Psychiatrists are the only mental health practitioners qualified to provide psychotherapy and medication treatment. While most psychiatrists in Charlotte, NC limit their practice to psychopharmacology (treatment with medication), and this may have colored your view of psychiatrists, it may well be worth your while to consult with a psychiatrist who is adept at providing psychotherapy as well as medication management.
Even if you are not looking to be on medication there are good reasons to consider seeing a psychiatrist for psychotherapy. In general a psychiatrist who is well trained in psychotherapy has a broader and deeper exposure to the types of mental health problems people experience than do other mental health professionals. Also, at times what seems to be a mental health problem turns out to be a medical problem with mental health symptoms. A psychiatrist, because of his or her medical training, is more likely to recognize it than a non-medical therapist. For people who have medical problems, therapy with a psychiatrist may be just what you are looking for: Someone with a good understanding not only of the medical problem but also of the real life problems and emotional challenges encountered with illness.
Often people enter therapy with a social worker, psychologist or counselor only to be referred to a physician for medication (a practice known as "Split Treatment"). This is a good recipe to end up on medication that might not be needed. If the doctor has only a hammer (the psychiatrist who only provides medication) you, the patient, are more likely to have a hammer used than if the doctor is skilled in the use of several tools and can choose which would be best for your situation. Furthermore, in this situation the therapist doesn't know much about medication and the doctor, who will spend and hour- and likely less- with you will know even less about you. With a psychiatrist providing psychotherapy you don't have to get to know two different practitioners and wonder how well they are communicating. (In fact, you would be surprised how poor communication can often be in split treatments). Therapy with a psychiatrist allows therapy and assessment for medication to unfold together. This ongoing close work with a psychiatrist can avoid unnecessary use of medication.
At the other end of the spectrum, a therapist may not recognize the need for medication, or may be uncertain and delay referral resulting in a prolonged and therefore more expensive treatment. With a psychiatrist as therapist any uncertainties about medication can be addressed without delays or having to wait to get yet another appointment.
When medication is needed, studies have shown that psychotherapy and medication provided by one practitioner (a psychiatrist) results in improvement over a fewer number of visits than when a psychiatrist (or other physician) provides medication and the patient sees someone else for psychotherapy (an arrangement known as split treatment). Unfortunatley, in a split treatment the reports of another competent practitioner to a psychiatrist do not fully duplicate what is learned directly from interactions between patient and psychiatrist during psychotherapy visits.
A psychiatrist's fees are generally, but not always, higher than those of non-medical mental health providers. This reflects the much longer and extensive training psychiatrists receive (eight years for an adult psychiatrist and ten years for a child and adolescent psychiatrist) in assessing and treating medical, psychiatric and psychological problems. Some studies have shown that the overall expense of seeing a psychiatrist who provides psychotherapy may in fact be less due to the fewer total number of visits needed with "one-stop treatment" versus split treatment.
Warren J. Steinmuller,MD Child, Adolescent, and Adult Psychiatry and Psychotherapy 225 E. Kingston Avenue Charlotte, North Carolina 28203 704 376-7654
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