Promoting Self-Reflection and Dialogical Skills in Psychiatry Residents as Components of Professional Resilience: Feedback From Ongoing Systemic Learning–Based Workshops
Maja Rus Makovec¹˒², Mirjana Delić¹, Silva Demšar¹, Vesna Gaberšek¹, Mirjana Radovanović¹, Borut Škodlar¹˒²
¹ University Psychiatric Clinic Ljubljana, Slovenia
² Faculty of Medicine, University of Ljubljana, Slovenia
Corresponding Author:
Maja Rus Makovec
University Psychiatric Clinic Ljubljana, Slovenia, Faculty of Medicine, University of Ljubljana, Slovenia
Published: 21/08/2026
Abstract
Background
Psychiatry residency training requires not only biomedical and psychotherapeutic knowledge, but also advanced relational, communicative, and reflective competencies. Increasing evidence suggests that self-reflection, empathy, and communication skills are essential for both patient care and physician well-being. However, these competencies are often insufficiently addressed through structured experiential learning during psychiatric training.
Objective
This article presents an educational initiative developed at the University Psychiatric Clinic Ljubljana aimed at strengthening self-reflection, dialogical skills, and professional resilience among psychiatry residents through systemic learning–based workshops.
Discussion
The workshop programme, entitled Meta-knowledge in Psychotherapeutic Interventions in Psychiatry, integrates experiential learning, systemic thinking, and reflective dialogue within a psychologically safe educational environment. The initiative focuses on meta-level competencies derived from different psychotherapeutic traditions, including empathy, relational awareness, communication, and understanding of unconscious interpersonal processes. Since 2019, the workshops have been delivered regularly to psychiatry residents across different stages of training. Participants reported improved tolerance of uncertainty, increased awareness of communication dynamics, enhanced understanding of relational processes, and greater confidence in professional interactions with patients, colleagues, and multidisciplinary teams.
Conclusions
Educational environments that intentionally cultivate reflective and dialogical competencies may contribute substantially to professional resilience and well-being among psychiatry residents. The workshop model presented here illustrates how relatively small but continuous educational interventions can complement standard residency training while preserving the humanistic core of psychiatry in increasingly complex and technologically driven healthcare systems.
Keywords
Psychiatry residency; self-reflection; communication skills; dialogical skills; resilience; experiential learning; systemic approach; professional well-being
Introduction
Psychiatry occupies a distinctive position among medical specialties because communication itself represents not only a clinical tool, but also a fundamental component of diagnosis, therapeutic alliance, and treatment. The ability to understand subjective experience, navigate relational complexity, and establish meaningful therapeutic connections is central to psychiatric practice.
A growing body of evidence demonstrates that empathic and patient-centred communication improves clinical outcomes, treatment adherence, patient satisfaction, and physician well-being. At the same time, concerns have emerged regarding the gradual decline of empathic communication during medical education, particularly under conditions characterised by stress, time pressure, and hierarchical learning cultures.
Psychiatry residents face additional profession-specific challenges. Clinical work frequently involves emotionally demanding situations, uncertainty, responsibility for vulnerable patients, and complex relationships involving families, multidisciplinary teams, and institutional systems. These pressures may contribute to burnout, emotional exhaustion, and reduced professional well-being.
In this context, professional resilience has become an increasingly important concept. However, resilience should not be viewed solely as an individual psychological trait. Rather, it develops within educational, relational, and institutional environments that either support or undermine reflective capacity, communication, and professional identity formation.
Traditional residency training often assumes that communication skills develop implicitly through clinical exposure, supervision, and psychotherapy education. While these components remain essential, they may not sufficiently address the flexible and context-dependent communication challenges encountered in everyday psychiatric practice. Competencies such as managing uncertainty, navigating institutional dynamics, responding to conflict, and communicating within multidisciplinary teams frequently require explicit experiential learning approaches.
At the same time, broader discussions concerning the future of psychiatry increasingly emphasise the importance of preserving humanistic and relational dimensions of care within healthcare systems shaped by technological development and growing administrative pressures. Artificial intelligence and digital tools may support psychiatric practice in many areas, but they cannot replace empathy, therapeutic presence, or relational understanding.
