Marriage counseling/family therapy

[Elisabeth Kate]

On the interview trail, I noticed that many programs had couples therapy as part of the psychotherapy requirements. I never knew psychiatrists did that. I thought marriage and family therapist was its own thing. So realistically, do psychiatrists do this? I'd be really interested in it as I seriously considered going the psychology route in undergrad to get into marriage and family therapy.

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[notdeadyet]

Mine does a bit of family and couples therapy. It is a small component of the psychotherapy training. It is mostly just a teaser to find folks who are interested in pursuing it more, and then there are options for elective rotations in it in third year and fourth year.


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[Elisabeth Kate]

Are there psychiatrists who do this for a living though? Can you make a psychiatrists's salary doing this?

 

[notdeadyet]

I know a couple that do. I couldn't tell you more than that. Couples therapy was far and away my least favorite part of psychiatry to date.

 

[masterofmonkeys]

There are a few psychiatrists out there who do a ton of family therapy. I know of big MFT programs in several locations, especially in the midwest/southwest.

 

[erg923]

Irving Yalom

 

[whopper]

realistically, do psychiatrists do this?

Yes

Some couples therapies books were written by psychiatrists, but one should only do it if they know what they're doing. I'd estimate the majority of programs don't teach couples/marriage therapy. If so, a psychiatrist from such a program shouldn't pretend to have expertise in it. Some programs do teach couples therapy, and some psychiatrists learn it on their own by reading textbooks on it, attending CMEs, getting training after residency, what have you.

Just because we're doctors we don't know everything.

The doc in this clip was trying to treat stuttering based on a Greek myth where one used marbles to treat it.

Just one doc out of a large group of docs thinking because he has an MD he knows everything.

Some docs have entertained a narcissistic belief that because they have an MD, they can do anything. If you don't have expertise in something you don't. I'm a psychiatrist. I still wouldn't trust myself to do an ECT (though I do plan to get more training in this area and expect to be able to do so), child psychiatry, or a whole range of things.

If you want to do couples therapy and your program doesn't teach it, attend CEUs or CME programs where you can get the expertise.

 

[rkaz]

I know a couple that do. I couldn't tell you more than that. Couples therapy was far and away my least favorite part of psychiatry to date.

It's interesting that you often don't know what you'll like until you try it. Going through interview season, I was actually excited to find programs that might specifically have marital therapy, as it sounds totally interesting to me. Maybe once I actually attempt therapy with couples, I will get a headache from all the back-and-forth bickering... who knows. At this point, I'm still hoping to be able to get additional training in marital and sexual psychotherapy.

 

[whopper]

I will get a headache from all the back-and-forth bickering...

Hey if you're billing for time, let them bicker all they want. Just remind them they're wasting their time and therefore money.

When I did private practice, often times the spouse or S.O. would come and and they'd argue. I'd just say "You got 30 minutes. You could just spent 25 minutes arguing. When your time is up it's up. You knew this coming in here. You know this now. I'm not cutting into my next patient's schedule because you guys want to argue.

 

[nitemagi]

If you don't have expertise in something you don't. I'm a psychiatrist. I still wouldn't trust myself to do an ECT (though I do plan to get more training in this area and expect to be able to do so), child psychiatry, or a whole range of things. If you want to do couples therapy and your program doesn't teach it, attend CEUs or CME programs where you can get the expertise.

This is exactly the way to think about these specialization questions always asked. You can specialize in anything, within your scope of practice, as long as you find a way to get trained in it (somewhere), and/or you innovate in it. And the market has an interest in it (someone will pay you for it). That's it, folks.

 

[Chimed]

My thought is that the importance of learning how to do couple's therapy in residency is more about learning how to deal with marital issues and working with patient's spouse in family meetings rather then learning how to become "a marital therapist." It's like a lot of therapy training and medication management. Even though a psychiatrist might do mostly medication management, you're always "doing therapy" and the skills you learn doing therapy as a resident are always valuable no matter what you end up doing.

 

[OldPsychDoc]

I would rather do opthalmic surgery on myself with a rusty carrot peeler.

 

[Chimed]

I would rather do opthalmic surgery on myself with a rusty carrot peeler.

 

[Therapist4Chnge]

Hey if you're billing for time, let them bicker all they want. Just remind them they're wasting their time and therefore money.

Maybe at $500+/hr someone might try and make that argument (*rimshot*), but to have a couple legitimately argue/verbally spar back and forth for an hour would be miserable. Add in possible custody issues (high rate of malpractice claims) and you have a recipe for disaster.

 

[whopper]

Every single time I've had a couple argue, it was never during couples therapy because I don't do couples therapy. I don't touch custody cases. If they were arguing over something related to custody I'd tell them upfront that as a treating doctor and not being a child psychiatrist, it's out of my area, and they got to take it somewhere else. I'll even give them referrals.

I declare this ASAP so they don't waste their time or money. In an outpatient setting, if they want to argue, I can't Haldol them into submission. I can only tell them they're wasting their time, but if they choose to do so, so be it.

 

[Shikima]

I would rather do opthalmic surgery on myself with a rusty carrot peeler.

This can be arranged along with kissing a wookie.