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Winer's review of psychoanalytic thinking in psychiatric textbooks invites a comment on psychoanalytic and psychodynamic teaching in psychiatric residencies. The decline in such topics in textbooks is matched by a decline recently in psychoanalytic and psychodynamic teaching in residency training.
This decline could be seen as the achievement of a healthy balance, owing to enormous advances in recent decades in biological treatments and non-psychoanalytically based psychotherapies such as cognitive and behavioral therapy. Psychiatry today has a far greater capacity to help than ever before.
Another influence affecting clinical practice patterns has been managed care and the pressure it exerts on resource use. This translates to reductions in length, frequency, and number of sessions, and in availability of third-party coverage for intensive outpatient treatment.
Still, psychodynamic concepts remain important in clinical care. To concede, given the increased effectiveness of other therapies and this pressure on resource use, that psychodynamic and psychoanalytic thinking should not be part of residency training is short-sighted. A capitulation here means producing psychiatrists with limited approaches to the breadth of human psychology and the treatment of mental illness.
A psychiatrist must be more than a human embodiment of DSM-IV or a walking therapies manual. A psychiatrist must bring to the appraisal and treatment of a psychiatric problem interest, understanding, and respect for the individuality of human beings. This means an empathic approach with knowledge of motivations and wishes, impulses and fantasies, defenses and resistance, transference and countertransference, and the various manifestations of unconscious mentality that characterize an individual's preoccupations, personality, and symptoms.