How psychodynamic factors influence medication adherence and treatment resistance.

The impact of transference, identity struggles, and dependency fears on pharmacotherapy.

Strategies for cultivating a psychodynamically-informed therapeutic alliance.

The role of ambivalence and unconscious resistance in medication nonadherence.

Practical techniques to integrate psychodynamic insights into pharmacotherapy for better patient outcomes.

As a psychiatrist working with complex cases at the Austen Riggs Center and the author of 

Psychodynamic Psychopharmacology: Caring for the Treatment-Resistant Patient

, I have often found that understanding treatment resistance in pharmacotherapy requires more than just prescribing the right medication. It necessitates a nuanced appreciation of the patient’s psychodynamics, relational patterns, and internal conflicts that undermine the patient’s healthy use of pharmacotherapy. This article is based on a course I presented for the Erikson Institute of the Austen Riggs Center. In that presentation, I explore a case study to illustrate the complexities of pharmacotherapy and to provide insights into an integrated psychodynamic psychopharmacology approach. If you wish to see the course in its entirety and receive free CE/CME, you can access it easily via 

Case Study: A Complex Pharmacotherapy Challenge

The patient in focus is a 23-year-old, single, trans woman, an art history graduate student of Lebanese Christian descent. She initially presented with a manic episode five months before her admission to Riggs, where she was prescribed olanzapine and lithium. However, as soon as she became euthymic, she stopped the olanzapine and reduced her lithium dose, prompting a second manic episode. This second episode was marked by religious delusions, culminating in a suicide attempt intended to redeem the world.

Her psychiatric history included gender dysphoria, social anxiety, self-harm, anorexia, chronic depression, and perfectionism. A pattern of nonadherence to medications was evident, reflecting deeper psychological resistance rather than straightforward pharmacological failure.

Determining the Most Pressing Intervention

From a narrowly biomedical perspective, approaches to treatment-non-response often focus on dose-optimization, ensuring trials are of adequate dose and duration, and trying treatments with different neurobiological mechanisms, as well as diagnostic re-evaluation, to ensure that medications are used for the correct psychiatric condition. In this case, however, the diagnostic evaluation that seemed most relevant was developing an overall diagnosis, a patient-centered evaluation which attempted to understand empathically those life-historical factors that made it difficult for her to use both medications and her doctors.

Social and Developmental History: Shaping Pharmacotherapy Approaches

The patient’s background revealed significant psychosocial stressors. She grew up in a high-achieving family with a critical, controlling father and an emotionally absent mother. Her struggles with identity, social alienation, and bullying in a conservative city in the US South contributed to her emotional and psychological distress and distrust of authority.

Understanding her relational patterns provided critical insights into her pharmacotherapy resistance. She exhibited sensitivity to authority figures and systems, often experiencing power struggles and oppositional behavior. These factors influenced her ability to trust medical recommendations, including medication adherence.

Psychodynamic Challenges in Pharmacotherapy

The case highlighted several key psychodynamic challenges:

Her experience with paternalistic authority figures shaped her mistrust of treatment recommendations.

 She feared that taking medication would alter her sense of self, exacerbating her identity diffusion.

 She expressed aversion to feeling “tied to something,” leading to counter-dependent behavior against both people and medications.

 Given her baseline dysphoria, manic episodes provided temporary relief, making her less inclined to adhere to mood-stabilizing treatments.

A Psychodynamic Approach to Addressing Treatment Resistance

Understanding and addressing treatment resistance requires a framework that goes beyond prescribing medications. The 

 model developed at Riggs offers a structured approach:

Understanding that response to medications is always complexly determined by biological and psychological/interpersonal factors.

Attempting to link pharmacotherapy to the patient’s developmental goals.

Knowing Who the Patient Is, Not Just What They Have

Beyond diagnosis, understanding the patient’s internalized models of caregiving and relational patterns is crucial.

Exploring fears, fantasies, and experiences regarding pharmacotherapy in order to illuminate underlying sources of ambivalence about treatment.

