What type of therapy do you do with medication management?

[AD04]

My program focuses more on pharmacology and is quite weak in therapy. I plan to learn therapy on my own.

What type of therapy is commonly done with medication management?

Where can I learn therapy specially to support medication management?

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[wolfvgang22]

Brief Supportive Therapy.

 

[erg923]

My program focuses more on pharmacology and is quite weak in therapy. I plan to learn therapy on my own.

What type of therapy is commonly done with medication management?

Where can I learn therapy specially to support medication management?

This will depend on what your "medication management" session really look like and how long they are.

Generally, combining the two in most employment setting doesn't work well or bastardizes the true definition of "psychotherapy."

If you are doing med checks, it should be therapeutic (in frame, nuance and tone), but lets not get carried away and pretending we are really doing Freud, Beck and Yalom stuff.

 

[watto]

My program focuses more on pharmacology and is quite weak in therapy. I plan to learn therapy on my own.

What type of therapy is commonly done with medication management?

Where can I learn therapy specially to support medication management?

I would start by reading this article about the psychodynamics involved in prescribing anything:

Psychodynamic Psychopharmacology | Psychiatric Times

 

[FlowRate]

We have the option of doing psychopharm for our psychodynamic patients. Spend the first few minutes on med stuff then spend the rest of session on therapy. I think we can also do psycopharm for our CBT patients if the CBT patient is an intake and not referral from the CBT waitlist.

 

[futuredo32]

Depends on what you want and what the patient wants. I do CBT supportive and psychodynamic.

 

[futuredo32]

This will depend on what your "medication management" session really look like and how long they are.

Generally, combining the two in most employment setting doesn't work well or bastardizes the true definition of "psychotherapy."

If you are doing med checks, it should be therapeutic (in frame, nuance and tone), but lets not get carried away and pretending we are really doing Freud, Beck and Yalom stuff.

There is a psychoanalytic training program in Michigan and a lot of psychiatrists train here and do psychoanalysis and medication management. My psychiatrist happens to be an analyst and he prescribes. It's easy with me, I know what I want so it takes a minute 🙂. He's amazing too. I really lucked out .

 

[clausewitz2]

We have the option of doing psychopharm for our psychodynamic patients. Spend the first few minutes on med stuff then spend the rest of session on therapy. I think we can also do psycopharm for our CBT patients if the CBT patient is an intake and not referral from the CBT waitlist.

We can do meds for any of our therapy cases provided our supervisor is an MD. As it is I spent perhaps twenty minutes six months ago talking about medication options at the request of one therapy case and it we haven't really talked about it since beyond "oh hey, can you call me in another refill?"

 

[Attending1985]

I think the best thing you can do to support medication management is psychoeducation. Think anxiety and the escape avoidance cycle, how depression perpetuates itself behaviorally and different factors that can contribute to mental illness. Be honest about realistic expectations of psychotropics.

Also limit setting and letting people know what is and is not mental illness. Patients will be quick to call things mental illness that are not, for example it is not “anxiety” when you’re living with an abusive partner it’s healthy fear. Make sure everything is in context and not symptom based.

 

[clausewitz2]

I keep meaning to go and bother the psychologists about ACT for people with primary psychotic disorders because it seems to align well with my basic approaches to the population and has at least some evidence supporting it. The crítical thing that has helped me with people who often don't have a surfeit of insight is establishing as soon as possible what the patient's conceptualization of their experience is and figuring out how to hang responsible psychopharmacology off of that. Also being willing to use FGAs, as it turns out that if someone tells you Risperdal makes them too sleepy and you swap it for Zyprexa they stop trusting you.

 

[J ROD]

therapeutics hugs

 

[AD04]

therapeutics hugs

Only if you got "milkshakes" that "brings all the boys to the yard"

 

[nitemagi]

I do hourlong sessions for many of my patients, which includes medication management, with psychodynamic, CBT, Gestalt, family therapies, and strategic therapies.

 

[whopper]

Many therapies out there and not everyone is right for everyone. E.g. exposure therapy IMHO is great in addicts who are prone to relapse or have a phobia. Motivational therapy for those who are abusing substances but don't want to quit, CBT for those that want to get better, have insight, and the power to get better is within their grasp but so far eluding them, psychoanalysis for people with dissociation and deep-rooted childhood issues.....

etc.

