We are in "a tragic phase in the history of psychiatric education," maintains APA President Alan Tasman, M.D., as fewer and fewer residents learn empathic listening skills and how to interpret the psychological meaning of symptoms.

A significant deterioration in the doctor-patient relationship is among the most troubling consequences of this increasingly narrow focus on teaching residents to treat patients by medicating their symptoms, he said during his Presidential Symposium last month at APA’s annual meeting in Chicago.

Tasman stated that psychiatry is "training a generation that lacks even the most basic psychotherapeutic skills or framework for understanding mental functioning from a psychological perspective."

He stressed his concern that future psychiatrists will be treating patients with less knowledge of therapeutic relationships than of medications and won’t realize how crucial both are in combination to managing patients’ treatment compliance and other aspects of the physician-patient relationship.

"Our young colleagues, and some older ones as well, don’t see the psychiatrist’s role as much more than treating the concrete manifestations of illness and providing pharmacologic interventions," he said.

This trend was propelled throughout the last two decades by academic medical centers placing their primary emphasis on how much research money faculty can generate, Tasman suggested, which led to "an exodus of psychoanalysts and experts in psychodynamic treatments’ from most academic centers.

"The explosion in the knowledge base" about psychiatric illnesses and their treatments has also created "intense competition for curriculum time, and what psychotherapy training time is available has become more complicated and complex because of the emergence of newer and more research-tested psychotherapy techniques."

The critical need for residents and faculty to engage in supervised clinical care has clearly taken a back seat to pharmacology training, he noted.

But psychodynamic techniques cannot be taught only by doing them and being supervised by experienced psychiatrists. "We’re in danger of training psychiatrists" who can see patients only through the prism of neurobiology and pharmacological treatment options, Tasman stressed.

He acknowledged that there is little psychiatrists can do to reverse this trend toward concentrating on training residents to medicate patients, but said that one hopeful development may pressure change beginning in January, when the Resident Review Committee for psychiatry introduces a requirement that residents will have to prove their competence in forms of psychotherapy to sit for the American Board of Psychiatry and Neurology’s certification examination. Tasman said he already sees evidence of an impact from this change as training directors’ discussions are focusing more than they have in a long time on how to make sure psychiatry residents receive adequate psychotherapy training.