Psychiatry or Psychology?

[XxSnow QueenxX]

Hey all, I know this has probably been asked before, but I haven't found a thread with my specific questions. I am very passionate about helping people that have mental illnesses and I want to help them. I was pursuing psychiatric PA, but I've found that I like my psychology classes better than I do my chemistry or physics. Can anyone give me some advice about how to come to a conclusion about what to pursue?
Thanks!

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[WisNeuro]

Would you like to treat people with psychopathology, or see them for 15 minutes every 3 months for medication management?

 

[XxSnow QueenxX]

Both sound really interesting so I'm torn, but I'm leaning a bit more to the psychopathology.

 

[thewesternsky]

? Did you mean psychotherapy maybe?

 

[smalltownpsych]

If it was psychiatrist vs psychologist I would say it's sort of a toss-up because as a psychiatrist you can do both although many jobs will push for just med management. As a PA, I think you would be much more limited in scope so I would think being a psychologist might be a good choice. Do you enjoy research, teaching, psychological assessment because those are aspects that are clearly in the psychologists wheelhouse?

 

[Drrrrrr. Celty]

Would you like to treat people with psychopathology, or see them for 15 minutes every 3 months for medication management?

That's cute. No really, let's not deflect.

The psychiatrists I know do both med management, therapy, work in hospital settings as mental health leaders etc.

Not to mention as a psychiatrist you can pursue fellowships and focus on extremely interesting subspecialties.


Personally I'm aiming for psychiatry and I'm aiming for hospital Somato-lIason psych. It's not med management it's working with people with medical issues that produce psychological and psychiatric issues.

 

[WisNeuro]

That's cute. No really, let's not deflect.

Have you worked in large hospitals (e.g., VA's, AMC's)? I'm not being sarcastic, this is what psychiatrists are hired to do for the majority of their work. They don't do therapy in these settings. I imagine it's different in PP, but those are also the minority of positions, especially with the ever increasing number of physicians selling their practices to join hospitals.

 

[Drrrrrr. Celty]

Have you worked in large hospitals (e.g., VA's, AMC's)? I'm not being sarcastic, this is what psychiatrists are hired to do for the majority of their work. They don't do therapy in these settings. I imagine it's different in PP, but those are also the minority of positions, especially with the ever increasing number of physicians selling their practices to join hospitals.

Yes I've seen plenty of psychiatrists in hospitals. They're doing very complicated combinations of work.

Also most psychiatrists are working private practice the way they like.


But I get it, you honestly have a negative opinion of psychiatrists and you for some reason think they're totally not doing anything in the treatment of mental disorder as opposed to you guys with your therapies.

Tbh, after studying animal behavior I really am pessimistic about CBT and I honestly don't think it works anywhere as well as the studies show. And even then the studies are clear in showing that meds are bigger in effect anyway.

 

[WisNeuro]

I would venture that more work in a hospital setting than you think, and that number is steadily increasing with changes in reimbursement and referral structures. It's a product of the system, institutions want them to manage medications, it pays much better than billing for psychotherapy. Simple economics.

Mis-management of those medications is a wholly separate can of worms.

 

[wesleysmith]

Tbh, after studying animal behavior I really am pessimistic about CBT and I honestly don't think it works anywhere as well as the studies show. And even then the studies are clear in showing that meds are bigger in effect anyway.

That seems like quite the leap... care to post said studies on medications? Perhaps supplemented with studies on the long term effectiveness of medication only vs the alternatives (med/therapy - therapy alone)?

 

[WisNeuro]

That seems like quite the leap... care to post said studies on medications? Perhaps supplemented with studies on the long term effectiveness of medication only vs the alternatives (med/therapy - therapy alone)?

The real answer is that it depends. For many things, especially on the anxiety spectrum, CBT benefits vastly outweigh medication benefits, especially in the long-term. For certain kinds of depression, medication can be better. Etc. Not a cut and dry answer.

 

[wesleysmith]

The real answer is that it depends. For many things, especially on the anxiety spectrum, CBT benefits vastly outweigh medication benefits, especially in the long-term. For certain kinds of depression, medication can be better. Etc. Not a cut and dry answer.

