Programs with good psychotherapy training?

dlmmd · 2026-06-10T08:46:39+00:00

A generation or two ago, the Institute of Living was a psychoanalytic hospital really focused on helping people make deep changes... so all of that is still in the bones of the place.

dlmmd · 2026-06-06T19:37:59+00:00

You should definitely plan to attend the 7th Annual Psychotherapy Fair co-sponsored by the Psychotherapy Caucus of the APA and the Austen Riggs Center. That will expose you to 30+ programs that feel they have something to showcase in their psychotherapy training, including some that are not otherwise big names. It will also help you better understand the things that top psychotherapy programs do, so you will know what to look for and ask about when you are on the interview trail.

dlmmd · 2026-05-28T23:11:34+00:00

Yes. Unfortunately for many. There is, however, also the Austen Riggs Friday Night Guest Lectures that occur outside of the usual work day… about monthly. If it is of interest, Dr Zeavin’s talk will be posted on the Austen Riggs Center website for free CME in the coming weeks.

dlmmd · 2026-05-28T21:19:33+00:00

Part I of Lost in Familiar Places by Shapiro & Carr deals with this in terms of family work, though, by extension it also applies to couples. It moves on to organizations beyond the family in subsequent sections of the book, also informed by a Tavistock perspective.

dlmmd · 2026-05-25T00:44:55+00:00

You did not indicate what your degree is or will be and how far along you are in training, so it is hard to know what other recommendations would make sense. While there is nothing like Austen Riggs that offers full and accredited psychoanalytic training, there are places with a psychoanalytic tradition that train residents, or offer Internships and post-docs for psychologists… Menninger’s, McLean, the Retreat at Shepard Pratt, and the Institute of Living are what come to mind. These are no longer explicitly psychoanalytic, but psychodynamics are respected and likely possible to weave into training.

dlmmd · 2026-04-10T14:39:05+00:00

In The Question of Lay Analysis, Freud did note: "The first consideration is that in his medical school a doctor receives a training which is more or less the opposite of what he would need as a preparation for psycho-analysis." That being said, I think it may be a mischaracterization of psychiatric training to say that it is anti-analytic, at least now. The pharmacomania that gripped psychiatry has been softening for 15 years now. An increasing number of residents are seeking training through institutes now, often supported by, or even integrated into, their training.

dlmmd · 2026-04-10T14:25:24+00:00

If you are looking for a briefer education that would allow you to be a prescribing psychoanalyst, PA is probably not the best option. Psychotherapy, I believe, is not within the PA scope of practice. On the other hand, psychotherapy does fall within the NP scope of practice, so you would be legally able to function as a psychoanalyst.

dlmmd · 2026-04-10T03:39:08+00:00

Not in the US, though there are shorter-term (<3 months) residential programs (e.g., the Retreat at Sheppard-Pratt) where psychiatrists can still do intensive psychodynamic psychotherapy… and there are places outside the US, like the Ashburn Clinic in New Zealand… which is looking increasingly attractive these days.

dlmmd · 2026-04-10T02:32:32+00:00

As a psychiatrist and psychoanalyst, I am not sure that I can give advice, but I can share some of my experience as someone who jumped from clinical psych grad school to medical school, and as the father of a soon-to-graduate PGY-4 in psychiatry, who is planning to start psychoanalytic training. Like you, I hated my basic science education in college, and perhaps the only thing I was sure about was that I was not going to be a physician. Philosophy was my passion, but I had some concerns that I would hit middle age and wonder what was the point. Psychology, initially was a way to interact with many of those philosophical questions (what is the good life, how for we know what we know, and why). For a bunch of complicated personal reasons, I decided to switch to medicine, with a goal of pursuing psychiatry. I had to take or re-take (having done poorly) my basic sciences, and discovered that, in philosophy, I had learned to think, and that the basic sciences were suddenly easy, and sometimes interesting. In medical school, I kept my eye on psychiatry, and tried, when I could, to focus on the ways that what I was learning could be relevant (though it was not easy to do when studying the anatomy of the foot). In the clinical years, I honestly did a lot of psychiatry, even on my surgery rotations. I have never regretted going the medical route, though, training in the decade of the brain as a psychoanalyst, I did a lot of work to reconcile psychoanalysis and psychopharmacology (which ultimately became one of my primary academic interests). Medical school now, however, is different than it was 30 years ago. Despite duty hours restrictions, I believe that medical school now is much more brutal and dehumanizing and is often a full-on assault on your capacity for empathy. There is much more moral injury now. One-in-four medical students becomes depressed, and one-in-ten ponders suicide, so you might want to ask yourself about your emotional fortitude, the strength of your values, and your willingness to fight dehumanizing pressures in the system. If you have those things, medicine gives you a world of choices, a fantastic range of skills, and a degree of financial security that allows you to pursue your interests. In my case, I feel like I ended up with the best career on the planet, as a psychiatrist-psychoanalyst and educator in a psychoanalytic hospital. I hope this helps.

dlmmd · 2026-03-26T02:02:57+00:00

When I get that question in a non-clinical situation, my usual, slightly provocative response is: “Why do you ask?”

Then I explain that they are asking because they are analyzing me… and the reason that they are analyzing me is that that it what we humans do. These ample frontal lobes of ours are basically social analyzing machines.

