Psychiatry and Psychoanalysis / Psychotherapy

[commonwealth ki]

To what extent are psychiatrists trained in or practice either psychotherapy or psychoanalysis?

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[Regnvejr]

In short, accredited programs require residents to be "proficient" in 5 types of psychotherapy.

 

[maranatha]

All programs will give you exposure to psychodynamic therapy. However, you will find varying degrees of training depending on the program. There are some programs that are by reputation going to have a lot more opportunities in psychodyanmics (Columbia comes to mind) and others that will have less training, such as a place like Hopkins. Another aspect is whether or not the program is associate with a psychoanalytic institute. I'm fortunate to be training at a program that has a good relationship with a psychoanalytic institute and we have the option of additional training, including a fellowship, that can be completed before the end of 4th year.

 

[rpkall]

Some programs have a more specialized psychotherapy curriculum for interested residents, which is completed over the later two years with more intensive supervision, and a chance to actually go to analysis yourself (which is helpful I hear if you want to be the best you can be).

There are also 1-2 year fellowships offered at psychoanalytic institutes that you can do after graduation from psych residency.

Some programs offer more resident experiences in psychopharm or just one or two modalities of therapy, and other programs seem to have more diversity or a focus on training residents to become therapists. Also, whether the supervision is with MDs or PhDs makes a difference to some incoming residents (the ones who really like behavioral neurobiology or psychopharm used in conjunction with therapy usually prefer their supervisors to be MDs).

 

[commonwealth ki]

Why are residencies trending away from psychotherapy? It seems that this feeds into Clinical Psychology's claim that Psychiatrists are only pill dispensers.

Do insurance companies compensate for psychoanalysis? I assume they do not.

What do insurances typically compensate for psychotherapy?

 

[sunlioness]

Insurances do compensate for psychotherapy. The thing is though that you can bill 3 twenty minute long 90805s in the same time that you are billing one 50 minute 90807. So economically, psychiatrists are not encouraged to do any degree of psychotherapy on a regular basis.

Interestingly though, I discovered recently that if you are analytically trained and devote a majority of your clinical time to analysis, your malpractice premiums are lower.

 

[commonwealth ki]

Do insurance companies compensate for analysis as well?

 

[sunlioness]

I doubt it. Not precisely because it's analysis, but because of the frequency of the visits. Most insurers, if they have outpatient mental health coverage at all, limit people to 10-20 sessions per year. You'd blow through those in no time flat doing analysis. The one person I know personally who does analysis negotiates the fee with her clients and they are, to my knowledge, all self-pay.

 

[cleareyedguy]

Probably obvious to most of you, but no residency trains its residents to be psychoanalysts. That takes an additional 5 or 6 years or so.

If you do graduate from a psychoanalytic institute, you are eligible for significantly reduced malpractice premiums regardless of what types of patients you see.

In terms of psychodynamic treatments, all residencies will expose its trainees to the theories, but few have a significant presence of practicing analysts. And it makes a big difference as to who does the teaching and supervising.

Insurance companies do prefer that therapy be done by professionals like social workers and psychologists who generally command lower fees; whether or not you decide to become a "pill pusher" is up to you.

 

[sunlioness]

Probably obvious to most of you, but no residency trains its residents to be psychoanalysts. That takes an additional 5 or 6 years or so.

At least. Part of the requirements to complete an analytic program includes treating two clients through to resolution. There's really no predicting how long that will take. Also becoming analytically trained is terrifically expensive, because not only are you paying for the actual training, you're also paying for your own analysis, which is required and not cheap. There's a psychologist in the group practice I just left who is becoming an analyst and I'm pretty sure she's been at it for longer than 5 years.

 

[Therapist4Chnge]

At least. Part of the requirements to complete an analytic program includes treating two clients through to resolution. There's really no predicting how long that will take. Also becoming analytically trained is terrifically expensive, because not only are you paying for the actual training, you're also paying for your own analysis, which is required and not cheap. There's a psychologist in the group practice I just left who is becoming an analyst and I'm pretty sure she's been at it for longer than 5 years.

To do it right, it will take quite a few years. There are some great institutes out there (mostly in major cities) that offer discounted options for training. If you plan on doing dynamic work, anything short of intensive training would not be advised.