I was actually just coming back on to edit my response to add just that; it varies based on the condition. My post was too broad, and in that regard, inaccurate. Whoops!

 

[WisNeuro]

I was actually just coming back on to edit my response to add just that; it varies based on the condition. My post was too broad, and in that regard, inaccurate. Whoops!

Fair enough question though. I believe the STAR*D trials are what most people use when they call for medications superiority in some forms of depression. Although the effect sizes were small, and the study has since been called into question for methodological concerns.

 

[Therapist4Chnge]

Tbh, after studying animal behavior I really am pessimistic about CBT and I honestly don't think it works anywhere as well as the studies show. And even then the studies are clear in showing that meds are bigger in effect anyway.

I think you may have that backwards…unless you want to limit it to a discussion on treating schizophrenia, catatonia, etc.

*edit*

Looks like this was covered, I should have kept reading.

 

[wesleysmith]

I'll have to read up more after work, but if I'm understanding this correctly it looks like patients who opted for CBT either alone or in addition to therapy not only had similar remission rates, but fewer adverse effects? It did state that the subjects who took medication improved faster, but it seems to me like that would be up to the individual (risks of slower remission vs adverse reactions to medication) or subjective based on severity of symptoms. Like I said though, I need to read through it in its entirety more carefully after work; I've already killed enough time on here !

 

[erg923]

Is that what we are after? "Bigger effect sizes. " Good lord how narrow some peoples view of what good psychiatry is. This statement is all the more bewildering since the sentence before it essentially says I don't care what the literature says, I'm gonna believe what I want to believe.

 

[WisNeuro]

I'll have to read up more after work, but if I'm understanding this correctly it looks like patients who opted for CBT either alone or in addition to therapy not only had similar remission rates, but fewer adverse effects? It did state that the subjects who took medication improved faster, but it seems to me like that would be up to the individual (risks of slower remission vs adverse reactions to medication) or subjective based on severity of symptoms. Like I said though, I need to read through it in its entirety more carefully after work; I've already killed enough time on here !

The bottom line of the literature on depression is that both sides can find data to support which is better for depression. I think there is more to say that outcomes are similar with less chance of adverse effects for CBT. There is some data coming out saying that either may be more efficacious depending on the characteristics of the depression and response to past treatment. So, for depression, no consensus either way.

As for anxiety disorders (PTSD, Panic, OCD, specific phobias), the literature is pretty clear that CBT is preferred. In fact, for many of these, benzos, especially short-acting ones, actually make the anxiety worse in the long run.

Obviously for some disorders (schizophrenia, bipolar) medication is preferred if it is serious enough. In those cases CBT is more focused on quality of life improvement rather than "curing" someone of the illness.

 

[Doctor Eliza]

Back to the OP, if you are an undergrad, I advise you to take both psych and premed coursework. The problem with premed is that it requires a lot of boring courses that have little to do with practicing medicine. Ask your physician how much they remember about organic chemistry. Psychology classes tend to be much more interesting right away.

This was the mistake I made. I jumped ship too quickly on premed because I was seduced by psychology. I regret it. I think I would have enjoyed being a physician.

 

[psychRA]

I would venture that more work in a hospital setting than you think, and that number is steadily increasing with changes in reimbursement and referral structures. It's a product of the system, institutions want them to manage medications, it pays much better than billing for psychotherapy. Simple economics.

To echo what WisNeuro is saying, in all of the settings where I've worked, psychiatrists generally do brief med checks every few months, as well as 1-time evaluations for new patients and acute patients. They rarely have time to do therapy, especially anything beyond brief supportive therapy. It's not a dig at psychiatrists - it's just what happens in a system where reimbursements are falling, and practicing therapy as an MD isn't supported by the hospital or the insurance companies.

