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Psychotherapy conducted by psychiatrists

May 2004

Position statement 54


Summary

Through its holistic approach and grounding in a bio-psychosocial model, psychotherapy conducted by psychiatrists can help patients to manage mental illness.

Introduction

Psychotherapy is a modality of treatment in which the psychiatrist and patient(s) work together to relieve psychopathological conditions and functional impairment through focus on:

  • the therapeutic relationship
  • the patient’s attitudes, thoughts, affect, and behaviour and
  • the social context and development.

Psychotherapy is based on a number of different theoretical foundations. The most commonly used are cognitive behavioural and psychodynamic therapy, which are derived from psychoanalysis. Psychotherapy may be practised with an individual patient or with a group.

Psychotherapy conducted by psychiatrists centres on a holistic approach to mental illness based on medical training and clinical experience. Patients who require and receive psychotherapy conducted by psychiatrists are ill, often seriously, and are improved by these forms of treatment. They may respond less favourably to alternative short-term treatments.

Psychotherapy within psychiatric treatment

Psychotherapy is a key component of every psychiatric treatment. Psychiatrists are uniquely versed in the clinical conditions that present as mental illness because they are trained in the biological sciences as well as in the social, cultural and interpersonal dimensions of mental illness. Psychiatrists conducting psychotherapy are suitably equipped to treat these clinical conditions. Psychiatric training provides expertise in the relevant developmental and psychodynamic models that address the importance of early infant development and its vicissitudes in the pathogenesis of many forms of mental illness. In particular the early infant vicissitudes of trauma, abuse and disorders of attachment are addressed. A psychodynamic understanding underpins each psychiatric treatment.

Psychotherapy conducted by psychiatrists is distinguished from psychotherapy conducted by other practitioners in that its practitioners have many years of both clinical and medical training combined with a bio-psychosocial perspective on mental health and mental illness. Having both medical and psychiatric training provides a breadth of exposure to severe, complex and co-morbid (medical and psychiatric) conditions not provided by any other training. Medical training enables a psychiatrist to conduct the concurrent treatment of medication and psychotherapy. This is common for severely ill patients and allows optimally integrated treatment that reduces cost.

The need for psychotherapy conducted by psychiatrists

In Australasia and internationally, the cost of mental illness to the community in both human and economic terms is growing. Many psychiatric conditions are complex and severe, and involve significant co-morbidity. Many require psychotherapy, including intensive long-term treatment.

Psychotherapy conducted by psychiatrists provides more effective management of patients with mental illness through its holistic approach and grounding in a bio-psychosocial model. Psychotherapy conducted by psychiatrists depends on verbal and emotional communication, and the interaction and relationship between psychiatrist and patient. The trust established allows for accurate diagnosis together with cooperation in outpatient treatment, concomitant medication and brief hospital admission. Psychiatrists may also arrange involuntary treatment if required. Intensive psychotherapeutic treatment has been shown to diminish symptoms, improve occupational function and personal relationships. People who have received therapy have decreased vulnerability to relapse and their recovery is sustained.

Prolonged psychotherapy in psychiatric illnesses

There are a number of different forms of psychotherapy practiced by psychiatrists. These include supportive psychotherapy, cognitive and behavioural psychotherapy, intensive psychodynamic psychotherapy and psychoanalysis. The therapy may be intensive or brief/focal. These treatments inevitably are complex and demanding of resources, yet are essential to complete the spectrum of patient care. Such treatments can be either life saving or the only viable treatment for the patient.

Psychotherapy is an important component of the overall treatment for the low prevalence disorders such as schizophrenia and bipolar disorder. Equally, psychotherapy is an important component of the treatment of high prevalence disorders such as anxiety, depression and substance abuse. These disorders often occur at a time when individuals are establishing their own families and the potential for trans-generational transmission of mental health problems is maximal. The high prevalence disorders may be as debilitating as the psychoses.

The position of the College

The College is committed to the promotion of mental health and the prevention of mental illness; to working always in alliance with consumers and carers and to engaging with and educating the broader community. The College endorses best clinical practice and evidence based medicine. The principles and practices of psychotherapy conducted by psychiatrists are underpinned by the two central principles of the National Mental Health Strategy guidelines that define Mental Health Practice Standards:

  • Mental Health practitioners need to learn about and value the lived experience of consumers, family members and /or carers.
  • Mental Health practitioners should recognise and value the healing potential in the relationship between the consumer and service provider.

The College training requirements address the complexity of the discipline of psychiatry by including the teaching of a number of different subspecialty areas and treatment methods. The requirements provide for a broad training in general psychiatry, together with a foundation in psychotherapy. Accordingly, all psychiatrists are trained to use psychotherapy; it is embedded in their basic training as a core skill. In addition, within the Section of Psychotherapy, advanced training in psychotherapy is available as a sub-speciality.

 


Disclaimer: This information is intended to provide general guidance to practitioners, and should not be relied on as a substitute for proper assessment with respect to the merits of each case and the needs of the patient. The RANZCP endeavours to ensure that information is accurate and current at the time of preparation, but takes no responsibility for matters arising from changed circumstances, information or material that may have become subsequently available.