Dr Weil and Dr Hirsch, both still living in Halifax, authored this paper as assistant and associate professors of psychiatry, respectively, at Dalhousie University; they had brought the sophistication of their psychoanalytically informed training at the Menninger Clinic and Johns Hopkins to the clinical realities of Nova Scotia. The result is a paper which, in 1964, emanates a concern for community psychiatric services, psychotherapeutic eclecticism, a multicultural and a biopsychosocial perspective, humility about the specific change agent within psychotherapy, the need for public and scientific scrutiny, and practical suggestions for a psychotherapy curriculum.  Thirty-six years later, none of their observations or suggestions are out of date.

David S Goldbloom, MD, FRCPC
Physician-in-Chief, Centre for Addiction and Mental Health, Professor of Psychiatry, University of Toronto

…Most psychotherapeutic activities are psychoanalytically oriented. There is no innate or basic disadvantage in this orientation as long as therapeutic techniques based on it remain flexible, and tempered by the awareness of its sociological limitations, and by a renunciation of a complete psychotherapeutic monopoly.

…Community psychiatry demands of the psychiatrist considerable skill in managing the more serious, ambulant and chronic psychiatric outpatient. He has to be proficient in handling psychiatric emergencies, deal with the psychopathology of families, treat groups, combine psychotherapeutic techniques with physical treatment, and provide psychiatric consultations to professionals and non-professional groups… Practicing in a smaller community, the psychiatrist will have far more contact with his patients. He will also be under greater scrutiny by his fellow citizens, professionally as well as socially. This exposed position will preclude the psychotherapeutic detachment held so sacred by many of our colleagues only a few years ago.

…The body of psychotherapeutic theory covers many approaches, philosophies and schools and it seems only reasonable that the budding psychiatrist be acquainted with all of them from hypnosis to existential psychotherapy. Whether the intimate knowledge of the theories and methods of the different psychotherapeutic schools contributes to an increased efficiency in psychotherapy may be questioned.

…The present day teacher of psychotherapy should encourage the resident to involve himself in a wide range of psychotherapeutic techniques with patients of different social classes and, if possible, of different cultures… He will see some patients who appear spasmodically in the out-patient department for short periods of psychotherapy, which will not lead to a resolution of their “infantile neurosis” but may very well help them to adjust satisfactorily to the community. He will find that no single therapeutic technique will be applicable to patients of the various diagnostic and sociological groups.

The exposure of the resident to such a broad teaching program is less likely to produce dogmatism or undue enthusiasm about one type of therapy…Witnessing successful psychotherapy performed by staff members, social workers, and other professional and non-professional therapists, the resident may be impressed by both the ease and the complexities of this form of treatment…  He will soon note that certain patients are difficult for any type of therapist and, on the other hand, that all kinds of therapists may get very good results, using not only different techniques, but techniques based on entirely different frames of references.

…The resident will be faced—as we all very often are—by the question: “What really helped the patient?” Viewing only his own contribution to the total therapeutic process, the resident may vastly overestimate his own therapeutic potential. However, if he evaluates the contributions of his collaborators or of physical therapy too highly, he may very well acquire an attitude of psychotherapeutic nihilism.

…The understanding of the different psychiatric needs encountered will be greatly enhanced by a comprehensive diagnostic evaluation of the patient and his problems. A bio-psycho-social evaluation in this diagnostic process will facilitate therapeutic planning. The importance of socio-cultural features in diagnosis and treatment should be emphasized by adding a social scientist to the psychiatric post-graduate teaching staff, if possible.

…As psychiatric services grow, the field of psychiatry, including psychotherapy will encounter more and more public and scientific scrutiny. This should be accepted as a healthy phenomenon which will encourage research. The coming generation of psychiatrists will have to meet ever-increasing pressures for psychiatric services and to delineate more carefully who can be helped. They must not allow themselves to be pressured into roles they cannot fulfil by an over-enthusiastic or desperate public. These factors contain significant implications for the teaching of psychotherapy.