LAUSR

Among the many challenges in learning psychotherapy are mastering the ability to observe the patient’s affective state, maintaining awareness of one’s own feelings, and making appropriate therapeutic interventions. In order to choose an appropriate intervention, the therapist must be able to identify nuances of behavior and shifts of affect and body language, which reveal key elements important to treatment planning. Video recordings of sessions can be useful in a number of areas. These include teaching the trainee to identify psychological themes, patterns of communication, and emotional responses from visual cues [1]. However, additional methodologies can enhance this process by fostering hypothesis generation and testing about mental states that are not conveyed through speech and changes in posture. Art exercises have been used to improve observational and pattern recognition skills among medical students [2–5]. These include identification and description of emotions in representational human portraits and reflection exercises with art portraying real-life conflicts focusing on developing insight and empathy for patients’ personal experiences [3, 5, 6]. Facilitated group discussions that encourage attention to and integration of visual details and description of emotions are key elements of these exercises [3, 5]. Art exercises have also been used in residency education to promote observational skills, reflection, critical thinking, interpretation of human emotions, and empathy [7, 8]. Recently, visual thinking strategies (VTS), an art-viewing curriculum that focuses on development of critical thinking skills [9], has been introduced to residency education to accomplish similar goals.While designed initially for school-age children, VTS has been successfully employed in medical education, where it was found to increase tolerance of ambiguity, empathy and analytical thinking [10, 11] by encouraging learners to engage in careful observation, evaluation, synthesis, speculation, and justification of their ideas [9]. We have used the visual arts in a variety of settings to encourage psychologically informed art appreciation in medical students and residents. Our clerkship curriculum has established a highly rated session in which visual art is utilized to increase observational skills of students and encourage them to speculate about psychological themes affecting the artist. Students are then provided with information about the artist’s work in the context of biographical data that can refine the students’ observations. To expand on the success of this session, we developed an “art and psychotherapy” exercise for PGY-2 through -4 residents, utilizing a similar, but more sophisticated format that emphasizes psychotherapy applications. The goal of the exercise is to enhance observational skills using visual stimuli, integrate conceptually the significance of what they observed to hypothesize psychological themes, postulate appropriate interventions, and revise their hypotheses based on real-time group and faculty feedback.