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J Psychother Pract Res. 1998 Winter; 7(1): 10–22.
PMCID: PMC3330482
Structuring Training Goals for Psychodynamic Psychotherapy
David A. Goldberg, M.D.
Received June 18, 1996; revised February 7, 1997; accepted May 15, 1997. From the Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut. Address correspondence to Dr. Goldberg, Department of Psychiatry, University of Connecticut School of Medicine, 10 Talcott Notch, East Wing, Farmington, CT 06030-6410.
A multiaxial model that structures educational goals for psychodynamic psychotherapy has been developed. It specifies core aspects of psychodynamic psychotherapy, clusters them in categories that further define and link related areas, and presents a sequence that enables educators and students to focus on training goals in a consistent progression. This model has been used by the Director of Education as a basis for developing the curriculum, by students as a way of focusing learning and giving perspective to current work, and by supervisors to link individual teaching to the goals of the training program. This method has enhanced consistency, clarity, and efficiency in the psychotherapy program.
Education in psychodynamic psychotherapy is steeped in a rich tradition. An extensive literature has evolved describing the supervisory relationship16 and teaching trainees how to think, in preference to a technique-oriented approach.710 The focus on process in education is of central importance and reflects the nature of psychotherapeutic work. There has been a more recent trend toward elaborating the specifics of teaching. This endeavor has included writing about supervisory styles,11,12 developmental models,1315 lists of objectives,16 innovative seminars,17,18 and questioning students and supervisors about their work together.19–21
A number of textbooks2234 provide comprehensive presentations of technique and theory. Although they are indispensable to psychotherapy education, they do not provide a concise framework from which to organize a training program. A model curriculum for teaching psychodynamic psychotherapy in psychiatric residency programs was developed by members of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry.35 It contains a consensus about core goals, an educational philosophy, and a recommendation for sequencing training over the course of the entire residency.
Further development of a curriculum approach to psychotherapy training will produce more consistent and effective methods of education. Overtly defined goals and objectives that are organized and sequenced can enable educators to approach the questions of what, when, how, and in what context to teach. Students and teachers can work more collaboratively when they share a defined set of educational tasks. A concise description of the areas and skills relevant to psychodynamic psychotherapy can be used to augment education that takes place in individual supervision and case-based seminars. There is always a need for balance between an objective curriculum approach and the individually focused orientation of traditional psychotherapy education.
A number of authors have directly addressed the question of educational goals and their possible sequence. Fleming and her co-workers7, 36,37 developed an educational model that moved from listening and gathering information to organizing and processing the data into meaningful units, integrating what has been learned, and responding to the patient. Fleming stressed the importance of beginning within a phenomenological context. She also advocated a planned learning approach in which both teacher and student actively work to meet overtly defined teaching objectives. Ornstein38 shares the view that early training should focus on observable data. The teacher's role is to facilitate the student's discovery of ways of observing and forming intuitions from the clinical situation without the early encumbrance of theory. Ornstein specifically elaborates the basic skills of observation, evocative listening, empathy, intuition, and introspection for beginning training in psychotherapy. Ralph13 describes a series of four developmental steps: 1) observation and listening, 2) a patient-centered approach within the theoretical framework of the training institution, 3) a relationship-centered approach that focuses on process, and 4) a self-perspective. Levenson39 favors a style of supervision that begins with boundaries of therapy, moves to a developmental history, and finally focuses on the analysis of transference. This method is for supervision of analytic candidates, but it is noteworthy that even here, emphasis on theory is saved for later in training. Melchiode40 describes a developmental supervisory model for psychiatric residents in six stages: 1) elaborating the history, 2) observing affect, 3) developing empathy, 4) recognizing unconscious processes, 5) using the therapist's fantasies, and206) understanding theory. Rodenhauser15 provides a comprehensive summary of developmental training approaches and offers an interactional developmental schema involving the supervisor, the supervisee, and the patient.
