Most people associate psychiatrists with medication. And fair enough. Psychiatrists are medical doctors, and prescribing is a core part of what many of them do. But there’s a side of psychiatric practice that doesn’t get nearly enough attention: the fact that many psychiatrists also provide psychotherapy. Some even specialize in it. Understanding what that looks like in practice can change how people think about getting help for mental health concerns.
The Medical Training Behind the Therapy
Psychiatrists complete medical school before specializing in mental health. That medical foundation gives them a unique lens on psychological suffering. They understand the biological side of things, including how brain chemistry, hormones, sleep, nutrition, and physical illness can all affect mood, thinking, and behaviour. But their residency training also includes extensive work in psychotherapy.
What many people don’t realize is that psychiatry residency programs require training in multiple forms of therapy. Residents learn cognitive-behavioural therapy, psychodynamic therapy, and often other modalities as well. Some psychiatrists go on to pursue additional training and supervision in a specific therapeutic approach, developing genuine expertise in the practice of talk therapy.
This combination matters. A psychiatrist doing therapy can hold both the biological and the psychological picture at the same time. They can recognize when symptoms have a medical component that needs attention and when deeper emotional patterns are driving the distress. That dual perspective is something patients don’t always know is available to them.
Psychotherapy as a Psychiatric Specialty
Not every psychiatrist focuses on therapy. Some work primarily in medication management, seeing patients for brief check-ins to monitor prescriptions. Others work in hospital settings or crisis care. But a meaningful subset of psychiatrists choose to centre their practice around psychotherapy, often seeing patients weekly for extended periods of time.
These psychiatrists tend to gravitate toward depth-oriented approaches. Psychodynamic therapy is especially common among psychiatrists who specialize in talk therapy. This approach looks beyond surface-level symptoms and explores the underlying emotional patterns, relationship dynamics, and unconscious processes that shape a person’s inner life. The goal isn’t just symptom relief. It’s lasting psychological change.
Research supports this direction. A growing body of evidence shows that therapies addressing root causes of distress produce more durable outcomes than approaches focused solely on symptom management. People who engage in deeper therapeutic work often report not just feeling better, but understanding themselves in fundamentally new ways.
The Object Relations Perspective
One framework that many psychodynamically oriented psychiatrists draw on is object relations theory. This school of thought holds that people’s earliest relationships shape internal templates for how they experience themselves and others throughout life. Those templates operate largely outside of conscious awareness, influencing everything from romantic partnerships to workplace dynamics to the way someone talks to themselves when they’re struggling.
In therapy grounded in object relations, the relationship between therapist and patient becomes a central tool. Patterns that play out in a person’s life will often emerge within the therapy room itself. A patient who struggles with trust, for example, may find it difficult to be honest with the therapist. Someone who tends to people-please might work hard to be the “perfect” patient. These moments, when noticed and explored, become opportunities for real insight and change.
Professionals working from this perspective often describe the therapy relationship as a living laboratory. It’s not just a space to talk about problems. It’s a space where the problems actually show up, in real time, where they can be examined and gradually shifted.
Why Some People Specifically Seek Out Psychiatrists for Therapy
There are several reasons a person might choose to work with a psychiatrist for psychotherapy rather than another type of mental health professional. Some people have complex presentations that benefit from the medical perspective. Depression intertwined with chronic pain, anxiety complicated by thyroid issues, eating disorders with serious physical health consequences. A psychiatrist can hold all of these pieces together without needing to coordinate between multiple providers.
Others are drawn to the depth of training. Psychiatrists who choose to specialize in therapy have typically invested years beyond their medical degree in developing their therapeutic skills. Many participate in ongoing consultation, personal therapy, and advanced training throughout their careers.
And some patients simply find that working with someone who understands both brain and mind feels more complete. There’s no need to wonder whether a symptom is “physical” or “psychological” because the psychiatrist can assess both dimensions.
The Misconception Problem
One of the biggest barriers is simply not knowing this option exists. People in Calgary and elsewhere often assume that if they see a psychiatrist, the appointment will be short, focused on medication, and largely impersonal. That assumption keeps some people from exploring what could be a very good fit for their needs.
There’s also a lingering cultural idea that therapy is therapy and psychiatry is psychiatry, as if they’re completely separate worlds. In reality, the overlap is significant. Many of the most influential figures in the history of psychotherapy were psychiatrists. Freud was a neurologist. The developers of object relations theory were largely psychiatrists and psychoanalysts with medical training. The tradition of psychiatrists providing intensive psychotherapy has deep roots.
That said, it’s true that the field has shifted. Managed care, shorter appointments, and the explosion of psychopharmacology have pushed many psychiatrists toward medication-focused practice. But the psychiatrists who continue to do therapy often do so precisely because they believe in its power to create the kind of change that medication alone cannot achieve.
Knowing What to Look For
For anyone considering therapy with a psychiatrist, a few things are worth thinking about. First, it helps to ask directly about the psychiatrist’s approach. Do they provide ongoing psychotherapy, or is their practice limited to medication management? If they do therapy, what kind? How often would sessions occur, and for how long?
A psychiatrist who specializes in psychodynamic or insight-oriented therapy will typically offer regular sessions, often weekly, and will be interested in more than just symptoms. They’ll want to understand the person’s history, their relationships, the ways they tend to get stuck, and what’s happening emotionally beneath the surface. The work is collaborative, but it also asks something of the patient. It requires honesty, curiosity, and a willingness to sit with discomfort at times.
The payoff, according to both research and clinical experience, is that this kind of work changes not just how a person feels but how they relate to themselves and others. It addresses the patterns that keep generating the same painful outcomes, rather than simply managing the fallout each time those patterns play out.
A Fuller Picture of Psychiatric Care
Mental health care isn’t one-size-fits-all, and neither is psychiatry. The field encompasses everything from emergency stabilization to long-term, relationship-based psychotherapy. Knowing the full range of what’s available helps people make more informed decisions about their care. For those dealing with depression, anxiety, relationship difficulties, eating disorders, low self-esteem, or a general sense that life isn’t working the way it should, understanding that some psychiatrists offer deep, sustained therapeutic work can open a door they didn’t know was there.
The key takeaway is simple. Psychiatrists who specialize in psychotherapy bring something distinctive to the table: medical training, psychological depth, and the ability to use the therapeutic relationship itself as an instrument of change. It’s a combination worth knowing about.
