Talk therapy vs. pill pushing

[andrea]

Hey again,

I've been reading up on the types of treatment available, and at least in Missouri, it seems that most psychiatrists do 95% pill pushing and very little talk therapy of any kind. Is this the norm everywhere? One psychiatrist I know got fed up with this because he wasn't being reimbursed for talk therapy, and went into private practice. He's a happy guy now, but seems to be a rare breed. So how important do you consider these two? If money was no option, what percentage would you do of each?

Thanks,
Andrea

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[ckent]

It really depends on the psychiatric disorder that you are treating. Studies have shown that for disorders like depression, OCD and anxiety, a combination of talk therapy and medication has proven to be the most efficacious. Oftentimes, studies show that medication alone's effects may last only for as long as the patient is on the medication, while therapy's effects can last for a little bit longer after the patient is finished with therapy. For disorders like schizophrenia, bipolar, there is a greater emphasis on medication and patient/family education over talk therapy. As for what psychiatrists do, it's true that reimbursement for psychiatrists to do things like talk therapy has really plumented recently, as insurance co.'s realize that it's cheaper to put someone on an antidepressant vs. paying for therapy every week for the patient. Also, with social workers and psychologists being trained to do therapy, there's not a lot of need for psychiatrists to be doing this anymore. So I think that's where the future of psychiatry is headed, with psychiatrists being pill pushers while working with psychologists and social workers who will handle the therapy part. Most of the psychiatry residents here at my med school (the largest psych residency program in the US) are not interested in talk therapy at all, and will be only doing the pill pushing part. That being said, of course every psychiatrist is trained to do some degree of talk therapy, as therapy is still a part of pill pushing, even with a 30 minute patient visit every other month or so.

 

[Asher]

Whether or not you include psychotherapy as a huge part of your practice, the skills you develop during residency training in this area will help with basic patient care in my opinion (i.e., interviewing). Even if you don't use it that much, being aware of how it can help various illnesses and making the appropriate referrals is an important part of psychiatry, IMO.