talk therapy

[Manicsleep]

No, nooo, not this stuff again...


I think people are completely missing the point. A PhD in Clinical psychology is not some kind of a "cheap-mid-level-psychotherapy-producing-machine". It is a doctorate level degree aiming at producing academic scholars who are also applied practicioners of psychology in clinical settings. There is a vast scope of research and specializations. Clinical neuropsychologists are the brain-behaviour experts and are the ones responsible for the measurement of neurocognitive deficits and the planning of rehabilitation. They can make a big difference in managing (and possibly improving) the deficits of some neurological patients (stroke, TBI) and also in supporting dementia/parkinsons/MS/Huntington/other neurodegenrative disorder (by psychometrically measuring strengths and weaknesses of language/executive functions/visuospatial processing/memory etc. and trying to minimize the weaknesses by expanding strengths. Also by the means of psychotherapy in the patients themeselves and their families) Clinical health psychologists apply psychology on medical settings and i believe that they make a substantial difference on the lives of cardiovascular, pulmonary or cancer (terminal) patients. Clinical child psychologists are valuable for the treatment and management of developmental disorders. Applying stuff like ABA/CBA they can change the lives of autistic children and make a positive impact on ADHD, Conduct etc (and ofcourse they can go more far than that by counselling the family, liaising with social work etc.). And yes adult clinical psychologists can make vast contributions by applying psychological interventions on various mental health problems. I haven't seen one psychiatrist making lengthy behavioural experiments/exposures on an agoraphobic or a PD patient, yet this method is essential for the treatment of many anxiety and mood disorders.

A clinical psychologist is essential for detailed assessement (psychometric) and lengthy psychological interventions that a psychiatrist-or other medical doctor for that matter- wouldn't have the time and the appropriate training to do. Simple as that. There is also a tendency for clinical (mental health) psychologists to be more appropriate on treating "neuroses" (anxiety/OCD/somatoform etc.) and for psychiatrists for the more serious bipolar/psychotic cases but still both are needed for every single mental health case. A patient with panic disorder and social anxiety may need some SSRI to be more able to receive lenghty and painful (for hi/her) exposure therapy/ cognitive-behavioural treatment/social training. A patient with psychosis may get some help from cognitive therapy for psychosis and it is a pity that many psychotic patients are just sent home with a cocktail and nothing else.


Plus, many clinical psychologists are experts on academic research and on the development of various models and theories of the human mind or brain. Some psychiatrists do some research but they are few and far behind in comparison to psychologists. This is not some innate weakness of psychiatrists. It is just that their model is much more "medical/applied" whereas PhD-level psychologists is much more "research" oriented. And it is just fine the way it is. There are many people with severe psychosis who are in desperate need for a psychiatrist (who in the US are not many as it seems) in contrast, the more numerous PhD-level psychologists can divide their time between assessment/interventions in applied settings and research. There are many, many good clinical psychologists who have made great contributions on theories of affection, emotion, personality, cognition (and now neuroscience stuff) and their disorders and this is because their training and the psychologist's life-style allowed them to do so. Most psychiatrists simple don't have the time (or the training) for that.


Every professional can make a difference and some of you people reach the point of disturbing (or disturbed) by making yourself look like you are the best salesman in town rather than an applied scientist. "HEREE MENTAL HEALTH PATIENTSS im a psychiatristt (or a psychologistt) i have the besst treatmentsss all heree for the besst treatmentsss". Narcissistic dumb people

Essential is a strong word and we don't need you to tell us what you think you can do. Show me the data otherwise its just irrelevant blather.

I think you are missing the point. This isn't a thread about psychologists. Its about psychiatrists. The forum is about psychiatry. I don't think you understand narcissism. Ask your friendly neighborhood psychiatrists, they will explain it to you.

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[Therapist4Chnge]

Essential is a strong word and we don't need you to tell us what you think you can do. Show me the data otherwise its just irrelevant blather.

I think you are missing the point. This isn't a thread about psychologists. Its about psychiatrists. The forum is about psychiatry. I don't think you understand narcissism. Ask your friendly neighborhood psychiatrists, they will explain it to you.

Know thy self?

There seems to be a "jack of all trades" theme in here, though the part that was left out was "master of none". There is great danger in assuming to be an expert in everything and feeding a strong confirmation bias to support the assumption.

 

[nitemagi]

Petran, your post reflects your indoctrination, and frankly your lack of experience as only a student at this point. Speak more after you've spent time in practice, or as ManicSleep says, back it up with data, please.

This post was never intended to be about psychiatrists vs. psychologists. Inflammatory remarks from both sides have just derailed it that way.

 

[PETRAN]

Essential is a strong word and we don't need you to tell us what you think you can do. Show me the data otherwise its just irrelevant blather.

I think you are missing the point. This isn't a thread about psychologists. Its about psychiatrists. The forum is about psychiatry. I don't think you understand narcissism. Ask your friendly neighborhood psychiatrists, they will explain it to you.

My friendly neighborhood psychiatrist told me that he can't administer, score and interpret a 6-hour neuropsychological assessment (i told him about visuocontructional and dysexecutive aspects of the Rey-Osterrieth's complex figure on frontal TBI patients but he didn't know what i ws talking about) or a lengthy personality assessment accompanied with qualitative behavioural oservation, that he couldn't administer multiple sessions of a long panic-induction and cognitive restructuring therapy on a patient with panic-disorder with social phobia and agoraphobia, that anyone who thinks that he is the best or that he can do anything could possibly have narcissistic traits and that anyone can write and contribute to a public forum unless it is Nazi Germany or Soviet Russia.


In Soviet Russia psychiatrist doesn't let you speak in forum.

Oh wait this is a free public forum right? RIGHT?

 

[Chimed]

It may seem like beating a dead horse however, I think there are some really important discussions going on here. Some of them are listed below.

1) Should someone who wants to do therapy go into Psychiatry?

2) Do Psychiatrists still do psychotherapy?

3) Are Psychiatrists good at psychotherapy?

4) Are Psychiatrists competent at psychotherapy?

5) What is the role of a Psychiatrist on the mental health team?

Psychiatrists are leaders of the mental health team and are trained in every aspect of the mental health treatment. The are at the forefront of this treatment. There is a concerted effort on the part of certain trade groups to undermine this and unfortunately some Psychiatrists as well as other physicians buy into this myth.

The psychologists association will try to tell you that the vast most psychiatrists only prescribe drugs and that they overwhelmingly don't do any therapy. This is simply not true. They also want prescribing privileges and believe that prescribing psychologists will be better equipped than MDs/DOs.

