Learning to Think Psychodynamically: A Resident's Experience at the Austen Riggs Center

For Sara Berzingi, MD, the decision to apply to the Austen Riggs Center's Elective in Psychodynamic Psychiatry came down to a single, persistent feeling: she was missing a piece of the puzzle. A fourth-year psychiatric resident at West Virginia University School of Medicine Berzingi had some exposure to psychodynamic psychotherapy during her training but found herself wanting a deeper educational experience to witness these concepts in practice.

"Psychiatry residency trainings have become a lot more biological in how they teach," she reflected in a recent interview. "The encounter tends to become focused more on the diagnoses and medications, and less about the interpersonal dynamics between patients and their loved ones—which often is at the root of what brings them into the room. It felt like we were missing a big piece of the puzzle."

That hunger for depth led her, with the encouragement of her psychotherapy supervisor, to discover a rare opportunity: an immersive away rotation at the Austen Riggs Center in Stockbridge, Massachusetts—one of the few settings in the country where psychiatric residents can spend dedicated time fully embedded in a psychodynamically oriented therapeutic community.

Berzingi arrived uncertain what to expect. She knew, in theory, that Riggs operated as an open therapeutic community with an emphasis on examined living—but the lived reality surpassed her expectations. "I was impressed by the extent to which it fulfils its stated mission," she said.

Her analogy for what the experience provides encapsulates something important about and intentional in the training:

"Psychotherapy training in psychiatry residency is a lot like learning a foreign language in high school. You learn the vocabulary and the basic grammar rules, but never really achieve fluency. Being here at Austen Riggs is a lot like a study abroad experience—you're immersed in the psychodynamic language constantly, and you start thinking in the new language pretty quickly."

The immersion, she noted, wasn't abstract. She found herself absorbing not just frameworks, but the language and ways of thinking that experienced clinicians use to name and interpret experience. Terms like ‘transference’ and ‘countertransference’ and a greater comfort with associative thinking started to emerge in her own reflections on her work back home. "I've noticed myself picking up on even just the words that people use and adopting them into my own vernacular," she said.

Berzingi described a structured but genuinely novel daily rhythm. Each week begins with a clinical staff meeting that draws together nurses, social workers, physicians, psychologists, and trainees—a deliberate "horizontalization of hierarchy," as she put it, where every voice is invited and no perspective is subordinated.

The centerpiece of the week, she said, is the case conference—a two-hour, multidisciplinary deep dive into a single patient's story.

"It's two hours dedicated to a single patient's story—and I think 'story' is the best word for it, because it really encapsulates the full breadth of their personhood. From birth—even prior to birth, the maternal experience during pregnancy—through today. All of the different factors that have affected them. It is unlike anything I've ever seen before."

Team members from nursing, the Activities Program, and work program contribute what they have observed; the patient is then briefly interviewed by the group, given space to respond to questions, and leaves so the team can brainstorm collaboratively. Feedback is ultimately provided back to the patient in the form of a comprehensive and personalized letter that details findings from the first six weeks of treatment including results of psychological testing and integrated perspectives from an interdisciplinary treatment team that give patients: 

"I don't know that I've ever seen that model replicated anywhere else," Berzingi said. 

Twice weekly, elective participants meet with Dr. David Mintz—a nationally recognized expert in psychodynamic and psychosocial aspects of psychopharmacology—to work through seminal papers in the field, connect theory to their own patient panels, and leave, Berzingi said, "feeling supported and connecting what we're learning here to what we have back home."

She also described her introduction to psychometric testing tools—including the Rorschach—that she had assumed were obsolete. "Naively, I thought they were out of practice," she admitted. "But it's really cool to see them being utilized here and to hear the individuals who do this type of testing talk about how, in this form, the testing itself is part of the care."

Perhaps the most personal dimension of Berzingi's account is what the elective made possible retroactively: a way to make sense of her own earlier experiences in clinical work.

"It reaffirmed to me that a lot of what I was experiencing and noticing—the struggles in my own psychotherapy with patients—are not new or unique, but are actually things that have been experienced hundreds of years ago and have been extensively written about. It made me realize that had I been exposed to it earlier in training, I might not have felt so alone with those feelings."

That sense of retrospective coherence—of a framework that catches what other training leaves unnamed—runs through everything she described about her time at Riggs. Including something as simple as lunchtime. Patients and staff eat together; no one wears badges that differentiate one from the other.

"There is such an emphasis on normalization—of just humanity," she said. "Anybody could be either patient or staff. And that's the point. The issues that bring people in are very human issues."

Berzingi is clear-eyed about the challenges of translating what she has absorbed at Riggs into a conventional residency program. But she is also explicit about her ambitions. She hopes to bring back not just new clinical tools, but a systems-level sensibility—a Riggs-influenced understanding of how an entire organization can be structured to support the psychodynamic work that happens within it.

"I would really love to see that in my program," she said of the collaborative, horizontalized model she experienced at Riggs. “I think it offers more to systems that I think they don't necessarily routinely consider."

The Austen Riggs Center offers distinct elective tracks for medical students and psychiatric residents, each designed to provide the kind of immersive, mentored depth that abbreviated psychotherapy training cannot replicate. For psychiatric residents, the curriculum includes fostering skills for work with difficult-to-treat patients, understanding dynamics contributing to resistance and psychotherapy impasse, learning the psychodynamics of psychopharmacology, and engaging with the therapeutic community program as a living laboratory for systems-level psychodynamic thinking. Medical students receive grounding in psychodynamic formulation, countertransference, and the fundamentals of the field—all integrated through supervision and mentorship by therapy staff.

Berzingi's message to anyone considering the opportunity is unambiguous:

"If there is anybody who is considering or wanting to get greater depth to their therapy training, this is the place to do it. There is something about this place that is so uniquely immersive. It's truly unlike any kind of brief psychotherapy experience that you're exposed to in a psychiatry residency."

Learn more and apply at www.austenriggs.org/elective