How endangered is dynamic psychiatry in residency training?

The future of psychodynamic psychotherapy in residency training is in jeopardy. New priorities and forces currently aligned in academic psychiatry challenge the importance of psychodynamic psychotherapy and, by extension, its core concepts of the unconscious, defense and resistance, transference and countertransference, and the past repeating itself in the present. The exit of psychoanalysts from academic centers in the last quarter of the past century was propelled by forces including biological psychiatry, managed care, and competition from other mental health disciplines. ACGME psychotherapy competencies introduced in 2001 renewed the focus on psychotherapy training in residency and set a residency training standard for psychotherapy competency. A recent shift in academia prioritizing evidence-based medicine and a shortage of psychiatrist researchers may threaten those gains.