The teaching of psychotherapy in Canadian psychiatric residency programs: residents' perceptions.

In order to determine the residents' perceptions toward their psychotherapy training, a questionnaire was distributed to 400 residents in the 16 Canadian psychiatric residency programs. The main areas studied were: the resident's demographic and educational characteristics; the residency program characteristics; the type of training available in different psychotherapeutic modalities; the analysis of quality and quantity of attention given to different elements of psychotherapy supervision (patient assessment, diagnostic formulation of treatment approach and goals); the degree of importance attributed by the residents to the above mentioned elements of psychotherapy supervision; and the residents' perception of their supervisor's attributes (examples: teaching ability and rapport). Forty-two percent of the residents completed the questionnaire. Residents mentioned that the most adequate supervision was for long-term individual psychotherapy cases and that behavioral and group therapy supervision was the least adequate. The three most essential qualities in a supervisor's profile were judged to be: capacity for the development of a good rapport with the trainee; ability to pinpoint residents' psychotherapy shortcomings and his willingness to help residents to overcome them; ability to teach. Three factors that significantly influenced the trainees perception of their psychotherapy training were: resident's age, a seminar in individual psychotherapy in the residency core program; having received more than one hour weekly of psychotherapy supervision. The understanding of patient's psychodynamics was the most adequately taught element during psychotherapy supervision.

Multidisciplinary survey of erectile impotence.

A study was done of 220 men referred principally by family physicians to a multidisciplinary erectile dysfunction study group to determine the factors causing or contributing to impotence that had persisted for more than 2 months and for which no cause was apparent. The men were aged 21 to 79 (mean 50.3) years, and the duration of impotence was a few months to 15 years (mean 2.65 years). The men were to be assessed from general medical, endocrinologic/metabolic, psychiatric and urogenital viewpoints. The significance of the causal or contributory factors detected was scored by application of defined criteria and a four-point scale. The degree of loss of potency and of libido as well as level of concern were also scored by each specialist. Impotence was complete in 60%, and an associated decline in libido was reported by 38%. The level of concern was high--that is, normal--in 81% and slightly reduced in 9%. Full investigation by all the specialists was precluded by the severity of other conditions in 16 patients, by the return of potency following relief of anxiety/depression or genitourinary tract infection in 16 and for logistic or other reasons in 34. Although the cause of the impotence could be attributed in 186 of the patients, only 154 were fully assessed. Among these patients general medical factors were contributory in 46%, endocrinologic/metabolic factors in 44%, psychogenic factors (primary or secondary) in 60% and urogenital factors in 49%. Multiple contributing factors were identified in 65%, which underscores the importance of a multidisciplinary approach to assessing many cases of impotence.

Erectile impotence: a clinical challenge.

The wide range of factors that may contribute to impotence is reviewed in an attempt to establish a systematized approach for assessing etiologic factors. The effects on potency of ageing, general fitness, weight, debilitating disease, use of therapeutic and other drugsincluding alcohol and neurogenic, vasculogenic, endocrine/metabolic, urogenital and psychogenic factors are considered and discussed. The review also affords a rationale for the methodology employed.