A Psychiatrist Who Still Does Psychotherapy

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Why this is unusual

American psychiatry split. Over roughly three decades the field divided into prescribing and therapy roles, driven mostly by reimbursement — three fifteen-minute medication visits pay considerably more than one fifty-minute therapy hour.

The published trend is clear: the share of psychiatrist visits involving psychotherapy fell from around 44% in the late 1990s to 29% by the mid-2000s, and has continued downward since.

What that produced is split care — a therapist for the therapy, a prescriber for the medication, and little communication between them. Your therapist doesn't know why the dose changed. Your prescriber doesn't know what surfaced in session. Each sees a fragment.

For a straightforward presentation that's fine, and often cheaper. For complex ones it's where treatment stalls.

What I actually practice

Not "therapy" generically. Specific modalities, matched to the problem:

CBT — CBT-certified. Strongest evidence base for depression, anxiety disorders, panic, and insomnia. Structured, time-limited, measured.

DBT-informed therapy — for emotion dysregulation, chronic self-harm urges, and the emotional dysregulation that medication doesn't reach in ADHD.

EMDR — for PTSD and trauma. Requires less verbal narration of the trauma than exposure protocols, which some people strongly prefer.

ERP — for OCD. This is the treatment, and general talk therapy for OCD can make it worse by supplying reassurance.

Psychodynamic psychotherapy — trained at the Emory University Psychoanalytic Institute and the Columbia University Center for Psychoanalytic Training and Research. Open-ended, pattern-focused work for recurring relational patterns and character-level difficulty, rather than discrete symptoms.

Modality matters more than credential

This is the thing to take from the page.

Asking "should I see a therapist" without specifying which therapy is like asking whether to take medication without specifying which. The mismatches are consequential:

Ask any clinician what specific modality they practice for your specific problem. It's a fair question and the answer is informative either way.

When one clinician for both matters

When medication and therapy are both indicated. Titration decisions and therapeutic work inform each other, and split care loses that.

When the diagnosis is uncertain. Differential diagnosis across medical and psychiatric causes is what medical training is for, and it's harder to do from the therapy chair alone.

When treatment has stalled. Frequently because an untreated condition sits underneath — ADHD, PTSD, sleep apnea, substance use. See second opinions.

When you're on several medications. Someone has to reconsider whether each is earning its place. See medication management.

When it doesn't

If you want psychotherapy and medication clearly isn't part of the picture, a psychologist or master's-level therapist is an appropriate choice and generally less expensive. Say so and I'll help you find the right modality rather than sell you the more expensive version of the same thing.

More on the credential differences.

Related

CBT · DBT · EMDR · ERP · Medication vs. therapy vs. both · How to choose a psychiatrist · What to expect

Frequently Asked Questions

Do psychiatrists do therapy?

Most no longer do. The share of US psychiatrist visits involving psychotherapy fell from roughly 44 percent in the late 1990s to 29 percent by the mid-2000s and has continued to decline, driven largely by reimbursement favoring brief medication visits. Some psychiatrists still provide both.

Is a psychiatrist better than a therapist for psychotherapy?

Not inherently. Modality and skill matter more than degree. What a psychiatrist adds is the ability to prescribe and to evaluate medical contributors — relevant when medication is part of the picture or the diagnosis is unclear.

What type of therapy do I need?

It depends on the condition. OCD requires exposure and response prevention. PTSD requires trauma-focused treatment. Emotion dysregulation requires DBT. Depression and most anxiety disorders respond to CBT. Ask any clinician which specific modality they practice.

What is split care?

Seeing a therapist for psychotherapy and a separate prescriber for medication. It's the standard American arrangement and works adequately for straightforward cases. For complex ones the limited communication between clinicians is where treatment tends to stall.

How long does psychotherapy take?

CBT for anxiety or depression typically runs 12 to 20 sessions. ERP for OCD is similar. EMDR for single-incident trauma is often 6 to 12 sessions. Complex trauma and long-standing patterns take longer.

Can I do therapy by telehealth?

Yes. Most modalities translate well to video, including EMDR with adaptations. I'm licensed in New York, Virginia, and Montana, and registered for telehealth in Florida.