Psychiatry and Behavioral Sciences
Areas of Intensive Training and Electives
Areas of Intensive Training and Electives
We firmly believe in allowing each resident to develop his or her own professional identity. Experience tells us that this produces the best psychiatrists in terms of clinical acumen, academic abilities, and personal fulfillment. Our program incorporates intensive training in multiple areas of psychiatry throughout all four years of training for all residents, and residents may then choose to further their knowledge and experience in these areas through elective opportunities, typically during PGY4. This allows residents to pursue areas in which they have an interest, such as child psychiatry, addiction medicine, forensic psychiatry, psychotherapy or research (many areas of basic and clinical research are well represented at Einstein). We pride ourselves on our willingness and ability to meet residents' specific requests for individualized programs of study. Several well-developed areas of training for all residents as well as electives available for those interested are described below, but options extend beyond the examples cited.
Click links below for more details on areas of intensive training and electives:
- Psychodynamic Psychotherapy>
- Addiction Psychiatry
- Child & Adolescent Psychiatry
- Cognitive Behavioral Therapy
- Family Therapy
Click below for more details on electives:
- Social and Community Psychiatry
- Behavioral Health Management
- Research Electives
- Research Electives
- Global Health Electives
In addition to the programs outlined above, there are many specialized clinical services that provide exciting opportunities for residents to pursue special interests or enhance expertise in a particular clinical realm.
Some elective experiences that residents have enjoyed include but are not limited to the following: Bariatric surgery, HIV and AIDS Mental Health Program, Women's Health Center, Adolescent Depression and Suicide Program, Southeast Asian Refugee Program, PS 8 School Based Mental Health Program, Russian Immigrant Ambulatory Mental Health Program, Empowerment Program for Trauma Survivors with PTSD, Palliative Care, Transplant Services, Sleep Disorders Center, Administrative Psychiatry, and Medical Student Education.
In addition, residents can always choose to use elective time to gain additional experience in geriatric psychiatry, child and adolescent psychiatry, addiction, emergency psychiatry, etc.
Salvatore Lomonaco, M.D.
Albert Einstein College of Medicine
Vice-chair for Education
Training and Supervising Analyst,
New York Psychoanalytic Institute
A crucial attribute that distinguishes the psychiatrist from other medical specialists is a sophisticated, trained understanding of the psychological forces, deficits and conflicts at work in the individual patient. These elements, which reflect the psychological make-up and personality of the patient, manifest themselves in all contexts from mild adjustment disorders to psychotic illnesses, trauma, loss etc.
Learning and practicing psychodynamic psychotherapy is the key experience that develops this psychological awareness in the trainee. Extensive clinical experience in this area consolidates the psychiatrist's identity and effectiveness and has applications to all branches of psychiatry, no matter what the resident's final subspecialization may be.
This component of our training program is unique in that a model of psychotherapy incorporating the four major theoretical dynamic orientations of drive, ego, object, and self, anchored in a perspective derived from developmental psychology, forms the basis of teaching. Since it has become increasingly evident that no single school of psychodynamics can meet the therapeutic needs of all patients, the essence of this model is the integration of the disparate psychodynamic theories in the clinical setting. This enables trainees to understand the nature of psychopathology from both the conflict and deficit viewpoint and allows them to apply this developmental model to the differential treatment of patients.
Simultaneously, a developmental perspective on the learning and practicing of psychotherapy that parallels the residents' overall professional development and maturation is applied to their training.
In PGY 1, considerable supervisory emphasis is given to psychodynamically informed clinical diagnostic interviewing, which marks the first phase of learning psychotherapy. An understanding of the clinical importance of the psychodynamic formulation from the viewpoint of the aforementioned integrated conceptual models is emphasized, showing their predictive value in the unfolding treatment of the patient. Didactic seminars during this year review these basic psychodynamic models and examine fundamental principles, such as transference, countertransference, ego defenses, and resistance, as they occur in the clinical situation.
In PGY 2, the long-term, in-patient treatment unit provides a unique venue for the application of psychodynamic psychotherapy principles to treating the more dysfunctional patient. Because of the grave psychopathology in this patient population, vivid demonstrations of unconscious phenomena and disturbances in ego functions can be seen. Weekly psychodynamically oriented supervision of the residents' psychotherapeutic treatment of these patients is a key element of PGY 2.
