The future for Psychiatrists and the use of psychotherapy

[psychgirll]

I interviewed at a program a few weeks back that proudly admitted their program doesn't put much emphasis on psychotherapy because that is where the future of Psychiatry is going. Any thoughts on this? At this point I do know that when my patients do not respond well to medications I would want to know that I can help them by providing psychotherapy. I have actually enjoyed many of the psychotherapy books I have read (e.g. Yalom, Beck) and could see myself doing half meds half therapy. Another question, even if a program doesn't boast about its psychotherapy training can I guarantee I'll still get adequate training since it is required by the ACGME? This program does offer electives in therapy. This program has a great reputation on SDN and I left with the impression that it is a strong program though lacking in the therapy training department.

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[SmallBird]

I interviewed at a program a few weeks back that proudly admitted their program doesn't put much emphasis on psychotherapy because that is where the future of Psychiatry is going. Any thoughts on this? At this point I do know that when my patients do not respond well to medications I would want to know that I can help them by providing psychotherapy. I have actually enjoyed many of the psychotherapy books I have read (e.g. Yalom, Beck) and could see myself doing half meds half therapy. Another question, even if a program doesn't boast about its psychotherapy training can I guarantee I'll still get adequate training since it is required by the ACGME? This program does offer electives in therapy. This program has a great reputation on SDN and I left with the impression that it is a strong program though lacking in the therapy training department.

Perhaps if this program had better psychotherapy training they would recognize the defensiveness of devaluing that which they don't have.

It is difficult to predict the future. But right now, if you graduate and wish to do almost only psychotherapy, that would be possible for you in private practice and certain employed positions. I don't think this model of care is particularly threatened, and in fact with the decline of interest in analytic training is possibly less crowded in some locations. However if you have gone to a program where you have learnt very little about therapy then you may not feel very comfortable doing this.

 

[F0nzie]

The future of psychotherapy in Psychiatry is already here. It's what you make of it. It can definitely be made in the private sector, but that's on you. It's also on you to read, ask questions, and take your therapy seriously in residency. Plus therapy isn't really a career selling point from a general medicine standpoint "hey! Extra training so nobody can pay you for it!"

 

[psychgirll]

I just can't imagine only using meds as treatment but if I went to this program I would most likely be influenced in the more biological way of thinking perhaps leading to me not practicing therapy. Then leading to that particular career path. Would I be unhappy or feel I'm missing out? I'm unsure about that, I'll probably adapt. I am having trouble deciding if what I think is important now to me, as a M4 who hasn't provided anything more than supportive therapy, may not be as important after being trained with a strong biological approach. Then at that point referring my patients to a therapist. Yes I love reading books on psychotherapy vs books on meds because I think anyone would enjoy reading the former more. I apologize for the confusing "what ifs" but I'm making my rank list and I do appreciate all of your input and feel the majority of you know something I do not in regards to expectations of training.

 

[OldPsychDoc]

Y0u sound like a fairly self-directed person. Given that, you'll probably rise to your personal level regardless of what the program does or doesn't offer. Now the RRC is going to require a certain basic exposure for all residency programs. Some may intentionally emphasize more--possibly even to the point of building resentment in certain residents who aren't interested that much in therapy; others may emphasize less, leaving it to you to seek out additional supervision or seminars outside of the main track of the program.

In the case of the OP's program in question, the more important question to ask is "If I'm interested in more of something 2-3 years from now, will they give me the latitude and support to pursue it?" Good programs will. (And this would be a perfectly good question to email a program director with in the next couple of weeks.)

 

[F0nzie]

I would not worry about your interests changing. They're supposed to change. Choose a more balanced program if it will give you peace of mind.

 

[psychgirll]

Thank you all for the advice. I will ask the PD if they support their residents who seek additional psychotherapy training and go from there. I know what answer I'll most likely receive. If I match somewhere that doesn't provide what I believe is sufficient training I will be one to speak up and ask for additional resources. It's good to know that regardless of where I match I'll end up being okay, I just may need to put more effort in getting the support I need.

 

[F0nzie]

At least your interests are within 1 speciality and not 2 or 3. It's normal not to know which path will make you happier. Sometimes I even wonder if IM-> GI would have been better. I don't know exactly what GI even does on a daily basis but I mean come on how can you go wrong with scoping and talking about diarrhea all day.

 

[psychgirll]

rectal exams and fecal disimpactions. I can see the allure

 

[SmallBird]

Y0u sound like a fairly self-directed person. Given that, you'll probably rise to your personal level regardless of what the program does or doesn't offer. Now the RRC is going to require a certain basic exposure for all residency programs. Some may intentionally emphasize more--possibly even to the point of building resentment in certain residents who aren't interested that much in therapy; others may emphasize less, leaving it to you to seek out additional supervision or seminars outside of the main track of the program.

In the case of the OP's program in question, the more important question to ask is "If I'm interested in more of something 2-3 years from now, will they give me the latitude and support to pursue it?" Good programs will. (And this would be a perfectly good question to email a program director with in the next couple of weeks.)

I agree that being self-directed can facilitate a lot. On the other hand, if you are really interested in psychotherapy, it makes sense to look at a program thats going to make a) good patient exposure and b) high quality supervision readily accessible. For example, if you are drawn to dynamic work, its going to be a lot easier to get that kind of exposure at a program were you can see several patients for weekly therapy - a type of experience that is very difficult to craft if you have a high case load of patients with more severe mental illness for whom you are expected to do a lot of medication and case management.

Much can be overcome no doubt, but when one has choices, why not make things easier?

