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      The Place of Psychotherapy in Contemporary Psychiatry

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          Abstract

          Psychotherapy has long been an essential component of clinical psychiatry and many young physicians choose to train in psychiatry residency programs in order to acquire necessary knowledge and skills, and become competent psychotherapists. Recent advances in psychopharmacology and neuroscience, and growing dominance of managed care and evidence-based medicine have had dramatic impacts on health care delivery systems and clinical psychiatry practice. Despite these changes in the field of mental health, psychotherapy still remains a crucial part of clinical psychiatry and comprises a great proportion of psychiatrists’ clinical practice. Hence, accreditation agencies and regulatory bodies determine compulsory minimum requirements for psychiatry residency programs to ensure that residents, at the end of their specialty training, can demonstrate competence in managing their patients through applying different approaches of psychotherapy.

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          National survey of psychotherapy training in psychiatry, psychology, and social work.

          Myrna M Weissman, Helen Verdeli, Marc J Gameroff … (2006)
          Approximately 3% of the US population receives psychotherapy each year from psychiatrists, psychologists, or social workers. A modest number of psychotherapies are evidence-based therapy (EBT) in that they have been defined in manuals and found efficacious in at least 2 controlled clinical trials with random assignment that include a control condition of psychotherapy, placebo, pill, or other treatment and samples of sufficient power with well-characterized patients. Few practitioners use EBT. To determine the amount of EBT taught in accredited training programs in psychiatry, psychology (PhD and PsyD), and social work and to note whether the training was elective or required and presented as a didactic (coursework) or clinical supervision. A cross-sectional survey of a probability sample of all accredited training programs in psychiatry, psychology, and social work in the United States. Responders included training directors (or their designates) from 221 programs (73 in psychiatry, 63 in PhD clinical psychology, 21 in PsyD psychology, and 64 in master's-level social work). The overall response rate was 73.7%. Main Outcome Measure Requiring both a didactic and clinical supervision in an EBT. Although programs offered electives in EBT and non-EBT, few required both a didactic and clinical supervision in EBT, and most required training was non-EBT. Psychiatry required coursework and clinical supervision in the largest percentage of EBT (28.1%). Cognitive behavioral therapy was the EBT most frequently offered and required as a didactic in all 3 disciplines. More than 90% of the psychiatry training programs were complying with the new cognitive behavior therapy requirement. The 2 disciplines with the largest number of students and emphasis on clinical training-professional clinical psychology (PsyD) and social work-had the largest percentage of programs (67.3% and 61.7%, respectively) not requiring a didactic and clinical supervision in any EBT. There is a considerable gap between research evidence for psychotherapy and clinical training. Until the training programs in the major disciplines providing psychotherapy increase training in EBT, the gap between research evidence and clinical practice will remain.
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            National trends in psychotherapy by office-based psychiatrists.

            Mark Olfson, Ramin Mojtabai (2008)
            In addition to prescribing medications, providing psychotherapy has long been a defining characteristic of the practice of clinical psychiatry. However, there are indications that the role of psychiatrists in providing psychotherapy may have diminished in recent years. To examine recent national trends in the provision of psychotherapy by office-based psychiatrists. Data from the 1996 through 2005 cross-sectional National Ambulatory Medical Care Survey were analyzed to examine trends in psychotherapy provision within nationally representative samples of visits to office-based psychiatrists. Multivariate analyses examined the time trend, adjusting for patient, visit, and setting characteristics. Practice-level analyses examined time trends in the percentage of psychiatrists who provided psychotherapy to all, some, or none of their patients during a typical week. Office-based psychiatry practices in the United States. Patients with psychiatric diagnoses visiting outpatient psychiatrists. Provision of psychotherapy in visits longer than 30 minutes. Psychotherapy was provided in 5597 of 14,108 visits (34.0% [weighted]) sampled during a 10-year period. The percentage of visits involving psychotherapy declined from 44.4% in 1996-1997 to 28.9% in 2004-2005 (P < .001). This decline coincided with changes in reimbursement, increases in managed care, and growth in the prescription of medications. At the practice level, the decrease in providing psychotherapy corresponded with a decline in the number of psychiatrists who provided psychotherapy to all of their patients from 19.1% in 1996-1997 to 10.8% in 2004-2005 (P = .001). Psychiatrists who provided psychotherapy to all of their patients relied more extensively on self-pay patients, had fewer managed-care visits, and prescribed medications in fewer of their visits compared with psychiatrists who provided psychotherapy less often. There has been a recent significant decline in the provision of psychotherapy by psychiatrists in the United States. This trend is attributable to a decrease in the number of psychiatrists specializing in psychotherapy and a corresponding increase in those specializing in pharmacotherapy--changes that were likely motivated by financial incentives and growth in psychopharmacological treatments in recent years.
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              Psychotherapy in the era of evidence-based medicine

              Vladan Starcevic (2003)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Iran J Psychiatry Behav Sci
                Journal ID (iso-abbrev): Iran J Psychiatry Behav Sci
                Journal ID (publisher-id): IJPBS
                Title: Iranian Journal of Psychiatry and Behavioral Sciences
                Publisher: Mazandaran University of Medical Sciences (Sari, Iran )
                ISSN (Print): 1735-8639
                ISSN (Electronic): 1735-9287
                Publication date (Print): Winter 2014
                Volume: 8
                Issue: 4
                Pages: 1-6
                Affiliations
                [1 ]Psychiatrist, Iranian Psychiatric Association, Tehran, Iran.
                Author notes
                [● ]Corresponding author: Saman Tavakoli, Iranian Psychiatric Association, Unit 7, Number 2, East 21st St, Azadegan Ave, Kordestan Highway, Tehran, Iran, Tel: +98 2188336726, Fax:+98 2188633240, Email: samantavakoli@gmail.com
                Article
                Publisher ID: ijpbs-8-001
                PMC ID: 4364470
                SO-VID: dc05a3ce-b1c4-444b-aeb3-049fdd4ff92e
                Copyright © © 2014, Iranian Journal of Psychiatry and Behavioral Sciences
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, ( http://creativecommons.org/licenses/by/3.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Subject: Editorial

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