Most people picture psychiatrists writing prescriptions and therapists guiding conversation toward insight. For a psychiatrist who also practices therapy, those worlds come together. This kind of clinician draws from neuroscience and pharmacology to understand how the brain and body shape emotion and behavior, while using psychotherapy to explore meaning, relationships, and change. The result is treatment that’s both scientific and deeply personal.
A Scientific Foundation—Applied Humanly
Grounding care in neuroscience and pharmacology means every medication decision is informed and deliberate. Prescriptions aren’t automatic; they’re chosen (or avoided) with an understanding of neurochemistry, side effects, and the larger context of a person’s life. Sometimes, the decision to refrain from prescribing can be more challenging than writing one. It’s not uncommon for patients to see their provider for only 15 minutes every few months. Thoughtful prescribing requires time, dialogue, and a trusting therapeutic relationship.
This approach aligns with psychodynamic psychopharmacology—the recognition that symptoms rarely map neatly onto diagnoses and that one’s relationship to medication often reflects deeper psychological processes. Anxiety might mask guilt; insomnia may signal conflict more than chemistry. The work involves interpreting not just symptoms but what they mean in the context of a life.
Therapy as a Prescriptive Toolkit
Just as a physician tailors medication to physiology and diagnosis, therapy must be adapted to individual needs. There are many empirically validated psychotherapies—treatments tested in clinical research and supported by data. Common examples include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT), and exposure and response prevention (ERP) for anxiety disorders. Each represents a distinct tool, chosen for fit and timing.
The Benefits of Integration
When therapy and medication come from one clinician, treatment becomes more cohesive:
– Continuity. No hand-offs or lost context between providers.
– Nuance. Therapeutic insights guide pharmacologic decisions, and biological changes shape the focus of therapy.
– Adaptability. Care evolves with a person’s needs—sometimes skills-based, sometimes exploratory, always integrated.
When another therapist is already involved, collaboration remains central; the psychiatrist coordinates care so psychological and medical treatments align.
Why This Model Is Uncommon—and Needed
In the U.S., psychotherapy is mostly provided by non-physician clinicians. The Bureau of Labor Statistics reports roughly 398,000 behavioral health counselors and 71,700 clinical or counseling psychologists—far outnumbering psychiatrists.¹ Meanwhile, psychiatry faces a shortfall of 14,000–31,000 clinicians, with over half of U.S. counties lacking even one.²
Surveys suggest that fewer psychiatrists practice both psychotherapy and prescribing. One national study found that over 50% provided no psychotherapy at all, while only about 41% practiced both.³ This makes psychiatrists who integrate the two increasingly rare—and their approach uniquely valuable.
Training varies as well. While psychotherapy remains part of residency, supervision and depth differ widely. Supportive psychodynamic therapy—though often practiced—is frequently the least formally taught.⁴
Who Prescribes Psychiatric Medications?
Most psychiatric medications are prescribed outside psychiatry. Primary-care clinicians account for about 70% of all psychotropic prescriptions, including nearly 80% of antidepressants.⁵ Psychiatrists are involved in only 28% of benzodiazepine visits,⁶ and nurse practitioners now write more stimulant prescriptions than psychiatrists (23.4% vs. 21.8%).⁷
These data highlight why integration matters. Psychodynamic psychopharmacology treats prescribing as part of a therapeutic relationship—considering the patient’s expectations, emotional meaning, and the dynamics influencing response and adherence.
Seeing the Whole Picture
A psychiatrist who practices both psychotherapy and psychopharmacology views symptoms as messages, not isolated problems. Panic may conceal anger; fatigue may reflect grief or conflict. Medication can restore balance, but exploring why distress appears in a particular form allows for real transformation.
This restores psychiatry to its original purpose—a discipline where biology and psychology work together rather than apart.
The Takeaway
Psychiatrists who integrate psychotherapy with medication management practice a modern form of relational medicine. Their work bridges the neurochemical and the narrative, applying the tools of science while remaining attuned to meaning.
It isn’t about choosing between therapy or medication. It’s about using both intelligently—recognizing that a diagnosis doesn’t tell the whole story, and that healing happens where brain and mind meet.
Endnotes
- 1. D. L. Chambless et al., An Update on Empirically Validated Therapies (1998). Div12.org.
- 2. U.S. Bureau of Labor Statistics (BLS) Occupational Employment and Wage Statistics, May 2023.
- 3. Mojtabai R., National Survey of Psychiatric Practice (2014). PMC4364470.
- 4. Fefergrad M., Acad Psychiatry (2021). Psychiatric News on inconsistencies in psychotherapy training.
- 5. Mojtabai R., Health Affairs (2011); Psychiatric Services (2008).
- 6. National Health Statistics Reports No. 137 (NAMCS 2014–2016).
- 7. IQVIA Report on Stimulant Trends (2012–2022), DEA Diversion Control Division (2024 update).