Monday, January 21, 2008

Everybody Doesn't Need Psychotherapy

There, I said it. And primary care docs do just fine at treating many cases of depression. Everybody doesn't need a psychiatrist. There, I said that, too.

So, with my years of experience with my psychotherapy practice, here is my bullet-point formula for who needs psychotherapy:

  • Oops, I don't have one.
I have no idea. Some people find that psychotherapy is essential to dealing with mental illness. Some people find it helps them sort out their maladaptive behavioral patterns and enables them to stop doing the same things over and over. Some people...oh I could go on and on. I touched on this in my post You're Supposed To Get Better, back in July, when I did go on and on (so what else is new?). The bottom line: there are people who come willing and readily to therapy, they talk openly about their problems, they do the work of therapy, and they don't get better, they don't change, but if they get comfort from it and it helps sustain them through their suffering, that's good. Only some people don't even find therapy comforting. Other people resist coming, "My primary care doc's been telling me to call you for two years now." They come in begrudgingly and filled with skepticism, talk about their problems, often for not all that long (a few weeks, a few months, maybe less) and they get a lot out of it. "I wish I'd come sooner."
Some people come, don't say much of anything, but still get better, feel comforted, or find that it's helped them to change.

My next post will be When To Refer. Maybe later? It's a holiday, so we'll see.

And finally, the Shrink Rappers met yesterday to do a couple of podcasts. They were both themed, though apparently Roy plans to post the second one first, so we had the pleasure of talking about the "last podcast" before it was done. So, if I have this right, Dr. Chris Kraft joined us for the "first" show and we talked about the Sexual Re-Orientation treatments. If ClinkShrink is our walking encyclopedia of Prison History, well Chris knows an awful lot about the history of Sex! The 'second' podcast is a discussion about the appropriate and inappropriate uses of Benzodiazepines. Essentially, the show consists of the three of us Screaming at each other. So I promised a series of posts on benzos, perhaps I do short ones as a prelude to the My Three Shrinks bloodiest podcast ever.

The best part was going out for Indian food after. I am the type of person who always enjoys eating a good meal with friends.


The Shrink said...

Everybody doesn't need formal psychotherapy, true. Indeed, psychotherapy (like any meaningful intervention) has it's treatement emergent adverse events, just like drugs or ECT or psychosurgery or whatever else is entertained.

But psychological factors need considering and, as you say, Primary Care can usually contain and support mild depression and adjustment disorders and episodes of intense dysthymia just fine.

In the UK, you invariably don't even get to see a psychiatrist to help with your depression unless you've had treatment in Primary Care that's not worked.

Anonymous said...

This is not related to this post in particular, but I was hoping that one of you three would write a post commenting on the efficacy of antidepressants. The evidence out there seems to say so strongly that they don't work, but is that really true? Has that been your experience? Do you think that some people really do respond strongly? What's the real story here from someone who uses these medications and sees the results?

Anonymous said...

Yes, but do all people depressed need medications?

Anonymous said...

Dear commenters:

The Shrink: What does an primary care doc do for Adjustment Disorder? I guess reassurance, but once it's progressed from an expected reaction to a stressor to an actual Adjustment Disorder, formal psychotherapy is often helpful, and primary care docs here are often pretty rushed.

Anon: this is easy. Some antidepressants work remarkably well in some people. Some antidepressants don't work at all in some people. Sometimes it's necessary to try a few different anti-depressants, or to add augmenting agents (a second or a third or a fourth med all at the same time) to treat all the symptoms. Some people have complete responses to the medications, they are cured. Some people have amelioration of their symptoms, but are only improved, not cured. Some people get lots of side effects with no discernible improvement and this sucks.
Read my post on Side Effects, that may help.

Jayne: All depressed people don't "need" medications...some people get better with cognitive therapies, some depressions remit on their own, there are Light Box therapies, ECT, psychotherapy....but I've noticed that most people who walk in my door with a full-blown depression WANT medications and "why don't you try X..." doesn't go over so well.

Rach said...

Based on my own experiences, Dinah, I'd like to offer the following insights:

As a person who deals with Bipolar Disorder on occasion, I have to say that I don't think I could be where I am without psychotherapy. Granted, having a long-term chronic illness like mine, or schizophrenia, or addiction, or OCD, or many other Axis I (and probably all of the Axis II) diagnoses is cause for psychopharmacological intervention. However, it seems to me that meds only go so far in empowering people.

During the years of learning what my illness was truly about, I needed to examine those factors which made me ill, and made me recover. Once those factors had been identified, they could be modulated into my daily life routines, which therefore had great effect on my medication dosages.

I'm not one for the fancy-shmancy freudian psychoanalysis (who has time anymore?), but I'm all for using CBT to educate people about how they can make changes in their lives so that they will live a more functional, healthy and enjoyable
life. But then again I'm biased.

Mel said...

So, if I have some brilliant question I'd like to ask, and honestly think would be a good blog topic, how would I go about doing so? I've been reading off and on for some time, but simply lurking in the background. The fiancee of a resident, as well as a mental health consumer in my own right, I tend to fancy up some interesting questions.

Anonymous said...


We all get the comments, you can leave a question in the comment section of a post.

If you'd like us to address a question on a podcast, write to MyThreeShrinks at gmail dot com

Last time we recorded, we were too busy screaming at each other to get to any of the questions.