Apr 7, 2010
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I am a behavioral science student, and right now my interest is in psychiatry. My hope is that there will be aspects of neuroscience, pharmacology, and clinical psychology in my future career. My question is this: how prevalent are psychiatrists who still deal with prescribing medicine, but who also have a very strong psychological aspect present in their therapy( such as personality tests, psychotherapy, psychoanalysis, etc.)? One of the main stereotypes about psychiatrists is that they just hand out medication, and even though I highly doubt this, I am wondering to what extent psychology plays a role in the psychiatric process. Also, what residency programs ( if any) provide this type of approach to psychiatry and patient treatment?
 

st2205

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If you go into private practice you can do whatever you please.
 

Doc Samson

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Psychometric testing is the domain of psychologists. Psychotherapy (including psychoanalysis) is well within the realm of psychiatry. Residency programs that emphasize psychotherapy (and psychodynamic psychotherapy in particular) tend to cluster in the Northeast (Boston, NYC) and the West (LA, San Francisco). Not to say that there aren't exceptions in between (e.g., Northwestern, Michigan).
 

st2205

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...as long as you are practicing within the scope of your training. Deciding to do therapy without extensive prior supervision and training would be unethical and possibly a risk to your license.
Of course.
 
Mar 24, 2010
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I am a behavioral science student, and right now my interest is in psychiatry. My hope is that there will be aspects of neuroscience, pharmacology, and clinical psychology in my future career. My question is this: how prevalent are psychiatrists who still deal with prescribing medicine, but who also have a very strong psychological aspect present in their therapy( such as personality tests, psychotherapy, psychoanalysis, etc.)? One of the main stereotypes about psychiatrists is that they just hand out medication, and even though I highly doubt this, I am wondering to what extent psychology plays a role in the psychiatric process. Also, what residency programs ( if any) provide this type of approach to psychiatry and patient treatment?
Hi alighieri,
As you know, psychiatry is a medical specialty addressing patients with brain disorders which manifest behaviorally. So yes, psychology plays a huge role in our training and daily practice. The patient assessment is largely psychological and thereby I imagine all psychiatric residency training programs provide psychology training.

While psychometric testings is the domain reserved for psychologists PhD/psyDs- psychiatrists generally do receive training in 1-2 years of various psychotherapy modalities. Unfortunately, there is alot of variability in how people practice psychotherapy so people often disagree with one another regarding the quality provided to patients. This occurs in other medical specialties as well. If one has chronic RLQ pain and look hard enough, eventually you'll find a specialist who will take out your appendix. Maybe more so in psychiatry but there are often disagreement with assessment and treatment in the other medical specialties as well.
Psychotherapy, while effective and important for some, remains a highly subjective tool we use to treat patients. Additionally, there are many psychiatrists(myself) who utilize ECT, TMS, and other neuromodulation therapies to treat their patients. Many has therapy patients as well. But insurance policy, patients preference, and supply vs demands often prevent many psychiatrists from carrying more therapy patients.

Medication use has gotten a bad reputation due to various reasons.But I believe it is also very important, can be lifesaving, and should not be minimize. Personal agendas and ignorance are probably the two main driving factors against medication use in psychiatry and to a lesser extent, the other medical specialties. Many of my patients come to me after failed treatment at their primary care doctors, NPs, psychologists, social workers, gastroenterologists, rheumatologists, etc.. Unfortunately and more often than not, these indviduals do need medicine after the evaluation. Sometimes more than one medicines are needed. Many arrive already with polypharmacy due to hypertension(2-3antihypertensives), CAD(multiple antilipids), DM(insulin, sulfu.), arthritis(steroids, methotrexate), etc, prescribe by other doctors or NPs/PAs. There is alot of thoughts in choosing which medicines I should use among all the classes and generations of medications available. Then there are labs, vital signs, ecg, eeg/mri considerations I need to think about. For me, prescribing medicine sounds easy but it is quite a task. The SSRIs are generally the only 'easy' medication to prescribe but the other class of medications require more thoughts. The fault is that we may make it look easy and not all psychiatrists, (or cardiologists, endocrinologists, pediatricians, GIs, surgeons, radiologists, psychologists, etc) always do the right thing. But I believe these cases are the exception rather than the rule. Everyone knows or heard of 1-2 bad doctors and these are the ones that stick out and not the good ones. This is how our psychologic brain works.

Psychoanalysis requires further training following general residency.
 

michaelrack

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...as long as you are practicing within the scope of your training. Deciding to do therapy without extensive prior supervision and training would be unethical and possibly a risk to your license.
doing psychotherapy as a psychiatrist will be no risk to your license, you'll be presumed competent in psychotherapy as residency trained psychiatrist. With all the variabilities in psychotherapy, it's going to be pretty hard for anyone to prove that you suck at it. The things that will get a psychiatrist in trouble, such as not doing a good suicide risk assessment, will get you in trouble wether you are treating someone with meds and/or psychotherapy.

Disclaimer: the only type of psychotherapy I do is occasional, limited cognitive behavioral therapy for insomnia (more behavioral than cognitive). Although I don't have a history of extensive supervision, I have a certificate hanging on the wall saying that I am certified in behavioral sleep medicine.
 

Therapist4Chnge

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doing psychotherapy as a psychiatrist will be no risk to your license, you'll be presumed competent in psychotherapy as residency trained psychiatrist. With all the variabilities in psychotherapy, it's going to be pretty hard for anyone to prove that you suck at it. The things that will get a psychiatrist in trouble, such as not doing a good suicide risk assessment, will get you in trouble wether you are treating someone with meds and/or psychotherapy.
Considering the liberal interpretation of most residency programs in this area, that is rather scary. There are admittedly some very good residencies that provide solid psychotherapy training, I've been told they can be counted on 1 hand. Psychiatrists that go for additional training at a psychoanalytic institute or a place like the Beck Institute definitely have shown a high level of competency in the area of psychotherapy.