One on One
Michigan Psychoanalytic Institute volunteers help train psychiatry residents
Readings and lectures take on real life for second-year psychiatry residents in the University of Michigan’s Psychodynamic Psychotherapy program. That’s when residents start seeing patients in outpatient psychotherapy, thanks to an innovative partnership between the Department of Psychiatry and the Michigan Psychoanalytic Institute (MPI).
Founded more than 50 years ago, the institute’s membership is comprised of practicing psychologists, social workers and psychologists trained in psychoanalysis. Institute members volunteer their time, typically more than 50 hours per year, to supervise and mentor U-M residents.
Like other types of talk therapies, the goals of psychodynamic psychotherapy include positive changes in behavior and relief from such troubling symptoms as depression and anxiety. “On top of that, psychodynamic psychotherapy allows a deeper exploration of personal difficulties,” explains Harvey Falit, M.D. (Residency 1973), the program’s director and immediate past president of the MPI. The purpose? To get a better handle on the motivations behind behavior — and the patterns within it — in order to bring about long-lasting changes in patients. It can be used in conjunction with medication, or independently.
The clinic rotation — as well as the lectures, seminars, case presentations and weekly supervision — benefits patients while changing residents’ perspectives. “This type of patient encounter feels very foreign to residents at the beginning,” says Falit. “Many are uncomfortable with the open-endedness of it. Sessions are guided by what’s on the patient’s mind, and that’s very different from asking, ‘Are you sleeping OK? Are you feeling depressed?’”
“This is like no other supervisory experience residents have,” says Margaret Walsh, Ph.D., associate director of the program. “Each supervisor — a seasoned, experienced clinician — works with one resident, helping him or her understand the patient as well as the resident’s own emotional reactions, and teaching therapeutic skills.”
To establish a relationship in which patients feel secure while deeply exploring their emotions, psychodynamic therapy calls for at least one visit per week, sometimes two or three. “Most of our early training is short-lived encounters in hospitals, rather than clinics — you see people for a week at a time, or a day, at most maybe a month,” says Sara Dumas, M.D., now a fellow in child and adolescent psychiatry. “There’s a big difference to working over time with them to see how things change in their lives.” Dumas recently won the Psychodynamic Psychotherapy Resident Award from the MPI for her work in the clinic and program.
Dumas has worked with patients facing a host of issues, from major life changes like divorce or career transitions, to struggles with mental illnesses. “For me,” she says, “it was very satisfying to watch people who get better stay better, to work through the ups and downs of their struggles with depression, anxiety and other types of mental illnesses.”
Dumas is taking a fellowship from the MPI to participate in further psychodynamic training this fall. Building those longer-term patient relationships and working with her mentor has had a big impact on her education and undoubtedly her career: “It’s taught me a different way to look at clinical encounters. I gained the ability to step back and think about what might be motivating a patient — to take or not take medications, perhaps — and what might have me worried for a patient at a given time.
“I will definitely take that with me no matter what I do.”
The partnership with the Michigan Psychoanalytic Institute was established in 2000 under the direction of John Greden, M.D., then chair of the Department of Psychiatry and currently executive director of the U-M Depression Center. — KIMBERLEE ROTH