Within the European context, the Union Européenne des Médecins Spécialistes (UEMS) identifies communication as a core professional competency for psychiatrists. These considerations formed the basis for the development of a structured workshop programme at the University Psychiatric Clinic Ljubljana aimed at strengthening self-reflection, dialogical competencies, and professional resilience among psychiatry residents.
Development of the Educational Initiative
The workshop series was developed at the University Psychiatric Clinic Ljubljana by six psychiatry specialists representing different psychiatric subspecialties and psychotherapeutic backgrounds.
The initiative emerged from the observation that formal psychotherapy education within residency training, although valuable, does not always sufficiently address the application of communication and relational skills across everyday clinical and institutional settings. Residents often encounter difficulties not only in patient communication, but also in interactions involving colleagues, supervisors, multidisciplinary teams, and institutional structures.
The programme therefore focused on meta-knowledge derived from psychotherapeutic approaches. Rather than teaching a single therapeutic model, the workshops explored broader shared principles such as empathy, alliance-building, awareness of unconscious processes, relational dynamics, communication patterns, and systemic thinking.
These principles were translated into a format suitable for experiential learning within residency education.
The workshops were intentionally designed as psychologically safe environments that encourage dialogue, reflection, and feedback while maintaining clear professional boundaries. Importantly, the workshops are not intended to function as psychotherapy for residents, but rather as structured professional learning environments supporting reflective clinical practice.
This approach aligns with contemporary educational models emphasising reflective practice, psychological safety, professionalism, and experiential learning within medical education.
Structure and Content of the Workshops
The workshop series has been conducted regularly since 2019 and has evolved into a structured longitudinal educational programme integrated into residency education at the University Psychiatric Clinic Ljubljana.
Residents may participate at any stage of their five-year residency programme. Participation is voluntary, and no prior knowledge is required. Workshops are conducted every two months during working hours and typically last four hours.
Attendance generally ranges between eight and fifteen participants, reflecting the rotating nature of psychiatric residency placements.
The workshops combine several educational components, including preparatory reading, experiential small-group discussions, role-playing exercises, reflective dialogue, brief theoretical input, and structured feedback processes.
Residents first engage in small-group reflection concerning selected themes related to psychiatric practice and communication. Discussions are subsequently integrated into larger group dialogue and role-playing exercises based on clinical scenarios.
The workshop programme addresses fourteen core themes relevant throughout psychiatric training. These include self-reflection and professional identity formation, first encounters with patients, development of therapeutic alliance, empathy, professional boundaries, attachment, institutional and therapeutic power dynamics, unconscious communication processes, resistance and change, motivation, separation, cultural competence, existential themes, and epistemic trust within conditions of uncertainty.
Rather than focusing exclusively on technical communication skills, the workshops encourage residents to examine their own assumptions, communication styles, emotional responses, and professional positioning within broader relational and institutional contexts.
An important pedagogical principle is the integration of multiple psychotherapeutic perspectives. The involvement of mentors from different psychotherapeutic traditions enables residents to observe reflective dialogue between supervisors themselves, thereby modelling tolerance for multiple perspectives and uncertainty.
Learning Experience and Resident Feedback
Continuous feedback from residents represented an important component of the workshop development process.
The authors acknowledge that the reported observations do not constitute a formal quantitative research study with predefined methodological design. Instead, the discussion reflects experiential observations and mentoring perspectives accumulated throughout several years of implementation.
An anonymous survey conducted in 2022 explored resident perceptions of the workshops and associated learning methods. Feedback demonstrated particularly strong appreciation for themes related to empathy, boundaries, first patient encounters, and separation.
Participants consistently described the workshops as environments that provided:
- New perspectives
- Greater self-awareness
- Improved understanding of communication dynamics
- Increased comfort with uncertainty
- Enhanced reflective capacity
Residents also reported feeling psychologically safe during discussions and indicated willingness to recommend the workshops to future generations of trainees.
Importantly, several participants highlighted that communication difficulties often emerged more strongly in professional interactions with colleagues, supervisors, and institutions than in direct patient encounters. This observation reinforced the importance of addressing communication within broader systemic and organisational contexts rather than focusing exclusively on therapeutic encounters.
