Tuesday, July 12, 2011

Psychotherapy and Psychiatry: Keeping it Alive

This is part of a simultaneous 3 site post.

On Shrink Rap Today over on the Psychology Today website, I talk about how high-volume, rapid-care psychiatry shows us at our absolute worst, and I report on survey results about how psychiatrists in Maryland are practicing--- please be forewarned, this was from an emailed poll and the data was not validated or verified, but it is interesting! 

On Shrink Rap News over on the Clinical Psychiatry News website, I make a case for why psychiatry residents should be required to learn how to do psychotherapy even if they don't plan to practice it when they finish training.  

We really don't even have a precise definition of what "psychotherapy" is, and CPT coding has defined it in terms of time spent in a session and reimbursements.  A 50-minute session gets coded as 90807 which stands for "45-50 minute psychotherapy session with medication management on an outpatient basis in a physician's office."   The frequency doesn't matter, nor does the content of what transpires-- at least not for the CPT codes.  But certainly, not everyone who comes for a 50 minute sessions is actually in a formal insight-oriented psychotherapy.  Good care involves listening to the patient before making decisions about medications, and seeing 4 patients an hour, lined up on a conveyor belt, hour after hour, regardless of the patient's need to talk or the complexity of the case-- is no way practice psychiatry (and I personally wouldn't have the stamina).  Those who do it have bought in to an insurer's idea of how the world should work.    In fact, very few psychiatrists in Maryland reported that they practice this way, even if the media would have you believe that this is the norm in psychiatry.

I like to think of psychotherapy as a process over time where the talking itself is part of what heals.  Certainly there is something about talking openly about things which may be troubling, embarrassing, or leave one feeling vulnerable, which is helpful, particularly in a setting deemed to be safe and free from negative judgment.  From the psychiatrist's point of view, psychotherapy is about looking for patterns in thoughts, feelings, behaviors, or reactions, and bringing these patterns to the patient's awareness in a way that may allow him to change.  

Obviously, I think psychotherapy is important to psychiatry.  
Please do check out the other posts on Shrink Rap News and Shrink Rap Today.

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Thank you for participating in today's 3-ring psychotherapy post!