Medical psychotherapy

Medical psychotherapists are trained psychiatrists (doctors who treat mental health problems) who have specialised in psychotherapy (psychological or talking treatments). This can include different therapies such as cognitive behaviour therapy, psychodynamic psychotherapy, and systemic (group or family) therapy.

This page provides useful information on the nature of the work, the common procedures/interventions, sub-specialties and other roles that may interest you.

Nature of the work

Psychotherapy allows patients to come to a better understanding of their difficulties, worries, abilities and motivations. This specialty makes use of techniques that help patients explore difficult and often painful emotions and experiences, or reflect on patterns of behaviour and habits that may not serve them well. What patients might experience within the therapeutic experience can also be healing. Psychotherapy can take place individually or in groups, and there are many different forms that can be tailored to meet individual needs.

Within the NHS, medical psychotherapists contribute a psychological and relationship-oriented understanding to other aspects of psychiatric practice, such as the impact of mental illness on patients’ lives and the role of carers and relatives in promoting health and compliance with medication.

Medical psychotherapists offer advice to the community mental health team (CMHT) on the treatment of complex patients. They also deliver training to different members of the CMHT to help them deal more effectively with more complex presentations such as borderline personality disorder.

There are many forms of psychotherapy, and a range of models for psychotherapeutic treatment.  Medical psychotherapists are likely to specialise in one form of psychotherapy, although they are trained to have a working knowledge of all the main evidence-based branches of psychotherapy.

Assessing complex psychiatric cases and deciding on treatment modality, or advising on management, is a core aspect of the medical psychotherapist’s work.

A wide range of patients are referred to psychotherapy services, especially those with more serious mental illnesses, psychological difficulties, personality disorders and co-morbid conditions.  Therapists may see patients individually or in groups, and may work alone or in a team.

Medical psychotherapists spend much of their time teaching and supervising, as well as advocating and managing psychotherapy services.  Often a medical psychotherapist will be the psychotherapy tutor who co-ordinates training locally.  This makes the work varied and often highly self-directed and autonomous.

Patients with a variety of mental health problems may be referred for psychotherapy, including those with:

  • depression and anxiety disorders
  • personality disorders
  • obsessive compulsive disorder
  • psychotic disorders
  • health anxiety and eating disorders
  • post-traumatic stress disorder (PTSD) and complex trauma disorders

Patients may have more than one diagnosis, and may have a range of psychological or other difficulties including low self-esteem, anger or recurrent self-harm. Some medical psychotherapists will work exclusively with children and their families.

Specialist psychotherapy is an important part of all psychiatric services, but there is increasing interest in applying psychotherapeutic principles in other settings, such as:

  • psychiatric liaison (physical health settings including the general hospital)
  • forensic centres
  • general practice

Medical psychotherapists have extremely varied working lives. In clinical practice, some chiefly assess patients in an outpatient setting, both treating patients themselves and also supervising the treatment of others. Other medical psychotherapists run units dealing with eating disorders, trauma, personality disorder, or deliberate self-harm.

There are also exciting developments in the use of new technologies to deliver psychotherapy, including computerised therapy, mobile phone apps and web-based approaches.

Common procedures/interventions

Medical psychotherapists make detailed assessments of patients to determine their suitability for psychotherapy. Therapists then decide, together with the patient, which therapy best suits their needs.  In other situations, the medical psychotherapist may consult health professionals or teams to help them manage complex situations.

The main types of therapy used are:

  • psychoanalytic/psychodynamic psychotherapy – the relationship between the psychotherapist and the patient is used to explore past and present ways of relating to others and to enable change. Early family and other important relationships are often explored.
  • cognitive behaviour therapy (CBT) – helps patients to identify unhelpful thought patterns and behaviours which may have contributed to symptoms such as depression and encourages more helpful ways of thinking and reacting to situations. The emphasis is on the present rather than the past, homework between sessions and developing new skills to get well and stay well.
  • cognitive analytic therapy (CAT) – looks at the way a person thinks feels and acts and also explores past and present in examining the events and relationships that underpin these experiences. The relationship between the client and therapist is also used to help achieve recognition and change.
  • systemic therapy – looks at the relationships between individuals as part of a unit and how systems work together. Groups and family therapy are examples of this approach.
  • trauma focused therapy - such as eye movement desensitising and reprocessing therapy (EMDR), focuses on the bodily felt-sense and aims to help the patient digest of process traumatic experiences which may have caused a variety of symptoms including PTSD.

Sub-specialties

Forensic psychotherapy is becoming a recognised sub specialty within medical psychotherapy. Applying psychotherapy to specialist areas of psychiatry is also a developing area.

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  •  This page provides useful information about the pay for junior doctors (doctors in training), SAS doctors (specialty doctors and associate specialists) and consultants.

