The Role of Personal Psychodynamic Psychotherapy in Becoming a Competent Psychiatrist

Abstract

Education (ACGME) has launched a competency movement that is causing a paradigm shift in psychiatric training. Psychiatry, like all medical specialties, is expected to attest to the specific competencies of its graduates. 1 In particular, the Residency Review Committee for Psychiatry (RRC) has defined the need for competency in several of the psychotherapies, 2 thereby generating, in turn, much discussion about how to develop this set of skills. The American Association of Directors of Psychiatric Residency Training (AADPRT) has provided specific guidelines for competency in each type of psychotherapy, including, most controversially, psychodynamic psychotherapy. 3 These guidelines state that the competent resident will "demonstrate understanding of the concept of the unconscious" and also of "the multiple and complex meanings" underlying behavior. Toward this end, the resident should be able to establish an alliance with the patient that allows for "an inquiry into the patient's inner life." Finally, the AADPRT guidelines specify that the resident should be able to recognize, utilize, and manage aspects of transference and countertransference, and to "utilize selfreflection to learn about his/her own responses to patients."One of the difficulties of attaining such competence in psychodynamic psychotherapy is that physicians-in- Correspondence: Adam M. Brenner, MD, Department of Psychiatry, Brigham and Women's/Faulkner Hospitals, 221 Longwood Ave., Mezzanine level,

Influence of personal therapy on learning and development of psychotherapeutic skills

“…The therapist's personal experience unconsciously influences her or his own work with patients and benefits the therapy process and the therapeutic alliance. Similar results have been described earlier (Brenner, 2006;Norcross, 2005).…”

“…Studies focusing on the experience of personal therapy during the therapist candidate's training have been published by Brenner (2006) and Moller, Timms, and Alilovic (2009), among others. How personal therapy specifically interacts with other curriculum-based experiences during training and thereby relates to possible professional development has been given scant attention, however.…”

The Training of Psychodynamic Psychiatrists: The Concept of “Psychodynamic Virtue”

“…Frawley-O'Dea and Sarnat (2001), writing from a relational perspective, suggest that the line between "teaching and treating" is inevitably blurred and must be uniquely and mutually constructed in each supervisory relationship. Alternatively, numerous authors have recommended that personal psychotherapy during residency training is the appropriate venue for such growth (e.g., Brenner, 2006). Habl, Mintz, and Bailey (2010) surveyed psychiatry residency directors and found that the overwhelming majority of respondents felt that personal therapy was helpful in developing the ability to manage emotional reactions to patients, in developing empathy, and in forging a professional identity.…”

Psychiatry Residents and Dynamic Psychiatry: Two Narratives, A Survey, and Some Ideas to Enhance Recruitment

“…It allows residents to become acquainted with their inner life, their conflicts, and the unconscious and often complex meanings of their behavior (Brenner, 2006). This experience often leads residents to reflect on the power of the therapeutic relationship and to think about themselves and their patients in new ways.…”