June 30, 2015
I stumbled upon this brief piece in the Huffington Post about when patients should consider doing psychotherapy, trying medication, doing both at the same time or not doing anything at all. I liked this article because it was short and to the point while giving some nice examples behind the answer to the question: “it depends.”
As a psychologist I have many patients ask for medications and I have many patients refuse my suggestion that they consider medications. I work with only a handful of psychiatrists who I trust, and one of the things that I really like about them is that they don’t always prescribe medication on the first visit and sometimes they don’t prescribe at all. Now days many psychiatrists have defaulted to the role of “prescription mill” and they just see patients on the quarter hour, back to back, writing scripts as quickly as they can. I feel fortunate that I have good relationships with some very thoughtful and knowledgeable psychiatrists.
I also feel fortunate that as a psychologist I have the luxury of time to get to really know my patients, develop a strong therapeutic relationship with them and then help them improve various aspects of their lives. One of my favorite things to do in therapy is to review my clinical notes with a patient when we’re close to terminating treatment. I have found that when people are feeling better they often forget just how bad things were when they first came to me. When we read through the chart together they are reminded of the incredible progress they made.
June 24, 2015
Over the years of doing psychotherapy with individuals and couples I have often observed a thematic trend from patient to patient. Sometimes I get a bunch of calls about relationship problems or several existing patients will bring up similar issues in the same week or even the same day. Lately I have noticed that I am talking with a bunch of folks about forgiveness. Often the historical issue that my patient is struggling with is an “unforgivable” event but we still find ourselves discussing what forgiveness means or what it looks like. I like to think about forgiveness as being a selfish – rather than a selfless – process. Sometimes we forgive people, not for them but, for ourselves.
Think about the amount of time, energy and emotion you devote (and continue to allocate) toward maintaining resentments, being angry and keeping hatred alive. Now imagine how liberating it would be to be able to let go of that and how you might reallocate that time, energy and emotion. I’m sorry, but I don’t have any magical answers about how this process unfolds other than to say that it is just that: a process, and it begins by talking about the transgression against you. Eventually you may or may not opt to have a conversation, write a letter or engage in some sort of symbolic gesture to “interpersonally” forgive your transgressor. I recently read an interesting article in the Huffington Post about forgiveness but the most inspiring thing I’ve come across regarding the concept of forgiveness was a great story on NPR’s The Story (scroll down to the second story and if you want to listen to the show, you can skip the first third of the mp3 file).
November 25, 2014
An article was recently published in The Lancet Psychiatry and nicely summarized in Forbes describing the benefits of even short-term psychotherapy on repeated suicide attempts and suicide related deaths. Not surprisingly, the data suggest that talk therapy serves to significantly reduce the frequency of suicide following a previous suicide attempt. The Forbes article also very briefly summarized several recent studies on the efficacy of psychotherapy as an adjunct to or instead of psychiatric medication.
September 10, 2014
Research has shown that when depressed people exercise 3-5 times per day for 45-60 minutes per session and achieve a heart rate of 50-85% of their max heart rate, the exercise is as effective, if not more effective, than medication. The Atlantic published a nice summary of the research and relevant literature.
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.
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.
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.
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.
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.”
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.