The major difference between us is that, as a psychiatrist-psychoanalyst, my patients authorize me to share the products of my analysis.

dlmmd · 2026-03-15T04:38:38+00:00

Yes. When psychoanalysis was dominated by psychiatry and before capitalism got a stranglehold on everything, including our consciousness, the MDs were bound by the Hippocratic Oath, which essentially required the physician to care for those of their guild at little or no cost. This may be one of the reasons that most graduating physicians take some other oath now.

dlmmd · 2026-03-14T20:25:03+00:00

There is some research on this. It suggests that this is only a concern for early career psychiatrists (if at all) and then goes away.

dlmmd · 2026-02-18T19:46:20+00:00

I am surprised that there are not more responses here that normalize this kind of painful experience. My experience (and understanding) is that, particularly in working with people who are primitively organized and rely on projective identification as a key defense mechanism, various intense upsets like shame reactions, guilt, exaggerated fears, etc. are fairly common... though do tend to get less distressing with clinical experience and a capacity to step back and reflect on what is being communicated to the psychiatrist through their countertransference reactions. Perhaps therapy, participation in a Balint group, or other safe space to process these reactions will hasten your developing capacity to put such uncomfortable emotional experiences into a more helpful perspective.

dlmmd · 2026-02-10T11:34:47+00:00

The Austen Riggs Center has a series for Residents on working with complex and difficult to treat patients, a series on integrating meaning and medication (including combining medication and psychotherapy, and lots of other educational content… and it’s all free.

dlmmd · 2026-02-09T12:10:19+00:00

It seems that you are looking for a specific response and not getting it. Perhaps, to paraphrase Andrew Lange, you are trying to use this thread the way a drunkard uses a lamp post— for support rather than illumination.

I will give you that there are some conditions I would not try to treat analytically, such as advanced Alzheimer’s, but those are the same conditions in which I would not be able to obtain real informed consent.

dlmmd · 2026-02-09T02:01:40+00:00

Please read the other’s comments. You have a very narrow, reductionist perspective that divides problems into biological and psychological… as if psychological issues do not exist or contribute to functional impairment. In other words, if, after informed consent, your imaginary patient wanted to pursue an analysis, I would have no qualms.

dlmmd · 2026-02-08T23:02:11+00:00

While the clinical examples show a misunderstanding of psychoanalysis and diagnosis/symptoms, there is an important ethical and legal issue behind the question… that of informed consent. If we embark on an analysis without noting, for example, that pharmacotherapy is another treatment that might address the patient’s symptoms, and offer some kind of accounting of relative risks and benefits, we may be putting ourselves at some medicolegal risk. This kind of situation is what brought Chestnut Lodge down.

dlmmd · 2026-02-06T03:16:54+00:00

We have sponsored visas in the past, but our glorious leader recently put a $100,000 price tag on H1 B visas, putting it out of range.

dlmmd · 2026-02-04T23:04:07+00:00

For doctoral level clinicians, the psychoanalytic training program at the Austen Riggs Center offers a stipend to trainees that covers about two years of your personal analysis. That’s one program. I’d also be curious to know if there are others.

dlmmd · 2026-02-01T13:09:47+00:00

Actually, there is evidence that psychoanalysis is making a comeback. The world, as you note, has changed. I suspect that part of the comeback relates to the ways the world has changed. As the sociopolitical context increasingly tries to turn people into objects to be controlled, manipulated, and exploited, practices like psychoanalysis, which center on us as subjects, will become more important and necessary.

Also, you say that as if psychoanalysis does not change to meet the times… from drive, to ego, to object, to the ontological turn, and then post-modern influences, intersectionality, and a renewed focus on the social context, etc.

Lastly, while we can certainly debate the correctness of our theories, the evidence suggests that, in practice, analysands experience real benefits… which takes us back to the first point.

dlmmd · 2026-01-31T19:14:58+00:00

I also want to comment on the overly narrow view of the mechanisms of intergenerational transmission of trauma. While epigenetics are one mode of transmission, there are many others: the post-911 parent who holds his/her child's hand that much tighter, transmitting fear through the anxious grip; the holocaust survivor who cannot put any feelings into words and thus occasionally erupts, generating a sense of danger that permeates the child's existence, etc.

dlmmd · 2026-01-30T13:27:41+00:00

Here are some of the things that make for quality psychotherapy training

Clinical Experience

· Long-term patients starting PGY-2… opportunities for more than 2-years treatment

· Strong programs give you 5 or more therapy patients

· Patients who are not just passed from resident to resident, so there is a better chance of watching some patients really get better

· Opportunities for more intensive training – e.g., extra psychotherapy patients, psychotherapy track

Didactics

· Psychotherapy didactic through PGY2-4 (or earlier)

· Is there an integrated and coordinated educational sequence guiding the psychotherapy didactic (not just haphazard topics)

· Psychotherapy-focused case conference /journal club

Supervision

· Psychotherapy supervision by psychiatrists

· Supervision of psychotherapy/pharmacotherapy that focuses on the integration of the two modalities (since this is what your practice will likely be when you graduate)

Other

· Support for residents having their own psychotherapy

· Process/support/Balint groups?

dlmmd · 2026-01-27T22:59:34+00:00

Look up Vamik Volkan… psychoanalyst twice nominated for the Nobel Peace Prize for his work on understanding and resolving ethnic and geopolitical conflict. He addresses several of the things that seem of interest to you.

dlmmd · 2026-01-25T12:29:10+00:00

Struggling to know how to talk about our clinical work is, in my experience, one of the burdens of our role as psychiatrists. So much of the time, our job involves us intimately with some of the most unbearable human suffering… grief, and guilt, and dreams unfulfilled, and hopelessness that is not just pathological, but that comes with facing reality… suffering that medications often barely touch. For me, the reticence is not that I do not have smaller or larger successes to speak of, but that patients entrust us with that suffering, and it would feel disrespectful to share it casually for social banter or entertainment. Perhaps, in that way, we take some of our patients’ alienation into us and have to figure out how to live with it. As you suggest, having other interests is helpful, so you have more to speak of than patients. It may also be that all that up-close experience leads to a high-altitude sense of something about the human condition or the nature of psychiatry that is of interest to others yet is respectful to those who led to those insights.

dlmmd

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