There is a burgeoning interest and recognition of the importance of the practice of cognitive-behavioral therapy (CBT). This is an issue which is actively being addressed at the University of Maryland-Sheppard Pratt Residency program in a multi-level fashion. Traditionally, The University of Maryland/Sheppard Pratt program, like many other programs across the country, approached psychotherapy from a much more psychoanalytically oriented perspective. The training program remains committed to the teaching and practice of psychodynamic psychotherapy, however, it is clear that CBT is a highly effective form of therapy--both alone and in combination with pharmacological interventions. It is essential that psychiatrists learn this modality of treatment. Moreover, The Residency Review Committee has now made it a requirement that residents be trained in CBT.

The following steps are being used at The University of Maryland-Sheppard Pratt Residency Program. First, a designated faculty member received extensive training in cognitive psychotherapy. This faculty member has been charged with training the residents and faculty in cognitive therapy. To successfully implement this project it was necessary to also change the culture of the program where briefer forms of psychotherapy were viewed as lesser forms of treatment.

The first goal of training the residents in CBT was accomplished by developing an integrated didactic curriculum across the four years. In addition, a special clinic was set up to attract patients appropriate for CBT. The faculty member trained in cognitive therapy supervised residents on an ad hoc basis as they picked up appropriate cases. Eventually, as the program had success in attracting patients and filling residents' caseloads, more faculty became trained to provide supervision. This second goal of training faculty in cognitive therapy was accomplished by setting up a weekly intensive training seminar for interested faculty. In return for the training, they provide supervision to residents.

Changing the culture has been a gradual process. First and foremost, the program has tried to make it clear that psychodynamic psychotherapy remains highly valued and is an essential part of the residents' training. CBT training is not meant to replace more traditional psychotherapies but is one more tool in the therapist's armamentarium to treat mentally ill patients in the most effective way possible. All residents continue to have a requirement to demonstrate competency in both psychodynamic as well as CBT.

Next year, the first cohort of residents who have completed the integrated cognitive therapy will graduate. Already there has been a significant increase in the knowledge, comfort, and familiarity with cognitive concepts and practice. This year's PGY-3's are the first group to score well on a cognitive therapy pretest and have been incorporating cognitive techniques into their practices on their own initiative.

We believe these multi-level interventions to establish cognitive-behavioral expertise in our residents has been quite effective and that our residents will be able to incorporate into their practice this essential and highly effective modality of treatment.