Teaching Psychotherapy

Although I am pleased that Psychiatric News is covering controversies in psychiatric education (August 1 issue), I must point out that some of the views I expressed at the annual meeting of the Association of Directors of Medical Student Education in Psychiatry were misrepresented in the article “Do Medical Students Benefit From Psychotherapy Training?”

While the article accurately reported my opinion that there are many reasons why learning the various types of psychotherapy should not be an aim of psychiatric clerkships, important aspects of my stated rationale for excluding psychodynamic psychotherapy from clerkship curricula were missing from the article—namely, what I referred to in the abstract of my presentation as psychoanalytic/psychodynamic theory’s weak evidential base and moribund status as psychological theory. Far from being “widely agreed upon” (which the article implied that I believe), the essential foundations of psychodynamic theory and therapy have never been more in doubt among scientists and philosophers.

The recommendations for psychiatric clerkship education with which I concluded my talk—some of which were inaccurately reported in the article—were:

1. Focus clerkship teaching on clinical evaluation, differential diagnosis, etiopathogenesis, natural history, and (to a lesser extent) differential therapeutics.

2. Teach the underpinnings of contemporary, empirically validated psychotherapies in the contexts of their established indications.

3. Introduce psychoanalytic/psychodynamic concepts in historical and philosophical context (and not as established principles that are “widely agreed upon”!).