Teaching Medical Students Psychodynamic Psychotherapy: An Interactive Method.

To the Editor: Grounding medical students in psychodynamic concepts is an important way to insure that future physicians will be empathically involved with their patients and able to handle with equanimity the inevitable transference and countertransference reactions that will occur. Several psychiatric educators [1–3] have described the need for including psychodynamics in the medical student curriculum. Sadly, because of insurance demands and increasing emphasis on evidence-based medicine, the physician as healer is often sacrificed [3]. Other authors have noted that teaching psychodynamic concepts requires special techniques and attitudes. Cutler [1] suggests explaining concepts without jargon and abstract metapsychology. Cabaniss [4] presents process notes from her own patients and asks students to assume the role of analyst by contributing their own interpretations and observations. This course met with considerable success [5]. In the tradition of Cabaniss, I have used the following teaching method to enable medical students to understand the importance of psychodynamic concepts to treating patients in all medical disciplines. I have a group of about 20 psychiatry clerkship students for two sessions of 90 minutes each. I start by introducing myself as a psychiatrist, a psychoanalyst, and a fellowmedical school graduate. I tell them this is Psychotherapy 101 and there is no 102 and that they can all benefit from what I’m teaching unless they are going into pathology and have a dead patient. Humor lessens the tension and resistance. Together, we define psychodynamics and its key concepts such as subjective experience, internal world, the unconscious, free association, transference and countertransference, resistance, empathy, and day residue for dream interpretation. I also include a definition of temperament and how it contributes to the development of personality to demonstrate that there are always biological underpinnings to our understanding of personality and psychodynamic psychotherapy. Next, I present sessions from an analytic case of my own, so they can feel what it’s like to be a psychoanalyst. I like to present a real patient because the students haven’t been exposed before to this kind of material, and it keeps them involved with a real human being. After presenting the patient’s history, I ask them what life themes they have heard and to predict the transference and countertransference, given the patient’s history. I then read verbatim notes from a session, stopping every few sentences to ask them what they think is going on and whether they like what I said to the patient or how they would say it differently. They like to do this. It equalizes us; they have great ideas and often I help them rephrase things they have said in order to sound more empathic. I’m hoping they will use this with their own patients. I frequently tell them: if they only say “that must be hard,” “tell me more,” or “what are you feeling?” they will get through five weeks of psychiatry. That usually makes them laugh. My goal is to make this fun as well as impart serious information. I then ask the students what they thought about the material and if they liked the patient or not and why. This helps them understand future positive and negative reactions about patients. I include a dream and solicit their ideas about what it means. I usually get wonderfully perceptive interpretations. After I present all the material, I ask them to predict how the patient did in treatment and if I helped him. This allows * E. P. Bender epbender12@gmail.com