Essentials of Psychiatry:
Empathy, Research, & Perspectives
Revised 2022
Hoyle Leigh, M.D.
Professor of Psychiatry, UCSF
Course Director
Overview
of the Series
hleigh.net/Essentials of
Psychiatry/Perspectives CRS/Why We Get Sick.pdf
Essentials of Psychiatry: Empathy,
Research, and Perspectives is
an integrated course consisting of three parts – 1. Empathy, 2.
Psychiatric Rsearch, and 3. Perspectives of
Psychiatry. The course begins with introduction to research, and the members of
the class will develop their research projects in the beginning part of the
course, then the class will study empathy and practice it in exercises and role
playing, and then study important perspectives in the
development of psychiatry. Interspersed in these parts will be reports
on the progress of the research project as well as critiques of published and
unpublished research papers. These exercises will help develop an
evidence-based approach to medicine and psychiatry. The course will end
with presentations of completed research projects, which must be submitted to
the course director in a publishable form prior to the end of the year-long
course.
____________________________________________________
Psychiatric Research Part 1
In Preparation
Everyone should take the Human
Research on-line course by going to https://www.citiprogram.org and Registering. This
is necessary to do any research in UCSF and/or the VA. Please
sign up for two institutions, one for VA - "Fresno, CA-570,"
(ID: 153) and "University of California, San Francisco" (ID:
1215). The course name is "Human Research." You can
affiliate with as many institutions as you like, so residents can use this as
they go on to do research at other hospitals. This will take up to 2 hrs.
Session
1. The
Consultation-Liaison Database: How to Use It, Confidentiality, Secure
Communication
Hilary Ross, Esq., Director, UCSF Fresno Risk Management
Hossein Moazamipour, Diector,
UCSF Fresno Information Technology and Security
Peter Heyne, Application Developer, Corporate Information Systems,
Community Medical Centers
Harpreet Bains,
Database specialist, UCSF Fresno
Hoyle Leigh, MD
This is a mandatory session for all residents and faculty
using the CL Database
Reading Material for Session 1: What is Research? Part I. Stories
An excellent optional background reading material:
The Conduct of Inquiry by Abraham Kaplan (selections)
Session 2.
Introduction: What is Research?
Reading Material for Session 2: Research Methods Part 2. Research Methods
Homework: Please develop a Research Question
Other optional readings: the famous Einstein-Podolsky-Rosen
Paradox
Science Article: Spooky twins survive Einsteinian torture
Einstein-Podolsky-Rosen Paradox
Session
3. Developing a Project
Discussion of the Research Questions each member brought
NOTE: IRB Approval is an Essential Procedure.
1. For those who will do the project using
records or patients at CRMC, including the CL database, you should fill out the
CRMC IRB form, or obtain it The IRB form is here. To obtain it from CRMC,
go to www.mycmc.com, then log on with your username and
password. Then, click on Community forum on the Left Side of the Page under DESKTOP
APPS.
2. 
Then you will get to the Community
Forum page. On top of the page, there is a bar with Home on the left, and
in the middle is the Documents. Click on the Documents, then on the Misc
Forms, then IRB Application.
2. For
those of you who wish to do a project on VA patients, please use the VA
forms here.
*Reading for Session 4: Review the Insomnia Manuscript and score it, write a critique
and bring them for discussion. The scoring form and critique form are in the
front of the manuscript.
Session
4. Critique of a Research
Paper, Writing Up the Proposal
Using Others to Help: Collaborators, Consultants, Statisticians, Slave
labor, etc.
After this session, please make appointment with the consultant
Reading
for Session 4: Review the Insomnia Manuscript and score it,
write a critique and bring them for discussion.
Session 5.
How to set up data so that they can be analyzed? What
statistical methods to use?
Ronna Mallios, Ph.D.
Session
6. Please
review and score the CATIE paper
for discussion during this session
Additional Resource: Harvard Review
of CATIE,
Please use the GENERIC SCORING FORM for all reviews.
Session
7. Report of Status of Projects to Consultant:
Are conceptual issues clear? Be ready to set up database/methods with Consultant
Ronna Mallios, Ph.D.
