Aspects of teaching psychotherapy to medical students

Much concern has centered on medical students' failure to choose psychiatry as a career. Little of this discussion focuses on the challenges of treating psychiatric patients. Although all students of psychotherapy face difficult training, the medical students' preparation is unique, especially in experiencing, tolerating, and using countertransference. Understanding and caring for psychiatric patients (whether pharmacologically, psychodynamically, or otherwise) involves exposure to extremes of emotion. A therapeutic response demands skills quite different from those culled by the medical admission process and the preclinical years. Appropriate handling of consequent problems is hampered when some of the psychotherapeutic aspects of clerk-patient relations go unrecognized and when supervisors avoid discussion of the student's reactions as an integral part of the work. Without specific attention to these areas, many students feel inadequate or frightened in the clerkship. With supervisory aid, such unwelcome situations can be converted to diagnostic and therapeutic tools of great value.