Psychotherapists can be incredibly helpful for patients struggling with their mood, anxiety, life circumstances and stressors. Patients typically meet with therapists weekly or biweekly, and regular appointments in this fashion can help to create a positive rapport, where individuals are more likely to open up about sensitive topics and struggles. If someone has a history of trauma, is engaging in self-destructive behaviors, or has very dark thoughts, their openness to discuss with a mental health provider can be lifesaving. Frequent visits and a strong rapport, can also create a sense of accountability. For instance, if a patient tends to isolate when feeling depressed, having to check in with someone regularly who asks about time spent with family or friends, or who gently encourages a patient to make an effort to be more social, can be extremely beneficial. This accountability can also be utilized to decrease alcohol or other self-destructive behaviors, to increase exercise, to improve diet, to practice yoga or mindfulness, and in countless other ways. Psychotherapy can create long-term change and self-improvement. Skills to improve distress tolerance and cope can be long-lasting. Having regular visits with a psychotherapist, can also be incredibly helpful for monitoring of psychiatric symptoms. For example, if a patient has a history of suicidal thoughts, they may be more likely to open up about their recurrence, if they are consistently working with someone whom they trust and have a therapeutic relationship with. In this manner, therapists can be incredibly helpful for recommending or encouraging a higher level of care (or a sooner visit with a patient’s psychiatrist), during times when they’re needed.
If a patient has moderate or severe psychiatric symptoms, I will 100% of the time recommend a full mental health evaluation with a psychiatrist as a patient’s first step. A psychiatric evaluation should include not only a screening for psychiatric conditions such as Major Depressive Disorder, Bipolar Affective Disorder, various Anxiety Disorders and Schizophrenia, but also a full medical history. When someone has significant symptoms that are related to a medical condition, and if that medical condition is not identified, a patient’s outcome will likely be poor; in these cases, long-term therapy (without a psychiatrist’s involvement) could delay proper medical diagnosis and care. It is not uncommon for a patient to believe that they have “textbook” depression or anxiety, when in-fact, anemia, a thyroid condition, a new cardiac medication, endometriosis, irritable bowel syndrome, hormonal fluctuations, a neurological illness (like multiple sclerosis or parkinson’s disease), an auto-immune disorder (like lupus or sjrogren’s) or even a mass in someone’s central nervous system are the root cause. Additionally, if someone is in their 30’s or older, with new-onset psychiatric symptoms (that were never experienced earlier in life), I would argue that an evaluation with a psychiatrist (as opposed to a psychotherapist) is not just recommended, but required.
Psychiatrists are trained in both psychotherapy and medicine. They typically have 4 years of college (with biology, organic chemistry, physics and other “pre-med” requirements), 4 years of medical school, a one-year internship in internal medicine or general surgery and then 3 additional years of training in diagnosing and treating mental illness. Rotations are required in not only general medicine, but pediatrics, OGBYN, surgery, emergency medicine, cardiology, neurology and others. Psychiatrists also have training in psychotherapy (albeit, I will be the first to admit, that a doctoral level psychologist (PhD or PsyD) has significantly more experience in psychotherapy than a psychiatrist). All this to say, that as Psychiatrists have training in Mental Health, General Medicine and Psychotherapy, they are the best “first stop” for an evaluation and formulation of a comprehensive treatment plan for a patient struggling with Anxiety, Depression or other psychiatric symptoms.
Finally, studies show that when treating psychiatric illness, therapy works better than no treatment, medications work better than therapy alone, and medication plus psychotherapy works better than medication alone. If a patient has mild illness, starting with therapy is completely reasonable. However, if someone has significant symptoms, medication may be needed to safely decrease an individual’s distress, and a provider trained in both psychotherapy and medication management (a psychiatrist) would typically be the most qualified person to formulate that plan.
Psychiatrists should work closely with a patient’s psychotherapist (and vice-a-versa) to coordinate care. As mentioned, psychotherapists spend more time with their patients (having longer and more frequent appointments) and they tend to be more up-to-date with a patient’s specific stressors and life-circumstances. They may also have a better understanding of a patient’s temperamental vulnerabilities, and even have helpful insight regarding a patient’s response to a psychiatric medication trial. Similar to obtaining history from a family member or significant other, sometimes these second opinions from psychotherapists, can be incredibly fruitful. This is why the prescribers at Rittenhouse Psychiatric Associates go out of their way, to have frequent check-ins and collaboration session with a patient’s psychotherapist.
