Do psychotherapists speak to psychopharmacologists? A survey of practicing clinicians

While more Americans are taking psychotropic medication than ever before, psychiatrists are providing less psychotherapy, leading to the prevalence of "split-treatment" whereby two professionals provide care. Communication between clinicians treating the same patient has traditionally been an accepted principle of optimal care, however there has been no published data documenting whether or not private practice therapists actually do communicate with the psychiatrists who prescribe for their patients. A pilot study was conducted in which a nine-item anonymous survey was distributed to non-medical psychotherapists in Manhattan. Information was gathered about professional degree and discipline, duration and size of practice, and frequency of communication with professionals who prescribe for their patients. Fifty-three psychotherapists averaging over 21 years in practice returned completed surveys. Respondents reported on 1,197 psychotherapy patients, with 434 (36%) concurrently taking medication. No communication had taken place between psychotherapist and psychopharmacologist on behalf of 22% of the psychotherapy patients taking medication. Only 7 of the 53 respondents reported having quarterly communication with the prescribing physician for all split-care patients. Despite methodological limitations, study findings document that communication between professionals is not taking place on behalf of many patients in split-treatment. These findings raise questions about the quality and safety of treatment delivered in this fashion, about the need for guidelines for the conduct of split treatment, and perhaps about the traditionally assumed need for communication itself.