I don't think you can make blanket statements about which one is "better," either. When I see patients with psychotic disorders, therapies like CBT can actually be helpful to some extent, but they also need to be on a stable medication regimen and meeting with a prescriber regularly, because any progress that I can make through therapy is going to be limited without med management. If I had to choose one or the other for those patients, I would choose medication. Likewise, when I see a patient with OCD, an SSRI can definitely help, but only as long as the patient it still taking it, and it certainly won't replace doing the hard work of getting through those exposure heirarchies and using ERP in therapy. If I had to choose one or the other, ERP is going to beat out medication.

 

[Drrrrrr. Celty]

Again, that's general psychiatry and that's if you're working the class 35 hour week. You can easily add a few hours a week in for therapy and work 45 hours or something.

Now add in fellowships in psychiatry and you've got a huge range of options. I mean do a fellow in adolescent or addiction or somatic-lIason and I'm pretty sure you're going to be doing a lot of therapy along with med management.

But again, for me I believe psychiatry is a better fit for me because I believe while specializing early on in treatment of specific disorders has benefits, it's not conducive to understanding a lot of other things. But that's me, I could easily see myself doing other residencies where psychiatry is incorporated within training.


Also idk where all the doom and gloom is coming from. Psych is very lucrative, and it will become even more lucrative thanks to ACA.

 

[CheetahGirl]

A psychiatrist is a physician first and foremost. If I recommended a patient for therapy, I would send them to a clinical psychologist b/c we spend our entire education learning to assess, conceptualize and treat with interpersonal intervention. You cannot learn 'to do therapy' in a one-year fellowship (not that anyone eluded to this). If I referred a patient to a psychiatrist for therapy, that psychiatrist better have had some intense sort of post-doc, like psychoanalytic training.

My argument stems from if you have a foot problem go to a podiatrist, not an internist...if you have a psychosis, by all means find a psychiatrist for medication management...but after stabilization, if you need therapy seek a clinical psychologist. If you have problems (or the need to) negotiating social systems, seek a social worker. Folks need to know that psychiatry is not a one-stop shop for all mental health. It is not

 

[Drrrrrr. Celty]

And a psychologist is a researcher first. And again, there are benefits to specializing early and negatives. I feel that without a true biological foundations or an examination of other human systems and disorders it is simply only teaching half the human experience. Fundamentally that was my main deterrent from psychology, I don't really want to do research my entire life and mainly as a side, and I want to learn about the entire body and how disorders of the body interplay with psychiatric disorders.

Again, psychologists do get a lot of training in therapy. I agree that they're the best choice for that. But simply saying that a psychiatrist is a med management machine is awful and wrong. Psychiatrists do a lot more ranging from lab tests to figure out whether psychosis is a result of a somatic disorder or whether it's psychologically based and many other things. Likewise they're being trained a lot more now in imaging methods as a method of diagnosis.

But in the end, a psychiatrist can do therapy on sometimes. And in some fellowships will focus intensively on that in an inpatient setting as opposed to outpatient clinics such as university settings. So basically what I'm saying is don't claim that they're just people who are seeing patients for 15 minutes and dependent on reimbursements and hospital settings.

 

[CheetahGirl]

And a psychologist is a researcher first.

A clinical psychologist is a clinician first (and the research supports our interventions). You are researcher first if you decide to be a developmental psychologist, experimental psychologist, social psychologist, etc, etc. or clinical psychologist who wants to mainly do research.

But simply saying that a psychiatrist is a med management machine is awful and wrong.

Of course it is...but, as others suggested above, when you work/train side-by-side with MDs in the clinical setting, this is what you observe on a daily basis. This is precisely why an integrated, multidisciplinary team is the optimal approach to patient care.

But in the end, a psychiatrist can do therapy on sometimes.

And so can social workers, but the patient is best served by those who are trained and skilled in the interventions most appropriate for each individual case.

 

[Drrrrrr. Celty]

Maybe, all of my friends who aimed for a PhD in clinical psych openly stated they have no interest in actually treating people but want to purely do research. And admittedly given the huge focus as well as people on here basically staying that you should stop at a MS if all you want is to therapy I thought it had a good amount of validation.

