Comprehensive Psychiatry… Psychiatry and Psychotherapy Combined.
“My doctor prescribed a medication for me. I’ve been on it for 6 weeks, but I’m not feeling any better. Do I need psychotherapy? Would it help?“
These are typical questions for many patients who have been given a medication to treat mental health problems. The answer in almost every case is that psychotherapy is a valuable component of mental health treatment. Comprehensive psychiatry refers to receiving all of your mental health treatment from one provider. Comprehensive psychiatry also tends to use the biopsychosocial model of mental health. This approach integrates medical and organic causes of psychiatric difficulties with the psychological challenges and stressors in one’s social environment. It also enables the provider to gather information from collateral sources when consent is given. Such sources can include former providers, primary care physicians, family members or friends.
What exactly is psychotherapy?
Psychotherapy, also called talk therapy, therapy, or counseling, is not easily described in general statements. It is a process focused on helping you heal and learn more constructive ways to deal with the problems or issues in your life. It can vary depending on the personality of the mental health professional and the patient. In addition, the issues that are being addressed also can affect the therapeutic process.
Current psychotherapy differs significantly from the Hollywood version. Typically, most people see their therapist once a week for about 50 minutes. It is most successful when the individual enters therapy on their own and has a strong desire to change. Most psychotherapy these days is short-term and lasts less than a year. Several common mental disorders tend to respond better to therapy. Examples include depression, anxiety, panic, social anxiety, obsessive compulsive disorder and any other issues that are causing conflict in one’s life. In some cases, medication may need to be added in order for the problem to be fully treated. Once this comprehensive therapeutic relationship has been established, it makes it easier for the patient to return to that provider at some point in the future should a crisis occur.
Is it always better to get my medication and my therapy from the same provider?
There are many reasons, including cost, convenience and decreased need for communication between two individuals, to have one provider do therapy and prescribe medications. This is referred to as a comprehensive approach. Having said that, there are certain situations in which therapy may not be needed. Such situations typically would include when the person has already been in therapy, and is able to recognize that some symptoms are returning and why.
Does it matter who I see as my provider?
The short answer is no. What research does show is that experience and specialization are what matters most. Generally, the more experienced a professional is in a specific topic area, the more likely that person will be able to help you. However, only a psychiatrist can prescribe medications. A psychiatrist has 4 years of medical school and 4 or 5 years of specialty training in both psychiatric medications and psychotherapy. There is ofter confusion between psychiatrists and psychologists. Psychiatrists are “real” doctors and only they, and not psychologists, physician assistants, nurse practitioners or social workers, can prescribe medication. In addition, because they specialize in psychiatric medications, they are familiar with the dosing, the side effects, and the interactions. In addition, a comprehensive psychiatrist will also be able to monitor the patient more frequently.
How long will I need to be on medication?
This answer varies greatly from person to person. It is also the reason why comprehensive psychiatry tends to be more successful. With this approach, one provider is able to see the progress of a patient over the course of therapy, and help determine, along with the patient, when the appropriate time is to taper or stop medication. There are certain disorders, such as schizophrenia or bipolar disorder, where cure is not always realistic. They have been shown to respond to some forms of therapy, but typically do require long term medication. A more appropriate term for these disorders is successful management. There is no reason a person with bipolar disorder, as long as they take their medication, cannot achieve their full potential. Because these disorders tend to last longer and patients frequently benefit from having just one provider, they also are better treated with comprehensive psychiatry.
Is Comprehensive Psychiatry always the best approach?
The short answer to this question is yes. Multiple studies have shown that a combination of psychotherapy and medication prove to be the most effective method of treatment. In addition, psychiatric medications are often needed in order to help the patient engage in psychotherapy. For example, an individual maybe too depressed to talk or have difficulty communicating due to disorganized or racing thoughts.
Cognitive Psychiatry of Chapel Hill is proud to offer Comprehensive Psychiatry to all patients. Please feel free to reach out to us at (919)636-5240 with additional questions or to schedule an appointment.
Dr, Gray, MD