How Do I Know If I'm Cut Out For It

[SabaMD]

I'm an MS with an inclination for psychiatry, I already finished my clinical rotation which was 2 months in a general psychiatry practice where most of what psychiatrists did was prescribe meds and refer to psychologists if patients needed CBT (I'm pretty sure it's the only type of psychotherapy done at our institution), I still found it really interesting. But I wonder whether I have the aptitude to actually be a psychotherapist and sit through DBT or CBT sessions and be able to master these skills later on, the idea of them seems boring but I can't tell for sure.

Is this a valid concern, and how can I make sure?

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[starri]

Doing only a private practice with the focus of psychotherapy, whether CBT or DBT, psychodynamic or otherwise, is really one one option in the field. There are a lot of others. I'm a bit surprised that your only exposure was OP.

 

[doggums]

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[Mad Jack]

Doing only a private practice with the focus of psychotherapy, whether CBT or DBT, psychodynamic or otherwise, is really one one option in the field. There are a lot of others. I'm a bit surprised that your only exposure was OP.

I'm guessing he's a Caribbean student given the user name. They have difficulty securing inpatient psychiatry exposure.

 

[wolfvgang22]

I attended Saba and did three psych rotations while in med school. PM me if you want to chat. One private inpatient psych hospital in the south that had a Suboxone program, one VA midwest inpatient rotation, and a child psych rotation that I took the initiative to set up, coordinating with my school and the rotation site in New England. All of these lead to residency interviews in the programs these rotations occurred and at nearby programs. Networking and performing well were necessary. Of course, this was in 2008-2009. Basically the only way to not get robust experience was to be geographically inflexible, which some students are.

Back to the original question. Usually an outpatient attending will be happy to let you sit with a psychologist or social worker doing therapy if you ask, you just need to pursue it, and tell him or her what you told us. Teachers love enthusiasm. We've all been there and know watching somebody write scripts all day can get boring.

 

[SabaMD]

Actually, I'm an international student (middle east) and my username is a reference to my actual name.

We were exposed to inpatients as well, but since the facility is only a short-stay (8 weeks max) ward I feel like I might not have gotten the exposure necessary to be sure I'll be comfortable with more severe patients that I might face in a psych residency.

The reason I am concerned is that I don't know where I'll end up practicing so I do wonder whether later on I'll be surprised with having to deal with things I didn't know about or sign up for.

 

[908377]

I would recommend you do a few more elective rotations... my suggestions are an acute inpatient unit, addiction psychiatry, and a Psych ER (CPEP/Crisis depending on the state).

 

[WingedOx]

Doing only a private practice with the focus of psychotherapy, whether CBT or DBT, psychodynamic or otherwise, is really one one option in the field. There are a lot of others. I'm a bit surprised that your only exposure was OP.

If the OP's username is a reference to her institution of higher education, it would explain a lot.

edit: I see MadJack beat me to it.

 

[Drrrrrr. Celty]

Honestly most of my psych exposure has been acutely psychotic patients, dementia, and occasionally some higher functioning individuals. It's been almost entirely drugs, wait, release until they end up back again. It kind of gave me a pretty bleak picture of psych too.

 

[starri]

We were exposed to inpatients as well, but since the facility is only a short-stay (8 weeks max) ward I feel like I might not have gotten the exposure necessary to be sure I'll be comfortable with more severe patients that I might face in a psych residency.

You can still see some pretty severe patients even if the setting is one that caps stays at 8 weeks. In my own experience, the patients you see in those kinds of facilities who are there toward the maximum stay are patients severe enough for a long-term facility who are just waiting for placement. In my own hospital, the ones that stay much longer that three or so weeks are there due to social services issues. Sometimes they're okay to go back in the community, but just as often, they need a long-term inpatient solution. So the pathologies aren't any different, just the amount of time they'd be under your care.

I'd also recommend seeing if you can do a rotation that includes some CAP or ECT.

 

[SabaMD]

If the OP's username is a reference to her institution of higher education, it would explain a lot.

edit: I see MadJack beat me to it.

You should've read my reply before jumping to conclusions.

 

[SabaMD]

Honestly most of my psych exposure has been acutely psychotic patients, dementia, and occasionally some higher functioning individuals. It's been almost entirely drugs, wait, release until they end up back again. It kind of gave me a pretty bleak picture of psych too.

Yep, you summed up my inpatient psych experience. I'm in a whole other part of the world though, so I just assumed it's different in North America.
I actually saw a good variety of disorders in both in and out patients, it was a mix of bipolar, schizophrenia, mood, anxiety and personality disorders with some child psych as well. The clinics were mostly follow-ups and med renewal, the ward rounds were about making sure the patient is stable and fit to go back to their daily life without any safety issues. The hospital I practiced at was a run of the mill secondary hospital so I didn't expect anything more than what I got.
I did wonder about the psychotherapy aspect because as I said, my exposure was in a general hospital, not a specialized psych facility so I'm not sure what they've got going on there.

 

[starri]

Honestly most of my psych exposure has been acutely psychotic patients, dementia, and occasionally some higher functioning individuals. It's been almost entirely drugs, wait, release until they end up back again. It kind of gave me a pretty bleak picture of psych too.

Personally, that's what makes the occasional win that much more rewarding.

 

[wolfvgang22]

If the OP's username is a reference to her institution of higher education, it would explain a lot.

edit: I see MadJack beat me to it.

Look, you and Mad Jack have made some faulty assumptions about Saba University rotations. Maybe you've met or heard from some less than stellar Saba students in person or online, but every school has some of those. The rotations I did were pretty good, rigorous, and a good variety of locations and experience was available, as I already said. If you don't believe an alum in practice, I guess nothing will convince you. I'll admit it was a harder road to tread than my friends who went to US DO or allopathic schools.