During PGY3 and 4, the central clinical experience focuses on conducting intensive long-term psychotherapy with higher functioning patients. Because a psychotherapy institute, which provides mental health services for medical students, graduate students, housestaff, and ancillary professionals, is housed in our outpatient department, all residents are able to have extensive experience in treating higher-functioning patients. Didactic seminars during these years include the practice of psychodynamic psychotherapy (based on a continuous case presentation format), fundamentals of psychoanalytic theory, and post-Freudian developments of psychoanalytic theory, and post-Freudian developments in psychoanalysis (reviewing the works of Kohut, Klein, Winnicott, Fairbairn and other theoreticians). Individual supervision of residents is provided by psychoanalysts affiliated with the major psychoanalytic institutes in New York City. For residents wishing to subspecialize, additional elective clinical and supervisory experiences are available.
By the end of the residency, each trainee will have a profound understanding of both conscious and unconscious mental functioning and will be able to apply an integrated model of psychodynamic psychotherapy, thus enhancing the clinical treatment of the full range of psychiatric and medical patients.
Merrill Herman, M.D.
Addiction Psychiatry Residency Program
The Unified Division of Substance Abuse (DoSA), a division of the Department of Psychiatry and Behavioral Sciences, offers advanced training in all aspects of alcoholism and other substance abuse or dependence.
In conjunction with its affiliated hospitals and medical centers, the division operates the largest academically affiliated substance abuse treatment program in the United States. The Division's largest component, the opiate replacement program, serves 4300 patients at twelve clinics located in five different communities throughout the Bronx. These clinics offer opiate replacement with methadone as well as comprehensive medical and psychosocial services to patients, including complete medical evaluation and follow-up, crisis intervention, and a variety of supportive services.
Integrally incorporated in the Division's activities is involvement in the teaching and training of medical students, psychiatry residents, and graduate students in the health care professions. It also offers consultation and liaison for patients in the care of hospitals affiliated with the medical school, and community education and relations efforts directed towards the grass-roots communities served by clinical units.
Clinical assignments may include inpatient and outpatient alcoholism settings, opiate replacement treatment, day programs, and drug-free outpatient and residential therapeutic community treatment.
In addition to strong clinical training in addiction psychiatry, residents have the opportunity to become involved in clinical and/or basic science research projects in substance abuse. Basic and clinical addiction medicine research is conducted within the Department of Psychiatry and Behavioral Sciences in collaboration with the Department of Epidemiology and Social Medicine, Family Medicine, Internal Medicine, Neuroscience, and Pathology.
Clinical research opportunities include studies in specific behavioral therapies, substance abuse medication development, drug interaction studies in a human lab setting, and clinical trials of new medications to treat primary substance-related disorders in patients with substance-related disorders.
All residents will rotate through addiction psychiatry as PGY2s, and residents who have an interest in clinical or basic science research, teaching, and clinical treatment of substance abuse and its related disorders may choose to continue their education by participating in an elective during PGY4.
Child and Adolescent Psychiatry
Louise Ruberman, M.D.
Co-Director of Training
Division of Child and Adolescent Psychiatry
Audrey Walker, M.D.
Co-Director of Training
Division of Child and Adolescent Psychiatry
The study of Child and Adolescent Psychiatry is an essential component of the general psychiatry residency training program. The training is multifaceted, and includes developmental, psychosocial, neurobiological, and cultural dimensions.
Residents have an opportunity to evaluate and treat children and adolescents from diverse backgrounds in inpatient and outpatient settings and in the context of the community in which they live. Clinical sites include New York City Children’s Center, Bronx Campus with inpatient and day treatment for children up to 18 years of age, Montefiore Medical Center Child and Adolescent Outpatient Clinic, CHAM (Children's Hospital at Montefiore), a state of the art children's hospital which provides a wide range of medical services from primary to tertiary care, and community based schools and clinics. An innovative Adolescent Suicide Prevention outpatient program, using DBT (Dialectical-Behavior Therapy), is available in the Child and Adolescent Outpatient Clinic as a rotation for elective study for interested residents.
