FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2517851071> ?p ?o ?g. }

• W2517851071 endingPage "1" @default.
• W2517851071 startingPage "1" @default.
• W2517851071 abstract "Back to table of contents Previous article Next article Psychiatry and PsychotherapyFull AccessECPs and Psychotherapy: Battling the ObstaclesNorman A. ClemensNorman A. ClemensSearch for more papers by this authorPublished Online:18 Aug 2016https://doi.org/10.1176/appi.pn.2016.8b5AbstractThe Psychotherapy Committee of the Group for the Advancement of Psychiatry (GAP) deals with a paradox. On the one hand, the evidence base for the effectiveness of psychotherapy in psychiatric treatment is strong and getting stronger. On the other hand, fewer and fewer psychiatrists make psychotherapy an important part of their psychiatric practice. In a 2008 study by Mojtabai and Olfson, the percentage of psychiatrist office visits involving the provision of psychotherapy declined from 44 percent to 29 percent over a 10-year period from 1996 to 2005! What intrigues the Psychotherapy Committee most right now is the exasperating incongruity between the robust evidence of effectiveness and diminishing practice of psychotherapy. In our view, this incongruity threatens the very identity of the psychiatrist. We suspect that many psychiatrists—even those who don’t talk much with patients any more—feel the same way but also feel helpless to resist the incentives to do check-box evaluations, write prescriptions, and spend less time talking with patients. In September 2014 the GAP Psychotherapy Committee wrote a special issue of Psychodynamic Psychiatry that analyzed many aspects of the situation in depth. One article in that issue was “Obstacles to Early Career Psychiatrists [ECPs] Practicing Psychotherapy.”ECPs who work in high-volume systems for economic reasons are especially vulnerable to the trends, yet they have the strongest need and motivation to gain experience and develop skills in psychotherapy. This was borne out in the enthusiastic response to a recent effort by the American College of Psychoanalysts to recruit ECPs for virtual clinical rounds in psychodynamic psychotherapy by videoconference; after two articles in Psychiatric News, applications were received from 12 states, Washington, D.C., and India. Medical graduates enter the field of psychiatry for many reasons, including concern about mental illness, a wish to help people who suffer from it, and the fact that psychiatry offers a fascinating, integrated perspective on both the subjective world of the mind and the objective workings of the body. Unfortunately, surveys in 2012 by Donna Sudak, M.D., and David Goldberg, M.D., and by Malkah Notman, M.D., and me demonstrated that residents’ training in formal psychotherapy varies greatly from one residency to another—despite the ACGME requirement for all residencies that residents acquire “competence” in cognitive-behavioral therapy (CBT), psychodynamic psychotherapy, and supportive psychotherapy.Yet, it is crucial for psychiatrists to be skilled in providing psychotherapy, especially when medication is also indicated and for treatment-resistant and complex cases. Most graduating residents do not have enough experience to make them proficient psychotherapists, let alone to qualify them to manage or supervise psychotherapy services of other professionals. Nonetheless, when these residents become ECPs, many still have a passion for learning more and gaining in-depth experience in this challenging and nuanced form of treatment. But serious obstacles present themselves. Because of the pressures of heavy educational debts, ECPs are likely to take salaried positions in community agencies that are faced with overwhelming service demands. Whether in private practice or in agencies, tilted insurance benefits pay much better for time spent on multiple brief medication visits than on psychotherapy services. There is great pressure for psychiatrists to do evaluation and medication management while nonmedical practitioners provide whatever psychotherapy is offered. Meticulous, rigidly detailed electronic-record keeping leaves little time for talk. Gone for the ECPs are the clinical satisfactions of providing integrated psychotherapy care that combines medication management based on thorough and ongoing knowledge of the patient with psychotherapy that meets the standards of a well-founded psychotherapeutic method. Even less likely is that employed ECPs are allowed to offer such psychotherapy when medications are not indicated. In this writer’s experience, the world is full of patients (and their primary care doctors) urgently trying to find “a psychiatrist who talks with patients” after several unsatisfactory experiences with psychiatrists who confront patients with a computer screen bearing a check-off electronic health record and a prescription app. So ECPs who brave the world of private practice to be able to talk with their patients may be pleasantly surprised at the demand for their services that they encounter. But even in this environment, the adversely unbalanced nature of skimpy insurance reimbursement for psychotherapy coupled with intrusive management can make participation in third-party payment daunting. Consequently, surveys show that a large percentage of psychiatrists in private practice do not take insurance. Through its data-gathering and publications, the GAP Psychotherapy Committee has actively supported advocacy and legal interventions under the parity law that show some signs of bringing about favorable change. What can ECPs do to assure the continued maturation of their needed psychotherapy skills? They are needed. They can use their clout to insist on terms of employment that allow them to do psychotherapy regularly when indicated or reserve time to do psychotherapy in other settings. They can do private practice that includes psychotherapy in medical settings adjacent to primary care practitioners; they will be welcomed. Importantly, they can seek out psychotherapy consultation or supervision with an experienced psychotherapist, or enroll in psychotherapy courses offered by psychoanalytic or CBT institutes or universities. Some obtain therapy for themselves, which is likely also to enhance their psychotherapy skills. For ECPs not geographically close to such resources, there may be peer-consultation arrangements or online consultation with reputable teachers (subject to the licensing laws of their state), or courses offered at professional meetings or through distance learning. Such efforts can lead to a far more enjoyable and rewarding career in psychiatry. ■The issue of Psychodynamic Psychotherapy on “Psychotherapy, the Affordable Care Act, and Mental Health Parity: Obstacles to Implementation” can be accessed here.Norman A. Clemens, M.D., is an emeritus clinical professor of psychiatry at Case Western Reserve University in Cleveland, Ohio, and a training and supervising analyst at the Cleveland Psychoanalytic Center. ISSUES NewArchived" @default.
