Psychiatrists Who Do Psychotherapy: Vanishing Breed?

I recently saw a couple of articles in Clinical Psychiatry News which seemed to send mixed messages. One was written by long-time favorite columnist Paul J. Fink, MD and it was about how important it is to not only train psychiatry residents in psychotherapy, but to train them to do the right psychotherapy–which fits both them and their patients. You can view the whole story at Therapists’ Characteristics Affect Treatment : Clinical Psychiatry News.

The other story was about the shrinking number of psychiatrists actually doing psychotherapy. This story emphasized a recent survey of almost 400 psychiatrists showing a 20% drop in psychotherapy practice from 2002 to 2010. Psychiatrists are prescribing more drugs and not offering psychotherapy.  One of the coinvestigators on the survey, Dr. John Christopher Perry, a professor of psychiatry at McGill University in Montreal, was quoted about this loss of skill in psychotherapy by psychiatrists, “If psychiatrists shift to mostly being diagnosticians and prescribers, we will lose this and become less knowledgable about understanding and helping people. When a psychiatrist only manages medications and someone else provides psychotherapy, it limits the view of a patient’s symptoms, and may lead to overprescribing. When the psychiatrist is also the therapist, there is better opportunity to deal with life stress, coping, and distress without relying primarily or soley on prescribing.” Dr. Perry also is director of psychotherapy research at Jewish General Hospital in Montreal.

The other side of the coin is systems challenge in that psychiatrists are inadequately reimbursed by insurance companies for psychotherapy. Moreover, many patients can’t afford to pay for psychotherapy out-of-pocket. See the whole article at Percentage of Psychiatrists Doing Psychotherapy Dwindles : Clinical Psychiatry News.

These articles seemed to say how important is for psychiatrists to be trained in providing psychotherapy, yet fewer and fewer psychiatrists believe they are able to do both prescribing and psychotherapy. As the cost of medical and psychiatric care continues to rise with no end in sight, and pressures to cut costs also target psychiatrists, the challenge to provide practical, effective, accessible, and affordable mental health care grows harder.

Let’s hope leaders with the power to do something about this are listening.

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