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Abstract: This paper describes forces that have adversely affected the place of the psychodynamic perspective within psychiatric practice and training over the last generation. One effect of these forces has been to create a lost generation of psychiatrists with little knowledge or experience with psychodynamic treatment. The article addresses opportunities to reverse some of the detrimental effects of recent changes. The Residency Review Committee's introduction of a requirement that residents achieve a measurable level of competence in five schools of psychotherapy represents a major opportunity to influence psychiatric training and practice. The past and present work of the Committee on Psychotherapy by Psychiatrists (COPP) is summarized, including efforts to integrate and revise the five existing core competencies in psychotherapy into a "Y"-shaped model in a way that secures the future of psychodynamic therapy training in residencies. One existing unusual training opportunity with a central psychodynamic focus is described.
A LOST GENERATION IN PSYCHIATRY
The last generation has seen dramatic changes in psychiatric training and practice that have been caused by several interdependent forces. First, there has been a societal shift affecting not only psychiatry, but also the larger world, as resource limitation has emerged as a new worldview. Just as global warming, depletion of fossil fuels, and extinction of zoological diversity have emerged as representations of resource limitation on the geopolitical scene, resource limitation in the form of managed care has emerged within the health care service sector, including the "behavioral health" domain of psychiatry (Plakun, 2002; Shapiro, 1997).
Concurrently, revolutionary advances in understanding of the biology of psychiatric illness have led to the introduction of a myriad of effective, well-tolerated medications for the treatment of mood, anxiety, substance use, and psychotic disorders. There has been some dimming of the initial promise offered by these pharmaceuticals because of evidence that their efficacy has been undermined by bias in sample selection, overstatement of positive results, and/or omission of negative results (Antonucci et al., 1999), but there is still reason to believe they have much to offer. The biological revolution has been associated with a resurgence of the medical model in psychiatry. Concurrently, psychiatry, like the rest of medicine, has emphasized so-called "evidence-based" treatments. That is, there is a preference for endorsing and funding only...