So you can think we are beating a dead horse or you can go and see that on the psychologists site there is an ongoing thread for this that has been going for years. Its just a matter of perspective.

You're right, this is an important issue and I do appreciate your effort. But after being on this forum for several years and seeing this issue come up multiple times it just never seems go anywhere.

 

[Manicsleep]

Know thy self?
There seems to be a "jack of all trades" theme in here, though the part that was left out was "master of none".

Brilliant. Keep coming in here with emoticons and clever quotes my 3 year old can get from an internet search (you aren't as advanced). You do however prove the point, time and time again, that you have nothing substantive to offer intellectually and are ineffectual in any meaningful debate.

You also happen to be the most prolific psychologist posting here.
Correlative and anecdotal only but sometimes a good case presentation is useful.

No more responding to your useless posts.

 

[PETRAN]

Petran, your post reflects your indoctrination, and frankly your lack of experience as only a student at this point. Speak more after you've spent time in practice, or as ManicSleep says, back it up with data, please.

This post was never intended to be about psychiatrists vs. psychologists. Inflammatory remarks from both sides have just derailed it that way.

I don't see anyone backing-up with data his/her posts so i can't see how my statements must be backed-up with data whilst e.g. the stuff that manicsleep writes must not. If he backs-up with data that all neighborhood psychiatrists are friendly and the best people in giving advice about who is narcissistic and who is not and that psychiatry forums are better if only psychiatry (professionals or students) contribute then i will try to back-up with data my statements as well. I have the relative experience and knowledge to contribute don't get stuck on what my avatar says there.

 

[Manicsleep]

My friendly neighborhood psychiatrist told me that he can't administer, score and interpret a 6-hour neuropsychological assessment (i told him about visuocontructional and dysexecutive aspects of the Rey-Osterrieth's complex figure on frontal TBI patients but he didn't know what i ws talking about) or a lengthy personality assessment accompanied with qualitative behavioural oservation, that he couldn't administer multiple sessions of a long panic-induction and cognitive restructuring therapy on a patient with panic-disorder with social phobia and agoraphobia, that anyone who thinks that he is the best or that he can do anything could possibly have narcissistic traits and that anyone can write and contribute to a public forum unless it is Nazi Germany or Soviet Russia.


In Soviet Russia psychiatrist doesn't let you speak in forum.

Oh wait this is a free public forum right? RIGHT?

My friendly neigborhood psychologist can't spell psychologist...ooh. I can flame too. Big deal.

This isn't Nazi Germany or the USSR.
It's Psychiatry in the USA we are discussing. Clearly you don't get it that 6 hour sessions are not the norm or 'essential' for treatment.

 

[PETRAN]

My friendly neigborhood psychologist can't spell psychologist...ooh. I can flame too. Big deal.

This isn't Nazi Germany or the USSR.
It's Psychiatry in the USA we are discussing. Clearly you don't get it that 6 hour sessions are not the norm or 'essential' for treatment.

are you for real? Who let you out?

Where did i say that? 6-hour long treatments?




We are talking about assessment manicsheep. Some psych assessments (like neuropsych ones) can take more than a couple of hours because you can't assess every cognitive domain in 45-minutes and reach a conclusion about a patient's cognitive status.

And because it is psychiatry in the USA we are talking and because according to your non-biased, data-supported, objective statement (NOT) " a psychiatrist can do everything a psychologist can and much more" you possibly suggest that psychologists are no more needed and we only need psychiatrists? Right? Realistic and pragmatic stuff like that...

 

[billypilgrim37]

You also happen to be the most prolific psychologist posting here.

He is also a former moderator of this forum.

I can flame too.

Yes, we know you can.

 

[nitemagi]

I don't see anyone backing-up with data his/her posts so i can't see how my statements must be backed-up with data whilst e.g. the stuff that manicsleep writes must not. If he backs-up with data that all neighborhood psychiatrists are friendly and the best people in giving advice about who is narcissistic and who is not and that psychiatry forums are better if only psychiatry (professionals or students) contribute then i will try to back-up with data my statements as well. I have the relative experience and knowledge to contribute don't get stuck on what my avatar says there.

If you go to post #43 of this thread, you will see I am unfortunately the only one backing my posts with data.

 

[Majesty]

Interesting to see psychiatrists attacking ManicSleep.
I have read this thread from the beginning again and it seems that the psychologists are basically picking on him or anyone who thinks they aren't kings of the universe.

Psychiatrists are also doing the same. Why, I have no idea. I have seen this phenomenon in psychiatry residents as well. They hate medicine/surgery and basically everything else not psychiatry and are the ones that end up becoming pill pushers because they never learned the skills to do complete psychiatry.

So what if a previous moderator is coming in here and acting like an idiot. He deserves to be called an idiot. What difference does it make if he was a moderator?

And pilgrim..did you read the post you are quoting...do you understand sarcasm in order to make a point or do you just practice it to be an ass?

Regarding data for psychiatry efficacy, just read Star D. There are plenty of studies regarding effectiveness of medications for clinical (read severe) depression. Show me where it shows a 6 hour psychological test is necessary for...how did you put it petran?

"many anxiety and mood disorders"

I think I will be letting residents who rotate through here know that SDN is a joke and to stick to sites like sermo.

Have fun manic and nitemagi. I have had my fill of these fools.

 

[PETRAN]

Regarding data for psychiatry efficacy, just read Star D. There are plenty of studies regarding effectiveness of medications for clinical (read severe) depression. Show me where it shows a 6 hour psychological test is necessary for...how did you put it petran?

"many anxiety and mood disorders"

I think I will be letting residents who rotate through here know that SDN is a joke and to stick to sites like sermo.

Have fun manic and nitemagi. I have had my fill of these fools.

If anyone is a fool, is some of you people who don't read what others say and write your "own versions" of others posts.


Where did i say that a 6-hour test is needed "for many anxiety and mood disorders"? More lengthy tests are needed for people with neurological deficits dummy. If you have a young man who has sustained damage in in the frontal lobes (e.g. from an automobile accident) you want to make sure what kinds of problems he has, especially problems in executive functions, attention and working memory in order to organize an effective rehabilitation treatment plan . PhD clinical psychologists can also specialize in clinical neuropsychology, clinical health psychology and other specialties (and work with neurological, medical and developmental cases) they are not only for providing "cheap therapy" as some of you ignorant people put it.

