Is there any appreciable difference in a 2 year psychodynamic fellowship vs a full on psychoanalysis program?

[slowthai]

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My goal is be strong in psychodynamic therapy, with maybe 1-4 therapy patients at any given time. I am not trying to be a pure, full time therapist.

What am I missing out on if I don't go into full analysis?

 

[comp1]

Self actualization? Certainly not money.

 

[R. Matey]

If your goal is to be psychodynamically informed, rather than psychoanalytically trained, why would you pursue the four-year program?

 

[Ivos]

Unless the difference is super important to you then maybe make your choice considering other factors such as geography, quality of life, etc.

 

[TexasPhysician]

My goal is be strong in psychodynamic therapy, with maybe 1-4 therapy patients at any given time. I am not trying to be a pure, full time therapist.

What am I missing out on if I don't go into full analysis?

For 1-4 therapy patients, neither seems worth the time. The few I know who have done the training did it to be FT therapy +/- meds.

We can’t be “strong” in every aspect of mental health by doing each thing 2 hours/week. My peak C&L skills may have been in residency when I last saw someone in a hospital. I do therapy a couple hours per week, but I wouldn’t consider those skills “strong” either when I have colleagues doing it 35 hours/week. I’d consider my skills below average, but with a niche good enough that a few find value in them.

If the goal is 1-4 therapy patients, I’d consider some retreats or extra training conferences in a specific niche of therapy that is most interesting to you.

 

[romanticscience]

You'd be missing out on the training to provide psychoanalysis, which is a very specific type of psychodynamic therapy. I considered this as well and decided to pursue training in a specific type of psychodynamic therapy training (TFP). Most analysts I've observed are primarily engaged in supportive therapy. No one wants to do the hard stuff (e.g., sitting behind the patient for 3 months without talking!).

Reviewing this paper helped. Even analysts are doing very little psychoanalysis. In my opinion, if you're going to offer twice-weekly therapy, shouldn't you be providing a therapy specifically designed for this frequency (such as Schema or TFP) rather than offering a "lighter" form of something completely different?

 

[smalltownpsych]

As a psychodynamic psychotherapist with years of experience working with and supervising therapists of all stripes, I would not recommend the psychoanalytic track unless the goal is to be a psychoanalyst. In the real world with my patients, I find a good understanding of neurobiological mechanisms and behavior principles and how that integrates the metaphorical language of object relations and the development of self than I would with real hardcore classical analytical stuff. Reading these three books while getting your psychodynamic supervision and experience would be far more helpful than years of analytic training in my mind.
Affect Regulation and the Origin of the Self: 9780805834598: Medicine & Health Science Books @ Amazon.com
The Interpersonal World Of The Infant (View from Psychoanalysis and Developmental Psychology): Stern, Daniel N: 9780465095896: Amazon.com: Books
Severe Personality Disorders: Psychotherapeutic Strategies: Otto F. Kernberg: 9780300053494: Amazon.com: Books

 

[slowthai]

You'd be missing out on the training to provide psychoanalysis, which is a very specific type of psychodynamic therapy. I considered this as well and decided to pursue training in a specific type of psychodynamic therapy training (TFP). Most analysts I've observed are primarily engaged in supportive therapy. No one wants to do the hard stuff (e.g., sitting behind the patient for 3 months without talking!).

Reviewing this paper helped. Even analysts are doing very little psychoanalysis. In my opinion, if you're going to offer twice-weekly therapy, shouldn't you be providing a therapy specifically designed for this frequency (such as Schema or TFP) rather than offering a "lighter" form of something completely different?

Can you please elaborate on your last question further?

Also, why do you like TFP?

 

[romanticscience]

Most of those presenting for psychotherapy are either healthy enough for psychoanalysis, but don't have the time, or have personality pathology in which psychoanalysis is sort of contraindicated. Therefore, providing dynamic treatments built for the twice-weekly format made more sense to me.

I liked TFP because of its intellectually satisfying, theoretically coherent, and consistent model. Psychoanalytic/Psychodynamic training can vary significantly in theoretical approaches (Freud's ego, Kernberg's Object relations, Kohut's self, Lacan's ??). I didn't care much for the wisdom of "use the model that best fits the patient."

Also, I liked TFP as a skill in managing severe personality disorders, which, in my training, I've seen psychiatrists handle poorly. Other alternative treatments involve a system and phone-based coaching for a crisis. But, to be honest, it's a very difficult therapy to practice. It involves withholding natural "doctorly supportive instincts," setting limits, and confronting/interpreting aggression. Sometimes those things aren't best for business lol.

Though I probably still utilize a lot of object relations/TFP theory, now I'm doing mostly Good Psychiatric Management (more supportive psychodynamic therapy) with patients. It preserves the emotional bandwidth to see more patients and do forensic work.

 

[theduderino]

I got interested in psychodynamic work/psychoanalytic models of development through training in mentalization based therapy, which like TFP is another dynamic therapy oriented towards treating people with personality disorders (primarily BPD). A few years after that experience, I did a year long online program around a particular school of psychoanalysis and I'm about to start a broader 2 year training program (psychodynamic). This is mostly for my own growth and curiosity and to keep things from getting stale as I get further into private practice. I see a mixture of patients in different formats - some mostly therapy w/ very simple medication management, others mostly medication management w/ more supportive therapy. I like the structure of classes to nudge me into reading/thinking about cases, but really it is the supervision and sometimes my own therapeutic work that has felt the most useful in my growth.

I thought a lot about doing a 4 year program as well. Ultimately, I don't want to be a clinician that mostly practices psychoanalysis (seeing someone 2-4x/week). I also don't really want to do my own analysis, which is required for 4 year programs. If that sounds interesting to you, then a 4 year training program could really make sense. The advantage of a 4 year program is that you'll get a really detailed sense of how different strains of psychoanalytic thought/technique communicate with one another (from sitting behind the patient for months w/o saying anything to a much more interpersonal style e.g Sullivan or Mitchell). Read Freud and Beyond - if you're excited to learn more, then perhaps one of these programs would be worth the considerable investment of time/money. There are also some logistics involved in being a psychiatrist that does mostly/soley psychoanalysis (most of them don't take insurance, which doesn't fit in with how I practice). There aren't any hard and fast rules here, just things to think about and consider.

As a first step, perhaps pay someone for supervision and see if you like talking about your therapy cases. Your career is long and you don't have to figure out right now exactly what your next step will be (for many of us this is a left over template from years of hopping from undergrad to med school to residency to fellowship to blah blah blah).