviewing (MI) or Brief Therapy Skills (BT) MI, done by family physicians, has been shown to be an effective intervention tool for positive lifestyle changes. Much of MI is based on BT practices. Some might consider what our program teaches as an advanced form of MI. Teaching residence BT provides family physicians with additional tools and lowers the singular reliance on psychopharmacology. Surveys have shown that nearly half of patients prefer psychological treatment from their family physician. 2

Preparation for Practice Trends by Subject

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Sample Resident Weekly Schedule on Community Medicine/Behavioral Science Rotation for 12 weeks. Time with Psychiatrists -4 weeks MondayTuesdayWednesdayThursdayFriday AM CFM Counseling with Mona AM with Psychiatrist CFM clinic PM Outreach clinic CFM clinicWith Dr Bloom - pts, video review, didactics CHC ClinicCHC (Counseling) 5

The Specific Process:  Read Chapter 1: Approach to Brief Treatment in Family Practice and discuss at our first half day. (from Bloom & Smith. Brief Mental Health Interventions for the Family Physician, 2001)  Resident sees Pts. with me and with another experienced therapist. The first few weeks resident does more observing but as time goes on assumes primary responsibility. From the start history is taken then we step out to discuss assessment and plan, then return to discuss plan with the pt. 6

The Specific Process: continued  Resident sees pts. by themselves with close supervision using the process outlined in Chapter 1. Resident focuses on presenting complaint and history. Resident steps out of room and discusses pt. history and assessment with faculty and a plan is developed. Resident returns to pt. and discusses plan.  All pts. seen alone by Resident are again reviewed at the next half day with the faculty supervisor.  Weekly meetings also cover discussions of book chapters (Bloom and Smith) 7

Treatment: Factors shared by EBP therapies (e.g.. MI, CB, Problem Solving, Interactional BT) (Bloom. Thinking Like a Therapist: A Novel Overview of Psychotherapy, 2013) 1. Reframing: viewing the problem differently leading to different behavior. 2. Altering behavioral and communication sequences surrounding the problem. 3. Motivating the patient and significant others to make useful changes 8

BT training for the family medicine resident includes: Reframing Self observational tasks As if techniques Solution focused tasks Relaxation exercises 9

Common problems addressed in brief therapy training for residents include: (All treatment approaches are evidenced based ) Anxiety: reframing, relaxation exercises, self observational tasks and gradual exposure. Depression: reframing, activation both physically as well as socially, solution focused interventions. Child behavioral problems: parent effectiveness training, Solution focused interventions. 10

Continued: Common problems addressed in brief therapy training for residents include: (All treatment approaches are evidenced based ) Nursing home and end-of-life family conflicts: family and nursing home care conferences, influenced by the Harvard Negotiation Project and MRI. Chronic pain disorders: reframing, self efficacy, activation both physically and socially, AS If interventions, solution focused interventions. 11

Key points for teaching residents brief therapy 1. Keep instructions and expectations of the residents simple. 2. Give residents specific guidelines for working on specific problems. 3. Make it happen—real therapy experiences are the best teachers. 4. Maintain sufficient support and feedback to the residents. 12

Useful Responses to Common Hurdles Faced When Teaching BT Skills Possible Case Based Discussion-Specific topics chosen by seminar participants. Bring your topics!  Making yourself useful to residents  Helping skeptical residence learn brief intervention skills o Residents who overly accept the chemical imbalance model o Residents who avoid introspection o Residents who refer to avoid dealing with psychosocial issues  Gaining support of Faculty 13

Continued: Useful Responses to Common Hurdles Faced When Teaching BT Skills  Helping residents see problems from the pts. perspective o Avoiding seeing pts. as weak or flawed (the DSM dilemma) o Helping pts. get important needs met in less problematic ways  Using pain pts. To teach the bio psychosocial model of brief interventions.  Rescuing the resident from a “difficult Pt.” vs. coaching 14