What is therapeutic about psychotherapy? More than a century of experience, thought and effort by dedicated people went into answering this question, with many schools of thought offering insights.
Some elements at the foundation of a relationship proposing to heal are true generally: the therapist promises to provide an environment for safe expression, and to act in a patient’s best interest. Education about health and about techniques (coping mechanisms) to deal with mental distress could also be seen as generally helpful.
Beyond the basics, psychotherapy is called “individual”, for a very good reason. Training in psychotherapy provides a set of tools that are intended to prepare a therapist to understand and help unique people, in their unique circumstances. One tool may work better than others for different problems, and different people, but mostly, healing depends on the doctor’s and patient’s ability to make a thoughtful team in using them.
Psychiatric medications, used judiciously, can improve functioning and relieve distress.
All medications have potential risks and benefits. The decision to take or not to take medication is made after a careful consideration, which is then periodically reassessed. Medications are, in many ways, double-edge swords, mostly in subtle ways. This is a subject I discuss extensively with my patients in sessions.
Deprescribing is an increasing concern and area of study. There is great appeal to resort to medications, since they appear often to be a quick solution, however, they could have significant drawbacks, especially with long-term use.
Medications that originally may have been helpful, may become, in time, the source of new problems.
Many people, as they advance in age, receive more and more prescriptions to help with various ailments, and often the side effects and interactions between medications compound rather than fix problems.
Overprescribing is an ongoing epidemic with multiple causes, that can benefit from some correction.
My view is that treatment done best would endeavor to find other means to take over the function served by medications, making them unnecessary. There are times when that may not be possible or desirable, but there is no shortage of means to reduce the necessity for medication use. There are many things life has to offer to aid health. Psychotherapy is just one of those things, one that I can offer, either as an only modality, or in conjunction with medication.
When mental distress manifests as bodily symptoms, or when a physical illness interferes with the mind's healthy functioning, the picture can become very confusing to patients, to their loved ones, and to their health care providers. At times, nothing seems to fit the usual, known categories. The more complex the situation is, the more likely it becomes for all parties involved to feel lost and overwhelmed.
My training and experience with situations in which both body and mind are suffering enable me to help patients and caretakers find ways to deal with difficult therapeutic puzzles.
My work in Consultation-Liaison Medicine involves communication with the patient and healthcare specialists with the goal of clarifying communications, establishing priorities, addressing expectations, formulating plans towards achieving cohesive approaches to complex problems and evaluating the effectiveness of those approaches once put in practice.