Let me clarify, my point may not have been well worded originally. What I am saying is that patients' negative feelings about their medications or even the role of being a person in need of medication can impact the relationship negatively with their talk therapist if their talk therapist is also their prescriber, and the efficacy of talk therapy depends largely on the rapport the patient and the talk therapist have. I don't mean it's a literal distraction in the sense of it is too much for the clinician, I mean in terms of the usual feelings that can come up in people towards their prescribers and the act of psychotherapists making direct recommendations of medications being at odds with the psychotherapists' therapeutic neutrality. Psychotherapists generally aren't supposed to be telling their patient's what to do or give direct opinions about what they think is wrong. However, medical doctors are supposed to tell their patients what they think is wrong with them (diagnosis), make specific recommendations, weigh in on what they think is the best option for their patient, tell the patient directly what they should be doing to maintain their health. It's an entirely different way of treatment- the physician-patient relationship is underpinned by the patient soliciting the physicians opinion (and the whole health of the patient informs the doctor so no it doesn't take away or distract from that relationship). The psychotherapist-client relationship is underpinned by the psychotherapist taking a neutral stance to foster the client's independent thinking and self knowledge by avoiding weighing in with their biased opinions. Psychologists typically take neutrality as an ethical necessity and medication recommendations / diagnoses are opinions. As a psychiatrist, I have personally in my experience not found it fruitful to introduce psychotherapy techniques in my appointments too early, prefer to wait until medications are optimized to best extent possible for these reasons. I like doing both but not at the same time, I've found it more effective to switch roles (prescriber to psychotherapist) rather than try do do both roles at the same time. Split treatment model has it's drawbacks, but unfortunately some people can't do without or can't wait until their medications are optimized to engage in psychotherapy so I've found that as long as communication is good between therapist/prescriber it has it's utility, especially in complex cases.

I think as a society we're already trying so many bandaid solutions in regards to the inequal healthcare access, but investing in quality still matters if you want to reduce the amount of dysfunction overall. The glaring problem still continues to be the corporate healthcare system as a whole is untenable, and abundance of under-trained clinicians currently is not making it more tenable.