Psychotherapy from the psychiatrist’s point of view

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 check out the other posts on Shrink Rap News and Shrink Rap Today for other takes on the issue

Dinah Miller is a psychiatrist who blogs at Shrink Rap and co-author of Shrink Rap: Three Psychiatrists Explain Their Work.

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