The question of whether to target psychiatric symptoms with psychotherapy or medications is a common source of strongly held opinions, debate, and disagreement. Depending on the circumstances, the answer may be neither, one, or both, and usually depends on both individual preferences of the patient and clinical experience and focus of the psychiatrist. Importantly, over the last half-century, the role of the psychiatrist in the treatment of mental illness has largely shifted from therapist/psychoanalyst to psychopharmacologist. There are many reasons for this shift, but in terms of the impact of this change, one may argue that the “medicalization” of psychiatry has resulted in too far a swing of the pendulum away from providing treatment with therapy, toward brief and sterile sessions focused solely on making medication adjustments. Ultimately, both therapy and meds can be powerful tools that are synergistically applied to treat and manage serious psychiatric conditions. In many cases, neither is sufficient alone.
One of the unique advantages of treatment by a psychiatrist who recognizes the value of multiple modalities of treatment is the opportunity to receive comprehensive treatment interventions from the same caregiver. This can result in increased efficiency, reduced overall costs, and the elimination of some of the complexities of coordinating care among multiple providers. Often, it is better to have one provider aware of both the big picture and the smaller details, than it is to have multiple providers that are only vaguely aware of the work the others are doing with the patient. Additionally, psychiatrists who value both approaches tend to have more flexibility in the way that they formulate treatment recommendations. This flexibility is important because treatment of any kind is most effective when the decision to accept the proposed treatment is made autonomously by the patient, with the support of the psychiatrist in the role of facilitator and guide, toward a state of health and wellness for the patient. This tends to result in a partnership that is based on mutual confidence, with equal importance given to the preferences of the patient as is given to the opinion of the physician, often producing synergistic results.