Mind Healing

Psychotherapy

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 (psychoanalysis and psychodynamic) 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. See also the My Approach page.

Psychiatric medications can often improve functioning and relieve distress.

All medications have potential risks and benefits. Medications are, in many ways, double-edge swords that can cut mostly in subtle ways, and occasionally in devastating ways. This is a subject I can discuss extensively with my patients in sessions.

There is great appeal to resort to medications, since they often appear to be a quick solution. However, they could have significant drawbacks, especially with long-term use. Even medications that have originally been helpful, may become, in time, the source of new problems that seem to require new medications. Often, it is the illness that is wrongfully assumed to be the cause for the worsening. 

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.

There is too little formal training and awareness of medication risks in psychiatry, most risks being seriously downplayed, brushed over, or plainly denied.

Poly-pharmacy (overprescribing) is an ongoing epidemic with multiple causes, that can benefit from some correction.

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Deprescribing is an increasing interest and area of study.

My view is that for most psychiatric issues, treatment done best would endeavor to find other means than medications, whether from the start, if possible, or later, if those other means are insufficient or inadequate at the start.  

Medications mostly serve a modulating function, and they are not uniquely able to serve that function. Ideally, the mind itself would take over that function.Many other tools can serve the same function as medications, with less risk, with fewer side effects. Ideally some of these tools could be implemented immediately, to serve from the beginning of the treatment, or to take over the function originally served by medications, making them unnecessary in time.

There are times when tapering down or discontinuing medications may not be possible or desired, but there is no shortage of means to reduce the need 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).

Like all important and valuable endeavors, tapering down medication and discontinuation can be quite challenging and not free of danger. It can demand a lot from the doctor or treatment team, from the patient, and from the patient's support system. It cannot be done well other than in a well informed, individualized, and patient-led fashion.

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