Why Psychiatry Residents Resist Psychodynamics—and How Teachers Can Fix It

When medical students and junior psychiatry residents hear the word psychodynamics, many of them hear a relic. In a new correspondence published in Academic Psychiatry, Alyson Gorun of Weill Cornell Medicine argues that the resistance is not simply a matter of fashion or misconception, but of how and where the subject is taught. As Director of Psychotherapy Training, Gorun reports hearing repeated versions of a single question: why is learning psychodynamics important at all? That question, she suggests, exposes a genuine pedagogical problem rather than a failure of the trainees. If psychodynamic understanding of a patient’s subjective experience is considered an essential component of a biopsychosocial formulation, then a discipline that residents dismiss as optional is being positioned wrong within the curriculum itself.

The core of her argument is a structural one. Psychodynamic teaching, in many programs, is concentrated in outpatient psychotherapy clinics, where patients are stable and carefully selected for suitability. That placement is valuable for learning psychotherapy as a treatment modality, but it carries a hidden message: psychodynamic thinking matters only when you are conducting psychodynamic psychotherapy. Everything else—emergency calls, inpatient rounds, consultation-liaison work—appears to belong to a different, more scientific psychiatry. The result is a perceived split between the biological and the psychological that residents internalize early, and that curricula inadvertently reinforce by the geography of their own schedules.

Gorun contends that this split is illusory. Acute care settings, she argues, demand psychodynamic concepts just as much as the consulting room does. Understanding unconscious meaning, defenses, attachment patterns, transference and countertransference can help a psychiatrist make sense of crises, ruptures in the therapeutic alliance, impasses over medication, conflicts within the treatment team, and the varied ways patients respond to hospitalization or to a new diagnosis. On an inpatient unit, a patient’s sudden hostility toward a resident or an inexplicable refusal of medication may be legible only when read through these lenses. The psychodynamic framework, in this view, is not a niche skill reserved for selected cases but a general-purpose interpretive instrument for all of clinical psychiatry.

The timing of instruction matters as much as its location. Gorun proposes introducing psychodynamic principles in the first two postgraduate years, precisely when residents are caring for the most acutely ill patients and are most likely to be flooded by intense emotional reactions. Demoralization, helplessness, anger, rescue fantasies and avoidance are among the experiences she names—reactions that residents often interpret as personal failings or as evidence of unprofessionalism. When supervisors model how countertransference can be used as clinical information rather than suppressed as embarrassment, residents gain a vocabulary for experiences that otherwise feel isolating. Framing these reactions as data about the patient and the relationship, rather than as noise to be managed, may also reduce shame and burnout, a claim with obvious appeal in a profession struggling with trainee wellbeing.

Attitudes, however, are not shaped by timing alone. Gorun draws on Gabbard’s earlier warnings about how psychotherapy should not be taught: in ways that devalue other modalities, lean on jargon, separate psychotherapy from the rest of psychiatry, or handle the research evidence poorly—either neglecting it or overemphasizing it at the expense of clinical usefulness. Her prescription is to lead with the evidence base. Psychodynamic psychotherapy is an empirically tested treatment, and residents should learn early which patient groups benefit most, including those with complex or chronic depression, histories of childhood trauma, or comorbid personality disorders. Presenting psychodynamics as a modality with defined indications, rather than an unfalsifiable worldview, directly addresses the common assumption that it is not evidence-based.

A further barrier is the perception that psychodynamics is outdated and socially narrow. Some residents arrive in training believing it is unhelpful and inaccessible to patients from certain socioeconomic backgrounds. Gorun responds that the field’s contemporary landscape is considerably broader than its stereotype: community psychoanalysis has developed in recent years, and short-term, manualized, problem-focused psychodynamic psychotherapies have brought structure and brevity to a tradition once associated with open-ended treatment. Teaching this range of applications, she argues, is part of correcting the impression that psychodynamic work belongs only to a particular class of patient or a particular kind of practice.

The most substantive revision she proposes concerns theory itself. Contemporary psychodynamic theories describe how discrimination and structural inequalities contribute to symptom formation. Relational psychoanalytic theories emphasize that treatment always unfolds within a social and cultural context, and that the identities of both therapist and patient can powerfully influence what happens between them. Armed with this background, residents can examine—with what Gorun calls humility and curiosity—how a patient’s perception of similarities or differences in race, gender, sexuality or class, together with the resident’s perceived position of authority, shapes the therapeutic relationship. Exploring these dynamics openly with the patient, rather than leaving them unspoken, becomes a practical route to stronger alliances.

Gorun also addresses the discipline’s history directly. She notes that there is evidence the failure to acknowledge sociocultural bias within psychodynamic theory has turned promising residents away from engaging with the field altogether. Confronting that history, rather than defending against it, is presented as a necessary condition for recruiting a new generation of clinicians. She extends the point to systems: racialized dynamics in groups and institutions inevitably surface in training clinics, and a psychodynamic lens can help make them speakable, turning uncomfortable observations into opportunities for active change rather than silent attrition.

The argument, taken whole, is less a defense of classical doctrine than a rebranding of an interpretive method. What Gorun asks educators to do is make psychodynamic relevance visible: integrate psychodynamic formulation across every clinical setting rather than ghettoizing it in the psychotherapy clinic, teach concepts in experience-near language instead of technical jargon, tie theory to the real clinical dilemmas residents face with complex and challenging patients, and present contemporary theories that deepen understanding of identity and social context in the treatment relationship. Framed this way, psychodynamics becomes two things at once—a practical clinical lens that strengthens residents’ relationships with their patients, and an essential analytic tool embedded in formulation and treatment. Whether the reframing succeeds will depend on whether programs are willing to move the subject out of the clinic and into the emergency room, the inpatient ward and the supervision hour where residents actually live. The correspondence, published on 31 August 2026, arrives as a pointed challenge to the assumptions embedded in psychiatric curricula worldwide.

Subject of Research: Integrating psychodynamic concepts into contemporary psychiatry residency training

Article Title: Reframing Psychodynamics for Contemporary Psychiatry Training

Article References: Reframing Psychodynamics for Contemporary Psychiatry Training. (n.d.). https://doi.org/10.1007/s40596-026-02426-5

Image Credits: AI Generated

DOI: 10.1007/s40596-026-02426-5

Keywords: psychodynamics, psychiatry residency, psychotherapy training, countertransference, biopsychosocial formulation, therapeutic alliance, relational psychoanalysis, medical education, evidence-based psychotherapy, trainee burnout, cultural bias, acute care psychiatry