For our resident psychologists

[OhioBlue]

Originally Posted by Archaea

After reading these displays, I feel cheated in my education. Even though I spent seven glorious years in college, and have often studied other matters thereafter, much of my day is spent reading over a mundane deed of trust, advising on a joint revocable trust and informing a client that "no, I don't believe you should give all your assets to your stripper daughter so she can hold them for you."

It would have been intellecutally enjoyable to have been a Renaissance man around the turn of the Twentieth Century. The breadth of knowledge of some here is quite simply aweinspiring, from Lebowski's clarity on engineering issues to SIEQ's philosophical understanding, to Jay's and Indy's statistical abilities, it amazes me how people can be aware of so much, that my education barely even touched upon. All we need are som chemists, physicists, a few more computer studs, and we'd be complete. Well not really, but I enjoy the topics discussed.

I vote for some physicists as well. It's been a while since the boards have seen a riveting discussion of string theory.

[RockyBalboa]

Originally Posted by Archaea

After reading these displays, I feel cheated in my education. Even though I spent seven glorious years in college, and have often studied other matters thereafter, much of my day is spent reading over a mundane deed of trust, advising on a joint revocable trust and informing a client that "no, I don't believe you should give all your assets to your stripper daughter so she can hold them for you."

It would have been intellecutally enjoyable to have been a Renaissance man around the turn of the Twentieth Century. The breadth of knowledge of some here is quite simply aweinspiring, from Lebowski's clarity on engineering issues to SIEQ's philosophical understanding, to Jay's and Indy's statistical abilities, it amazes me how people can be aware of so much, that my education barely even touched upon. All we need are som chemists, physicists, a few more computer studs, and we'd be complete. Well not really, but I enjoy the topics discussed.

Agreed. Because I'm pretty much a dumbass.

[Archaea]

Hey, the first time I read Hawkings "A Brief History of Time", it brought clarity to me for all those years I'd studied those things in college. I know it was physics for dummies, but apparently that's what I was, and never knew it.

I'd love to see some discussions of string theories.

SIEQ brings clarity, as do you and Danimal, on issues of humanities and psychology.

I enjoy Mike's discussions of psychiatric issues as well.

Seattle's discussions of ancient Rome and some historical battles fascinate me, but I am unfortunately unable to discuss anything of use to most of you. Unless of course you'd like to know about the Stark Law, Phase II regulations or the Anti-Kickback Statute's safe harbors and proposed Safe Harbors. We could also discuss the unenforceability of restrictive covenants in hospital physician recruitment agreements if you like.

[MikeWaters]

FWIW, almost all the psychiatrists I know that see patients do not do 15min med checks. These MDs are in academic practice (they see patients at the med school) or are voluntary faculty (may not be representative of the community). Also the MD residents here do more indiv psychotherapy than the PhD candidate psychologists.

[OhioBlue]

Originally Posted by MikeWaters

FWIW, almost all the psychiatrists I know that see patients do not do 15min med checks. These MDs are in academic practice (they see patients at the med school) or are voluntary faculty (may not be representative of the community). Also the MD residents here do more indiv psychotherapy than the PhD candidate psychologists.

That would fit my experience as well--psychiatrists in those settings have been the exception in my limited experience. I said I could count them on one hand--that's because they've all been connected in some way to colleges or universities, where I'm guessing they are better able to provide time for patients. And by 'they' I mean the two that I can think of. And to be fair, I was also only speaking to what I've seen--which is obviously just a small snapshot of a much bigger picture. I don't want to claim intimate knowledge with the psychiatric profession. But I do find it interesting to study the history, see that we all started at essentially the same place, and then observe where psychiatry has ended up.

So why are the PhD candidate psychologists doing so little therapy? I mean, that's kind of the point of going into a clinical program. Unless you're talking about the academics-only PhDs. That's odd.

[MikeWaters]

many of my fellow residents would be seeing 5 therapy patients a week in addition to their regular clinical duties. From what I understand the psychology students see less. They are busy doing a group (which we also had to do for a year), doing neuropsych, doing psychological testing, etc.

I had always thought that they did more and was surprised to learn that they did less.

Not every psychiatry dept. is the same. Some probably require little or none. I'm not sure what the minimum is, but I know our program is above the minimum. We were also required to have supervision for therapy, including one year from a psychoanalyst.

And the chairman of our dept. is a molecular biologist.

[OhioBlue]

Originally Posted by MikeWaters

many of my fellow residents would be seeing 5 therapy patients a week in addition to their regular clinical duties. From what I understand the psychology students see less. They are busy doing a group (which we also had to do for a year), doing neuropsych, doing psychological testing, etc.

