Your opinion of occupational therapists in mental health

[InfoNerd101]

they can. just like anyone else. my first therapist had a masters in public administration from harvard. she had no health professional background before becoming a psychoanalyst and was excellent. anyone with the right suitability for the work and appropriate training can become an effective psychotherapist. and what the mental health industry has suppressed for too long is that caring individuals with very little training can do very effective therapeutic work with disturbed individuals. quite frankly i cant think of any worse training for psychotherapy than an MD. as psychiatrists we have to spent so much time having to unlearn everything in order to become an effective psychotherapists.

Would you say the concept of all of these other individuals (ie social workers nurses etc.) pushing for psychotherapy privileges is the same as all these other professionals now wanting prescribing rights such as nurse practitioners and psychologists?

---

Members don't see this ad.

 

[clausewitz2]

case managers used to be called therapists before they got forced to carry such large numbers of patients and become paper pushers. some still do effective therapeutic work with their clients.

I can accept that that is true. I also reckon that the overlap between people doing that effectively and the people who are very pressed to tell a medical student that they are really basically therapists already is slim.

 

[beestrng]

Would you go to an LCSW for psychotherapy?

My local health system uses them for psychotherapy so I probably would.

 

[smalltownpsych]

There are unlicensed therapists, they are called life coaches. There is a reason for licensing health care professionals and to limit the only treatment that needs to be regulated in mental health to medications is not a good thing for psychiatry or the field of treatment in general. The medical doctors that I work with, along with my patients, are grateful for my expertise, skill, and knowledge. i agree that much of what I provide for patients could be done by many other caring people, including good MDs, nurses, ministers, and lay people, but these caring people are also some of my biggest referrers because they recognize when the patient needs more.

One other note, the caring people have been guilty of some pretty harmful practices and I worked at a facility in the troubled teen industry that had such a history and my job was to bring it into compliance with standard of care. I saw first hand why regulation and oversight in this line of work is necessary. Some of the people were willing to stop the abusive practices and some had to be fired. They all wanted to help the kids and believed that they were. It even included how they handled the medications and I worked closely with an experienced RN to develop medication administration protocols that would help keep patients alive. They almost lost one right before I got there because of a big error. Many of the caring staff didn't believe in medications and subversively worked against our insistence on error free administration protocols. A couple of them were also fired.

 

[Shikima]

When I was a MS3, I remember a graduating (PGY3) FP doc who told one of his patients that was struggling with depression and anxiety, "I can provide you with some talk therapy because I've had a little bit of training in it." The reason was he could bill for encounters based on time codes at that time.

 

[Doctor Bagel]

they can. just like anyone else. my first therapist had a masters in public administration from harvard. she had no health professional background before becoming a psychoanalyst and was excellent. anyone with the right suitability for the work and appropriate training can become an effective psychotherapist. and what the mental health industry has suppressed for too long is that caring individuals with very little training can do very effective therapeutic work with disturbed individuals. quite frankly i cant think of any worse training for psychotherapy than an MD. as psychiatrists we have to spent so much time having to unlearn everything in order to become an effective psychotherapists.

I'm assuming she had a ton of training, though, in becoming an analyst. While training to be an analyst, she would be doing her own work and also working closely with a supervisor. That's hardly similar to seeing someone who truly had no training in psychotherapy.

 

[smalltownpsych]

Many people seeking counseling or psychotherapy are not mentally ill anyway. They are simply lonely, bored, unhappy, struggling in their relationships, stuck or have problems in living. whether it is really all that helpful to seek this kind of professional relationship is a different question altogether.

I guess this depends on where you draw the line for mental illness. Also, as with many illnesses, the symptoms might be mild, such as a fever or flu, but does that mean that the doctor doesn't provide treatment? Sometimes to prevent more serious illness and sometimes just to alleviate the symptoms. The attitude of psychological distress and symptoms not needing intervention leads me to have patient after patient showing up to my office or even the ER in acute crisis when much of this could have been prevented or ameliorated if they had come to me earlier.