    Find out more about the current pay scales for doctors and there's more information on the BMA website  

    NHS employers provides useful advice and guidance on all NHS pay, contracts terms and conditions.

    Medical staff working in private sector hospitals, the armed services or abroad will be paid on different scales.

  • Read about consultant and non-consultant roles in medical psychotherapy, flexible working and about wider opportunities.

    Consultant roles

    You can apply for consultant roles six months prior to achieving your Certificate of Completion of Training (CCT). You will receive your CCT at the end of your psychiatry training.

    Managerial opportunities for consultants include:

    • clinical lead - lead NHS consultant for the team
    • clinical director - lead NHS consultant for the department
    • medical director - lead NHS consultant for the Trust

    Here are some examples of education and training opportunities:

    • director of medical education - the NHS consultant appointed to the hospital board who is responsible for the postgraduate medical training in a hospital. They work with the postgraduate dean to make sure training meets GMC standards.
    • training programme director - the NHS consultant overseeing the education of the local cohort of trainee doctors eg foundation training programme director. This role will be working within the LETB/deanery
    • associate dean - the NHS consultant responsible for management of the entirety of a training programme. This role will be also be working within the LETB/deanery

    SAS doctor roles

    SAS doctors (Staff, Associate Specialists and Specialty Doctors) work as career grade specialty doctors who are not in training or in consultant posts. You will need at least four postgraduate years training (two of those being in a relevant specialty) before you can apply for SAS roles.

    Further information on the SAS doctor role is on this site.

    Other non-training grade roles

    These roles include:

    • trust grade
    • clinical fellows

    Academic pathways

    If you have trained on an academic psychiatry pathway or are interested in research there are opportunities in academic medicine. However, opportunities with psychiatry are fairly limited. Academic psychiatrists make up 7.6% of the total medical academic workforce. There has been a 33% decrease in the number of academic psychiatrists between 2000 and 2013. 11% of the total medical workforce are academics, meaning that psychiatry is under-represented. (CfWI 2014).

    For those with a particular interest in research, you may wish to consider an academic career in psychiatry. Whilst not essential, some doctors start their career with an academic foundation post. Entry is highly competitive. This enables them to develop skills in research and teaching alongside the basic competences in the foundation curriculum.

    Entry into an academic career would usually start with an Academic Clinical Fellowship (ACF) at ST1-2 and may progress to a Clinical Lectureship (CL) at ST3 and beyond. Alternatively some trainees that begin with an ACF post then continue as an ST trainee on the clinical programme post-ST4.

    After completion of the academic foundation trainees can then apply for academic core training posts (instead of normal core training).  A PhD is often taken, either during core or specialty training.

    Applications for entry into Academic Clinical Fellow posts are coordinated by the National Institute for Health

    Applications for entry into Academic Clinical Fellow posts are coordinated by the National Institute for Health Research Trainees Coordinating Centre (NIHRTCC).

    There are also numerous opportunities for trainees to undertake research outside of the ACF/CL route, as part of planned time out of their training programme. Find out more about academic medicine.

    The Clinical Research Network (CRN) actively encourages all doctors to take part in clinical research.

    Other opportunities

    Psychiatrists often undertake research, which includes collaborating with colleagues in the UK and overseas, writing papers and presenting work at conferences. Research within this specialty, as is often the case, is subject to financial constraints. There is not always sufficient money to carry out all the necessary work.

    There may also be opportunities to work in the private sector and overseas.

  • This section provides useful information about the availability of jobs, how to find vacancies and sources of further information.

    Job market information

    Psychiatry is the fifth largest medical specialty in the UK, although medical psychotherapy is the smallest specialty within psychiatry. Most areas of psychiatry have seen considerable growth in the consultant workforce in the last ten years, although this has not been echoed in medical psychotherapy.

    NHS Digital regularly publish workforce statistics which show the number of full time equivalent consultants and doctors in training for each specialty: NHS Digital workforce statistics

    Competition ratios for medical specialty training places are published on Health Education England's specialty training webpage

    For information regarding Scotland, Wales and Northern Ireland please click on the links below.

    NHS Scotland medical and dental workforce data
    NHS Wales medical and dental workforce data
    Department of Health, Social Services and Public Safety workforce information for Northern Ireland

    Where to look for vacancies

    Specialist medical psychotherapy training is open to those who may want to train flexibly on a less than full-time basis (LTFT). You can request and apply for this after you have been offered the job. Restrictions apply. Link to our new article on LTFT

    Recruitment into specialist psychiatry training (excluding Northern Ireland) is coordinated by the North Western Deanery, Health Education North West.

    Registration and applications for psychiatry core and higher specialist training is online via Oriel.

    Northern Ireland has its own recruitment process for psychiatry. For further details please visit the Northern Ireland Medical and Dental Training Agency website.

Other roles that may interest you

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