Learning and delivering psychotherapy to psychiatric patients is a challenge for most psychiatry residents; for the international medical graduate (IMG) physician, psychotherapy is an even greater challenge. IMG physicians enter training programs in the United States with their unique cultural experiences, social norms, language, and varying degrees of exposure to communication skills training or psychotherapy in medical school. These are some of the factors that can influence learning psychotherapy in this cultural environment, and attention must be paid to these issues when designing training programs. More importantly, there should be an emphasis on learning the general relationship skills before learning specific psychotherapeutic interventions. Certain methods of teaching and learning psychotherapy have been found to be effective; and these techniques should be incorporated in training programs. This chapter will not only discuss the critical issues IMG physicians face in learning psychotherapy but also will discuss important areas for consideration in designing psychotherapy training for this group of trainees.