The Mentorship Program began in 1992–1993, the second year of The American's Fellowship Program. Fellows were each assigned a mentor, a senior psychoanalyst who would talk with them, read papers, suggest research projects, supervise work with patients, introduce them to other analysts and to candidates, invite them to society meetings, provide assistance navigating the program at meetings of The American, and do whatever else might be useful. In short, the mentor's task was to make analysis user-friendly. The mentorship rapidly became the core of the Fellowship Program. So successful was it that two years ago the Fellowship Subcommittee decided that all applicants would benefit from having a mentor. This past year, at the suggestion of Michael Gundle, mentors were assigned as applications were received. Thus, applicants are already engaged in the mentoring process when they are notified whether they have been awarded a fellowship. To date, more than two hundred fifty active members of The American have either been mentors (some several times) or have indicated a willingness to serve as mentors in the future.
One Fellow found mentoring so useful she traveled regularly from Arkansas to St. Louis, where she stayed for weekends at the home of her mentor. One former Fellow, when she moved to another city to undertake a neuroimaging fellowship, asked that a new mentor be assigned her to ensure that her work would continue to be psychoanalytically relevant. Several applicants have written papers with their mentors, and others are engaged in research projects with them. The following brief reports are from a mentoring dyad. The applicant, Bryan Touchet, a psychiatric resident in Tulsa, did not receive a fellowship.
After my involvement with the Tulsa psychiatric team that responded to the Oklahoma City bombing, I am more convinced than ever of the value and practicality of dynamic psychiatry. Working dynamically with the families required a quick assessment of their level of ego functioning. Many of these people were overwhelmed, their defenses failing. It was important to understand this and to know how to strengthen defenses and contain affects that threatened to cause disorganization. Another important focus was to create a safe container or holding environment for the intense emotions experienced by the victims' families. This involved learning how to be with them without necessarily doing something to them. This was difficult, but in the end this approach allowed the families to feel they had been heard and provided with a consistent, structured environment within which they could experience their feelings. A critical aspect of this kind of work was monitoring my countertransference. The wish to rescue was incredibly intense and led many mental health professionals to overextend themselves. Without a doubt, I would say that this experience validated my decision to become the kind of psychiatrist who is fully versed in psychodynamic principles and able to make practical use of them.
The Mentorship Program has been an exciting addition to my residency training experience. Through the program I've been able to work closely with an experienced psychoanalyst—a definite plus for me, as there are no analysts associated with my residency. My mentor and I have talked about the history of psychoanalytic theory and about questions I have about my long-term patients. With the help of my mentor, I hope to increase my ability to formulate clinical problems into a coherent and practical dynamic framework. I then want to learn more about self-examination and the use of the dynamic framework therapeutically. I hope to share what I learn with my fellow residents to enrich the educational experience of us all.
The response of my department to my participation in the Mentorship Program has been very positive. I have been approached by at least one other resident who wants to apply for a fellowship and have the opportunity to work with a mentor. I recommend the move as an invaluable addition to my colleague's psychiatric residency training.
The most immediate problem facing us was one of distance. Bryan is a psychiatric resident in Tulsa, and my office is in Topeka, a substantial drive of more than two hundred fifty miles. Thus, Bryan and I were aware that we would not be able to have a great many face-to-face meetings. For our first get-together, Bryan drove to Topeka. We talked for a few hours about the future of psychoanalysis and psychodynamic psychiatry, and went over a number of his cases. Recognizing that the distance places a great burden on Bryan, we decided to be innovative in arranging our working relationship. We could always use the phone, and we also decided to correspond about particular cases. In addition, I arranged for him to get a fellowship to the U.S. Psychiatric Congress in New York this November. Bryan, who heard me speak at last year's congress in Washington, jumped at the chance to go again. Since we will both be in New York at that meeting, it provides another opportunity for us to get together and talk about Bryan's clinical work. He has also agreed to drive to Topeka periodically for meetings like our first one.
I have been extremely impressed with Bryan's knowledge of psychiatry and his grasp of psychodynamic concepts. Even in an area that has no practicing analyst, he has clearly assimilated a great deal from his clinical teachers and his reading. Although he is uncertain about whether he will pursue analytic training at this point, his enthusiasm for understanding his patients will certainly lead him to continue his pursuit of dynamic knowledge and training. In fact, he is an
example of why psychodynamic thinking will never die out in psychiatry. He recognized the shortcomings of a purely descriptive approach to treatment, even in a twenty-minute med check. He continually observes patterns of interaction between his patients and himself that stimulate his interest in understanding more.
Bryan accepted with a good deal of maturity the fact that he was not awarded a fellowship. He said to me that he got so much out of just being nominated that it was a “win-win” situation for him. The application process is designed to be exactly that, and I feel we have made a major step in accomplishing that goal.