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Though psychiatric residents are expected to be competent psychotherapists on graduation, further growth in skill and versatility requires continued experience in their ongoing career. Maturity as a psychotherapist is essential because a psychiatrist is the only mental health provider who, as a physician, can assume full responsibility for biopsychosocial patient care and roles as supervisor, consultant, and team leader.
Graduating residents face an environment in which surveys show a steady and alarming decline in practice of psychotherapy by psychiatrists, along with a decline in job satisfaction. High educational debts, practice structures, intrusive management, and reimbursement policies that devalue psychotherapy discourage early career psychiatrists from a practice style that enables providing it. For the early-career psychiatrist there is thus the serious risk of being unable to develop a critical mass of experience or a secure identity as a psychiatric psychotherapist.
Implementation of parity laws and the Affordable Care Act (ACA) will affect the situation in unpredictable ways that call for vigilance and active response. Additional service and administrative demands may result from the ACA, creating ethical dilemmas about meeting urgent patient needs versus biopsychosocial standards of care.
The authors recommend 1) vigorous advocacy for better payment levels for psychotherapy and freedom from disruptive management; 2) aggressive action against violations of the parity act, 3) active preparation of psychiatric residents for dealing with career choices and the environment for providing psychotherapy
Norman A. Clemens, M.D., Emeritus Clinical Professor of Psychiatry, Case Western Reserve University School of Medicine; Training and Supervising Analyst, Cleveland Psychoanalytic Center.
Eric M. Plakun, M.D., Associate Medical Director, Director of Admissions, The Austen Riggs Center.
Susan G. Lazar, M.D., Clinical Professor of Psychiatry: Georgetown University School of Medicine, George Washington University School of Medicine, and Uniformed Services University of the Health Sciences; Supervising and Training Analyst, Washington Psychoanalytic Institute.
Lisa Mellman, M.D., Samuel Rudin Professor of Psychiatry at Columbia University Medical Center, Columbia University College of Physicians and Surgeons.
in their practice, and 4) post-graduate training in psychotherapy through supervision/consultation, continuing education courses, computer instruction, and distance learning.