Only thing I can tell you is to start somewhere, start learning but remember that what it is isn't the end all be all. I've seen many therapists fall into a trap of thinking their type of therapy is right for all.

 

[futuredo32]

I do hourlong sessions for many of my patients, which includes medication management, with psychodynamic, CBT, Gestalt, family therapies, and strategic therapies.

Cash only? I do hourlong but only charge for 45 minutes. my biller said Medicare only pays for 45 minutes of therapy and 60 minutes will trigger an audit.

 

[futuredo32]

I keep meaning to go and bother the psychologists about ACT for people with primary psychotic disorders because it seems to align well with my basic approaches to the population and has at least some evidence supporting it. The crítical thing that has helped me with people who often don't have a surfeit of insight is establishing as soon as possible what the patient's conceptualization of their experience is and figuring out how to hang responsible psychopharmacology off of that. Also being willing to use FGAs, as it turns out that if someone tells you Risperdal makes them too sleepy and you swap it for Zyprexa they stop trusting you.

Do you tell them that Zyprexa will make them more tired and gain weight 🙂 ?

 

[clausewitz2]

Do you tell them that Zyprexa will make them more tired and gain weight 🙂 ?

Yes. But this is where understanding the phenomenonology is so crítical. It allows you to identify how they describe their positive symptoms among the frequent mass of irrelevances if they disagree with the diagnosis. So you can be honest about the adverse effects and say "but I think it will help slow your thoughts down" or "it will help you ignore the threats you get from the FBI" or 'you won't worry as much about the true meanings of what people are saying to you". And if they do not seem to mostly be displaying strong positive symptoms then it is almost certainly not worth the rapport you lose if you whomp them with a medication making it difficult for them to achieve their goals or indeed have any kind of life.

Also, you know, people will follow you a lot farther if you can ask specific questions about very strange experiences they have had, because they are willing to allow you might have some idea what you are talking about.

 

[whopper]

Olanzapine causes weight gain in 40% of users.

But you know what? From experience with my patients seems like it's twice as much.

 

[Attending1985]

Cash only? I do hourlong but only charge for 45 minutes. my biller said Medicare only pays for 45 minutes of therapy and 60 minutes will trigger an audit.

can you bill for 45 minutes of therapy and 15 minutes of medication management?

 

[tr]

I'd say motivational interviewing is the bedrock therapeutic skill that all prescribers should have. It should really be taught in med school IMHO, but that's a pipe dream I guess. Nonetheless it's useful in many situations beyond substance abuse.

Other that that I sometimes provide some CBT-like exercises like cost-benefit analyses, Socratic Questioning, and Downward Arrow in a med mgmt context, although they really aren't as powerful without the full CBT framework that ensures patient buy-in.

Reflection is a useful therapeutic strategy that cuts across orientations and can be beneficial in many many contexts, even isolated from a more structured therapeutic milieu.

If you're just worried about documenting some therapeutic activity for the purpose of billing an add-on code, behavioral activation and sleep hygiene are basic advice-type stuff that fit very nicely with med management and require no psychotherapeutic training or skill, but could nonetheless fit under the heading of 'psychotherapy' for billing purposes.

 

[clausewitz2]

I'd say motivational interviewing is the bedrock therapeutic skill that all prescribers should have. It should really be taught in med school IMHO, but that's a pipe dream I guess. Nonetheless it's useful in many situations beyond substance abuse.

Although I never learned it in med school, at the school my residency program is attached to all the medical students apparently get a couple of hours of MI training at some point during their studies, which has made them significantly less useless at interviews when they rotate during their clerkships.

 

[WisNeuro]

I'd say motivational interviewing is the bedrock therapeutic skill that all prescribers should have. It should really be taught in med school IMHO, but that's a pipe dream I guess. Nonetheless it's useful in many situations beyond substance abuse.

I'd argue that it should be a pre-requisite for licensure in ANY healthcare profession. But, that's an even bigger pipe-dream.