In all of these phased-learning approaches to education, there is remarkable consistency in moving from a descriptive position to various ways of organizing clinical data. An early focus on clinical phenomenology is also reflected in the results of research on residents' preferences in supervision.19 These models have the attributes of clarity and a sense of movement over time. They present organizing principles in stages, but they do not delineate the multiple areas of psychotherapeutic work. A more fully articulated developmental model describing core skills and concepts is a natural progression from these earlier conceptualizations.
The model presented here is an amalgamation of a developmental approach with a more inclusive list of discrete learning tasks such as those found in many psychotherapy texts and described by Buckley and co-workers.16,41 This model provides a framework from which to develop a sequence of seminars. It also provides a framework for periodic review by residents and supervisors to focus learning and evaluate progress. It is not intended to impose a static structure on psychotherapy education. Rather, it adds a counterpoint to the richness and diversity contained in individualized, process-oriented, student/patient-focused teaching.
The fundamental assumptions used in constructing this model are that 1) the educational process can be facilitated if the training goals for dynamic psychotherapy are explicitly defined and structured; 2) there exist a variety of goals that can be organized into clusters (here called “developmental categories”); 3) relatively discrete “phases of learning” can be postulated that outline a progression in education; and 4) there is a complex interplay and individual variation among the various kinds of skills, knowledge, and behaviors across developmental categories and phases of learning.
The model as illustrated in Table 1 describes a traditional analytic approach. It does not include the most recent advances in psychodynamic psychotherapy or make specific connections to cognitive, interpersonal, and other approaches. The model structure can include such additions as they become relevant to a specific emphasis or are indicated by an evolving consensus in the field. The details presented here represent a classical or baseline approach so that the model can be presented most clearly. In actual practice, newer ideas are included, as well as links to other psychotherapeutic disciplines. Advances in technique, especially brief treatment models,33,34 integrate various approaches, and integration is increasingly a central focus in education. This is particularly true after basic skills are acquired and the emphasis of each approach is understood. This model is helpful in articulating the analytic perspective, presenting aspects common to all psychotherapies (particularly in Phase I), and providing points of connection to other techniques. The ultimate purpose of the model is to facilitate education for practice in the evolving mental health environment. Brief psychotherapy, focused interventions, and integration with psychopharmacologic treatments all benefit from a psychodynamically informed perspective.
The model consists of two coordinates: the “phases of learning” along the horizontal axis and the “developmental categories” along the vertical axis. The concept of “phases of learning” is an attempt to delineate broad sequential steps in the educational process. Each phase describes the primary learning perspective for the educational objectives within it. The “developmental categories” are groupings of closely related learning tasks that evolve toward increasing complexity and sophistication. The phases and developmental categories are described in detail in the next section.
The sequence of learning moves through each successive phase; the student achieves basic competence in areas within one phase before learning in substantive areas within the next. There are times when it is necessary or reasonable to focus on more advanced areas prior to the completion of a phase. This usually occurs when supervision of a treatment requires interventions that are in advance of a resident's clinical experience. The handling of early disruptive transference reactions, for example, is an area that frequently needs attention before the student has gained a true understanding of the phenomena. Supervision also depends on the proclivities of individual residents and the preferences of some supervisors. Students are exposed to the entire training agenda from the outset so that they can place their current areas of learning in context. They will have an intellectual notion of transference and resistance, for example, long before they are ready to do sustained, integrated work in these areas. They are also able to benefit from supervision in specific aspects of technique in advance of their readiness to learn about them in depth.
This model posits a sequence of learning that moves from what is directly observable to areas that are more difficult to understand and integrate. The specific developmental phases are based on the notion of beginning with clinical phenomena, organizing them into clusters that are informed by a psychodynamic perspective, and, finally, demonstrating important clinical interrelationships. Not all learning goals fit neatly into each phase. The trend is consistent enough, however, to make such categorization useful. The phases also roughly follow the progression in treatment, from data gathering, to the identification of consistent patterns and processes, through to a detailed and integrated understanding.
