Discussion of Transference-Focused Psychotherapy Training during Residency: An Aide to Learning Psychodynamic Psychotherapy

My interest in the article by Bernstein, Zimmerman, and Auchincloss (this issue) comes from my role as the residency training director of a program with 24 General Psychiatry residents and 10 Triple Board residents (Adult Psychiatry/Child Psychiatry/Pediatrics) with varied degrees of interest in psychodynamic psychotherapy. While many of our residents are interested in how to apply psychodynamics to various aspects of psychiatric treatment, only a few residents (approximately 1 resident per year) imagine that they will practice psychodynamic psychotherapy upon graduation, largely due to the local psychiatric culture. Our residents rotate through six different hospital systems, including a VA hospital, a county hospital, a university hospital, a city hospital, a state hospital, and a children's hospital, all with different systems and varied attitudes toward psychotherapy training and practice. As an educator in psychiatry and an active member of the American Academy of Directors of Psychiatric Residency Training (AADPRT), I am interested in Bernstein et al.'s article, which addresses a topic that psychiatric educators grapple with on a seemingly continual basis, that is, how to effectively teach psychotherapy. As educators, we struggle over when during the four years of residency is the “right time” to teach this practice? Should theory be taught first? Or does theory only make sense after some clinical experience has been achieved? How do we teach psychotherapy in such a way as to not alienate skeptical students? How long does it take for our residents to learn to be competent psychodynamic psychotherapists? Furthermore, how do we measure competence in psychodynamic psychotherapy? These are just a few of the questions that psychotherapy educators and