Due to the mid-century pre-eminence of psychoanalysis in the United States, it was at one time common for psychiatric residents to become analysands during their training. The psychoanalysts reasoned that individuals could in no way be expected to adequately help others unlock repressions and develop mature defenses without first acquiring some mastery of these tasks themselves. The belief was that enhancement of self-knowledge made better therapists, less prone to complicated counter-transferences that might adversely affect patients.

Due to many factors, including the waning of psychoanalysis as a primary mode of treatment, the discovery and use of effective pharmacologic agents, and the prohibitive cost of intensive psychotherapy, residents can no longer assume their training programs will provide opportunities for analysis or any other form of psychotherapy. In some institutions, there is little or no support for the premise that psychotherapy should be a feature of training. Why, the training directors ask, when psychotherapy is a treatment, should it be provided as a form of training?

There are many who believe this is a great loss to the novice psychiatrists of today—that trainees will somehow be less competent by this absence. Many argue that the experience of being a patient makes a better therapist; by finding our own insights and solutions we might be better able help others find theirs. Like psychoanalysts, they propose that psychiatrists must keep their own closets clean before attempting to guide others.

Psychotherapy is a treatment; and like other treatments, not necessarily benign. One does not have to look far for examples of adverse side effects; just call the nearest chapter of the False Memory Syndrome Foundation. Even appropriate and effective psychotherapies have side effects—for example the financial consequences taken on by the mother who finally leaves her abusive husband, or the changes that occur in the family when an alcoholic stops drinking. When we prescribe therapy, we must always keep our goals and the risks of treatment in mind to mitigate potentially negative outcomes.

We therefore need to consider carefully the underpinnings of the premise that psychotherapy should be an integral part of training. When we suggest therapy as a training modality, what are we teaching? Are we taking side effects into account? In general, one would have difficulty arguing that psychotherapeutic training, alone, demands treatment. It seems we might be holding ourselves to a different set of rules from the ones we use for our patients.

Must one experience therapy to practice it? The novelist does not improve his storytelling by becoming the protagonist of a novel. The surgeon does not undergo an operation to hone his skills. No one would ever suggest that a physician should take nifedipine or sertraline to more ably prescribe it.

Maybe, we reason, psychotherapy allows for insights no other aspect of training, or life, will offer. Is psychotherapy an appropriate antidote to the vicissitudes of life? Everyone experiences confusion, sorrow, hatred, and can occasionally become overwhelmed by these emotions. We have difficulty talking to people we care about, or caring about the people to whom we talk, yet all of this is a part of being human. There are so many often more appropriate venues for exploring these very human experiences and learning how to best manage them. We can go to church, the museum, read books, write poetry, call our mothers. Psychotherapy should never be confused with life, for it is treatment, not a means of building character.

There is another more insidious idea hidden in the belief that psychiatrists-in-training should routinely enter psychotherapy. We live in a culture that, in general, is uncomfortable with problems of the mind. A diagnosis of depression for many is still experienced as a label, a codification of their weakness and failings. Despite efforts to educate our patients and others, most still have difficulty recognizing that illness can affect the mind; that its symptoms can be no more meaningful than the symptoms of heart disease or asthma. Psychiatric diagnoses and treatments are still seen by many as the stigmata worn by those who simply cannot manage their lives well enough.

On the other end of the spectrum are those people who see the treatment as a badge, worn to flaunt their suffering and victimization. They engage in the current fad of diagnosing the disease du jour in themselves or those they purport to love. They come to us already prepared with a diagnosis and a treatment plan, indifferent to our expertise and training.

Is it possible, when suggesting that psychiatric residents need psychotherapy, that we are fueling this confusion? Are we, too, afraid of being seen as weak or incapable when psychotherapy is in fact the treatment we need? Or are we ensnared by the charm and intrigue of psychiatric diagnosis and treatment, seeing them as antidotes to the uncertainties of life?

Psychiatric residents are as likely as anyone else to require the help of a psychotherapist for they, too, can reach that point where life’s situations and their capacity to cope are thrown out of balance. Yet one must always remember to call a spade a spade, a problem a problem. There is no way for us to combat the confusion and shame our patients face when they require psychiatric treatment, unless we cure our own confusion and shame. If we cannot name our own problems and needs clearly, we will never be able to help our patients out of the quagmire. The stigma will remain.

Psychotherapy is a treatment, not a tool to create psychiatrists. If a resident physician requires psychotherapy, then so be it. Label it appropriately, without hiding under the umbrella of training requirements. If we cannot define our field with clarity, then who can?