Dr. Carole Lieberman

Therapy Soup is fortunate enough to be able to speak with three-time Emmy award winning psychiatrist and author, Dr. Carole Lieberman. We wanted to discuss why the vast majority of psychiatrists no longer do psychotherapy and why Dr. Carole (who is a psychiatrist who does psychotherapy), believes this to be detrimental to the patient.

Welcome, Dr. Carole. Can you tell us a little bit about the genesis of psychiatry and how it has changed over the years?

Before the advent of psychiatric medication, the influence of Sigmund Freud, the Father of Psychoanalysis, and his ‘talking cure’ was profound. Then medications became the ‘shiny new toy’ that caught the eye of psychiatrists and gradually distracted them away from getting at the underlying root of the problem through therapy. There is no doubt that psychiatric medications can be, literally, lifesaving for many patients, but they should not be used without psychotherapy given along with them. Otherwise, the medications are simply masking the symptoms and allowing the patient to pretend that he doesn’t have any underlying problems. If a patient has a problem serious enough to require medication, then he certainly needs psychotherapy, as well.

You are an anomaly in today’s world of psychiatry. Although there have been some recent changes, currently, most psychiatrists see patients for a 45 minute evaluation and 30 minute maintenance visits. How did psychiatry devolve (some say evolve) to medication appointments only?

I am appalled and saddened by the deterioration of psychiatry and psychiatrists, who have allowed the cost-cutting measures of insurance companies and governmental agencies to dictate the kind of treatment they give to patients.

Instead of doing what is best – weekly sessions in which psychiatrists do both psychotherapy and medication management (when medications are also indicated) – many psychiatrists now see patients for medication only. These ‘med visits’ are typically once a month, but may be as infrequent as once every three months. And these patients may or may not be seeing a psychologist, social worker or marriage and family therapist on the side for therapy. There is usually little communication between such therapists and the psychiatrist, and the patient, more often than not, falls through the cracks.

Psychotherapy can be arduous and painful for the patient, and for the therapist. These days, there seems to be a collusion taking place between psychiatric training programs, psychiatrists-in-training, psychiatrists already out of training and their patients. Everyone is trying to avoid the hard work entailed in therapy, so they pretend to themselves and others that medication (and upcoming ‘shiny new toys’ of biology, chemistry and physics) is sufficient to cure all psychological problems. Psychiatrists have found that brief and infrequent sessions allow them to avoid the discomfort of transference and counter-transference, while finding a more reliable new patient stream through insurance and governmental agencies. These third-party payers more readily pay for such med visits, preferring to pay less to non-psychiatrists to do the ‘dirty work’ of therapy.

Since when did psychiatrists become such wusses? I am ashamed of them for making these concessions, when they know that their patients are not getting the real help they need. These days, whenever I am asked about my work – from media interviews to cocktail parties – I get astonished reactions when I tell them that I do therapy, and am an expert at the inner workings of the psyche – not just the latest drug fad. Each time it reminds me of how disgusted I am with my colleagues because they have let society down by narrowly focusing on ‘big pharm’ instead of the unconscious mind.

I don’t understand how these pharmacologically-focused psychiatrists don’t die of boredom. If all I talked about with patients were symptoms, side effects, dosage schedules, and a cursory update of their life, it would bore me to tears. I became passionate about becoming a psychiatrist when I read Freud’s Interpretation of Dreams as a teenager. I never would have become one if I had to conform to the current job description.

One of the hats I wear is as a psychiatric expert witness, so I have seen the damage done to patients who are only being treated by psychiatrists with these so-called ‘medication management’ visits and not receiving any psychotherapy, human connection or compassion. Lawsuits against psychiatrists are increasing, as their patients harm themselves or others because they are being sent out with a prescription instead of insight into their problems. And far greater numbers of such tragedies end, not in the court system, but quietly in misery.

Whenever someone calls to make their first appointment with me for treatment, I have to ask them whether they are just looking for a psychiatrist to see them once a month to give them a prescription, or whether they are looking to do psychotherapy to get to the root of their problem. I tell them that I only see patients who are willing to come in once a week for psychotherapy, and that if they need medication, I will also prescribe that at these weekly therapy sessions. But I refuse to see anyone for medication only.

Part Two coming soon–you ain’t seen nothing yet!

About Dr. Carole Lieberman: Carole Lieberman, M.D., M.P.H. is a board certified psychiatrist who still believes that medication, although extremely important for some patients, is not a cure in itself. It is a band-aid that helps with symptoms, while the true healing is done through intensive psychotherapy. Dr. Lieberman was chief resident at New York University-Bellevue Hospital, and studied under Anna Freud in London. She is currently on the Clinical Faculty of UCLA’s Neuropsychiatric Institute and has a private practice in Beverly Hills. Dr. Lieberman is a best-selling author, talk show host, media commentator, speaker and expert witness. Her books include: Bad Boys: Why We Love Them, How to Live with Them and When to Leave Them; and Coping with Terrorism: Dreams Interrupted. Please visit her at her web site.  Enjoy media videos with Dr. Carole and her radio show on Voiceamerica.com.

Comments

This post currently has 5 comments/trackbacks.
You can read the comments or leave your own thoughts.

Trackbacks

No trackbacks yet to this post.

    Last reviewed: 25 May 2010