Shirah Vollmer MD

The Musings of Dr. Vollmer

Psychiatry Residents: Thinking About Psychoanalytic Training

Posted by Dr. Vollmer on April 3, 2012

This is not the group I spoke to today, but the picture gives you an idea of psychiatry residents, physicians who decided sometime in their medical career to specialize in psychiatry. These folks, graduates of medical school,  have decided to spend four years doing adult psychiatry training and they can then decide to add-on another one to two years to do child psychiatry training. At a noon-time talk, we discussed why I did psychoanalytic training and whether it makes sense for them. “I felt when I finished my adult residency and my child psychiatry fellowship that I needed more psychotherapy training.” I said to astonished faces. “After all this training you did not feel competent?” One resident asked me. “First, you have to remember that I trained in the eighties where we had a lot of psychotherapy training in residency and we did not have as many psychopharmacological tools, which means that we did not have psychopharmacology clinics like you have now.” I say, emphasizing that doing psychotherapy in residency made me appreciate the depth of knowledge necessary to do deeper work, such that more training seemed mandatory to me.

On the one hand, I understood that from their perspective, they are about to graduate from ten years of education, many of them saddled with substantial debt. The idea of further education must seem both financially and academically absurd. On the other hand, the work of a psychiatrist/psychotherapist can be so deep that training is never finished. This is a field of ongoing in-depth analysis of the human mind, which requires expert consultants, ongoing study, along with group training experiences to fully appreciate the nuances of motivation. “The end of residency is not the end of learning,” I say to a group that continues to look stunned.

I am left to reflect on my own classmates in residency. We knew that psychoanalytic training was in our future. We accepted that as part of our professional development. Psychopharmacology was a nice addition to our tool box, but it was no substitute for studying how the mind navigates a complicated world. I fear that my cohort is a dying breed. “The one thing I am sure about is that I cannot be replaced by a computer.” I say with confidence. “Oh yes, you can” the residency director  says. “One day a computer will study your every move and then be able to do exactly what you do, except that you keep learning and the computer cannot do that,” he corrects himself with a good point, supporting my point. Psychoanalytic training, as a lifelong process, makes my work deepen with time. Each patient adds to my experience and my wisdom, along with consultation with colleagues and study groups, such that replication of my work is nearly impossible. “I work in a personalized way and I am grateful for that opportunity,” I tell the residents. “No one else thinks like I do, and so I bring something unique to each session,” I say, without modesty, emphasizing the privilege of being a psychiatrist. I am not sure these residents will be able to say the same thing, but I sure hope they will.

4 Responses to “Psychiatry Residents: Thinking About Psychoanalytic Training”

  1. Shelly said

    While someone may be able to type in a list of symptoms into a computer and it would spit out the recommended medication, your patients come to you for individualized therapy and attention. No computer would ever be able to take your place because your power of diagnosis, empathy, and the ability to teach your patients to see through your eyes are things no computer could do. You can׳t explain it to these students. They will have to experience it for themselves.

    • Thanks, Shelly. There is a push to automating medicine, which might be very beneficial for patients in general, but psychiatry needs to push back as the field which does not lend itself to that. Thanks Again.

  2. Danny said

    Very few psychiatrists think outside the medication realm as you do Dr vVollmer. Thanks for your commitment . Is the analytic training period and schools of thought in Europe similar or different than the US track ? Thanks for your blog as always !

    • Hi Danny,
      I believe this to be a generational experience. I am in the transitional generation, where my colleagues above me think in terms of psychotherapy, and generally speaking, my colleagues who trained after I did, think more in terms of psychopharmacology. There is always hope that this might change. The analytic schools in Europe are similar to the US, although I am not sure how many psychiatrists in other countries go into psychoanalytic training. That is an interesting question. Thanks Again.

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