COMMENTARY

What Does Return to In-Person Psychiatry Mean for You?

Drew Ramsey, MD

Disclosures

August 02, 2021

This transcript has been edited for clarity.

 Welcome back to the Brain Food vlog. I'm Dr Drew Ramsey, an assistant clinical professor of psychiatry at Columbia University, founder of the Brain Food Clinic, and host of this vlog, where we discuss what's going on with nutritional psychiatry, clinical practice, and mental health.

I've been trying to make a vlog post for what seems like a couple of months about what many of us are doing, transitioning back to practicing in person. Personally, I was practicing a mix of about 25% telepsychiatry and the rest in person. With the pandemic, that changed into 14 months of complete telepsychiatry. In the midst of that, there were also a lot of changes in my own personal therapy. I know a lovely, older Upper West Side psychoanalyst who didn't think he was going to do this video therapy thing. Now, a year later, he's not going to go back into the office at all. This has really changed our field, obviously.

What I've been wanting to talk about is the effect of that transition on us as clinicians. I've made lots of videos about how, before I went back in to see my first patient in person, I was in some ways both nervous and excited. Then, as I began seeing my patients in person back in New York, it hit me that we've all been doing this for a long time. It felt very normal and very natural.

But there were still a few things I was trying to figure out. What struck me is that I was asking the wrong question: What's better? Is it better to see patients by video? Perhaps it's more convenient or accessible. Or is it worse? You might think, Gosh, it gets really annoying talking to this screen forever, and there's something about being with people that feels better for a lot of patients, but not for some.

Adjusting the Frame

I realized that what's missing from the conversation — which is surprising because it's one of my favorite terms to talk about in supervision and as I think about treatment — is "the frame." As many of us shift frames to this mixed model of seeing some people by video and some in person, it really adds a new element. A few of the patients I saw in person were visibly more anxious to see me.

There has been a disruption. So many of you have been working hard to create good frames in a digital space. After essentially being forced by circumstance to see more patients in this way, I think a lot of us noticed that we had to find ways to not only get used to it, but to also get good at it. Something really shifted as a result of that. Treatments got deeper and better, at least more so than they were at the beginning of the pandemic.

So, as you're considering your own work and your own transitions, I would just ask that, first, you keep taking care of your mental health. Clinicians are burned out like every other healthcare provider out there. Think about your frame and some of these transitions. In my experience, at least, they haven't been as simple as I thought. I was thinking that getting back in person was going to be better. Then I realized it disrupted some treatments. And some treatments were doing really well, and for whatever reason (eg, geographic changes), they weren't going to easily go back to being in person.

I'm curious to hear how the concept of frame is affecting you and your clinical work as you transition back into seeing people in person or have decided to stay all digital. Let's keep the conversation going.

Thanks so much for your time and attention. Take good care of your own mental health and keep taking good care of everybody else's.

I'm Dr Drew Ramsey. I'll see you next time.

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