I’ve noted before that the role of psychiatrists is largely focused only the medication that a patient takes. To be fair, there are a few psychiatrists out there who do actual psychotherapy. Recent research shows this to be declining very steadily. (1)
I think the recent research on the decline of psychotherapy in psychiatry underestimates the ‘true’ shift in the field of psychiatry. The research is based on billing codes, and I know a little about that. I do computer consulting with a mental health center on their electronic medical record system. If the session goes over 15 minutes, it is billed as medication review + MD psychotherapy. So, in other words, if the session lasts more than 15 minutes, it is considered psychotherapy. This is whether it is true psychotherapy, or just an extended discussion of medication. There are no psychiatrists within a 50 mile radius of my practice that I would consider that provide true “psychotherapy.” So, the research results from 2004-2005 showing that 29% of psychiatrists provide ‘psychotherapy,’ is quite distorted. It frankly just means that sometimes they run over 15 minutes in the discussion of medication. I’m not saying that there are not any psychiatrists who provide psychotherapy, I’m just saying that it is very rare. That’s why you ought to be very skeptical about psychologists who have prescription privileges, because it is likely that they will go the way of psychiatrists.
(1). http://www.medscape.com/viewarticle/578684?src=mpnews&spon=12&uac=107497SN
5 comments
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August 15, 2008 at 8:06 pm
catherine
One thing I liked about my doctor is that even though it was only scheduled for a fifteen minute appt, sometimes we would talk for much longer than that and on things other than medication. It was nice.
(btw, I turned the comments back on)
August 15, 2008 at 8:58 pm
thecountryshrink
I’m glad to hear that Catherine. It helps restore a little of my faith in psychiatry. I’ve just heard to many negative stories I think sometimes.
Such as, “So, you’re more depressed. Are you suicidal? No? Okay, well I’ll see you next time.” Not that I haven’t heard bad stories about therapists and counselors to, but this stands out in relation to my post. But I’ve had others comment that their psychiatrists was interested in more than just meds, so this helps me to be a bit less cynical. Thank you.
September 5, 2008 at 6:45 pm
WW
Those are interesting stats. Is there any way to take into account the number of GP’s who prescribe antidepressants?
I had occasion to utilize my GP (about 5 years ago) to obtain a prescription for an antidepressant. (The local psychiatrists were all booked up at least 6 months out.)
This GP gave me an extended amount of his time at each appointment. Of course he wanted to know if I was continuing in psychotherapy, a requirement of his to issue the prescription. But he spent at least a half hour at each appointment “just chatting,” yet really testing my mood on a variety of levels. I have very found memories of him. Really, now that I recall all of this, I must send him a note, thanking him for his kindness.
There are doctors, then there are Doctors. My GP fell into the latter group.
WW
September 5, 2008 at 6:47 pm
WW
oh, heavens!!! typos……
I have fond, not found, memories of the GP!
WW
September 5, 2008 at 7:56 pm
thecountryshrink
WW,
I know the vast majority of antidepressant prescriptions are given out by GPs as compared to psychiatrists. I don’t know of any stats of GPs providing psychotherapy. My guess is that they use a completely different billing code than would psychiatrists (in other words they would bill for a medical office visit of xx minutes duration). So, while the billing code would reflect one thing, what took place in the actual meeting with the physician might be quite different. I think the take home message is to find a provider that is a good match for your needs and that you connect with.