As for the mood and anxiety disorders, what i say is that-yes- more lenghty treatments are needed for many anxiety and mood disorders even if you like it or not. Because you simply can't give a bloody SSRI to a person with chronic panic disorder who has social problems and send him home. This person will always struggle with his panic and social problems, relying in the bloody SSRI for a lifetime for some relief. This person needs a well-structured CBT-treatment plan in order to face his panic (panic exposure) and deal with his social anxiety problems (cognitive restructuring within the context of the therapeutic relationship etc.). Very few psychiatrists will do that kind of stuff and i have the data if you want it.


http://www.sciencedaily.com/releases/2008/08/080804165316.htm


And nowhere did i say that medication isn't effective. You just have a tendency to jump into conclusions and generalize.


And yes the US system sucks for being money-driven (health-wise) and not so patient-driven as in Europe. And yes, clinical social workers can provide some therapy but they are not specialists in that domain, their role (therapeutic-wise) is (and should be) more supportive. Their job is not the "psychological" of the bio-psycho-social. Its the "social". They already have a role and its different from that of testing and psychological interventions.


Plus as i said before, many psychologists have a primary role in research. Many modern theories of psychosis and OCD (among others) are formulated in neuropsychological/systems terms (the "hypofrontality" model of schizophrenia, the "error detection failure" in OCD etc.) and many have been developed by psychologists who divide their time between clinical work and (exprimental/psychometric) research. Modern basic neuropsychology and cognitive/behavioural neuroscience are the dominant paradigms of the mind and "speak" the language of psychology. "Executive functions", "planning", "meta-cognitive monitoring", "information processing", "working memory", "episodic memory", "autobiographical memory", "phonological and semantic representations", "associative learning"... Whilst the majority of modern neuroscientific concepts have derived from 60s-80s experimental cognitive psychology, many modern-day clinical psychologists spend their time in researching the structures and processes of the disordered mind and they contribute to our knowledge-base. It is the life-style of the scholar-practicioner that allows that. The majority of modern psychiatrists don't have the time (or the knowledge-base) for that stuff and they have a more primary and applied role in the medication management of the more severe cases.


Everyone contributes people. In contrast to what some of you think. Learn manners. Have some respect for other professionals.

 

[Chimed]

I think I will be letting residents who rotate through here know that SDN is a joke and to stick to sites like sermo.

Have fun manic and nitemagi. I have had my fill of these fools.

Ahhh....So now you know why I think this thread is like beating a dead horse. You may have laid out good discussion points earlier, but these conversations inevitable lead to a "psychologist vs. psychiatrist" discussion and this is where they end up going.

 

[PETRAN]

Ahhh....So now you know why I think this thread is like beating a dead horse. You may have laid out good discussion points earlier, but these conversations inevitable lead to a "psychologist vs. psychiatrist" discussion and this is where they end up going.

Why is that seriously? Why should one get into this stupidity all the time "ohh the psychiatrist is better, no the psychologist is better he can do this and that, but no the psychiatrist has a bigger penis and what about the social worker who is cheap and provides good services....


Enough with the pissing competitions. Like anyone cares about who is a psychologist and who is a psychiatrist and who is a "clinical social worker". This ego-stupidity buggers me. people in desperate need of respect for their occupational and social status (coming from "human behaviour experts"). WTF.

 

[billypilgrim37]

Enough with the pissing competitions. Like anyone cares about who is a psychologist and who is a psychiatrist and who is a "clinical social worker". This ego-stupidity buggers me. people in desperate need of respect for their occupational and social status (coming from "human behaviour experts"). WTF.

The majority of folks on this board would share this sentiment (including the person who I think you were just arguing with), but they've given up on this thread. Most of us value and very much respect our cross-disciplinary colleagues (even if we may have strong opinions that certain aspects of evaluation and treatment belong to those with certain training histories).

There are some SDNpsych rules of thumb:

If Kugel or OPD tries to intervene as the voice of reason in a thread, and their attempts fall on deaf ears, not much of value is going to be said subsequently.

Also: if whopper gives up on a thread, it's probably done being valuable. Whopper has tremendous frustration tolerance, and will keep engaging reasonably LONG AFTER it's clear it's going nowhere good.

Also: Nitemagi has much better weather than the rest of us. His/her optimism should be thus viewed suspiciously.

 

[nitemagi]

Also: Nitemagi has much better weather than the rest of us. His/her optimism should be thus viewed suspiciously.

Nitemagi is a his.

My tolerance for listening to arguing and stubbornness stems from my training in psychotherapy

 

[PETRAN]

Nitemagi is a his.

My tolerance for listening to arguing and stubbornness stems from my training in psychotherapy

Wish the system was different (or maybe...genes as well?) and every mental health professional was like you

 

[Manicsleep]

Dr. Majesty is young and idealistic. Thats all.

Originally posted by PETRAN
Why is that seriously? Why should one get into this stupidity all the time "ohh the psychiatrist is better, no the psychologist is better he can do this and that, but no the psychiatrist has a bigger penis and what about the social worker who is cheap and provides good services....

Go back and read your first post. There are quite a few sentences about what a psychiatrist can't do, in your opinion.
When you come in attacking, don't expect us to listen to you as a reasonable person. The American psychological Association takes the stance that psychiatrists aren't capable of therapy and that psychologists with what is tantamount to less that what a med student would do in a month's clinical rotation is ready to prescribe medication.
That kind of arrogance is what you represent and although I have done and understand neuropsych testing as well as therapy, you are incompetent when it comes to medicine.

Ahhh....So now you know why I think this thread is like beating a dead horse. You may have laid out good discussion points earlier, but these conversations inevitable lead to a "psychologist vs. psychiatrist" discussion and this is where they end up going.

Perhaps that is a discussion that needs to occur.
I don't think all psychiatrists think the same way about their role in the mental health arena. There are some who truly do see themselves as pill pushers only. It is a sad state of affairs.

Nitemagi is a his.

My tolerance for listening to arguing and stubbornness stems from my training in psychotherapy

I happen to know that Majesty does limited bedside psychotherapy and received extensive psychotherapy training in residency. I do regular psychotherapy and also received extensive training. We both supervise therapists as well. However, I save my tolerance for my patients and not for the forum.

 

[Therapist4Chnge]

That kind of arrogance is what you represent and although I have done and understand neuropsych testing as well as therapy, you are incompetent when it comes to medicine.

