Integration or segregation of theoretical frameworks: A challenge in psychiatric eduction

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SYCHIATRY TODAY finds itself without an orthodox philosophy, but divided by factions each espousing their own self-evident truths and viewing skeptics within the discipline as adversaries rather than as allies in the search for a more complete conceptualization of the process of intrapsychic function and subsequent behavior. The major dichotomy in theoretical thinking is presently polarized between the psychoanalytic framework and the models of learning theory. Attempts at amalgamation or isolation have been made with a variety of motives. Firth’ outlines some of the parameters which separate the purists of these two schools and reiterates some of the traditional accusations. Behaviorists charge that dynamic psychiatry lacks experimental validation. On the other hand, the analytically oriented psychotherapists tend to minimize behavioral theory as having been derived from infrahuman experimental research which has produced simplistic models which are inapplicable to the more complex circumstances of human patients. Complicating the matter further is the question of ethical considerations which arise from the greater overt manipulations of behavioral therapists, resulting in diminished personal freedom of individual patients. Unfortunately, these charges and countercharges do little to bring greater understanding between the two factions and instead foster a protective isolationistic position. One consequence of assuming such an isolated stance is that there is a lack of exchange of information between two large segments of the psychiatric community. The effect is that a large body of experienced, well-trained psychotherapists becomes unavailable to review critically the work and theoretical conceptualization of the alternative schools of thought. If only to minimize this elimination of critical review of our work, it would seem to be a valid premise that psychiatric residency programs of high caliber would prepare the psychotherapists of the future at least to be able to conceptualize the basic psychopathological problems to be dealt with in both frameworks. Unfortunately, this is not the case in most programs today and is not even a projected goal for some in the future, as demonstrated by Chessick.* While describing an idealized training program he states, “There must be agreement on the philosophy of training and orientation reaching from the director of the program all the way down to the aides on the ward . . . frequent meeting, formal