Do Psychiatrists Do Therapy?

Some do. Most do not, at least not in the way people imagine when they picture weekly sessions on a couch. Psychiatrists are medical doctors who specialise in diagnosing mental illness and prescribing medication, and over the last thirty years the share of their work that is talking therapy has fallen sharply. If ongoing therapy is what you are looking for, a psychiatrist is usually not the person who will provide it.

The short answer

Psychiatrists are trained in psychotherapy. Every psychiatry residency includes it, and some psychiatrists build entire careers around it. But training in something and practising it daily are different things. In the United States, where the data is best, psychotherapy accounted for 44.4 per cent of psychiatrist visits in 1996 to 1997. By 2004 to 2005 that had dropped to 28.9 per cent. By 2016 it was 21.6 per cent. Over the same period the proportion of psychiatrists who provide no psychotherapy at all to any patient rose past half. If ongoing weekly sessions are what you have in mind, that is talk therapy, and it is a different appointment from the one a psychiatrist usually offers.

So the honest answer to do psychiatrists do therapy is: a minority of them, some of the time. If you book a psychiatrist expecting fifty minutes of talking, what you are more likely to get is a longer first appointment for assessment and diagnosis, then fifteen to twenty minute reviews focused on how the medication is working. Neither is worse than the other. They are answers to different questions, and it is worth knowing which question you are bringing before you book.

Why the shift happened

It is not that psychiatrists stopped believing in therapy. It is mostly economics. Research into the reimbursement structures found that a single forty-five to fifty minute psychotherapy session pays roughly forty-one per cent less than three fifteen-minute medication management visits filling the same hour. A psychiatrist who wants to run a viable practice is pushed, appointment by appointment, toward the shorter format. None of that is a comment on any individual psychiatrist, and most would tell you the same thing.

Alongside that, the field itself specialised. As psychiatric medicine grew more complex, and as psychologists, counsellors and psychotherapists became widely available, the natural division of labour was for psychiatrists to hold the medical side and for therapists to hold the therapy. That is not a failure of the system. In most cases it works well.

One caveat worth stating plainly: these figures come from US national survey data, and the strictest of those studies counted only sessions over thirty minutes that were explicitly designated as psychotherapy. Practice in Australia, the UK and India differs, and a psychiatrist who spends ten minutes of a review appointment doing genuinely therapeutic work would not show up in that number. The direction of travel, though, is not in dispute.

You would not see a generalist for something a specialist does all day

Think about how you handle the rest of your health. If your knee keeps giving way, your GP is the right first call, but you would not expect your GP to rebuild the ligament. They refer you to someone who does that operation several times a week. Nobody experiences this as a downgrade. It is simply what specialisation is for.

Mental health is the one area where people quietly assume the opposite, that the most medically qualified person in the room must also be the best at everything mental health related. A psychiatrist is a specialist in psychiatric medicine, diagnosis and the management of severe and complex illness. That is a demanding speciality and it takes years. A psychotherapist is a specialist in the thing that actually happens in the room: the relationship, the pattern that keeps repeating, the conversation that changes how you respond next Tuesday. Within that there are further specialisms again, which is why the different types of therapy exist rather than one generic version. Those are different skills, held by different people, and each is a full-time job.

The question is not who has more letters after their name. It is what you want to happen in the hour. If you want a medication reviewed, go to the person who reviews medication all day. If you want to work out why every relationship ends the same way, go to the person who sits with that all day, and who works with relationship patterns as a subject in its own right.

Working with someone who does this all day

This is the work I do. I am a registered counsellor and psychotherapist, ACA Level 2 and PACFA, with post graduate study in counselling and psychotherapy at the University of Adelaide. I do not prescribe and I do not diagnose. What I do is sit with people, week after week, in the part of this that is a conversation.

In practice that means an appointment is a full session rather than a review. There is time to get to the thing underneath the thing. We work with the methods that fit what you are bringing, whether that is CBT for the thought patterns that will not let go, trauma-focused work where something from the past is still setting the terms, or ordinary open-ended talk therapy when what you need is to be properly heard by someone who is not in your life. People come to me for anxiety, for low mood, for relationships that keep stalling in the same place.

I work online with clients worldwide and in person in Melbourne. If you are already seeing a psychiatrist, that does not have to change. The two roles sit alongside each other perfectly well, and many of the people I see are doing exactly that. You can book a first session or read more about how I work.

When you genuinely do need a psychiatrist

None of this is an argument against psychiatry. There are situations where a psychiatrist is not optional, and a good therapist will tell you so rather than keep you in the room.

See a psychiatrist if you need medication assessed, started, adjusted or withdrawn. If you have symptoms that point toward bipolar disorder, psychosis, severe OCD or a major depressive episode that has not shifted with therapy alone. If you are not eating or sleeping in a way that is affecting your body. If there is a diagnostic question that needs a medical answer, including ruling out a physical cause. And urgently if you are having thoughts of ending your life, or if you are in a crisis that needs more support than a weekly appointment can hold.

In several of those situations the best arrangement is both. The psychiatrist manages the medical picture, the therapist does the weekly work, and they can communicate with your consent. Medication can quieten symptoms enough that therapy becomes possible; therapy can address what the medication is not designed to touch.

What a psychiatrist appointment actually looks like

The first appointment is usually the longest, often forty-five to sixty minutes. It covers history, symptoms, family history, physical health, previous treatment and current medication. The output is an assessment, a diagnosis where one applies, and a plan.

Follow-ups are typically shorter, in the region of fifteen to thirty minutes, and focused on how the medication is working, side effects, and whether anything needs adjusting. Supportive conversation happens inside those appointments. Structured, ongoing psychotherapy usually does not, and most psychiatrists will refer you to a therapist for it.

Some psychiatrists do run a psychotherapy caseload, and those who do are often excellent at it. They tend to be fewer, they often work privately, and they usually cost more per session than a counsellor or psychotherapist. If that is what you want, the practical step is simply to ask when you enquire: do you offer ongoing therapy sessions, or medication management?

How to choose, in one paragraph

If your main question is should I be on something, and is this the right dose, start with a psychiatrist or your GP. If your main question is why do I keep doing this, and how do I stop, start with a therapist. If both are true, do both. And if you are unsure which of those two questions you are actually asking, that itself is a good thing to bring to a first therapy session, where there is enough time to work it out. If you are unsure what to say in that first hour, this is a useful place to start.