Psychiatric News June 18, 2004
Volume 39 Number 12
© 2004 American Psychiatric Association
p. 35
Programs Try to Restore Luster To Psychodynamic Psychotherapy
Joan Arehart-Treichel
Psychodynamic psychotherapy is no longer the dominant treatment that it
once was in psychiatry. Psychiatrists recently discussed ways to change that
situation.
As American psychiatrists know, psychodynamic psychotherapy has lost some
of its standing as an important treatment tool. Yet before Sigmund Freud rolls
over in his grave out of distress over the status of his brainchild, he should
know that some heroic efforts are being made to breathe new life into
it.,
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David Mintz, M.D.
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Mintz, a talented cartoonist, brings his multifaceted observational
skills to his work with patients—and his colleagues.
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The attempts have to do with passing psychodynamic psychotherapy on to the
next generation of American psychiatrists— and in a way that makes the
therapy meaningful to them.
This was the major take-home message of a number of sessions held at the
annual meeting of the American Academy of Psychoanalysis and Dynamic
Psychiatry, held in New York City April 29 to May 2.
Competencies Come to the Rescue
One major effort to ensure that psychodynamic psychotherapy remains a
valued treatment option is that all U.S. graduating psychiatry residents must
demonstrate competence in five core psychotherapies—brief psychotherapy,
supportive psychotherapy, cognitive-behavioral therapy, psychodynamic
psychotherapy, and psychotherapy combined with psychopharmacology. The
competency standards were designed for residency programs throughout the
United States by the American Association of Directors of Psychiatric
Residency Training Task Force on Core Competency and the APA Committee on
Psychotherapy by Psychiatrists (Psychiatric News, January 18, 2002).
The requirement to test residents' competency in the five psychotherapy
modalities was implemented by the Residency Review Committee in Psychiatry in
2001.
David Mintz, M.D., director of residency training at the Austen Riggs
Center in Stock-bridge, Mass., believes that the competency standards are
helping stem the tide regarding the demise of psychodynamic psychotherapy.
Psychodynamic Courses Get Creative
Another crucial attempt to give psychodynamic psychotherapy new life is to
pep up psychiatry residency courses on the subject.
One such course is being taught by Elizabeth Auchincloss, M.D., director of
psychiatry residency training at Weill Cornell Medical Center. It is directed
to psychiatry residents in their second year and presents some of the
scientific evidence underpinning psychodynamic psychotherapy. Students are
requested, for example, to read a paper by psychiatric geneticist Kenneth
Kendler, titled: "What Is the Mind?" They are also asked to read
about scientific findings regarding unconscious processes and the role of
consciousness in meditation.
Another innovative course is being taught by Eve Caligor, M.D., a clinical
professor of psychiatry at Columbia University. She focuses on a model of the
mind that she has evolved over a number of years and that she considers a
framework for psychodynamic psychotherapy. Residents who have been exposed to
this model appreciate it, she reported, and she is optimistic that they will
not forget it as they move along in their psychiatric careers.
A third course is being taught by Mintz, in which he combines psychodynamic
psychotherapy with psychopharmacology. "Residents are hungry to become
better prescribers," he said, "so you can actually teach a lot of
psychodynamics by teaching the psychodynamics of pharmacology."
This course, he pointed out, also dovetails with the new psychiatry
residency competency of being able to combine psychotherapy with
psychopharmacology.
What does Mintz do in this course? For one thing, he tries to show
residents how an education in psychodynamic psychotherapy can benefit them in
practical ways. For instance, he said, such an education can reveal to
residents why they so often feel distressed or in conflict; it may also help
them come to realize that when they fail to help patients, it may be due not
just to their personal inadequacies, but to the nature of psychiatry
itself.
Such an education can also explain why patients with personality disorders
may want to use medications to deaden themselves when they do not want to face
something. It can also demonstrate how psychodynamic psychotherapy can be used
to help lower patients' resistance to taking medications.
Then Andrew Gerber, M.D., a psychiatry resident at Weill Cornell Medical
Center, will be introducing a psychiatry residency course this fall on the
crossover between psychodynamic psychotherapy and neuroscience. He not only
will be presenting studies on the two subjects of psychotherapy and
neuroscience to residents, but also will be discussing some of the challenges
of conducting research on psychodynamic psychotherapy—for example, how
do you measure therapeutic change in patients, and what is it about the
therapeutic alliance that helps patients get better? All of this material,
Gerber anticipates, will give residents an idea of where psychodynamic
psychotherapy stands today. In fact, it may even prompt some residents to want
to do some of this research and move the field forward.
Still other suggestions on how to return psychodynamic psychotherapy to its
rightful place were aired at the meeting. For example, Myron Glucksman, M.D.,
a clinical professor of psychiatry at New York Medical College, suggested that
some radical methods are needed to engage in psychodynamic
psychotherapy—say, perhaps some could specialize in it.
"I like your idea of having a subspecialty training track for those
who would like to specialize in analysis," a psychiatrist listening to
his talk commented afterward.
Then Joel Wallack, M.D., director of psychiatry at Cabrini Medical Center
in New York City, suggested teaching an integrated model of the
psychotherapies to residents, and afterward they could become experts on
specific therapies during later fellowships. 
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