Can psychiatrists work in the capacity of a therapist?

[ladylolita]

Hi,
I was wondering if psych residents are taught therapy techniques to use with patients? What I really want to know is if it's feasible for a psychiatrist to also act in the capacity of a therapist???

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[TexasPhysician]

Yes to all questions.

 

[Technotronic]

 

[atsai3]

Hi,
I was wondering if psych residents are taught therapy techniques to use with patients? What I really want to know is if it's feasible for a psychiatrist to also act in the capacity of a therapist???

Yes, they are. The reasons why you don't see many psychiatrists in primarily therapy-based practice are mostly structural in nature.

In the time that it takes you to see one psychotherapy patient you can see 3-4 medcheck patients, and insurance will reimburse you more for the latter.

If you were to work for an organization like Kaiser, they would pay you to do medchecks. They would not be as enthusiastic about paying you to do therapy, because they can pay a social worker to do that (and pay him or her less than you). You could propose to your employer that they pay you a social worker's salary to do therapy, and they might accept -- but I have never seen this in practice.

Thus if you want to do therapy, then to make it worth your while you will need to have a cash-only practice, and typically the only people who can afford this are relatively wealthy patients.

What many early-stage psychiatrists end up doing is working part-time at a salaried job (e.g. county mental health system -- doing med checks) to get benefits, and part-time private practice (doing therapy, running a Suboxone mill, running a Ritalin mill, etc). And then when your private practice gets large enough, they quit working for the county and go full-time private.

 

[Therapist4Chnge]

Hi,
I was wondering if psych residents are taught therapy techniques to use with patients? What I really want to know is if it's feasible for a psychiatrist to also act in the capacity of a therapist???

Some better than others. There is also the option to go for additional training after residency. There are a number of excellent institutes that offer discounted training for early career clinicians.

 

[Manicsleep]

All psychiatrists are therapists. Not all therapists are psychiatrists. There are also physicians who are therapists who aren't psychiatrists. Some Family Medicine doctors also do therapy.

 

[nitemagi]

In certain locales (big cities), it's also more feasible to build a private practice as a psychiatrist that does therapy, since patients often prefer a sole practitioner over split care.

 

[Chimed]

It may also help to set up a practice and be associated with a psychoanalytic institute, if psychodynamic therapy is your thing. The institute serves several purposes including psychotherapy referrals and networking.

 

[cleareyedguy]

When you ask about psychotherapy, you are probably referring to a once or twice a week, 45", extended relationship that aims to be therapeutic. That is a difficult skill to learn, which is an additional reason why many psychiatrists opt for medication back-up (beyond simply the desire to maximize income). Plenty of psychologists and social workers are more empathic, more motivated, and more technically competent than some /many psychiatrists, so referrals to them are a good idea and not simply expedient.

Many psychiatrists believe that their role is to prescribe meds and that the therapy is kinda bogus, but meds alone do not adequately help most people who walk into your office. To be a good psychiatrist, from my perspective, it is necessary to do a therapeutic/dynamic evaluation of all patients so that you can figure out what would be the best treatment. If all you do is ask a few dsm questions and offer an SSRI or a benzo, I feel you're abrogating your responsibility as a physician. Instead, you should learn how to really assess patients and then assiduously keep up with the literature to know what seems to work and keep up with your local environment to know the realistic options for patients. And then you can offer a biopsychosocial recommendation that maximizes the likelihood they'll get better. If a residency program offers to let you bypass having to learn one of the three angles on patients, run away.

 

[whopper]

As much as I emphasize the importance of psychotherapy, I have in private practice, often been referring people out to others. One reason is some people have better training than I in specific techniques such as EMDR or DBT. Another reason is pure and simple, money. For most of my patients, money is very important and I can refer them to someone who can do it for them at a cheaper cost that I have some confidence can help.

At least for me, if someone can offer something I can for a cheaper price, and from experience they've been doing a good job at it, I'd rather my patient save money. I am in no situation where I am starving for patients and the money they bring to the degree where I'd skimp on their care or push a treatment on them that I wouldn't want for a family member.

I've had several patients in private practice where our relationship is becoming much more psychotherapy than medication based. These are patients where they feel stabilized and aren't satisfied, they want more such as possibly getting off of meds permanently (if possible, certainly not with psychosis or bipolar disorder). This is usually after I've stabilized what I can with medications, and the psychotherapy then becomes more on compliance, self-improvement, and seeing what we can do to chip away the need for meds if possible. Several of them want to stay with me even when I tell them it could be cheaper for them to see someone else.

 

[sunlioness]

I agree with Whopper. While I believe that psychotherapy is very important, I also believe that there are people better trained to deliver it than I am and who can deliver it in a more cost-effective fashion. I also realized in my year of solo practice that while I enjoy knowing about it and collaborating with therapists, I actually don't much enjoy doing it myself.

 

[Manicsleep]

Plenty of psychologists and social workers are more empathic, more motivated, and more technically competent than some /many psychiatrists, so referrals to them are a good idea and not simply expedient.

Of course, the opposite is also true. The rest of your point is very salient and a good psychiatrist should be a complete psychiatrist however the mid 90s-early 2000s movement of drugs drugs drugs has now been seen to be idiotic by psychiatry (for the most part) and there is a slow and steady shift in the psychiatry paradigm back towards holistic treatment. However, this is being impeded by various forces such as the myth that psychiatrists cannot do therapy as well as others, HMOs putting psychiatrists in defined and limited roles as well as greed. Although those that do it for greed are shooting themselves in the long term as you can work much longer and comfortable hours if you do therapy.

From an economic standpoint and from the patient standpoint, nitemagi's point about split care vs dual care is well stated. There is data showing that a psychiatrist doing both therapy and med management leads to better outcomes and is cheaper and the patients like it better to have to go to only one visit (and pay less money.)

 

[whopper]

I also realized in my year of solo practice that while I enjoy knowing about it and collaborating with therapists

Agree. I very much hate the type of psychiatrist or other mental health professional that gives the wrong type of treatment. E.g. psychotherapy only for bipolar disorder.

I also can't stand the type of therapist that doesn't get their patient better at all and just listens----just listens but doesn't really have anything else to do with the patient in getting them better. While listening can be important, no, I'm referring to the therapists and listen and nothing else when there's more that needs' to be done. I see this type of therapist as no more effective than the guy from There's Something About Mary
http://www.dailymotion.com/video/x7mo1i_there-s-something-about-mary-bath-h_fun

I do psychotherapy, real psychotherapy with a lot of my patients in private practice but I only do so if I feel I can get them better and both the patient and I see results we're happy with and I don't think others can do a better job at it.

 

[Majesty]

Psychiatrists are therapists. So yes, they can work in the capacity of psychiatrists.