Management vs. interpretation: teaching residents to listen.

It is possible to teach residents to listen psychodynamically within pressured clinical systems that are organized around brief management interventions without changing the structure of the training program to create "selected psychotherapy cases." Two case vignettes illustrate the amount of psychodynamic data that can be elicited from a time-limited clinical assessment. Focusing on the psychodynamics of social systems and the subtle ways in which patients and clinicians become involved with each other during assessment meetings can allow trainees to grasp unconscious functioning, projective identification, transference/countertransference, and interpretation.

A view from Riggs: treatment resistance and patient authority-XII. Examined living: a psychodynamic treatment system.

Hospitalized patients with treatment resistant comorbid Axis I and II psychiatric disorders have in common a developmental history that includes a lack of fit between their needs and their human environment. Adaptation of their personalities to this environmental failure contributes to these patients' lack of trust in authority. Treatment resistance may represent a repetition of this early experience, with the current biological and symptom focus of the field representing yet another insufficient environment.

Joining a group's task: the discovery of hope and respect.

When engaged with others in tension-filled dialogue, the temptation is for us to treat the other disrespectfully by unconsciously choosing an exclusive subgroup in our minds to belong to, and assigning the other to a devalued group. Unconsciously asserted exclusive membership allows us to deny the ways in which, by disconnecting the other, we are also alienating parts of ourselves. Using three stories, the author explores the notion of unconscious group membership and raises the possibility of discovering a shared membership in the midst of conflict.