Your flippant responses about all of your/psychiatry's expertise while simultaneously claiming all psychologists are poorly trained is what is coming across as arrogant. The bolded section above is just one small example of assuming you have "done and understand neuropsych testing". Minimizing everyone else's training can rub people the wrong way; it also reinforces many of the stereotypes about psychiatry/psychiatrists. For every OPD there seem to be a dozen others who automatically discount anything that isn't from psychiatry, which is probably why there is the latent hostility between psychiatry and other specialities/fields.

 

[PETRAN]

Dr. Majesty is young and idealistic. Thats all.



Go back and read your first post. There are quite a few sentences about what a psychiatrist can't do, in your opinion.
When you come in attacking, don't expect us to listen to you as a reasonable person. The American psychological Association takes the stance that psychiatrists aren't capable of therapy and that psychologists with what is tantamount to less that what a med student would do in a month's clinical rotation is ready to prescribe medication.
That kind of arrogance is what you represent and although I have done and understand neuropsych testing as well as therapy, you are incompetent when it comes to medicine.



I happen to know that Majesty does limited bedside psychotherapy and received extensive psychotherapy training in residency. I do regular psychotherapy and also received extensive training. We both supervise therapists as well. However, I save my tolerance for my patients and not for the forum.

Nowhere in my first post i attacked the profession of psychiatry. I value psychiatrists a lot because they can make a big difference in the lives of even the most seriously ill patients. I don't know or care if psychiatrists should or should not receive training in psychotherapy. My view was that realistically, the vast majority of modern psychiatrists don't do it, so it would be completely unrealistic to say "clinical psychologists" are not needed. This is what you said and that was completely out of touch with reality (i guess that arrogance and egoism can do that kind of stuff to a person, even to a human behaviour expert that is) And no, social workers can't provide extensive and rigorous therapy to a challenging case because of lack of training and expertise. As i said before a social worker's job is different than that. . Plus, clinical psychologists are not just "cheap therapy providers" , they are research scholars and they can use their strong research skills in elegant and detailed evaluations (and ofcourse research). I wrote all that in response to your disturbing attitude for psychologists.


You again come as "know-all-i-can-do-neuropsychology-as-well" and this is just stupid, because a psychiatrist doesn't receive extensive practical training in neuropsychology in the same way that a clinical neuropsychologist doesn't receive extensive practical training in psychopharmacology (yeah, a couple of modules or practica are not sufficient for either neuropsych or psychopharm). You can practice as a neuropsychologist and still develop your skills after years of practice because this is not something simple or easy which can be learned and applied just like that. Your "know-all" attitude is problematic and i don't buy the "selectively-tolerant" stuff. "Oh have tolerance with patients but i don't have in the internetz or other people". You either have tolerance and respect or you don't and you (and the other guy) come strongly as intolerant and disrespectful individuals.

 

[Manicsleep]

There are some SDNpsych rules of thumb:

If Kugel or OPD tries to intervene as the voice of reason in a thread, and their attempts fall on deaf ears, not much of value is going to be said subsequently.

Also: if whopper gives up on a thread, it's probably done being valuable. Whopper has tremendous frustration tolerance, and will keep engaging reasonably LONG AFTER it's clear it's going nowhere good.

Also: Nitemagi has much better weather than the rest of us. His/her optimism should be thus viewed suspiciously.

Another few:
Too many Psychiatrists are afraid of confrontation.
They are particularly afraid of the idea that Psychiatry's training in therapy and testing be discussed.
This becomes more pronounced if a psychologist comes and makes it known that they will not accept such statements. This will make all the old guard psychiatrists run for cover. These are then called "reasonable" psychiatrists.

If you attempt this in the psychology forum, they will run you out, ridicule you and totally attempt to minimize any contribution, no matter how rational. Ask nitemagi on his experience. Or just search for nitemagi's posts in the psychology forums.

You will also see psychiatrists going over to the psychology forums (i won't name names but it is disgusting) and placating the psychologists. They get a nice "good boy" or "good girl" and they move on after getting self esteem boosts.

 

[dl2dp2]

Your "know-all" attitude is problematic and i don't buy the "selectively-tolerant" stuff. "Oh have tolerance with patients but i don't have in the internetz or other people". You either have tolerance and respect or you don't and you (and the other guy) come strongly as intolerant and disrespectful individuals.

The flip side of the coin is whenever these threads pop on on SDN, psychologists are always very gun-ho about how they aren't being "respected". While in real life I almost never see anything overtly disrespectful, I suspect that there is a subtle undertone of antagonism that is real. In academic centers where the division of labor is clearer, this is not as much a problem, but in the community there really is a fight going on regarding the RxP movement, therapy reimbursement, market for private pay therapy patient, etc. And the reality is that in the community patients don't respect psychologists as much, and perhaps as they should. They often sharply differentiate between a "real doctor" and a psychologist once they know the difference. The difference in terms of salary (and power in real life clinical decision making, as well as in terms of legal onus) is also often quite substantial. Now how did clinical psychology become the way it is (i.e. why is it now becoming less respected per se as a profession in our society) now is an interesting question, but I think the fact that these threads always degenerate in this situation and almost ALWAYS because of posts from non-MDs, is very tell-tale. I genuinely think that there is a large component of insecurity involved.

To the extent of the original question, whether psychiatrists do a better/worse job at talk therapy than a psychologist, the real answer is, nobody knows. But psychiatrists can charge more for it. So even though it's not better therapy, for whatever reason the market thinks that psychiatry therapy is WORTH more. I'm not really sure what that means.

To respond to some of PETRAN's issues, psychiatrists are doctors. Doctors are not expected to know how to carry out certain allied healthcare professional's job descriptions. Neuropsychological testing falls within the rubric of such tasks. Doctors don't do speech and swallow testing. Doctors don't do physical therapy evaluation. Doctor's don't do dietitian evaluations. Doctor's don't do social work. Etc. etc. This does not mean however that any of the allied health professionals (i.e. midlevels, whatever you want to call it) are NOT under the supervision of the physician in terms of patient care, because the ultimate responsibility and legal duty to the patient rests upon the physician in charge of the patient. There is no replacement in terms of that responsibility. For psychiatric patients, the psychiatrist is and will be the physician on the case. Disrespecting that hierarchy is not acceptable for patient care. You may feel disrespected and not tolerated and that's fine, and you can work by yourself in the community if you don't like your work place. But if you work within a multidisciplinary team, you need to know who makes the final call for management decisions, and that person won't be the psychologist.

