You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Many training problems have been incorporated by Dr. Kubie under this one title. All are worthy of consideration as they are the psychiatric training problems of the future, but space limits discussion to only two.
The traditional assignment of residents to psychiatric hospitals was not changed when psychoanalysis began to influence psychiatric training because it was at the hospital that the resident could study the unconscious in its most florid form. Before the advent of the somatic therapies and psycho-tropic medication, patients expressed unconscious impulses verbally and/or behaviorally, and the resident had an opportunity to relate primary process to symptoms. This opportunity is still present, but with present therapeutic measures, one must be where the acute patient is admitted.
The resident can observe the original instinctual drive and its restitution by the ego in the psychotic leading to an understanding of dynamic ego psychology and the roles of the super-ego and ego-ideal. This learning experience permits the resident to study the psychodynamics of the individual as he appears at a particular cross-section of his life and to relate psychoanalytic theory to the patient. The hospital experience also demonstrates to the resident another use of psychodynamic understanding of the patient besides that of “the talking therapies.” He can apply his psycho-dynamic knowledge in the development of a milieu which will assist the patient in the return to his pre-morbid state.
Psychotherapy of the psychotic patient or any patient, is inappropriate at an early level of training. Learning how to be sensitive to
one's own emotions, how to listen, to understand the unconscious in its expression through derivatives, and the contribution of emotional development to emotional problems is the beginning resident's task. The observation of children, adolescents, and adults of all ages would assist the resident in learning.
With the increasing sophistication in psychiatry throu