Psychotherapy Competency Debate

I read the article “Need to Prove Psychotherapy Competence Fuels Heated Debate” in the June 4 issue with great interest and found myself agreeing more strongly with the Yager/Rubin team.

The problems within our current training paradigms stem from the lack of agreement on what is the basic nature of current psychiatric treatment. Research has pointed to young psychiatrists having difficulty integrating the biologic and psychotherapeutic perspectives. Most training in what is called“ psychodynamics” involves the rehashing of tired psychoanalytic concepts rather than conveying a modern understanding of the neurobiologic dynamism of mental life. Despite having the most recent annual meeting focused on the theme “Dissolving the Mind-Brain Barrier,” we are not any closer in our consensual practice expectations to such an undertaking.

In my view, the teaching of psychotherapy should be subsumed under an overarching biologic framework such as “interpersonal neurobiology.” This would put it squarely in the middle of the dominant thrust of the psychiatry of the 21st century. A rich body of literature from neuroscience offers insight into psychological change (changing one's mind-brain system). Specific technical modalities could be taught to mitigate dysfunctional states with the goal of mind-brain optimization. This would be both comprehensible to trainees and patients and would clearly be integrated within neuroscience.

A good introduction for residents might be Jerome Frank's Persuasion and Healing: A Comparative Study of Psychotherapy, Daniel Siegel's The Developing Mind: Toward a Neurobiology of Interpersonal Experience, and Lou Cozolino's The Neurobiology of Psychotherapy. The current competency standards in my view are a superficial attempt by the RRC to paper over a larger problem.