Editor's Introduction to the Special Issue

This special issue of Psychodynamic Psychiatry focuses on the education of psychiatric residents. In previous editorials we have emphasized the need for the discipline of psychodynamic psychiatry to construct a unique professional identity that welds knowledge, attitudes, and skills from academic psychiatry with those of psychoanalytic psychology. We have stressed the usefulness for this emergent discipline of George Engel's (1977) biopsychosocial model. Engel discussed this model in a classic article that we reprinted in Volume 3 of this journal. The biological part of the paradigm has received substantial recent attention but is challenged by a tendency among modern psychiatrists toward biological reductionism. Application of the biopsychosocial developmental model also helps build bridges between psychodynamic psychiatry and public health.

Modern psychodynamic psychiatry must emphasize the psychodynamically informed diagnostic assessment of all psychiatric patients, treatment planning that includes continuity of care between inpatient and outpatient settings, treatment of patients from all parts of the illness and socioeconomic spectra, brief treatments (both manual and nonmanual based), and longer term treatments and flexible multimodal treatments of the chronically mentally ill. These treatments include psychotherapy, psychopharmacology, family therapy, group therapy, and milieu therapy in various combinations. The treatments used and their frequency and duration depend on specific clinical situations that are assessed in diagnostic examinations. Crucial aspects of diagnosis and treatment include unconscious influences on repetitive maladaptive behavior and the role played by unconscious conflict in suffering. The capacity to understand patients in depth, including the irrational determinants of their behavior, is and must remain an essential part of the education of psychiatrists. The journal Psychodynamic Psychiatry is particularly fortunate to have Dr. Elizab