Cultivating a Psychodynamically Informed Therapeutic Alliance

Recognize and address negative transference, helping the patient to differentiate past and present caregiving figures.

Actively involve patients in treatment decisions to enhance their agency.

Very early in the treatment, directly explore patient concerns by asking exploring questions such as, 

“What is it like for you to take medications?”

"What might you stand to lose if treatment works?”

Address fears that medications may undermine their identity, autonomy, or coping mechanisms.

Recognizing Counter-Therapeutic Uses of Medications

Identify instances where patients use medications to suppress emotions or avoid developmental challenges.

Differentiate between treating symptoms and enabling maladaptive coping strategies.

Managing Countertransference in Prescribing

Recognize that clinicians, as much as patients, are under the sway of the unconscious, and grappling with irrationality. Avoid reacting to challenging countertransferences to complex patients with impulsive or irrational medication changes.

By integrating psychodynamic insights into pharmacotherapy, clinicians can improve adherence and treatment outcomes. Key strategies include:

Establishing a shared understanding with the patient about the purpose and limitations of medications.

Recognizing when nonadherence is a meaningful expression of deeper psychological concerns rather than simple forgetfulness or negligence.

Using psychotherapy to address transferential concerns (e.g., fears of dependency, loss of control, and identity disturbances related to medication use).

Collaborating with therapists to create an integrated treatment plan that aligns pharmacotherapy with the patient’s psychological needs.

In my experience, effective pharmacotherapy is not just about prescribing the right drug; it is about understanding the meaning of medication in the patient’s life and how it interacts with their psychological landscape. A psychodynamic approach helps clinicians navigate complex cases where resistance is deeply rooted in identity, relational dynamics, and unconscious conflicts. By addressing these underlying factors, behavioral health professionals can foster better treatment engagement, enhance therapeutic alliances, and ultimately, improve patient outcomes.

I hope you found this article helpful. If so, feel free to check out the 

. You can earn CE/CME credit after you view the presentation and successfully complete a short quiz derived from the content.

A patient getting their medications at the Austen Riggs Center medication area.

Medication Management at Austen Riggs

News

Understanding and addressing treatment resistance requires a framework that goes beyond prescribing medications. The Psychodynamic Psychopharmacology model developed at Riggs offers a structured approach.

Understanding Treatment Resistance in Pharmacotherapy: A Psychodynamic Approach

The principles and benefits of Measurement-Based Care (MBC)

How MBC can be integrated into psychoanalytic-informed psychotherapy

The importance of patient involvement in treatment evaluation

Practical applications of MBC in clinical settings, including individual and system-based approaches

Insights from real-world case studies demonstrating the value of Measurement-Based Care on evaluating patient outcomes

I'm Steve Ackerman, a treatment team leader and psychoanalyst in the Austen Riggs Center 

. And I'm Seth Pitman, Associate Director of the 

 at Riggs. The two of us have developed Measurement-Based Care (MBC) programs in our respective areas at the Center that integrate measurement tools into psychoanalytic therapy, ensuring that patient voices remain central to the treatment process.

In this article we provide an overview of an online course we offered via the Erikson Institute of the Austen Riggs Center regarding how Measurement-Based Care can integrate systematic and routine assessments into treatment processes. While commonly utilized in cognitive-behavioral and medically driven therapeutic models, MBC has been underexplored in psychoanalytically informed care. In this piece, we explore how MBC can be effectively applied in psychoanalytic settings to understand treatment outcomes and therapeutic relationships, while shaping treatment interactions.

 in its entirety and receive free CE/CME from our online catalogue.

MBC involves the systematic collection of data to track patient progress and refine treatment plans accordingly. Traditionally, data collection in medical settings has been retrospective, meaning it informs future care rather than benefiting the current patient. MBC, however, is designed to adapt treatment in real-time, allowing therapists and patients to make informed decisions together.

