Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Psychiatry residents need to learn psychotherapy

Dinah Miller, MD
Education
August 1, 2011
40 Shares
Share
Tweet
Share

For years, I supervised residents. They would come in each week and tell me about a patient in crisis. If no one was in crisis, they’d say all their patients were fine and they didn’t know what to talk about, even though I had told them to pick a patient they saw weekly and either audio-record the sessions or take detailed process notes. Psychotherapy, I would say, is a process that occurs over time; it’s not always about the latest crisis. I once inspired a resident to record some sessions, but they were difficult to hear, and another resident took process notes, but those two were the exceptions.

I thought it was me, so I asked some other psychiatrists for suggestions. A psychoanalyst told me the residents were anxious about having their work scrutinized and I should address the anxiety. It seemed like a great idea, but it didn’t work. Another colleague suggested I tell them if they didn’t bring process notes, I would tell their training director. This tactic just didn’t feel right. Even the residents who were interested in learning psychotherapy were not seeing patients weekly, and one told me they were just too busy for regular psychotherapy sessions.

I finally realized that it wasn’t me. The residents were not primed to understand or do psychotherapy, and I was catching them too far along in the process. Many have no interest in ever seeing a patient for psychotherapy, and they’ve bought in to the idea that psychiatrists “manage meds.”

I believe that people in general, and psychiatrists in particular, should do what they like doing. I don’t believe that every psychiatrist in every setting needs to practice psychotherapy, and even if I did, no one would listen. I do, however, think that every resident should learn to do traditional (and I suppose that means psychodynamically-based) psychotherapy, even if they never plan to see another therapy patient after their training is complete. Let me tell you why I believe that:

  • Psychotherapy is a fundamental component in the treatment of mental illnesses. Psychiatrists should have a good understanding of what psychotherapy is, how it is done, what problems it treats effectively, what problems it does not address well, and what types of issues may come up in the course of a psychotherapy. It’s not just about symptoms and diagnoses — just as we don’t know whose depression will lift with Prozac and who will develop a discontinuation syndrome after stopping Paxil, the outcome of psychotherapy remains unpredictable and residents should treat a variety of patients in order to appreciate the variables that influence outcomes. I don’t believe this is something one can learn from a textbook.
  • Learning to do psychotherapy well prepares psychiatrists for interactions that will occur with patients outside of a traditional psychotherapy. It helps psychiatrists to learn the importance of active listening and understanding unspoken components of interactions, and these are important during even brief appointments.
  • There is a vocal (and growing) body of patients and ex-patients who feel they have been harmed by psychiatric treatments. It may be that patients who meet with psychiatrists for brief, time-pressured encounters are more likely to feel victimized by psychiatric treatments. The media feeds this anti-psychiatry frenzy when it portrays psychiatrists as being all about medications. Psychiatrists are no longer seen as being interested and caring, and this is not good for our profession.
  • When treatment is focused solely on diagnosis, symptoms, and medications, it leads psychiatrists to make decisions with tunnel vision. It further encourages patients to identify their symptoms as the result of illness and inadequate, or suboptimal, medication management and it leaves some patients to believe they have no ability to modify their own feelings or behaviors. Since most psychiatric symptoms are also part of the normal human experience in the absence of psychiatric illness, an understanding of the psyche on a richer level gives the psychiatrist a better understanding of how to approach human suffering and how to differentiate these experiences from psychiatric disorders.
  • What happens in psychotherapy can certainly influence the course of treatment.  A psychiatrist who is not trained in psychotherapy can not judge whether the therapy provided by other mental health professionals is adequate or appropriate and is certainly not able to direct treatment.
  • Good therapeutic skills enhance the therapeutic alliance and this may well improve both adherence to medication regimens and treatment outcomes.
  • There continues to be a demand for well-trained psychiatrists who can provide both psychotherapy and medications.

In case you’re wondering, the Accreditation Council on Graduate Medical Education program requirements for psychiatry is 35 pages long. The words “psychotherapy” and “psychotherapies” appear a total of four times.