Phase I, Observation and Description, focuses on the student's ability to observe, collect clinical data, and describe what is seen, heard, and experienced. There is little attempt to organize observations around theoretical knowledge. The student learns how to describe the patient and his or her behaviors in detail, enable the patient to talk freely, listen openly and carefully, and pay attention to the interactive nature of the clinical encounter. An important aspect of this work includes consensual validation by teachers and peers. Students are also asked to pay attention to themselves as participants. Most of these skills, although difficult to work on, require no leap of faith. Working from the manifest data is in the biomedical tradition, so residents do not need to see psychotherapy as an unfamiliar departure from their work up until that point. Phase I includes many skills that are basic to all forms of psychotherapy.
Phase II, Conceptualization, centers on placing manifest communications, behaviors, and interactions within frameworks that help to explain psychotherapy process and aid in the choice of interventions. Students begin paying attention to repetitive themes and behaviors, patterns of interactions, latent communications, and the ebb and flow of the therapeutic working relationship. At this point, a variety of clinically useful theoretical concepts are learned and integrated directly with clinical data. An overview of the analytic theory of technique as well as a psychodynamic view of behavior are needed. The Conceptualization phase therefore represents a major shift from manifest phenomena to more covert data and abstract levels of understanding.
Phase III, Synthesis, involves a fuller integration of the skills, knowledge, and behaviors learned up until this point. The most important abilities needed here are a fluidity of thinking that can integrate multiple areas of knowledge about the patient and the therapy process, the ability to understand complex interrelationships, and the freedom to see the same phenomenon from different perspectives. Although new knowledge is continually being introduced, the major emphasis is on the integration of already existing knowledge and its increasingly skillful applications during clinical work.
During Phase III, the resident develops the ability to place recurrent behaviors and thematic material within the context of the therapeutic relationship, the evolving psychodynamic formulations, and the patient's life history. The interplay between resistance, transference, and thematic interpretation, together with the content, depth, and timing of interventions, becomes increasingly important. Brief psychotherapy, for example, requires the ability to rapidly assess process within the session and direct efforts at focused and effective interventions. This requires the integration of knowledge and skills drawn from multiple areas and coupled with new techniques. Phase III is a time for the expansion and integration of theoretical and clinical knowledge from interpersonal, cognitive, existential, and other perspectives.
Discrete areas of learning are grouped together into “developmental categories.” Different numbers of categories and other organizing principles could be used, but the educational goals included here represent widely agreed-upon fundamentals in the field. Placing discrete learning tasks into larger groups is not only an organizational aid but also helps to demonstrate the interrelationships among the tasks. The developmental categories are understood to have a dynamic character: each category is composed of a variety of goals that are closely interrelated, and each depends upon learning within the other categories for optimal progression.
The five developmental categories are 1) Goals, Roles, and Boundaries; 2) Participants; 3) Verbal Flow; 4) Technique; and 5) Theory. Each group of learning goals will be briefly described over the course of its progression through the three phases of learning. This is not a comprehensive review, but rather a demonstration of the ways in which this form of organizing educational goals can be useful.
Category 1: Boundaries, Roles, and Goals
The establishment of the roles, boundaries, and goals specific to the practice of dynamic psychotherapy is a fundamental aspect of training. These dimensions define the frame in which therapy takes place, together with the expectations for participation and the purpose of the work. The educational tasks include 1) the practical aspects of structuring the relationship between patient and therapist, 2) a clear definition of the necessary attitudes and responsibilities of both participants, and 3) an understanding of the realistic goals of this method of treatment. Of particular importance are 1) the accent on a safe and stable environment against which behaviors can be observed, 2) an understanding of the characteristics of the analytic attitude, and 3) the development of open and active participation by the patient.