Enhances the therapeutic alliance by joining patients and treaters in a shared task

Allows for early detection of alliance ruptures or negative therapeutic reactions

Increases patient engagement by giving them a voice in their own treatment

Helps therapists refine their approach through real-time feedback

Improves clinical outcomes by identifying barriers to treatment success

Why Measurement-Based Care Matters in Psychoanalysis

While MBC has often been associated with structured, symptom-focused treatments, its principles can be successfully adapted to psychoanalytic frameworks. Psychoanalytic therapy emphasizes understanding the patient's unconscious dynamics, subjective experiences, and emotional patterns. When combined with MBC, clinicians can create a more tailored and responsive treatment approach.

1. Tracking Progress Beyond Symptom Reduction:

 Many therapy outcome measures focus primarily on symptom improvement. Psychoanalytic-informed MBC assesses symptom improvement and goes deeper, examining underlying conflicts, relational patterns, and self-perception changes.

 Psychoanalytic therapy is relationship-driven, making it crucial to detect early signs of resistance or disengagement. MBC processes can reveal alliance shifts and highlight moments when a patient may struggle with deeper issues.

3. Encouraging Patient Reflection and Agency:

 Instead of merely collecting data, therapists can use the information to invite patients into discussions about their experiences, allowing them to take a more active role in their treatment.

 MBC data informs therapists about their strengths and areas for growth, fostering professional development over time.

, we present an in-depth case study to illustrate how a psychoanalytically informed approach to MBC can help clinicians highlight mismatches between patient’s self-reported symptoms and clinical presentation, uncover transference dynamics that might otherwise go unnoticed, and identify signs of deterioration that require a shift in therapeutic interventions.

For therapists in private practice, implementing MBC does not require large-scale system integration. It can be as simple as introducing a few key assessments to enhance reflection and therapeutic dialogue.

Steps for Private Practitioners to Implement MBC

 Start with simple, widely validated tools that capture common symptoms like depression (Patient Health Questionnaire-9; PHQ-9) and anxiety (Generalized Anxiety Disorder-7; GAD-7), the patients’ experience of the therapeutic alliance (Working Alliance Inventory; WAI), or even more nuanced measures like 

 to capture suicide risk from multiple angles.

 Have patients complete measures periodically and discuss results collaboratively.

 Consider tracking your own experience of the working alliance by filling out the therapist version of the WAI or using countertransference measures, such as the Therapist Response Questionnaire (TRQ), to gather additional diagnostic information about your patients.

4. Use Data to Enhance, Not Replace, Discussion:

 The key is to bring results into sessions as a conversational tool rather than letting them dictate treatment.

 Collect and review data over months or years to assess patterns in both patient outcomes and your own clinical development.

Measurement-Based Care in psychotherapy examines treatment outcomes by integrating systematic data tracking, improving patient engagement, and refining therapist interventions. At the heart of this approach is the commitment to centering the patient’s experience.

By combining structured assessments with deep, relationally driven inquiry, therapists can:

For therapists, MBC provides a structured approach to improving patient outcomes by incorporating common validated self-report measures along with tools that capture psychoanalytically relevant concepts such as psychic pain and countertransference. This evidence-based practice fosters better patient engagement, identifies hidden treatment barriers, and strengthens therapeutic alliances, ensuring that therapists remain responsive to both the evolving needs of their patients and their own professional growth – whether in large institutions or private practice.

MBC represents an invaluable tool for deepening psychotherapy’s impact.

We hope this article was both informative and helpful to you. 

The full online course is available for free

 online and you can earn continuing education credit after you view the presentation and successfully complete a short quiz derived from the content.

A woman talking to her therapist at the Austen Riggs Center.

Psychodynamic Psychotherapy at Austen Riggs

In this piece, we explore how MBC can be effectively applied in psychoanalytic settings to understand treatment outcomes and therapeutic relationships, while shaping treatment interactions. 

