Management vs. interpretation: teaching residents to listen

It is possible to teach residents to listen psychodynamically within pressured clinical systems that are organized around brief management interventions without changing the structure of the training program to create "selected psychotherapy cases." Two case vignettes illustrate the amount of psychodynamic data that can be elicited from a time-limited clinical assessment. Focusing on the psychodynamics of social systems and the subtle ways in which patients and clinicians become involved with each other during assessment meetings can allow trainees to grasp unconscious functioning, projective identification, transference/countertransference, and interpretation. This perspective opens a way of thinking that illuminates the patient's struggles, reduces the need for management by helping the patient take charge of his or her treatment, and opens possibilities for both patient and trainee to improve their capacity to listen, both to themselves and to the human systems that surround them.