And fair enough, I think they both do jobs together that are extremely necessary and conducive to the health and bettering of patients. That being said, there's no denying that a lot of psychologists have negative perspectives on psychiatry, hell many psych classes really try to push the agenda that psychiatry is harmful or not as helpful as psychology either by bringing up notions like ECT which is a valid and biologically proven treatment, to the whole psychologists faking schizophrenia thing.

I think a lot of social workers do therapy these days. A lot of them claim that they make more money than PhDs doing it actually. I don't know if it's all that proper, but who knows.

 

[CheetahGirl]

Maybe, all of my friends who aimed for a PhD in clinical psych openly stated they have no interest in actually treating people but want to purely do research. And admittedly given the huge focus as well as people on here basically staying that you should stop at a MS if all you want is to therapy I thought it had a good amount of validation.

Yes, probably your friends are more focused on being researchers. The huge SDN focus on research for the clinician is mainly the concept that our treatments must be evidence-based and the research informs this notion...and if you don't like research, you will never make it through the long hours dedicated to your dissertation, which can take years if you don't have the support and subjects to finish in a timely manner.

Thanks for the convo, serenade. Just be open to our statements from our point-of-view because we systemically view other aspects of the human experience, as you are being trained in similarly, closely-related aspects.

I'd like to end on the note that I DO NOT think psychologists should have prescription privileges. We do not study the physiological systems of the human body the way physicians do, and if a psychologist does not work closely with a physician, then psychiatric meds could have negative interaction effects with other medications that may seem unrelated (i.e., as an example, who would've thought that an oral anti-fungal medication prescribed for toes could react negatively with hypertension meds prescribed for the heart?!). Likewise, if you're trained in clinical psych (and not medicine, aside from some postdoctoral psychopharamocology), then how would know to look for systemic changes in a person's physiology that may impact the overall health of the patient?! Someone please enlighten me if I am wrong, but I still feel that psychiatrist should prescribe, not psychologists. A lot goes into all of our training and education, and one should be cautioned when attempting to be a 'one-stop shop.'

 

[psych84]

If you look at the research being done currently, the concentration isn't on genetics or environment, it is both. We've come to a point where we realize it isn't a question if something is genetic or environmental, we know its both. The environment can dictate how a gene expresses itself and change how it expresses itself. This means that their is a role for both understanding the biology and understanding the environment, and one isn't more important than the other. This means that we need smart people in both areas.

 

[Drrrrrr. Celty]

Yes, probably your friends are more focused on being researchers. The huge SDN focus on research for the clinician is mainly the concept that our treatments must be evidence-based and the research informs this notion...and if you don't like research, you will never make it through the long hours dedicated to your dissertation, which can take years if you don't have the support and subjects to finish in a timely manner.

Thanks for the convo, serenade. Just be open to our statements from our point-of-view because we systemically view other aspects of the human experience, as you are being trained in similarly, closely-related aspects.

I'd like to end on the note that I DO NOT think psychologists should have prescription privileges. We do not study the physiological systems of the human body the way physicians do, and if a psychologist does not work closely with a physician, then psychiatric meds could have negative interaction effects with other medications that may seem unrelated (i.e., as an example, who would've thought that an oral anti-fungal medication prescribed for toes could react negatively with hypertension meds prescribed for the heart?!). Likewise, if you're trained in clinical psych (and not medicine, aside from some postdoctoral psychopharamocology), then how would know to look for systemic changes in a person's physiology that may impact the overall health of the patient?! Someone please enlighten me if I am wrong, but I still feel that psychiatrist should prescribe, not psychologists. A lot goes into all of our training and education, and one should be cautioned when attempting to be a 'one-stop shop.'

It seems like they're actually claiming that you're not even making money doing a PhD over a MS if you only want to do therapy and that research and etc is necessary for making ends meet.

Right, I enjoyed our convo, it acknowledged both professions as bringing something to the table as opposed to one being this evil pharma based illuminate offshoot.

I think psychologists can and should be allowed to prescribe if you're living in a truly deficient state lacking PCP or mental health doctors. But again, would you be comfortable prescribing heavier meds like risperidone or benzos to patients without running health panels or having a medical history? I mean some kids come in with psychiatric symptoms but actually have Lyme's disease for example or fibromyalgia or etc. Not to mention the populations psychiatrists deal with also include what I'd imagine are non-therapy responsive patients like dementia patients with aggression issues ( Actually on the topic, do you guys get training to deal with dementia patients or other 'organic disorders'?).

