In a psychotherapy career, a psychiatrist specialises further in the psychological assessment and treatment arm of the bio-psycho-social paradigm. As a senior trainee, you complement and extend your junior training in the ‘talking therapies’. The three main modalities used in the NHS – psychodynamic (individual or group), systemic and cognitive-behavioural, are represented in all training schemes. You will be immersed in one modality, and gain complementary experience in the other two. The aim is for you to become a psychiatrist who is a competent therapist in one type of psychotherapy, with an understanding of different psychological treatments that may be appropriate for some of the patients you will encounter in your career. Some schemes also offer experience in Cognitive Analytic Therapy (CAT) or Interpersonal Therapy (IPT), depending on the clinical issue and local resources.

Psychotherapy is an emotionally demanding specialty dealing with complex emotional states of patients and the impact of these on their families and staff. It gives a privileged view of a person’s inner world, and encourages you to think about your own mind and your personal development. To help with this, supervision usually involves more disclosure of your own emotional experience than in other psychiatric specialties, and personal psychotherapy is mandatory for trainees in psychodynamic psychotherapy. This would consist of either twice weekly group therapy or individual therapy (from three to five times a week), and may be subsidised in London training schemes. The trainee has to dedicate time for this, and also has to make a significant commitment to provide a setting that allows their patients’ therapy to develop. As a result, you have to plan absences created by holidays and study leave carefully, thinking about the effect on patients’ therapy and giving plenty of notice. This may take some adjusting for new trainees. On the other hand, it is a truly rewarding experience on a professional and personal basis. In addition, this specialty is well suited to flexible training.

Two common anxieties amongst senior trainees are whether one needs to complete an ‘external’ training outside of the NHS and job availability on attaining a CCT. Firstly, an external training is not mandatory for working as a consultant, but a rigorous training may be invaluable in helping you deal with difficult cases. Some senior trainees now wait until taking a consultant post to complete an external training. Secondly, the skills gained in a psychotherapy training – learning to use a specialised form of treatment, dealing with disturbed emotional states and difficult treatment relationships – are useful in many psychiatric settings. This is particularly useful in developing and staffing those services dealing with entrenched and difficult cases, such as forensic and personality disorder services. There is also currently a government drive to invest in psychological treatment provision – mainly short-term, easily accessible interventions delivered initially by graduate mental health workers – and as these services develop, a need for more highly specialised clinicians to deal with the more complex cases is becoming apparent.

If you are considering psychotherapy as a career, you will have enjoyed the experience you’ve had so far in using ‘talking treatments’ to care for your patients. You will have a curiosity about your own mind and the minds of others. If you would enjoy learning a unique skill in accessing people’s emotional experience and understanding what drives them, then psychotherapy may be for you.

You have taken the first step by looking at this website. Talk with your local psychotherapy trainees and psychotherapy tutor. They would be able to offer you more locally appropriate information.