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A Career in Psychiatry

By Lynn Friedman, Ph.D.
Special to washingtonpost.com
Friday, June 25, 2004; 11:33 AM

What does a psychiatrist do? How do I prepare for a career in psychiatry? Psychiatrists are medical doctors who have been trained to work in a wide range of mental health care settings. Because of the current climate of managed care, an increasing number of psychiatrists find themselves pressed into the role of consultant. Often, they evaluate patients for medication, while other mental health professionals treat their patients in psychotherapy.

If you are interested in "brain-behavior" relationships and want to help people using medication and psychotherapy, then psychiatry may be the career for you. All aspiring psychiatrists must complete medical school. After graduation, they devote a year to a clinical internship in pediatrics, OB/GYN or other clinical medicine. Although most psychiatric residents pursuing a career in adult psychiatry do their internship in internal medicine or family practice, those who are preparing for a career in child psychiatry do their internship year in pediatrics. Some opt to do their year in other areas of clinical medicine. Next, they enter a three-year program designed to train them in the basics of psychiatry. Those who want to work with children do an additional two-year fellowship.

Psychiatric residents, as they are called, work in a wide range of settings including inpatient and outpatient care. They engage in a series of rotations designed to help them acquire skills in working with different kinds of patients: substance abusers, patients with character pathology, bipolar disorder, schizophrenia, and eating disorders. Also, psychiatrists provide consultation to medical patients with psychiatric difficulties.

Learning to manage patients with major psychiatric disorders such as bipolar disorder and schizophrenia is heavily emphasized. These are patients who have a difficult time with "reality testing," distinguishing what is real from what is not. They learn how to help these patients with psychoses through the use of medication and psychosocial interventions. They also serve as administrators on inpatient psychiatric units.

They work with outpatients, providing medications and outpatient psychotherapy. Outpatient therapy entails helping patients to deepen their self-awareness by encouraging them to talk openly and candidly and then pointing out conflicts. All psychiatrists receive a heavy dose of training in psychopharmacology. Some programs are devoted to helping psychiatrists develop real proficiency as psychotherapists. Thus, medical students can choose a residency program that reflects their interests. After completing residency, many psychiatrists seek postgraduate specialty training in an area of clinical practice or research.

Lynn Friedman, Ph.D. is a clinical psychologist in Bethesda, Maryland. She specializes in worklife and organizational consultation and psychotherapy.

Editor's note: This article by Lynn Friedman, Ph.D., was acquired by washingtonpost.com in April, 2003.

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