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

Prev

KevinMD speaks at Plain Talk in Complex Times

August 1, 2011 Kevin 0
…
Next

Improving the relationship between intern and nurse

August 1, 2011 Kevin 4
…

Tagged as: Residency, Specialist

Post navigation

< Previous Post
KevinMD speaks at Plain Talk in Complex Times
Next Post >
Improving the relationship between intern and nurse

More by Dinah Miller, MD

  • What do physician coaches do, and what can they do for you?

    Dinah Miller, MD
  • a desk with keyboard and ipad with the kevinmd logo

    There is no oversight for prior authorizations. There should be.

    Dinah Miller, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Why psychiatrists don’t take insurance

    Dinah Miller, MD

More in Education

  • The role of income in medical school acceptance

    Carter Do
  • Balancing tension and kindness in medical education

    Chloe N. L. Lee, MD, MPH
  • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

    Nandini Erodula
  • A chance encounter in Chicago: lessons in compassionate medicine

    Emily S. Hagen
  • Business education’s role in preventing physician practice decline

    Curtis G. Graham, MD
  • The impact of assumptions on patient communication in medical training

    Esther Covington
  • Most Popular

  • Past Week

    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Unveiling excessive medical billing and greed

      Amol Saxena, DPM, MPH | Policy
    • Bitcoin’s role in diversified portfolios [PODCAST]

      The Podcast by KevinMD | Podcast
    • Dying is a selfish business

      Nancie Wiseman Attwater | Conditions
    • Navigating medical decision-making: Embracing limits and growth

      Benjamin Wade Frush, MD | Physician
    • Empathy and compassion in palliative care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Navigating the broken medical system: challenges faced by foreign medical graduates

      Anonymous | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • The essence of medicine: genuine connections in practice

      Jennifer Tillman, MD | Physician
  • Recent Posts

    • Bitcoin’s role in diversified portfolios [PODCAST]

      The Podcast by KevinMD | Podcast
    • 1 in 5 doctors will become disabled. Are you prepared?

      Amarish Dave, DO | Finance
    • The pros and cons of whole life insurance for high-income earners

      Shane Tenny, CFP | Finance
    • Family support is pivotal in the treatment of schizophrenia

      Frank Chen, MD | Conditions
    • Is emergency medicine your calling? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Exploring disfigurement and self-worth

      Kathleen Watt | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 2 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • CDC Advisors Endorse Maternal RSV Vax to Protect Newborns
  • Amoxicillin Alone for Acute Sinusitis Holds Up Against Broad-Spectrum Cousin
  • Despite Taboo, Med Students, Doctors Use Substances Too
  • White House Opens Gun Violence Prevention Office
  • Nurses Step Up to Bat on Educating Patients About Climate Change

Meeting Coverage

  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • AI Has an Image Problem in Healthcare, Expert Says
  • Want Better Health Outcomes? Check Out What Other Countries Do
  • ERS Roundup: Cell Transplant Boosts Lung Function in COPD Patients
  • Most Popular

  • Past Week

    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • Unveiling excessive medical billing and greed

      Amol Saxena, DPM, MPH | Policy
    • Bitcoin’s role in diversified portfolios [PODCAST]

      The Podcast by KevinMD | Podcast
    • Dying is a selfish business

      Nancie Wiseman Attwater | Conditions
    • Navigating medical decision-making: Embracing limits and growth

      Benjamin Wade Frush, MD | Physician
    • Empathy and compassion in palliative care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Navigating the broken medical system: challenges faced by foreign medical graduates

      Anonymous | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • The essence of medicine: genuine connections in practice

      Jennifer Tillman, MD | Physician
  • Recent Posts

    • Bitcoin’s role in diversified portfolios [PODCAST]

      The Podcast by KevinMD | Podcast
    • 1 in 5 doctors will become disabled. Are you prepared?

      Amarish Dave, DO | Finance
    • The pros and cons of whole life insurance for high-income earners

      Shane Tenny, CFP | Finance
    • Family support is pivotal in the treatment of schizophrenia

      Frank Chen, MD | Conditions
    • Is emergency medicine your calling? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Exploring disfigurement and self-worth

      Kathleen Watt | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Psychiatry residents need to learn psychotherapy
2 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...