Session
8. Work with Consultant
Ronna Mallios, Ph.D.
Session
9. Please review and score the Star*D study
Additional Resources: Star*D after SSRI
Grik gene and treatment for depression
Serotonin transporter gene and treatment
Session 10. Work with Consultant
Session 11. Work with Consultant
Session 12. Work with Consultant
Session 13. Project Review : Are we all set to obtain/analyze data?
Session 14. Review and Critique of
Huntington paper
Also, please review and score the serotonin transporter, depression, stress
and heart study.
.
Session 15. Review and Critique
of cataplexy paper
Session 16. Project Status and Discussion
NEXT SESSION BEGINS
Part 2 of the Course, Empathy, to be followed in the Spring by Research again.
Part
2. Empathy
Course Objectives:
This course is
designed to teach the resident or advanced student the basic concepts and
skills concerning empathy and to teach basic counseling techniques utilizing
empathy. At the end of this course, the trainee should be able to define
and discuss the concept of empathy, and associated terms (such as active listening),
be able to conduct an interview using empathic skills, and perform
problem-oriented counseling.
Reading Material (Sections provided in
the Syllabus):
The basic textbooks are: The
Skilled Helper: A Systematic Approach to Effective
Helping, by Gerard Egan, Brooks/Cole Publishing Co, Pacific
Grove, CA, 1990.
and Interpersonal Living: A
Skills/Contract Approach to Human-Relations Training in
Groups, Brooks/Cole Publishing Co, Monterey, CA ,
1976
Sections of The Skilled Helper are
reproduced in the syllabus followed by sections of Interpersonal
Living.
Other reading material will be
distributed as necessary.
Session 1. Doctor Patient
Relationship
Reading: Leigh & Reiser, The
Patient: Biological, Psychological, & Social Dimensions of Medical
Practice, 3rd Edition, Chapter 17,The Doctor-Patient Relationship
M & Rizzolatti, G
: Mirror Neurons and
Mirror Systems in Monkeys and Humans
1. What is doctor-patient
relationship? Doctor-client ?
2. What are the expectations of the
doctor by the patient?
3. What do patients feel when they call
a doctor, sees him/her,
4.What are the specific therapeutic
effects of simple doctor-patient relationship?
5. Are all expectations of the patient
about the doctor conscious? If not, why not?
6. What are the expectations of the
doctor about the patient?
7. What are "sick role"
expectations (Talcott Parsons)?
8. What is the role of
communication in doctor-patient relationship?
9. Why is empathy a sine qua non of
successful doctor-patient relationship?
Egan G: Skilled Helper Chapter 5. Communication Skills I: Attending and Listening (pp 106-121)
1.
Is communication skill itself beneficial? If so, for whom, if not,
why not?
4.
Why should a helper not sympathize with a client?
5.
What is the goal of attending and active listening?
7. What is context and why is it important?
8. How do you know if empathy is accurate?
9. How might empathy be misused?
Session 3. Techniques of Empathy,
Probing, Exercises
Egan G: Exercises in Helping
Skills Part Two - Basic Communication Skills for Helpers
Reading: Egan G: Skilled
Helper Chapter 6. Communication Skills II: Empathy and Probing
In what
helping situations would one or more of SOLER be inappropriate?
a. Respond empthically to
move on (make progress)
Then, check out your understanding with
the client with the formula:
You feel is followed by appropriate FAMILY and
INTENSITY of feeling
Because is followed by experiences and/or
behaviors
Listen to the CONTEXT, not just the
words
HOW TO TELL IF EMPATHY IS ACCURATE
a) some form
of verbal or nonverbal confirmation
b) client moves
on to provide more details about the problem situation
a) some verbal
or nonverbal indication of inaccuracy
b) should lead
to helper’s restatement, modification, or correction
c) which will
move the therapy forward
Some Do's and Don'ts in Expressing
Empathy
gear yourself to client, but
remain yourself
sympathy --- leaves the helper in
a participant stance only
1. Do not assault clients with volleys
of questions
2. Ask questions that serve a purpose
4. Keep the focus on the client
: have clients ask relevant questions of themselves
5. Statements that encourage clients to
talk and clafify
6. Interjections that help clients to
focus
7. Cautions in the use of probes
The Communication of Accurate Empathic
Understanding: Creating a Climate of Support
Primary-Level Accurate Empathic
Understanding
Primary Level Accurate Empathy
Communication to the other person that
you understand what he says explicitly about himself.
