Psychotherapy Long case Please advise!!!!

6 posts in this topic

I am stuck with this competency. First 4 cases were discharged as ineligible. Am now seeing my fifth case. I have the following questions I will be grateful if you can share your experience in the following areas 

1. Case selection- does the consultant choose the case or trainee choose the case? Please state the locality if you know 

2. Duration- how many sessions? Please state the locality if you can 

How long? Locality if you can

3. Assessment- when is SAPE done? Please state locality if you can 

When is PACE done? 

4. Signing off- what is the criteria? 

5. Special circumstances- 4 cases I had were not suitable and I started my 5th case on 23 Feb (My ARCP for CT3 was due in August). So ARCP gave me an extension of 6 months.Then due to my family circumstances my parents being too old and frail, I needed to go home abroad on unpaid leave for 4 weeks in  August. Then I continued the therapy. Now I am told that I need to do until the end of March. The attendance was regular.

On the other hand due to my family circumstances, I might need to leave at anytime. I was told that if I don't complete it till March I won't be signed of and I will not progress into the higher training

Does anyone has any advice? 

Many thanks 



Edited by ppaung

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Hi, I think you need to ask your own training programme about this, as different places will have different views. I can give you the answers from my experience though...

1. My supervising consultant chose my case. The consultants identified all the cases for my cohort of trainees, and most engaged reasonably well. There were a couple of patients who discontinued, but other suitable cases were identified.

2. In my area, the long case is for 1 year. As most trainees start it in CT3 (due to the structure of the psychotherapy training in my area), there's an agreement that the trainee will continue to see the patient into their next job unless they move out of the area.

3. My SAPE was done at 6 months - most of my cohort of trainees had theirs done at around that time, as it's meant to be about halfway through your case. The PACE is done at the end. But, only 1 PACE is required for CT3 sign-off, so that's achieved in the other modality.

4. I'm not at the stage of doing the PACE yet, so can't comment on the sign-off criteria for it. But, time-wise, I think it's at least 20 sessions, plus passing the competencies in the assessment.

Given that you've had 4 unsuitable cases or discontinuing patients, I think it would be reasonable to think about whether those clinical contacts could count towards the competencies. Sometimes people can count some of their appointments with a discharged patient towards the sessions needed for sign-off - so, you might be able to argue that you've met at least some of the time commitment required. Speak to your TPD and Psychotherapy supervisor about your concerns, as there are generally options available - maybe a time-limited case of 20 (or fewer) sessions, or seeing someone more than once per week for some modalities, writing up and being assessed on the cases you've done (if you saw them for some time before they didn't work out)?

If people aren't being supportive, it might also be worth speaking with the BMA and asking their opinion on this. Another option would be to leave the long case for now and go into a specialty doctor post until things with your family are more settled, although I can appreciate that has its own challenges.


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Dear Vakarian,

Thank you very much for your suggestions and sharing your experiences

Appreciate it very much

It's very kind of you taking time to answer my questions

Do you know if there is any document where I can find how many PACE is required? Do you have medical psychotherapist to supervise you? In our place only one person who is the medical psychotherapist who is a consultant supervise and sign off the trainees.

In our place, we are asked to do 2 SAPEs and one PACE for the long case and one SAPE and one PACE for short case. My short case is completed with successful outcome. 

The situation is tricky in my workplace where there is a shortage of juniors and releasing a trainee is a loss and we have difficulty recently

Have a good weekend,

Edited by DoctorInTraing

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Seriously I just realized PACE is not listed in curriculum or ARCP aid!

I emailed portfolio to clarify.

In my place we have long case of minimum 20 sessions. 

As far as I understand the supervisor doesn't have to be medical psychotherapist but someone who has competencies to do supervision for psychotherapy, 

so senior psychologist is ok. 

Have a good weekend


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They replied saying that "The college no longer provides minimum numbers of assessments as it felt that it encouraged trainees to focus on the quantity of assessments."

So I'm guessing it's down to local arrangements.

Hope it helps,

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