In Phase I, Observation and Description, the need for a stable environment, neutrality, and the nondirective stance, and the purpose of helping patients to talk freely, all require a basic conceptual framework. Residents need to understand the purpose of their activities and the requests of their patients. It is helpful for them to realize that the frame of the therapy dramatically influences the kinds of data available, the processes that unfold, and the kinds of outcomes that are attainable.
In Phase II, Conceptualization, the student begins to appreciate more conceptually the patterns of behaviors that are important to both therapist and patient. Now some of the “rules” of therapy begin to make more sense. At this time, the focus will be on observing the ways in which boundaries and roles are breached. Some understanding of the reasons why this takes place will also be possible, as will moves to restore a stable working environment. Residents can begin to understand the concept of intrapsychic change as a goal and its relationship to symptom relief and change in behaviors. This phase is also a time to educate residents further about specifying treatment goals and maintaining a focus.
During Phase III, the Synthetic phase, a deeper understanding of the importance of boundaries and therapeutic posture takes place. The resident is now able to make use of breaches in these areas as a means for deeper understanding and effective interventions. There is also a greater flexibility in setting goals in response to the needs, capabilities, and requests of particular patients. Therapists are now more comfortable with their unique styles of doing therapy while still being able to maintain a consistent treatment approach. There is also more tolerance for changes in goals over time, together with an ability to use dynamic psychotherapy in an integrated way in other approaches.
Category 2: Participants
This category contains some of the most important facets of training: the life history; in-depth description of behavior; dynamic formulations; introspection; the working alliance; and the ability to work with transference, countertransference, and resistance. Seeing psychodynamic psychotherapy as an experience occurring between and within two people is one of the most central aspects of this treatment.
The beginning therapist must learn to become a participant-observer. During Phase I, the focus is on manifest feelings and thoughts. The influences of the patient and therapist on each other and the context in which these influences are felt is a subject for observation, description, and discussion. In these ways, the resident develops the ability to observe carefully, along with vocabulary and perspectives through which to portray the richness of human behavior.
During Phase II, the student begins to link recurrent patterns to conceptual frameworks. A richer appreciation of psychoanalytically informed clinical phenomena (transference, countertransference, defense, and resistance) is fostered. Now the student can understand what is occurring in therapy in ways that can provide other levels of information about the patient and can aid in the selection of areas to intervene. By this time, for example, the student is able to understand a particular form of resistance in a patient who seems to know more than he or she professes, comes late to sessions that follow a “good” hour, and has stimulated annoyance and boredom in the therapist. The student can then go beyond a manifest affect or behavior to explore with the patient the presence of resistance and begin to understand its functions and meanings. Phase II abilities provide the developing therapist with a greater sense of control of the process and allow for interventions that deepen the work.
In Phase III, the Synthetic phase, the student confronts a matrix of intersecting educational tasks involving the interplay of transference, countertransference, resistance, the status of the working alliance, the deepening understanding of the patient's dynamics, and an ability to select and maintain a treatment focus. It is desirable for all residents to have an overview of the work at this level, even if they do not develop into competent dynamic psychotherapists. The application of analytic understanding to general clinical psychiatry is of great importance to the field,42,43 and an appreciation of interrelationships at this level is relevant to that goal.
Category 3: Verbal Flow
The patient's communication through language and the therapist's ability to recognize emerging themes are fundamental to psychotherapeutic work. Phase I involves training the resident to pay attention to the details and flow of what is being said without premature closure and to be able to summarize what has been heard. Some residents will be able to begin to quickly “hear” latent levels of meaning, but the student must first be able to absorb what the patient is saying before paying closer attention to underlying themes. The technical skills of interviewing are closely connected to this process.
Phase II learning centers upon active, flexible listening for preconscious themes. There is a shift from content to process and manifest to latent. The starting point always remains, however, with the data obtained from the patient and from the therapist's reflections. While the way in which thematic material is organized, understood, and applied will be strongly influenced by psychodynamic perspectives, the validity of this method must be repetitively demonstrated by direct links with what is observable.
