A few Spo-fans – and coworkers – sent me an article from The New York Times. It was about the changing role of psychiatrists. The senders are curious to hear what I think about this topic.

Once upon a time psychiatrists were ‘listeners’ . Their patients talked for an hour, usually once a week but sometimes 3x a week, if they were in analysis. Your shrink knew you better than anyone else. You were an individual.

Nowadays most psychiatrists see people for 15 minutes in what’s called a ‘medication check ups’. If a patient is in counseling, it is provided by a social worker or psychologist. Even where I work I hear the receptionist screening new patients with statements like “Are you looking for a psychiatrist or someone to talk to?”

I can speak on behalf of my colleagues: we generally loathe the ‘split‘ of Rx from one and counseling by another. Most shrinks would rather do counseling and medication; it makes sense to have these combined with one mental health professional. Not a psychiatric journal goes by without another article bemoaning the demise of psychiatrists providing therapy.

I miss being an analyst – it is far more interesting to work on a person’s psyche and Life Journey than manage the pills. I hardly know my patients anymore. At times it makes me sad how much of my training is no longer being used – or wanted.

Economics is the bottom line. Insurance companies are not willing to reinburse a psychiatrist for counseling when it can be done cheaper by a social worker. Everyone allows this – both the doctor and the patient. Most psychiatrists earn far more seeing four ‘medication management’ patients than one therapy case.

Psychotherapy is a craft that can be done by a variety of mental health persons. My two best counselors were a psychologist and a social worker. My two worst? Both were psychiatrists. If psychiatrists really wanted to retain talk therapy patients they would charge competitive rates. But few are willing to do so. Therapy rates compatible to a social worker’s are far less than medication check ups.

Another aspect is a psychiatrist can prescribe Rx and there is such a demand for this. My own bosses want me to do evaluations and med-checks, not therapy. They get more money out of this service.

Psychiatrists historically used hour long talk treatments as there was little more else to provide. Psychiatry is slowly evolving into neurology.

How ironic – psychiatrist are becoming more like ‘real doctors’ who struggle with quick check ups, medication oriented – and no time really to talk or listen.

Not a work day goes by when my analytical therapy training is not put to use. I constantly open my mouth and some insight or comment hits a bull’s eye. Ofttimes this is more therapeutic than the prescription.

Because of this, I don’t loose hope. So long as people have a need to talk to someone, I will listen. And I will do what I can in 15 minutes (or less) while simultaneously managing their prescriptions.

 

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