• W2517851071 created "2016-09-16" @default.
• W2517851071 creator A5085657157 @default.
• W2517851071 date "2016-08-19" @default.
• W2517851071 modified "2023-09-25" @default.
• W2517851071 title "ECPs and Psychotherapy: Battling the Obstacles" @default.
• W2517851071 doi "https://doi.org/10.1176/appi.pn.2016.8b5" @default.
• W2517851071 hasPublicationYear "2016" @default.
• W2517851071 type Work @default.
• W2517851071 sameAs 2517851071 @default.
• W2517851071 citedByCount "0" @default.
• W2517851071 crossrefType "journal-article" @default.
• W2517851071 hasAuthorship W2517851071A5085657157 @default.
• W2517851071 hasConcept C102655426 @default.
• W2517851071 hasConcept C118552586 @default.
• W2517851071 hasConcept C15744967 @default.
• W2517851071 hasConcept C159110408 @default.
• W2517851071 hasConcept C162324750 @default.
• W2517851071 hasConcept C175444787 @default.
• W2517851071 hasConcept C2426938 @default.
• W2517851071 hasConcept C2778223634 @default.
• W2517851071 hasConcept C29122968 @default.
• W2517851071 hasConcept C501888929 @default.
• W2517851071 hasConcept C542102704 @default.
• W2517851071 hasConcept C5458421 @default.
• W2517851071 hasConcept C71924100 @default.
• W2517851071 hasConcept C73484699 @default.
• W2517851071 hasConceptScore W2517851071C102655426 @default.
• W2517851071 hasConceptScore W2517851071C118552586 @default.
• W2517851071 hasConceptScore W2517851071C15744967 @default.
• W2517851071 hasConceptScore W2517851071C159110408 @default.
• W2517851071 hasConceptScore W2517851071C162324750 @default.
• W2517851071 hasConceptScore W2517851071C175444787 @default.
• W2517851071 hasConceptScore W2517851071C2426938 @default.
• W2517851071 hasConceptScore W2517851071C2778223634 @default.
• W2517851071 hasConceptScore W2517851071C29122968 @default.
• W2517851071 hasConceptScore W2517851071C501888929 @default.
• W2517851071 hasConceptScore W2517851071C542102704 @default.
• W2517851071 hasConceptScore W2517851071C5458421 @default.
• W2517851071 hasConceptScore W2517851071C71924100 @default.
• W2517851071 hasConceptScore W2517851071C73484699 @default.
• W2517851071 hasIssue "16" @default.
• W2517851071 hasLocation W25178510711 @default.
• W2517851071 hasOpenAccess W2517851071 @default.
• W2517851071 hasPrimaryLocation W25178510711 @default.
• W2517851071 hasRelatedWork W1991529803 @default.
• W2517851071 hasRelatedWork W2016075698 @default.
• W2517851071 hasRelatedWork W2077722497 @default.
• W2517851071 hasRelatedWork W2148426735 @default.
• W2517851071 hasRelatedWork W2412808675 @default.
• W2517851071 hasRelatedWork W2578295835 @default.
• W2517851071 hasRelatedWork W2728193975 @default.
• W2517851071 hasRelatedWork W2741081986 @default.
• W2517851071 hasRelatedWork W2962778310 @default.
• W2517851071 hasRelatedWork W3096347354 @default.
• W2517851071 hasVolume "51" @default.
• W2517851071 isParatext "false" @default.
• W2517851071 isRetracted "false" @default.
• W2517851071 magId "2517851071" @default.
• W2517851071 workType "article" @default.