Initial training in psychotherapy for psychiatrists in France: Results of a national survey
La formation aux psychothérapies des internes de psychiatrie en France : résultats d’une enquête nationale
Résumé
According to a recent change in the French legislation (2010) regarding the regulation of the use of the title of “psychotherapist”, psychiatrists are now allowed to use this title at the end of their training, without any additional training. However, various publications from 2000 have shown that there is no specific training in psychotherapy at a professional level during the training of psychiatrists.
Goals
To study the current situation of the Academic training of French psychiatrists in psychotherapy during their residency, their interest for these therapies, their level of satisfaction regarding their training, and the importance of additional private training programs.
Methodology
A survey was carried out among residents in psychiatry from October 2010 until January 2011. An anonymous questionnaire covering five domains (academic teaching, psychoanalysis, extra-academic training, interest in a more developed model of training, supervision) was sent by the French Federative Association of Psychiatrists Trainees (AFFEP) to all French psychiatrist trainees, through their local trainee associations (n = 26).
Results
The questionnaire was answered by 869 of the 1334 psychiatry residents (65%). The vast majority of the trainees reported being interested in psychotherapy, but 75% thought that their training in psychotherapy (psychoanalysis, cognitive-behavioral therapy [CBT] and systemic therapy) is insufficient. In 20 of the 26 universities, more than half of the trainees reported that their training was insufficient in the three fields; in four universities, more than half of the trainees were satisfied with at least one field. Yet, satisfaction rates were very different among universities: for example, 27% were satisfied with their psychoanalytic training in Paris and 87% in Strasbourg; 7% were satisfied with their CBT training in Strasbourg, but 65% in Nice. The vast majority (97%) believes that supervision about therapeutic relationship is necessary during residency rotations in the hospital. More than three quarters (78%) would like to have supervision at least twice a month. Yet, only 51% of respondents have such supervision. Once again, large disparities were observed between different Academies: for example 74% had supervision in Montpellier, but only 29% in Marseille. The vast majority (95%) of trainees would like a two-phase model of training (general theoretical teaching plus in-depth training in one or more methods), which is different to the current training model.
Conclusion
Our results show a clear discrepancy between the importance of training in psychotherapy for psychiatrists, the interest of psychiatry students for these therapies, and the very high rate of dissatisfaction for the training received, as well as the rate of students supervised during their training period at the hospital. These results differ from what is observed in other countries, where satisfaction rates are much higher among students, and various psychotherapy training methods are proposed in a much more homogeneous manner. More research is required to understand the reasons for these difficulties with the psychotherapy training of psychiatrists in France, and to propose new models of training to improve this situation.
Aux termes du décret no 2010-534 d’application de l’article 52 de la loi de santé publique du 9 août 2004 sur l’usage du titre de psychothérapeute, les psychiatres sont « de droit » psychothérapeutes à l’issue de leur formation universitaire. Or, l’enseignement du Diplôme d’études spécialisées (DES) de psychiatrie n’intègre pas de formation qualifiante pour la pratique des différentes techniques psychothérapeutiques, contrairement à d’autres pays. Afin d’obtenir un état des lieux de la formation aux psychothérapies délivrée aux internes de psychiatrie français dans le cadre de leur DES, de connaître l’intérêt des internes pour ces thérapies, leur niveau de satisfaction quant à la formation qu’ils reçoivent et d’évaluer l’importance des formations extra-universitaires dans ce domaine, nous avons mené une enquête quantitative auprès des internes inscrits au DES de psychiatrie pour l’année universitaire 2009–2010, à laquelle 869 des 1334 internes ont répondu. L’immense majorité des répondants sont intéressés par la psychothérapie, mais plus des trois quarts sont insatisfaits de la formation reçue. Ce résultat global masque une très grande disparité selon les régions dans la satisfaction, comme dans les contenus de formation et la supervision durant les stages. Nos résultats suggèrent que la formation actuelle à la psychothérapie des internes en psychiatrie pose problème et qu’une enquête complémentaire approfondie est requise, en préalable à une évolution de cette formation.