 

[Manicsleep]

The flip side of the coin is whenever these threads pop on on SDN, psychologists are always very gun-ho about how they aren't being "respected". While in real life I almost never see anything overtly disrespectful, I suspect that there is a subtle undertone of antagonism that is real. In academic centers where the division of labor is clearer, this is not as much a problem, but in the community there really is a fight going on regarding the RxP movement, therapy reimbursement, market for private pay therapy patient, etc. And the reality is that in the community patients don't respect psychologists as much, and perhaps as they should. They often sharply differentiate between a "real doctor" and a psychologist once they know the difference. The difference in terms of salary (and power in real life clinical decision making, as well as in terms of legal onus) is also often quite substantial. Now how did clinical psychology become the way it is now is an interesting question, but I think the fact that these threads always degenerate in this situation and almost ALWAYS because of posts from non-MDs, is very tell-tale. I genuinely think that there is a large component of insecurity involved.

To the extent of the original question, whether psychiatrists do a better/worse job at talk therapy than a psychologist, the real answer is, nobody knows. But psychiatrists can charge more for it. So even though it's not better therapy, for whatever reason the market thinks that psychiatry therapy is WORTH more. I'm not really sure what that means.

In this case my argument is that in a simple patient without any other comorbidity, a social worker is probably the best therapist. Because cost is an issue, it is probably best to go with the cheapest cost option. However, as the complexity of the patient goes up, especially medical complexity, a Psychiatrist is better able to treat.
Clinical psychologists, particularly in the community, through a combination of poor training and poor focus have found themselves in an area where they really don't know what they are supposed to be doing. A social worker can do therapy as well as they can and often has better training while the physician always has a vastly superior understanding of the medical condition.

It puts the psychologist in a bit of a quandry. Perhaps this is why they are so defensive and insecure. The classic cornered animal on the offensive?

 

[nitemagi]

I think market forces can be blamed for a lot of the issues. Psychiatrists are in shorter supply, and insurance willing to reimburse for med management at the same rate as a full hour of therapy. So more lucrative for many psychiatrists to give up full therapy in their practice.

Psychologists have flooded the market with for-profit training facilities, and just more professionals than there are jobs. When there's an oversupply, you'd expect a cutback elsewhere. Instead it has led to turf wars, namely trying for psychology prescribing, and extra specialization into the market to try to stay viable. Social workers as cheaper therapists furthers the pressure.

I blame diploma mills for flooding the psychology market, and I blame psychiatrists for ceding territory that was initially created by us. Just like pain and sleep fellowships were created by psychiatry but then given up largely to anesthesiologists, neurologists, and pulmonologists. We have a bit of blame in it all as well.

 

[PETRAN]

In this case my argument is that in a simple patient without any other comorbidity, a social worker is probably the best therapist. Because cost is an issue, it is probably best to go with the cheapest cost option. However, as the complexity of the patient goes up, especially medical complexity, a Psychiatrist is better able to treat.
Clinical psychologists, particularly in the community, through a combination of poor training and poor focus have found themselves in an area where they really don't know what they are supposed to be doing. A social worker can do therapy as well as they can and often has better training while the physician always has a vastly superior understanding of the medical condition.

It puts the psychologist in a bit of a quandry. Perhaps this is why they are so defensive and insecure. The classic cornered animal on the offensive?

I get it, you get some kind of sick paraphilic pleasure when you flirt with those masturbatory domination fantasies and delusions of grandeur of yours. You must touch yourself when you write these posts.

 

[Manicsleep]

Another few:
Too many Psychiatrists are afraid of confrontation.
They are particularly afraid of the idea that Psychiatry's training in therapy and testing be discussed.
This becomes more pronounced if a psychologist comes and makes it known that they will not accept such statements. This will make all the old guard psychiatrists run for cover. These are then called "reasonable" psychiatrists.

If you attempt this in the psychology forum, they will run you out, ridicule you and totally attempt to minimize any contribution, no matter how rational. Ask nitemagi on his experience. Or just search for nitemagi's posts in the psychology forums.

You will also see psychiatrists going over to the psychology forums (i won't name names but it is disgusting) and placating the psychologists. They get a nice "good boy" or "good girl" and they move on after getting self esteem boosts.

Another one.
If you actually challenge them, the psychologists of the psych Rx movement, have little of value to add.
If you don't back down they implode.

I get it, you get some kind of sick paraphilic pleasure when you flirt with those masturbatory domination fantasies and delusions of grandeur of yours. You must touch yourself when you write these posts.

Thanks for making my point(s).

 

[Manicsleep]

Also, regarding the article that is often sourced as data indicating that psychiatrists only have 10% psychotherapy rates and therefore 90% of us don't do psychotherapy.

This 90% number was posted earlier by one of the psychiatrists here although I am not sure if he was explicitly using this data. It has been used over and over like a bad Fox news feed until the sheeple get indoctrinated.

It was also sourced as the article in "science daily" (laughable from a 'scientist') when the actual citation is as follows:
1. Mojtabai R, Olfson M. National trends in psychotherapy by office-based psychiatrists. Arch Gen Psychiatry. 2008;65:962-970.

As I have already refuted the article regarding its misleading parts:
1) Only minimum 30 minute appointments were allowed.
2) These appointments must have been scheduled as psychotherapy. If they were scheduled as med management and psychotherapy was done, even if longer than 30 minutes, too bad. Not psychotherapy.
3) 15, 20, 25 minutes of psychotherapy...aka brief psychotherapy as described by gabbard is not allowed.
4) Data showing that 60% of psychiatrists do psychotherapy for some patients, even under these absurd parameters is rarely presented.

Under these parameters, I would not be counted as someone who does psychotherapy. Also, any psychologist who does psych testing doesn't do psychotherapy. You must provide psychotherapy to all your patients to meet the ridiculous criteria and this is the difference between a psychiatrists and a psychologist.

You can teach a monkey to do surgery. You just can't teach it when not to do surgery.

Not everyone needs psychotherapy.

 

[Majesty]

ALright!

Some fire from my guys. Thats what I like.
Thumbs up to sluox, manic and nitemagi. After reading all that I had to come back.
I also noticed you stopped feeding the PETulant little troll.

To address a statement by Kugel.

Of the 100 or so psychiatrists that I know reasonably well, not a one got enough training in residency to be good at all the general medicine required plus the diagnosis and treatment planning of psychiatric patients, plus the psychopharmacology AND was also taught sufficiently to be really good at all the modes of psychotherapy delineated in the ACGME requirements. So, out of 101 (me included), 0% got enough training in residency to master all of that. I know a few who think they are good at all of it - but none of them are.