 

[Drrrrrr. Celty]

If you look at the research being done currently, the concentration isn't on genetics or environment, it is both. We've come to a point where we realize it isn't a question if something is genetic or environmental, we know its both. The environment can dictate how a gene expresses itself and change how it expresses itself. This means that their is a role for both understanding the biology and understanding the environment, and one isn't more important than the other. This means that we need smart people in both areas.

Inevitably I think psychology is going to progressive grow more and more biology based as behavioral and cognitive neuro begin to provide more clear insight into some more difficult to measure behaviors. I mean even on the undergrad level there is a push towards psych students to be more competent in science and math. Then again, I personally think that intro science should be a requirement equal to liberal arts for all majors in college, if anything it'll have people stop facebook liking posts like "JHU publishes new report on cancer".

 

[CheetahGirl]

I don't think pediatricians should prescribe psychotropics to children - only child psychiatrists should AFTER a thorough and comprehensive psychological evaluation by a trained clinical psychologist. So i'm coming from a very conservative medication use/management place.

 

[psych84]

I hope serenade realizes that even if he becomes a Psychiatrist, he won't be considered a real doctor by most people. Because this is what it seems to be about.

 

[CheetahGirl]

Are you telling me our father, Freud, was not a real doctor?! I beg your pardon.

Medicine has the greatest hierarchy w/ anesthesiology & neurosurgery at the top, and by the grace of goodness, psychiatry at the bottom b/c IMO people are often afraid to face their issues (but must when they interfere w/ daily functioning) or there are cultural stigma that precludes reaching out for mental health issues (shhhh! keep it in the family) so everyone thinks it's a bunch of 'quackery' because psychiatrist are not as popular as other types of docs or people are wary of the need for them. But you can always be "King of the dips***s," (16 candles reference if any of you know of Molly Ringwald.) or the most highly respected low-guy on the totem pole.

 

[AcronymAllergy]

It seems like they're actually claiming that you're not even making money doing a PhD over a MS if you only want to do therapy and that research and etc is necessary for making ends meet.

Right, I enjoyed our convo, it acknowledged both professions as bringing something to the table as opposed to one being this evil pharma based illuminate offshoot.

I think psychologists can and should be allowed to prescribe if you're living in a truly deficient state lacking PCP or mental health doctors. But again, would you be comfortable prescribing heavier meds like risperidone or benzos to patients without running health panels or having a medical history? I mean some kids come in with psychiatric symptoms but actually have Lyme's disease for example or fibromyalgia or etc. Not to mention the populations psychiatrists deal with also include what I'd imagine are non-therapy responsive patients like dementia patients with aggression issues ( Actually on the topic, do you guys get training to deal with dementia patients or other 'organic disorders'?).

To speak to this point--yes. It's going to vary based on specialty, but psychologists do have training in biology/biological psychology, and are aware of the ideas that "organic" conditions (e.g., hypo/hyperthyroidism, the various dementias, delirium, etc.) can masquerade as psychiatric conditions. When it comes to dementia, neuropsychologists in particular tend to have quite a bit of training in that area, and are aware of the opposite situation as well (i.e., in which various other conditions, including psychological distress, can masquerade as various types of dementia).

However, after a certain point, you're going to treat many of the behaviorally-oriented manifestations of various conditions (particularly the currently non-reversible variety)--TBI, dementia, SMI--in very similar ways from a psychological standpoint.

As for Freud, I believe he was actually a neurologist who ended up delving into that whole psychoanalysis thing, not a psychiatrist.

 

[CheetahGirl]

AA, you are correct. Freud was not a psychiatrist (was there such a thing back then?) but studied neurology whilst developing psychoanalysis with bunch of other folks who never get credit. I was perpetuating the stereotype.

