Psychotherapy in this field? Is it still around?

[drab]

Hello, I have been lurking. This is my first post, and sorry if this is the wrong section.

I am reaching out to anyone in the field of psychiatry. I am a senior in college, and have been studying psychology. I became interested in going into psychiatry about a year ago, and have started taking my pre-med requirements (just started). Now, I am having second thoughts. Go for med school, or get a master's in psych and go straight into talk therapy. My situation sets me up for about a 10 year difference in education (including residency) from where I am now.

I want to do psychotherapy. I began looking into med school because of the many benefits it would offer- I could prescribe meds, have better job security than psychologists, and so on. But what is the field really like now? Is there a realistic ability to do therapy? I know there are some residency programs that focus more on psychotherapy than just psychopharm, but the field seems much more focused on the latter. I have lived exceptionally poor, so the meager earnings of a psychologist (compared to a doc) is more than enough for me. It really comes down to me wanting to enjoy what I do in my career, and I know I want to do therapy. I am generalizing, I understand that if I become a psychiatrist, that it won't be 100% therapy, but can there be any?

I have seen and heard many accounts of medical students that chose a different specialty than what they originally planned on, but I feel that I am "different" because I want to stay in mental health. If I don't go into psychiatry, then I will go for being a psychologist. I just am facing a big fork in the road and any input or opinions to clarify what the current medical side of mental health is like would be a great help. Thanks

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[heyjack70]

Psychotherapeutic interactions happen with each patient I see, to greater and lesser extents. Though I don't spend hour long sessions with patients very often, it does happen occasionally. If you want to do therapy as a psychiatrist you will have no barriers if you pursue the training opportunities in residency and continue to learn after residency. You will most likely earn more money including medication treatment.

 

[Psychczar]

If your primary goal is to do therapy and you already know you want to work in mental health, going to medical school is an awfully long and arduous process to achieve that end. The cost, for one, vs doing a masters or getting a PhD and being funded. You can establish your career sooner. You are also learning a ton of biology, anatomy, physiology, and only a couple months are spent learning neuroscience and psychiatry. That's not to say you cannot do talk therapy in psychiatry, but if salary and being able to prescribe medicine is not of significant importance going the medical school route does not seem worth it to me.

 

[cookymonster]

There is no doubt that as a psychiatrist that you can do as much psychotherapy as you want if you have the right kind of job. The easiest way to do that is in private practice. If you are working for an employer, they are going to want you to bill as much per hour as you can, but if they let you eat what you kill and are fine with doing psychotherapy and billing it, you can make that a large part of your income.

What others said is correct. When you go through med school and residency, the costs, assessments, and tests you have to pass is enormous, and these pretty much have nothing to do with psychology. If what you mainly want to do is psychotherapy, there are much easier ways to get to do this point. Yeah, it will be a nuisance that you will have to refer your patients out to get their meds prescribed... but I can tell you for a fact, most psychiatrists will be ecstatic to take a patient who is already established with a therapist they are willing to continue seeing.

 

[nitemagi]

I do 70% therapy.

 

[F0nzie]

I do 70% therapy.

Kudos for keeping it up.

 

[Doctor Bagel]

If your primary goal is to do therapy and you already know you want to work in mental health, going to medical school is an awfully long and arduous process to achieve that end. The cost, for one, vs doing a masters or getting a PhD and being funded. You can establish your career sooner. You are also learning a ton of biology, anatomy, physiology, and only a couple months are spent learning neuroscience and psychiatry. That's not to say you cannot do talk therapy in psychiatry, but if salary and being able to prescribe medicine is not of significant importance going the medical school route does not seem worth it to me.

I would guess it's easier to get into medical school than to get into a funded clinical psychology Ph.D. program. I'm not sure about funding options for MSWs, but I'm guessing those aren't that frequently found either. One thing to say is that we make a lot more money than anyone else in the mental health field, which says something. I'm also not sure medical school + residency is more arduous than going down the psychology doctorate route. I've complained a lot about training, but I think we're in the best spot in the mental health world with the most flexibility and options. Second best option is psych NP -- they have less therapy training in school but can pursue it afterwards.

 

[Psychobabbling]

Psychology and to be a therapist without supervision requires PhD
LCSW quickest route

Psychiatry training isn't really what it used to be. Also really depends on residency program.
- Some are really just "medicine" programs (i.e., Psychopharm)
- Some do a good job of training you to do therapy well
- Some actually do both (I think Yeoman is out of Cornell? He does a lot of work with Kernberg; I imagine you'd learn a lot of Analysis/Transference Focused Therapy)
(on a side note - just to add, some programs actually teach; others it's more of a self-motivated thing; obviously all of a residency is self-motivation, but having a good role model for (what evidence base we do have) is invaluable)

I try and squeeze in some therapy, even into my med management visits. To me, any cave man can say "depressed, more med; no more depressed, we stay here." Or "oh you psychotic but you take med and doing good, I keep you here; oh you look bad, me go up; oh you look really bad, you go hospital."

I tend to take note of people's temperaments, defenses, what led to the depressive episode/anxiety/manic episode/psychotic episode (the latter two with very few of my patients who can explore that; I have pt who talks about cycling like a version of him has to die off - admires the manic qualities he possesses in the beginning phase, and feeling guilty about that, etc). By no means whatsoever do I feel competent at all in doing this (haha) but it's just something I've always done really, it's just now I kind of know some words to bring it all together.

The other thing is - earning potential is higher in psychiatry. Not that money means anything, but I think part of the equation has to be: "how many kids do I want to have, what kind of neighborhood do we live in, what kind of car, what kind of college do I want to be able to afford for my kids, how many vacations per year, etc" If you're personality disordered, add in several divorces, alimony and child support (kidding!). Doing this can help you create an idea of what you'd like you're monthly income to be (adjusted). This calculates differently for each and every person. I think it's a good place to start though

 

[Monocles]

I try and squeeze in some therapy, even into my med management visits. To me, any cave man can say "depressed, more med; no more depressed, we stay here." Or "oh you psychotic but you take med and doing good, I keep you here; oh you look bad, me go up; oh you look really bad, you go hospital."

That is fantastic.

 

[GreenBirch]

If you KNOW you want to do psychotherapy, be a psychologist. You will also have a job, as a clinical psychologist. Going to medical school is not worth what you described as the benefit of being a psychiatrist. I actually went through a similar roadblock as you when I was a senior in college, debating between med school and psychology, although my interest in psychology at the time was completely non-clinical... so not quite the same thing.

I think that if you want to go to medical school, first and foremost you need an interest in science and medicine. It is the basis of a physician and a psychiatrist, at the end of the day, is a physician. And a psychiatrist who can truly approach a patient as a whole person and not just the mind is a better psychiatrist. For example, you would be thinking about medical causes to depressive symptoms and how to best approach those patients. And given lack of neuropsychiatrists out there, you'll encounter patients with TBI/dementia with psychiatric symptoms, and you should probably understand the medical nuances when treating those patients.

So when you think about clinical psychology vs psychiatry, don't just think of it as psychotherapy vs psychopharm, because it's not that simple. Think about whether medicine is a field that excites you. Medical school is 2 years of basic sciences and pathologies, a year of rotating through internal medicine, surgery, ob/gyn, etc, a year of freedom. Residency will be more medicine before psychiatry. I'm not saying you have to love sitting down with an organic chem textbook, but you should be truly excited about science and medicine, or it's going to be a grueling time ahead.