Psychotherapy and the Professional Identity of Psychiatry in the Age of Neuroscience

Some Essential Steps for Keeping Psychotherapy at the Core of Psychiatry Training: A Response to Belcher

“…In keeping with Belcher's remarks [2], the importance of psychotherapy in psychiatric practice has eroded, such that "'to treat' has come to mean 'to medicate'" [3] with concern that psychiatric treatment has been reduced to "just a DSM diagnosis and pharmacological advice" [4] even though psychotherapeutic interventions have well-established efficacy in treating a range of psychiatric disorders [5]. Furthermore, psychotherapy education provides an opportunity to develop empathic therapeutic relationships and to enhance the ability to listen to patients, both of which are essential elements to the professional identity of a psychiatrist [6].…”

“…The ideal time to commence psychotherapy training during psychiatry residency is unclear. Belcher's narrative [2] mirrors findings by Wiesenfeld et al [15] indicating that emphasis on psychotherapy training was a significant motivating factor in attracting graduating medical students to psychiatry residency. There may be value in beginning formal psychotherapy training in the first year of residency, given research findings supporting that interest in psychotherapy is highest among first-year psychiatry residents compared with their senior counterparts [16,17].…”

“…We were drawn to Belcher's recent article [2], which attends to the considerable debate regarding the role of psychotherapy in the professional identity of the contemporary psychiatrist. Belcher asserts that psychotherapy is essential in psychiatric treatment, and yet despite this, the proportion of psychiatrists who deliver psychotherapeutic treatment continues to decline.…”

“…Providing education to psychiatry residents in the early years of residency around the neurobiological underpinnings of psychotherapeutic treatment may enhance the preservation of interest in psychotherapy throughout residency training, especially for residents who intend on practicing psychiatry with a chiefly "biological" treatment model. Belcher [2] raises concern about the effects of neurobiological reductionism on the understanding of psychiatric illness, and a curriculum that integrates biology, psychodynamics, and psychology may protect against such reductionistic thinking [29].…”