Phase III, Synthesis, involves connecting the predominant themes or focal conflicts to the emerging understanding of the patient and therapy process. This connection of theme, patient, and process requires the integration of knowledge about the patient's life history, current life stressors, recurrent behaviors, character style, and manner of self-expression with the evolving dynamic formulation. This understanding must, in turn, be informed by an appreciation of the degree of transference and resistance present. In this way, the student will be able to select the most useful treatment interventions.
Category 4: Technique
Technique can be conceptualized as existing across a continuum, ranging from interviewing to the subtleties of interpretive work. These abilities must be placed within a theoretical context that defines the major areas in therapy that require intervention. This developmental line is therefore divided into 1) the acquisition of knowledge about the theory of therapy and 2) the technical skills of questioning, responding, and interpreting.
The psychoanalytic theory of therapy rests primarily on the concepts of transference, countertransference, resistance, and working through with the use of interpretation. Attaining this theoretical perspective is a necessary precondition to conceptualizing clinical phenomena and working with a traditional psychodynamic method. For example, in order for a student to make use of an important transference reaction during treatment, there must be a working definition of 1) what transference represents, 2) the way it can be used to work through unresolved conflicts, 3) its relationship to resistance, and 4) how the interpretation of this phenomenon relates to the patient's problems and the goals of treatment. This knowledge must be combined with a sense of when and how transference is to be addressed. An awareness of the degree of rapport and empathy, the status of the working alliance,25 and where the patient is on the supportive/expressive continuum34 are also necessary preconditions for the understanding of transference interpretation. Although there is considerable variation in the translation of these analytic principles to the practice of dynamic psychotherapy, an integrated overview of this aspect of therapy is essential.
In the model, the theory of technique has been divided to correspond to the phases of learning so that each area anticipates the focus of each phase. Thus, Phase I stresses the importance of a developmental history, the fact that outside relationships are paralleled in treatment, and the need to set the stage for the interpretive work that is to follow. Phase II requires some explication of transference, countertransference, resistance, and working through so that the student will be able to recognize these phenomena in clinical work. Over time, these categories are placed within an integrated model of the process of therapy, and this leads to the synthetic work of Phase III.
The technical skills needed to practice dynamic psychotherapy have only more recently received the attention they deserve. Training has shifted toward technique because of the recent emphasis on treatment specificity, variations in technique, focused goals, and outcome research. Well-defined interventions and manualized dynamic treatments33,34,44 are much more explicit about how to do the work. The considerable variety in emphases and styles of intervention continues to grow as newer approaches are validated. The basics of traditional technique are presented here, but more recent technical advances can also be added.
Phase I skills enable the listening and data-gathering process and introduce the ability to move treatment toward interpretation. They therefore begin with interviewing skills and the nondirective stance. The student learns to pay attention to the interactive process, including listening, making an intervention, and then listening again for the consequences of the intervention. The type and timing of interventions and the interplay of support and pushing the work further (as in the supportive/expressive dimension34) are introduced here.
During Phase II, there is increasing emphasis on interpretive work. Once the student understands the presence of a resistance, for example, the technique of pointing this out to the patient and beginning interpretive work can be addressed. The major educational goals of this phase allow for the fuller development of a working alliance and early interpretive work on focal dynamic content, transference, and resistance. This level of technique is attainable by many psychiatric residents and is necessary for the practice of brief dynamic psychotherapy.
Phase III requires a more in-depth development and integration of interpretive abilities. The student is now able to learn how to rationally choose which areas within an hour to address and interpret. There is more sophisticated work on the choice, timing, depth, and content of interventions.
Category 5: Analytic Theory
Of all the areas in psychodynamic psychotherapy education, the timing and depth of exposure to theory is most open to question. This is a reversal from the earlier history of education in this discipline and reflects widespread debate about the validity of analytic theory, as well as its relevance to clinical work. Yet most educators agree that basic theory is essential. The questions are what it should consist of, how much diversity of viewpoints is desirable, and when to teach it.
