How to Think Like an Analyst 101: A Model for Teaching Psychotherapy to Medical Students

Iwent to medical school determined to be a family practitioner. Then, during my third-year psychiatry clerkship, I met doctors who knew more about talking to patients than any doctors I had ever met. They could anticipate what people were going to say, they talked to people about things no one else would (such as thoughts, fears, fantasies, and dreams), and it seemed to me that they could help people simply by talking to them. One teacher, sensing my interest, recommended to me that I read Charles Brenner's Elementary Textbook of Psychoanalysis. I read it every night until 1:00 a.m. I gradually realized that I could train myself to be like these doctors—to effect change in people not with scalpel or pill but simply by talking to them. I was sold. Did I know that these doctors were psychoanalysts? Sort of. Did I understand anything about psychoanalytic theory? Certainly not. But the idea of the unconscious and its role in human behavior had captivated me, and that was enough. I would have time to learn the rest. That, I think, is the essential role for psychoanalysts in medical education, and I think it is one of the most important roles psychoanalysts can play. The physician without a sense of the unconscious has difficulty understanding patients, whether the physician is a psychiatrist or an orthopedic surgeon, and only psychoanalysts and psychoanalytically informed psychiatrists can offer that sense of the unconscious to students at this formative stage of their medical careers. Yet analysts do not seem to want to teach medical students, for many reasons. It goes without saying that this type of teaching often goes unnoticed by groups like analytic institutes and departments of psychiatry and that it is not particularly valued. Psychoanalysts frequently feel that they are not even welcome in medical schools and that there is no role for them. The traditional teaching role for the analyst—supervision—has no place in the medical school curriculum. But even more, I think that psychoanalysts fear that they will take the time off from their offices, losing income and earning no wage, to travel to the medical schools only to be met with blank looks, overt hostility, or, worse yet, disinterest. However, in five years of teaching third-year medical students, week after week, that has almost never been my experience. And my task is to teach a weekly seminar on a topic of which medical students frequently have no experience and which they often think is irrelevant to their medical training: psychotherapy. My goal is simple. I want to give my students some idea of what psychoanalytically trained psychiatrists do in their offices and, in doing so, interest them in the unconscious and the power of psychoanalysis and psychoanalytically oriented psychotherapy. Every five weeks I get a new group of approximately eight medical students with whom I meet weekly for a one-hour seminar. Some groups have some students who want to become psychiatrists. Some groups consist solely of future urologists. In my experience, the future urologists are often as interested as the future psychiatrists. Are they interested the minute they walk in the door? Not usually. Are they often hostile to psychotherapy and psychoanalysis in general? You bet. But psychoanalysts should be able to handle resistance, and here is the approach that has worked for me.