Tag Archives: Pharmaceutical drug

The Changing Face of Psychotherapy

Many years ago when I first started out in the field it was not uncommon for people to be in psychoanalysis or psychotherapy 3 – 4 times per week.  These days someone coming even 2 times per week is rare.  This change is partly because of the intrusion of insurance into medical treatment of all kinds.  Insurance controls what services are reimbursed and the frequency of visits, tests, etc.  This is especially true for mental health services, often considered by many as the stepchild of medicine.  Few can afford to see a psychotherapist more than weekly.

We can blame insurance companies & say “they’re the culprits”.  Insurance companies are offering less and reimbursing less for services they do approve, making it harder to get needed mental health services.  But this change is also because of the availability of different forms of psychological treatment, including medication, the difficulty in providing studies which can ‘prove’ the efficacy of psychotherapy, and the evolving nature of our culture at large.

The popular culture has become one of ‘quick fixes’, a ‘just do it’ mentality, and one of instant gratification.  Medication has changed the way people deal with issues. They often look first to a pill to solve their problems.  I have said before that I believe in medication.   But it’s not the magic answer and it is not right for all.   Studies have shown that medication in combination with psychotherapy is most effective.  But just as important a factor is that people are less willing to ‘go deep’.  And I don’t know if that’s all negative.  Sometimes Cognitive Behavioral Therapy – CBT makes a dent and I use it.  But there is a vast difference between knowing something intellectually & have it filter down into emotional understanding.  There are many who know the right ways they should think but can’t make the switch even with workbooks and reminders.  Then there are those who don’t make the effort because of underlying issues that stand in the way.  Our quick fix society wants to believe that these things work, but in my experience they are an aid for some but definitely not for all.  Just like medication, there is no magic.  I often say that if there was a magic pill or if I had a magic wand I would use it & find another line of work.

My friend reminds me that readers today have very short attention spans – no more than a paragraph for a blog.  I don’t know if that’s true or not but, there is definitely a trend toward shortening all aspects of communication.  I don’t know if that is good or bad or just a fact of the modern world and our busy lives.  The jury is out.  But it has certainly affected the practice of psychotherapy from the time I began working.

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Mixed Thoughts on Medication

Medication and its efficacy is a very hot topic and these are just my observations over a very  long time period in both private practice and a clinic setting.

My feelings about medication are mixed.  Neurology & chemistry effect how we all see things.  Over the years medication has dramatically helped the very severely disturbed, but for others, the feedback is more ambivalent.  And even for those that ‘really’ need it, the side effects can be daunting.

It is often said that medication changes the black to gray (if one is lucky), but the way people approach their problems and how they interpret themselves and their world, is not changed much by medication – in my opinion.  Pathways that are more adaptive need to be created by self understanding and hopefully by softening the effects of trauma.  This is not easy to do by any means. Tons of CBT work books & self help books attest to how hard it is. It helps to know, but it is no guarantee that it will filter into our beings.  What the brain knows intellectually is very different from what is experienced emotionally.

I often recommend medication in conjunction with psychotherapy and have worked with some excellent psychiatrists.  But I do not push it unless it seems critical.  People I see are often very reluctant if not down right opposed to medication.  Partly because of the side effects but mostly because it feels like that means they are ‘really sick’ and it signifies a loss of self-esteem.  Also, many would like to try more ‘natural’ products.  Often people improve without medication & others decide at a later time to try it.  I have never kept statistics because I never see individuals as numbers.  I have also noticed that for some people, medications that were helpful stop working after about 2 years..  And there are so many medications & cocktails out there that the choices are enough to make you dizzy as well as cautious.

All this being said, there is no question that psychotropic medication has been a godsend for many.  But it is no panacea and for those who think it is, there is often a let down.  There is no magic wand.  If I had one, I would use it.

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