any psychiatry folks feel they are missing out?

[gaki]

any psychiatry folks feel they are missing out on not having gone the psychology route? maybe are open to going for psychology studies one day? or taking more psychology or theory based classes?

and vice versa for psychology people who might be lurking around here..?

i am having a hard time deciding if i should go into psychology or psychiatry.

thanks in advance!

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[gaki]

oh c'mon now.. there must be at least others like me, who were waivering between psychology and psychiatry. (Rather than say .. dermatology vs psychiatry in med school)

Of these, there are no people who decided to go the psychiatry route who are at least a little concerned with limited opportunities to study theory? to get more comprehensive psychoanalytic training?

I had the chance to chat with an already established psychiatrist who went through a psychiatry program that was very biologically based. He mentioned that does not feel he has a good grasp of theory, and can recognize that psychologists in general are better trained in psychotherapy.

Has anyone wondered about these things and found some answers through their experiences?

 

[Big Lebowski]

You asked a good question that I think deserves a response, though I have to say I was never really in your shoes. I'm currently a second year resident and happened to stumble into psychiatry as I did not know what I wanted to do when I started med school. Overall, I love medicine and would consider myself more biological than psychoanalytical. But I must admit, I've become very interested in psychanalytical theory and found myself more and more interested in psychotherapy and truly considering having myself analyzed and then pursuing analysis. However, I do not feel that I'm missing out. Though I believe that psychoanalytic theory definately has its place in psychiatry, I think the future is going to continue to find organic associations with psychological pathology and there is going to be more and more in common with neurology. Because of this, I feel that pursuing the medicine route has prepared me well...at least for what I'm interested in....

 

[gaki]

Hello Big Lebowski!

Thank you very much for posting your reply.
I have actually just started looking for practicing psychiatrists to email, instant message, and call on the phone to ask questions about real-world complications when trying to walk that line between psychiatry and psychology. One psychiatrist I talked to who does more work with non-medicated clients (i don't know what the actual ratio is) said that when he was in his second year of psychiatry residency they did have to learn about psychoanalytic theory, get psychological supervision, and be anaylized. All the residents in his program had to choose someone to be their therapist, essentially. He also learned the differences between types of psychotherapy, including psychoanalytic, supportive, interpersonal, family therapy, etc. Maybe you will get into this later if you havent already?

Also, do you have interest in things like interpersonal relationships, crisis, meuroses, and medication/treatment resistant people?

Can you post where you are getting your residency done?

Again thanks for your post.. even if you are comfortable with your choice it is very useful to see the rationale behind it

 

[mdblue]

1. No, I don't feel that I am missing out any psychology training by going thru the MD route .
2.You can't possibly get trained adequately in all the schools of therapy that are out there. But you should know the basics and the indications to use them. Most of the therapists I have worked w/ are eclectic and obviously the more experienced you are, the artificial differences between these schools of thought get blurred.
3. Being a MD gives you the better decision-making power on your future -you can decide whether to do 10/20 minute med-cks or having your own therapy pts. However the problem w/ psychiatry is inherent in it's team approach, that you'll be working w/ people who will think 'medical model' is BS and prescribing meds is the easiest task in the world. You have to find your own level of comfort.
4. Training in social psychology and/or developmental issues are stressed lot more in grad programs than in a MD curricula-however you will have time to work on these stuffs during your residency.
5. i would stress that neither one is inferior to other-so relax and figure out what's best for you.
Hope this helps.

Hello Big Lebowski!

Thank you very much for posting your reply.
I have actually just started looking for practicing psychiatrists to email, instant message, and call on the phone to ask questions about real-world complications when trying to walk that line between psychiatry and psychology. One psychiatrist I talked to who does more work with non-medicated clients (i don't know what the actual ratio is) said that when he was in his second year of psychiatry residency they did have to learn about psychoanalytic theory, get psychological supervision, and be anaylized. All the residents in his program had to choose someone to be their therapist, essentially. He also learned the differences between types of psychotherapy, including psychoanalytic, supportive, interpersonal, family therapy, etc. Maybe you will get into this later if you havent already?

Also, do you have interest in things like interpersonal relationships, crisis, meuroses, and medication/treatment resistant people?

Can you post where you are getting your residency done?

Again thanks for your post.. even if you are comfortable with your choice it is very useful to see the rationale behind it

 

[gaki]

1. No, I don't feel that I am missing out any psychology training by going thru the MD route .

**That is good.. would you say you were primarily interested in psychology or medicine before getting into psychiatry?

2.You can't possibly get trained adequately in all the schools of therapy that are out there. But you should know the basics and the indications to use them. Most of the therapists I have worked w/ are eclectic and obviously the more experienced you are, the artificial differences between these schools of thought get blurred.

**That is very interesting to hear.. do you think most psychologists would probably agree with that in terms of clinical practice? that even they can't be trained adequately in all the schools of therapy, and that schools of therapy get blurred anyway?

3. Being a MD gives you the better decision-making power on your future -you can decide whether to do 10/20 minute med-cks or having your own therapy pts. However the problem w/ psychiatry is inherent in it's team approach, that you'll be working w/ people who will think 'medical model' is BS and prescribing meds is the easiest task in the world. You have to find your own level of comfort.

** I have come across some psychiatrists who are in private practice, doing primarily psychotherapy, who are not working as part of a team. One person I talked to said his reason for this is because he is in a rural area where he was experiencing difficulty in setting up a group practice and there was not one already established. According to him, psychologists in the area were treating him just as you described.. They were just thinking of him as a pill pusher and were not putting up the effort to keep him closely and regularly informed of his patiets status on meds. So, he has taken on more of a role of psychotherapist. He is aware of the problems in this situation, having worked in group practice with other psychologists in an urban area, but found that psychologists in his new place didn't treat him like as much of a collegue.