This model deemphasizes theory early in training. At Phase I, what is necessary is an introduction to the notion of the dynamic unconscious and its link to development. The centrality of human relationships, attachment, psychic trauma, repetitions, and historical versus narrative truth are concepts that are readily grasped and applicable to early clinical work.
Phase II learning includes knowledge of developmental theory; the concepts of symptom formation, conflict, and defense; object relations; and a richer understanding of the repetition of patterns of behavior. Subjective reality and fantasy are also addressed. Without an awareness of these ideas, it is not possible to understand the utility of dynamic formulations and the interpretation of resistance and transference. Aspects of psychosexual stages, structural theory, object relations theory, and ego and self psychology can be introduced, but there is no attempt at a systematic presentation of these models. What is necessary is a basic conceptual framework that links development, intrapsychic life, repetitive patterns, and unconscious themes seeking expression.
Phase III education can include discussion of the classic analytic literature to promote understanding of the central tenets of each model. Recent contributions and trends are also important here. The ways in which the orientations interrelate and inform clinical work are of particular importance. Links to and comparison with cognitive, behavioral, and systems models are more understandable at this time. It is important to introduce students to the evaluation and current directions of theory. However, the study of theory in depth goes beyond the purview of residency.
Attempts to objectify and systematize training in psychodynamic psychotherapy have met both intellectual and emotional resistance. Many educators feel that the field is so complexly interwoven and the learning process is such a personal undertaking that moves toward standardization are undesirable. The supervisory/apprenticeship model has been the primary mode of training, and in that model the individual supervisor's approach to education, together with the student's proclivities and the treatment of specific patients, determine what is taught. There is no question that psychotherapy training must be approached with a flexible attitude that encourages individual variation. The needs of both patients and students must be attended to, and these needs do not follow a uniform sequence. There also has to be room for supervisors to teach what they value and have particular strengths in. Awareness of issues of process in supervision, attention to teaching and learning styles, support for the resident's emotional needs, and personal growth are all necessary. However, there is a need for a content/process, didactic/experiential dialectic in psychotherapy education. Teaching with definite, realistic educational objectives will facilitate education—whether the immediate accent is on an experiential approach, discussion of content, or a specific technique.
This model is an attempt at delineating those aspects of training that can be described objectively and placed within a structure that demonstrates interrelationships and a progression in learning. A major constraint has been the desirability of constructing a model that not only accurately reflects the practice of therapy and helps to inform educational efforts, but is also concise enough to be of use in ongoing training and for evaluation purposes. Three separate steps have been taken in the construction of this model: specifying training goals, organizing them into categories, and placing the categories within learning phases. Each step offers advantages and imposes limitations, and each can be evaluated on its own merits, but it is the combination of the three that gives the model depth and provides educators and students with guidelines for training.
The discrete goals have been chosen as being most representative of the practice of traditional dynamic psychotherapy. Some goals are more specific than others. Although the list is comprehensive, it does not include the nonspecific aspects of therapy, such as warmth, sensitivity, compassion, and a sense of humor. Recent contributions have not been included here. Training programs interested in teaching dynamic psychotherapy will vary considerably with respect to how traditional their approach will be. Some will lean more toward a focus on the elucidation of meaning and observable interpersonal process, while others will prefer an accent on dynamics and transference/resistance interpretation. Although there are important differences among them, all dynamic approaches derive from a perspective that includes influences from development, the unconscious, subjective meaning, process between patient and therapist, and insight.
Placing the educational goals into the categories of development aids training by creating manageable gestalts that serve to highlight important interrelationships and trends. Some of the arbitrariness of this kind of categorization is balanced by an awareness of the dynamic interconnections across boundaries and the constant flow between larger perspectives and minute details. This is an aspect of education that can only be hinted at in an organizational map.
