Psychiatric News December 17, 2004
Volume 39 Number 24
© 2004 American Psychiatric Association
p. 17
Psychiatry Residents in Treatment Prefer Psychotherapy to Medication
Christine Lehmann
A study that looks at psychiatry residents' use of psychotherapy and
medication found that psychotherapy was more common and acceptable than
medication use.
Residency is a challenging and stressful time for psychiatry trainees, and
many seek psychotherapy to help them cope.
"Residents are often encouraged by training directors and faculty who
teach psychodynamic psychotherapy to enter individual psychotherapy for the
educational value," said Ronald Rieder, M.D., a clinical professor of
psychiatry and vice chair for education at Columbia University College of
Physicians and Surgeons in New York.
Yet the majority of psychiatry residents (60 percent) who completed a
51-item questionnaire in 2002 and said they had sought psychiatric treatment
did so for personal reasons compared with 22 percent who said they entered
psychotherapy for the educational value and 18 percent who did so for both
reasons, Rieder said last month at the New York Academy of Medicine (NYAM)
Section on Psychiatry 2004 Stuart Asch Memorial Lecture.
The topic of the session was residents' mental health examined from a
multicultural perspective (see article above). Rieder is also the residency
training director at Columbia and the New York State Psychiatric
Institute.
Seventy-four percent of the respondents who received psychotherapy sought
psychotherapy treatment for the first time during residency, compared with 26
percent who said they began treatment before residency.
The survey was mailed in 2002 to all 288 psychiatry residents at a
Manhattan facility in their second through fourth years of training, and 48
percent responded, according to lead investigator Sylvia Emmerich Fogel, M.D,
who is with the Columbia University Center for Psychoanalytic Training and
Research. The results of the study appeared in the summer American Journal
of Psychoanalysis.
Fogel told Psychiatric News that the research team at Columbia
excluded first-year psychiatry residents "because they do not become
connected with the psychiatry department until the second year." Also,
to ensure confidentiality, residents were not asked any information that could
identify them.
Residents face numerous stresses including long hours of work for low pay,
increased patient responsibilities with less supervision, and fatigue, said
Rieder, who described common residency stresses and responses at the NYAM
program.
"Residents, especially in the first year, often feel overwhelmed,
anxious, tired, apathetic, guilty when patients die, and angry at being put in
this situation," said Rieder. "In addition, their support network
is disrupted because residents barely have time for their spouses or
significant others."
About two-thirds of the residents in treatment were in individual
psychotherapy only, while 17 percent were in therapy and taking a psychiatric
medication, and less than 1 percent were on medication only, according to
Rieder. The medications that were most commonly prescribed for these residents
were antidepressants, sleeping aids, and antianxiety drugs.
Psychiatry residents who completed the questionnaire believe that
significantly more stigma is associated with medication use than
psychotherapy, both in their training program and U.S. psychiatry as a whole,
Rieder said.
He urged psychiatry faculty and training program directors to "do a
better job of recognizing that residents may have serious mental illnesses
such as major depression and to encourage the use of medication and
psychotherapy."
An abstract of "Personal Psychiatric Treatment Among
Psychiatric Residents in Manhattan: Evidence of Stigma" can be accessed
online at
<www.apsa.org/japa/522/Posters-449-481.pdf>
by clicking on the title. 
Related Article:
-
Bias Toward Some Residents Can Impede Patient Care
- Christine Lehmann
Psychiatr News 2004 39: 17.
[Full Text]
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