I had always thought that they did more and was surprised to learn that they did less.

Not every psychiatry dept. is the same. Some probably require little or none. I'm not sure what the minimum is, but I know our program is above the minimum. We were also required to have supervision for therapy, including one year from a psychoanalyst.

And the chairman of our dept. is a molecular biologist.

There are still people out there calling themselves psychoanalysts??

wow that's seriously subpar therapy training for the psychologists, if that's the case (less than 5 hours per week). Is the program APA-accredited? I would imagine a more likely explanation is that the rotation in the site where you're at is one of many that they do or have the option to do. That way they could get the more therapy-intensive practica done elsewhere, and come to your site if they want an inpatient feel with lots of assessment. From the time I was a 2nd year masters student until the end of my pre-doc internship, I did no less than 10 hours/wk of individual, at the least. Usually much more. And that was in addition to groups, assessment, supervision, consultation, outreach, etc. In fact, an issue right now in psychology training is that the post-doc year prior to licensure, where even more hours have to be accrued, is being seen as superfluous because people are graduating with more than ample numbers of hours already.

Interesting.

I would say, based on what little I know from psychiatrists I've worked with or in association with, that your program is in the minority. I respect that, as I think that if people want to specialize in the medical side of things fine, but you ought to at least have the ability to critically evaluate from a broader perspective. Sounds like your program tried to facilitate that.

Btw, I do not mean to imply an attack on your profession per se. We could point out the deficiencies and problems with psychology and I'd be right there. At times I am quite frustrated by my field, kind of a love-hate relationship some days.

What do psychiatrists like yourself and your colleagues think about psychologists getting prescription privileges?

[MikeWaters]

I agree with you that psychologists pursuing prescribing rights is stupid. Mainly because it doesn't differentiate what you do from what I do. And who would choose to see the lesser trained person for meds? It would erase the profession to some degree. Not to mention that I don't think a one semester course is suffiencient to understand comorbid illnesses (physical) and their associated treatments which may interact with psych meds. Recipe for disaster.

My program tries to produce clinicians that aren't into 15 minute med-checks. I think they succeed for the most part.

I think there is a role for medication management practices. If these folks didn't exist, many people would not be able to afford treatment. And a lot of people aren't interested in therapy.

I have a patient that has tried therapy with me and another doc. He just wants the panic attacks to go away (they have). He needs refills. And he couldn't afford 50min therapy anyway.

[OhioBlue]

Originally Posted by MikeWaters

I agree with you that psychologists pursuing prescribing rights is stupid. Mainly because it doesn't differentiate what you do from what I do. And who would choose to see the lesser trained person for meds? It would erase the profession to some degree. Not to mention that I don't think a one semester course is suffiencient to understand comorbid illnesses (physical) and their associated treatments which may interact with psych meds. Recipe for disaster.

Agreed. There are a few compelling arguments here and there for it, but by and large some of my principal concerns are those that you've stated.

Originally Posted by MikeWaters

I think there is a role for medication management practices. If these folks didn't exist, many people would not be able to afford treatment. And a lot of people aren't interested in therapy.

I have a patient that has tried therapy with me and another doc. He just wants the panic attacks to go away (they have). He needs refills. And he couldn't afford 50min therapy anyway.

I agree. We all play for the same team after all, we just often fill different niches and respond to different needs. I don't tend to get feces-smearing severity (although you might be surprised what makes it into even a university counseling center on occasion) and you don't tend to get the 'walking worried' or 'wounded well' so to speak.

I guess I just think if people in my field wanted to be medical doctors, they should have done so. There are those that argue about limited availability of psychiatrists in rural areas, and those that say psychologists would do a better job of it. But in the end I can't ignore that there is a big financial incentive as well that people in my field wish to de-emphasize, but it's still there.

And speaking of money, I know this goes both ways, but I also have clients that don't want to spend any more money on meds as they've been doing for 7 years, and instead give 10-12 sessions a try. In those cases, I think even at $100/hr (unless you're in a setting like mine which is free) it ends up being considerably cheaper. Depends a lot on what people are willing to do.

On a side note, Acceptance and Commitment Therapy is particularly effective for panic attacks among other things I do. I won't call it a specialty yet because I hold myself out as a generalist, but I do tend to have a lot of success with the spectrum of anxiety-related problems and kind of enjoy working with it.

[MikeWaters]

if you specialize in anxiety and are looking to build an academic-research career, you should look into UTSW. Dept. chair is acutely interested in building the anxiety wing.