Oh, good. I'm still premed and very interested in becoming a psychiatrist. I believe in the necessity of drugs for a lot of mental illnesses but I really would like to offer some form of therapy. I heavily believe drugs + therapy is more effective than either alone, and I believe many studies cite this effect.
This isn't really a matter of opinion or "belief." Every reasonable person in the field believes that, mostly because it is a fact. I often liken it to diabetes - diet/exercise and medications are both often necessary, and it's silly for anybody to think that a doctor should only recommend one or the other.
When you go to med school, you'll learn about how evidence-based medicine governs how we practice in any specialty. For most principles in everyday medicine, we have enough science so that we no longer have to decide what we "believe in" - usually, there are good studies that answer those questions. Such is the case for the idea of psychotherapy/meds - it is well-established in the literature that certain types of psychotherapy are effective for certain disorders, other types are effective for other disorders, and other types are really just art forms with little scientific basis. It is also well-established that certain drugs are effective for certain disorders and others are just placebos. There is plenty of overlap. Suggesting that it's a matter of "belief" cheapens the validity of the data.
That said, there are plenty of topics that have not yet been conclusively answered by the data. In those cases, we might cite "belief" based on personal experience or a theoretical understanding of the underlying neurobiology. I believe that verapamil is useful for some patients with bipolar disorder (I believe that it's probably for the patients with the calcium channel mutations that we have barely started to discover), I don't believe that Latuda is useful as a primary treatment for schizophrenia (despite the fact that the drug company tries hard to convince me to the contrary), I believe that CBT is wonderful, I believe that transcranial direct current stimulation of the dorsolateral prefrontal cortex will make a patient respond better to formal CBT or even informal CBT (i.e. the cognitive reframing that a depressed patient will experience in everyday life situations and interpersonal interactions), and I don't believe that Freudian psychoanalysis is likely to benefit a patient with real mental illness more than other psychotherapies.
In the real world, the reason why most psychiatrists refer a patient elsewhere for therapy is because of practicality/logistics. There are several factors at play... the first few that come to mind are:
1. Both psychiatrists and psychologists can do therapy, while only psychiatrists can do med management. You could help more patients as a psychiatrist if you focus on the med management while referring to therapists.
2. Most patients ideally say that they want therapy, but when you present them with the option of real-world psychotherapy, they find it to be too difficult and don't commit to it. If I had a nickel for every borderline patient who I actually convinced to do DBT (I always make a genuine effort) instead of trying to get me to prescribe placebos at homeopathic doses, I'd have two or three nickels.
3. You can make a lot more money by doing 15-minute med checks than by doing 1-hour psychotherapy sessions because of insurance reimbursements, unless you have a cash practice, in which case most patients won't be able to afford to see you.
4. For most psychiatric disorders, biological treatments (medications, ECT) work faster, are easier to implement, and are cheaper than psychological treatments. This creates a positive reinforcement loop in the mind of the practitioner.
5. Effective psychotherapy requires close follow-up with multiple frequent sessions, which is expensive. Many patients can't afford it, and most insurance companies have strict limitations on what they'll pay. Prozac costs $4.
That said, most good psychiatrists will do some therapy along with med management. Some psychiatrists will do purely one or the other. I've never met a psychiatrist or a psychologist who thought that only one or the other was necessary, although I have occasionally run into patients whose therapist was trying to treat something that should have been managed medically (the example that comes to mind is a patient who was floridly manic).