Role-playing exercises and structured feedback processes were reported as particularly useful for identifying implicit assumptions, communication patterns, and misunderstandings influencing clinical interactions.
Discussion
The experiences described in this initiative suggest that reflective and relational competencies among psychiatry residents may be strengthened through relatively small but continuous educational interventions integrated within residency training.
The workshops appear to complement conventional psychiatric education by addressing dimensions of professional development that are often implicit or insufficiently explored within traditional curricula. These include communication within institutional systems, management of uncertainty, relational awareness, emotional processing, and reflective professional identity formation.
A particularly important feature of the programme is the emphasis on dialogue and multiplicity of perspectives. By engaging in reflective discussion among themselves in the presence of residents, mentors model a “reflecting team” approach that demonstrates how different viewpoints may coexist constructively within psychiatric practice.
This pedagogical approach aligns with growing educational interest in reflective learning models that support tolerance of ambiguity, collaborative thinking, and patient-centred communication.
The workshops also illustrate the importance of psychological safety within medical education. Residents require educational environments where uncertainty, vulnerability, mistakes, and emotional complexity may be discussed openly without fear of judgment or negative evaluation.
Such environments may contribute not only to communication competence but also to professional resilience and well-being.
Importantly, the programme conceptualises resilience not as individual endurance or emotional toughness, but as a relational and institutional phenomenon shaped by learning culture, professional support, communication practices, and opportunities for meaningful dialogue.
Relevance for Contemporary Psychiatry Training
The workshop model described here may hold particular relevance within contemporary European psychiatry training.
Healthcare systems across Europe increasingly operate under conditions characterised by:
- Workforce shortages
- Administrative burden
- Technological transformation
- Time pressure
- Emotional exhaustion among healthcare professionals
Within such environments, there is a risk that relational and humanistic aspects of psychiatric care become progressively marginalised.
At the same time, rapid development of artificial intelligence and digital psychiatry has intensified discussion regarding the future role of human interaction within mental healthcare. Although technological tools may enhance diagnostic and therapeutic processes, they cannot replace empathy, therapeutic alliance, or reflective understanding of subjective experience.
Educational initiatives that intentionally strengthen self-reflection, dialogical competence, and relational awareness may therefore represent an important counterbalance within technologically evolving healthcare systems.
The Slovenian experience also demonstrates how relatively resource-efficient educational interventions may be implemented successfully within smaller European healthcare systems with limited financial and human resources.
Limitations and Future Directions
Several limitations should be acknowledged.
The present article reflects experiential educational observations rather than a formal research study using structured qualitative or quantitative methodology. Outcome evaluation therefore remains primarily descriptive.
Future research may benefit from:
- Development of longitudinal evaluation methods
- Qualitative analysis of resident experiences
- Assessment of communication competencies
- Evaluation of burnout and resilience indicators
- Exploration of long-term professional impact
Further adaptation of similar workshop models within other psychiatric residency programmes may also help evaluate transferability across different cultural and institutional contexts.
Conclusion
Psychiatry residency training requires educational environments that support not only clinical knowledge acquisition, but also self-reflection, communication, relational understanding, and professional resilience.
The workshop programme presented in this article illustrates how experiential and systemic learning approaches may strengthen reflective and dialogical competencies among psychiatry residents through relatively small but sustained educational interventions.
Importantly, professional resilience should not be understood solely as an individual responsibility. Rather, it emerges within supportive educational cultures that promote reflection, dialogue, psychological safety, and collaborative learning.
In an era characterised by increasing technological transformation and systemic pressures within healthcare, preserving and intentionally cultivating the humanistic dimensions of psychiatric practice remains essential for both patient care and physician well-being.
Open Access & Copyright
© 2026 The Authors. Published by the European Medical Specialist Review (EMSR) under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0).
How to cite this article
Rus Makovec M, Delić M, Demšar S, Gaberšek V, Radovanović M, Škodlar B. Promoting Self-Reflection and Dialogical Skills in Psychiatry Residents as Components of Professional Resilience: Feedback From Ongoing Systemic Learning–Based Workshops. European Medical Specialist Review. Published 21 August 2026. https://doi.org/10.67452/EMSR.2026.014
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