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Bio/Psycho/Social: Seeking Balance in Psychiatric Training and Practice

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At a certain juncture in their training, some medical students and psychiatric residents confront a profound question: What is the best intervention to treat patients suffering with mental health problems—Is it medication? Is it psychotherapy? Is it both?  

Over the course of two weeks, six students explored a psychodynamic perspective on this question by participating in a virtual version of the Austen Riggs Center’s Elective in Psychodynamic Psychiatry, receiving more than 40 hours of formal instruction from Riggs clinical staff along with opportunities to observe supervisions and complete numerous reading assignments. Riggs hopes to offer the virtual elective again in the Spring of 2021.

        Medical students and psychiatric residents in Austen Riggs Center’s virtual Elective in Psychodynamic Psychiatry reflect on their learning.    

This first virtual class of students and residents noted that the experience highlighted for them something they felt was absent or underrepresented in much of mainstream psychiatric education: the importance of psychotherapy as part of an integrated approach to treatment.  

When asked specifically what some of the most important things they learned during the elective, they each had insight to offer: 

“I learned how wonderful psychotherapy could be. It gave me a chance to reflect on my own past clinical experiences and strengthened my determination to become a psychiatrist.” – Yuxi Zhang (University of Kentucky College of Medicine)  

“It’s possible to think psychoanalysis is an artifact, but that’s not the case at Riggs. Their approach can be utilized more widely and they are well-positioned to be a leader in changing perceptions about what psychiatry can be.” – Devin H. Van Dyke (Geisel School of Medicine at Dartmouth)  

“Before my experience with this elective, I wondered, ‘Am I going to be able to practice therapy?’ I was getting discouraged, but Riggs helped me see a way of working that I had always imagined myself practicing in the future and reinforced my intent to do so.” – Omar Shawaf (University of New England)  

“Psychodynamic psychiatry is alive and well at Riggs and the staff are passionate about it. It is good to know places like Riggs exist and that there are future opportunities for training here.” – William Butler (Florida State University College of Medicine)  

“This experience showed me what treatment could be and presented an important counterbalance to the sometimes reductive way medical school teaches us to think about and talk to patients.” – Laura Avigan (Ben-Gurion University of the Negev) 

“Before starting this elective, I had an idealized form of psychiatry but felt like there was no place that worked toward this ideal. Riggs does.” – Sarah Azim (Philadelphia College of Osteopathic Medicine) 

Challenges  

Their positive experiences with the virtual elective notwithstanding, participants did note challenges that remain. The field of psychiatry, over the past several decades, has been dominated by a biomedical approach to treatment, often at the expense of the psychological and social factors present in all psychiatric illness. This, along with the ongoing struggle to achieve mental health parity relative to insurance coverage has led to challenges including:  

  • Funding and reimbursement issues related to insurance, which often does not fully cover treatment for mental health issues in the same way it covers treatment for physical health issues 

  • Stigma of psychodynamic approaches that exists in many psychiatric circles  

  • Lack of culturally-sensitive practitioners to engage with a broader group of those seeking help (the therapeutic alliance is strengthened when patients are able to see themselves reflected in their mental health providers) 

  • Difficulty bringing psychodynamic approaches to underserved or disadvantaged populations given the current structure of insurance and many community mental health systems 

Opportunities  

There are, however, some bright spots that the virtual elective participants also noted, including:  

  • Movement toward a more holistic approach to treatment in some psychiatry residency programs 

  • Applicability of a psychodynamic approach to treatment systems beyond psychiatry and mental health; it can be taught, exported, and applied in myriad ways to improve treatment delivery 

  • Belief that a new golden age for psychiatry is yet to come and that a psychodynamic perspective can help usher it in  

To learn more about the Elective in Psychodynamic Psychiatry, visit: www.austenriggs.org/elective-psychodynamic-psychiatry or contact Psychiatry Training Director Dr. David Mintz: david.mintz@austenriggs.net or 413.931.5315. 

  

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