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Addressing Nicotine Dependence in Psychodynamic Psychotherapy: Perspectives From Residency Training

Received February 8, 2006; revised May 9, 2006; accepted July 6, 2006. Drs. Prochaska, Fromont, Banys, Eisendrath, Horowitz, Jacobs, and Hall are affiliated with the Department of Psychiatry, University of California, San Francisco, California. Dr. Fromont is also affiliated with Alta Bates Summit Medical Center, Berkeley, California. Dr. Banys is also affiliated with the San Francisco Veterans Administration Medical Center, California. Address correspondence to Dr. Prochaska, 401 Parnassus Avenue, TRC 0984, San Francisco, CA 94143-0984; JProchaska{at}lppi.ucsf.edu (e-mail).

OBJECTIVE: According to APA treatment recommendations, psychiatrists should assess and intervene in tobacco use with all of their patients who smoke. The ease with which this occurs may vary by treatment model. This study examined perspectives in residency training to identify a framework for addressing nicotine dependence within psychodynamic psychotherapy. METHOD: The authors collected data from a focus group of psychiatry residents and interviews with psychiatry residency faculty with expertise in psychodynamic psychotherapy. The transcribed interviews were analyzed for key themes and synthesized. RESULTS: Though the residents reported hesitancy to address patients’ tobacco use, specifically in psychodynamic psychotherapy, the consensus from the expert faculty consultants was that tobacco interventions can and should be incorporated. The faculty provided suggestions, consistent with a psychodynamic formulation, for assessing patients’ tobacco use and their interest in quitting, providing cessation treatment and/or referrals, and following up with patients to address relapse. CONCLUSIONS: The findings provide a useful framework, consistent with a psychodynamic model, for assessing and treating tobacco use with patients. Additional training and supervision likely are needed to increase residents’ confidence and comfort with implementing these strategies.

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