We recently sat down with Austen Riggs Psychology Fellow Evan Good, PhD, to discuss a paper he authored with some of his colleagues titled “A Re-introduction of the Psychodynamic Approach to the Standard Clinical Psychology Curriculum” that appeared in the Journal of Clinical Psychology.
- There is a national trend that sees a decrease in programs that offer psychodynamic coursework and faculty who identify as psychodynamic.
- Cognitive theories and approaches are often pitted against psychodynamic ones or presented in ways that suggest they are incompatible (which is not true).
- The earlier we can educate people more accurately about psychodynamic theories and work against some of the bias, the better chance we have at creating a culture of more acceptance, increased understanding and respect for psychodynamic work and its effectiveness.
- Moving away from a “which one is better” approach when it comes to different psychological theories, practice, and research, and moving to a place of integration, could ultimately benefit patient care.
What PhD program did you attend and what exposure to psychodynamic principles did you have?
I attended Michigan State University’s (MSU) clinical science program
, which is now part of a distinct group of clinical psychology programs that are really focused on building a more empirical research base to psychological science. In practice, this means that they are training psychologists to go on to professional positions focused on the production of psychological research and its dissemination.
When I first entered the program there were probably three or four psychodynamic faculty and two courses that focused on more of a dynamic perspective. Within a year or so, this was essentially winnowed down to one or two faculty, and one of the courses was eliminated.
What led you and your colleagues to write “A Re-introduction of the Psychodynamic Approach to the Standard Clinical Psychology Curriculum”?
During my time at MSU, I was seeing this trend that my colleagues and I write about in our paper (“A Re-introduction of the Psychodynamic Approach to the Standard Clinical Psychology Curriculum
,” Journal of Clinical Psychology
, 2023) of clinical PhD programs moving away from psychodynamic approaches in favor of more cognitive behavioral or cognitive neuroscience approaches.
Unfortunately, these more cognitive theories and approaches are often pitted against psychodynamic ones or presented in ways that suggest they are incompatible, which I do not believe is true.
The national movement away from dynamic and analytic approaches was startling to me. One, because I found a richness and utility in the coursework and in the theories and the thinking from the more dynamic and analytic perspective that led me to think of them as incremental to the cognitive behavioral cognitive neuroscience perspective.
And two, I was really concerned that dynamic approaches would be eventually eliminated from doctoral training, particularly in clinical psychology, and particularly at these universities that were identified as clinical science programs, which tend to be the institutions that get the most grant funding, are some of the most competitive, and tend to place their students in faculty positions.
My colleagues who authored this paper with me all had similar experiences from different parts of MSU and we felt it was important to explore this national trend away from psychodynamic approaches and look for ways to re-incorporate them.
What are some of the most salient findings from this paper?
The data analysis we conducted confirmed our concerns: there is a national trend that sees a decrease in programs that offer psychodynamic coursework and faculty who identify as psychodynamic. While this data was unsurprising, it was startling to see just how much of a decline there has been over time, particularly in clinical science programs.
Another important thing that stuck out was a real need to better integrate psychodynamic and psychoanalytic traditions with cognitive and behavioral neuroscience and research. The reality is that psychodynamic approaches have somewhat resisted this integration and participation in research more broadly, which reifies this idea that they're incompatible in some way, or that programs would have to be giving up something to include it in their programs.
So, we have to think about how to integrate those things and create, I think not only the basic research, but also the theoretical literature to integrate them. The good news is that there are people working on it and certainly people who have made this argument, but I think that it is something that doesn't currently exist and may take several years.
Why do you think there has been a decline in psychodynamic faculty in clinical psychology PhD programs over the past 20 years?
I think it boils down to research funding and program prioritization. Many universities want their faculty to acquire grants, conduct grant-funded research, and publish their findings. And, in terms of what is funded, of what is privileged when it comes to psychology research, it's certainly not the more dynamic work, but rather more cognitive neuroscience work.
Our group applied for various different grants for dynamic research we were interested in and it just wasn’t considered as competitive. Now, grants that were funded included ones that looked at more physiological data, so to the extent dynamic research moves toward including that kind of data, it may increase the research funding available, but that is not the current state of things.
What programs prioritize is certainly related to research funding, but I also think in general there is a lot of bias against dynamic approaches. Even in introductory psychology textbooks, dynamic and analytic theories are sometimes positioned as old or pseudo-scientific, whereas the more cognitive behavioral approaches are still, in my opinion, heralded as the foundation of current psychology and the gold standard.
I think there's a way in which psychoanalytic thought is oftentimes thought of as synonymous with Freud and there isn't really an acknowledgment or understanding of the developments that have happened since his death in 1939. Contemporary dynamic interpersonal psychology is related to, but different from where it began. There are pieces of social learning and ways in which exposure is part of the work that a dynamic analytic therapist does, but we just don’t call it that. There are similarities to other types of therapies that are glossed over or ignored in favor of emphasizing differences as reasons that dynamic therapies are incompatible with modern approaches and should be devalued or dropped.
Can you talk briefly about the “four critical tenets of contemporary relational psychodynamic theory”?
Because psychology has so many schools and there isn't one comprehensive theory per se, we were really trying to identify major flagpoles of a dynamic approach and particularly the ones that we feel are more implicit or at least not focused on within the more traditional cognitive behavioral training programs, and things that aren't necessarily manualized.