The breadth of psychiatric disorders with which patients present is large and ranges from adjustment disorders to psychotic spectrum disorders. Emerging character pathology, disorders of conduct and attention, mood and anxiety disorders and substance abuse are frequently encountered problems. Residents conduct diagnostic assessments as part of a multidisciplinary team, which includes psychiatrists, psychologists, social workers, nurses, teachers and recreational therapists and learn how different mental health practitioners contribute to diagnosis and treatment. Patients are treated with a variety of modalities including:
- Individual psychotherapy
- Family therapy
- Group therapy
- Recreational therapy
- Therapeutic meetings
There is intensive supervision on all cases with particular focus on issues of child and adolescent development and intrapsychic dynamics as well as state of the art pharmacotherapy and cognitive and behavioral modalities. In addition, the resident has the opportunity to learn about consultation and forensic adolescent psychiatry.
Cognitive Behavioral Therapy
Katherine L. Muller, Psy.D.
Director, Cognitive Behavior Therapy Training Program
Assistant Professor, Albert Einstein College of Medicine
Cognitive behavioral psychotherapy is a state-of-the-art treatment approach that has received considerable empirical support and is a critical component of training for psychiatrists today. Our unique program provides comprehensive training in this effective form of assessment, conceptualization, and intervention.
The Cognitive Behavior Therapy Training Program provides residents and psychology interns with an understanding of the cognitive behavioral view of problem development and maintenance. Comprehensive case conceptualization is emphasized throughout the training curriculum. Residents experience the following as part of the PGY3 cognitive behavioral curriculum:
- 16 didactic training seminars
- Weekly small group supervision of clinical cases with expert faculty (3 trainees per group)
- Individual consultation and review of video-taped/audio-taped sessions by expert supervisors
- Structured assessment training and experience with empirically-supported interview and self-report measures
- Supervised structured psychiatric evaluation experiences utilizing the Mini International Neuropsychiatric Interview (MINI) and Structured Clinical Interview for DSM-IV Axis I Disorders
Our program emphasizes the use of empirically-supported treatment interventions. As such, residents may elect to participate in advanced training in specific empirically-supported treatment protocols including:
- Prolonged Exposure for Posttraumatic Stress Disorder
- Cognitive Behavior Therapy for Eating Disorders
- Cognitive Behavior Therapy for Panic Disorder
- Exposure treatment for Specific Phobias
- Exposure and Ritual Prevention for Obsessive Compulsive Disorder
Residents also receive training in cognitive behavioral group psychotherapy approaches and may co-lead a group with our expert faculty members. Some examples of recent groups include:
- Group Education and Skills Training for Posttraumatic Stress Disorder
- Group Skills Training for Depression
- Smoking Cessation Group
- Insomnia Treatment Group
- Weight Management Group
The Cognitive Behavior Therapy Program's training goals are enhanced through the use of materials in our extensive video and audio training library. All trainees have access to these audio and visual materials and may also utilize our assessment materials library. Trainees will have the opportunity to participate in clinical research projects and presentations at major cognitive behavioral therapy conferences.
As part of the PGY 4 curriculum, trainees may choose to continue their cognitive behavioral psychotherapy experience with an individually customized elective. The elective includes further applied training, individual supervision, and a clinical project.
Madeleine Abrams, C.S.W.
Director Family Studies
The family studies program offers a comprehensive training experience in which components of family therapy and systems theory are interwoven throughout all phases of training. Courses and supervision in family therapy are included in the curriculum for the first three years and frequently are continued into the fourth year, the fellowship in Child and Adolescent Psychiatry, and in postgraduate training.
During the first year, residents are introduced to family therapy concepts and systems theory and begin to meet with families. Residents learn to view problems from multiple perspectives, to assess family dynamics and resources, to interview a family, and to conduct a brief intervention. The most extensive experience in working with families occurs during the second year within the six month rotation at Bronx Psychiatric Center.
Residents receive intensive supervision in working with families, participate in a weekly seminar, and have the opportunity to go on home and community visits with their supervisors in order to understand the complexities of mental illness in a multicultural, economically diverse community.
Treatment of couples and families with children is the main focus of supervision in the third year at the outpatient clinic. At the completion of training, residents should understand the importance of family dynamics and context and be comfortable when intervening with couples, families and larger systems. They should have an appreciation for the complex interaction of the family and the identified problem, and should be able to negotiate with and refer to other systems of care as appropriate.