How Measurement-Based Care Informs Psychoanalytic Psychotherapy

The Trevor Project For Young LGBTQ+ Lives Logo

Trevor Project’s 2024 National Survey on the Mental Health of LGBTQ+ Young People

 is an illuminating and essential resource for understanding the mental health needs of youth in America. At a time when national repositories of essential national health information are disappearing, the incredible efforts and dedication of the 

 to documenting and advocating for the needs of LGBTQ+ youth have never been more important or impactful.

these results highlight several positive findings

, including a strong sense of acceptance by community (90% of all respondents and 89% of youth identifying as trans or non-binary, specifically) and general accessibility of mental health services. Interestingly 70% of survey respondents who were engaged in mental health treatment indicated that they accessed care through virtual modalities, signaling the importance of telehealth options and services for addressing mental health needs within the LGBTQ+ youth population.

At the same time, significant obstacles and challenges remain, with respondents acknowledging high exposure to stressful or/or discriminatory experiences and general reluctance to talk about these experiences to mental health providers (nearly half of respondents for example cited fear of talking about their mental health concerns with a provider as a reason for not engaging with services).

Given the high rates of depression, anxiety, suicidality, and exposure to trauma and adversity in LGTBQ+ youth, public health officials and providers must redouble efforts to provide a safe and supportive environment for clients and to offer a range of modalities to address the unique needs of vulnerable youth.

 has led efforts across both of these fronts in increasing accessibility of care for students and young adults residing in MA, offering intensive psychodynamically-informed treatment that supports individuals while they navigate the challenges and benefits of living in their communities and work on developing a sense of safety and mastery in their daily lives and relationships.

The Trevor Project

The Trevor Project’s 2024 National Survey on the Mental Health of LGBTQ+ Young People is an illuminating and essential resource for understanding the mental health needs of youth in America.

The Trevor Project Releases National Survey on the Mental Health of LGBTQ+ Young People

Photo by Matt at Unsplash - Image of a white lily 

Riggs adjunct faculty member Lucy LaFarge, MD, died on Thursday, February 20 after a long struggle with a recurring illness. You can 

In speaking about Lucy’s work at Riggs teaching August Special Seminars and participating in continuous case seminars, staff psychologist Jennifer Stevens, PhD, ABPP, remarked, “Her clinical wisdom, theoretical brilliance and encyclopedic psychoanalytic mind were evident in abundance.” So many Riggs medical staff members benefited from her clinical expertise. She also presented several Friday Night Guest Lectures at Austen Riggs and was a notable speaker and teacher.

Outside of Riggs, Lucy was a training and supervising analyst and Theory II course chair at the 

Columbia Center for Psychoanalytic Training and Research

. She was the book review editor and then North American editor of the 

. In addition, from 2021 to 2024, she served as the first woman editor-in-chief of 

She received her MD from the Albert Einstein College of Medicine and completed her psychiatry residency at Albert Einstein/Bronx Municipal Hospital Center.

Contributions in Lucy's honor may be made to the 

 or by mail to Paul LaFarge Memorial Fellowship, MacDowell Colony, 100 High Street, Peterborough, NH 03458, Att: Robin Cheroff.

Iris

Riggs adjunct faculty member Lucy LaFarge, MD, died on Thursday, February 20 after a long struggle with a recurring illness.

Riggs Mourns Loss of Adjunct Faculty Member Lucy LaFarge

Behind the Inn of the Austen Riggs Center

Since the 1960s, Austen Riggs has been licensed as both a hospital and a Residential Treatment Center. Over time, credentialing agencies have increasingly defined “hospital” care as short-term crisis management focused on protection and safety. Given Riggs’ commitment to maximizing patients’ capacity to take authority over their lives, we gradually reduced the number of beds designated for “hospital care”—beds that provided more intensive nursing support during crises while preserving therapeutic relationships. However, these beds were rarely used. In the past five years, only four of our 71 beds have been hospital-licensed, averaging just 6.6 days of use per year. The last time they were used was December 2023.

These four beds, located in the Inn, formed our Voluntary Hospital Program (VHP), a short-term, fully open, and voluntary level of inpatient care. The VHP offered brief, intensive engagement with nurses and staff to help patients stabilize and assess whether they could safely continue treatment in our open setting or required transfer to a more restrictive facility.