4. Training in social psychology and/or developmental issues are stressed lot more in grad programs than in a MD curricula-however you will have time to work on these stuffs during your residency.

Ooo.. i hope its enough.. for me anyway.

5. i would stress that neither one is inferior to other-so relax and figure out what's best for you.
Hope this helps.

I don't think any one side is inferior.. I know both fields have overlap, but I am trying to find which one is best for me (as you say).. so thats why I'm asking all these silly little questions

and thanks for your replies

 

[mdblue]

"would you say you were primarily interested in psychology or medicine before getting into psychiatry"
I come from a strong biological background-I don't know what to call it-probably psychoneurobiology, for lack of a better term.
"That is very interesting to hear.. do you think most psychologists would probably agree with that in terms of clinical practice? that even they can't be trained adequately in all the schools of therapy, and that schools of therapy get blurred anyway"
I guess so, the more you know the more humble you get, e.g. look at the posts in this forum and you'll realize people who are supporting the so-called med-psychologist scripting(excl Dr. Svas!), they are not even in med-school. Seriously, the more you get trained you'll understand the limitations of your skills and you'll tend to acquire newer ones to help your pts- and you'll develop and be comfortable w/ your own style.
Good luck.

 

[purpledoc]

oh c'mon now.. there must be at least others like me, who were waivering between psychology and psychiatry. (Rather than say .. dermatology vs psychiatry in med school)

Of these, there are no people who decided to go the psychiatry route who are at least a little concerned with limited opportunities to study theory? to get more comprehensive psychoanalytic training?

I had the chance to chat with an already established psychiatrist who went through a psychiatry program that was very biologically based. He mentioned that does not feel he has a good grasp of theory, and can recognize that psychologists in general are better trained in psychotherapy.

Has anyone wondered about these things and found some answers through their experiences?

Comprehensive psychoanalytic training -- to become an analyst -- is something MDs do either after residency, or can start while still a 3rd or 4th year resident. PhDs can also train to be analysts, starting in about the same time frame with regard to their completion of Psychology training. Psychoanalytic training is done at an analytic institute, and involves taking classes, undergoing your own analysis, and being supervised seeing analytic patients. It is approximately a 5-yr process, varying depending on the institute and your luck at keeping analytic patients long enough. So, becoming a psychoanalyst does not require you to choose between an MD and a PhD. (MDs, or PhDs, can also do 2 yr training programs in psychoanalytic theory in many places, instead of full analytic training.)

In general, I'd say this. There is less psychotherapy training "built in" to most residency programs than there is in most clinical PhD programs. However, you can choose to go to the residency programs that emphasize it more, or even that emphasize the particular style of therapy you like more. For example, New York City is highly populated with analysts, so almost all the NYC programs give you great training in psychodynamic theory. When you are looking at residencies, just ask the residents what the emphasis in the program is on -- psychotherapy vs. psychobiology -- and how much supervision they get in doing psychotherapy, which is the best way to learn it.

If you are dissatisfied with what you learn in residency, the two best solutions are reading up on theory and finding a expert mentor to discuss it with, or else getting more training during or after residency. I did a psychoanalytic fellowship for 1 year during residency that involved take-home reading, monthly meetings, and seeing case discussions. You can take classes at institutes or clinics for CBT, DBT, and IPT, among other styles, either during or after residency. You can also attend conferences and attend courses there.

In other words, yes, with an MD degree you can learn to be a very good psychotherapist as well as a psychopharmacologist. Just choose your program wisely, and take the initiative to supplement your knowledge in any areas you feel are lacking.

As for which degree to choose, MD or PhD, that's a very personal decision. I'd say the main criteria should be whether or not you like medicine, because if you don't, you'll be miserable for four years of medical school and you should become a PhD. On the other hand, if you really, really love medicine, you'll be unhappy in a PhD program and should become an MD. If you're in the middle regarding medicine -- could take it or leave it -- then think about the practical situations (debt from school vs. salary after school; lifestyle and length of training; etc) and then just talk with lots of psychologists and psychiatrists and go with your gut instinct.

Peace,
Purpledoc

 

[gaki]

Thanks much mdblue and purpledoc, your insights and info about these things are great, and I am definately using it all to outline a tentative training route for the next 10 years or so.

purpledoc, you mentioned: "I did a psychoanalytic fellowship for 1 year during residency that involved take-home reading, monthly meetings, and seeing case discussions. You can take classes at institutes or clinics for CBT, DBT, and IPT, among other styles, either during or after residency. You can also attend conferences and attend courses there."

was your fellowship connected to the place you were doing your residency, or was it an independant analytic institute? How important (what are the ethics involved) with certification in any one kind of therapy?

mdblue, thanks for your opinion on this (and other inane question threads of mine ) .. I had a feeling about the "the more experience you get the more the schools of thought blur" thing, but I guess I wanted some kind of reassurance about it. Because of my personal biases (and maybe insecurities) I have been thinking I should have solid footing on at least one type of popular or reputable type of psychotherapy. I am leaning heavily towards looking for psychiatric residencies that emphasize cbt and cbt related therapies to start, but am keeping an open mind to expanding or evolving later.

of course all of this is going to be important years from now as I am still just taking my undergraduate classes but its nice to have a clearer direction, so thanks again folks for helping me out