Psych question

[bth7]

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The level of miscommunication and misinformation on this thread is award-winning.

I'm a psych resident, in training to become a psychiatrist.

Psychiatry, as with ever other branch of medicine, uses a team approach. There are many different types of providers: psychologists, psychiatrists, social workers, therapists, mental health workers, nurses, etc.

Generally, we work together.

For outpatient psychiatry, people often go to a psychologist or therapist first. Part of that initial encounter will no doubt be an assessment. If the problem is serious, or there's a thought that medication would be helpful, of course, the therapist, or psychologist or social worker, would CALL A PSYCHIATRIST.

Getting an appointment with a psychiatrist these days can be very tough, especially in certain regions. The wait list can be months. (Obviously, if the situation is an emergency, there's ways to deal with that.)

Further, many psychiatrists, though certainly not all, have their primary practice in psychopharmacology, not psychodynamic psychotherap, e.g. traditional psychoanalysis, cognitive behavioral therapy, etc.

Patients go to psychologists / therapists because they are highly-trained, licensed professionals who understand mental health issues AND because its often difficult/expensive to get an appointment directly with a psychiatrist.

If the therapist assesses that the patient needs a psychiatrist, they will refer, often to a psychiatrist with whom they have an established relationship, i.e. part of the same practice group.

Many psychiatrists still do practice different forms of "talk therapy." They are trained in this as part of their residency. But many will seek out additional training post-residency in some specialized from of therapy, should they choose to make this central to their practice. The most usual form of this is getting certified in psychoanalytic therapy after (or concurrently with) one's residency, at an institute of psychoanalysis.

See: http://www.psychoanalysis.org/tande.html

bth

 

[chman]

The level of miscommunication and misinformation on this thread is award-winning.

I'm a psych resident, in training to become a psychiatrist.

Psychiatry, as with ever other branch of medicine, uses a team approach. There are many different types of providers: psychologists, psychiatrists, social workers, therapists, mental health workers, nurses, etc.

Generally, we work together.

For outpatient psychiatry, people often go to a psychologist or therapist first. Part of that initial encounter will no doubt be an assessment. If the problem is serious, or there's a thought that medication would be helpful, of course, the therapist, or psychologist or social worker, would CALL A PSYCHIATRIST.

Getting an appointment with a psychiatrist these days can be very tough, especially in certain regions. The wait list can be months. (Obviously, if the situation is an emergency, there's ways to deal with that.)

Further, many psychiatrists, though certainly not all, have their primary practice in psychopharmacology, not psychodynamic psychotherap, e.g. traditional psychoanalysis, cognitive behavioral therapy, etc.

Patients go to psychologists / therapists because they are highly-trained, licensed professionals who understand mental health issues AND because its often difficult/expensive to get an appointment directly with a psychiatrist.

If the therapist assesses that the patient needs a psychiatrist, they will refer, often to a psychiatrist with whom they have an established relationship, i.e. part of the same practice group.

Many psychiatrists still do practice different forms of "talk therapy." They are trained in this as part of their residency. But many will seek out additional training post-residency in some specialized from of therapy, should they choose to make this central to their practice. The most usual form of this is getting certified in psychoanalytic therapy after (or concurrently with) one's residency, at an institute of psychoanalysis.

See: http://www.psychoanalysis.org/tande.html

bth

Thanks. This thread needed that.

One thing is for sure though, our mental health system needs some serious work. A lot of people who need help are not getting it. In fact, just this morning, four police officers were killed not too far from where I live. My guess is that it is another person with mental health issues. Who knows, it is possible that this could have been avoided if our mental health system was in better condition. Then again, I am only speculating in this case.

 

[apumic]

bth7[/URL]]
Psychiatry, as with ever other branch of medicine, uses a team approach. There are many different types of providers: psychologists, psychiatrists, social workers, therapists, mental health workers, nurses, etc.

Generally, we work together.