So, I have some data in a sample of about 100.
What does your survey of 100 psychiatrists trained in the last 20 years show?
How many feel they got good training (while in residency) in all those modes of psychotherapy in residency to be able to do it well now?

This may be 'beating the dead horse' but its where the rubber hits the road right. You may have your experiences but I have mine and others have theirs. Data gathered indicates that plenty of psychiatrists, the majority actually, still do therapy. I am more interested in your value judgments.

Who do you think is good at therapy?
How do you know?
Why do you think psychologists are so great?
What is your basis for assessment of the psychologists? Especially those coming out of mills.

How can you say NONE. What is your definition of good?

As a response to your question, everyone got about 4 years of psychotherapy where I did residency. I know at least 5 other residency programs that have similar programs. This doesn't mean thats all we did, just that we had a lot of exposure to it. I also know that it was different about 10 years prior to that and it was re-organized to increase therapy again. Perhaps your experience is similar to the Carlat experience where everyone thought that prozac would fix the brain, so they forgot the mind. The pendulum is (has been) swinging back in psychiatry.

 

[nitemagi]

I do believe the pendulum is swinging back, as evidenced by the enthusiasm within this thread alone. But the teachers all too often are again in the in-between generation, where they really are using meds only.

As a field I think we are pretty good at the diagnostic interview, and in observation. Where I'd say psychiatrists are undertrained is in psychotherapy interventions. I actually believe this is a huge opportunity. Psychologists (it seems) are so focused on proving themselves legitimate by making sure they're only practicing "evidence based" therapy, namely CBT, they're missing the forest for the trees. There are amazing therapies and interventions that haven't been disproven, but are under-studied. To name a few - brief therapies, hypnosis, psychodrama, other humanistic practices. Solid training and study for psychiatrists in these techniques I believe could lead to not just more efficiency, but better use of even brief interactions with patients. My own little pipe dream.

 

[PETRAN]

Also, regarding the article that is often sourced as data indicating that psychiatrists only have 10% psychotherapy rates and therefore 90% of us don't do psychotherapy.

This 90% number was posted earlier by one of the psychiatrists here although I am not sure if he was explicitly using this data. It has been used over and over like a bad Fox news feed until the sheeple get indoctrinated.

It was also sourced as the article in "science daily" (laughable from a 'scientist') when the actual citation is as follows:
1. Mojtabai R, Olfson M. National trends in psychotherapy by office-based psychiatrists. Arch Gen Psychiatry. 2008;65:962-970.

As I have already refuted the article regarding its misleading parts:
1) Only minimum 30 minute appointments were allowed.
2) These appointments must have been scheduled as psychotherapy. If they were scheduled as med management and psychotherapy was done, even if longer than 30 minutes, too bad. Not psychotherapy.
3) 15, 20, 25 minutes of psychotherapy...aka brief psychotherapy as described by gabbard is not allowed.
4) Data showing that 60% of psychiatrists do psychotherapy for some patients, even under these absurd parameters is rarely presented.

Under these parameters, I would not be counted as someone who does psychotherapy. Also, any psychologist who does psych testing doesn't do psychotherapy. You must provide psychotherapy to all your patients to meet the ridiculous criteria and this is the difference between a psychiatrists and a psychologist.

You can teach a monkey to do surgery. You just can't teach it when not to do surgery.

Not everyone needs psychotherapy.

After all the fallacies of generalizations, jumping to coclusions/cum hoc ergo propter hoc/non sequitur, ad hominem, ad populum, straw mans plus 200 other logical fallacies (some of them not yet discovered by logicians) i will argue with you but after you take an extensive neuropsychological 6-hour evaluation

 

[PETRAN]

I do believe the pendulum is swinging back, as evidenced by the enthusiasm within this thread alone. But the teachers all too often are again in the in-between generation, where they really are using meds only.

As a field I think we are pretty good at the diagnostic interview, and in observation. Where I'd say psychiatrists are undertrained is in psychotherapy interventions. I actually believe this is a huge opportunity. Psychologists (it seems) are so focused on proving themselves legitimate by making sure they're only practicing "evidence based" therapy, namely CBT, they're missing the forest for the trees. There are amazing therapies and interventions that haven't been disproven, but are under-studied. To name a few - brief therapies, hypnosis, psychodrama, other humanistic practices. Solid training and study for psychiatrists in these techniques I believe could lead to not just more efficiency, but better use of even brief interactions with patients. My own little pipe dream.

Nitemagi, what do you think of Manicsleep's and Majesty's attitude and behavior from an Adlerian point of view? I believe that huge internal conflicts and inferiority complexes are involved

 

[Majesty]

I am not even going to bother reporting this because as PE said...911 is a joke on this forum!

Yes I thought that was clever early in the morning.

I do believe the pendulum is swinging back, as evidenced by the enthusiasm within this thread alone. But the teachers all too often are again in the in-between generation, where they really are using meds only.

As a field I think we are pretty good at the diagnostic interview, and in observation. Where I'd say psychiatrists are undertrained is in psychotherapy interventions. I actually believe this is a huge opportunity. Psychologists (it seems) are so focused on proving themselves legitimate by making sure they're only practicing "evidence based" therapy, namely CBT, they're missing the forest for the trees. There are amazing therapies and interventions that haven't been disproven, but are under-studied. To name a few - brief therapies, hypnosis, psychodrama, other humanistic practices. Solid training and study for psychiatrists in these techniques I believe could lead to not just more efficiency, but better use of even brief interactions with patients. My own little pipe dream.

I certainly think that at institutions where there has been a history of good psychotherapy training, the old psychotherapists are out there and willing to teach. This occurred where I am and many came back when the chair asked them. I have seen this occur at other places as well. It did seem that sometimes we knew more psychotherapy than our younger attendings.

I got significant exposure to gestalt and hypnosis as well as many other group therapies. We did a lot of CBT, IPT and 3 years of psychodynamic.

 

[Manicsleep]

I also got most of my therapy training from older psychiatrists however this is not entirely true. Some of my best training with geriatric patients and bedside manner actually came from a psychiatrist who had trained in the late 90s.

I have relatively few patients that I provide therapy for more than 30 minutes but I do have some weekly therapy patients. I also discuss therapy weekly with the social workers and psychologists to whom I refer my patients (not every patient, every week). I do therapy with my insomnia patients as well as motivational therapy with my CPAP avoiders.