 

[splik]

I'm assuming she had a ton of training, though, in becoming an analyst. While training to be an analyst, she would be doing her own work and also working closely with a supervisor. That's hardly similar to seeing someone who truly had no training in psychotherapy.

yeah she had a ton of training. my point is I don't think one needs to be a psychologist or psychiatrist or sw etc to get such training. in the UK lots of these therapists are English graduates. I'm not advocating for random people doing wild psychotherapy but there is decent evidence that you can train people to deliver effective interventions who have no prior training.

 

[Salpingo]

yeah she had a ton of training. my point is I don't think one needs to be a psychologist or psychiatrist or sw etc to get such training. in the UK lots of these therapists are English graduates. I'm not advocating for random people doing wild psychotherapy but there is decent evidence that you can train people to deliver effective interventions who have no prior training.

Well, everyone who has been trained to be an effective therapist had no prior training at some point (tautology?). However, I'm not comfortable with therapists who have not been exposed to severe mental illness. No amount of study could have replaced standing in the same room as someone with a legitimate manic episode or with first-break psychosis. I've seen well-intentioned, intelligent therapists totally miss psychotic disorders or, alternatively, mislabel someone as bipolar. So while you could get away with treating the majority of people in the community with JUST psychoanalytic training (and even provide good treatment for them), there's always a risk of missing something.

That being said, if the curriculum involves exposure to inpatient units or emergency rooms, I'd be OK with it.

 

[Ceke2002]

I'd see an OT for Psychotherapy only if they had proper training, and by that I don't mean they've just completed a few required or elective model as part of their occupational therapy training. They would have had to have completed a masters degree from an institute approved by the regulatory body of psychotherapists in Australia, anything less than that and I wouldn't consider them to have the required skill set to implement a proper psychotherapeutic approach/treatment plan.

 

[Shikima]

So for OTs do to therapy, would they be extending their schooling by 3 years and include another 2-3 years of supervised clinical work?

I don't see a problem with this. If you do a combined residency, for example FP/Psych, that residency combination is extended longer.

 

[smalltownpsych]

So for OTs do to therapy, would they be extending their schooling by 3 years and include another 2-3 years of supervised clinical work?

I don't see a problem with this. If you do a combined residency, for example FP/Psych, that residency combination is extended longer.

That isn't what would happen though based on what I have seen with other mid-levels. It would just be added into their existing curriculum with maybe some increased supervision requirements after graduation. The question I ask is if OT is a valuable profession (which I believe it is), why do they need to do what I am already extensively trained to do?

I also want to add to the conversation that oftentimes the desire to do more comes about because insecure and/or poorly trained psychotherapists are frequently telling allied professionals to "stop doing therapy with my clients" because they conflate any therapeutic relationship with psychotherapy. A good psychotherapist utilizes any type of relationship in the patient's life as grist for the mill. This happens in schools with teachers too. The only thing I worry about with allied professionals would be abusive practices. If they want to give advice or suggestions to patients, no problem here. It's not like everyone else in the world is not going to do the same. If I was an OT and everytime I had a good connection with a patient and I was chastised by some psychotherapist I would fight that same battle.

 

[InfoNerd101]

I'd see an OT for Psychotherapy only if they had proper training, and by that I don't mean they've just completed a few required or elective model as part of their occupational therapy training. They would have had to have completed a masters degree from an institute approved by the regulatory body of psychotherapists in Australia, anything less than that and I wouldn't consider them to have the required skill set to implement a proper psychotherapeutic approach/treatment plan.

The only point I was making is a lot of psychotherapists in Australia have first professional degrees in either social work or occupational therapy or even nursing

 

[Ceke2002]

The only point I was making is a lot of psychotherapists in Australia have first professional degrees in either social work or occupational therapy or even nursing

Yes, and there are also a lot of 'I did a 6 week online course, check me out I'm now a qualified psychotherapist' types as well. Seriously, I received a discount voucher offer in my inbox the other day - Just $19, marked down from $99, for a course that would 'qualify' me as a psychotherapist, and hypnotherapist, all ready to go right ahead and start practicing in just 6 weeks. Psychotherapy is not this innocuous thing that just anyone can do, not matter how well meaning, or caring, or highly trained in other fields a person is.