Organizational dynamics and leadership skills are taught to residents within the family therapy curriculum utilizing a group process model. Residents learning family therapy concepts, begin to apply the concepts to themselves and their own families, then to the families of their patients, and, finally to the larger system. By adapting components of family therapy and systems theory within a group at different phases in training, residents develop skills necessary to effectively engage the larger system in which they work, and to become a leader within an organizational structure. Thus, the residents learn to integrate the personal, clinical, and systemic levels of understanding in order to become effective leaders.
Much supervision occurs in small groups and seminars in which the residents become a working group using videotape, film, experiential exercises, live supervision, and case based learning. The process culminates in the PGY4 year within a leadership seminar for chief residents that the Director of Family Studies co-leads with the Deputy Director of Residency Training.
Opportunities for electives and advanced supervision include:
- advanced work in a particular area of couples or family therapy
- mentoring in beginning to teach in the family therapy courses
- individual or small group work on a clinical or research project to be presented at a national or international conference
- publication of an article
- supervision in the area of working with complex systems, and other areas of interest to particular residents
Creativity and the pursuit of innovative projects are encouraged and supported. Full or half day seminars, during which recognized leaders in the field of family therapy are invited to make presentations further enriches the training experience in family therapy.
Social and Community Psychiatry
Daniel Smuckler, M.D.
Associate Director for PGY II Residents Director
Division of Social and Community Psychiatry
Our Department of Psychiatry and Behavioral Sciences has played a major innovative and leadership role in the evolution of Social and Community Psychiatry as a subspecialty area in our field.
Some of the services pioneered or substantially developed within this department include:
- Day hospital
- Community mental health centers
- Mental health advocacy
- Community residences
- Sheltered work
- School consultation
- Prison mental health programs
- Family-based community clinics
- Homeless shelters
This tradition continues in an exciting range of areas emphasizing the comprehensive care of defined populations at risk. Starting with an epidemiologic base, residents learn preventive efforts with community and family groups and review service delivery systems. Supervision covers evaluation, research, fiscal concerns, and cultural dimensions. Residents examine the context in which people live and service is delivered. Resources used include:
- Intensive Case Management teams, which offer comprehensive care of chronic patients and innovation strategies of psychiatric rehabilitation;
- Forensic Psychiatry, affording experience in service delivery issues, suicide prevention, careful neuropsychiatric diagnosis, and substance abuse issues;
- School-based services for adolescents with psychiatric difficulties, including consultation to staff, supervised clinical groups and program development;
- Refugee clinics, offering a review of the refugee experience, and evolving concepts of Post Traumatic Stress Disorder, and collaboration with ethnic communities on culture-based healers;
- Liaison to primary care medicine, including the teaching of nonpsychiatric physicians, the planning of medical self-help groups, and designing primary prevention programs.
- Attend a lecture seminar on seminal readings in social and community psychiatry and have an overall preceptor and field supervisors for their clinical work.
Behavioral Health Management
Bruce J. Schwartz, M.D.
Deputy Chairman and Clinical Director
Professor of Clinical Psychiatry
Department of Psychiatry and Behavioral Sciences
Trainees in the Einstein/MMC Department of Psychiatry and Behavioral Sciences have a unique opportunity to gain experience and training in the management of behavioral health service through our own nationally renowned,academically-owned and operated management company. The practice of psychiatry has changed significantly over the last decade, driven by the reorganization in the delivery and financing of health care. Changes are occurring throughout medicine, and challenges to the way our profession cares for patients are being brought about by insurers, health maintenance organizations (HMOs), and for-profit behavioral managed care organizations, which are seeking to control expenditures and care delivery.
These forces have fostered the development of care continua, integrated delivery systems, and new attention to practice guidelines and outcome assessment. The ever-increasing market dominance by HMOs and managed care organizations requires psychiatrists to develop special skills, a sophisticated understanding of cost effective treatment strategies, and knowledge of economic and organizational issues to advocate for our patients and profession.
