Commentary on: “Training in psychodynamic psychotherapy: the psychiatric trainee's perspective”

Abstract

The concerns expressed by Dr. Trigwell and his colleagues are not new. They have been expressed by many critics of psychoanalysis and psychodynamic psychotherapy including within the past decade Frederick Crews and Robert Wilcocks. What gives them a particular relevance and urgency is the fact that they have been articulated by young psychiatrists in training, individuals exposed to the actual practical application of psychoanalytic theory as distinct from theoretical explorations of it. The depressing thing is the reaction of one of the course supervisors. It may well serve only to reinforce their critical view.The criticisms can be summarised as follows. First, the theories of Freud and his successors were taught on this course at any rate as scientifically established facts rather than as theories or constructs concerning human behaviour, helpful insights in certain instances but not always relevant. These theories and related interpretations were formulated in a way that made it impossible to refute them. They tended to be used in a way that suggested that they explain everything from the most trivial and reflex of thoughts and responses to the most complex and profound.These criticisms, it might be said, relate to the actual content of psychoanalysis and psychodynamic psychotherapy, to what is being taught. Raymond Tallis has put the same general criticism with somewhat more force, observing that the manner in which psychoanalytic conclusions are drawn from clinical case histories “is reminiscent of how a first year medical student or a hypochondriac, using a few observations to light a gunpowder trail of inference primed with his own preconceptions, might arrive at a wrong diagnosis”.