In “Reviving Plain Old Therapy” in the May 18 issue, Jon Allen, M.D., argues for a return to an older form of psychotherapy that can be combined with the modern alphabet soup of new therapies to aid our patients. While he refers to psychotherapy researchers who support his hypothesis, he does not address how we currently train residents to do psychotherapy versus how we did it in the past.
Thirty years ago in the “prime” of “plain old therapy,” learning psychotherapy was a keystone of most psychiatry residency programs. Residents had many psychotherapy patients and many supervisors. In supervision they went over their interactions with their patients in great detail. Additionally, they followed patients for years, not weeks. Today, rather than a detailed review of the doctor-patient interaction, the resident frequently presents only a summary of how he or she believes the patient is doing.
Psychotherapy was and is an art in which therapists use a number of scientific disciplines to aid their patients. As in learning every art, the students must work assiduously to gain skills. In the past, the resident had an immersion in what Allen calls “plain old therapy” to learn the essential skills to become a psychotherapist. Today the resident may briefly taste a number of therapies. The resident applies a number of techniques described as unique to each therapy in working with patients. However, without long-term immersion with patients and supervisors, the resident cannot clearly appreciate his or her role in the therapy or the effectiveness of the treatment. These are critical experiences to becoming a competent therapist. Not surprisingly, without the opportunity to clearly establish a foundation as a psychotherapist in residency, the resident in practice after graduation relies mainly on medication and refers patients to others for psychotherapy.
Psychotherapy as an essential skill for psychiatrists can be attained only by reform of the current manner in which it is currently taught.
Sidney Weissman, M.D.,