You might want to have a look at this link.

http://www.therapyabuse.org/t2-unsafe-psychotherapy.htm

 

[InfoNerd101]

Yes, and there are also a lot of 'I did a 6 week online course, check me out I'm now a qualified psychotherapist' types as well. Seriously, I received a discount voucher offer in my inbox the other day - Just $19, marked down from $99, for a course that would 'qualify' me as a psychotherapist, and hypnotherapist, all ready to go right ahead and start practicing in just 6 weeks. Psychotherapy is not this innocuous thing that just anyone can do, not matter how well meaning, or caring, or highly trained in other fields a person is.

You might want to have a look at this link.

http://www.therapyabuse.org/t2-unsafe-psychotherapy.htm

But some of them have the full professional qualifications and get the four years of trained or whatever that it takes lol... I know there's a difference between "counselors" and "psychotherapists" in Australia, the former less qualified but some still go around claiming to be psychotherapists. That in my opinion is an issue and should be fixed.

 

[Ceke2002]

But some of them have the full professional qualifications and get the four years of trained or whatever that it takes lol... I know there's a difference between "counselors" and "psychotherapists" in Australia, the former less qualified but some still go around claiming to be psychotherapists. That in my opinion is an issue and should be fixed.

At what point have I denied that many psychotherapists in Australia, including those previously trained as OTs, do have the requisite amount of training and should be able to practice within the full scope of their training. The issue I have is with people trained in other disciplines, who study 'psychotherapy' as part of their curriculum and then thinks that makes them a psychotherapist; or those who think all they have to do is complete a short course or two and they're ready for business (and they advertise themselves as Psychotherapists, not as Counsellors). So can an OT practice Psychotherapy? Sure, if they have the proper amount of training through an accredited/industry recognised institute of education then I don't see why not. Apart from that, no, being a well trained OT does not make you a good Psychotherapist or capable of implementing Psychotherapeutic treatments effectively or safely.

edited to add: And again, Psychotherapy is not some innocuous treatment. It has risks, it can worsen certain conditions and lead to poorer outcomes (especially in the hands of someone who doesn't know what they're doing). It's not indicated for everyone, and in some cases it can be contraindicated. Seriously, just google 'Dangers of Psychotherapy' and take a look at some of the links that come up, and then read what they have to say. And this is coming from someone who is in long term psychotherapy and has been receiving a great deal of benefit from it.

 

[notdeadyet]

So for OTs do to therapy, would they be extending their schooling by 3 years and include another 2-3 years of supervised clinical work?

In fairness, if you took your average four years of medical school and your average four year psychiatry residency, you'd probably have a grand total of maybe 6 months of full time psychotherapy training and supervised psychotherapy work.

The majority of a psychiatry residency is training to become a physician, not a psychotherapist.


Sent from my iPhone using Tapatalk

 

[Shikima]

In fairness, if you took your average four years of medical school and your average four year psychiatry residency, you'd probably have a grand total of maybe 6 months of full time psychotherapy training and supervised psychotherapy work.

The majority of a psychiatry residency is training to become a physician, not a psychotherapist.


Sent from my iPhone using Tapatalk

And OP is citing that OTs can be fine psychotherapists with their training as cited by examples in other countries.

 

[InfoNerd101]

So for OTs do to therapy, would they be extending their schooling by 3 years and include another 2-3 years of supervised clinical work?

I don't see a problem with this. If you do a combined residency, for example FP/Psych, that residency combination is extended longer.

It would only extend their schooling should they choose to go for the additional psychotherapy training

 

[Shikima]

It would only extend their schooling should they choose to go for the additional psychotherapy training

Or they can go back and get a MSW/PhD to learn to do talk therapy properly.