 

[wolfvgang22]

Was the program Washington University? Sounds like my past experience interviewing there some years ago.

 

[psychgirll]

It's a southeast program. I just hope I get my #1 program which has practically everything I'm looking for. Although there are 3 other programs I interviewed at that are more balanced, two didn't seem to be family friendly and the other was a program that seemed very lax. I interviewed at 8 places. And then I interviewed at others that have some red flags like losing hospital privileges, poor quality of relationship between residents and the PD, etc. So you can see why I'm struggling with the southeast program because overall it's still a much better program than half of the ones I interviewed at.

 

[nitemagi]

Do as much therapy as you want. I do.

Others will give you space for it if you prioritize and make it known. Most don't expect you to know how to do it.

 

[splik]

Another question, even if a program doesn't boast about its psychotherapy training can I guarantee I'll still get adequate training since it is required by the ACGME?

unfortunately you cannot rely on this there are many programs that don't even attempt to teach various psychotherapeutic modalities (as someone mentioned on another thread MCG for example does not teach psychodynamic therapy at all as no one does it there and none of their patients could actually benefit from it) The ACGME requirements are quite loose and the interpretations have been quite stretched at some places.

You need to think about what is important to you. The secret no one wants to talk about is no residency program can teach you everything, there is only a certain amount of time. some programs have a more biologically oriented bent, some try to be balanced, a vanishing minority emphasize psychotherapy etc. You cannot learn it all. However if you dont get exposure to something during residency the chances are you won't practice it afterwards. Now it is possible to get training in psychotherapy after residency, and anyone really serious about making that part of their practice should do so but that will cost you and you won't get free supervision etc anymore.

 

[nitemagi]

You need to think about what is important to you. The secret no one wants to talk about is no residency program can teach you everything, there is only a certain amount of time. some programs have a more biologically oriented bent, some try to be balanced, a vanishing minority emphasize psychotherapy etc. You cannot learn it all. However if you dont get exposure to something during residency the chances are you won't practice it afterwards. Now it is possible to get training in psychotherapy after residency, and anyone really serious about making that part of their practice should do so but that will cost you and you won't get free supervision etc anymore.

This. The key is to have an eye on what's missing, and to seek that out on your own, rather than expecting that the residency will have it all.

 

[thepoopologist]

Maybe there is a psychoanalytic center nearby

 

[Ceke2002]

Echoing what Splik and NiteMagi have said, my Psychiatrist completed his Fellowship/Residency in Advanced Adult Psychiatry more than a decade ago, but he's still continued to study and train in different Psychotherapeutic modalities. If a particular residency doesn't exactly meet your requirements for Psychotherapy studies, but is still a good fit, then I don't see any reason why you can't complete residency and then complete other studies on your own after that.

 

[NickNaylor]

Do as much therapy as you want. I do.

Others will give you space for it if you prioritize and make it known. Most don't expect you to know how to do it.

Agree with this. I have a strong interest in psychotherapy and make it a point to bring this up in interviews. I add the caveat that I expect to pursue that interest with my elective time, but some programs have been reassuring and mentioned that the curriculum has quite a bit of built-in therapy training - more than many other programs. Some programs seem less responsive to this interest.

I'm not sure if that issue is in and of itself worth choosing a program for for you, but I'd recommend at least going to a place that has the opportunity to engage in more substantive therapy training - even if that means pursuing it electively. After all, PGY-4 at most programs seems to largely be dedicated to developing your professional interests. As long as you have the ability to pursue those interests and the culture of the program isn't completely anti-therapy, I'm sure you'll be fine.

 

[notdeadyet]

When you're looking at therapy training, I wouldn't ask about the number of hours, but also the number of supervision hours and what they do for supervision. Some programs are just tacking aside therapy hours and a few didactics and considering it their therapy piece, but it's not particularly valuable.

Also, ask about when the therapy hours are. The PGY-4 elective thing is fine to get a taste but the better psychotherapy programs will give you exposure earlier and you will get supervision with continuity of patients that you've carried for 2 or more years.

 

[nitemagi]

When you're looking at therapy training, I wouldn't ask about the number of hours, but also the number of supervision hours and what they do for supervision. Some programs are just tacking aside therapy hours and a few didactics and considering it their therapy piece, but it's not particularly valuable.

Also, ask about when the therapy hours are. The PGY-4 elective thing is fine to get a taste but the better psychotherapy programs will give you exposure earlier and you will get supervision with continuity of patients that you've carried for 2 or more years.

I agree with this. Therapy is best learned longitudinally, as it's a skill rather than knowledge. It takes time to develop it, so earlier is better.

 

[smalltownpsych]

I interviewed at a program a few weeks back that proudly admitted their program doesn't put much emphasis on psychotherapy because that is where the future of Psychiatry is going. Any thoughts on this? At this point I do know that when my patients do not respond well to medications I would want to know that I can help them by providing psychotherapy. I have actually enjoyed many of the psychotherapy books I have read (e.g. Yalom, Beck) and could see myself doing half meds half therapy. Another question, even if a program doesn't boast about its psychotherapy training can I guarantee I'll still get adequate training since it is required by the ACGME? This program does offer electives in therapy. This program has a great reputation on SDN and I left with the impression that it is a strong program though lacking in the therapy training department.

I would state that ignoring the efficacy of interpersonal factors in treatment in favor of the biological would limit your efficacy. Regardless of whether or not psychotherapy is the focus of your practice, a psychiatrists should have an ability to conceptualize the psychological and social factors especially since they are often the head of the treatment team.