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Comments and Controversies

Thinking outside of the box

Vol. 10, No. 03 / March 2011

After reading Dr. Henry A. Nasrallah’s editorial, “Out-of-the-box questions about psychotherapy” (From the Editor, Current Psychiatry, October 2010, p. 13-14) I had some questions. What is the appropriate dose of 30-minute “med eval” sessions before you prescribe? What if no medicine is necessary because your patient improves after several sessions of really listening to him or her? Is the “maintenance dose” for a psychopharmacology med check follow-up really 15 minutes? Is there a cure for bored psychopharmacologists who just write follow-up prescriptions at 15-minute med checks? Is there an entity such as psychotherapy deficiency because psychiatrists are poorly trained in practicing psychotherapy and the indications for its various forms? Is there an overabundance of lawsuits because of poorly managed therapist-psychopharmacologist treatment splits? Do nonmedical psychotherapists hear more about side effects than the pre-scriber because therapists see patients more often and rarely confer with the “real doctor”? Does “modern” psychiatry’s touting of medications for all maladies feed into Americans’ excess use of substances as solutions to all problems?

Peter A. Olsson, MD
Psychiatrist and Psychoanalyst
Private Practice
Keene, NH
Assistant Professor of Psychiatry
Dartmouth Medical School
Hanover, NH

Dr. Nasrallah responds

Thanks for joining me in thinking outside of the box. You responded to my editorial’s questions with probing questions of your own, and your questions are equally rhetorical. Your questions also are an incisive commentary on how contemporary psychiatry has been reduced to 15-minute med checks in many clinics and psychotherapy is delegated to nonmedicalstaff. I remind my trainees every day that they must be their patient’s physician and therapist, and be equally adept at pharmacotherapy and psychotherapy. However, to our patients’ detriment, systems of care now dictate what psychiatrists can or cannot do.

Henry A. Nasrallah, MD

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