Where Has Psychotherapy Gone?

Stephen M. Strakowski, MD; John G. Gunderson, MD; David J. Reinhardt, PhD; Ruth R. Staten, PhD, APRN-CS

Disclosures

August 18, 2011

In This Article

Could Some Patients Benefit From Multiple Caregivers?

Dr. Staten: This is a great conversation. It seems we are seeing things in pretty much the same way. I do wonder what current psychiatric residents think about their experiences. We who were trained years ago, with psychotherapy being central to our education and practice, mourn the loss of this approach to treatment. However, it seems that newer generations experience and accept the new reality. I cannot imagine that being a "prescriber" only would be rewarding in anyway, but I am not sure that the same would be true for new practitioners. This brings me to my other strand of thinking.

It seems we have not necessarily documented through research which patients might most benefit from having a provider who can provide medication management and psychotherapy and those who might do well with 2 different providers. I wonder if clients with numerous medical problems and psychiatric problems might best benefit from a provider who can do both -- assuming that there are so many interactions among all conditions and treatments that it would take one person to make all the necessary observations and interventions work together.

Often times these are the subjects who are excluded from the studies of particular interventions -- medication related or psychotherapy -- but may be just the patients who need a practitioner who can do both. We could ask the same of persons who may need very intensive psychotherapy and a little bit of medication. Perhaps they would best benefit from 2 different providers, each practicing from their greatest strength, one as a therapist and one as a medication manager. I'm saying all of this just to make the point that we really don't understand very well which patients need what level/type of care, and at what point they can return to their primary care provider for continued treatment.

The changes that are abreast give us some opportunity to think about things differently. However, I cannot imagine psychiatrists without some degree of psychotherapy preparation and skill. That might be the question -- not should they or shouldn't they, but what training should they receive? In psychiatric nursing, we have just gone through several years of review of advanced practice psychiatric nursing education and concluded that psychotherapy must continue to be an essential component of education and practice. How do we maintain these opportunities in a practice world that wants, needs, and rewards prescribing?

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