The Department of Psychiatry and Behavioral Sciences is at the forefront of mastering these challenges and changes in the behavioral health marketplace. Through our own not-for-profit behavioral management services organization (MSO), University Behavioral Associates, and our independent provider association (IPA), the Montefiore Behavioral Care IPA, we have pioneered a new model of provider-dominated behavioral health care delivery. Our provider organizations oversee the delivery of care to Medicare, Medicaid, and commercially insured populations on a fully capitated basis throughout the Bronx and Westchester Counties.
Residents may choose this elective to prepare themselves for careers in administrative psychiatry, managed care, practice in organized settings or the general practice of psychiatry, as forces in the medical marketplace are shaping it. Trainees gain a working knowledge of a provider-driven utilization and quality management company and become familiar with financial, clinical, theoretical, and regulatory issues pertaining to provision of managed behavioral healthcare.
Residents also have opportunities to work with staff providing managed behavioral healthcare and to receive additional training in brief psychotherapy, cognitive behavioral treatment, and psychopharmacology. Additional options include participation with senior management to analyze utilization, quality and outcomes data for possible publication.
A wealth of information in the understanding of brain and behavior is unfolding daily, and MMC is strongly committed to cultivating research aptitude in our trainees. Interested residents are encouraged to participate in research activities at either the Moses or Weiler Divisions of Einstein. Working within the ACGME requisites, residents will be able to engage in research elective activities as early as the PGY 2 year and sustain involvement throughout training. There are several research opportunities throughout the Einstein-MMC complex, a few of which are highlighted below.
At the Moses Division, residents may opt to conduct research in a variety of psychiatric disorders ranging from Autism to Mood Disorders. Dr. Eric Hollander is currently investigating Compulsive, Impulsive and Autism Spectrum Disorders.
Elective study may include research on the phenomenology, neurocognition, neuropharmacology, brain circuitry and treatment of these disorders. Current research projects in OCD Spectrum disorders include developing new pharmacological treatments for pediatric body dysmorphic disorder and participation in reviews and field trials for DSM-V.
Research in Impulse Control Disorders include raclopride PET imaging of dopamine release in the striatum in response to computerized gambling tasks in Pathological Gamblers, and comparison of these findings to those in other addictions. Current research opportunities in Autism Spectrum Disorders include developing new treatments for autistic adult core symptom domains, such as social deficits and repetitive behaviors, with the intranasal oxytocin peptide, and participation in NIH STAART publications.
The Anxiety and Depression Program seeks to develop and evaluate a number of new treatments for these disorders as well as understand their biological underpinnings. Examples of projects are evaluating alternative treatments for depression that may be more promising than those that are now FDA approved, including the use of a neurokinin antagonist, the addition of an atypical antagonist to an SSRI, and a new norepinephrine reuptake inhibitor. In addition this program has interdisciplinary protocols with the Gastroenterology division evaluating, treating and preventing interferon-induced depression and insomnia. Residents are encouraged to participate in all phases of research including presenting and publishing study results.
Residents may also elect to become involved in clinical research exploring parasuicidal behavior in adolescents, effects of trauma in the chronically mentally ill, and PTSD. Elective rotations are individualized to meet the resident’s scientific and clinical interests.
Forensic Elective Awaiting description Global Health Electives
Residents have the opportunity to travel to Uganda to participate in a global mental health elective. There, they experience and learn more about differences in attitudes toward and treatment of mental health while being fully immersed in the local culture. Please continue reading for a description of the experience from one of our residents who visited Uganda in April 2015.
“In Uganda, we stayed in the town of Kisoro, in the southwest corner of the country, very close to the border with Rwanda. We stayed in housing that is designated for visiting doctors, and it was comfortable. We each had our own bedroom and shared a kitchen and bathroom in a 3 bedroom apartment. Kisoro is frequented by travelers, as there is much to do and see in the area, including gorilla trekking, hiking mountains, and relaxing at nearby lakes. We took advantage of all of these! The hospital where we worked is called Kisoro Hospital, which has multiple wards on which we saw patients, both primary psychiatry patients and medically hospitalized patients who needed psychiatric consults. On market days, when people from the surrounding villages would flock to Kisoro for the market, we would see outpatients in the psychiatric clinic located on the hospital grounds. We also traveled (by car and by foot) to the villages in the mountains surrounding Kisoro and did home visits with patients who were either too sick or lived too far away to easily see us in the clinic. It was a wonderful experience, highly recommended.”