Some Essential Steps for Keeping Psychotherapy at the Core of Psychiatry Training: A Response to Belcher
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COMMENTARY
Some Essential Steps for Keeping Psychotherapy at the Core of Psychiatry Training: A Response to Belcher Matthew Morrissette 1
&
William Fleisher 2
Received: 22 July 2020 / Accepted: 2 October 2020 # Academic Psychiatry 2020
There are two kinds of fools: One says, “This is old, therefore it is good”; the other says, “This is new, therefore it is better.” William R. Inge [1]. We were drawn to Belcher’s recent article [2], which attends to the considerable debate regarding the role of psychotherapy in the professional identity of the contemporary psychiatrist. Belcher asserts that psychotherapy is essential in psychiatric treatment, and yet despite this, the proportion of psychiatrists who deliver psychotherapeutic treatment continues to decline. It is suggested that contributory factors to this trend include the provision of psychotherapy by other professionals, an increasing emphasis on neurobiology in psychiatry, and significant financial disincentives for psychiatrists to provide psychotherapy. At the same time, Belcher suggests that psychiatrists are expected to “see more” of their patients and to more wholly understand their experiences in a way that cannot be captured by diagnostic reductionism. Belcher writes that “learning psychotherapy is to learn listening with purpose, which is the skill on which our entire work depends.” It is therefore imperative that psychotherapy remains at the core of psychiatry training and that some essential steps must be taken in order for this to happen. In keeping with Belcher’s remarks [2], the importance of psychotherapy in psychiatric practice has eroded, such that “‘to treat’ has come to mean ‘to medicate’” [3] with concern that psychiatric treatment has been reduced to “just a DSM diagnosis and pharmacological advice” [4] even though psychotherapeutic interventions have well-established efficacy in treating a range of psychiatric disorders [5]. Furthermore,
* Matthew Morrissette [email protected] 1
University of Alberta, Edmonton, Alberta, Canada
2
University of Manitoba, Winnipeg, Manitoba, Canada
psychotherapy education provides an opportunity to develop empathic therapeutic relationships and to enhance the ability to listen to patients, both of which are essential elements to the professional identity of a psychiatrist [6]. As psychiatry residency programs face increasing academic curricular demands to ensure trainees attain a wide range of competencies, there has been a concurrent decline in the emphasis placed upon psychotherapy education during psychiatry training [7]. This decline has been attributed to a variety of factors, including alignment of general psychiatry with a neurobiological model of understanding psychiatric illness, financial incentives for pharmacological over psychotherapeutic treatment, decreased numbers of psychotherapists in academia, and competition with therapists from other mental health disciplines for psychotherapy patients [8,9]. Failure to effectively teach psychotherapy deprives residents of the opportunity
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