Is psychotherapy dead in psychiatry?

[LEdaddy]

Sorry for the dramatic title, but I'm a medical student considering psychiatry as a specialty and I was hoping I might get some enlightening answers here. Please excuse any of the naivete I reveal in this post...

I was curious what percentage of psychiatrists still spend most of their days in 50 minute psychotherapy sessions. I believe there is a definite place for antidepressants, etc., but I am interested in a career where I can develop long term therapeutic relationships with patients built around talk therapy often in tandem with the drugs.

My questions:
Is full-time therapy mainly performed by MSWs and PhDs these days?
Is it financially possible for a psychiatrist to build a practice around talk therapy or do you have to refuse insurance in order to make it work?
What programs still emphasize psychotherapy as a core part of their training?
Is talk therapy more a part of the culture in certain parts of the country than others?

I recently began the Carlat book and it made be have doubts about whether this field is one I should pursue.

I appreciate insights any of you might have.

Thanks.

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[hippiedoc13]

The short answer: No, psychotherapy is not dead.

This topic has been discussed extensively on this forum:
http://forums.studentdoctor.net/showthread.php?t=702272&highlight=psychotherapy

http://forums.studentdoctor.net/showthread.php?t=681189&highlight=psychotherapy

http://forums.studentdoctor.net/showthread.php?t=688646&highlight=psychotherapy

http://forums.studentdoctor.net/showthread.php?t=634059&highlight=psychotherapy

http://forums.studentdoctor.net/showthread.php?t=169122&highlight=psychotherapy

As you can see, there is still plenty of interest in psychotherapy.

I personally see a therapist who is a psychiatrist in a small group practice. From what I can tell, the practice seems to be doing quite well. Many of my residency colleagues also see psychiatrists for psychotherapy. Finally, through my involvement in my local professional organization, I have gotten to know many psychiatrists in the community, and plenty of them do psychotherapy in their practices.

 

[SmallBird]

In the UK, psychiatrists in National Health can spend up to 90% of their time on therapy, and only 10% on so-called "medical reviews", which involve medication.

 

[cyneuron]

In the UK, psychiatrists in National Health can spend up to 90% of their time on therapy, and only 10% on so-called "medical reviews", which involve medication.

any article or evidence in support of this statement with figures ?

 

[SmallBird]

Just got back from working there for a month, could determine this from the way the service was structured. They had specified slots for "therapy" and others for "medical review". One of the psychiatrists I worked with had only one medical review in the time I was there, and reported this to be the norm for her. No doubt there is much variation in this respect.

 

[EarlyCareerAcademicPsych]

No

 

[dl2dp2]

Your questions are worded in a very simplistic way that's hard to answer. For example, w.r.t. the financial question: yes, it is dead in the sense that it's next to impossible to provide psychotherapy with insurance reimbursement in the indigent population. however, no it is not at all dead--in fact demand is probably going up--for a small group of psychiatrist focusing on psychodynamic psychiatry (and other therapy modalities) in wealthy areas (similar to how ivy league college tuition has gone way up...)

 

[NickNaylor]

To answer your questions...

1) Yes, that's generally how things are handled for patients that have commercial insurance as, for the reasons mentioned above, it is not financially viable for most psychiatrists to have psychotherapy-only patients with third-party (as opposed to cash or private pay) payers.

2) Yes, it is possible with the appropriate skill set and in the appropriate geographic setting, but it will almost certainly require a cash-based practice to remain financially viable.

3) Psychotherapy is an ACGME requirement, so you will get some degree of minimal psychotherapy training during residency. If you're interested in more substantial psychotherapy training, I would suggest trying to identify programs that have a strong relationship with their local psychoanalytic institute (as they are likely to be more therapy-friendly) and talking with current residents about their training experiences. Unfortunately, there's no easy way to suss this out beyond word-of-mouth.

4) Yes - psychotherapy generally seems to be more commonplace in the sense of being practiced by psychiatrists in the northeast and west coast than in other areas, but I imagine you would find psychiatrists practicing psychotherapy just about anywhere.

 

[justfolks]

Just a patient, but to echo the others above, it is not dead in NYC for those in private practice who don't take insurance. I see my psychiatrist for therapy only, cash only. I don't know how many of his other patients are the same re therapy-only, but I know he doesn't take any insurance. I also know that if either of us needs to reschedule without much notice he tends to have very limited options (like one or at most two alternative times on different days), which suggests that he has no problem filling up his schedule with whatever it is he wants to do.