What Does It Mean to Have a Psychiatrist Who Also Does Therapy?

If you're thinking about starting care, or wondering whether the kind of psychiatrist you're looking for even exists, someone who can think about medication and also really get to know you,I want to talk directly about what that looks like with me.

When people hear the word psychiatrist, they usually think about medication. That makes sense — psychiatrists are physicians, and knowing when medication may help, and when it may not, is a real part of our training.

But it's only one part of how I think about the work. I'm also a psychotherapist. That means I'm not only interested in the symptoms you're having, I want to understand you. What's been happening in your life. What your relationships are like. How you tend to respond when things get hard. You are not a list of symptoms to me. You're a whole person who's been carrying something, and I want to understand what that's been like.

Looking beyond the symptom

Someone might come to see me because their anxiety has gotten worse — they aren't sleeping, they can't concentrate, everything takes more out of them than it used to. Whether medication could help is a legitimate question. But it isn't the only one.

I also want to understand what was happening when things started to shift. Maybe work became unbearable. Maybe an important relationship changed. Maybe you've always carried enormous pressure on your own shoulders, and the ways you used to manage it aren't working anymore. Or maybe nothing seems to have changed at all and that not-knowing is its own kind of frightening.

If you've ever felt like a diagnosis or a prescription didn't quite capture what you were going through, that reaction makes complete sense. You deserve care that has room for the whole story, not just the symptom list.

Looking at the whole body, not just the symptom

Because I'm a physician, part of what I bring to that first conversation is a question that's easy to overlook: is something medical contributing to what you're feeling?

Thyroid problems, vitamin and iron deficiencies, sleep apnea, hormonal shifts, certain medications or medication interactions, all of these can look remarkably like depression, anxiety, or the kind of persistent fatigue and "brain fog" that brings people in to see me in the first place. It's not that everyone needs extensive testing, but it's a question worth asking before assuming a symptom is purely psychiatric. I'd rather rule something out than have someone spend months in treatment for the wrong thing.

This is also where medical training changes how I think about medication itself. Understanding how a medication interacts with someone's other health conditions, other prescriptions, or life stage isn't a side detail, it shapes what's actually safe and effective for that particular person, not just what treats the diagnosis on paper.

Perimenopause and menopause are a good example of why this matters. The hormonal shifts involved can bring on anxiety, depression, rage, panic, and a kind of cognitive fog that feels genuinely frightening if you don't know what's causing it and many women are told it's "just stress" or handed an antidepressant without anyone considering what's actually happening hormonally. I think about mood symptoms during this transition as needing both lenses at once: what's happening in your body, and what's happening in your life. Sometimes hormone-related treatment is part of the answer. Sometimes therapy or medication for mood is. Often, it's some combination, and figuring out which requires actually asking the question rather than assuming.

So when I say I want to understand the whole person, I mean that literally as well as emotionally — your body, your hormones, and your history all matter to the picture.

Therapy allows the conversation to go deeper

There are questions I need to ask as your psychiatrist: how's your sleep, how's your mood, is the medication helping. But over time, in therapy, different questions get to emerge, the ones that often matter most.

Why is disappointing someone so hard for you? Why does making a mistake feel unbearable instead of just uncomfortable? Why is asking for help so much harder than giving it to everyone else in your life?

Often, people come to therapy because something in their life isn't working, without fully knowing why the same situation keeps repeating, or the same reaction keeps showing up, even when you can see it coming. If that's familiar, please hear this: that's not a failure of willpower or insight. It's one of the most common human experiences there is, and exactly the kind of thing therapy can help with.

We're not simply trying to make an uncomfortable feeling disappear. We're trying to understand it well enough that you have more choices in how you respond to it.

My approach is primarily psychodynamic , I pay close attention to emotions, relationships, and earlier experiences that may still be shaping your life today. I also draw on CBT, DBT, and other approaches when they're useful, because you shouldn't have to bend yourself to fit a treatment model. My goal is to understand what you need.

Knowing someone well can change how we think about medication

When therapy and medication management happen together, medication decisions get to happen inside an ongoing relationship, not a fifteen-minute check-in with a stranger.

If someone I've been seeing tells me, "I think my medication stopped working," I'm not starting from scratch. I know who they are when they're doing well, and what's been happening in their life lately. Sometimes that leads us to adjust medication. Other times, we recognize the medication is doing exactly what it should and that something difficult is happening that needs to be worked through, not medicated away.

I don't take that distinction lightly. Medication can be genuinely life-changing, and I don't see it as competing with therapy. But I also never want it to become the automatic, only answer to every hard emotion. You deserve someone thinking carefully with you, not just prescribing at you.

There are many good ways to receive psychiatric care

Not everyone needs a psychiatrist who also provides therapy, and that's genuinely okay. Some people already have a therapist they trust and want a psychiatrist specifically for medication support I'm glad to work that way, collaborating closely so your care feels connected rather than split apart. Others want both with the same person, so they're not dividing themselves into different versions depending on which appointment they're walking into.

Of course I want to know if your depression is lifting or your anxiety feels more manageable. But I also want to know what feeling better would actually mean in your life. Maybe it means making a mistake without replaying it all day. Maybe it means having a disagreement with someone you love without fearing the relationship is over. Or maybe it's simpler than that just feeling more like yourself.

Good psychiatric care starts with an accurate diagnosis, but it doesn't end there. It means taking the time to truly understand the person who came in asking for help and I'd be glad for that person to be you.

Dr. Christine M. Crawford is a Harvard-trained, board-certified adult and child and adolescent psychiatrist in Boston. She provides psychotherapy and medication management for adolescents, young adults, and adults, as well as consultation and guidance for parents and families.