 

[Drrrrrr. Celty]

AA, you are correct. Freud was not a psychiatrist (was there such a thing back then?) but studied neurology whilst developing psychoanalysis with bunch of other folks who never get credit. I was perpetuating the stereotype.

Right, he was a neurologist and biologist. You should see some of his drawings of neurons and tissues. But yah, I like Freud and I like a lot of psychoanalytic theory. I think his ideas on many things were quite brilliant as he truly tried in many cases to piece together evolutionary requirements as foundations that are repeated in development, i.e kids eat because it is pleasureful and etc.

On the topic a lot of psychiatrists tend to be psychodynamicists probably because of the more seemingly biological aspects of things.

 

[Drrrrrr. Celty]

I hope serenade realizes that even if he becomes a Psychiatrist, he won't be considered a real doctor by most people. Because this is what it seems to be about.

Personally i've never really cared for what other people regard me lol. And despite being interested in psych I could probably easily go towards IM-> Onco since cancer is another really strong interest of mine.

 

[AcronymAllergy]

Right, he was a neurologist and biologist. You should see some of his drawings of neurons and tissues. But yah, I like Freud and I like a lot of psychoanalytic theory. I think his ideas on many things were quite brilliant as he truly tried in many cases to piece together evolutionary requirements as foundations that are repeated in development, i.e kids eat because it is pleasureful and etc.

On the topic a lot of psychiatrists tend to be psychodynamicists probably because of the more seemingly biological aspects of things.

I'd actually say it's more a matter of psychodynamic theory and practice being a longstanding bastion of psychiatry, and that it's simply one of the methods that's more frequently perpetuated via psychiatric training rather than having any inherently stronger ties to biology. Psychiatrists developed it after all, much in the same way that psychologists developed crucial aspects of CBT and are its primary promoters. Beck, of course, was a psychiatrist, though.

The specific example you gave actually sounds more like recapitulation theory than anything else (or at least very similar to it in its wording), although could also easily be explained in terms of learning theory/behavioral principles (e.g., kids eat because eating is positively and negatively reinforcing in a variety of ways).

 

[CheetahGirl]

serende, you may want to consider medical training and a post-doctorate in psychoanalytic training from an institute preferably in NYC (where I reside - Ha!). You seem to have what one desires in a psychiatrist who practices therapy - you seem like one of those who may value the totality of it all and can carry both roles simultaneously (as I gather the MDs who are analysts can do).

 

[Drrrrrr. Celty]

Haha, I'll give it some thought when I get there

 

[DD214_DOC]

Where does this idea that psychiatrists don't learn therapy come from? I've been having didactics, seminars, long-term therapy cases, and supervision for the past 3 years. It's an ACGME requirement that every psychiatry residency have a minimum amount of didactic and clinical training in specific therapeutic modalities.

So I will ask you guys this question: Why does therapy work?

 

[erg923]

Because many of them suck at it and readily admit to such. Thus, one naturally doubts that they were trained to do it..or at least to do it properly.

Why does therapy work? Well, it doesn't much of the time. When it does, its generally cause the patient puts in the work. If you are asking from a standpoint of variance, many many meta analysis over the years have attempted to break it down. I would maintain that it's a combo of therapist and patient factors intermingled with "relationship/rapport", however you want to operationalize it.

 

[WisNeuro]

Depends on the therapy. They work in different ways.

 

[DD214_DOC]

Because many of them suck at it and readily admit to such. Thus, one naturally doubts that they were trained to do it..or at least to do it properly.

Why does therapy work? Well, it doesn't much of the time. When it does, its generally cause the patient puts in the work. If you are asking from a standpoint of variance, many many meta analysis over the years have attempted to break it down. I would maintain that it's a combo of therapist and patient factors intermingled with "relationship/rapport", however you want to operationalize it.

I think this highlights the point. Most of the time, it doesn't work. You can make profound and intricate interpretations worthy of accolades all day long, but it really doesn't matter. You never really know if the way you conceptualize things is true or not. What matters is the relationship between therapist and patient and the therapist's willingness to bring to the forefront a patient's maladaptive pattern of behaviors in a supportive, non-judgmental way.

