Psychodynamics: The State of the Art

Whither psych odynamic psychotherapy in th e era of managed ca re? This is th e ce nt ral qu estion raised (and a nswere d) in a new text ed ited a nd, in part , au t ho red by H a rveyJ. Schwartz, MD . In his introduction, Schwar tz says, "T his book is int ended as an inv itation. An invit at ion to ge t to know how a number of psych oa nalyt ic psychi atri s ts think abou t th eir patien ts, th eir work, a nd in th e process, th em selves." His book , however, ends up being a grea t deal more t ha n th a t. The ea rly cha pters ent itled " Bas ic Conce p ts " serve as a n in troducti on to th e hist ory and th eory of psychod ynamics. The heart of th e tex t deals with th e a pp lication of psych odyn a mic principl es to va rious current ly recogni zed diagn osti c en t it ies. In taking this approach , Schwartz makes th e case ove r a nd over th at psychodynamic psychotherapy has a br oad er ap plica tion th rou gh ou t th e who le ran ge of psych iatric illnesses th an most resi dent s wou ld have im agined. He see ms to be saying " . .. yes , mos t of us agree th a t psychodynamic psycho th erapy is im porta n t a nd th e tran smi ssion of it s core concepts shou ld be preserved , but how ca n we apply th e techniq ues to spec ific t rea t ment se tt ings and clin ical synd romes?" By havin g th e variou s cont ributors res po nd within very specific d iagnost ic areas , Schwartz has chose n to mee t th e qu estion head-on . In th ese central chapters, th e biases of th e ind ivid ual a ut ho rs cer tain ly show through but overa ll we a re presen ted wit h a wealth of informative and, more importantly, useful mat erial. The latter chap te rs deal wit h a few spec ia lty a reas including int errupt ion s in treatment , resea rch a nd psychodyna mics, a nd th e psych ology of prescribing a nd taking me d ica t ion. In th e book 's final chapte r, "A Recommended C urriculum for Psychodyna mic Training," Allen T asm an sums up th e importance of th e issu e at hand when he says, "At sta ke is our vision of th e futu re psychi atrist. " From a resid ent 's poin t ofview, this last cha p te r should pr obably be read first. The qu estions he ra ises are, " Do we think th e fu ture psychi atrist should / will be a n applied neu robi ologist who sho uld know onl y th e indications for explora to ry psych otherapy, so as to mak e a ppropriate referrals to psych ologists and socia l workers as many neurologist s and fa mily practition ers now do? Do we think that th e re marka ble new knowled ge of neurobiology . .. , will render