 

[WisNeuro]

As a psychologist, I'm actually fine with other disciplines doing therapy. But, there needs to be much more oversight in how people can say that they are proficient in certain methods. As I've stated before, I am aware of more than several examples of mid level people touting "specializing in X" after attending a half day workshop in the subject. Reading up/attending didactics on the subject is great, but the vast amount of learning you will get in therapy is the supervised experience. And, this needs to be supervised experience in some sort of vivo (one way mirror, audio tapes, video tapes).

 

[InfoNerd101]

Or they can go back and get a MSW/PhD to learn to do talk therapy properly.

They would be learning to do it properly in their program just like an msw student does in the program. That what I'm explaining and you amongst others are not getting it lol... Just like an msw student has the option to take a clinical tract where they would learn psychotherapy, an OT student would have this option too!

 

[WisNeuro]

I believe the other posters are getting it just fine. What they are questioning is the appropriateness of the "tracks" to adequate training in a certain set of treatments. It is not something that can be easily picked up in a 2-3 month rotation.

 

[InfoNerd101]

I believe the other posters are getting it just fine. What they are questioning is the appropriateness of the "tracks" to adequate training in a certain set of treatments. It is not something that can be easily picked up in a 2-3 month rotation.

Oh I see what you are saying! So you're weaning if mid-level practitioners have enough training?

 

[WisNeuro]

Weaning?

 

[InfoNerd101]

Weaning?

I mean to say wondering*

 

[Shikima]

Weaning?

Freudian slip.

 

[Ceke2002]

In fairness, if you took your average four years of medical school and your average four year psychiatry residency, you'd probably have a grand total of maybe 6 months of full time psychotherapy training and supervised psychotherapy work.

The majority of a psychiatry residency is training to become a physician, not a psychotherapist.


Sent from my iPhone using Tapatalk

Wow, Psychiatry in the US really doesn't have that much emphasis on Psychotherapy? I guess I already knew it wasn't necessarily a priority, but I didn't think the training was that little. I'm just looking at the 5 year training program for Fellowship in Australia. At a minimum, from what I can see (admittedly I've just skim read it), there's a requirement of a 1 year or 40 session equivalent Psychotherapy case, plus mandatory EPAs (entrustable professional activities) of psychoeducation in stage 1, supportive psychotherapy in stage 2, and therapeutic alliance by stage 3 (stage 1 is 12 months, stage 2 and 3 are 24 months respectively) - plus one of the 6 month required rotations in stage 3 can be in a Psychotherapy based clinic. Plus if you then go on to complete an advanced certificate of training concurrent (I believe) with stage 3 requirements, there are further psychotherapy units to complete with that as well. From what I can see over the entire pathway to Fellowship with RANZCP, you're probably getting at least 18 months worth of psychiatry training , and possibly upwards of 2 years depending on advanced training options.

 

[Ceke2002]

the Australians have even less emphasis on psychotherapy in their psychiatric training. only in some fictional alternate universe are Australian psychiatrists getting 18 months or anywhere near it of psychotherapy training. unlike on the US at least they can potentially do a full time psychotherapy rotation but most aren't even doing that I don't think. most of what your highlighting is just showing how de-emphasized psychotherapy is in the training of psychiatrists down under. they also don't get much exposure to minor mental illness or private practice is their training. I remember reading something about that a while back

I was going by the updated curriculum, and certainly going by my own prior experiences in the mental health system I have no doubt psychotherapy was even lower on the list here than most other places. I was just surprised at the newer training schedule seeming to put more emphasis on psychotherapy than in the US -- sorry I should have clarified that. I'll have a closer look on the newer schedule, maybe I'm missing something, like a functioning brain (it was our turn for hospice vigil this afternoon, so yeah I'm a tad drained of energy...wouldn't surprise me if I was reading stuff upside down and back to front).

edited to add: I'm pretty sure my Psychiatrist only did 6 months psychotherapy rotation (not mandatory) when he was studying to be a fellow (from what I understand most of his training in the therapy side of things has been post-fellowship). So I think you're right, psychotherapy wasn't something they paid a lot of attention to in previous curriculums.

This is the current curriculum https://www.ranzcp.org/Pre-Fellowship/2012-Fellowship-Program.aspx