For some years my colleagues and I have been teaching counselling skills to undergraduate medical students and to postgraduate trainees in medicine, social work, nursing, clinical psychology and occupational therapy. We started teaching these skills to postgraduates (particularly family planning clinic doctors and nurses) at the request of the Family Planning Training committee of the West Midlands Regional Health Authority. At first we concentrated on teaching simple psychosexual counselling skills but latterly, as a result of consumer demand, we have extended the number of topics. We have also begun to apply the lessons we have learnt in postgraduate teaching to the teaching of medical undergraduates.

If medical students are to be effective in clinical practice they must acquire the skills needed to put patients with psychiatric problems at ease, to promote trust and confidence, and to elicit an accurate and relevant history. Unfortunately, there is considerable evidence that traditional methods of medical training fail to equip them with these essential skills.

An assumption underlying this paper is that knowledge of psychotherapy should be available to all psychiatry trainees, not just to those with a special interest in psychotherapy. It does not, of course, follow that all trainees should practise psychotherapy throughout their careers, but they should know something about the therapeutic aspects of the doctor-patient relationship. These aspects are highlighted in psychotherapy but are by no means exclusive to it. Given this assumption, we are faced with the problem of how to provide this training—in terms of content and logistics.

In psychiatry signs and symptoms are observed and arranged into diagnostic patterns or clusters. The diagnosis is the ‘what’ of what is wrong with the patient. In order to plan effectively, we also need to know the whys and wherefores of his state. The understanding that we have of this is expressed in the psychodynamic formulation. In preparing it we draw upon our human capacity for understanding and empathy, our capacity to read the story of the other person's reactions.