Tuesday, October 23, 2012

National Public Radio on the changing face of psychiatry

Dr. Steve Balt, psychiatrist and editor-in-chief, The Carlat Psychiatry Report, and Dr. Richard Friedman, director, Psychopharmacology Clinic, Weill Cornell Medical College

Copyright © 2012 National Public Radio. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

This is TALK OF THE NATION. I'm Neal Conan in Washington. Just about everyone's image of a psychiatrist's office includes a long couch, dim lights and a doctor with a notepad asking: And how did that make you feel? A stereotype, of course, and way out of date at that. Over the past 20 years, few professions have seen more change than psychiatry.

Weekly, 45-minute appointments are largely a thing of the past. Many psychiatrists see patients for 15 minutes, one after another. Instead of listening, they ask a series of questions, write out prescriptions, and refer their patients to a psychologist or to a social worker for therapy.

While some in mental health circles feel these changes are necessary, others worry they hurt both patients and doctors. We want to hear from psychiatrists in our audience today. How has your practice changed? Give us a call, 800-989-8255. Email us, talk@npr.org. You can also join the conversation by going on our website. That's at npr.org. Click on TALK OF THE NATION.

Read the rest of the transcript and listen to the audio link.


  1. The only change I notice is they'll be asking lists of questions whilst not listening and being rude and dismissive during shorter appointments now.

    I think the changes around listening occurred a long time ago, and only concerns them now the amount of time they can earn money for not doing it is threatened.

    Because what they actually do is now so simple and could be easily automated they have to justify their position via the erroneous argument that they need the extended time to do something which they no longer do.

    1. "The changing face of psychiatry" is a title for the show that doesn't seem to fit the content of what was actually said. It seems like business as usual.

  2. Ms. Forbes,

    I think it depends on what sort of treatment the individual patient seeks out. I see my psychiatrist for 45 minutes every week and we sit face-to-face in a well-lit room. She does ask me questions but she doesn't dominate the conversation.

    She does prescribe my medications and she asks how I am from time to time: whether I think my drugs are working or not, whether I'm having side effects or not. But that doesn't take very long.

    Mostly, we talk about what's going on in my life. We disagree about where I should be going and what I should be doing from time to time but that's to be expected, considering how long I have been seeing her.

    She is a very warm, caring person. I've had more than a few very difficult episodes where I wouldn't have blamed her for taking the easy way out and bailing on me but she never has and I do not believe she ever will.

    I don't want to go on and on about our personal relationship. I just want you to know that 45 minute sessions are definitely NOT a thing of the past and that psychiatry is not ALL about medication.

  3. Hi, Anonynmous,
    The NPR interview was demonstrating probably how most Americans get to see a psychiatrist. There are, of course psychiatrists like yours and like Chris's. We are fortunate in that our insurance continues to pay for her services. However, I look forward to the day when Chris is no longer dependent on a psychiatrist. I feel that no matter how warm and caring the person appears, the power relationship is inherently unequal. Psychiatrists, particularly the ones who see less patients because they aren't merely doing med checks, have every incentive to hold onto their patients, to create doubt that the person can survive without them. That may seem cynical on my part, but I think what I'm describing is human nature. That being said, in my opinion, Chris's psychiatrist has helped him immensely to understand himself better, but there is always a danger of dependency.

  4. You have only to read Elyn Saks'es "The Centre Cannot Hold" to realise how unhealthily dependent a patient can become on his/her psychiatrist. (Anonymous 2)

    1. I have read the book, but I have a different view of her relationship with her psychiatrist. I assume you are referring to the Kleinian psychotherapist who Saks saw every day when she was a student at Oxford. Saks herself admits that she was utterly dependent on her, but, on the other hand, Saks managed to get through her post-grad work at Oxford and credits her psychotherapist for helping her stay the course.


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