Steven Field, M.D.: "Studying psychodynamic psychotherapy has only
re-emphasized for me that you can't just treat physical ailments if something
psychological is going on. You ignore the psychological at your own
Credit: Joan Arehart-Treichel
Back in his youth, Steven Field, M.D., sold some science fiction articles
and flirted with the idea of becoming a science fiction writer. However, he
decided on another trajectory, one that first thrust him into the human gut
and now has him spiraling into the human mind.
Field is a gastroenterologist studying to become, at age 56, a
It all started in 1977, when Field graduated from New York University
Medical School, did a general internal medicine internship and residency at
Bellevue Hospital, and then decided on gastroenterology as a specialty.
"Gastroenterology offers a broad perspective," Field explained
during a recent interview in his Manhattan office. "I mean, people go to
gastroenterologists because of all sorts of symptoms, some of which are not
even related to the GI tract. So you have the opportunity to practice some
degree of general internal medicine; you have to be up on
Yet while some gastroenterologists are content performing endoscopies and
colonoscopies, Field stopped doing them about five years ago, "not
because they are not important, but because you have to choose what you want
to do. And I decided that I was much more interested in people
And this interest in learning more about his patients, in turn, spurred
Field's interest in psychodynamics. "I would find that patients would
come into my office with complaints," he said, "and very often, in
the process of talking to them, something would come out that was going on in
their life that seemed to trigger, if not the visit, at least the onset of
Field's curiosity about psychodynamics was also enhanced by the discovery
that the gut uses the same neurotransmitters as the central nervous system and
by the fact that new therapies for irritable bowel syndrome (as for anxiety
and depression) target neurotransmitters, specifically serotonin. Serotonin is
a major regulator of gut motility, he pointed out.
Finally, Field came to realize that he wanted to care for gastrointestinal
patients using both psychological and medical expertise.
So in 2002, he asked the chair of psychiatry at New York University what it
would entail if he retrained in psychiatry. During this conversation, the
chair suggested that since Field was more interested in psychodynamics than in
brain neurotransmitters, he might consider studying at the New York University
"One of my perceptions was that mainstream psychiatry, certainly in
New York City, is more biologically than psychoanalytically oriented,"
Field said. "Thus, I felt that psychoanalysis rather than psychiatry
would probably be a better choice for me."
Field contacted the New York University Psychoanaly tic Institute and
arranged an interview; shortly after, he was accepted. The institute has two
tracks—a purely analytic one that takes four years and a psychodynamic
psychotherapy one that takes two years. Field opted for the latter. "I
wanted to get to the basics and then put them into practice as soon as
possible," he explained.
From 2002 to 2004 Field took didactic courses in psychodynamic
psychotherapy in the evening while continuing with his gastroenterology
practice. The director of his program, Seth Eichler, M.D., was especially
supportive and helpful, he noted. "The institute was in a funny position
with my candidacy, because it usually trains mental health providers, and I am
not one. So a whole series of things had to be done."
For example, institute leaders arranged a tutorial for him in basic areas
of psychopathology to flesh out the curriculum a bit. And while students at
the institute usually practice analysis or psychodynamic psychotherapy with
their own patients, Field was not able to do that with his gastroenterology
patients because of boundary issues.
"I mean, I am these people's doctor, I examine them with their
clothes off, I do all sorts of intrusive things to them," he commented
wryly. But fortunately some of his medical colleagues referred a few
psychotherapy patients to him with whom he could work under supervision."
Currently, I have two patients in supervised psychodynamic
psychotherapy," he said.
Although Field is not yet a full-fledged psychotherapist, he has learned
some fascinating things from his psychodynamic courses.
"In medicine—in internal medicine certainly—there is a
sharp line between what is normal and what is pathological. So I was surprised
to learn that many of the traits you find in people with personality disorders
are really dysfunctional exaggerations of things lots of perfectly normal
people think about, have, or do on a daily basis.
"Also, many people believe that in conducting psychotherapy, all you
have to do is listen. But of course it's not that easy, I've found. I have a
particular style with patients that I have developed over 25 years in medical
practice. It involves a significant degree of interactivity, with me sometimes
almost finishing patients' sentences for them. But in a formal psychodynamic
encounter, as your readers well know, you have to have a lot more patience,
you have to be able to sit there and let patients come to a lot of their own
As he steadily broadens his knowledge about psychodynamic practices and
principles, he is already applying what he has learned to his gastroenterology
For example, he has found that his psychotherapy training is especially
helpful in treating patients with irritable bowel syndrome since anxiety,
depression, childhood physical abuse, or childhood sexual abuse are among
factors that can be linked to the syndrome. He has also found it helpful to
some extent in treating patients with inflammatory bowel disease. While he
noted that there is no solid evidence that this illness is caused by
psychological factors, it tends to strike young adults and be chronic."
So there are many psychological issues that arise when young, otherwise
healthy adults have a chronic illness."
He is also tapping his new font of knowledge when gastrointestinal patients
are sent to him for a second opinion. "I review everything medical, but
I also listen to them with a psychotherapeutic ear now. This way they often
feel that a physician understands more about them even if no one has come up
with a specific medical diagnosis."
One particularly valuable aspect that Field has taken from his new
erudition is being able to identify gastroenterology patients who would
benefit from psychotherapy and to help them obtain it.
"I have told certain patients that it is very important for them to
see a psychotherapist if they really want to see their condition improve as
much as possible," he said. "Many have followed my
And those who have followed his advice appear to have profited from the
therapy they received, he added.
Asked how he anticipates using his psychodynamic training over the next
several years, Field gave a light laugh. "What I would like to do is...
well, it is still sort of a work in progress. At one point I actually thought
that there might be a time where I would want to do psychoanalysis rather than
gastroenterology. But I like what I do. I like general medicine, and I like GI
a lot. So I think I'll use it in GI patient care. For instance, some
gastroenterologists are starting to refer patients to me where they suspect
that the patient's GI problems have a strong psychological component. I'm also
flirting with the idea of working with a psychotherapist—having a
And, said Field, who is a clinical assistant professor of medicine at New
York University as well as a private practitioner, "I think it would be
great to launch an educational initiative that exposes medical students and
house staff to some of the concepts of psychodynamic treatment. I think it
would make physicians more complete physicians, more able to care for the
whole patient." ▪