I have had the most successes with this approach: "You know, we have been meeting for awhile now and I have noticed you do XXXX whenever you are in this type of situation/relationship/whatever. You have said that you want things to change. Have you considered trying something different?" I'm amazed every time this works because it's so simple. Put the responsibility back where it belongs -- on the patient.

 

[erg923]

I think this highlights the point. Most of the time, it doesn't work. You can make profound and intricate interpretations worthy of accolades all day long, but it really doesn't matter. You never really know if the way you conceptualize things is true or not. What matters is the relationship between therapist and patient and the therapist's willingness to bring to the forefront a patient's maladaptive pattern of behaviors in a supportive, non-judgmental way.

I have had the most successes with this approach: "You know, we have been meeting for awhile now and I have noticed you do XXXX whenever you are in this type of situation/relationship/whatever. You have said that you want things to change. Have you considered trying something different?" I'm amazed every time this works because it's so simple. Put the responsibility back where it belongs -- on the patient.

"Profound interpretations?" Are you serious with this?

Look dude, I work in primary care in the VA. Believe it or not we used evidence-based therapies using, gasp, the science of psychology. This isn't 19th century Austria and the G man don;t pay for fancy fainting couches.

I get the feeling that you think your approach is novel or something. Sounds like classic cognitive-behavioral theory/orientation to me. Throw in some rubber-bands, behavioral activation, and some pleasure and mastery activity scheduling and you'll have yourself a party.

I think we agree on the role of the patient, hence why I said that most of the time it doesn;t work because they don't put in the work. Anytime you are working harder than your patient at this, something is wrong?

 

[DD214_DOC]

So you're saying that you do something similar to CBT and it works? Imagine that.

Yes, it works because of the relationship. But I don't sit down and go through a manualized CBT protocol.

 

[WisNeuro]

There is plenty of research to show incremental effects of CBT methods above and beyond supportive therapy. Feel free to do a lit review, I won't do it for you.

 

[erg923]

But I don't sit down and go through a manualized CBT protocol.

Why

 

[erg923]

if you are claiming you dont need to do any formal CBT beyond thought challenging, apparently, then you are selling the therapy and your patients short. And, where's the B in all that? You dont think that's important?

 

[CheetahGirl]

Wait a minute, folks...before we start bashing psychodynamic therapies...

The therapeutic alliance can be one of the strongest predictors of change (see Norcoss, summarized here: http://www.nrepp.samhsa.gov/Norcross.aspx)

But to the point of psychiatrists being trained in therapeutic interventions, it is NOT your primary focus...but it IS mine and others with similar degrees. So I say don't consider a psychiatrist a "one-stop shop" if the little bit of CBT that you're trained in (minimal standards) and the interpersonal interventions (i.e. stemming from strong alliances & good rapport) don't work, prescribe away (or don't) and refer out to the professionals.

 

[CheetahGirl]

I don't really think that pointing out that psychodynamic and similar therapies have only modest research support for only a few conditions (e.g., Depression, BPD, Panic Disorder), is contraindicated for some (e.g., OCD), and is far from a front-line treatment based on the available evidence is "bashing".

Ok. I'm not going into the psychodynamic vs. CBT debate here... However, psyscientist, I will let you know that psychodynamic case conceptualization is not for only a "few conditions," it can be for most conditions. Although, I agree we must recognize what the body of research on psychodynamic therapies has afford us thus far. Perhaps you're thinking those trained in these approaches use psychodynamics alone...they mostly do not (most never go on to post-doctoral psychoanalytic training, which is an extra five+ years...no thanks, right now). We use it to assist in case conceptualization and perhaps how/when to use appropriate interventions for each particular case... and most contemporary psychodynamic/cognitive/behaviorally-balanced programs train individuals to just focus on the cognitive/behavioral techniques that are supported by the literature and keep your psychodynamic training in your back pocket for when psychiatry sends you a referral (being facetious here).

My post was mainly to point out the roles of the two professions (and limitations). Hell, we're all still trying to support our interventions with more research. It is also what we do.

 

[psych84]

I find that staring at the patient is really impactful.