My apologies to SabaMD for making an erroneous assumption about your school.

 

[SabaMD]

Actually, I wasn't bothered by the assumption as much as by the condescending undertones in what they said. I can only imagine how annoying it would be if I actually went to Saba University and got this on a regular basis.

 

[splik]

I'm a little unclear on why you think you'd need to do psychotherapy as part of your practice when in your clinical rotation it sounds like they didn't even do it and just referred out. I think the minority of psychiatrists actually do CBT or any kind of formal psychotherapy. Most study it to better know its indications and draw from that skill set in patient interviewing, med adherence, de-escalation, etc, but ultimately refer out if necessary. There are so many areas you could go into (inpatient, forensic, C/L, sleep med, etc) that don't involve doing therapy.

Psychotherapy is one of the fundamental skills of the psychiatrist. If you cannot think psychologically, cannot formulate patients from different psychological models, and cannot deploy psychotherapeutic interventions as part of your day to day work, then you're not a psychiatrist. I am a forensic psychiatrist, and in my forensic evaluations I often need to break down highly defended individuals, and thus even though I am not their therapist, in order to be effective at conducting my evaluations, I draw heavily from my psychotherapeutic training to get people to talk with me and use concepts from psychotherapy (without the jargon) to explain criminal behavior to the courts. As a C/L psychiatrist, I create behavioral plans for patients with personality disorders, provide supportive psychotherapy with patients struggling with serious illness, provide motivational enhancement therapy for patients with poor adherence to treatment, and use hypnotherapy in order to treat patients with conversion disorder and medically unexplained symptoms.

It is true that most psychiatrists don't do formal psychotherapy nowadays but formulation and psychotherapeutic techniques are relevant in every facet of psychiatry if you're doing it correctly. For the OP, there are also other approaches than CBT and DBT and there is wide variation in psychotherapy practice.

As for outpatient only experience, well the medical school I am on faculty at has some students to only outpatient psych clerkships (and is one of the top medical schools in the country with a high level of students going into psychiatry). given that people often say "since most of psych is outpatient and wouldn't it be great if med students saw what most of psych really looks like rather than being stuck on a grim inpatient unit" I'm surprised people are deriding the OP's psychiatry experience when actually more longitudinal outpatient experience is the trend in medical education and potentially more relevant clinical experience.

 

[WingedOx]

As for outpatient only experience, well the medical school I am on faculty at has some students to only outpatient psych clerkships (and is one of the top medical schools in the country with a high level of students going into psychiatry). given that people often say "since most of psych is outpatient and wouldn't it be great if med students saw what most of psych really looks like rather than being stuck on a grim inpatient unit" I'm surprised people are deriding the OP's psychiatry experience when actually more longitudinal outpatient experience is the trend in medical education and potentially more relevant clinical experience.

kinda an appeal to authority w the bolded there don'cha think?

These longitudinal patient experiences are a new trendy thing in medical education (Thanks HMS) and seem like a decent enough idea, but not sure we can draw any conclusions yet that they produce better clinicians. And doing outpatient only in a traditional 6 weekish rotation? oh hell no. You're giving the students even LESS of a "longitudinal" experience in that way. At least with a traditional inpatient setting you can have the students take leadership of the patient throughout their hospital course and see it through from beginning to end. A rotation of outpatient only is giving the students only spot checks of the patients' pathology in a usual clinic setting. Intake clinics can be more useful to working with students, but it's far from sufficient to give an M3 the experience and knowledge I want them to gain from their rotation.

 

[splik]

kinda an appeal to authority w the bolded there don'cha think.

It’s to counterpoint theassumptions she was at some off shore medical schools. I didn’t render my own opinion on whether or not this trend to outpatient clerkships is a good thing or not do there was no appeal to authority. As I’ve always said just cuz someone at Harvard (or wherever) doesn’t mean theyre not a f******* idiot.

 

[OldPsychDoc]

Actually, I'm an international student (middle east) and my username is a reference to my actual name.

We were exposed to inpatients as well, but since the facility is only a short-stay (8 weeks max) ward I feel like I might not have gotten the exposure necessary to be sure I'll be comfortable with more severe patients that I might face in a psych residency.

The reason I am concerned is that I don't know where I'll end up practicing so I do wonder whether later on I'll be surprised with having to deal with things I didn't know about or sign up for.

Only replying to point out that we would hardly consider 8 weeks a "short stay" at any typical US inpatient facility, other than the vanishingly few state hospitals. Inpatient rotations at most US residency programs will typically see 5-7 day lengths of stay for mood disorders and 10-21 days for psychotic disorders. As splik said, stays beyond 3 weeks are usually due to placement issues.

 

[Nasrudin]

I find it notable that you referenced CBT and DBT. I think these are exceedingly boring modalities. Although in it's more exploratory and philosophical iterations CBT could become more interesting. And when wrangling hotly dysregulated patients in a group modality a boring, boundary-declaring, didactic, parliamentarian, approach is a necessary relief.

But it could be just that those modalities don't resonate with you. Which is fine.

But if you find talking to people uninteresting. Then. Psychiatry is not for you. We have enough biological reductionism to deal with by factor of trying to compress ourselves within the medical tribe, to then have to deal with complicit camps of biological psychiatrists who think there is a point to dividing Bipolar DO into eleven subcategories to refine our biological sx targeting produced by funneling human phenomenon into language based sx screens.

As if there is nothing ironic about producing diagnostic categories based on language reporting. And then using those categories to process undifferentiated phenomenon.

 

[MacDonaldTriad]

Nasrudin, you have to promise to keep the Kermit thing going. With your word smithing abilities, it adds something when we read your posts in Kermit's voice. It reminds me of George of the Jungle's ape friend reading Darwin.