Placing the categories within the sequential learning phases provides an overall dimension to training at different points in the process and helps to further define the progression of specific areas of knowledge. This approach is of help in addressing the difficult questions of what to teach when. The model does not presume a naturally occurring sequence, but rather that such a structure helps to prioritize areas of training. The phases are intended to be used flexibly to orient rather than to strictly define or limit teaching practices. There is always a mixture of observing, conceptualizing, and synthesizing.
The model makes no attempt to suggest how far an individual resident should be expected to progress in training. It is helpful for the resident with no interest in practicing this form of treatment to know how certain clinical skills relate to the dynamic treatment method. Establishing boundaries and rapport, enabling the patient to speak openly, listening, and experiencing oneself as part of the treatment process are examples of core clinical skills that all psychiatrists should possess. Understanding the purview of psychodynamic psychotherapy can enable clinicians to recognize problems and look for help or refer a patient when that is needed. Those residents who wish to become competent dynamic psychotherapists can use the phases to measure progress and help guide ongoing education far beyond residency.
The sequential training model was developed 15 years ago with the primary purpose of constructing a progressive series of seminars that followed a consistent set of overtly defined expectations. With the timing and specifics of the training goals established, there was greater freedom to develop various teaching strategies. A mixture of readings and didactic discussions, process notes and audiotaped case material, roleplaying, and use of the teacher's clinical work all became organized around a progressive set of educational objectives.
Once this model was used to develop and teach a series of seminars, other advantages followed. The Director of Education was able to more consistently assess the progress of individual residents as well as begin to set goals and standards for the program. All residents and teachers had a better sense of what was expected from their work together. The evaluations of supervision, completed by both resident and supervisor, began to reflect a more consistent focus on learning expectations related to timing in training.
Psychiatric residents begin doing psychotherapy in advance of much knowledge of the process. The lack of an organized framework within which to anticipate their work with patients causes more anxiety and confusion than necessary and can interfere with early learning. This model provides an overview of therapy in a concrete format that can be supportive. It provides a context and rationale for educational goals. The specification of skills and knowledge gives residents a tangible place to start. They can actively pursue agreed-upon objectives rather than believing that they have to learn everything at once and therefore feeling incompetent or paralyzed. As residents progress, they can continue to use the model for orienting current learning and for assessing growth. Since the model encompasses advanced areas of learning, it can continue to be valuable long after formal training has ended.
The supervisor must focus on the resident's educational and emotional needs, the patient, the progress of the therapy, and a diverse variety of related issues. Each supervisor develops a way of using different kinds of information to teach, but some consistent organizing principles can be of great benefit. Without a structure, it becomes easier to become stuck on one area and to miss the possibility that movement in this area is premature or first requires education in other related aspects of therapy. A structure can also help to prevent idiosyncratic choices or education solely based on the needs of the patient presented in supervision. The use of this model encourages the supervisor to be more selective and cautions against moving ahead to complex tasks before basic areas are understood. The overt delineation of current training objectives with the resident enhances the working relationship and improves learning. Impasses between supervisor and supervisee can often be resolved with a refocusing on the most relevant phase-appropriate learning objectives. A rigid adherence to any group of educational goals, however, leads to a stale supervisory experience.
Structuring educational goals offers a number of advantages for ongoing psychotherapy training. More important than any given model, however, is the process that this form of inquiry sets in motion. It causes all involved to think more systematically about what they are doing and to endeavor to improve on current practice. The field of psychotherapy education is hampered by the lack of consensual standards, objective measurement, and research. This model is also an attempt to establish a baseline from which to research more effective educational strategies.
Conclusion
An organized and integrated approach to education in psychodynamic psychotherapy is possible and desirable. In order for this to occur, the essential knowledge and abilities that define this method must be clearly articulated. The clustering and sequencing of these goals further enables educators to develop an effective method of training. In this way, questions about the timing and methods of teaching specific aspects of psychotherapy can be more rationally addressed. Evaluation of progress, the establishment of minimal and optimal levels of competence, and comparison with other psychotherapy models can also be facilitated.
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