For outpatient psychiatry, people often go to a psychologist or therapist first. Part of that initial encounter will no doubt be an assessment. If the problem is serious, or there's a thought that medication would be helpful, of course, the therapist, or psychologist or social worker, would CALL A PSYCHIATRIST.

Getting an appointment with a psychiatrist these days can be very tough, especially in certain regions. The wait list can be months. (Obviously, if the situation is an emergency, there's ways to deal with that.)

Further, many psychiatrists, though certainly not all, have their primary practice in psychopharmacology, not psychodynamic psychotherap, e.g. traditional psychoanalysis, cognitive behavioral therapy, etc.

Patients go to psychologists / therapists because they are highly-trained, licensed professionals who understand mental health issues AND because its often difficult/expensive to get an appointment directly with a psychiatrist.

If the therapist assesses that the patient needs a psychiatrist, they will refer, often to a psychiatrist with whom they have an established relationship, i.e. part of the same practice group.

Many psychiatrists still do practice different forms of "talk therapy." They are trained in this as part of their residency. But many will seek out additional training post-residency in some specialized from of therapy, should they choose to make this central to their practice. The most usual form of this is getting certified in psychoanalytic therapy after (or concurrently with) one's residency, at an institute of psychoanalysis.

Sounds about right to me.
From what I understand as far as psychiatrists and psychological therapies (more than just "talk therapy") is that most don't end up practicing a whole lot of them, although that is obviously very much variable. Where I am, our mental health system is far overloaded and psychiatrists really don't have time for anything but Rx. I don't think that's how it should be, but that is how it is for the most part here, unfortunately. (That is the experience from which I speak, which is probably very different from yours in residency -- at least I would hope so. I've also heard rumors of [some] psych residencies moving in the direction of more alternatives to pure drug therapy; that is, of taking a more integrative approach. Is this true, in your observation?)

Thanks. This thread needed that.

One thing is for sure though, our mental health system needs some serious work. A lot of people who need help are not getting it. In fact, just this morning, four police officers were killed not too far from where I live. My guess is that it is another person with mental health issues. Who knows, it is possible that this could have been avoided if our mental health system was in better condition. Then again, I am only speculating in this case.

This is definitely a problem. Mental health has been a vastly-undertreated problem and needs attention in many areas of the country. Unfortunately, it remains somewhat of a taboo topic and, therefore, is often difficult to "fix" at the societal level.

On the other hand, it would also help if POs/LEOs were actually trained in how to handle mental health cases. From talking with officers here, at least, the training in handling the mentally ill a is a complete joke (sorry). At least here, the police academy considers an 8-hour training on handling the mentally ill to be "impressive." Some of the stuff I've seen LEOs do when attempting to handle some of my own patients makes me wonder how they (the LEOs) haven't gotten their heads blown off yet (things like screaming at and shoving a known potentially violent inpatient who had done nothing to provoke that kind of response). They'll do things with an unstable individual that would cause escalation in a "normal," which means an unstable person is likely to escalate to a state of violence and, if you value your life, the last you want to do with someone who already has a history of violence and/or antisocial bx is to cause unnecessary stress.

 

[bth7]

Thanks. This thread needed that.

One thing is for sure though, our mental health system needs some serious work. A lot of people who need help are not getting it. In fact, just this morning, four police officers were killed not too far from where I live. My guess is that it is another person with mental health issues. Who knows, it is possible that this could have been avoided if our mental health system was in better condition. Then again, I am only speculating in this case.

For those that are interested in learning more about the "bigger picture" of psychiatry training in the United States or the US mental health system, I highly recommend these two books:

Of Two Minds: An Anthroplogist Looks at American Psychiatry by T.M. Luhrmann Permalink: http://amzn.com/0679744932

Crazy: A Father's Search Through America's Mental Health Madness by Pete Earley Permalink: http://amzn.com/0425213897


Both are written by non-psychiatrists, are well-written, and offer fascinating discussions.

bth