Shirah Vollmer MD

The Musings of Dr. Vollmer

Teaching Psychotherapy

Posted by Dr. Vollmer on April 27, 2015

 

Do Psychiatrists need to learn Psychotherapy? This is the nagging question which focuses this blog. My answer is that yes, all psychiatrists, need to learn psychotherapy so that they can understand self-sabotaging behaviors such that when medications do not work,  when neuromodulation techniques do not work, then there is another framework in which to conceptualize human suffering. This alternative framework involves recognizing the importance of childhood relationships on adult mental frameworks. Privileging early developmental experiences as important aspects of “here and now” problems allows the therapist and the patient to deeply explore how the past impacts the present. If Psychiatric Residencies eliminate psychotherapy training then the toolbox narrows such that the field of psychiatry will be so focused on biological interventions that the vast majority of folks who have anxieties and chronic suffering will not benefit from the work of a psychiatrist. This narrowing of the field is my deep fear, not for myself or for my practice, but for my students who are entering into a world of huge student debt, along with tools which mainly focus on medication and neuromodulation. It is watching these students hatch from a University cocoon into the world that I shutter to think about the future of my profession. It is not that there are not exceptional young psychiatrists, but the majority are tuned to play very few instruments. Like a surgeon who does not emphasize physical therapy as an intervention, the future psychiatrist could limit him/herself to tools which help only a minority of patients. A surgeon should understand the benefits and limits of physical therapy, as the psychiatrist should understand the benefits and limitations of psychotherapy. However, a surgeon does not need to become a physical therapist to grasp the field, but the psychiatrist does need to do in-depth psychotherapy to appreciate the depth of human experience. The rant continues.

6 Responses to “Teaching Psychotherapy”

  1. Bravo…bring on the rant. I agree with your statement “This alternative framework involves recognizing the importance of childhood relationships on adult mental frameworks. Privileging early developmental experiences as important aspects of “here and now” problems allows the therapist and the patient to deeply explore how the past impacts the present.” All too often I find clinicians stuck on labels or discount cultural norms as neurosis. Psychiatrists trained in psychotherapy and possess warm bedside manners probably would make a different in overall patient well being

    • Hello Varigated Stacks and welcome to my blog. I agrees. Overall well-being is often missed with the emphasis on diagnosis and medication management or neuromodulation. Thanks.!

  2. Shelly said

    Oh my. Of COURSE psychiatrists need to learn psychotherapy! Medication and neuromodulation techniques are relatively modern solutions to mental angst, aren’t they? Wasn’t psychotherapy the first tool used? It seems such a shame that young psychiatrists jump with the medication first and don’t try to understand their patients or their problems.

    • Yes. Sadly though psychotherapy is slowly fading away from many psychiatric residencies and as such, a new generation of psychiatrists will have a very narrow professional experience, and likewise, patients will search for other resources, outside of psychiatry to alleviate their suffering. At the moment, that is the landscape of my field. Sad.

  3. I agree with you Shelly and also kind of surprised that psychotherapy and psychiatry practices aren’t more interrelated. Everyone knows that medicine plays a small part in overall wellness. Learning the tools to cope/manage long term illness is where therapy comes into play.

    • Yes. When I trianed psychiatrists were in the unique position to help patients cope with both mental and physical illness. As our tools become more narrowly focused, my field has become limited in its utility, despite the fact that advances in medication and neuromodulation offer the promise of a wider tool box. Thanks.

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