Magazine article Clinical Psychiatry News

Working with Psychotherapists Now Important in Physician

Magazine article Clinical Psychiatry News

Working with Psychotherapists Now Important in Physician

Article excerpt

SAN FRANCISCO -- In psychiatry, the thinking has changed on working with psychotherapists who lack medical degrees, according to Dr. John Q. Young.

Dr. Young, a psychiatrist with the University of California, San Francisco, said knowing how to collaborate with doctorate- or masters-level psychotherapists is an increasingly important skill.

Years ago, not only was the emphasis on treatment by the medical doctor, but the physician often showed undisguised hostility to other clinicians, Dr. Young said at a meeting on depression research and treatment sponsored by the university. Some psychiatrists framed these issues in ethical terms. For example, a survey of psychiatrists in the 1980s showed that fully two-thirds believed that it was unethical to collaborate with non-MD therapists, he said.

More recent models of interactions between psychiatrists and psychotherapists emphasize relationships that are supervisory, consultative, or collaborative.

In a typical collaborative scenario, the psychiatrist manages the patient's medications while the other clinician--a psychologist, a clinical social worker, or a marriage and family therapist--provides psychotherapy.

Other, more complex scenarios also are possible. For example, while the psychiatrist provides pharmacotherapy, one therapist might provide group dialectical-behavior therapy, another therapist might provide individual therapy, a neurologist might treat the patient's complicated migraines, and a primary care physician or specialist might treat the patient's chronic fibromyalgia pain.

Even the typical scenario sets up complicated triangular patterns of transference and counter transference. Still, Dr. Young offered several tips aimed at making such collaborations pleasant and therapeutically fruitful.

Dr. Young recommended establishing a written or oral contract with the patient and the other clinician at the beginning of therapy. At the Langley Porter Psychiatric Hospital and Clinics, where Dr. …

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