Recently, in line with national trends, the Massachusetts Department of Mental Health (DMH) further tightened its interpretation of hospital regulations, requiring complete physical separation of “hospital” beds from our therapeutic community. This would have forced Riggs to wall off a section of the Inn, fundamentally altering our mission centered on patient authority and deep therapeutic relationships.

After careful consideration, Riggs has decided not to pursue re-licensure as a hospital. This decision does not affect our licensure as a Residential Treatment Center, nor does it alter our treatment model or non-profit status. During crises, we will continue to provide increased engagement and assessment for transfer when a higher level of care is needed.

“Our discussions with DMH over the past 10 months have been thoughtful and comprehensive,” said Medical Director/CEO Edward R. Shapiro, MD. “However, the increased restriction and isolation required for hospital beds would compromise the openness and therapeutic freedom fundamental to the Riggs model. Our decision reflects the broader shift in psychiatric care, where hospitals now primarily focus on protection and safety, while treatment increasingly takes place in Residential Treatment Centers. Riggs remains steadfast in its commitment to an open therapeutic environment, deep respect for individual autonomy, and a community that fosters meaningful engagement in treatment.”

Founded in 1919, Riggs provides intensive residential treatment for individuals with complex mental health challenges who are not in acute crisis but for whom outpatient care has been insufficient. Many Riggs patients have undergone multiple treatments—including medication, therapy, and inpatient care—without achieving lasting relief or the ability to take charge of their lives.

At Riggs, there are no locked doors, privilege systems, or physical restraints. Instead, patients balance freedom with responsibility. Our treatment pathway begins at the Inn Residence, where each patient has a private room and works with the same interdisciplinary team from admission to discharge. This care starts with 24-hour nursing support and transitions through step-down programs as patients take increasing authority over their lives and treatment costs decrease. Throughout their stay, patients engage in intensive four-times-per-week psychodynamic psychotherapy, active participation in our Therapeutic Community Program, medication management, family interventions, casework, and a diverse range of arts and education activities.

This decision reaffirms Riggs’ dedication to its core mission: providing deeply relational, psychodynamic treatment that helps patients understand and work through the meaning of their symptoms, fostering lasting change within a therapeutic community.

Austen Riggs Center Inn

After careful consideration, Riggs has decided not to pursue re-licensure as a hospital. This decision does not affect our licensure as a Residential Treatment Center, nor does it alter our treatment model or non-profit status. 

Riggs Clarifies Its License Status

Established in 1919 in Stockbridge, Massachusetts, the Austen Riggs Center is internationally recognized as a leading continuum of care that promotes personal resilience and self-direction in adults with complex psychiatric problems. Our treatment is built around an open setting and therapeutic community that emphasizes the importance of relationships, the voice and authority of patients, and intensive psychoanalytic psychotherapy. Over its 106-year history, Riggs has developed a psychoanalytic and systems psychodynamic approach for patients who have been unable to effectively use other treatments. The most recent addition to our services, the Online Intensive Outpatient Program (IOP), was created in response to the growing need for quality, affordable access to care which serves college students and emerging adults. We also have a deep history in clinical education, research and accessibility including Fellowships and high-quality training opportunities through our Erikson Institute.

The mission of the organization is to promote resilience and self-direction in those with complex psychiatric problems—to help people take charge of their lives. Our work is grounded in the conviction that an individual’s problems are inherently meaningful, that such problems are best understood in a social context, and that treatment leads to a more fulfilling life when the sources of suffering are addressed. 

The Austen Riggs Center seeks a Medical or Clinical Director/Chief Executive Officer (CEO) to lead the organization. 

This is a unique opportunity for a psychoanalytically oriented psychiatrist or psychologist, trained in the Riggs approach or its equivalent, to have a positive impact, not only on one of the nation’s oldest, most well-established, and well-respected treatment centers, but also on the entire field of psychology and psychiatry.

Reporting to the Board of Trustees, the Medical or Clinical Director/CEO will be responsible for the general management and oversight of both clinical and non-clinical affairs of the Center. The Medical or Clinical Director/CEO will guide a process (inclusive of Trustees, staff, and patients) that results in a comprehensive strategic plan for Riggs. This plan will address an increase in the visibility and impact of Riggs, communication of the efficacy of the Riggs approach, and the strengthening of strategic alliances with multiple constituencies. It will also address the need to strengthen the current infrastructure of the organization through cultural and technological advancement.

