Teaching Psychiatric Trainees to "Think Dirty": Uncovering Hidden Motivations and Deception

Despite the prevalence with which trainees encounter patients who attempt to manipulate, deceive, or withhold information from them, trainees receive little formal training in "thinking dirty"-that is, incorporating elements of hidden patient motives into their interview, formulation, and plan. Lack of acknowledgment of these aspects of patient care can lead to resident dissatisfaction, negative countertransference reactions, and decreased empathy for patients.

In this article, the authors outline a multimodal approach used in a large psychiatry training program for teaching trainees to recognize hidden motivations and deception, which involves formal didactic teaching, process rounds, and clinical experience.

This approach improves trainee understanding of patients' motivations, and it allows trainees to better regulate their emotional responses to patients withholding information or deceiving them.

Formally addressing this topic in the curriculum can lead to improved patient outcomes and decreased resident burnout, particularly on high-intensity rotations.