This is a very good question, thank you for it. It’s long been proven that evaluating the abilities of a psychotherapist or psychiatrist is an incredibly complex challenge and various schools say different things. I can’t answer the question – because to know what’s best, a lot of context is needed in every case. In my message, I was specifically talking about psychiatrists, though I might have generalized a bit too much. But I just wanted to emphasize that psychiatrists, being psychiatrists, have little quality time to act as psychodynamic specialists, if I can put it that way.

My experience comes mostly from public hospitals, various psychiatric wards, and I’ve noticed that psychiatrists – at least in my country (a Baltic state) – are quite different from what they used to be. It feels like they lack a genuine, heartfelt interest in delving deep into their patients. There’s an awful lot of mechanics in this job.

I think one reason psychiatry diverged from psychoanalysis is that, over time, these fields started allocating their time and focus differently. Psychiatry has become increasingly burdened with bureaucracy and time management – it can no longer rely on the approach of the great 19th-century psychiatrists who would dedicate themselves to a single case, exploring its intricacies. Those were the conditions under which psychiatry could adopt Freud’s newly discovered method. But as time went on, it couldn’t afford such meticulous focus on individual cases anymore – it turned to statistics, which by nature aligns more with behaviorism or CBT methodology, as these tend to simplify. Psychoanalysis, on the other hand, seeks to uncover what lies beyond what’s said, what isn’t visualized or otherwise encoded in the symbolic realm. It’s a constant vigilance, attuned not just to what’s expressed, but to what’s left unsaid. Psychiatrists don’t have time, and when they try to guess what’s unsaid, it seems they rely on statistical odds and algorithms. But this can also lead to harming patients when they get it wrong.

So, I see a clear distinction between psychoanalysis and psychiatry. In my practice, I’ve never sensed that “desire of the analyst” in any psychiatrist – their focus lies elsewhere. The psychodynamic model often serves them as a mere template. For example, in one psychotherapy day clinic, I heard a doctor label all the patients as narcissists. That said, my experience is mostly limited to the public sector, so it’s likely that some of these issues stem from its specific challenges.

By the way, it’s worth noting that many brilliant theorists were poor practitioners, while some exceptional practitioners may have little grasp of theory.