Finding Psychodynamic Psychiatry's Lost Generation (2006)

“Finding Psychodynamic Psychiatry's Lost Generation” described the displacement of the biopsychosocial model, with which psychodynamic psychiatry was most identified, by the biomedical model, with associated changes filling departments of psychiatry with biological psychiatrists instead of psychodynamic psychiatrists to train residents. As noted in the paper, the American Psychiatric Association (APA) and the Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee (RRC) for psychiatry recognized the danger that future psychiatrists could lack skills as therapists and become mere prescribers, since practitioners cannot practice, and teachers cannot teach, what they never learned. An APA Committee on Psychotherapy by Psychiatrists (COPP) was formed, while the RRC mandated teaching of multiple schools of psychotherapy in residency, including psychodynamic psychotherapy (PDT). The paper was the first to describe the Y-Model for teaching psychotherapy competencies that emerged from work of COPP—a psychotherapy teaching model adopted by multiple residency programs as a unifying way to teach psychotherapy based on common factors across schools and evidence-based differentiating features of PDT and cognitive-behavioral therapy (CBT). The paper also described the emergence of postresidency psychotherapy training programs, including the one offered by the Austen Riggs Center, with 2-year Fellowships in PDT and 4-year Fellowships accredited as psychoanalytic training.

Since the paper's publication, both research and case law have evolved in ways that support the relevance of psychodynamic psychiatry. Hundreds of controlled studies now demonstrate the efficacy of PDT for single and complex comorbid mental disorders. Meanwhile, findings from biomedical research better fit a biopsychosocial than a biomedical model. Despite the prediction that decoding the human genome would transform diagnosis and treatment of mental disorders