The future of psychotherapy

Psychotherapy, once the dominant vehicle of psychiatric care, and still the most distinctive aspect of the psychiatric therapeutic armamentarium, is rapidly becoming an endangered species within psychiatry. The author reviews the decline in psychotherapy training since World War II. In the immediate decades following the war, as many as 3,000 hours (50%) of the 3-year residency training program were devoted to the learning and practice of psychoanalytic psychotherapy, under close supervision. The current situation is totally transformed from that earlier period, as psychiatry has grown and diversified with the explosive rise of neurobiology (especially in the areas of molecular biology and molecular genetics), clinical psychopharmacology, competing psychological paradigms (behavioral, family, and social systems) and their therapeutic applications, and community psychiatry, with its preventive, crisis-oriented, and epidemiological approaches. Today, various authoritative bodies recommend as little as 200 hours (2 1/2%) of psychotherapy training out of the 8,000 hours of the current 4-year residency program. The author explores the implications of this significant reduction in psychotherapy training.