Psychodynamics Curricula Should Stress Data: Experts Want the Next Generation Made Aware of the Evidence Supporting Psychodynamic Theory

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NEW YORK -- If the next generation of psychiatrists is to take psychodynamic psychiatry seriously, they must be made aware of the evidence base that supports its theory and practice, according to speakers who described curricula to accomplish this during residency.

'It's a widespread myth that there is no empirical evidence for the principles of psychoanalysis, its model of the mind, or its effectiveness as treatment,' Dr. Andrew Gerber said at the annual meeting of the American Academy of Psychoanalysis and Dynamic Psychiatry. "I heard this throughout my training, from both friends and foes of psychoanalysis."

In fact, there is "an enormous body of research we should know more about," including, most recently, discoveries in "neuropsychoanalysis," its crossover with neurobiology, said Dr. Gerber of New York-Presbyterian Hospital-Weill Cornell Medical Center, New York.

Dr. Elizabeth Auchincloss, vice chair for graduate medical education at the medical center, said the theoretical basis of psychoanalytic psychiatry is often neglected. "Psychodynamic psychotherapy is mainly taught as a series of operations unconnected to a model of the mind. But you can't really teach clinical procedure without attaching it to a theory: a theory about how to do therapy, about what's wrong with the patient, about how things go right."

Dr. Auchincloss described an evidence-based course on the psychoanalytic model of the mind that she has been giving in the second postgraduate year of residency training since 1985.

"My goal is to connect this material with what's going on in the world beyond psychoanalysis," she said.

The course begins by placing the psychoanalytic model in the context of great philosophical issues like "What is the mind?" and examining why a model of the mind is needed. "Mentalization research helps answer this question. It has shown that human beings operate with models of the mind whether we know it or not, beginning in childhood We use theories about other people's minds to figure out what to do next," she said.

In that regard, she cited a neuroimaging study showing that the process of imagining another person's mental life activates the same brain areas as thinking about doing something oneself, rather than those engaged when thinking about an object "We know other minds through empathy," she said.

Other areas covered by her curriculum are an up-to-date version of the psychoanalytic map of mental structures, with evidence documenting "the scientific status of unconscious process," the role of consciousness in mediating mental life, fantasy structure, and dreams.

"I want residents to know we're not the only ones working in these areas. …