We wanted to synthesize the major building blocks that are important for understanding dynamic approaches and encouraging programs to integrate more dynamic theories in their training programs. The four tenets are:
- Unconscious processes
- Internal representations of self and other
- Dimensional model of psychopathology
- Therapeutic relationship as primary mechanism of change
Can you speak about how diversity, equity, and inclusion factors into these tenets, specifically tenet #3?
While I was at MSU it shifted from a program that identified as more inclusive to one that began to really value diversity, social justice, and taking action in a kind of advocacy role. This mirrored shifts that were going on more broadly in society and I think we were left with major questions at MSU: How do we integrate diversity into our work? How do we make sure we’re thinking about things like cultural context when we're engaging with patients? How do we keep diversity from being absent from our thinking?
There was anxiety about these questions, particularly from those who identified as more cognitive behavioral, many of whom felt we needed to create manuals and modules for each different kind of intersection of identity. This felt directly juxtaposed to the more dynamically oriented faculty or trainees who were thinking about the integration of diversity in ways that weren’t all that different from the way we’re always thinking about a person's unique experience, being curious about it and not making any assumptions. From a dynamic perspective, any interaction is two people from very different experiences coming together and learning to relate to and understand each other, despite and through those differences. It’s part of understanding a whole person and not just seeing someone as a collection of symptoms or fitting into certain clusters or categories that we're treating. As clinicians we're treating a whole person, which includes their breadth of experiences which always are within a cultural context which are important to understand.
We do need to increase our focus on diversity, and we need to increase talking about it. We need to think about how we do that, and maybe think about it differently than other aspects of identity. And we need to remember that this is all part of a larger complexity of how a person experiences themselves in relation to others and in relation to the world.
What (if anything) surprised you while working on this paper?
I was surprised by how hard it was to write about how moved we were by the experience of this research project; there was something kind of intangible about it that required a good deal of back and forth to arrive at a draft we were all happy with.
I was also reminded that during training is when many clinicians find themselves at odds with or thinking differently from other clinicians who are studying different theories or approaches. However, research shows that over time clinicians begin to look or practice more similarly than when they first graduated, even though they may maintain different theoretical identities or specialties. A cognitive behavioral trained clinician may not initially think as much about relationships but may see over time the importance of the relationship between the patient and the therapist as it relates to positive outcomes. Likewise, a dynamically oriented clinician may come to the realization that sometimes what someone needs may be psychoeducational in nature or more skills based. In other words, there is something artificial about how differentiated these camps are.
There is a Kuhnian idea that when there is a major paradigm shift, it is often to respond to a certain crisis in the field. There may be questions that the old theories can’t answer and a cultural pressure to answer the questions. So, when a new theory comes along and is better able to offer answers to the crisis, there still may be things it doesn’t solve that the previous theory did.
There are some things that I think have been thought about very deeply in the more analytic dynamic tradition that run the risk of being lost if they are eliminated from graduate psychology programs and I think it's important that we think about how contemporary dynamic theories can answer the types of questions the field and the world are grappling with today.
There is a lot of work to be done, but it is concerning to me that we could lose so much rich thinking and writing - things that are very relevant today but need to be translated in research and in contemporary terms. We need clinicians who have robust training in research, theory, and practice to take us forward. Psychology cannot be a monolith; it is not helpful to science.
What do you see as possible roadmaps to getting psychodynamic approaches added back to psychology curricula?
This was one of the trickier sections to write, not because we didn’t have lots of ideas, but more because we recognized the practical realities and the amount of time and bureaucracy it takes to just make minor adjustments to training curriculums. So, we tried to focus on what's actually viable.
Some of the recommendations about inviting lecturers and writing people to give talks, simply introducing psychodynamic ideas in a way that doesn’t require reconstructing curriculums are the easiest way to start the integration. Just having some exposure can make a difference.
I took a psychodynamic course in my training program at MSU that was enough to give me a taste of it and made me realize that there was something there I wanted to explore and learn more about. That led me to want to find opportunities to grow in that direction, even if it's not something that my program necessarily cultivated.
So, it might seem small, but just making psychodynamic ideas available to trainees can be really helpful and can help expose more clinical trainees to these ideas in a way that will ultimately help facilitate more integration of psychodynamic ideas into research, practice, and training.
I think the earlier we can educate people more accurately about psychodynamic theories and work against some of the bias, whether that is at the undergraduate level or even at the high school level, the better chance we have at creating a culture of more acceptance, increased understanding and respect for psychodynamic work and its effectiveness.
Do you have any final thoughts you’d like to share?
One thing that I was hoping for, but in some ways surprised by, was the way that the paper has already been received by the field. There's been a lot of excitement and some of my co-author colleagues have even been asked to talk about the paper.
It’s really exciting that this isn't just the felt experience of the four authors, but that it's something that a lot of other people are concerned about. I hope that this will also catalyze other people to write about it, to think about it, to think about how to advocate and disseminate psychoanalytic ideas and research.
I do hope that we can move away from a “which one is better” approach when it comes to different psychological theories, practice, and research, and move to a place of integration, which I believe would ultimately benefit patient care.
Last year I gave a presentation on a measure of mentalization that some colleagues and I were developing and received some pushback—that this was something we couldn’t measure or shouldn’t try to bother trying to measure. I’m not suggesting that the measure we came up with was the best measure, but if you don’t start trying to measure, you’ll never get to a place where you can measure. Sometimes there’s a resistance in the field to making something imperfect, even if it moves us closer to a place of integration that would ultimately benefit the field.