We seek strong leadership from an individual whose integrity, intelligence, and clear thinking will maintain the long tradition of clinical excellence at the Center while expanding its referral base, partnerships, national recognition, and educational and research contributions to the fields of psychology and psychiatry. The ideal candidate will be a good communicator, both internally and with the external world, whose decisive and confident leadership is balanced with the compassion and sense of humor necessary for open, collaborative engagement with the community at the Center.

The Executive Committee of the Board of Trustees named a national firm to assist in the recruitment of the Medical or Clinical Director/CEO. Applications, nominations, and inquiries should be directed in confidence to the firm as indicated at the end of this document.

The current climate of biological and evidence-based treatments for psychiatric disorders in a managed care system provides both challenges and opportunities for the Austen Riggs Center. While we continue to be well respected in the field and our Fellowship training program is almost universally viewed as second to none, we operate in a context of increased competition, biological reductionism, symptom and crisis management, and preference for “evidence-based” treatment. In many ways the Center is at a crossroads with how it engages with the world beyond its campus in Stockbridge. We have an important opportunity to be more vocal advocates for the efficacy of psychoanalytic treatment and systems psychodynamic understanding. The Medical or Clinical Director/CEO will be charged with developing strategies to achieve these goals while maintaining the Riggs tradition of clinical excellence.

The Medical or Clinical Director will be the CEO of the Corporation, the Austen Riggs Center, and Manager of the IOP. Subject to the direction and control of the Board of Trustees, the Medical or Clinical Director/CEO will have general management and oversight of all clinical and non-clinical affairs.

The senior leadership team reports to the Medical or Clinical Director/CEO. It is comprised of the Medical or Clinical Director/CEO plus 9 other members: Associate Medical Director/Director of Admissions, Director of Patient Care, Chief Nursing Officer, Chief Operating Officer/Chief Financial Officer, Director of the IOP, Director of the Therapeutic Community Program, Director of the Erikson Institute, Director of Human Resources, and Director of Communications.

The Austen Riggs Center seeks candidates for this position who are prepared to move to Stockbridge, Massachusetts upon assuming the position and live in a home provided by the Center near its campus; who will make a minimum five-year commitment to the leadership of the institution; and who bring the following skills and experience:

A doctoral-level degree e.g., MD, DO, PhD, PsyD, EdD

Have substantial experience and recognition as an effective psychoanalytic clinician treating patients with complex psychiatric difficulties, including supervisory expertise.

Have a minimum of 10 years progressive experience in organizational leadership and management and the capacity to inspire excellence in others.

Have experience in Tavistock-style group relations conferences.

Be able to help the Center take a leadership position in the mental health world at large regarding the psychodynamic treatment of complex patients.

Be able to think systemically about organizations as a whole, and about the Center and its relationship to the outer world.

Embrace research and have a record of scholarly contributions/publications.

Have demonstrated capacity to understand organizational finances.

Have Riggs training, either from having completed the Fellowship or served on the medical staff.

Bring an understanding of and experience with systems thinking.

Embrace the complexity of the Riggs treatment model while bringing fresh perspectives and innovative ideas.

Recognize and support the Center’s broad educational responsibility to the mental health field and larger society.

Have a deep understanding of the psychodynamics of family systems.

Understand the importance of fundraising; have experience with, or be capable of, participating in successful fundraising.

Have established networks with professional leaders, other institutions, and potential funders.

Have recognized stature in the mental health field.

All inquiries, nominations, and applications, including a resume and cover letter, should be submitted in confidence via 

Application for Medical or Clinical Director/CEO

Jaynanne Calaway-Habeck, President
Zack Funk, Senior Consultant
Calaway Habeck Talent Consulting

Review of candidates will begin immediately and will continue until the position is filled. To ensure full consideration, materials should be submitted by May 1, 2025. Ideally candidates should be prepared to assume the position between July 1, 2025, and January 1, 2026. Start date can be negotiated but will be no later than July 1, 2026.

