Side effects of psychotherapy

October 14, 2013

When people compare psychotherapy to medication, one of the arguments often used is that psychotherapy does not have any “side effects.”  I totally disagree… everything we do has side effects.  Every time we opt to turn right we do so at the expense of turning left.  But even beyond that, psychotherapy surely has side effects… even negative side effects.  For example, it is not uncommon for a patient to leave a particularly difficult therapy session feeling lower in mood after coming to a hard realization about the viability of a significant relationship that is crumbling, or after discussing a particularly painful time in their life.  But that doesn’t mean that this “side effect” is a bad thing.  In fact, when this occurs, it is often very situationally appropriate, and sometimes is the first time that a person has really grieved a lost (or soon to be lost) relationship, fully addressed a painful memory with logic and emotion, etc.

I found a nice blog post from GoodTherapy specifically addressing myths about psychotherapy including whether therapy makes things worse.

Review of a tutorial approach with disruptive physicians

September 24, 2013

My friend and colleague, Mike Plaut, has another paper out (actually it’s still in press) in the Journal of Health Care Law and Policy.  Mike’s writing is great – almost conversational – so I always enjoy reading his stuff.  In this paper he describes the work he’s been doing for years at the University of Maryland’s Medical School with health care professionals who act out sexually with patients.  Similar to the work I do with disruptive professionals, Mike works individually with physicians and other providers rather than working with groups, and he tailors his interventions to the individual.  Now, in contrast to most of my work, Mike holds tighter to the role of the academic advisor than therapist or even coach, as he guides the professional through the relevant literature and has them write a paper about the reason for their referral to him.  I typically blur the boundary between coach and therapist as I believe there are more similarities between remedial coaching and psychotherapy than differences, and I have found this to be an invaluable approach to my work with physicians, psychologists, nurses, other healthcare providers and other professionals who have gotten themselves into hot water at work, usually because of interpersonal problems.

Psychotherapy is as good as (or better than) medication

September 13, 2013

Yet another article was published recently that touted the positive effects of psychotherapy.  In this study the authors noted that psychotherapy was as effective as antidepressant medication at treating and preventing relapses of depressive episodes.  Of course the side effects from psychotherapy are much less than those from medication, which is nice.  But what made this article special was that it was published in JAMA Psychiatry.  Yup, one of the best professional publications for psychiatrists said that medications are not better that psychotherapy.  This is great for several reasons.  First and foremost, it’s a wonderful demonstration that the ever-increasingly medicalized field of psychiatry is willing to acknowledge the benefits of non-medical approaches.  Of course the content of the article is great too; there are many people who cannot tolerate psychiatric medications or simply do not want to use medicine to treat their psychological issues, and this (and many other) article(s) supports these individuals in not caving in to popping a pill to rid themselves of psychological pain.  Now, please don’t get me wrong… in no way am I opposed to appropriate use of psychiatric medication.  However, I am very frequently disappointed by medical professionals who prescribe antidepressants, sleep aids and antianxiety medications without considering empirically validated better options first or at least in conjunction with the medications.

Physician Burnout

June 10, 2013

I just came across a recent article in the AMA’s newsletter, AMedNews.com, about physician (and staff) burnout.  Nothing all that new here, but it talks about how overwork and burnout of one member of the treatment team or office staff – - physician or non-physician – - affects the productivity, engagement and satisfaction of others in the office.  Many of the physicians and other healthcare workers who come to see me for therapy or coaching suffer from burnout.  This tends to be particularly troubling for those professionals who are highly specialized in their training and expertise as they often feel that there are no other options but to continue in their current mode of practice, leaving them to feel trapped.  Burnout is relatively easily dealt with once the problem is identified and the professional invests her/his attention and time to the matter of resolving the situation.

Therapy works.

