My new patients often volunteer that they understand I only prescribe meds and they will seek a therapist elsewhere. It is a stark reminder of how psychiatry and therapy have become so dissociated from each other. This is so ironic as therapy used to be the core of psychiatry.
Our training in psychiatry is comprehensive and not limited to prescribing medications. The curriculum covers training in a vast variety of treatment modalities, including psychotherapy.
Some patients live with anxiety and depression for several years before they reach out to psychiatrists. There is fear that they will be put on medication as psychotherapy is perhaps not instinctively associated with psychiatrists now. Both reasons are not surprising as there is a lot of misinformation about psychotropics out there and psychiatrists have very limited time and resources to do therapy thus less likely to do it.
For the benefit of patients, it is time to reset the narrative and emphasize that meds and therapy are indeed core trainings of psychiatry. Programs vary in therapy trainings during residency but majority receive robust training in the more common modalities such as CBT, DBT, supportive therapy, ACT, and psychodynamic psychotherapy. We, as a profession, need to introspect how far away we have moved away from psychotherapy as a profession.
However, there are a number of us who do psychotherapy. There are different psychiatric treatment modalities such as individual psychotherapy, group therapy, family therapy, ECT, TMS, DBS, biofeedback, EMDR, etc. that we employ depending on the patient’s presentation.
I regularly incorporate trauma-informed interventions, supportive psychotherapy, psychodynamic psychotherapy, existential therapy, DBT, informal mindfulness, problem-solving etc. during our sessions.
Psychiatrists have come to be boxed into this role of only prescribing meds perhaps due to the huge shortage of psychiatrists in the US. Most psychiatrists I know have heavy caseloads, thus very less ability to devote to longer and more frequent therapy sessions. However, a good number of psychiatrists still do therapy routinely.
So, please reach out for psychiatric treatment as soon as you need it. Discuss your treatment preferences during the initial visit with your psychiatrist, ask questions, and hear what the recommendations are. Discuss with your psychiatrist if you want to try therapy first and if your psychiatrist can do it. Some may say no but others may say yes. If no, request a referral to a therapist. Most places should at least be able to give you a list of therapists in your area.
So, yes, psychiatrists very much do therapy, even if the numbers are fewer than those who don’t. Do not hesitate to reach out to a psychiatrist even if you do not want to start meds and want to explore therapy first. Effective comprehensive psychiatric care is much more than just medication management.
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