Psychiatry: treatments
Other therapies: IPT, supportive, ACT, mindfulness
Beyond CBT and psychodynamic therapy, psychiatrists use several other evidence-based therapies, including interpersonal therapy (IPT), supportive psychotherapy, acceptance and commitment therapy (ACT) and mindfulness-based approaches. Knowing their strengths lets a psychiatrist match therapy to the person.
Depth by stage, Pre-U → Consultant (details)
What is it?
No single therapy suits everyone. Interpersonal therapy (IPT) focuses on relationships and life changes, such as grief, conflict or role transitions, that are linked to depression. Supportive psychotherapy, the most widely practised form, uses empathy, reassurance, advice and problem-solving to help people cope.
Acceptance and commitment therapy (ACT) helps people stop struggling with painful thoughts and act in line with their values. Mindfulness-based cognitive therapy (MBCT) teaches meditation-based skills to prevent depressive relapse. Eye movement desensitisation and reprocessing (EMDR) is a recognised treatment for PTSD.
Psychiatrists may not deliver all of these, but they need to know what each offers, its evidence, and who in the local service provides it.
Why does a psychiatrist need it?
Matching patients to the right therapy improves outcomes. Supportive psychotherapy skills are used in nearly every psychiatric consultation, and recommending IPT, MBCT, ACT or EMDR appropriately depends on knowing their indications and evidence.
What level is expected at each stage?
Scale: 1. Aware → 2. Understands → 3. Applies → 4. Masters / Teaches. What the levels mean.
- Pre-UNot expected
- Pre-clinicalNot expected
- ClinicalAwareRecognises that several talking therapies exist.
- HousemanshipAwareUses basic supportive skills with distressed patients.
- Medical officerUnderstandsProvides supportive psychotherapy in clinic and knows referral options.
- Psych traineeUnderstandsUnderstands theory and evidence of each therapy; delivers supportive therapy competently.
- Specialist / consultantAppliesSelects and recommends therapies wisely; some specialise and teach particular models.
What are the key topics?
Interpersonal therapy (IPT)
- Four problem areas: grief, role disputes, role transitions, interpersonal deficits
- Time-limited structure (often 12 to 16 sessions)
- Evidence in depression, including perinatal and adolescent depression
- Group IPT adaptations in low-resource settings
Supportive psychotherapy
- Building the alliance and instilling hope
- Reassurance, advice and problem-solving
- Strengthening coping and adaptive defences
- Use in chronic illness, crises and when other therapies are unsuitable
Third-wave and mindfulness approaches
- Acceptance and commitment therapy: defusion, acceptance, values, committed action
- Mindfulness-based cognitive therapy for recurrent depression
- Mindfulness-based stress reduction
- Compassion-focused therapy
Other approaches
- EMDR for post-traumatic stress disorder
- Cognitive analytic therapy (CAT)
- Solution-focused brief therapy
- Problem-solving therapy
- Behavioural couple therapy
- Art, music and occupational therapies within multidisciplinary care
How is it learned and assessed?
- Introduction in undergraduate psychiatry teaching
- Seminars and supervised supportive psychotherapy during specialist training
- Examined as psychotherapy knowledge in MMed (Psychiatry) and MRCPsych written papers
- Further certified training available for clinicians wishing to deliver IPT, EMDR, ACT or MBCT
Typical textbooks and resources
- Introduction to Psychotherapy — Bateman, Brown & Pedder
- Comprehensive Guide to Interpersonal Psychotherapy — Weissman, Markowitz & Klerman
- Mindfulness-Based Cognitive Therapy for Depression — Segal, Williams & Teasdale
- Acceptance and Commitment Therapy — Hayes, Strosahl & Wilson
Titles are widely used examples; editions change. Use university libraries or legitimate purchases.
Common questions
What is supportive psychotherapy?
It is a flexible therapy that uses empathy, encouragement, advice and problem-solving to help someone cope and stabilise. Psychiatrists use it in almost every consultation, and it can be the main therapy for some patients.
Is mindfulness religious?
Mindfulness techniques have roots in Buddhist meditation, but clinical programmes such as MBCT are secular. Psychiatrists in Malaysia often explain this and adapt practices to suit patients of all faiths.