Hypnosis, psychodrama, gestalt...that would be fun. I did use the empty chair in a group last year, does that count?

 

[edieb]

The flip side of the coin is whenever these threads pop on on SDN, psychologists are always very gun-ho about how they aren't being "respected". While in real life I almost never see anything overtly disrespectful, I suspect that there is a subtle undertone of antagonism that is real. In academic centers where the division of labor is clearer, this is not as much a problem, but in the community there really is a fight going on regarding the RxP movement, therapy reimbursement, market for private pay therapy patient, etc. And the reality is that in the community patients don't respect psychologists as much, and perhaps as they should. They often sharply differentiate between a "real doctor" and a psychologist once they know the difference. The difference in terms of salary (and power in real life clinical decision making, as well as in terms of legal onus) is also often quite substantial. Now how did clinical psychology become the way it is (i.e. why is it now becoming less respected per se as a profession in our society) now is an interesting question, but I think the fact that these threads always degenerate in this situation and almost ALWAYS because of posts from non-MDs, is very tell-tale. I genuinely think that there is a large component of insecurity involved.

.

So narcissistic, especially considering most MDs don't even consider psychiatrists to be real doctors either...

 

[st2205]

So narcissistic, especially considering most MDs don't even consider psychiatrists to be real doctors either...

 

[Manicsleep]

So narcissistic, especially considering most MDs don't even consider psychiatrists to be real doctors either...

I get it, you get some kind of sick paraphilic pleasure when you flirt with those masturbatory domination fantasies and delusions of grandeur of yours. You must touch yourself when you write these posts.

I also noticed you stopped feeding the PETulant little troll.

Spike before the extinction.

 

[nitemagi]

So narcissistic, especially considering most MDs don't even consider psychiatrists to be real doctors either...

I think you may need to look up the definition of narcissistic. Feeling superior to YOU is not the same as feeling superior to EVERYONE.

 

[nitemagi]

Nitemagi, what do you think of Manicsleep's and Majesty's attitude and behavior from an Adlerian point of view? I believe that huge internal conflicts and inferiority complexes are involved

I'd be careful of the pot and kettle issue here. Sorry to say PETRAN, but you entered this thread with a very defensive long post about how indispensible psychologists are. If you look back at the original post, this thread was never about psychologists.

Adlerian aspects of compensation for inferiority by portraying oneself as superior could easily be seen in your own post.

In general I'd think of this thread as be more about psychiatrists discussing our collective identity as psychotherapists, rather than a degradation of psychology. When non-psychiatrists question our credentials (as with any professional group, such as the questioning of psychologists by psychiatrists, or MFT's by psychologists), the common reaction will be defensiveness. Speaking as a psychiatrist (3 months away from finishing residency), I personally find it ridiculous that others could call into question our ability or aptitude at psychotherapy. So should anyone do that I will of course be extremely angry, and launch back picking apart the actual data from the indoctrination that has been hammered in over years and years of graduate education.

We all want to feel that our work is relevant, and I'm sure you can take stock that your patients feel a benefit from working with you. Just recognize there are differences in opinion, and while You may feel that lengthy psychological assessments are essential, I have unfortunately rarely found clinical use for them, except as a fourth piece of additional supportive evidence to what I already suspected and had three other pieces of evidence to support.

When people are willing to step out of name calling and question their assumptions, then an actual discussion can take place. But without a willingness to entertain alternative perspectives, two sides just dig their trenches deeper.

 

[Majesty]

I was thinking about the economics argument and why psychiatrists don't do psychotherapy.

I do mostly inpatient but I still have a couple of clinics a week. I notice that I use the 90862 code most of all (i don't do any billing inpatient, ER or consults). The only psychotherapy code I use is 90805 which I can see and document in a little over 20 minutes. I make my life simple and with these 2 codes I can pretty much account for everything.

I do make a little more with 4 patients/hr as 90862 than 3 with 90805 but not by much. For those who figured that it will take more than a hour...account for no shows. It works because although its slightly less money, its a lot more rewarding. If you want to do hour long sessions, multiple times a week then either you have to be rich or they do and most of my patients aren't wealthy.

I am no business genius. Most of my income is from inpatient work but it seems that even if psychiatrists (the ones that aren't doing therapy) would add these patients every day, their day would go by a lot faster.
Also, the study showing that only 10% of psychiatrists do therapy, by definition, misses the 90805 code. It is probably the most commonly used therapy code by psychiatrists.

The code is written, the therapy is driven by the economics of the code, the data crunching doesn't take it into account. What you have is a misleading article that then is repeated ad infinitum. Indoctrination sets in and we have psychiatrists believing they can't and don't do psychotherapy.

 

[Manicsleep]

It gets more convoluted with entities like Kaiser, where you have to be a round peg in a round hole. They pretty much give you 15 minutes a visit.
However, you can still do a little therapy or talk to your chiefs and ask them to add some therapy spots.

You can, if you are aggressive and present it as a good business plan, work out a good schedule. Use the whole psychotherapy and med management done by the psychiatrist being the most efficient tool. See 3 patients per hour. 2 therapy/med management and one pure med management or some combination.

You can always do therapy. Even if it is for 20 percent of your visits. Sure, you may lose a small percentage of money but you will provide better patient care. Eventually, you may be able to negotiate with insurances to pay you more on those codes if you can show that those patients seek individual therapy at much lower rates.

 

[nitemagi]

Jon, nice post. I agree the field is in the process of giving more power to those with less training, which I consider the same as your comment on "dumbing it down." I wish I had a great deal of experience where psychological or neuropsychological testing gave a huge revelation, but a majority of the time, it's either confirmatory "Well that's already what we thought," or equally nebulous with no particular diagnostic insight. I further wish it was attributable to something like my asking the wrong question or our psychologists not using the right instruments. But that just hasn't been the case with the former, and as for the latter I have decent confidence our people are top of the line, so to speak.

 

[Manicsleep]

I don't think we are saying that neuropsych testing is useless. If that is how you percieved it, it is not the case. I use it but I just don't think it is essential for most mood and anxiety disorders as it was previously stated.

Just to be clear. For certain patients, neuropsych testing can be invaluable even if the diagnosis is known but is just not that common. The same can be said for certain imaging or lab tests. However, these are not routine things that we get.

 

[PETRAN]

I don't think we are saying that neuropsych testing is useless. If that is how you percieved it, it is not the case. I use it but I just don't think it is essential for most mood and anxiety disorders as it was previously stated.