If advanced accurate empathy is used
too early in a relationship, it can be too frightening.
Some Common Problems in Communicating
Primary-Level Accurate Empathy
2. Premature advanced accurate empathy
6. Jumping in too quickly or letting
the other ramble
Session 4: Counseling - A Basic Technique in
Psychotherapy
Egan, G: The Skilled
Helper Chapter 2 - Overview of the Helping Model
Egan, G: Exercises in
Helping Skills: Part One - Laying The Groundwork
The Kinds of Helpers: formal, informal, etc.
Helping as an Education Process
The Starting Point: Clients with problem situations and
unused opportunities
The stages of the helping process
Stage 2: The Preferred Scenario
Egan, G: The Skilled
Helper Chapter 3 - Building the Helping Relationship - Values in Action
Egan,
G: The Skilled Helper Chapter 4 - Action I - helping Clients Act
Session 6. Exercise
and Role Playing (1)
Session 7. Exercise
and Role Playing (2)
PLEASE NOTE: BEGINNING NEXT WEEK, PERSPECTIVES OF PSYCHIATRY BEGINS
READ THE MATERIAL BEFORE THE SESSION
EACH RESIDENT WILL TAKE TURNS IN DISCUSSING THE READING MATERIAL
Part 3. Perspectives of
Psychiatry
Brenner, Charles : An Elementary Textbook of Psychoanalysis
paperback, Doubleday
Anchor Book
Hall, Calvin S & Nordy, Vernon J: A Primer
of Jungian Psychology
SCHEDULE AND ASSIGNED READING
MATTER
Each resident takes turns in discussing the reading material and
raising questions
Session
1. Cross Cultural Psychiatry 1:
Session 2. Cross Cultural Psychiatry 2:
When the Spirit Catches
You, You Fall Down
Background Reading:
Malleus Maleficarum (Witch's
Hammer)
Session 3. Freud
I
Charles
Brenner: An Elementary Textbook of Psychoanalysis
Movie:
Spellbound, directed by Alfred Hitchcock,
Optional
Viewing - DVD from Netflix, etc. or
free at Youtube (13 segments)
Freud
Case Histories (Optional Reading)
Session
4. Freud II.
Brenner:
An Elementary Textbook of Psychoanalysis
Session 5. General Discussion of Freud and Dynamic Psychiatry
Session 6. Jung I. Audrey Punnett, Ph.D.
Analytical
Psychology of C.G. Jung
A
Study of the Application of Psychological Types in Psychotherapy
Session 7. Jung II. Audrey Punnett,
Ph.D.
C. G. Jung: Man and His Symbols (Readings
from) Part
I
Session 8. Hypnosis
I
Session 10. Psychiatry: 21st Century & Beyond I.
Session 11. Psychiatry: 21st Century & Beyond II.
A
Proposal for a New Multiaxial Model of Psychiatric Diagnosis:
A
Continuum-Based
Patient Model Derived from Evolutionary
Developmental Gene-Environment Interaction
Psychopathology
2009;42:1–10
Session 12-13. Psychiatry: 21st Century & Beyond. III-IV.
E. Epel: Telomere shortening and
stress
H. Leigh: Genes, Memes, Culture, and Mental Illness: Toward an Integrative
Model
Chapter
9. Storage and Evolution of Memes in the Brain.
Chapter
12. What is Mental Health?
Chapter 13. What is Mental
Illness?
Session 14. Psychiatry: 21st Century & Beyond V.
Chapter.
16. Principles of Memetic Therapy
Chapter
26. Challenges for the Future
RESEARCH
COURSE PART 2
Session 1.
Overall Progress of Each Project
Session 2.
Project Presentation
Session 3.
Project Presentation
Session 4.
Project Presentation
Session 5. Project
Presentation