For more information about the Austen Riggs Center,
please visit our website: 

The Austen Riggs Center is an equal opportunity employer.

Austen Riggs Center

The Austen Riggs Center seeks a Medical or Clinical Director/Chief Executive Officer (CEO) to lead the organization.  

 Austen Riggs Opens Search for Medical or Clinical Director/CEO

Austen Riggs Center Medical Office Building

"Identifying and nurturing the next generation of psychodynamic and biopsychosocial psychiatrists, educators, and leaders is essential to advancing the field of psychiatry," says 

, Director of Psychiatric Education at Austen Riggs Center. "That’s why we created the 

Austen Riggs Award for Excellence in Psychotherapy

Now in its 6th year, this prestigious annual award highlights and supports outstanding psychiatric residents who have demonstrated a strong interest and talent in psychodynamic psychotherapy or psychiatry. Additionally, it recognizes those showing promise as researchers in biopsychosocial approaches to psychiatric practice, including psychotherapy.

Winners of the 2024 Excellence in Psychotherapy Award given by the Erikson Institute of the Austen Riggs Center.

2024 Excellence in Psychotherapy Recients

Vanderbilt University Medical School Department of Psychiatry and Behavioral Sciences

Kaiser Permanente San Jose Medical Center Psychiatry Residency Program

Beth Israel Deaconess / Harvard Psychiatry Residency Training Program

University of Maryland Medical Center Psychiatry Residency

UT Southwestern Medical Center General Psychiatry Residency Program

Yale School of Medicine Psychiatry Residency Program

MGH McLean Adult Psychiatry Residency Program

UCLA Psychiatry Residency Training Program

nominated by: Farooq Mohyuddin, MD CGP, F-AGPA

Saint Elizabeths Hospital Adult Psychiatry Residency

We will be accepting nominations for the 2025 prize after July 1, 2025.

Now in its 6th year, this prestigious annual award highlights and supports outstanding psychiatric residents who have demonstrated a strong interest and talent in psychodynamic psychotherapy or psychiatry.

Riggs Announces 2024 Award for Excellence in Psychotherapy Recipients

 has a distinct focus: we aim to help individuals who struggle with the most difficult aspects of human experience and have been unable to use conventional treatments. Riggs has learned a lot about what gets in their way, and our organization is designed to address that. We prioritize 

 to discharge helps patients increasingly take charge of their lives. Our 

 reflects this commitment by maximizing our ability to meet basic dependency needs and minimizing how much we “take over” for our patients.

"We prioritize patient authority, ensuring that everything from admission to discharge helps patients increasingly take charge of their lives."

Edward R. Shapiro, MD, on the Austen Riggs' Mission

Bringing patients to an open setting–often when they are struggling with severe emotional distress, suicidal thinking, social isolation, or hopelessness–means we all share in the anxiety that comes with offering both freedom and responsibility. We collectively work to manage this anxiety with the patients and their families. We do our best to recognize that our patients are competent adults even if they’re entangled in destructive patterns. Our setting provides opportunities for them to take responsibility: at admission, in self-government in our community, in sponsoring other patients, in taking responsibility for their resources and their 

, we help patients learn how their minds work, why certain feelings overwhelm them, how behavior communicates unspoken issues, and how irrational roles can develop in families and relationships. Our operations staff assists with food, housing, medical needs, finances, and daily logistics–support that frees our clinical staff to focus on treatment. Of course, we sometimes get it wrong, either because we trigger old traumas for our patients, or because defending ourselves against the painfulness of our work makes it harder for us to listen objectively.

This mission places significant demands on all of us. We have agreed to serve this mission on behalf of our patients and on behalf of the broader field, which can sometimes reduce patients to their symptoms alone, leaving aside the importance of the whole person.

Riggs’ mission has a distinct focus: we aim to help individuals who struggle with the most difficult aspects of human experience and have been unable to use conventional treatments.

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