Just to be clear. For certain patients, neuropsych testing can be invaluable even if the diagnosis is known but is just not that common. The same can be said for certain imaging or lab tests. However, these are not routine things that we get.

If you refer to my post, i never said that. I talked mainly about neuro(psych)- patients (i state frontal TBI as an example) not anxiety and mood. The only thing i said about anxiety and mood disorders is that extensive psychotherapy (e.g. a CBT program of an OCD patient or a patient with PD) is sometimes needed and that the system is not good for not promoting that. Neuropsych is mostly needed on behavioral neurology or liaison/neuro psychiatry services rather than the "pure functional" psychiatry (although psychosis is almost always accompanied with cognitive deficits of some sorts and it is good for the neuropsychologist to assess the "functionality" of the patient, not just perform the evaluation for diagnostic purposes which is usually easier and no extensive testing is needed nowadays)

 

[DrGachet]

Neuropsych testing, specially those eight-hours long ones for insurance purposes done on a distressed patient who'd rather stab himself in the eyes instead, is an ancient form of torture, used in the Middle Ages to break down the ego of a suspected wrongdoer. As such, it should be used only if the patient's life depends on it. Literally. Oh, and if patient is being particularly unpleasant to the mental health professional or if you're being paid a lot of money to perform the test.

 

[nitemagi]

Neuropsych testing, specially those eight-hours long ones for insurance purposes done on a distressed patient who'd rather stab himself in the eyes instead, is an ancient form of torture, used in the Middle Ages to break down the ego of a suspected wrongdoer. As such, it should be used only if the patient's life depends on it. Literally. Oh, and if patient is being particularly unpleasant to the mental health professional or if you're being paid a lot of money to perform the test.

 

[PETRAN]

Neuropsych testing, specially those eight-hours long ones for insurance purposes done on a distressed patient who'd rather stab himself in the eyes instead, is an ancient form of torture, used in the Middle Ages to break down the ego of a suspected wrongdoer. As such, it should be used only if the patient's life depends on it. Literally. Oh, and if patient is being particularly unpleasant to the mental health professional or if you're being paid a lot of money to perform the test.

 

[Manicsleep]

Ann Clin Psychiatry. 2011 Feb;23(1):30-9.
Do psychiatry residents identify as psychotherapists? A multisite survey.
Lanouette NM, Calabrese C, Sciolla AF, Bitner R, Mustata G, Haak J, Zisook S, Dunn LB.
Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093-9116, USA.

Abstract
BACKGROUND: Psychiatric training was once synonymous with learning psychotherapy, but current psychiatric trainees face many options for integrating psychopharmacology and psychotherapy into their future practices, including providing primarily medication-focused visits. We examined psychiatry residents' attitudes towards learning psychotherapy, practicing psychotherapy in the future, and overall identification as psychotherapists.
METHODS: We surveyed residents from 15 US residency programs during 2006-2007. The survey included 36 Likert-scaled items inquiring about residents' attitudes towards their psychotherapy training and supervision, their level of psychotherapy competence, the role of psychotherapy in their psychiatric identity, and their future practice plans. Four items asked about personal psychotherapy experience. Here we describe findings related to attitudes concerning being a psychotherapist and future practice plans.
RESULTS: Among 249 respondents, most (82%) viewed becoming a psychotherapist as integral to their psychiatric identity. Fifty-four percent planned to provide formal psychotherapy, whereas 62% anticipated psychopharmacology would be the foundation of treatment for most patients. Residents with personal psychotherapy experience and first-year postgraduate residents (PGY-1) were more likely to identify as psychotherapists, plan to pursue further psychotherapy training postresidency, and anticipate psychotherapy being central to their future practice.
CONCLUSIONS: Despite concerns about the diminishing role of psychotherapy in the practice of psychiatry and in psychiatrists' professional identity, most psychiatric residents view psychotherapy as integral to their professional identities and future practice plans.

 

[Chimed]

Ann Clin Psychiatry. 2011 Feb;23(1):30-9.
Do psychiatry residents identify as psychotherapists? A multisite survey.
Lanouette NM, Calabrese C, Sciolla AF, Bitner R, Mustata G, Haak J, Zisook S, Dunn LB.
Department of Psychiatry, University of California, San Diego, La Jolla, CA 92093-9116, USA.

Abstract
BACKGROUND: Psychiatric training was once synonymous with learning psychotherapy, but current psychiatric trainees face many options for integrating psychopharmacology and psychotherapy into their future practices, including providing primarily medication-focused visits. We examined psychiatry residents' attitudes towards learning psychotherapy, practicing psychotherapy in the future, and overall identification as psychotherapists.
METHODS: We surveyed residents from 15 US residency programs during 2006-2007. The survey included 36 Likert-scaled items inquiring about residents' attitudes towards their psychotherapy training and supervision, their level of psychotherapy competence, the role of psychotherapy in their psychiatric identity, and their future practice plans. Four items asked about personal psychotherapy experience. Here we describe findings related to attitudes concerning being a psychotherapist and future practice plans.
RESULTS: Among 249 respondents, most (82%) viewed becoming a psychotherapist as integral to their psychiatric identity. Fifty-four percent planned to provide formal psychotherapy, whereas 62% anticipated psychopharmacology would be the foundation of treatment for most patients. Residents with personal psychotherapy experience and first-year postgraduate residents (PGY-1) were more likely to identify as psychotherapists, plan to pursue further psychotherapy training postresidency, and anticipate psychotherapy being central to their future practice.
CONCLUSIONS: Despite concerns about the diminishing role of psychotherapy in the practice of psychiatry and in psychiatrists' professional identity, most psychiatric residents view psychotherapy as integral to their professional identities and future practice plans.

Thanks for posting this.

I would agree with this as someone still in training. Correct me if I'm wrong, but historically there was a period in the late 80's and 90's ("The Age of the Brain") where psychotherapy was downplayed. It seems, however, that the pendulum has really shifted with new residents. It just seems like common-sense to me that therapy is a critical part of treatment and we need to know at least the basics of it regardless of whether we are doing medication management or "pure therapy." I have argued before that "therapy" is always taking place regardless of how you bill it.

 

[Manicsleep]

Yeah pretty much. Especially happened when prozac came out as well as after the release of the DSM IV.

The shift started in the late 90s and intensified in the last decade. It is in full swing now. The great thing is that it hasn't really swung the other way as much as basically gone to center. There are more balanced psychiatrists being 'produced' than ever before.