In Response: The Place of Psychotherapy Training in Residency Programs

As a belated response to th e deba te about the value of teaching psych othe rapy in psychi atric residency traini ng, (j efferson J ournal of Psychiatry, Vol. 5( I ):54-66, 1987) 1 wo uld like to add my vo ice to th e affirmative side. That there is suc h a debat e seems sym pto mat ic of a n unfo r tunate and unnecessary misuse of impor tan t ad vances in neurobiol ogy to justi fy the sidelining of psych odynamic psych o therapy. A sea rc h of the psych iat r ic literature of recent years re veals an em phasis on biol og ical psych iatry and a re lative neglect of psych otherap y. A similar trend has been no ted in some residency programs a nd in th e an nua l meet in gs of the American Psychiatr ic Association . However, th e pendulum appears to be swinging back , as was demonstrated at a recent meeting of the A PA, where pan els and lectures on psych otherapy attracted overflow audiences. A symposium on psych otherapy sponsored by the Am erican Psych oanalytic Associat ion could not be contained in th e 200 seat room and several hundred other people had to be sh unte d into adj ace nt rooms where the dis cus sion cou ld be hea rd over loudspeak ers. T he a ud ience, co mposed mainly of young people , was obv ious ly hungr y fo r more infor mation on the psychologi cal aspect of psychiatry, a fact no ted by officers of the A PA who recognized th e relat ive im balance of the recen t p rograms. As a n examp le of th e kin d of interest that brough t so man y you ng psych iatrists to that symposium, quest ions were raised by severa l in th e audience about deali ng with unruly emotions a nd irrat ionality in thei r patients, whil e others extended th a t to include simi lar reactions in themselves . T hey were clearly not satisfied with a medication-only approach th at wo u ld assume th at such reac tions we re sim p ly epip henomena of a biological di sorder , fo r which drugs could be give n to erad icate undesirable emotions. A prefer ence for this way of avoid ing or co ntro lling unreason and d ist r essing affects ma y often ste m from a need to control fee lings aroused in resonance with the patient's storm y emot ions . It is a lso frequently co up led with claims that th e efficacy of psych otherapy is un p roven , or that it is not co st-effective, or that other health professionals can supply it. T he other way is to recogn ize that bo th we and our patients are ca pa ble of a wide ra nge of fee lings and th ou gh ts, sometimes reasonable and som etimes