May 29, 2013

There have been many studies that have demonstrated the positive effects of psychotherapy.  A new study was just published in PLoS Medicine that looked at seven different types of psychotherapeutic intervention.  The study essentially showed that there was no significant difference between the different types of psychotherapy, but that all approaches seemed to benefit depressed patients, particularly those with mild to moderate depression.  Health Day summarized the article saying, “Various forms of “talk therapy” can help people with depression, but no single type stands out as better than the rest, according to a new analysis.  Experts said the results confirm what is generally thought: Psychotherapy can help lift depression, and there is no one form that is best for everyone.  Instead, a person’s therapy choice may come down to the nature of the depression, and practical matters — like finding a therapist you’re comfortable with, and being able to pay.”

Overuse of Antidepressants

January 23, 2013

Look around the room and you’re likely to find at least one person who is on an antidepressant medication now.  I just did a Google search for the “top prescription drugs” and according to Drugs.com, one antidepressant and another psychiatric medication are in the top ten ranking.  I often perform this search with my patients and there have been times when three or even four of the top ten prescribed drugs have been antidepressants and antianxiety medications.

In a recent piece in The Daily Telegraph from the UK, a general practitioner spoke out about the overuse of such medications, often without adequate discussion about the potential side effects of these drugs.  I couldn’t agree more.  Now with that said, I should be clear: I often recommend (sometimes quite strongly) that some of my patients consider taking antidepressant and other psychiatric medications.  We should not be polarized in our thinking about such treatment… these meds are often quite effective and when properly prescribed can have limited side effects (or we can even “leverage” the side effects to our advantage by prescribing antidepressants that have a more sedating side effect profile to patients with insomnia or meds with a more activating side effect profile to folks having trouble getting out of bed in the morning).  But such medications should not be used instead of other treatments such as psychotherapy; they are typically most effective when used in conjunction with talk therapy.  For more information see some of my other blog posts such as APA Promotes Psychotherapy and Use of Antidepressants.

APA Promotes Psychotherapy

October 17, 2012

The American Psychological Association (APA) recently launched a new awareness initiative about the benefits of psychotherapy.  There are a couple cute videos (below) that mock the pharmaceutical commercials that we see too often.  Though I very much appreciate this approach, I do not fully agree with the claim that psychotherapy has no negative side effects.  I can’t think of anything we can ingest, be exposed to or do that doesn’t have some side effects; for example everything we do comes at the expense of something else that we otherwise could have done.  I speak often about “compromise formation” with my patients and consulting clients, and with this concept, I believe firmly that psychotherapy does have side effects, but that they are almost always “worth it” from a cost-benefit analysis perspective.

Enjoy the videos…

 

Mental Illness in America

February 2, 2012

Last month, SAMSA released a report about the incidence of mental illness in America.  A striking one in five (20%) of American adults experienced some sort of mental illness in the past year.  Even worse, nearly 30% of young adults (ages 18-25) had a brush with mental illness in the past year.  Women are more likely than men to have a mental disorder (23% vs 17%), though there is a gradual increase in the incidence of men dealing with psychiatric disorders.

Most disturbing is the fact that slightly less than half the people with any mental illness — and only 60 percent of those with serious, disabling ones — receive treatment each year.  There are many obstacles to treatment, ranging from stigma and ignorance to financial and health care policies.  This is clearly a growing issue that cannot be ignored.

Stress in America

January 10, 2012

Tomorrow the American Psychological Association (APA) releases the results from their annual “Stress in America” study.  As part of the release of their findings, they will be holding a webcast tomorrow (Wed, 1/11/12 at 4:30pm EST) that is open to all.  You can register online.  For more information, go to APA’s Stress in America page.

Healthy Lifestyles

October 31, 2011

I have to admit that though I receive The American Psychologist (the main journal of the APA) monthly, I rarely get through more than one article per issue because the articles are so dense.  This month, there was a great article about Lifestyle and Mental Health.  What I loved about this article is that there was nothing all that radical in it; it simply listed dozens and dozens of published articles that support the association between improved mental and physical health with exercise, nutrition and diet, time in nature, relationships, recreation, relaxation and stress management, religious or spiritual involvement and service to others.

These “lifestyle” issues are all things that I have been talking about with my patients in therapy for years.  This article simply provides a wonderful review of the scientific literature that supports these lifestyle changes.  Take a moment and read through the article.  Hopefully it’ll inspire you to make a few lifestyle changes of your own.

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