Teaching Psychotherapy

I read with interest and dismay the article in the August 1 issue featuring Dr. Scott Waterman, who “believes clerkships are an inappropriate venue in which to instruct future physicians in psychotherapy.”

I believe that Dr. Waterman’s views are retrogressive and reflective in part of the chronic disavowal of the centrality of psychotherapy to psychiatry. In the current thinking of the best minds in our field, for example, Eric Kandel, M.D., Nobel laureate in neuroscience, psychotherapy is our best and most precise tool for modifying the central nervous system. Furthermore, we are living in an era in which the appreciation of the mind-body interface has grown by leaps and bounds. Most major medical centers are jumping on the bandwagon of informing departments or divisions of integrative medicine, and psychiatrists ought to be at the forefront of this movement, as it is the original integrative discipline. Moreover, an interest in the importance of spirituality and the outcome of medical interventions has grown in our field. The work of Dr. Herbert Benson at Harvard is at the forefront of the examination of these important questions.

I commend Dr. Theodore Feldmann for his efforts in maintaining psychotherapy education in psychiatry clerkships. However, I believe that stronger measures are in order. The teaching of psychology as a basic clinical science is long overdue and is at least as important as the teaching of microbiology to the performance of physicians as a whole. It is there that the basic principles may be taught. Then during a clinical skills course, interviewing and observational skills, both of self and patient, are immediately salient.

Finally, in a clerkship it is entirely appropriate to teach a variety of psychotherapeutic skills, including relaxation training, meditation, and brief dynamic psychotherapy, as well as crisis intervention. Teaching such skills would no more devalue the practice of psychotherapy than does the teaching of doing histories and physicals in the practice of internal medicine.