For the Love of Psychotherapy: A Resident Perspective

Psychiatry is a broad field; at its core is the person and the complex pieces of that individual’s mental health. Psychiatry emphasizes the person’s family, friends, livelihood, and many other social factors. Psychiatry is more than medication management; it truly is about uncovering a person’s essence to understand his or her goals and barriers to treatment. Psychiatry leverages the connection between patient and physician to garner trust. Psychiatry is beyond medication; it is about medications and relationships with others. What better way to understand the patient than through psychotherapy?

“You’re the one who gives out meds, right?,” ask many of my patients who are hesitant to see a psychiatrist. I emphasize that I am a psychiatrist with a “therapy bias” and that, broadly, there are three components to mental health treatment: (1) what patients and I do together regarding medication management, (2) what work they do with their therapist, and (3) how to use the knowledge gained from those appointments and apply this knowledge in the “real world” outside of the confines of the office. I have found patients who are medication hesitant become less tensed and begin speaking with me freely after I express my “therapy bias” because they want a psychiatrist who listens to their story.

I structure my appointments around new changes in patients’ lives, their recent highs as well as lows, what barriers are present, and what barriers are they working to overcome for their goals in life. I learn about patients and those closest to them while also unpacking their difficult relationships. I incorporate psychotherapy into the care of all my patients, especially when medications are not yielding the desired symptom relief. At this stage, it becomes critical to investigate and dissect patients’ relationship with medication, relationships with others, and relationship with themselves. I have found that taking a step back from medications and focusing more on social factors has helped to improve their psychiatric symptoms by allowing them a space to be heard and explore their stressors. Psychotherapy allows a psychiatrist to view patients outside of their diagnosis and understand them through the intricate details of their life.

In addition to medication management patients, I have experience seeing my own psychotherapy patients. Operating as a patient’s therapist has helped me have a deeper appreciation for mental illness beyond neurotransmitters. Becoming the therapist offers an additional perspective and closer relationship as we meet weekly. I have cultivated a new understanding of patient behavior to process complex emotions.

Psychotherapy allows you not only to evaluate, investigate, and understand a patient’s life, but also to identify your own biases or feelings toward a patient. Understanding more about yourself will further serve you as a psychiatrist in practice. I have found myself increasing my empathy, becoming more patient, and improving the identification of barriers for my patients by employing psychotherapy outside of my “psychotherapy only” patients.

Overall, psychiatrists cannot avoid psychotherapy; it is a key component of treating patients holistically. To treat mental illness, we must understand that the illness impacts multiple facets of patients’ lives, not only their neurobiology, which is how psychotherapy is able to improve patient care. ■

Breyauna Spencer, D.O., is a PGY-3 psychiatry resident in the Authority Health Psychiatry Residency Program in Detroit.